Comparison of 18F-fluoroethylo-L-thyrosine PET/CT and MR in the diagnosis of primary brain tumors referred to radiation therapy

BACKGROUND: The diagnostic efficacy of 18F-FDG-PET imaging in brain tumors is markedly reduced due to high glucose metabolism in normal brain tissue. This requires further research for more sensitive and specific tracers. 18F-fluoroethylo-L-thyrosine (18F-FET) is an interesting PET radiotracer, which shows promising results in patients with brain tumors. The aim of this study was to compare 18F-fluoroethylo-L-thyrosine PET/CT and MRI in the diagnosis of primary brain tumors referred to radiation therapy. MATERIAL AND METHODS: Thirteen patients (5M, 8F) with mean age of 56y ± 13 and histologically confirmed primary braintumors were investigated. The MRI scans were performed on MRI 1.5T scanner with FSE, DWI method, T1, T2 and FLAIR sequence. The examination was performed using brain protocol for 35 minutes and prior to PET imaging. The PET scans were performed 20–40 min after intravenous injection of 160 MBq of 18F-FET. Scans were acquired on Gemini TF PET/CT scanner using 3D brain imaging protocol for 10 minutes acquisition time. The reconstructed PET images were evaluated on a dedicated EBW workstation with Time-of-Flight reconstruction algorithms. On reconstructed images, the tumor borders were drawn using dedicated software, based on various threshold values and tumor borders and volumes were calculated on each nuclear image and compared with the volume calculated on the diagnostic MRI. For statistical analysis the t-test was used. RESULTS: 18F-FET-PET imaging in total showed more abnormal lesions that MRI; however, the difference was not significant (p > 0.05). There were two patients with lesions detected only on the MRI study and 4 patients with abnormal tracer uptake within the brain in 18F-FET study with no correlation in the MRI study. 18F-FET-PET method showed 30 lesions in 11 patients with mean SUVmax value of 2.33 (range from 1.6 to 3.5). Based on 70% threshold cutoff value, the mean volume of brain focus was calculated on at 31.15 ± 26.89 mm3 and was in concordance with mean lesion volume measured on the MRI scan 31.51 ± 34.97 mm3. For radiation planning purposes other threshold values, as well as gradient based methods were evaluated on 18F-FET-PET imaging. CONCLUSION: PET/CT imaging with 18F-fluoroethylo-L-thyrosine is complementary to MRI in the diagnosis of primary brain tumors referred to radiation therapy

Treatment of advanced lung cancer by external beam radiotherapy and high dose rate (HDR) brachytherapy

PurposeBrachytherapy is a highly valued and effective palliative treatment for lung cancer, especially as it reduces intensity of dyspnoea and other symptoms arising from tumours inside the respiratory tract. In some cases, due to the location of the lesion brachytherapy is a treatment of choice. However, its curative role is unclear. A combination treatment of brachytherapy and an external beam irradiaton may play a significant role when the mediastinal lymph nodes are involved.The paper presents the results of treatment of advanced lung cancer patients by external beam irradiation and brachytherapy, and the role of this palliative treatment is discussed.Material and methodsBetween May 1999 and March 2000 at the Greatpoland Cancer Centre fifteen patients with advanced lung cancer were treated by HDR brachytherapy and palliative external beam irradiation using the method of hypofractionation. The patients’ age ranged between 39 to 80 years, mean: 54.3 years. The treatment consisted of external beam irradiation (total dose of 20–30 Gy), and a weekly high dose rate (HDR) brachytherapy (three fractions of 7.5 or 10 Gy, at 1 cm from the source). In three cases the treatment was started with external irradiation, whereas in 12 cases the first stage was brachytherapy. During the patients’ clinical and endobronchial follow-up of 1, 3 and 6 months, local remission and regression of difficulties in breathing, cough, pain and haemoptysis were assessed.ResultsIn all our patients subjective improvement (regression of all symptoms) was found on the first check-up following treatment. In one case complete remission of the tumour lasted for over 6 months, in 9 cases partial remission and in two cases progression were found. Severe complications due to the high total local dose were not observed.ConclusionsCombined palliative treatment (intraluminal brachytherapy and external beam irradiation) in advanced lung cancer was an efficient method that led to regression of symptoms and improvement of well-being in many patients

Effect of education level on diabetes control and quality of life in insulin-treated type 2 diabetic patients

WSTĘP. Celem pracy była próba oceny wpływu edukacji zdrowotnej prowadzonej przez doświadczoną, merytorycznie przygotowaną pielęgniarkę diabetologiczną na parametry wyrównania metabolicznego i jakość życia oraz stopień kontroli własnego zdrowia u chorych na cukrzycę typu 2 leczonych insuliną. MATERIAŁ I METODY. Przebadano grupę 53 chorych (32 kobiety i 21 mężczyzn) z cukrzycą typu 2 leczonych insuliną. Średni czas trwania choroby wynosił 9,5 roku, czas leczenia insuliną 4 lata i 4 miesiące. Średnia wieku badanych to 58,4 lat. Jakość życia oraz stopień kontroli własnego zdrowia pacjentów badano 2-krotnie: przed rozpoczęciem edukacji diabetologicznej i po 3 miesiącach po jej przeprowadzeniu. W pracy wykorzystano metodę sondażu diagnostycznego wykonanego techniką kwestionariuszową. Do oceny stopnia kontroli własnego zdrowia przez pacjenta użyto: 1) kwestionariusza wielowymiarowej Skali Umiejscowienia Kontroli Zdrowia MHCL (wersja B) Wallstona, Wallstona, DeVelisa w polskiej adaptacji Juczyńskiego, 2) Kwestionariusza Zachowań Zdrowotnych Komasińskiej- Moller oraz 3) ankietę własną do oceny glikemii i preferencji edukacyjnych. Do oceny poziomu jakości życia użyto: Skali Satysfakcji z życia autorstwa Diener, Larson, Emmons, Griffin w polskiej adaptacji Juczyńskiego. WYNIKI. Uzyskano znamienne różnice w zakresie spadku i wzrostu glikemii na czczo oraz kontroli zdrowia, a także jakości życia przed edukacją zdrowotną i po jej przeprowadzeniu. WNIOSKI. Prowadzenie edukacji w grupie chorych na cukrzycę w ocenie pacjentów wpływa na wzrost poczucia zadowolenia i satysfakcji z życia. Zaobserwowano pozytywne zachowanie zdrowotne związane z prowadzeniem samokontroli oraz zmniejszenie częstości hiper- i hipoglikemii na czczo. (Diabet. Prakt. 2010; 11, 2: 46-53)BACKGROUND. The aim of the study was to evaluate how health education by the experienced nurseeducator affects quality of life and metabolic control in patients with type 2 diabetes treated with insulin. MATERIAL AND METHODS. The studied group consisted of 53 insulin treated diabetic patients who had never before undergone structured education. The mean diabetes duration in the group was ± 9.5 years and the mean duration of insulin treatment ± 4 years and 4 months. 32 women aged from 36 to 72 years and 21 men aged between 33 and 70 were included in the study. Mean age in the control group was ± 58.4 years. The quality of life in the group was studied twice: before the education and three months later. A diagnostic poll method with the use of questionnaire was used in the study. For patient’s estimation of their own health authors used following tools: 1) A Multidimensional Health Scale of Control Location (MHCL) Questionnaire, version of B. K.A. Wallston, B.S. Wallston, R. DeVelisa - adapted by Z. Juczyński; 2) Health Behaviour Questionnaire by M. Komasińska-Moller; 3) author’s own questionnaire for educational preferences and glycaemia estimation. RESULTS. Significant differences were observed with respect to fasting glycaemia, cooperation with the doctor and the sense of inner control in the group of patients who have undergone structural education. CONCLUSIONS. Structural education has positive influence on patients diabetes control as measured by fasting glycaemia as well as on patients cooperation and quality of life which in trun may affect diabetes control. (Diabet. Prakt. 2010; 11, 2: 46-53

High dose rate endobronchial brachytherapy in the management of advanced lung cancer – comparison of different doses – preliminary assessment

PurposeBrachytherapy is one of the most efficient methods of overcoming endobronchial obstruction in palliative treatment of lung cancer. In single cases, brachytherapy is performed as radical treatment, however in most of cases, due to advanced clinical stage it has a palliative aim. In the absence of clear consensus regarding the value of doses used in brachytherapy different fraction doses are used in clinical treatment. The aim of this work is to compare results of palliative high dose rate brachytherapy using various treatment protocols with the view to analysing differences in survival and diminishing breathing difficulties.Material and methodsBetween May 1999 and February 2000 at the Greatpoland Cancer Center, 69 patients with advanced lung cancer were treated by high dose rate brachytherapy. They were disqualified from radical treatment due to advanced clinical stage. The age of the patients ranged from 39 to 76 years (average 53,2 years). Fifty-one patients received a total dose of 22,5 Gy in 3 fractions once a week, 18 patients received one single fraction of 10 Gy. All the patients were divided into two groups according to their clinical stage and the Karnofsky score – those with the Karnofsky score lower than 50 were qualified for a single fraction treatment. They were under clinical and endobronchial observation as regards survival rates, local remission and subsiding dyspnoea, breathing, cough and haemoptysis in the first, third, sixth and twelveth month of observation.ResultsFour weeks after the end of treatment subjective improvement (subsidence of all symptoms) was ascertained in 61/69 (88,4%) patients. In 12 cases (17,4%) complete remission (CR), in 49 cases (71,0%) – partial remission (PR) of the tumor were found. During one year of observation 45 (65,2%) patients died, in 10 cases (14,5%) improvement of in dyspnoea was observed and in 14 cases (20,3%) recurrence and progression of the disease were noted. There was no statistical difference in the survival rates between the two groups of patients treated with different fractions protocols.Conclusions1.Brachytherapy in advanced lung cancer is an efficient method that led in most of patients to subcidence of symptoms and to improvement of the quality their lives.2.The two treatment protocols showed similar efficiency in overcoming difficulties in breathing.3.Survival rates were similar in both group of patients treated with different treatment protocols

Polish statement on food allergy in children and adolescents

An adverse food reaction is defined as clinical symptoms occurring in children, adolescents or adults after ingestion of a food or chemical food additives. This reaction does not occur in healthy subjects. In certain individuals is a manifestation of the body hypersensitivity, i.e. qualitatively altered response to the consumed food. The disease symptoms observed after ingestion of the food can be triggered by two pathogenetic mechanisms; this allows adverse food reactions to be divided into allergic and non-allergic food hypersensitivity (food intolerance). Food allergy is defined as an abnormal immune response to ingested food (humoral, cellular or mixed). Non-immunological mechanisms (metabolic, pharmacological, microbiological or other) are responsible for clinical symptoms after food ingestion which occur in non-allergic hypersensitivity (food intolerance). Food allergy is considered a serious health problem in modern society. The prevalence of this disorder is varied and depends, among other factors, on the study population, its age, dietary habits, ethnic differences, and the degree of economic development of a given country. It is estimated that food allergy occurs most often among the youngest children (about 6-8% in infancy); the prevalence is lower among adolescents (approximately 3-4%) and adults (about 1-3%). The most common, age-dependent cause of hypersensitivity, expressed as sensitization or allergic disease (food allergy), are food allergens (trophoallergens). These are glycoproteins of animal or plant origine contained in: cow's milk, chicken egg, soybean, cereals, meat and fish, nuts, fruits, vegetables, molluscs, shellfish and other food products. Some of these allergens can cause cross-reactions, occurring as a result of concurrent hypersensitivity to food, inhaled or contact allergens. The development of an allergic process is a consequence of adverse health effects on the human body of different factors: genetic, environmental and supportive. In people predisposed (genetically) to atopy or allergy, the development of food allergy is determined by four allergic-immunological mechanisms, which were classified and described by Gell-Coombs. It is estimated that in approximately 48-50% of patients, allergic symptoms are caused only by type I reaction, the IgEmediated (immediate) mechanism. In the remaining patients, symptoms of food hypersensitivity are the result of other pathogenetic mechanisms, non-IgE mediated (delayed, late) or mixed (IgE mediated, non-IgE mediated). Clinical symptomatology of food allergy varies individually and depends on the type of food induced pathogenetic mechanism responsible for their occurrence. They relate to the organ or system in which the allergic reaction has occurred (the effector organ). Most commonly the symptoms involve many systems (gastrointestinal tract, skin, respiratory system, other organs), and approximately 10% of patients have isolated symptoms. The time of symptoms onset after eating the causative food is varied and determined by the pathogenetic mechanism of the allergic immune reaction (immediate, delayed or late symptoms). In the youngest patients, the main cause of food reactions is allergy to cow’s milk. In developmental age, the clinical picture of food allergy can change, as reflected in the so-called allergic march, which is the result of anatomical and functional maturation of the effector organs, affected by various harmful allergens (ingested, inhaled, contact allergens and allergic cross-reactions). The diagnosis of food allergy is a complex, long-term and time-consuming process, involving analysis of the allergic history (personal and in the family), a thorough evaluation of clinical signs, as well as correctly planned allergic and immune tests. The underlying cause of diagnostic difficulties in food allergy is the lack of a single universal laboratory test to identify both IgE-mediated and non-IgE mediated as well as mixed pathogenetic mechanisms of allergic reactions triggered by harmful food allergens. In food allergy diagnostics is only possible to identify an IgE-mediated allergic process (skin prick tests with food allergens, levels of specific IgE antibodies to food allergens). This allows one to confirm the diagnosis in patients whose symptoms are triggered in this pathogenetic mechanism (about 50% of patients). The method allowing one to conclude on the presence or absence of food hypersensitivity and its cause is a food challenge test (open, blinded, placebo-controlled). The occurrence of clinical symptoms after the administration of food allergen confirms the cause of food allergy (positive test) whereas the time elapsing between the triggering dose ingestion and the occurrence of clinical symptoms indicate the pathogenetic mechanisms of food allergy (immediate, delayed, late). The mainstay of causal treatment is temporary removal of harmful food from the patient’s diet, with the introduction of substitute ingredients with the nutritional value equivalent to the eliminated food. The duration of dietary treatment should be determined individually, and the measures of the effectiveness of the therapeutic elimination diet should include the absence or relief of allergic symptoms as well as normal physical and psychomotor development of the treated child. A variant alternative for dietary treatment of food allergy is specific induction of food tolerance by intended contact of the patient with the native or thermally processed harmful allergen (oral immunotherapy). This method has been used in the treatment of IgE-mediated allergy (to cow's milk protein, egg protein, peanut allergens). The obtained effect of tolerance is usually temporary. In order to avoid unnecessary prolongation of treatment in a child treated with an elimination diet, it is recommended to perform a food challenge test at least once a year. This test allows one to assess the body's current ability to acquire immune or clinical tolerance. A negative result of the test makes it possible to return to a normal diet, whereas a positive test is an indication for continued dietary treatment (persistent food allergy). Approximately 80% of children diagnosed with food allergy in infancy "grow out" of the disease before the age of 4-5 years. In children with non-IgE mediated food allergy the acquisition of food tolerance is faster and occurs in a higher percentage of treated patients compared to children with IgE-mediated food allergy. Pharmacological treatment is a necessary adjunct to dietary treatment in food allergy. It is used to control the rapidly increasing allergic symptoms (temporarily) or to achieve remission and to prevent relapses (long-term treatment). Preventive measures (primary prevention of allergies) are recommended for children born in a "high risk" group for the disease. These are comprehensive measures aimed at preventing sensitization of the body (an appropriate way of feeding the child, avoiding exposure to some allergens and adverse environmental factors). First of all, the infants should be breast-fed during the first 4-6 months of life, and solid foods (non milk products, including those containing gluten) should be introduced no earlier than 4 months of age, but no later than 6 months of age. An elimination diet is not recommended for pregnant women (prevention of intrauterine sensitization of the fetus and unborn child). The merits of introducing an elimination diet in mothers of exclusively breast-fed infants, when the child responds with allergic symptoms to the specific diet of the mother, are disputable. Secondary prevention focuses on preventing the recurrence of already diagnosed allergic disease; tertiary prevention is the fight against organ disability resulting from the chronicity and recurrences of an allergic disease process. Food allergy can adversely affect the physical development and the psycho-emotional condition of a sick child, and significantly interfere with his social contacts with peers. A long-term disease process, recurrence of clinical symptoms, and difficult course of elimination diet therapy are factors that impair the quality of life of a sick child and his family. The economic costs generated by food allergies affect both the patient's family budget (in the household), and the overall financial resources allocated to health care (at the state level). The adverse socio-economic effects of food allergy can be reduced by educational activities in the patient’s environment and dissemination of knowledge about the disease in the society

The Role of Communication in Planned Organizational Change Processes

W artykule przedstawiono podział procesu wprowadzania planowanych zmian organizacyjnych na trzy etapy, ze względu na funkcje, jakie pełni w nim komunikacja, a mianowicie: relacyjną, informacyjną oraz rozwojową. Etap poprzedzający wprowadzenie planowanej zmiany akcentuje znaczenie relacyjnej funkcji komunikacji. Kształtowanie relacji cechujących się zaufaniem powoduje, że wzrasta gotowość do zmian. Rzetelna i wiarygodna informacja, przekazywana na etapie realizacji zmian, sprzyja redukcji niepewności, wywołanej zmianami. Etap następujący po przeprowadzanych zmianach wymaga wysokiej jakości komunikacji, w której jej aspekt informacyjny i relacyjny zostają zintegrowane na rzecz procesów uczenia się nowych wzorców komunikacyjnych i nowych sposobów działania. Ponieważ komunikacja jest podstawowym narzędziem integracji zbiorowych działań w organizacji, jej rola w procesie planowanych zmian ma znaczenie fundamentalne.This article presents the three–stage implementation process for organizational changes where the role of communication is a key—relational, informational, and developmental. The relational function of communication is stressed in the stage preceding the introduction of planned changes. Building relations based on trust fosters a readiness for change. Reliable and trustworthy information provided during the implementation stage reduces uncertainty evoked by changes. The post implementation stage demands high quality communication. In it, the informational and relational aspects are integrated to facilitate learning processes aimed at new communication models and new ways of acting. Since communication is a basic tool in the integration of the collective actions in the organization, its role in the planned change process is of fundamental importance

Silence in the Organization: The Role of Social Mindfulness and Contextual Factors

W artykule przedstawione zostały wyniki badań nad milczeniem w organizacji, rozumianym jako świadome powstrzymywanie się od zabierania głosu w sytuacji dostrzeżonych nieprawidłowości w organizacji. Znaczenie badań nad milczeniem ujawnia się zarówno w sferze produktywności, jak i etyki. Koszty milczenia, a w tym mniejsza innowacyjność, spadek efektywności zespołów oraz kreatywności jednostek, skłaniają do rozpoznania czynników modyfikujących rozmiary milczenia. Mają one charakter zarówno indywidualny, jak i kontekstowy. Uważność społeczna, czyli skłonność jednostki do takiego działania, które wyraża zrozumienie dla potrzeby autonomii innych ludzi oraz nastawienie na dobro innych ludzi, stanowi czynnik indywidualny. W ramach czynników kontekstowych wyróżniono ocenę zaangażowania kierownika w pracę, dokonywaną przez podwładnego, zajmowaną pozycję w hierarchii władzy oraz rodzaj zatrudnienia. Wyniki badań przeprowadzonych na pracownikach różnych firm wskazują na redukcję milczenia u osób uważnych społecznie oraz osób zajmujących stanowiska kierownicze. Milczenie rośnie wraz ze spadkiem zaangażowania przełożonego w pracę. Jeżeli milczenie jest motywowane nastawieniem na ochronę własnej grupy, to jego wielkość rośnie w przypadku umowy na czas ograniczony.This paper presents the results of the research into silence in the organization, which is understood as a conscious decision not to voice one’s own objections towards perceived wrongdoings or improper behavior. The significance of research into silence is visible in both the sphere of productivity and ethics. The costs of such silence can be felt in lower productivity, lower team effectiveness, and lower individual creativity. This is why it is important to define factors that can modify the intensity of silence. Their character is both individual and contextual. Social mindfulness—the tendency of the individual to act in a manner recognizing the need of autonomy of other people as well as an orientation aiming at the good of others—is an individual factor. Among contextual factors taken into account in the research are the engagement of the manager in work as assessed by the employee, position in the hierarchy, and type of employment. The results of research as conducted in various organizations show that silence is reduced in the case of people considered as being socially mindful as well as in managerial positions. Silence is stronger in the case of lower manager engagement. If the silence is motivated by a need to protect one’s own group, it intensifies in the case of defined–period employment contracts

The language as a tool of cognition and communication

The paper presents arguments for treating language as a tool for cognition and communications. It articulates an opposite view to the one which considers language as an independent module shaping cognition and thinking. According to the conception of the socially – based cognition the mind is a controller of the adaptive behavior, and communication is a strategic action to which language is subjected. The model of the linguistic categories arranges words according to the level of their abstraction; and a number of research results presented in the paper indicate that there is a relationship between the level of abstraction of the words used and the inference related to events, emotions and memory. Recognizing language as a tool for cognition and communication leads to the acceptance of the necessity to widen the language awareness. This kind of thinking is supported by the presented results of research on the relationship between linguistic categories and the stereotypes, communication of the interpersonal distance and the process of asking questions and giving answers