Diagnostic Difficulties in Woman with Crohn’s Disease, Ascites, and Elevated Value of Serum CA125 Antigen

Variety of symptoms and atypical clinical course of Crohn’s disease (CD) often create the need for additional diagnostic procedures. In the described case of woman with CD, there was a suspicion of coexistence of ovarian cancer. This issue is particularly important in patients treated with immunosuppressants and biological agents. The discussion focused on the usefulness of CA125 (cancer antigen 125, mucin 16) serum level estimation in clinical practice and draws attention to the possible reasons for the increase of its value which is not associated to ovarian cancer

Depressive and anxiety symptoms among patients with inflammatory bowel diseases

Introduction. This study was conducted on a population of patients with inflammatory bowel disease (IBD) and was based on an assessment of the prevalence and severity of depression and anxiety symptoms in various clinical aspects. The psychological features of IBD patients are very important in the perception of symptoms, but crucial as triggers of IBD or as a releasing factor for IBD symptoms recurrence. Methods. The study included 130 patients with IBD, including 68 with Crohn’s disease (CD) and 62 with ulcerative colitis (UC). The severity of anxiety and depression symptoms were examined by the Hospital Anxiety and Depression Scale (HADS). Patients were also subjected to assessment of anthropometric attributes, clinical factors, quality of life, and symptoms of the disease, with dedicated clinical scales. Results. The occurrence of significant symptoms of anxiety was estimated at 45.5% in patients with CD and 30.5% in the UC patients. Significant depressive symptoms related to 20.5% of people with CD and 17.5% of patients with UC. The parameters of anxiety and depression showed significant associations with parameters of quality of life, BMI, and the scales describing the exacerbation of the diseases. Conclusions. The analyses did not reveal significant differences in the severity and prevalence of symptoms of anxiety and depression in subgroups with IBD. The expansion of relevant symptoms of anxiety and depression in this population was greater than in the general population. In addition, there was a significant correlation between parameters of HADS and clinical factors

Zaburzenia rytmu serca u pacjentów operowanych metodą Fontana

Wstęp: Późne pooperacyjne zaburzenia rytmu serca należą do głównych czynników ryzyka nagłych zgonów u pacjentów po operacyjnym leczeniu wrodzonych wad serca. Celem pracy była retrospektywna ocena występowania zaburzeń rytmu u pacjentów po operacji metodą Fontana w zależności od wieku dziecka w chwili przeprowadzenia zabiegu i zastosowanej techniki operacyjnej. Materiał i metody: Badaniami retrospektywnymi objęto 30 dzieci (16 chłopców i 14 dziewcząt) w wieku 2–20 lat (średnio 10 lat), u których w latach 1988–2001 przeprowadzono jedną z modyfikacji operacji Fontana: BDG (7 osób), ETCPC (5 osób), APC (4 osoby), TCPC (14 osób). Wszystkich pacjentów badano w odstępach nie dłuższych niż 3 miesiące, za pomocą EKG i badania echokardiograficznego. U każdego wykonano co najmniej jeden raz 24-godzinne badanie EKG metodą Holtera. Wyodrębniono dwie grupy pacjentów w zależności od wieku przeprowadzenia operacji. W chwili zabiegu 15 dzieci było w wieku poniżej 4 rż. - grupa I i 15 powyżej 4 rż. - grupa II. Okres obserwacji w grupie I wynosił 2–9 lat (średnio 4,5 roku), a w grupie II - 2-15 lat (średnio 5,5 roku). Wyniki: Wśród 15 dzieci z grupy I u 5 dzieci odnotowano następujące zaburzenia rytmu serca: bradykardię zatokową/rytm węzłowy (3 pacjentów), napadowy częstoskurcz nadkomorowy (1 pacjent) i pojedyncze, przedwczesne jednoogniskowe pobudzenia komorowe (1 pacjent). Wśród 15 dzieci z grupy II u 11 zarejestrowano: bradykardię zatokową/rytm węzłowy (3 pacjentów), pojedyncze przedwczesne pobudzenia nadkomorowe (2 pacjentów), częstoskurcz nadkomorowy (3 pacjentów), migotanie przedsionków (1 osoba) i komorowe zaburzenia rytmu serca (2 pacjentów). U żadnego z badanych pacjentów zarówno w grupie I, jak i w grupie II nie stwierdzono zaburzeń przewodzenia przedsionkowo-komorowego. Zaburzenia rytmu występujące u 3 pacjentów po operacji Fontana w większości przypadków stanowiły formę "łagodnych" arytmii, niewymagających przewlekłego leczenia antyarytmicznego. Wnioski: Arytmia występowała znacznie częściej u dzieci operowanych powyżej 4 roku życia, leczonych jednoetapowo. Nie zarejestrowano zaburzeń rytmu u dzieci operowanych z zastosowaniem pozasercowego homograftu aortalnego. Pacjenci po operacji metodą Fontana wymagają odpowiednio zaplanowanego schematu i zakresu badań kontrolnych, m.in. w celu oceny i kwalifikacji do dalszego leczenia występujących arytmii. (Folia Cardiol. 2003; 10: 535–540

Rezensionen

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Satisfaction and discontent of Polish patients with biological therapy of rheumatic diseases : results of a multi-center questionnaire study

Objectives: Biologics are medications widely applied in the management of inflammatory rheumatic diseases. The drugs were found to be effective but their application is associated with some disadvantages. Medication with biologics is relatively expensive, and in Poland, it is carried out in specialized centers. The study was designed to evaluate various aspects of satisfaction and dissatisfaction of Polish patients treated with biologics. Material and methods: An anonymous questionnaire was distributed in 23 Polish rheumatological centers involved in the treatment; 1212 returned questionnaires were used for analysis. Responses were received from 606 patients with rheumatoid arthritis, 427 with ankylosing spondylitis, 117 psoriatic arthritis, and 62 adult patients with juvenile idiopathic arthritis (in whom administration of the drugs had been introduced before they were 18 years old). The investigated group constituted about one-fifth of all rheumatic patients on biologics in Poland. Results: A beneficial or very beneficial influence of the medication on the state of physical health was found mostly in patients with rheumatoid arthritis (51.3 and 30.5%) and ankylosing spondylitis (51.0 and 36.8%). Family life was improved by the treatment especially in patients with ankylosing spondylitis (40.7 and 35.6% beneficial and very beneficial, respectively), sleep quality and sexual life mostly in those with ankylosing spondylitis (beneficial/very beneficial influence 41.5/38.4, and 38.7/23.9, respectively). There was a rather small influence of biological treatment on the financial situation of the patients. In general, satisfaction with the treatment was evaluated as positive or very positive in 88% of all investigated patients. In a significant part of the patients, transportation to the medical center was considered as a disadvantage of the treatment. About one-third of the patients considered laboratory and imaging tests to be done before initiation of the medication as a difficulty, and for about 40% waiting time for qualification for the medication was a significant disadvantage. The route of drug administration was without importance for 4/5 of the patients. Conclusions: Summing up, the results were similar in the patients suffering from various diseases although those with psoriatic arthritis felt the highest satisfaction (possibly due to the positive aesthetic effect), and those with ankylosing spondylitis had significant improvement in sexual life (probably due to younger age). Relatively low satisfaction was found in patients with juvenile idiopathic arthritis. There was a small influence of medication on financial status of the patients. Application of biologics has few disadvantages and most of them are associated with the organization of health services (waiting time for the tests, transportation to the medical centers)

Analysis of risk factors for oral cavity and oropharynx cancer in the authors’ own material

Introduction: The aim of the study was to analyse the risk factors for oral cavity and oropharynx cancer in peopled examined under the Head and Neck Cancer Awareness Week in 2016, Lodz. Material and methods. In Lodz, 21st September 2016, under the Head and Neck Cancer Awareness Week, 106 people, including 67 women aged 29–77 and 39 men aged 23–84, underwent preventive examinations in the hospital department. Prior to the laryngological examination, the patients were asked to answer questions that referred to their education, medical case history, symptoms, smoking habits with the number of cigarettes per day, alcohol intake, the number of lifetime sexual partners, oral sex engagement, incidents of head and neck cancer in the family history. Results: The major part of the examined patients were women and men with the secondary and high level of education, 47,76% and 35,82%, and 58,97% and 35,91% respectively. The patients were informed by mass media about the planned preventive medical examinations – 80,60% women and 79,49% men. The most common symptoms reported by women were: hoarse voice in 61,19% cases, dysphagia in 32,84% cases and burning sensation and/or pain in the oral cavity in 29,85% cases. The examined male patients mainly showed hoarse voice (46,15%), other symptoms (43,59%) and dysphagia (25,64%). 28,35% women and 28,20% men smoked cigarettes, while passive smokers were 22,38% and 25,64% respectively. Alcohol consumption was reported by 67,16% women and 82,05% men, rather occasionally. Having oral sex was noted in 25,37% women and 38,46% men, mostly with multiple sexual partners. Among the studied patients, 13,43% women and 5,12% men suffered from malignant cancer, including 2,98% women and 2,56% men who reported head and neck carcinoma in the medical interview. On the basis of the interview and ENT examination, 11,94% women and 17,94% men were qualified for the extended oncological diagnostics. Conclussion. The Fourth Head and Neck Cancer Awareness Week shows the increased interest in preventive screening, especially oncological screening, and thus the necessity of such preventive activities in the future