Mieszany rak gruczołowo-neuroendokrynny (MANEC): opis przypadku i przegląd piśmiennictwa

  Mieszany rak gruczołowo-neuroendokrynny (MANEC — mixed adenoneuroendocrine carcinoma) jest rzadkim nowo­tworem złośliwym o złożonym utkaniu patomorfologicznym, łączącym cechy gruczolakoraka z komponentem neu­roendokrynnym. Zgodnie z nową klasyfikacją World Health Organization (WHO) z 2010 roku zmieniono nazewnictwo nowotworów neuroendokrynnych (NEN — neuroendocrine neoplasms), wykorzystując to określenie dla całości tej grupy nowotworów. Określenie „guzy neuroendokrynne” (NET — neuroendocrine tumors) obejmuje nowotwory wy­soko zróżnicowane, określane w stopniowaniu patomorfologicznym jako G1 (NET G1) lub G2 ( NET G2). Dodatkowo wyróżnia się raki neuroendokrynne (NEC — neuroendocrine carcinoma) oraz raki mieszane o utkaniu gruczołowo­-neuroendokrynnym (MANEC — mixed adenoneuroendocrine carcinoma). Po przeszukaniu bazy PubMed znaleziono około 50 doniesień o tym nowotworze, głównie o jego lokalizacji w żołądku, węzłach chłonnych, jelitach, wątrobie, otrzewnej, pęcherzyku żółciowym, trzustce, przełyku. Nie spotkaliśmy opisu zmian przerzutowych typowych dla MANEC w oponach mózgu, pniu mózgu i płucach. Przedstawiamy przypadek pacjenta 63-letniego, który został przyjęty na Oddział Neurologii z powodu nasilonych zawrotów głowy z towarzyszącym podwójnym widzeniem, bólem głowy, nudnościami i drętwieniem rąk. Dolegliwości pojawiły się dzień przed przyjęciem, z nasileniem po nocy. Pacjent był diagnozowany początkowo na Oddziale La­ryngologii z powodu głuchoty ucha prawego i głębokiego niedosłuchu ucha lewego na 4 tygodnie przed przyjęciem na nasz Oddział. W badaniu neurologicznym stwierdzono: przytomny, niespokojny, mowa dyzartryczna, niewielka duszność wdechowa, głuchota ucha prawego, głęboki niedosłuch ucha lewego, odruchy gardłowy i podniebienny — obecne, mierne napinanie fałd podniebienno-gardłowych, obustronnie cechy centralnego uszkodzenia nerwu VII, nieznaczne zbaczanie języka na lewo, siła mięśniowa kończyn bez deficytu, nieznacznie obniżone napięcie mięśnio­we w kończynach lewych, ataksja kończyn dolnych, obustronnie zachowany odruch podeszwowy. W Izbie Przyjęć wykonano TK głowy i stwierdzono ognisko hypodensji w lewej półkuli móżdżku, hypodensyjne ogniska wokół rogów czołowych obu komór bocznych oraz drobne jamy malacyjne na poziomie jąder podkorowych. Wykonano punkcję lędźwiową, uzyskując płyn o podwyższonej cytozie i obniżonym poziomie glukozy. W drugiej dobie hospitalizacji stan ogólny i neurologiczny pacjenta uległ znacznemu pogorszeniu, wystąpiła burza wegetatywna. Następnie doszło do zatrzymania krążenia. Pacjent został skutecznie resuscytowany, a następnie ponownie wystąpiło NZK i pomimo długotrwałego prowadzenia RKO nie udało się przywrócić akcji serca i oddechu. Po badaniu patomorfologicznym ustalono, że całość obrazu przemawia za nowotworem typu MANEC umiejscowionym w żołądku, z rozsiewem głównie do opon mózgu, pnia mózgu i płuc. W diagnostyce różnicowej należy zawsze brać pod uwagę rzadkie przyczyny zachorowań. Dodatkową trudnościąw rozpoznaniu MANEC jest różnica w nazwach w zależności od piśmiennictwa i kraju pochodzenia artykułu oraz brak polskich odpowiedników niektórych nazw nowotworów. Dopiero rzetelna analiza histopatologiczna jest w stanie wykryć nowotwory z tej grupy

Antiphospholipid Syndrome and Pregnancy

Antiphospholipid syndrome is an autoimmune disease with a wide spectrum of manifestations from different organs, therefore it is challenging to diagnose. The disease presents antiphospholipid antibodies such as anticardiolipin antibodies (aCL), lupus anticoagulant (LA) and antiβ2-glycoprotein 1 antibodies (β2GPI). The most common symptoms include thrombosis in veins and arteries and obstretical complications such as early miscarriage, intrauterine fetal death, intrauterine growth restriction (IUGR), placental insufficiency, premature labor and eclampsia. To diagnose a patient with APS certain criteria have been chosen, where at least one clinical and one laboratory criterion must be present. In many cases it takes a lot of time before a proper diagnosis has been made, when a female patient presents obstretical complications. Adequate pharmacological treatment increases the odds of live birth rate from 20-30% to 70-80%. Scientific research shows correlation between antiphospholipid syndrome, infertility and premature ovarian insufficiency. Treatment mostly consists of heparin and low-dose aspirin, in certain cases hydrochloroquine is prescribed. Aside from pharamcological therapy, it is very important to minimize the effects of modifiable risk factors. The following article focuses on complications, diagnosing and therapy in pregnant women suffering from Antiphospholipid syndrome. All sources can be found in Pubmed’s website database

Erythema nodosum as a manifestation of many systemic diseases

Introduction and purpose: Erythema nodosum is a most frequent form of panniculitis and it appears as erythematous, painful rounded, nodules typically localized on the pretibial area. The purpose of our review is to present diseases that can be underlying causes of erythema nodosum and to draw attention to accompanying symptoms that can guide us to the appropriate diagnosis. Brief description of the state of knowledge: Currently, erythema nodosum is thought to be a symptom associated with hypersensitivity reactions to various antigens. Although the majority of the causes are considered idiopathic, erythema nodosum may be caused by many etiological factors. Summary: Erythema nodosum is usually an acute condition that resolves without treatment. However, it can sometimes be the first sign of a serious condition - autoimmune diseases, infections or malignancy. In such cases it is essential to observe it carefully and implement appropriate diagnostics that allow us to make a correct diagnosis

Dietary Therapies in Pediatric Crohn’s Disease

Introduction and Purpose: Crons’ disease is a chronic illness of the digestive system. Its etiology is multifactorial and one of the factors is nutrition. That is why the researchers are trying to labour the valuable types of dietary therapy, which could be used in treatment of pediatric CD. The purpose of our review is to point out the impact of dietary therapy on achieving remission in pediatric Crohn’s disease. Materials and methods: We have reviewed the literature from the PubMed database searching for clinical trials, meta analysis and randomized controlled trials from the past years. The keywords we agreed on offered us the most informative articles and made us hope for the further development of our article. Brief Description Of The State Of Knowledge: Steroid therapy is the principle of CD treatment, but it has a number of side effects that influence the quality of pediatric patients’ life. It has been shown that the use of dietary therapies (EEN, CDED+PEN, SCD) enables the achievement of clinical and biochemical remission, mucosal healing and regulation of dysbiosis. There are many hypotheses explaining this effect, probably the reason of this is the exclusion from the diet of food products that provoke inflammatory processes. Summary: Despite its effectiveness, dietary therapies require motivation and full commitment from patients in order to achieve results. That is why it is so important to conduct further research in this area so that the selected therapy is as acceptable and tolerated by the patient as possible. In addition, education of children and parents, psychological and dietary support are also crucial in the treatment process

The impact of shift work and sleep deficiency on health

Shift work refers to work that takes place at different hours, including at night. It is estimated that 15% to 20% of the working population works in shift work, particularly in the healthcare, energy, communication systems, public safety, and hospitality industries. Research indicates that shift work, particularly night work, can lead to health problems such as fatigue, exposure to harmful work environments, increased risk of workplace accidents, and sleep disorders. Night work is also associated with increased risk of hypertension, nervous system dysfunction, cardiovascular dysfunction. Those working at night are also more prone to hormonal disorders, digestive disorders, lowered immunity, and cancer. Sleep-wake cycle disorders, such as excessive sleepiness during waking hours and insomnia at night, are symptoms of shift work intolerance syndrome, which can occur after several months or years of shift work. It is estimated that over 20% of shift workers suffer from sleep-wake cycle disorders, and various factors such as chronotype, age, gender, family and social obligations, medications, medical and psychiatric conditions, and shift work experience can impact tolerance of shift work. The treatment of sleep and wake disorders related to shift work includes planning for main sleep and supplementary naps, appropriate exposure to light, treatment with melatonin, taking sleeping and psychostimulant medications.&nbsp

Basal cell carcinoma in the elderly Cryosurgery or surgery – a case study with reference to the literature

Introduction The aging of society leads to an increase in the occurrence of basal cell carcinoma (BCC). BCC includes both superficial and nodular lesions with a good prognosis as well as foci that are difficult to treat and require a multidisciplinary approach. There are two basic methods of treating BCC, surgery to remove the tumor and cryosurgery. The paper presents a case of an 82-year-old female patient suffering from BCC in a non-advanced stage of the disease with the presentation of subsequent stages of treatment.Aim of the studyAn attempt was made to confront an alternative method of BCC treatment by cryosurgery with the first-choice procedure - surgical excision of the tumor with a margin of healthy tissues.Description of the caseAn individual clinical case study including the patient's medical records.ConclusionsThe work emphasizes the importance of comprehensive care for a patient diagnosed with BCC.Individualization of the diagnostic and therapeutic process is the basis for dealing with the elderly patient

Association between caesarean section and childhood asthma development

According to the World Health Organization (WHO), the rates of caesarean section delivery, which is the most common surgical procedure in gynecology and obstetrics, are increasing globally and amount to 21%. In Poland percentage of caesarean sections (CS) is one of the highest in Europe and amount to 42.2%. The reason for this is the extension of medical indications, but also an increase in the number of CS at the request of pregnant women. Although CS can be a lifesaving procedure, it can also cause many health complications for both - the woman and the child. Numerous studies indicate that caesarean delivery is associated with childhood asthma. Several hypotheses of the pathogenesis of this relationship have been presented. One of them, which is based on the hygiene hypothesis indicates that mode of delivery can cause different bacteria colonization in infants. Lack of contact of fetus with the mother’s vaginal flora during CS labor may cause improper immune system maturation. Another hypothesis is that reduced exposure to stress hormones and mechanical forces during CS labor can indicate infant respiratory complications such as respiratory distress syndrome (RDS) or transient tachypnea of the newborn (TTN). It is suggested that these abnormalities have an impact on asthma development in later life. On the other hand, there are studies which do not confirm that mode of delivery has an influence on the induction of asthma. Due to the significant heterogeneity of studies and unclear risk factors and pathomechanism of the childhood asthma it is impossible to strong confirm the association between caesarean section and asthma developing

Diagnosis and management of lip filler complications – a case study with literature review

Introduction Aesthetic medicine treatments are becoming more popular in the 21st century due to the changing beauty standards and the treatments’ ability to help slow down the aging process. One of the most asked for treatments is a lip filler using hyaluronic acid. The popularity and frequency of the said treatment are directly connected to the rising number of complications in this area. The right diagnosis of lip filler complications allows to implement correct management and therefore therapeutic success for the patient. The aim The aim of the work was to analyze and discuss patient’s complications and implemented medical management after lip filler treatment using hyaluronic acid. Case report An individual case study that included clinical examination, medical and photographic documentation analysis. Results The patient was diagnosed with one of the most common complications after lip filler which is swelling. The swelling was a result of an allergic reaction and was classified as severe. Medical management using corticosteroid and antihistamines was implemented with a good therapeutic outcome. Conclusions Implemented management using corticosteroids and antihistamines for severe swelling after lip filler is effective. Due to the rising number of treatments using soft tissue fillers, it is expected that more patients will present with complications after aesthetic medicine procedures

Association between caesarean section and childhood asthma development

According to the World Health Organization (WHO), the rates of caesarean section delivery, which is the most common surgical procedure in gynecology and obstetrics, are increasing globally and amount to 21%. In Poland percentage of caesarean sections (CS) is one of the highest in Europe and amount to 42.2%. The reason for this is the extension of medical indications, but also an increase in the number of CS at the request of pregnant women. Although CS can be a lifesaving procedure, it can also cause many health complications for both - the woman and the child. Numerous studies indicate that caesarean delivery is associated with childhood asthma. Several hypotheses of the pathogenesis of this relationship have been presented. One of them, which is based on the hygiene hypothesis indicates that mode of delivery can cause different bacteria colonization in infants. Lack of contact of fetus with the mother’s vaginal flora during CS labor may cause improper immune system maturation. Another hypothesis is that reduced exposure to stress hormones and mechanical forces during CS labor can indicate infant respiratory complications such as respiratory distress syndrome (RDS) or transient tachypnea of the newborn (TTN). It is suggested that these abnormalities have an impact on asthma development in later life. On the other hand, there are studies which do not confirm that mode of delivery has an influence on the induction of asthma. Due to the significant heterogeneity of studies and unclear risk factors and pathomechanism of the childhood asthma it is impossible to strong confirm the association between caesarean section and asthma developing