Przeglad lekarski最新文献

Background: Coronary artery diseaseis a major cause of death worldwide.Despite different standard revascularizationoptions, significant numberof patients remains not suitable for anytreatment. The aim of the study was toevaluate long-term outcome of patientswith diffuse coronary artery disease,treated with autologous stem cells injectionscombined with transmyocardiallaser revascularization.

Material and methods: 9 patients underwentHolmium:YAG laser revascularizationand autologous bone marrowderived stem cells implantation between2007 and 2009 in the Department of CardiovascularSurgery and Transplantology,John Paul II Hospital, Kraków andwere subsequently followed up in 2015.

Results: The mean follow-up periodwas 73 months. The mean CCSclass significantly improved (1.4±0.5vs 3.3±1.0; p<0.001) and cardiac relatedhospitalizations significantly decreased(1.1±0.8 vs 3.1±2.1; p<0.001). One deathdue to heart failure was observed. Themean LVEF increased from 38% to 42%(p>0.05).

Conclusions: Clinical status improvementwas observed with low mortalityrate in the long-term follow-up. Nonew regional wall motion abnormalitieswere observed, and the increase ofglobal ejection fraction was noted.

Klotho, the gene encoding theantiaging protein, was discovered in1997 and named after a Greek Goddeswho spun the thread of life. Numerousexperiments on mice confirmed thatdestruction of the klotho gene or lossof klotho function leads to an acceleratedaging and premature death.In addition to shortened life span,klotho-deficient mice demonstratedchanges in functioning of multipleorgans, ectopic calcification, enhanceddevelopment of arteriosclerosis,osteoporosis and atrophy of skin. Incontrast, overexpression of a gene inmice inhibited aging and prolongedsurvival. The multisystemic phenotypeinduced by Klotho deficiency indicatesthat Klotho works on a variety oforgans. Klotho is highly expressedin the kidney, brain, and to a lesserextent in other organs. Protein Klothoexists in two forms: membrane andsecreted which play different functions.Membrane Klotho function asan obligate co-receptor required forsignaling for the phosphaturic factorFGF23, regulates calcium-phosphatehomeostasis through renal ion transportin addition to modulation of PTHand 1,25(OH)2D3. Soluble klotho functionsas a humoral factor and regulatesthe activity of several ion channels andtransporters. The secreted Klotho canalso inhibit oxydative stres and theinsulin and insulin-like growth factor 1(IGF-1) pathways. The discovery of theprotein klotho led to the identificationof new axes connecting endocrinedisturbances in the homeostasis ofthe calcium-phosphate to the aging ofthe organism. Klotho deficiency maynot only be a trigger for acceleratedaging but also in development of age--associated diseases, including hypertension,osteoporosis, cardiovasculardisease, and CKD. Conceivably, betterunderstanding of Klotho protein mightprovide a novel treatment strategy foraging and age-associated diseases.

Introduction: This is an update regardingthe treatment results of 200prostate cancer patients’ (PCP) CyberKnifebased radioablation (the firstgroup in Poland).The purpose of this study is reevaluation(after 2 years) of this treatmentmodality results of low (LR) andintermediate risk (IR) (including T2c)PCP and failure analysis.

Material and methods: 200 PCP (95LR, 86 IR, 19 T2c) 53 – 83 y.o. (mean 69)treated between 2011 and 2014. 48%used neoadjuvant ADT. The patientswere irradiated every other day witha fraction dose of 7.25 Gy to the totaldose 36.25 Gy (5 fractions in 9 days).Fiducials based tracking was performed.The patients were controlledon the treatment completion day, 1, 4,8 months later and subsequently every6 months. The PSA concentration,ADT usage, acute and late adverse effects(EORTC/RTOG) and other symptomswere evaluated. FU ranged from1 to 63.6 months (mean 32.2, median32.9).

Results: The adverse effects percentagewas very low; only 1 monthafter treatment the percentage ofacute urinary reaction exceeded 40%.Only single G3 adverse effects werenoted. Over 4 months the medianPSA concentration declined from 3.75to 0.27 ng/ml. 9 failures (4.5%) werenoted – more among IR and patientswithout neoadjuvant ADT. No failurein the T2c group was found. Mediantime to failure was 32.4 months. Coxanalysis revealed that the failure riskincreases with the value of maximalPSA before treatment.

Conclusions: CK based radioablation of LR andIR PCP is a safe and highly effectivetreatment modality.The main prognostic factor of failureafter this treatment is probablythe maximal PSA concentration beforetreatment.The neoadjuvant ADT in IR groupshould be considered.The lack of failures in the T2c group enables us to suggestthat even more locally advanced patients (T3) withlow PSA and maximal Gleason 3+4 could be treated withthis modality.

Introduction: According to theESC guidelines, syncope is a transientloss of consciousness causedby transient, general cerebral hypoperfusion,characterized by rapid onset,short duration and spontaneousrecovery.

Objectives: The aim of the studywas a comparative analysis of syncopeprovoking factors and prodromalsigns in patients with vasovagalsyncope with consideration given togender.

Materials and methods: We investigated 80 patients, aged 18-74years with previously diagnosedvasovagal cause of syncope. Specialattention was paid to the frequencyof triggering factors and prodromal signs.

Results: In the studied group themean age at first syncope was significantlylower in women (23.2±10.7)as compared to men (30.7±17.4).The mean total number of syncopaland presyncopal episodes was significantlyhigher in women (13.3±11.0vs. 7.8±6.6; 26.6±12.9 vs. 13.8±6.9). Inthe group of men syncopal episodeswere more frequent after urinationand defecation. The remainingcircumstances related to syncopewere more prevalent in women, butonly the occurrence of a syncopalepisode during walking achievedstatistical significance. All the prodromalsigns that were analysed occurredmore frequently in the groupof women compared to men. Statisticalsignificance was achieved for theanalysed signs such as generalizedweakness, dyspnea, heart palpitations,cold sweats, feeling of cold orheat, visual disturbances, tinnitus,headache.

Conclusions: Syncope provokingfactors and prodromal signs occurmore frequently in women.

Introduction: Crohn’s disease (CD)is a chronic inflammatory disease,which may involve any part of the gastrointestinaltract, including the oralcavity. Mucosal lesions in the oral cavityare described in various populations,but observations in active diseasewith severe clinical symptoms arequite rare.

Objectives: To evaluate the prevalenceand nature of oral mucosa lesionsin adult patients with active CDand their correlation with clinical andlaboratory indicators of disease activity.

Material and methods: Prospectivestudy was performed in 62 patients(29 women, 33 men, age 18-49 years)admitted between December 2010 andFebruary 2013 to the gastroenterologydepartment with a confirmed diagnosisof CD and exacerbations of symptoms,and 40 sex- and gender-matchedhealthy volunteers. CD activity wasclassified according to clinical andblood parameters, and the CD activityindex (CDAI). We examined: blood morphology,hemoglobin and CRP levels,BMI. Examination of the oral cavity includeda detailed interview and physicalexamination, based on the WHOrecommendations.

Results: In patients with activeCD we found: increased CDAIscore (258.4±21.5), higher CRP levels(24.6±1.3 mg/l) and platelet count, anemiawith significantly reduced RBC andhemoglobin level, and reduced BMI, incomparison to controls. The specificfor CD symptoms were found in themouth: indurated tag polypoid lesionson vestibular retromolar region in12.9% of patients, cobblestoning of themucosa in 9.7%, diffuse asymptomaticbuccal swelling in 16.2%, mucogingivitisin 19.4% of patients. Oral nonspecificlesions were more frequent: angularcheilitis in 29.1%, atrophic glossitis in14.5% of patients. Oral lesions correlatedwith hemoglobin and CRP concentrations(r=-0.431 and r=0.437; respectively;p<0.001), platelet count (r=0.45;p<0.003), CDAI (r=0.421; p<0.001) andBMI (r=0.307; p<0.006). No correlationhas been found between specific ornon-specific lesions and location ofinflammatory changes in the gastrointestinaltract.

Conclusions: Changes in the oral mucosa in adult patientswith active CD are frequent. They should be correlatedwith other clinical symptoms of gastrointestinal tract and biochemicalparameters in patients with CD. The nature of thesechanges may have an impact on the further therapeutic approach.

Introduction: Due to the high incidence of postpartum anxiety disorders and their serious health and social consequences, it is essential to analyze the possible risk factors to identify groups of women particularly vulnerable to cover their proper care and control. The aim of our study was to investigate the relationship between the anxiety in women in the postpartum period, and their living conditions and lifestyle.

Materials and methods: The study was conducted from April to July 2016. We included 102 women in the postpartum period, living in the city of Cracow and the Cracow district. The study was based on a survey of our own authorship, State Anxiety Inventory (STAI) and the Jurczyński’s Inventory of Health Behavior (IZZ).

Results: The anxiety level in women in the postpartum period depends on the conditions of life and health behaviors. The level of health behavior of women in the postpartum period is an average and independent of age, number of children, and the material situation. Residents of cities, women with higher education, who planned pregnancy, have a higher level of health behavior. Good housing conditions have a positive influence on health behavior. Low levels of health behavior significantly affect the severity of maternal anxiety. Residents of the village, women with lower education and who not planning pregnancy have higher levels of anxiety during the postpartum period. Anxiety level of women in the postpartum period is inversely proportional to their housing conditions. Women with a job have lower levels of anxiety than non-working. The anxiety level in women in childbirth does not depend on age or financial situation.

Conclusions: The anxiety level in women in the postpartum period, significantly depends on the living conditions and health behaviors. Verification of distinguished factors should be applied appropriately in health promotional activities and prevention programs.

Postpartum thyroiditis is a formof autoimmune thyroiditis developingduring the first 12 months postpartumin 5-10% of women as a consequenceof the immunologic flarefollowing the immune suppressionof pregnancy. Autoimmune polyendocrinesyndromes are rarely diagnosedconditions characterized bythe association of at least two organspecificautoimmune disorders, andon the basis of their clinical picture,they may be divided into four differenttypes. The underestimation oftheir real frequency probable resultsfrom physicians’ inadequate knowledgeof these clinical entities andsometimes their atypical clinical picture.Although autoimmune thyroiddisease may be a component of bothtype 2 and 3 autoimmune polyendocrinesyndromes, but the associationbetween postpartum thyroiditisand autoimmune conditions of otherendocrine organs has very rarelybeen described in literature. We reporta case of a young woman, whoafter two subsequent pregnanciesdeveloped postpartum thyroiditisof different clinical pictures. Afterher second pregnancy, postpartumthyroiditis was followed by the developmentof autoimmune adrenalfailure and premature ovarian failure,which allowed to diagnose type 2 autoimmunepolyendocrine syndrome.Our case study suggests that everyperson with postpartum thyroiditis,particularly if this disorder is accompaniedby atypical clinical manifestation,should be assessed for thepossible presence of autoimmunepolyendocrine syndrome.

Purpose: The aim of the study wasto assess functional and structuralophthalmologic outcomes in 4-year oldvery low birth weight children (VLBW).

Material and methods: A group of 82 VLBW children including: (1)children without retinopathy of prematurity– group O (n = 30), (2) childrenwith retinopathy of prematurity with noindications for laser coagulation- group1 (n = 20 ), (3) children with retinopathyof prematurity treated with lasercoagulation – group 2 (n = 32) wereenrolled. Functional (visual acuity,visual evoked potentials, stereopsis,color vision test) and structural (anterioreye segment examination andfundoscopy) outcome, cycloplegicrefraction, intraocular pressure andangle of squint were examined in allchildren. Developmental Test of VisualPerception was also assessed.

Results: Very good visual acuitywas presented in 56 (68.3%) patients,good visual acuity in 11 (13.4%) children,visual acuity between 0.4 and 0.2in 13 (15.9%) and unfavorable function(equal or less than 0.1) was observedin 2 (2.4%) children. Twenty-three patients(28.1%) were myopic, 57 patients(69.5%) were hyperopic. Astigmatism> 1D occurred in 49 (59.8%) patients.Anisometropia larger than 2 D occurredin 7 patients (8.7%). There was nostatistical difference between frequencyof mentioned above complicationsbetween the groups. Abnormal VEPresults were more common (14 children-54%) in group 2 as comparedto other groups (group 0 - 7 children-25%, group 1 – 4 children -24%; p =0.044). Moreover, the lower percentageof group 2 children presented stereopsisvision (46.9%, group 0 – 93.3%,group 1 – 90%; p<0.05). Children withretinopathy of prematurity treated withlaser coagulation had significantlylower Developmental Test of VisualPerceptions scores. In group 1, in 1child naevus pigmentosus of the eyelidwas observed, in group 2 in one childeyeball atrophy in the right eye andaphakia in the left eye were diagnosed.In 1 child in group 0 optic disc drusenwere observed, in 2 children optic discswere pale. In 2 children in group 2retinal detachment stage 5 was diagnosed.

Conclusion: An important factor affecting final ophthalomolgicalassessment in prematurely born children isretinopathy of prematurity treated with laser coagulaion.Children with retinopathy of prematurity without lasercoagulation had examinations results comparable wihchildren without retinopathy of prematurity. Diode laserphotocoagulation is an effective method of treatment fotactive stages of retinopathy of prematurity.

Metformin, a drug of biguanide class, is now one of the most widely used drugs in the treatment of type 2 diabetes. It activates adenosine monophosphate-activated protein kinase (AMPK) and through AMPK activation, inhibits the mammalian target of rapamycin (mTOR) pathway. Recent literature has explored metformin as an option in pain management, given its role in the AMP-activated protein kinase (AMPK) pathway and its ability to modulate pain in animal models. Based on a variety of preclinical pain models, it is now clear that mTOR signaling plays a major role in the sensitization of the nervous system in chronic pain conditions. The activation of AMPK with metformin has led to decreased pain in neuropathic and postsurgical pain models, suggesting that these drugs and this mechanism of actin might be effective in humans. Despite the strong preclinical rationale, there are only very few data considered the utility of metformin as a potential pan therapeutic in humans. Further, randomized studies were needed to identify the role of metformin in pain perception and chronic pain conditions in humans.