Roczniki Akademii Medycznej w Bialymstoku (1995)最新文献

Patients who crossed operation where exteriorization stoma was integral her part the aside from of cause, location and far-gone of illness which hereinto brought require special care. In moment of entry we to European Union should advert on introduction by us the surgeons of new operating techniques not only, but to attach importance to quality of sick's life after operations also, particularly these which violate beauty of our body. They are of the patients' groups the nation from stoma, particularly if cause the exteriorization stoma the state the neoplasmic disease of alimentary canal or arrangement urinary. The stay in Clinic whether the surgical squad, perspective of operation which is final effect producing artificial accompanying urinary content tract intestinal or fecal it joins with high-level of phobia. The Information Bureau for Stoma in year 1993 at Medical University was created and on the basis of this the information bureau the therapeutic complex worked out own model of these patients' care over group. The model of care over sick from stomy hugs three periods: preoperative, early and late surgical period (ambulant). On the basis of The Information Bureau from Stoma in 1994 year The Department was created of Podlasie the Society of Care over Patients from Stoma in Bialystok--association of working on thing sick's good. Organization this assembles from stomy the men, their family and guardians, workers of medical service and different men of good will. Meetings are forms of working, which performance of bothering patient's problems connected with nurturing and supply stomy is aim, and also psychical and help support in readaptation to life in family, company and society. The volunteers' training is to help different form of working this sick's group. Volunteer in this case--then living from stomy over year happily, adopted to life in every respect, person which exemplifies for sick prepared to operation positive (exteriorization stoma) or beginning one's "path stoma". Both the analysis and opinion of work of therapeutic complex, as and the workings The Association be made by only patients, their family and guardians, and also the workers of medical service. The elaborate model of care over sick from stoma on the basis of Information Bureau is accepted universally and resoluteness improves quality of life of this patients' group. Patient in XXI age from stomia on Podlasie it can appropriately living in family, work professionally, grow sport and hobby not only thanks to work therapeutic complex, but also and men who earlier found oneself in similar situation, as he alone.

Purpose: Staphylococcus aureus septicemia (SAS) is usually described in immunocompromised patients and during serious weakening diseases, associated with a neutropenic condition. Over the last recent years, clinic relevance of SAS has become more prominent owing to the progressive rise of methicillin-resistent strains in hospital-acquired infections and to its development in non-neutropenic patients.

Material and methods: The aim of our study was to evaluate the clinical features and outcome of non-neutropenic patients with positive blood culture for Staphylococcus aureus (SA) hospitalized in Internal Medicine Wards of our hospital during 1 year of observation. 24 patients with those characteristics were retrospectively recruited; five of them were then excluded from the analysis because of concomitant oncohematologic disease. The median age of the study group of patients (19 cases) was 56 years (range 18-87); 10 (52.6%) patients were male.

Results: Infection was hospital-acquired in 10 patients (52.6%). Predisposing factors were: central venous catheter (CVC) (47.4%), recent surgical intervention (21.0%), drug-addiction (15.8%). Main comorbidities were diabetes mellitus in 10 patients (52.6%), heart disease in 4 (21.0%), chronic renal failure in 3 (15.8%), cerebral vascular disease in 3 (15.8%). Fever >38 degrees C was found in all patients at the moment of SA isolation in blood culture. SA isolated-strains were methicillin-resistant in 7 patients (36.8%). Complications of bacteremia were: pneumonia in 4, endocarditis in 3, vertebral osteomyelytis in 2, septic splenic embolization in 1 and endophtalmitis in 1 patient. The septicemia-attributable mortality was 36.8% (7 patients).

Conclusions: SAS in non-neutropenic patients observed in Internal Medicine Units are associated with significant morbidity and mortality, closer to that reported for neutropenic illnesses.

Purpose: Our aim was to study the blood oxygen-carrying function during the oxidative stress with a modification of the L-arginine-NO pathway.

Material and methods: Oxidative stress was induced by intravenous administration of Escherichia coli lipopolysaccharide (LPS) to rabbits. To modify the L-arginine-NO pathway, animals were administered with NG-nitro-L-arginine methyl ester intravenously 60 min after the LPS. Mixed venous blood was sampled for evaluation of blood oxygen transport before and at 120 and 240 min after the LPS administration; tissue samples (heart, lung, liver, kidney and muscle) were also prepared. The following parameters were measured hemoglobin-oxygen affinity, concentrations of conjugated dienes, Schiff bases, alpha-tocopherol and activity of catalase.

Results: During the NO synthase inhibition the oxidative stress was characterized by a shift of hemoglobin oxygen dissociation curve rightwards, more prominent activation of lipid peroxidation and decreased tissue levels of antioxidant defense factors.

Conclusions: The inhibition of NO generation induces a shift of prooxidant-antioxidant balance--obviously, not only due its potentially high levels and reactivity with the various target molecules (with a development of oxidative stress), but also because of the lower contribution of other factors including the hemoglobin-oxygen affinity change into the body antioxidant potential.

Purpose: To evaluate serum pepsinogen I (PG I) and gastrin-17 (G-17) levels in patients with Helicobacter pylori (H. pylori)-associated chronic atrophic gastritis, with reference to endoscopical Kimura-Takemoto's staging, chromoendoscopical and histological features.

Material and methods: 267 dyspeptic H. pylori-infected patients were examined by chromoendoscopy with biopsy sampling according to the Sydney System and according to Kimura-Takemoto's scale. Simultaneous assessment of serum pepsinogen I (PG I) and gastrin-17 (G-17) levels by enzyme immunoassay was performed. The serologic and morphologic results were compared with correlation analysis.

Results: There was strong reverse correlation between the stomach mucosal atrophy (antral part or corpus) and the proper serologic markers (respectively, G-17 or PG I) in H. pylori-associated chronic gastritis when gastric biopsies taken according to the Sydney System were assessed. The use of Kimura-Takemoto's scale has revealed the decrease of serum PG I levels only at 0-2 and 0-3 grades of the corpus mucosa atrophy. Probably, these results reflects the development of functional failure of the stomach corpus mucosa at late stages of atrophy when its compensatory capacity becomes insufficient. There were not any advantages in sampling biopsies for the detecting of intestinal metaplasia (IM) by the Sydney System, or by Kimura-Takemoto's scheme. The obvious concordance between histologically proven extent of IM and the number of IM foci detected by chromoendoscopy has been revealed.

Conclusions: The biopsy sampling for the diagnosis of precancerous changes of the stomach mucosa after non-invasive screening of atrophic gastritis (e.g., by means of EIA) should be based preferably on the visual signs acquired via chromoendoscopy than through routine endoscopy, independently of the scheme of examination of stomach mucosa, either according to the Sydney System, or to the Kimura-Takemoto's scale.

Purpose: Although many studies demonstrated expression of TNF family members in the course of B-CLL, there is a little known about relationships between soluble forms of these proteins. Furthermore, there is no study reported on effects of used therapy on this relation. The present study was designed to asses the relationships between the serum concentrations of sFas, sFasL and sTRAIL in patients with B-CLL regarding their correlation with clinical stage and used therapy.

Material and methods: We studied 40 patients with B-cell chronic lymphocytic leukemia (B-CLL) at diagnosis, before treatment and four weeks after therapy. To measure sFas, sFasL and sTRAIL levels in serum commercially available ELISA kits were used.

Results: We found increased concentrations of sFas in sera of all patients with B-CLL before treatment in comparison to the control group. There were no significant differences in concentrations of sFasL and sTRAIL between patients and control group. Increased sFasL concentrations after FC and CC therapy as well as decreased concentrations after 2CdA therapy in comparison to values before treatment were found. The concentrations of sTRAIL after FC and CC therapy were higher than those in patients before treatment.

Conclusions: Results obtained suggest that relationship between sFas, sFasL and sTRAIL in sera of patients with B-CLL before treatment may facilitate the growth B leukemic cells. Changes in these relations after therapy with FC and CC can make a contribution to inhibit B cells growth on the apoptosis way in this patient group.

It is well known that subjects with type 1 diabetes are at an increased risk of death from coronary heart disease in comparison to non-diabetic age-matched individuals because hyperglycaemia is believed to be a key risk factor for the development of micro- and macrovascular complications. On the other hand there is increasing evidence about the role of inflammatory mediators in the pathogenesis of atherosclerosis and the development of acute coronary syndromes. It has been recently suggested that IL-18 and sICAM-1 have a strong predictive value for cardiovascular diseases and deaths in patients with coronary artery disease and/or in apparently healthy men. The aim of our study was to estimate the serum levels of IL-18 and sICAM-1 in subjects with type 1 diabetes and their relatives, who share HLA diabetic susceptibility genes (with or without pancreatic autoantibodies), but still without glucose level disturbances, as an evaluation of the possible role of genetic predisposition to the presence of IL-18 in diabetic families. The study was carried out in 35 type 1 diabetic subjects, their 101 healthy first-degree relatives: 36 siblings and 65 parents and the control group consisted of 31 healthy volunteers. We have found increased IL-18 and sICAM-1 levels in subjects with type 1 diabetes and their first degree relatives, who share diabetic HLA haplotypes: DRB1*03/DRB1*04 or DRB1*03/*04/DQB1*02 independently of their autoimmune status. There was a strong positive correlation between IL-18 and sICAM-1 levels in diabetic subjects and their first degree relatives without glucose level disturbances. To our knowledge this is the first study, which suggests that sICAM-1 elevations could be a result of IL-18 overproduction in type 1 diabetic subjects and their first degree relatives. Since in previous studies IL-18 and sICAM-1 were found to be predictors of death in subjects with CHD, one could speculate that high levels of IL-18 observed in subjects with genetic predisposition, but still with normal glucose levels, are an in addition to hyperglycaemia, pathogenic factors responsible for a higher risk of acute coronary events in subjects with diabetes type 1.

Purpose: In the general population there is association between Chlamydia trachomatis (Ch. trachomatis) infection and reactive arthritis (RA). RA is a systemic illness characterized by inflammatory synovitis. Arthritis tends to be oligoarticular and involves mainly the lower limbs. The aim of this study is to assess the age and sex specific prevalence of Ch. trachomatis infection in dialysis population and to find possible relationship between manifestation of infection and renal osteodystrophy.

Material and methods: The study was conducted in 53 patients: 22 women (W) and 31 men (M), with a mean age of 58.1 +/- 15 years, treated with HD for 28.5 +/- 28.2 months. The Ch. trachomatis infection was assessed by the detection IgG antibodies for Ch. trachomatis. Also some other biochemical parameters of osteodystrophy, inflammation and malnutrition were measured.

Results: The presence of a high titre of anti-Ch. trachomatis antibodies was found in 22 patients--41% [G IgG (+)]. Mean level of anti-Ch. trachomatis antibodies was significantly higher in G IgG (+) than in seronegative patients [G IgG (-)]: 19.0 +/- 8.6 vs 4.0 +/- 2.1 U/ml, p<0.001. There was no difference in mean age of seropositive and seronegative patients for Ch. trachomatis (62.4 +/- 13.1 vs 56.2 +/- 15.9 years). We did not observe in both groups of patients any differences in mean level of C-reactive protein (CRP): 12106.2 +/- 10791.0 vs 14015.3 +/- 11194.3 ng/ml. The mean ferritin level was significantly higher in G IgG (+): 624.3 +/- 375.7 vs 418.3 +/- 341.4 ng/ml, p<0.05. Significant negative correlations were found in G IgG (+) between IgG antibodies and transferrin saturation (r=-0.645719, p<0.001) and between CRP and calcium (r=-0.4526, p<0.05). IgG antibodies were detected frequently in W (60%) than in M (29%). Mean level of IgG was significantly higher in seropositive W than in seropositive M (23.3 +/- 7.8 vs 12.1 +/- 4.2 U/ml, p<0.0001). The seropositive W were older (67.9 +/- 11.8 vs. 53.8 +/- 11.0 years, p<0.02) and seropositive W were shorter treated with HD (18.1 +/- 16.6 vs 43.7 +/- 30.6 months, p<0.02). The mean serum calcium conc. and phosphorus were significantly lower in seropositive W (2.1 +/- 0.1 vs 2.3 +/- 0.2 mmol/l, p<0.05 and respectively 1.3 +/- 0.3 vs 1.8 +/- 0.2 mmol/l, p<0.005). Likewise the mean transferrin saturation (TS) was significantly lower in that group (25.7 +/- 7.3 vs 38.0 +/- 11.3%, p<0.01). There were no differences between seropositive men and women in mean serum concentrations of CRP, iPTH, albumin and hemoglobin. We found in seropositive W significant negative correlation between IgG antibodies and age (r=-0.633, p<0.02).

Conclusions: The patients treated with HD were quite frequently shown significantly elevated level of IgG antibodies for Ch. trachomatis. It could have be connected with past infection. The antibodies were more commonly detected in women

Purpose: People with normotension and with essential hypertension are subjected to the diurnal rhythm of blood pressure (BP) with higher values during the day than during the night. Among dialysed patients nocturnal reduction of BP is blunted. The aim of the study was to evaluate diurnal BP rhythm and adrenergic activity measured as values of catecholamines.

Material and methods: Study was performed among dialysed patients with normotension: 13 haemodialysed patients (HD), 8 patients treated by continuous ambulatory peritoneal dialysis (CAPD) and 10 controls (C). Ambulatory BP monitoring (ABPM) was done by using Micro SJ7400 AMP device. Catecholamines concentrations were measured by HPLC-ED method before and after cold pressure test.

Results: There was no significant difference between manual measurements of BP done by dialysis nurses and mean values of 24-hours ABPM in CAPD group and C group and 48-hours ABPM among HD patients. Diurnal BP was blunted in 80% of HD patients during the day of haemodialysis, 70% during the day without haemodialysis and in CAPD group in 50%. Heart rate (HR) variability was comparable in HD and CAPD groups and significant lower than in C group. Baseline noradrenaline (NA) as well as NA (ng/ml) post cold pressure test levels were significantly higher among HD patients (463 +/- 21, 546 +/- 31) and CAPD patients (452 +/- 76, 527 +/- 92) as compared with C (206 +/- 53*, 315 +/- 61*). (x +/- SD), *p<0.001

Conclusions: Despite increased adrenergic activity and altered diurnal rhythmof BP and HR exist in dialysed patients we didn't find directly relationship. Another or composed factors couldaffect diurnal rhythm of BP and HR.

Purpose: Evoked potentials were recorded in patients with DCD to evaluate the integrity the afferent pathways and to rule out the presence of any neurological lesions.

Material and methods: Two boys: 5 and 16 years old with recognized DCD were examined. Battery of tests: short-latency somatosensory evoked potentials (SEP), pattern-reversal visual evoked potentials (VEP), cognitive event-related potentials (CERP) and EEG were recorded. CT and neuropsychological assessment were also performed.

Results: N20 and P25 latencies and also central conduction time of SEPs in both patients were longer. N9, N11, N13 latencies were normal. VEP, CERP, EEG and neuroimaging scans were normal.

Conclusions: Relationship among perceptual--motor skills, cognitive impairment and electrophysiologic findings in children with developmental dyspraxia are discussed. The disturbances of the integrity of the afferent pathways could to be one of many causal factors. Further researches are required to determine the specific source of the neurological deficit of clumsy children.

Purpose: Worsening of health as well as raising disability in course of aging lead to the increase in the needs for medical and nursing services. The on-going reforms of the primary health care system has brought the organizational transformation in community nursing care into the forms of non-public community nursing units. The aim of the study was to describe the characteristics of community nursing care provided to older people with regard to the differences between a traditional model of the public (SPZOZ) and new model of non-public units (NZOZ).

Material and methods: The study was carried out in all 113-community nurses employed in Bialystok, regardless of the form of employment. The questionnaire was answered by 101 nurses, from which one was excluded due to double employment in public (SPZOZ) and non-public (NZOZ) settings. From among of the remaining 100, 76 were employed in SPZOZ and 24 in NZOZ. As the research tool was used the questionnaire.

Results: The data obtained show the predominance of the therapeutic (95%) and diagnostic (78%) services which were more frequently provided by nurses employed in public sector (SPZOZ). Assessment of social situation as well as a caring process, education was rarely provided in both groups of nurses.

Conclusions: Mostly instrumental and therapeutic activities predominated in the community nursing. Generally, any significant differences between two settings of nursing care there were not found. The traditional model of community nursing care enables the realization the full professional competence of nurse in the primary health care system.