Adrenocortical carcinoma (ACC) with massive liver metastases in a 4-year-old female patient: the significance of chemotherapy and imaging studies in treatment and diagnosis – a case report

Background: Adrenocortical carcinoma (ACC) is a retroperitoneal tumour, accounting for less than 0.2% of all malignancies in children. In pediatric patients, the most common clinical presentation is virilisation, either isolated or in combination with hypercortisolemia. Case report: A 4-year-old girl was admitted to the hospital for diagnostic evaluation of precocious puberty and features of hypercorticism. Ultrasonography revealed a heterogeneous neoplastic lesion between the left kidney and spleen. Computed tomography (CT) scan confirmed a pathological mass in the left adrenal region. The urine steroid profile was suggestive of adrenocortical carcinoma. The patient was qualified for surgery. Histopathological examination confirmed the diagnosis. A PET scan performed a few months later showed a metabolically active lesion in the left lobe of the liver. Due to the suspicion of a metastatic focus, it was proposed to implement systemic treatment, to which the patient's parents did not agree. After 15 months of no treatment and oncological follow-up, the girl was referred to the ED with symptoms of progression of the neoplastic process. In the face of a renewed lack of consent to the inclusion of treatment, the patient was referred to a home hospice, where she died a short time later. Conclusions: In the pediatric population, adrenocortical carcinoma is a rare neoplasm with a very poor prognosis. Prompt diagnosis enables early identification of the primary tumour and implementation of appropriate treatment. Imaging examinations are crucial in order to assess the size of the tumour, the extent of local invasion and the presence of potential metastases

Ischemic stroke in a pediatric patient – a case report

Background Childhood ischemic stroke (AIS) is a relatively rare disease with an estimated incidence of 1.3-13/100,000/year. It most commonly affects children under the age of 5. Major risk factors include arteriopathies, heart disease, hypercoagulable states and infections. Case report A 2-year-old patient was admitted to the Department of Neurology at the University Children's Hospital in Lublin after suffering a head injury 3 days earlier. Neurological examination revealed features of left hemiparesis. A CT scan revealed an uncharacteristic hypodense, poorly demarcated area, an indication for further diagnostics. MR imaging revealed diffuse ischemic lesions. Angio-MR showed a lack of signal within the branches of the right posterior cerebral artery. Based on the clinical picture and additional examinations, a diagnosis of ischemic stroke was made and pharmacological treatment was implemented. To determine the cause of the stroke, an echocardiogram was performed, which showed flaccid atrial septal tissue with a defect and a trace left-right leak. Genetic testing for congenital thrombophilia confirmed a 4G/4G polymorphism in the PAI-1 gene. Conclusions Ischemic stroke is a life-threatening condition that requires prompt diagnosis and appropriate treatment. The relatively rare occurrence among children and nonspecific symptoms may result in difficulties in making a definitive diagnosis. Each case of stroke in children requires a comprehensive diagnosis including neuroimaging studies and identification of specific risk factors

The striped field mouse (Apodemus agrarius) as a host of fleas (Siphonaptera) and tapeworms (Cestoda) in suburban environment of Lublin (eastern Poland)

The striped field mouse, Apodemus agrarius, is one of the most abundant species among small rodents in Poland. It occurs commonly across the whole country inhabiting diverse ecological niches as meadows, farmlands, enclaves of natural habitats in cities. Wide range of ecological tolerance of this species makes it often the host, reservoir and vector of many pathogens: viruses, bacteria, protozoa, helminths and arthropods. The aim of the present study was to carry out a qualitative and quantitative analysis of the fleas community and intestinal tapeworms of A. agrarius in suburban environment of Lublin (eastern Poland). In studied population three species of Siphonaptera class i.e. Ctenophthalmus agyrtes, Nosopsyllus fasciatus, Hystrichopsylla talpae and one intestine Cestoda species Hymenolepis diminuta were identified. The results of our researches confirmed role of A. agrarius as the reservoir for tapeworms and host for fleas in urban environment. High level of the prevalence of fleas and tapeworms in rodents indicates the significant degree of contamination and can cause an epidemiological threat for human’s health

Vaccination against influenza in pregnant women – safety and effectiveness

Influenza is a major cause of morbidity and mortality worldwide. During seasonal influenza epidemics and pandemics, pregnancy places otherwise healthy women at an increased risk of complications from influenza. The factors believed to increase the susceptibility of complicated influenza infection during pregnancy are linked to the physiologic changes, including immunologic changes (attenuation of the cell-mediated immune responses, selective suppression of T-helper 1 cell mediated immunity while the adaptive humoral immunity remains unimpaired), increased cardiac output and oxygen consumption and tidal volume. Pregnant women have similar incidence of seasonal influenza as the general population, however, because of the physiological changes, they are at an increased risk of complications (including secondary pneumonia, acute respiratory insufficiency, increased risk of stillbirth, premature deliveries) and death. Immunization of pregnant women against influenza is currently recommended in many countries. Vaccination against influenza with trivalent inactivated vaccine (TIV) has been proven to be safe and effective. Lack of harmful effect of TIV on pregnant women and newborns has been demonstrated in several studies: no increased risk of spontaneous abortions, preterm birth, low birth weight, congenital malformations, cesarean section have been reported. Vaccination against influenza has been proven to be effective in reducing rates and severity of the disease in vaccinated mothers and their children. Several studies revealed a decreased risk of influenza-like illnesses among mothers who were vaccinated during pregnancy, but also a decreased risk of laboratory confirmed cases of influenza and hospitalizations due to influenza and its complications among newborns and infants born to vaccinated mothers. Currently available inactivated influenza vaccines are not licensed for use in infants younger than 6 months. Protection of young infants against the infection in early life thus requires a cocooning strategy to reduce the number of vulnerable individuals among care givers and contacts. Neonates and infants may be also protected against influenza directly by antibodies of maternal origin that cross the placenta or are transferred via breast milk. The duration of passively acquired antibodies depends on the initial blood concentration and is probably less than 6 months. Vaccine coverage among pregnant women remains low. Possible explanations include lack of education by health care workers, the feeling among the general public that influenza is not a serious problem, and the failure of prenatal care providers to offer the vaccine. Overall, the most important factor for a woman to decide to be immunized during pregnancy was to have a clear recommendation from the health care provider. Reasons evoked by obstetricians for not providing influenza vaccines included lack sufficient data on safety and efficacy, concerns about the medical legal risks of vaccination during pregnancy and the perception that pregnant women would not want to be vaccinated. Educational intervention targeting health care workers in charge of pregnant women should be primary implemented to provide higher influenza vaccine coverage and to protect pregnant women and young infants from influenza related morbidity

Adrenocortical carcinoma (ACC) with massive liver metastases in a 4-year-old female patient: the significance of chemotherapy and imaging studies in treatment and diagnosis – a case report

Background: Adrenocortical carcinoma (ACC) is a retroperitoneal tumour, accounting for less than 0.2% of all malignancies in children. In pediatric patients, the most common clinical presentation is virilisation, either isolated or in combination with hypercortisolemia. Case report: A 4-year-old girl was admitted to the hospital for diagnostic evaluation of precocious puberty and features of hypercorticism. Ultrasonography revealed a heterogeneous neoplastic lesion between the left kidney and spleen. Computed tomography (CT) scan confirmed a pathological mass in the left adrenal region. The urine steroid profile was suggestive of adrenocortical carcinoma. The patient was qualified for surgery. Histopathological examination confirmed the diagnosis. A PET scan performed a few months later showed a metabolically active lesion in the left lobe of the liver. Due to the suspicion of a metastatic focus, it was proposed to implement systemic treatment, to which the patient's parents did not agree. After 15 months of no treatment and oncological follow-up, the girl was referred to the ED with symptoms of progression of the neoplastic process. In the face of a renewed lack of consent to the inclusion of treatment, the patient was referred to a home hospice, where she died a short time later. Conclusions: In the pediatric population, adrenocortical carcinoma is a rare neoplasm with a very poor prognosis. Prompt diagnosis enables early identification of the primary tumour and implementation of appropriate treatment. Imaging examinations are crucial in order to assess the size of the tumour, the extent of local invasion and the presence of potential metastases

Commercially important properties of plants of the genus Plantago

The centuries-old experience of folk medicine, nutritional traditions, and the results of numerous research studies show that plants of the genus Plantago can be used for medicinal, cosmetic, dietetic, and ritual purposes. In the phytochemical composition of Plantago, there is an abundance of biologically active substances (among others, glycosides, flavonoids, polysaccharides, and vitamins) exhibiting beneficial effects and, simultaneously, there is a low content of compounds that may exert a toxic effect. Scientific research has confirmed that Plantago plants have antioxidative, apoptosis-inhibiting, protective, healing-enhancing, spasmolytic, anthelmintic, and antimicrobial properties; they inhibit the development of some tumours, reduce the level of lipids in blood and inhibit tissue glycation. In phytotherapy, leaves, stems, and/or seeds of different plantain species are used. Plantago leaves and seeds are also used to manufacture creams, lotions, and face masks. Different parts of these plants (fresh plant material, extracts, or isolated substances) are also used in human and animal nutrition. Plantain leaves can be eaten like lettuce or added to salads, fried in pastry, used to prepare a tea, juice, or wine. Its seeds are added to cakes, bread, breakfast cereals, ice cream, and drinks, or they are cooked like groats. Animals fed with plantain can live longer and are healthier, while meat derived from such animals is tastier and healthier to humans. Plantago seeds are readily eaten by cage birds. Plantain pollen, produced in large amounts (up to 20,000 pollen grains per 1 stamen of P. lancolata), can cause allergies in sensitive people. Due to a long flowering period of plants of the genus Plantago, the effect of the allergenic factor persists for many weeks. In Poland days with the maximum concentration of airborne plantain pollen most often occur in July

The evaluation of the central retina after laser therapy in diabetic retinopathy

WSTĘP. Celem niniejszej pracy jest ocena wpływu laseroterapii na stan przedmiotowy siatkówki centralnej w retinopatii cukrzycowej. MATERIAŁ I METODY. Analizie poddano 200 oczu u 101 chorych na cukrzycę typu 1 i typu 2. W badanej grupie było 47 kobiet i 54 mężczyzn w wieku 23-72 lat. Na podstawie szczegółowego badania oftalmoskopowego i angiograficznego w 168 oczach stwierdzono objawy makulopatii. W 105 oczach (62,5%) wykazano ogniskowy obrzęk plamki, w 54 oczach (32,1%) - makulopatię rozlaną, a w 9 oczach (5,4%) - makulopatię niedokrwienną. Zgodnie z zaleceniami Diabetic Retinopathy Study (DRS) oraz Early Treatment Diabetic Retinopathy Study (ETDRS) pacjentów poddano laseroterapii laserem argonowym firmy Coherent 920. Efekty leczenia oceniano po okresie 1,2–4,4 roku od czasu wykonania fotokoagulacji. WYNIKI. Po zastosowanej laseroterapii poprawę zaobserwowano w 88,6% przypadków z makulopatią ogniskową i w 83,3% z makulopatią rozlaną. Stabilizację zmian stwierdzono w 8,6% przypadków z makulopatią ogniskową i w 11,1% przypadków z makulopatią rozlaną. Autorzy niniejszej pracy progresję makulopatii ogniskowej zaobserwowali w 2,8% przypadków, a makulopatii rozlanej - w 5,6%0. W oczach z makulopatią niedokrwienną uzyskali stabilizację procesu w 60%, a poprawę zaledwie w 20%. Liczba mikrowłośniaków zmniejszyła się w 81,8% przypadków, liczba wysięków twardych - w 77% przypadków. Wybroczyny śródsiatkówkowe uległy regresji zaledwie w 24,2% przypadków, a strefy braku perfuzji jedynie w 3,6% przypadków. WNIOSKI. Pozytywne wyniki laseroterapii, szczególnie w makulopatii ogniskowej i rozlanej, uzasadniają uznanie tej terapii jako metody z wyboru w leczeniu retinopatii cukrzycowej.INTRODUCTION. The purpose of this study is the evaluation of the photocoagulation impact on central retina in diabetic retinopathy. MATERIAL AND METHODS. 101 patients (200 eyes), age varied from 23 to 72 years, 47 women and 54 men with insulin-dependent and insulin non-dependent diabetes were analyzed. On the basis of detailed ophthalmology and angiography examination diabetic maculopathy were found in 168 eyes. The focal macular edema was stated in 105 eyes (62.5%), diffuse maculopathy in 54 eyes (32.1%) and ischemic maculopathy in 9 eyes (5.4%). Patients were treated with argon laser Coherent 920, in accordance with DRS and ETDRS recommendations. The effects of laser therapy were estimated in 1.2 to 4.4 years after photocoagulation. RESULTS. In 88,6% eyes with focal macular edema and in 83.3% eyes with diffuse maculopathy we noticed an improvement after the photocoagulation. Stabilization was found in 8.6% eyes with focal macular edema and in 11.1% eyes with diffuse maculopathy. Deterioration was found in 2.8% eyes with focal maculopathy and in 5.6% eyes with diffuse maculopathy. Ischemic maculopathy was stabilized in 60%, improved only in 20%. The amount of microvessels decreased in 81.8% eyes, the amount of hard exudates in 77%, intraretinal blood extravasations in 24.2% eyes and zones of lack of perfusion only in 3.6%. CONCLUSION. The positive results of photocoagulation, especially in focal and diffuse maculopathy, justify the application of laser treatment as a method of choice in diabetic retinopathy

Nowotwory wtórne ujawniane podczas BAC tarczycy — analiza częstości występowania i charakterystyka obrazu ultrasonograficznego

  Introduction: Metastases to the thyroid are revealed at autopsy with a frequency of 2–24%; however, clinically they appear less frequently, at 0.1–3%. The aim of the study was analysis of the frequency of revealing metastases to the thyroid (TM) and to the regional lymph nodes (NM) (neoplasms other than primary thyroid tumours) in preoperative diagnostics of the thyroid in patients with positive (C+) and negative (C–) history of cancer; analysis of ultrasound (US) images of metastases. Material and methods: Results of US/fine needle aspiration (FNA) of the thyroid in 1276 C+ patients and 18,947 C- patients. Results: TM and NM were diagnosed/suspected in 57 patients (0.3% of all examined; 40 TM, 22 NM, 5 both), and their frequency was higher in the C+ group (2.9% vs. 0.1% in C–, p < 0.0001). In the C+ group, diagnosis of metastasis accounted for 72.3% of FNA results from the category “malignant neoplasm”; in the C– group it was 9.5% (p < 0.0001). The highest relative frequency of TM was found for cancers infiltrating thyroid by direct extension (> 10%), lymphomas (7.7%), and kidney (5.3%) and lung (4.9%) cancers. The mean age of patients with metastasis (63.9 ± 11.7 years) was similar to that of the C+ group and higher than the C- group (53.9 ± 14.8 years, p < 0.0001). The proportion of males among the patients with metastasis was three-fold higher than in the patients without metastasis (p < 0.0001). TM lesions presented suspicious borders in US twice as often as primary cancers . Conclusions: Metastases to the thyroid are rare; however, for patients with a history of cancer, their presence is more likely than primary thyroid cancer. US/FNA imaging of metastases allows the selection of patients requiring further diagnostics and treatment. (Endokrynol Pol 2015; 66 (6): 495–503)    Wstęp: Przerzuty do tarczycy ujawnia się podczas autopsji z częstością 2–24%, jednak klinicznie stwierdza się je rzadziej: 0,1–3%. Celem pracy była analiza częstości ujawniania podczas diagnostyki tarczycy przerzutów do tarczycy (TM) i węzłów chłonnych szyi (NM) (nowotworów innych niż pierwotne tarczycy) u osób z dodatnim (C+) i ujemnym (C–) wywiadem nowotworowym; analiza obrazu ultrasonograficznego przerzutów. Materiały i metody: Wyniki US/FNA tarczycy 1276 osób z grupy C+ oraz 18947 z grupy C-. Wyniki: TM lub NM rozpoznano/podejrzewano u 57 osób (0,3% wszystkich badanych; 40 TM, 22 NM, 5 oba), częstość ich ujawniania była wyższa w grupie C+ niż C– (2,9% vs. 0,1%, p < 0,0001). W grupie C+ rozpoznania przerzutu stanowiły 72,3% wyników FNA należących do kategorii nowotwór złośliwy, w grupie C–: 9,5% (p < 0,0001). Najwyższą względną częstość ujawniania przerzutów stwierdzono dla nowotworów naciekających tarczycę przez ciągłość (> 10%), chłoniaków (7,7%), raków nerki: 5,3% i płuca 6,2% (4,9% bez NM). Średni wiek pacjentów z przerzutem: 63,9 ± 11,7 lat był podobny do wieku osób z grupy C+ i wyższy od wieku osób z grupy C– (53,9 ± 14,8, p < 0,0001). Odsetek mężczyzn wśród osób z przerzutem był 3-krotnie wyższy niż wśród osób bez przerzutu (p < 0,0001). Ogniska TM — 2-krotnie częściej niż pierwotnych raków tarczycy miały podejrzane granice w US. Wnioski: Przerzuty do tarczycy są rzadkie, jednak u pacjentów z dodatnim wywiadem nowotworowym ich obecność jest bardziej prawdopodobna niż pierwotnych raków tarczycy. Obraz US/FNA przerzutów umożliwia wyodrębnienie pacjentów wymagających dalszej diagnostyki i leczenia. (Endokrynol Pol 2015; 66 (6): 495–503)

Niewydolność serca w przebiegu nieleczonego nadciśnienia tętniczego oraz zaburzeń metabolicznych

We present the case of a 38-year-old previously untreated patient admitted to the hospital because of hypertensivecrisis. The patient apart from hypertension was initially diagnosed with heart failure, diabetes type 2, dyslipidemia.Coronary ischemic disease was excluded due to angiography. Cardiac magnetic resonance imaging has shown thealternations indicating metabolic etiology of heart failure. After hypertension, hypolipidemic and diabetes treatment,patient’s general condition, normalization of blood pressure and lipids values, glycemic control and the improvementof left ventricular systolic function were observed.Przedstawiamy przypadek 38-letniego dotychczas nie leczonego pacjenta przyjętego do szpitala z powodu kryzy nadciśnieniowej. U chorego poza nadciśnieniem tętniczym stwierdzono wieńcową, cukrzycę typu 2, dyslipidemię. Na podstawie koronarografii wykluczono chorobę wieńcową. W rezonansie magnetycznym serca (MRI) stwierdzono zmiany wskazujące na etiologię metaboliczną. Po zastosowanym leczeniu hipotensyjnym, hipolipemicznym i diabetologicznym uzyskano poprawę stanu pacjenta, normalizację wartości ciśnienia tętniczego (RR), poziomu lipidów, dobrą kontrolę glikemii oraz poprawę funkcji skurczowej lewej komory

Acute aortic dissection in a patient with long-standing untreated hypertension and metabolic syndrome

Ostre rozwarstwienie aorty jest jednym z potencjalnych powikłań nieleczonego nadciśnienia tętniczego. Jego objawy, w tym silny rozrywający ból zamostkowy promieniujący do kręgosłupa, często sugerują ostry zespół wieńcowy. Podstawą diagnozy jest wykonanie tomografii komputerowej aorty. Pacjenci z ostrym rozwarstwieniem aorty wymagają pilnej operacji naczyniowej. Jednym z warunków jej powodzenia i dobrego rokowania jest uzyskanie redukcji wartości ciśnienia tętniczego. W pracy przedstawiono przypadek pacjenta z nieleczonym wieloletnim nadciśnieniem tętniczym, u którego doszło do rozwarstwienia aorty zstępującej oraz jej odgałęzień i w konsekwencji do pogorszenia funkcji nerek. Po początkowych trudnościach w ustaleniu optymalnej farmakoterapii uzyskano redukcję wartości ciśnienia tętniczego oraz nie obserwuje się poszerzenia wrót rozwarstwienia.Acute aortic dissection (AOD) is one of the possible complications of untreated hypertension. Its symptoms (severepopping chest pain radiating to the back) are often confused with acute coronary syndrome. The basis of diagnosis isa computed tomography of the aorta. Patients with AOD requires emergency vascular surgery. One of the conditions forthe success and good prognosis is to reduce blood pressure. The paper presents a case of a patient with long-standinguntreated hypertension, in whom there was a dissection of the descending aorta and its branches, and consequentlythe deterioration of renal function. After initial difficulties in determining the optimal pharmacotherapy reduction ofblood pressure was achieved and widening gates delamination is not observed