MULTIPLE CEREBRAL METASTASES MIMICKING WERNICKE'S ENCEPHALOPATHY IN A CHRONIC ALCOHOLIC

Aims: Alcohol dependent patients in withdrawal display a wide spectrum of neurological and neuropsychological symptoms that complicate diagnosis. We report the case of a 53-year-old male alcoholic with disorientation, ataxia and nystagmus in alcohol withdrawal probably due not to initial supposed Wernicke's encephalopathy (WE) but rather due to multiple cerebral metastases of a non-small cell cancer of the lung. Results: The findings illustrate the importance of initially maintaining a tentative attitude toward causation of symptoms and the role of brain imaging in formulating an accurate diagnosi

Systemic inflammation in a melanoma patient treated with immune checkpoint inhibitors—an autopsy study

BACKGROUND: Immune checkpoint inhibitors targeting cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1 (PD-1) have been recently approved for treatment of patients with metastatic melanoma and non-small cell lung cancer (NSCLC). Despite important clinical benefits, these therapies are associated with a diverse spectrum of immune-related adverse events (irAEs) that are typically transient, but occasionally severe or even fatal. CASE PRESENTATION: This autopsy case illustrates that clinically overt irAEs may represent only a fraction of the total spectrum of immune-related organ pathology in patients treated with immune checkpoint inhibitors. We report a comprehensive analysis of systemic irAE pathology based on the autopsy of a 35-year-old female patient with metastatic melanoma treated first with ipilimumab and then nivolumab. The clinical course was characterized by a mixed tumor response with regression of skin and lung metastases and fatal progression of metastatic disease in the small bowel, peritoneum and brain. During therapy with ipilimumab, radiographic features of immune-related pneumonitis were noted. The autopsy examination established a sarcoid-like granulomatous reaction of the lung, pulmonary fibrosis and diffuse alveolar damage. Importantly, a clinically unapparent but histologically striking systemic inflammation involving the heart, central nervous system, liver and bone marrow was identified. Severe immune-related end-organ damage due to lymphocytic myocarditis was found. CONCLUSIONS: Autopsy studies are an important measure of quality control and may identify clinically unapparent irAEs in patients treated with immunotherapy. Pathologists and clinicians need to be aware of the broad spectrum of irAEs for timely management of treatment-related morbidity

Role of director of a kindergarten in shaping school culture

Thesis deals with the role of the director of a kindergarten within shaping of the school culture and with the potential of school culture in terms of contemporary education. Thesis focuses on the factors which the director influences the most and which leads to increased level of quality of teachers' work. In the theoretical part the emphasis is on understanding the concepts in the school culture, school climate, management and leadership and also on relationships in kindergarten, which create and develop a quality society. Further, the thesis concerns the research investigation, which detects the orientation of the issue of school culture and current use of knowledge in connection to the management of kindergarten. Key words Kindergarten surrounding, communication, kindergarten culture, interpersonal relationships, labor relations, director, employee satisfaction, styles of management