Roczniki Akademii Medycznej w Bialymstoku (1995)最新文献

Investigations of solid tumors have shown that a very specific characterization of aberrant tissues can best be performed using a combination of cytologic, cytogenetic and molecular-cytogenetic methods. Thus, cytological analyses may serve to examine various features of tumors cultivated in vitro, e.g. growth peculiarities, cell morphology, specific details of cell division and mitotic rates, and anomalies of the spindle apparatus. Besides, chromosomal diagnostics characterizing non-specific aberrations focuses on the pathological karyotype and its evolution and heterogeneity, as well as on the development of secondary chromosomal aberrations. In the field of molecular-cytogenetic diagnostics we emphasize particularly the combination of metaphase and interphase analyses and the investigation of specific structural aberrations by fluorescence in situ hybridization (FISH). In contrast to the method of comparative genomic hybridization (CGH), the spectrum of applications for both methods is discussed. The findings described in this paper were obtained primarily from the analysis of 68 tumors of the urogenital tract (20 kidney tumors, 33 bladder tumors, 15 testis tumors).

Acute pancreatitis is an autodigestive disease, of which protease inhibition has been the focus of experimental and clinical research. Different from Europe and the United States, protease inhibitors are often applied in the treatment of acute pancreatitis in Japan. However, in clinical settings, the effect of protease inhibitors on acute pancreatitis is still controversial. Continuous Regional Arterial Infusion (CRAI) of protease inhibitors and antibiotics therapy were developed in Japan and it has been demonstrated that CRAI therapy has beneficial effects on severe acute necrotizing pancreatitis. In the Japanese clinical guidelines for the treatment of acute pancreatitis, published in 2003, CRAI therapy is still classified as a special therapy. However, a Randomized Controlled Trial for CRAI therapy has started and CRAI therapy is expected to become a new standard therapy for severe acute pancreatitis. CRAI therapy is aimed at preventing the progression of pancreatic inflammation and pancreatic infection. CRAI therapy can decrease the mortality rate and the frequency of pancreatic infection in severe acute pancreatitis, but it should be started as soon as possible after the onset of acute pancreatitis.

The introduction of a new 1318 nm wavelength Nd:YAG laser has created new possibilities in lung parenchyma surgery. The potentially curative surgical resection of pulmonary metastases in suitably selected cases had been recognized slowly. Using the new laser technology a greater number of patients can now offered salvage surgery. This paper reviews the history of surgical management of pulmonary metastases, development of new laser technology, conventional and extended indications for pulmonary metastasectomy and use of laser in thoracic surgery.

Purpose: Free wall cardiac rupture (CR) is one of the most common cause of in-hospital death in acute myocardial infarction (AMI). The early diagnosis of CR and selection of the patients predisposed to CR become an important clinical tool.

Aim: assessing the occurrence of CR in patients with AMI, to determine the factors which could help to identify the patients threatened with CR.

Material and methods: 2320 consecutive patients with AMI. CR was proved by autopsy or by echocardiography performed during cardio-pulmonary resuscitation (CPR).

Results: In-hospital mortality was 11% (254 patients). 50 patients (2%) died from CR. CR was the cause of 20% of total in-hospital death. Patients with CR were older than survivors (72 vs 60 years, p<0.0001). Women prevailed in CR group: (62% in CR group vs 27% in the survivors, p<0.01). 29% of patients were treated with thrombolytics (Th+). Out of 58 patients from Th (+) group who died, 17 (29.31%) died because of CR. CR occurred in 33 (16.8%) patients out of 196 died in Th (-) group. In the logistic regression analysis only age and sex remained as predictors of CR. 16 patients died from CR during first 24 h from admission (ECR). In 34 patients CR occurred >24 h (LCR). In ECR group were no prevalence of women, while in LCR women constituted 68%. In ECR group all but one patient had no previous history of MI (p=0.06). Frequency of thrombolythic therapy was equal.

Conclusions: Advanced age patients, particularly women with first AMI are at risk of CR. Decision of thrombolytic treatment in this group of patients must be very cautious.

Purpose: Increased HBV-DNA concentration is a prognostic factor of disease progression in chronic hepatitis B patients. Moreover, active hepatic inflammation during HBV replication influences apoptosis intensification. The aim of this study was to estimate occurrence of HBV replication among carriers of HBsAg. Furthermore, we analysed the correlation between HBV replication and HBeAg or anti-HBe presence as well as known apoptosis indicators--sFas and sFasL concentration.

Material and methods: The study included 34 HBV infected patients, aged 20-43 yrs defined as HBsAg healthy carriers. HBV-DNA was extracted from patients' serum using two different DNA isolation kits: the QIAamp DNA Mini Kit (QIAGEN Ltd, USA) and the Gene Elute Mammalian Genomic DNA Miniprep Kit (Sigma, USA). HBV-DNA concentration in serum was measured by RT-PCR based on TaqMan Universal Master Mix (Applied Biosystems). The detection limit of this system was as few as 10 HBV-DNA copies/mL of serum. HBV-DNA concentration was calculated from a linear standard curve obtained between 10 and 10(8) DNA copies/reaction. HBeAg and anti-HBe in serum were detected by MEIA method (ABBOTT, Germany). The concentration of sFas and sFasL in serum was-estimated by ELISA method (Bender MedSystems, Austria).

Results: HBV active replication was detected in 79% HBsAg carriers. The HBV-DNA levels exceeding 10(5) copies/mL were observed in 64% patients. Among HBsAg carriers presenting HBeAg, HBV replication occurred more often and was more intensify than in HBsAg carriers presenting anti-HBe antibodies. The sFasL occurrence in serum of 56% HBsAg carriers shows an active apoptosis, independent from ALT and AST activity within normal ranges.

Purpose: Descriptive epidemiology characterises frequency of appearance of given event (here decease) in dependence of many factors concerning a person, region or time of existence of given salubrious phenomena. The source of information was the official death registry that provides complete records of all deaths that took place in Pomeranian province. This description of sanitary situation of people from particular area enables doing comparison between regions, facilitates researching etiological factors, planning work of medical workers and programming preventive rules. Cardiovascular diseases during last fifty years are the main reason of death of people from developed countries which is also Poland.

Material and methods: The aim of this work is to find out differences in health condition between citizens of Pomeranian province and other people in Poland and countries of European Union.

Results: In Pomeranian province in 2002 the highest mortality from cardiovascular diseases was observed for Sztum county (587.5/100,000) and was 72.5% of all deaths in this region. Similarly, there was high mortality these reasons in Tczew county (442.1/100,000), Malbork county (406.9/ 100,000) and also in Tricity (424.8/100,000). The lowest mortality from cardiovascular diseases was observed in Gdańsk county (257.2/100,000) and was only 40% of all deaths in this region. Relatively low mortality was in Czluchow county (288.9/100,000). Frequency of death from cardiovascular diseases in Pomeranian province has become lower from year 2000 (361.0/100,000) to year 2002 (347.9/100,000). It was lower than in other parts of Poland (449.8/100,000 in year 2000) but higher than in countries of European Union (257.8/100,000 in year 2000).

Conclusions: Mortality from cardiovascular diseases has decreased during last few years. Also there are distinctions in this phenomena among regions of Pomeranian province, other parts of Poland and countries of European Union. From these reasons health care should be differentiated to address the differences in spatial patterns of risk observed.

Purpose: Atopic eczema/dermatitis syndrome (AEDS) is often the first manifestation of atopic disease in children. Food hypersensitivity should be considered in approximately 40% of these patients. AEDS children with cow's milk allergy are commonly prescribed a hydrolyzed formulas or amino acid-based formulas for an alternative protein source. The aim of this study was to investigate hypersensitivity to extensive hydrolyzed casein and whey proteins in AEDS children with cow's milk protein allergy (CMA).

Material and methods: The study included 67 hospitalized children with AEDS (m/f--43/24), aged 1-28 months (mean 11.34 +/- 8.52) and CMA confirmed by oral food challenge. All patients were treated with extensively hydrolyzed formulas: 48/67 children with casein hydrolysates and 19/67 children with whey hydrolysates.

Results: In most of studied children we recognized severe AEDS (SCORAD Index: mean 55.41 +/- 17.4; 95% CI 51.17-59.66) with elevated total IgE (mean 432.98 +/- 1030.46; 95% CI 181.63-684.33). In 22/67 children (32.8%) we established diagnosis of hypersensitivities to hydrolyzed formula (HHF): in 17/22 to casein hydrolysates, in 4/22 to whey hydrolysates and in 1/22 to amino-acid based formula. Children with HHF did not differ in the severity of AEDS evaluated by SCORAD (57.18 +/- 16.59 vs 54.56 +/- 17.90), the serum level of total IgE (603.9 +/- 1253 vs 349.4 +/- 906.1) and the time of breast-feeding (4.4 +/- 4.0 months vs 6.8 +/- 7.28). They differ in the number of plasma eosinophils and positive correlation between number of eosinophils and serum level of total IgE (p<0.05, r=0.46 vs r=0.07).

Conclusions: Children with moderate or severe atopic eczema/dermatitis syndrome can demonstrate hypersensitivity to hydrolyzed formula recommended for therapeutic indications.

Lung cancer is the second most common malignant neoplasm after prostate and breast cancers. It is the most frequent cause of death related to neoplasms. The elderly people over 65, are the most numerous population suffering from lung cancer. Risk of incidence and death increases with aging process. In majority of patients, diagnose is established in highly advanced neoplastic process. More than 80% of all types of lung cancers make non-small cell lung cancer (NSCLC) and less than 20%--small cell lung cancer (SCLC). The choice of the managment must be individually considered and should be based on the stage of cancer clinical advance, clinical and functional status, concomitant diseases, nutritional status, cognitive functions. The patients age is not a contradiction for the introducement of the treatment. Surgical treatment is a method by choice at the early stages of NSCLC. Radical radiotherapy should be introduced in the elderly disqualified from the operation. Single-agent chemotherapy seems to be benficial for the elderly with advanced NSCLC in good general condition, mainly due to less toxicity and satisfactory the survival rate. In the cases of SCLC polychemotherapy with prophylactic brain radiation is the first-line managment. Unfortunately, the effectivity of the therapy is occupied by its toxicity. Still frequent occurrence and late diagnosis of lung cancer, high mortality, low efficiency of chemo- and radiotherapy causes the necessity of newer research for more effective screening methods, more effective and safer lung cancer treatment schemes for the elderly.