Roczniki Akademii Medycznej w Bialymstoku (1995)最新文献

In children, it is usually one of the stages of treatment of lower alimentary congenital defects. Such patients require long-term professional medical and nursing attention as well as solicitous care of the parents at home. The aim of the study was the analysis of educational and nursing problems that are faced by parents of children with stoma, the influence of a nurse on the quality of their care, and determination of nurse educational assignment in preparing the parents for the care at home. The study was performed in the group of 30 parents of children, 0-2 years old, with lower alimentary congenital defects who had intestinal stoma inserted in 2003. The questionnaire revealed that the main causes of the stoma were Hirschsprung disease (40%), anal atresia (37%), perianal fistula, intestinal perforation and necrosis (10% each). All responders stated that the knowledge acquired in the ward was of great help while nursing a child at home. The results showed that above 80% of parents had the opportunity to change the stomal sacks by themselves, once or more times, in the presence of medical staff. Skin changes (33%) were the most common complications in case of stoma, which could encounter for inappropriate care. Other complications included hemorrhage (20%), prolapse (13%), and stoma narrowing (10%).

Systemic sclerosis (SSc) is a connective tissue disease which etiology and pathogenesis is still unknown. The vascular and immunological changes are the major elements of the SSc. The preliminary ACR criteria of SSc are the oldest criteria for rheumatic diseases and are not sensitive enough in respect to early SSc. Many authors suggest that these criteria should be extended by capillaroscopic and immunological changes. In 2001 LeRoy and Medsger proposed new criteria for SSc that could help to identify SSc patients with early stage of the disease. This will give the opportunity for the early and proper treatment.

Purpose: The aim was to compare quantitative EEG analysis of REM sleep in children with Down syndrome (DS) and normal age-matched controls.

Material and methods: Twenty-one channel EEG of 21 patients with Down syndrome and 21 normal children, with ages ranging from 1 to 8 years, were submitted to quantitative analysis EEG of discharge-free epochs. The signals were recorded using a set of 17 (F3, F4, F7, F8, Fz, C3, C4, Cz, P3, P4, Pz, O1, O2, T3, T4, T5, T6) scalp electrodes. For each child, 20 artifact-free EEG epochs, each of 2 s without epileptiform discharges were selected for spectral analysis to calculate spectral power. Delta, theta, alpha and beta frequency ranges were compared between groups for all electrode positions.

Results: Quantitative analysis of the REM sleep from DS group disclosed reduction of the power mainly in the alpha when comparing the healthy group. Beta, theta and delta bands did not differ significantly between the groups.

Conclusions: Our findings agree with recent evidences that these children may differ from children normal development.

The aim of the study was to determine the factors allowing non-smoking for the next 2 years after a 5-year period of non-smoking. A questionnaire study was performed in October 2003 among 449 of men and women chosen from among 1700 contest' 'Quit & Win' Competition participants, which was ending in 1996 2nd International Antinicotine Campaign "Quit & Win" in Poland in the region of Lódź and Kalisz. Chosen people were respondents, who during studies conducted in the years 1998 and 2001 stated that they were not smoking at all since their participation in the contest. Filled-in questionnaires were sent back by 296 people (65.9%). The analysis showed that the surveyed with elementary education more rarely than people with other level of education could preserve in non-smoking habit for the next 2 years after a 5-year period of non-smoking. Further maintenance of nicotine abstinence was not dependent on: age, sex, the place of living, the marital status and the source of income.

Unlabelled: The aim of the study was to estimate the need for information support concerned with care of a baby and evaluation of lying-in women expectations referred to sources of support, methods and devices used during presentation. The research included 200 lying-in women hospitalized in Clinic of Obstetrics and Perinatology, Pomeranian Medical University in Szczecin; there were separated the study group which consisted of primiparas (n=100) and reference group - multiparas (n=100). The applied method was medical history of a patient, and a research tool was author's questionnaire. The results show that primiparas noticeably more often than multiparas need information support related to care of umbilical stump (p < 0.001), bathing (p < 0.001), care of skin and mucous membranes (p < 0.001), management of regurgitation, management of colic (p < 0.001), signs of neonatal transient states, and checking for concern-raising signs (p < 0.001). Lying-in women much more often indicate a nurse/midwife and a doctor working in maternity ward as a source of information support, and considerably more often expect information to be provided in the form of training and chatty lecture with the use of brochures.

Conclusions: (1) Primiparas require greater involvement of health professionals in providing information support and especially giving information on baby care. (2) A nurse/midwife and a doctor are these people in maternity ward who are particularly expected to provide information support for both primiparas and multiparas. (3) Different methods (training, chatty lecture) may be applied when information support is provided and the choice should correspond with patients' needs, goals and organizational possibilities. (4) Lying-in women expect various devices used for providing information support, but in most cases they are brochures with information on particular topics.

Purpose: The aim of the study was to determine the influence of the psoriatic patient knowledge of the disease on the quality of life.

Material and methods: The study was carried out in 149 patients with psoriasis. All patients answered on anonymous questionnaire, in according to Psoriasis Disability Index (PDI).

Results: Almost 43% patients could not show any factor which provoked their disease, 31.5% could not tell any recommendations for cure and care of the psoriatic lesions and 32.2% patients could not point out any methods to avoid psoriatic lesions spread. Almost 60% of the group admitted that their quality of life fell because of the disease. At the same time, patients who did not have enough information concerning the disease had lower quality of life index.

Conclusions: The level of the disease knowledge in the patients with psoriasis influences their quality of live. Therefore it is indicated for the patiens and their families to be involved in the proper educational program.

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: 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.

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.