Neurocognitive dysfunctions and functional state of patients after internal carotid endarterectomy

Introduction. Carotid endarterectomy (CEA) is a method of treatment of carotid stenosis, which significantlyreduces the risk of ischemic stroke. This procedure may affect the patient’s neurocognitive functioning. Theaim of the study was to evaluate the occurrence of neurocognitive disorders and to determine the functionalstatus of the patients undergoing CEA. Material and methods. The study group consisted of 102 people who underwent CEA. Studies wereperformed preoperatively and repeated on the fourth postoperative day. The following scales were used: theMini-Mental State Examination (MMSE), Activities of Daily Living Scale (ADL), Instrumental Activities of DailyLiving (IADL) and the Hamilton Depression Rating Scale (HAM-D). Results. The average number of points obtained by patients in the MMSE, both before and after surgery is26 points to 30 that may be obtained, which shows a subtle cognitive impairment. Almost every patient showedfitness both in terms of basic (ADL), as well as complex (IADL) activities before and after surgery. Conclusions. Low or average level of cognitive performance is observed in most subjects, both before andafter CEA. There are many different factors that can affect the cognitive functions. The functional status ofpatients stood without significant changes

Micro-computed tomography for analysis of heavy metal accumulation in the opercula

Micro-computed tomography (micro-CT) provides numerous opportunities in biomedical research. It allows the examination of samples in a non-destructive manner and visualization of the inner structures of various biological and nonbiological objects. This study was conducted to evaluate the potential of micro-CT scanner in the assessment of heavy metal accumulation in the opercula. The samples were taken from Prussian carp (Carassius gibelio) exposed to waterborne Cd (4.0 mg/L), Zn (4.0 mg/L), and the mixture of these two metals (4.0 mg Cd/L and 4.0 mg Zn/L) for 28 days. Heavy metal concentrations were determined using atomic absorption spectrometry. The results demonstrated higher concentrations of Cd and Zn in the treatment group opercula samples compared with the control group opercula samples. A simple micro-CT scan was performed to verify whether heavy metal accumulation could be determined in the reconstructed images. The results showed that micro-CT is potentially a powerful tool for metal accumulation detection. Moreover, it allowed visualization of the examined samples, revealing regions of heavy metal accumulation and providing the opportunity to compare samples exposed to different types of heavy metals

Fournier's gangrene – a clinical case report

Fournier’s gangrene is an acute, rapidly progressive, necrotizing infection of the skin and subcutaneous tissues surrounding the genitals and perineum. Necrotizing fasciitis of the genital area is a rare disease entity. Although it concerns mostly males, can also occur in females and adolescents. In this syndrome, bacteria produce gases which accumulate in the infected tissue. The damage may also comprise tissue of the penis and scrotum. The infection is caused by aerobic and anaerobic bacteria. Usually the Fournier’s gangrene is caused by Staphylococci, Streptococci and Enteric bacteria. Bacterial infection can accompany the fungal infection. The high mortality rate is associated with bacterial contagion of the skin, fat, fascia and blood vessels. Harmful enzymes, produced by micro-organisms, induce numerous blood clots. They can lead to ischemia, which contribute to the development of necrosis. Fournier’s syndrome is a disease with a high mortality rate. Immunodeficiency, diabetes and chronic alcohol abuse favor the development of gangrene. Abrasion, burn or surgery complication may be the route of infection for microorganisms. Clinical symptoms appear within few days. Diagnostic process is based on the clinical picture. It is crucial to start treatment as soon as possible. Delay of the wide spectral intravenous antibiotic therapy and surgical removal of the necrotic tissue may result in death of the patient

Management of melanoma metastases in the brain

The basic principle for the diagnosis of melanoma metastases in the brain should be the management of multidisciplinary teams including at least a neurosurgeon, radiotherapist and clinical oncologist experienced in the treatment of melanoma and melanoma metastases in the CNS. Detection of brain lesions is associated with poor prognosis; metastases in the brain are the cause of death in 20–50% patients, and symptomatic tumours are a direct cause of death in about 90% patients. Treatment of melanoma with CNS metastases may include local management and/or systemic and symptomatic treat­ment. In the last 5 years, 10 new advanced melanoma drugs have been registered in Europe. Two-drug therapy anti-PD-1 and anti-CTLA-4 (nivolumab with ipilimumab) is the treatment of choice for asymptomatic melanoma metastases in the brain, while in the presence of BRAF mutations and asymptomatic metastases systemic treatment with BRAFi and MEKi may be the first-choice treatment

Retained neuroprotection filter after stenting of the internal carotid artery

Retained neuroprotection filter after carotid stenting (CAS) is an extremely rare complication. We report thecase of a 61-year old patient with an accidentally retained neuroprotection filter after urgent CAS. The patientdid not consent to open surgical removal of the retained basket. We did not observe any flow disturbances inthe filter and the patient remains asymptomatic in ten years follow-up. In some cases, the neuroprotectionfilter left in the internal carotid artery may not cause cerebral flow disturbances or occlusion of the stent. Incase of the poor neurological or general condition of the patient, we can wait for its improvement or stenting

Zastosowanie wemurafenibu u chorych na uogólnionego czerniaka z obecnością mutacji w genie BRAF — wybrane przypadki kliniczne

The incidence of cutaneous melanoma is constantly increasing. The primary treatment in early stage of disease re­mains surgery. New therapeutic strategies such as immunotherapy or selective BRAF inhibitors — vemurafenib and dabrafenib, have improved outcomes of treatment in the group of patients with stage IV melanoma. In Poland still only vemurafenib is available in routine clinical practice. In this article we present clinical experiences in treating of BRAF-positive metastatic melanoma patients with use of vemurafenib.Liczba zachorowań na czerniaka skóry stale wzrasta. Podstawowym leczeniem we wczesnym stadium zaawanso­wania choroby pozostaje zabieg chirurgiczny. Nowe terapie, takie jak immunoterapia czy selektywne inhibitory BRAF — wemurafenib czy dabrafenib, poprawiły wyniki leczenia w grupie chorych w IV stopniu zaawansowania. W Polsce w praktyce klinicznej w ramach programu lekowego dostępny jest wemurafenib. W pracy prezentujemy doświadczenia z wykorzystaniem wemurafenibu w leczeniu chorych na uogólnionego czerniaka z potwierdzoną obecnością mutacji BRAF

Male breast hypertrophy - a review of modern methods of treatment

Gynecomastia is a benign enlargement of the mammary gland in males. Nowadays it is a common disorder of all ages, including newborns, adolescents and adults. It may be bilateral or unilateral enlargement of the breast. Gynecomastia may be a severe problem in adolescents resulting in development of psychological disorders. Evolution of surgical treatment options, depending on the degree of breast hypertrophy advancement, brought significant improvement in aesthetic effect and patient’s quality of life. This paper presents the development of pharmaceutical and surgical treatment technics. The manuscript proposes the optimal methods of clinical approach to the patients with an enlargement of the breast

Postępowanie w przerzutach czerniaka do mózgowia

Czerniak stanowi trzeci po raku piersi i płuca nowotwór złośliwy pod względem częstości występowania przerzutów do mózgowia. Aktualnie coraz częściej przerzuty do mózgowia diagnozuje się na etapie bezobjawowym, w badaniach obrazowych wykonywanych w ramach kontroli lub kwalifikacji chorego do leczenia systemowego. Leczenie chorych na czerniaka z przerzutami do mózgowia stanowi jedno z największych wyzwań w opiece nad chorym na czerniaka w stadium zaawansowanym. Celem niniejszego opracowania jest przedstawienie wielospecjalistycznych wskazówek co do postępowania diagnostyczno-terapeutycznego w tej grupie chorych. Leczenie chorych na czerniaka z przerzutami do mózgowia obejmuje w zależności od sytuacji klinicznej leczenie miejscowe i/lub leczenie systemowe oraz leczenie objawowe. Decyzje terapeutyczne powinny być podejmowane w zespołach, w skład których powinni wchodzić co najmniej onkolog kliniczny, neurochirurg i radioterapeuta