Przeglad lekarski最新文献

The aim of this pilot study was to evaluate changes in the concentration of prostaglandin E2 (PGE2) in induced sputum supernatant in 3 groups: sub- jects with NSAID-exacerbated respira- tory disease (NERD), aspirin tolerant asthma (ATA) and healthy controls (HC), before and after oral aspirin chal- lenge test. The study was conducted in the years 2014-2015 at the Clinical Department of the Pulmonology Clinic at the University Hospital in Cracow. 43 patients were enrolled in the study (NERD - n = 15, ATA - n = 15 and HC - n = 13). All of them underwent a placebo-controlled oral aspirin challenge. Sputum was induced 24 hours before the challenge and immediately after the test. Induced sputum was processed in order to obtain cystospin slides to depict inflammatory cell patterns and supernatants, in which PGE2 was measured. The concentration of PGE2 was determined using mass spectrometry coupled with gas chromatography (gas chromatography/mass spectrometry - GC/MS). After aspirin challenge, the concentration of PGE2 in induced sputum supernatant decreased in both asthmatics hypersensitive to aspirin (p = 0.01) and those who tolerated aspirin well (p = 0.17). The change in the healthy control group was not statistically significant. These results support the cyclooxygenase theory of PGE2 inhibition by aspirin. However, the mechanism of bronchoconstriction after aspirin administration alone in patients with NSAID-exacerbated respiratory disease remains unclear.

Background: Myasthenia gravis (MG) is an autoimmunologic disorder. It is characterized by various clinical symptoms and their dependency upon the exertion and the rest as well.

Material and methods: Between 2002-20014 in the Neurophysiology Laboratory at the Chair of Pediatric and Adolescent Neurology, Jagiellonian University in Krakow, the electrophysiological repetitive nerve stimulation study were performed in 44 children. The clinical picture and positive electrophysiological test were the ground to diagnose MG in 19 of them (12 girls and 7 boys). The mean age at onset of MG in the examined group was 12.8 years. In 5 patients the diagnosis was completed using edrophonium test. In 14patients the titer of AchRAb was also tested. In 18 patients with MG the radiological examinations of the chest were performed. In 14/19 patients with MG the control electrophysiological testing was performed 2 to 8 months after the first one.

Results: The gen-ralized MG was diagnosed in 14 patients, and ocular in 2 of them. The amplitude of electro-physiological testing was normal during the first response in all patients, but the decrement of amplitude 4:1 in patients with MG was 26% to 88%. In 3 patients with MG the persisted thymus, while in 7 hypertrophy of thymus, in 2 thymoma nad inl thyinflammation of the thymus was detected. In 5 children the result of chest examination was normal. Among 5/8 patients (62.5%) with positive AChRAb, in one ocular MG was diagnosed, in the other 7 generalized MG. The titer of AChRAb was between 0.4 and 30.8 nmol/l (mean 9.44 nmol/l), and the decrement of amplitude 4:1 was 22% to 58%.. In the treatment pirydostygmine bromide (Mestinon) was used in all children, however in 4 of them together with azathioprine, and in 7 with steroids. In the treatment of myasthenic crisis in 5 patients plasmapheresis was performed. In 42% of patients thymectomy was performed during the first year after diagnosis. The clinical remission was succeed in 90,9% patients. The electrophysiological control examination detected the decrement of amplitude 4:1 in 1% to 80% (mean 36%). The electrophysiological remission, correlating with clinical remission was achieved in 2 patients. In 6/10 patients with clinical remission, the decrement of amplitude 4:1 in electrophysiological examination continued to be at the level similar to initial examination. In 1 patient remission was complete allowing significant reduction of doses of Mestinon, even though in the electrophysiological test the decrement was 80%.

Conclusions: (1) Among hospitalized children, the generalized myasthenia was the most common. (2) Neurophysiological studies plays still fundamental role in diagnostic methods in the diagnosis of myasthenia gravis in children. (3) The correlation of the clinical state and electrophysiological results was not established.

Introduction: Self-influence on the disease course has a significant impact on coping with disease and adherence to medical recommendations.

Aim: Elaboration of a brief scale for screening of patient perception of self-influence on the course of disease among hemodialysis, which could be used during usual medical practice.

Methods: In the first stage of the study, based on a group focus interview with 6 hemodialysis (mean age 65.2 ± 14.8 year)--5 women (83%) and 1 men (17%), mean time of dialysis 43.8 ± 38 months, a list of 51 characteristics of patients with low (LP) and high perception (HP) of self-influence on the curse of disease, was constructed. In the second stage 99 patients (mean age 66.1 ± 14.7 year)--51 men (52%) and 48 women (48%), mean time of dialysis 48.7 ± 48.1 months, assessed scale reliability. They were selected by their nephrologists to groups with LP and HP. Based on the results 11 items had the strongest power of discrimination of those two groups. 15 (13.2%) hemodialysis refused to participate at this part of study. In a third step 70 (mean age 68 ± 13.3 year) patients--40 men (57.1%) and 30 women (42.9%), mean time of dialysis 48.1 ± 45.6 months, assessed validity of the tool.

Results: The reliability alfa-Cronbach = 0.9 and validity tau-Kendall = 0.6.

Conclusions: Scale has a very high reliability and satisfactory validity. It can be used for those of hemodialysis who have problems with adherence to medical recommendations or have difficulty in contact with the medical staff or other patients.

Introduction: Psychotherapy is being used as the primary treatment in nonepileptic psychogenic seizures and tension headaches in children. Children's intelectual functioning is related to certain endogenous neurophysiological parameters.

Aim: The goal of this study was to establish whether the endogenous potential P300 is different in children with nonepileptic psychogenic events and with tension headaches, and whether it changes under the influence of the cognitive-behavioral psychotherapy.

Material and methods: The study included a group of 47 children: 20 with nonepileptic psychogenic seizures (18 girls and 2 boys), aged 11.09-17.11 years, and 27 children with tension headache (25 girls and 2 boys), aged 10.11-17.11 years. The P300 potential was induced using an auditory stimulus. The reaction time, the amount of mistakes and the percentage of attention focus was measured in all children. All children attended 8-10 psychotherapy sessions. The P300 potential was registered before and after the course of therapy, and additionally in both cycles also after a 3 minutes hyperventilation.

Results: Medium P300 parameters were closer to normal in the group of children with tension headaches rather than in the group with nonepileptic seizures. The shorter was the reaction time in the first measurement, the higher the attention score and the shorter the reaction time in the second measurement - this was visible in the results of children with nonepileptic seizures, in contrast to children with tension headaches. The use of hyperventilation caused a noticeable extension of the reaction time in the P300 measurement, with other components unchanged (mistake count and percentage of attention focus).

Conclusion: The endogenous potential P300 does vary, although on a statistically insignificant level, in groups of children with tension headaches and nonepileptic seizures.

Heart Failure (HF) is one of themost serious diseases of cardiovascularsystem. Epidemiological studiesconducted in the first decade of 2000sin industrialised countries show thatheart failure occurs in approx. 1-2 %of the population and significantlyincreases up to 10 % in people overthe age of 70. Because of the increasein incidence and high mortality heartfailure is one of the most importantchallenges for modern medicine.

Objective: The aim of this studywas to isolate and characterise emotionaland adaptive changes observedin women treated for heart failure.Heart failure may be caused bymyocardial infarction, myocarditis,cardiomyopathy, untreated hypertension,valvular heart disease, abuse ofalcohol and other toxic substances.Its most serious symptoms andtherefore most exhausting for patientsare: shortness of breath, forced verticalposition while breathing, paroxysmalnocturnal dyspnea, weakness,fatigue and generalized edema.

Material and methods: Observationsand psychological examinationwere conducted in 64 women treatedfor heart failure. Women with HF wereprovided with help and individual supportivetherapy. In conducting individualtherapy the role and importance offamily support was taken into account.

Results: The results of conductedobservations and psychologicaltherapy showed that women withHF revealed many negative emotionalstates: fear, anxiety, insecurity,depressed mood, depression,impatience, anger and a sense of loss.Progressive heart failure contributedto the increase of negative emotionsand lead to the development of mentalcrisis. The State-Trait Anxiety Inventory(STAAI) by C.D. Spielberger andThe Hospital Anxiety and DepressionScale (HADS) A.S. Zigmond and R.P.Snaith were used in psychologicalexamination.

Conclusions: Conducted researchand psychological observations allowto conclude that patients with heartfailure require professional help andpsychological intervention. Psychologicaltherapy should be provided topatients at different stages of diseasedevelopment. Techniques of psychological therapy mustbe focused on strengthening psychological resilience andproviding help to survive mental health crisis.

Diuretics are the longest-useddrugs in heart failure after digoxin.This is due to their effect on the retentionof sodium and an increase in thevolume of fluid in the extracellularspace secondary to neurohormonaland hemodynamic disorders occursin heart failure, and their effectivenessin the treatment of symptomaticheart failure. Discontinuation of treatmentwith diuretics or use them in toosmall doses is one of the causes ofexacerbation or acute heart failure.Theeffectiveness of most of diuretics doesnot confirm in the clinical trials, andthe indications for their use are oftenbased only on expert opinion. The effectof these drugs on morbidity andmortality in patients with HF was notexamined. Diuretics reduce shortnessof breath and swelling. For this reasonsit is recom-mended to use themin patients with signs and symptomsof fluid retention regardless of the leftventricular ejection fraction.

The aim of this paper is to presenta case of the patient who was hospitalizedin the Toxicology and CardiologyDepartment because of suicidal digoxinand theophylline intoxication. Bothdrugs have complicated mechanismof action and affect cardiovascularsystem differently, but both predisposeto ventricular and supraventriculararrhythmias. In the presented patientconduction disorders, cardiac musclerepolarization disorders and ventriculararrhythmias typical to digoxinpoisoning were observed. During hospitalizationthe patient experienced theECG and biochemical abnormalitiesresulting from myocardial infarction.In our paper we have analyzed digoxinand theophylline mechanisms of actionand possible impact of each ofthese drugs on the clinical symptomsthat our patient presented.

Recently we observe an increase inthe number of intoxications due to xenobioticsthat may induce acute methemoglobinemia.Our study showed acase of acute methemoglobinemia(MetHb 55..2%) in 25 – year old man.Clinical symptoms were caused by ingestionof “poppers” which was usedby patient as “aphrodisiac”. Summary:Conclusions: 1. Oral intake of alkyl nitrites,including isobutyl nitrite, is burdenedwith the risk of life-threateningmethemoglobinemia . 2. In the case ofpoisonings running with normal pO2,reduced level of oxygen saturation,clinical signs of cyanosis does not reactto oxygen therapy, and “chocolate”tinge of blood methemoglobinemiashould be suspected. 3. In every caseof MetHb the use of antidote, which ismethylene blue, should be considered.4. The severity of cyanosis correlateswith the level of methemoglobin.

Introduction: Glomerular filtrationrate plays a key role in the diagnosis ofchronic kidney disease (CKD). In everydaypractice GFR is estimated usingequations based on serum creatinine.Commonly used abbreviated MDRDformula is not very precise in patientswith mildly impaired renal function,underestimating eGFR when greaterthan 60 ml/min/1.73 m2. CKD-EPI formula,recommended by KDIGO, mightbe a good alternative in this situation.The aim of the study was to comparethe prevalence of consecutivestages of CKD in the group of patientsfrom Emergency Department havingcalculated eGFR according MDRD andCKD-EPI formulas

Materials and methods: The retrospectivestudy was performed in thegroup of 1,452 patients (762 womenand 690 men aged 57.4 years ± 19.8years). Estimated GFR (eGFR) was calculatedbased on MDRD and CKD-EPIformulas and the obtained results wereanalyzed according patients location inthe consecutive group of CKD, usedformulas, sex and age.

Results: The mean values of eGFRfor both formulas were similar and forMDRD was 68.6 ± 22.3 ml/min/ 1.73 m2while for CKD-EPI 69.18 ± 24.4 ml/min/1.73 m2. The highest differenceswere observed in the early stages ofCKD where the calculation of eGFRbased on CKD-EPI vs MDRD formulagives an increase of population instage G1 of CKD by 5.7% (342 vs 241persons) and reduction by 7.8% (625vs 737) in the stage G2.

Conclusions: Both formulas havethe similar value in the estimationof CKD. The differences concerningmainly G1 and G2 stages.

Background: Smoking is a majorrisk factor for peripheral artery disease(PAD), which correlates withprogression of the disease, the prevalenceof chronic wounds, amputationincidence and mortality. On theother hand, abstinence from smokinghas a beneficial effect on the bypassgrafts patency after surgical revascularization.Poland fits in the steadydecline in the percentage of smokers,but there is a lack of current data,whether those changes are observedalso in patients with PAD and whetherthey lead to the improvement ofhealth condition.

Objective: This study evaluatedthe impact of smoking and otherknown risk factors for cardiovasculardisease on the occurrence of PAD,the risk of adverse outcomes (death,amputation, tissue necrosis), developmentof chronic wounds and theirhealing after arterial revascularization.

Materials and methods: The study was conducted in groups of 208 patientswith PAD scheduled for surgicaltreatment (28.4% of patients withadverse outcomes of PAD, 38.5%of patients with ischemic wounds)and 190 control subjects. The studygroups were interviewed concerningsmoking, characterized by knownrisk factors for cardiovascular disease,and in the incidence of amputation,and deaths within 30 days aftersurgery. In the group of 48 patientswith ischemic wounds a prospectiveassessment of the progress ofwound healing in terms of changes inthe wound advancement and changesin pain severity associated withwounds was performed.

Results: Over 90% of patients withPAD were smokers: 53.8% former and36.5% past in relation to 27.4% and14.7%, respectively, in the controlgroup (p <0.0001). Among patients,a higher proportion of former smokerswas found in those with poorerhealth condition: with adverse outcomes of PAD (48.0%vs 64.1%, p <0.05), and with ischemic wounds (70.7% vs65.1%, p = 0.056). Advanced age, female sex, and the presenceof diabetes were associated with both, the presenceof PAD adverse outcomes, as well as the development ofischemic wounds. In the prospective study, major factorsprolonging the process of wound healing were advancedage, diabetes and smoking (evaluated as peaks years ofsmoking).

Conclusions: Smoking is still the most common riskfactor for PAD, and smoking cessation is the result of thedeterioration of health condition. Simultaneously this factor,in addition to diabetes, advanced age and female sex,affects both the risk of unfavorable course of PAD and decreasethe progress of wound healing. Control of risk factorsfor cardiovascular disease should be especially carefulin women in whom, despite the lower PAD incidence,further prognosis of disease progression seem worse.