Malignant hyperthermia – state of knowledge

Malignant hyperthermia (MH) is a relatively rare, but potentially lethal genetic disorder. That disease is characterized by hypermetabolic response of the skeletal muscles caused by exposure to triggering agents e.g. volatile anesthetics or depolarizing neuromuscular blockers. The object of this article was to review and assess the most recent published works about the epidemiology, etiology, pathomechanism, therapy of the MH and the new advances in all these fields. Authors scrutinized PubMed and Google Scholar using keywords: malignant hyperthermia, volatile anesthetics, ryanodine receptor mutation. In addition to this, the references of chosen articles were manually scoured for supplementary applicable articles. The literature was selected on the basis of a general medicine readership and prioritized clinical practice guidelines, systematic reviews and case reports. The references include the latest reports on malignant hyperthermia, apart from works of historical importance. Available treatment methods consist mainly of pharmacotherapy, symptomatic treatment and monitoring of vital parameters. Dantrolene is a first-choice drug in initial treatment of MH and is considered the only specific antidote. In spite of the constant advances in the areas of medicine there is still much to be discovered about MH. Further studies are necessary, as the amount of credible evidence is not adequate

Frey syndrome

Frey syndrome is a condition of gustatory sweating and hyperemia related to damage of the auriculotemporal nerve. It affects around 80% of patients after parotidectomy. Syndrome may be easily diagnosed with an iodine-starch test, even in patients without symptoms, which are about 20% depending on studies. Authors searched PubMed and Google Scholar using searchterms Frey syndrome, auriculotemporal nerve, greater auricular nerve, tympanic nerve, parotidectomy. We manually searched the references of selected articles for additional relevant articles. We selected articles relevant to a general medicine readership and prioritized systematic reviews, clinical practice guidelines and cases. The literature contains the latest reports on Frey syndrome. Symptoms of Frey syndrome are: redding of the skin due to vasodilatation, excessive sweating or tingling and burning sensation of the cheek skin. Clinicians should pay attention to frey syndrome in patients after parotid gland surgery. Treatment includes botulinum toxin type A most commonly, topical injection of alcohol, scopolamine, glycopyrrolate and less common surgical treatment including transection of auriculotemporal nerve. Frey syndrome is not such a rare disease and should be always considered by clinicians because it may worsen the quality of patients' life

Palliative surgery in cases of unresectable pancreatic head cancer

Wstęp. W niniejszej pracy omówiono postępowanie paliatywne u chorych z nieresekcyjnym rakiem głowy trzustki. Celem pracy było porównanie różnych rodzajów operacji, wykonywanych przy braku możliwości leczenia radykalnego. Materiał i metody. Analizie poddano 108 chorych z rakiem głowy trzustki, których operowano w Klinice Chirurgii Ogólnej i Transplantacyjnej w latach 1995-2004. U 94 chorych śródoperacyjnie stwierdzono nieresekcyjność zmiany bez naciekania dwunastnicy. Chorych tych podzielono na 2 grupy: w pierwszej (60 chorych) wykonano zespolenie odbarczające drogi żółciowe, a w drugiej (34 chorych) - zespolenie odbarczające drogi żółciowe i dodatkowo zabieg drenujący żołądek. W obu grupach operowanych chorych porównano średni czas pobytu w szpitalu, częstość występowania powikłań chirurgicznych i śmiertelność. Wyniki. Obydwie grupy chorych były porównywalne pod względem wieku i płci. Chorzy po operacji zespolenia żółciowego przebywali w szpitalu średnio 19,2 ± 7,9 dnia, a po zabiegu uzupełnionym o profilaktyczne zespolenie żołądkowo-jelitowe - 18,1 ± 9,1 dnia. Porównując częstość powikłań pooperacyjnych i śmiertelność w grupach, nie stwierdzono pomiędzy nimi różnic istotnych statystycznie. Wnioski. Tradycyjnie stosowany w zabiegach paliatywnych przy zaawansowanym raku trzustki drenaż dróg żółciowych można rozszerzyć o zespolenie żołądkowo-jelitowe bez ryzyka zwiększenia częstości powikłań pooperacyjnych.Background. The authors discuss surgical palliative procedures in patients with unresectable pancreatic head cancer. Aim of the study is to compare diffrent surgical procedures in respect of postoperative complication and mortality rate in cases, when the radical treatment was not possible. Material and methods. We analysed 108 patients who underwent surgery for the pancreatic head cancer in Department of General and Transplant Surgery of the Medical University in Łódź between years 1995 and 2004. Of those in 94 cases unresectable lesion without duodenal involvement was detected during surgery. The patients were divided into two groups - in the first group of 60 - biliary by-pass procedure has been done and in the second group of 34 - similiar procedure with gastroenterostomy. We compared the frequency of postoperative complications and mortality rate in mentioned above groups. Results. Patients, who underwent combined biliary and gastric by-pass remained in hospital for 18.1 ± 9.1 and following biliary by-pass alone - 19.2 ± 7.9 days. There were no statistically significant differences between these groups while the complication frequency and mortality rate were found similar. Conclusions. In advanced pancreatic cancer, traditionally executed biliary drainage can be extended by a gastro-jejunostomy without the increased risk of post-operative complications or mortality

Oral diseases in patients infected with HIV

Introduction: In recent years, more and more people have become infected with Human Immunodeficiency Virus. Of great importance in the course of HIV infection are symptoms and diseases, which often occurs in the oral cavity with a corresponding decrease in lymphocytes.Aim: The aim of the study was the study was to present the most common oral diseases in patients infected with Human Immunodeficiency Virus like hairy leukoplakia, Candidas, angular cheilitis, Linear Gingival Erythema, Herpesviridae virus infections, ulcerative lesions or xerostomia.Description: Clinicians should pay attention to oral manifestation of HIV infections because it may speed up the diagnostics process and may allow better control of the course of the infection. Hairy leukoplakia related to EBV is a marker of HIV on the side border of the tongue and appears as a hyperkeratotic stripes. Candidiasis may occur in many forms as acute pseudomembranous candidiasis, acute erythematous candidiasis, hyperplastic candidiasis or Median Rhomboid Glossitis. The most common fungus is Candida albicans but there may also be Candida krusei, Candida glabrata or Candida tropicalis. Another disease is Angular Cheilitis which is an inflammatory process localized in the commissure of the labia and can be caused by vitamin B deficiency, Candida, Staphylococcus or Streptococcus infection. Linear Gingival Erythema is a red linear lesion on the gingival margin infiltrated by polynuclear leukocytes and plasma cells. Patients with HIV also present Herpesviridae infections symptoms, ulcerations. Summary: This review shows that HIV/AIDS patients should be monitored for oral manifestation of the HIV infection and weakened immune system. Diseases described in this study are reliable markers of the HIV infection and clinicians should pay attention to them to monitor the course of primary infection

Revitalization in Plock. Report study

Raport zawiera wyniki badań przeprowadzonych w 2014 r. w związku z aktualizacją „Lokalnego Programu Rewitalizacji Miasta Płocka”.Report contains the results of research carried out in 2014 in connection with updating of „Local revitalization programme of Plock city”