Przeglad lekarski最新文献

Chronic kidney disease (CKD) isconsidered as a disease of civilizationof the XXI century. The increaseof patients with CKD is associatedwith a higher incidence of hypertension,diabetes and aging. Hypertensionoccurs in 60-90% of patientswith CKD. It is worth to underline thatthe nephroprotective therapy can delayor even stop the progression ofCKD to end-stage renal disease. Thetherapy nephroprotective should beunderstood as both pharmacologicaland nonpharmacological treatment.The aim of this study was toevaluate the health awareness ofpatients with CKD, as well as thedegree of patient compliance especiallyin terms of pharmacologicaland non-pharmacological treatment.

Material and methods: A crosssectionalsurvey was offered for1300 patients with CKD who are areunder the care of the Department ofNephrology, Transplantology and InternalMedicine, University Hospitalin Gdansk. 972 patients (M/F) (74.8%)responded positively to participate inthe study

Results: It was shown that 91.2%of the patients measured blood pressureat home. 41.2% measured bloodpressure everyday and 54.2% of patientsused at least one non-pharmacologicaltreatment for hypertension.71.7% of patients declared that buyall drugs prescribed by the doctor.53.4% of patients used the possibilityof substitution drugs prescribedby a doctor for cheaper preparationsrecommended by the pharmacist.85.7% of patients taking medicinesaccording to doctor’s advice (frequency,dose).

Conclusions: The results of thestudy indicate that the education ofpatients, the therapeutic process andtheir health awareness are good, especiallyamong patients treated withperitoneal dialysis. It should be continuedas educational program because these activitiesmay contribute to improving the prognosis and quality oflife. A patients after kidney transplantation are particularlyvulnerable to the effects of failure to comply with recommendations.

The magnitude of unfair, absurd,pointless suffering we cannot acceptor understand makes it a phenomenonwhich defies human logic - especiallywhen it concerns children. The sourceof suffering of a dying child is pain,fear, failure to satisfy the basic humanneeds and concern about the parents.It is also heightened by medical procedures,including treatments aimedat preventing the unavoidable death.Such actions, resulting from the fearof death and a lack of acceptance ofdeath as the end of life burdened withsuffering, pose a risk to the child’s fundamentalrights and violate the sourceof human freedom - one’s inalienabledignity.Our priority should be to unconditionallyrespect the children’s rightspostulated by Korczak, to ensurethat while providing holistic care fora dying child, their dignity is alwaysconsidered the greatest good.

Cardiovascular complicationsare the main cause of increasedmortality in patients with chronic kidneydisease. Besides traditional riskfactors, accumulated uremic toxinscontribute to the accelerated atherosclerosis,which is accompanied bythe progression of chronic kidneydisease. Increased clearance of toxinswith low molecular weight doesnot significantly improve survival ofhemodialysis patients, and thereforethe role and influence of other toxins,including protein-bound solutes(PBS) is intensively investigated. Inour work, PBS is discussed on theexample of indoxyl sulphate and pcresolsulphate. These substancesare highly bound to proteins andremoved from the circulation duringdialysis to a small extent only.In our article, pathophysiological effects,the impact on the progressionof chronic kidney disease and thesurvival of patients were discussed.We also assessed available methodsof removing toxins from the system.

Although the development oftechnologically advanced imagingtechniques has progressively reducedthe use of chest X-ray in clinicalpractice, it is still an invaluabletool to evaluate different diseases ofthe respiratory and cardiovascularsystems. We are presenting a caseof a 55-year-old male with arterialhypertension, severe mixed hearingloss who was referred to an internalmedicine ward due to abnormal mediastinaland cardiac contours observedin a routine chest X-ray. Thefinding was linked to an anomalousaortic course what was confirmedwithin transthoracic echocardiography.The computed tomography angiographyof the whole aorta revealedthe right sided aortic arch (RSAA)with four large arteries arising fromthe aortic arch, including the aberrantleft subclavian artery compressingthe esophagus causing thoughno symptoms. Since RSAA might beassociated with other cardiovasculardiseases and genetic disorders including22q11.2 deletion syndrome,we have conducted a complex diagnosticswhich showed additionallya decreased level of lymphocytes.The patient did not consent to geneticdiagnostics and was qualifiedfor conservative treatment of his disorders.In conclusion, a plain chestradiograph with the assessmentof heart silhouette must not be neglectedin cardiologic diagnostics.The identification of even asymptomaticaortic anatomic variant shouldbe followed by the whole aorta angiographyand a detailed assessmentof the patient. RSAA bears potentialrisk of tracheostomy bleeding, unforeseenproblems in transradialcoronary procedures and potentialproblems during thyroid surgery,also because of abnormal recurrentlaryngeal nerves’ course.

Hypoglycemic syndromes associatedwith immune reactions againstinsulin are rare phenomena describedpredominantly in Asians. Steroidtherapy, immunosuppression or plasmapheresisis often required.

Case report: A 73-year-old Whitewoman with a 20-year history of type2 diabetes was admitted to hospitaldue to recurrent incidents of hypoglycemiathat started several monthsafter insulin initiation (lispro 75/25)and increased in severity over thenext 5 years. They were accompaniedby postprandial hyperglycemia upto 25 mmol/l. The patient’s glycatedhemoglobin (HbA1c) was 70 mmol/mol (8.6%). During hypoglycemicepisodes recorded serum C-peptidewas 0.57-0.73 nmol/l (1.7-2.2 ng/ml),while insulin concentration exceeded7000 pmol/l (1000 mIU/l). Surreptitiousinsulin administration was ruled out aswas, based on diagnostic imaging, thepresence of an insulin secreting tumor.Anti-insulin antibody (AIA) level measuredby 125I-insulin binding method was92.5% (normal < 8.2%). Hypoglycemicepisodes occurred for four days afterdiscontinuation of insulin therapyand then resolved completely. Goodglycemic control was maintained withmetformin, acarbose and dapagliflozin.Three months later dapagliflozin wasreplaced with vildagliptine due to poortolerance of a SGLT-2 inhibitor. Patient’sHbA1c was 54 mmol/mol (7.1%),total fasting insulin level 2577 pmol/land AIA binding 85.9%. Over the nextyear the patient has not experiencedhypoglycemia and maintained goodglycemic control, as HbA1c level was 53mmol/l (7.0%) and AIA binding 39.5%.

Conclusions: In this rare case ofa patient with diabetes and hypoglycemicsyndrome related to AIA, weachieved a rapid and stable remissionof hypoglycemia without immunosuppression.Good glycemic control, despite 20-year historyof diabetes was achieved with oral hypoglycemic agents.

Introduction: Minimally invasivedirect coronary artery bypass (MIDCAB)allows achieving similar safetyand efficacy, with markedly reducedpost-operative length of stay whencompared to conventional surgicalrevascularization. Despite promisingresults, a small number of minimallyinvasive procedures are performed inPoland. The aim of the study is to assessshort- and long-term outcome ofMIDCAB revascularization in order toevaluate the safety of the procedure.

Materials and methods: Retrospectiveobservational study analyzing 38consecutive patients who underwentMIDCAB procedure between 2014 to2016 in the Department of CardiovascularSurgery and Transplantologyat the John Paul II Hospital, Kraków.Perioperative data was obtained frompatient medical records and the medianfollow-up period valued 17.3months.

Results: No postoperative deathsand only 1 case of postoperativemyocardial infarction were observed.Throughout the follow-up period, thesurvival rate and freedom from MACCErate valued 100%, with only 1 caseof repeated revascularization.

Conclusions: Minimally invasiverevascularization is a safe procedurewhich can be performed with excellentshort- and long-term outcome inlow-risk patients.

Introduction: Cervical cancer (CC)is the fourth most common, in termsof incidence of new cases, cancer inwomen and the third leading cause ofcancer deaths in women worldwide.Survival of patients with CC dependson many factors, including the typeof cancer, grading, FIGO staging andtreatment.

Material and methods: Analysis of survival of 524 patients diagnosedwith invasive and non-invasive CC dependingon histopathologic diagnosis,clinical staging, tumor grading andcombination of therapy.

Results: The 2-fold increase in therisk of death at diagnosis in order ofHSIL> ca planoepitheliale> adenocarcinoma>sarcoma was noted. Grading2 and 3 significantly reduces the averagesurvival in patients diagnosed withCC. The higher staging, the shorter theaverage survival. Each pass by oneFIGO stage was shown to increasethe risk of death by 46%. The risk ofdeath increases by 4% with every yearof woman’s life. The longest averagesurvival, 72 months, characterized agroup of women undergoing curettage,followed by radical hysterectomy/trachelectomy and lymphadenectomywithout adiuvant radio-/ chemotherapy.The shortest survival, 26.9 months,was observed in the group treated withcurettage followed by chemoradiation.

Conclusions: Histopathology, clinical staging, grading, age andcombination of treatment proved to besignificant factors affecting survival inwomen with CC.

Anemia is the most common disorderof the blood with iron deficiencybeing the predominant cause. On theother hand, diabetes prevalence isincreasing rapidly. Over time, diabetescan damage the heart, bloodvessels, eyes, kidneys, and nerves.Diabetic kidney disease (DKD) maybe present in both types 1 and type2 diabetes mellitus. Anemia is one ofthe common feature of chronic kidneydisease. The epidemiological data onanemia prevalence are limited. In thisreview data on epidemiology, pathogenesis,complication and treatmentof anemia in diabetic kidney diseaseare presented.

Introduction: Abnormal uterinebleeding (AUB) is the most commonsymptom of endometrial cancer (EC)and endometrial hyperplasia with(AH) or without (EH) atypia. Risk ofmalignancy and hyperplasia is significantlylower in premenopausalthan in postmenopausal women. Only10% of EC occurs before menopause.Obesity and age are well-recognizedrisk factors of endometrial cancer.Endometrial sampling is recommendedin women at high risk of endometrialmalignancy. The primary objectivewas to determine the incidenceof EC, AH and EH in premenopausalwomen undergoing dilation and curettage(D&C) because of AUB. Additionalobjective of the study wasto estimate the risk of EC and AH inoverweight and obese women withtwo types of AUB: heavy menstrualbleeding (AUB-HMB) and intermenstrualbleeding (AUB-IMB), accordingto PALM-COEIN classification.

Material and methods: Retrospectivestudy in the population of womenundergoing D&C in tertiary hospitalbecause of AUB between Jan-2016and Dec-2016. The incidence of EC,AH, EH was established. The influenceof the variables: age, BMI, AUBHMB/AUB-IMB on the occurrence ofabnormal histology (EC, AH, EH) wasevaluated. Finally, the model built byusing backward stepwise regressionand mechanism of v-fold cross-validation,showed no statistically significantrelationship.

Results: EC was detected in 2/213cases (0.9%; 95% CI 0.0003 to 0.036),AH in 3/213 cases (1.4%), giving a totalof 5/213 (2.3%) women with AH orEC. EH was detected in 16/213 (7.5%)women. High BMI raises the chance ofAH diagnosis: OR 1.16 (95% CI 1.05-1.28). The presence of HMB comparedto IMB reduces the chance of EH: OR0.24 (95% CI 0.07-0.9). IMB increasesthe chance for the diagnosis of EH 4.11 times compared toHMB (OR 4.1, 95% CI 1.1-14.9; p = 0.016).

Conclusions: EC in premenopausal women with AUBundergoing D&C is rare. There is a need to search formore effective methods of selection of patients than commonlyused. Age and BMI do not seem to be factors thatshould be used to select patients.

We retrospectively analysedthe results of 120 renal biopsy, performedin 52 women, 62 men and 6children hospitalized mainly in theDepartment of Internal Medicine,Nephrology and Endocrinology St.Queen Jadwiga Clinical District HospitalNo. 2 in Rzeszów from 2013 to2016. The average age of patients onwhom renal biopsy was performedamounts to 44 (7-78) years. The mostcommon indications for renal biopsywere nephrotic syndrome in 47 patients(37.3%), non-nephrotic proteinuriain 31 patients (24.6%), worseningrenal function in 22 patients(17.5%), coexistence proteinuria withhematuria in 16 patients (12.7%), nephriticsyndrome in 9 patients (7.1%)as well as an isolated hematuria in 1patient (0.8%). Membranous glomerulonephritiswas the most commonhistological diagnosis observed inbiopsies, and was diagnosed in 19patients (15.1%). In 14 patients wediagnosed lupus nephritis (11.1%).With the same frequency we diagnosedfocal glomerulosclerosis, andmesangioproliferative glomerulonephritis(11 patients, 8,7%). Membraneproliferativeglomerulonephritis wasdiagnosed in 10 patients (7.9%).Other nephropathy accounted forless than 8% of all diagnoses. Mostpatients with membranous nephropathy(8 patients, 61%) had antibodiesagainst phospholipase A2 receptor.All patients with a diagnosis of membranousnephropathy received the renin-angiotensin-aldosterone systemblockade, and 13 patients (68.4%) receivedimmunosuppressive therapy.Complete remission was achieved in 11 patients (64.7%)with primary membranous nephropathy. In 35 patients(27.8%) of all patients who underwent renal biopsy theyhad complications after procedure in the form of small andclinically insignificant perirenal hematomas. Hematuriawas observed in 7 cases (5.56%). In one case, due to retroperitonealbleeding, the patient required a transfusion ofblood products.