Management of cervical cancer during pregnancy – a systematic review

Diagnosis of neoplasms during pregnancy and establishing a treatment schedule that is safe for both mother and fetus is problematic. This review summarizes knowledge about the problems associated with cervical cancer during pregnancy and current recommendations for diagnosis and treatment. The systematic review was performed according to PRISMA guidelines. The search was performed using PubMed, Scopus, Web of Science, and Google Scholar. Seven articles on 317 pregnant women with cervical cancer were included. Stage of disease, gestational age at diagnosis, treatment in pregnancy, type of delivery, gestational age of delivery, treatment after delivery, follow-up and main conclusion were analyzed. The rare phenomenon of neoplasms during pregnancy, as well as a limited research, do not allow for the development of clear guidelines for the treatment of cervical cancer in pregnant women. It is warrant to address discussed problems in future clinical research to provide the best care for pregnant cancer patients

„Duszek” w miejscu cewnika centralnego

A case of 51-year-old male patient with a history of malabsorption, nephrolithiasis, chronic pancreatitis, insulin-dependent diabetes, suspicion of celiac disease and ankylosing spondylitis was reported. Patient was admitted to the hospital to remove infected central catheter. Six days after the catheter removal short fragment of the catheter was found in computed tomography angiography in the internal jugular vein, at the junction with the subclavian vein. In fact, it was not the catheter as several days ago it was removed entirety from the patient, but the fibrous sheath covering venous catheter called “ghost”.Długotrwałe użytkowanie centralnego dostępu dożylnego (CVC) jest związane z kilkoma powikłaniami — uszkodzeniem ściany naczynia lub infekcjami, co wymaga jego usunięcia. Może to być trudne lub niemożliwe, zwłaszcza gdy dochodzi do rozwoju otoczki włóknistej wokół cewnika. Co ciekawe, po interwencji usunięcia CVC można zaobserwować resztki włóknistej tkanki w miejscu usuniętego CVC, która w praktyce radiologicznej określana jest mianem „duszka”. Wspomniane zjawisko jest zwykle obserwowane podczas badania echokardiograficznego, po usunięciu elementów rozruszników serca z powodu infekcyjnego zapalenia wsierdzia (CDRIE), ale jak pokazuje opisywany przypadek, może być także zaobserwowane za pomocą angiografii tomografii komputerowej, po usunięciu zainfekowanego cewnika żylnego

In pursuit of COVID-19 surgical risk stratification to manage a limited workforce and supplies in minimally invasive surgery

The protective barriers used so far in surgery do not provide adequate protection against SARS-CoV-2 virus, and reinforced protective equipment is needed. The rapid increase in the number of patients and the worldwide panic associated with the increasingly low availability of protective equipment has resulted in a shortage of protective equipment In many hospitals. Appropriatepersonal protective equipment must be provided so that the surgical team proceeding to surgery is not excluded from the further struggle for patients’ health, especially in MIS. Reckless and excessive use of maximum protective equipment may result in a severe shortage of these products when the number of infected person

COVID-19 infection in patients on long-term home parenteral nutrition for chronic intestinal failure

To investigate the incidence and the severity of COVID-19 infection in patients enrolled in the database for home parenteral nutrition (HPN) for chronic intestinal failure (CIF) of the European Society for Clinical Nutrition and Metabolism (ESPEN).Period of observation: March 1st, 2020 March 1st, 2021.patients included in the database since 2015 and still receiving HPN on March 1st, 2020 as well as new patients included in the database during the period of observation. Data related to the previous 12 months and recorded on March 1st 2021: 1) occurrence of COVID-19 infection since the beginning of the pandemic (yes, no, unknown); 2) infection severity (asymptomatic; mild, no-hospitalization; moderate, hospitalization no-ICU; severe, hospitalization in ICU); 3) vaccinated against COVID-19 (yes, no, unknown); 4) patient outcome on March 1st 2021: still on HPN, weaned off HPN, deceased, lost to follow up.Sixty-eight centres from 23 countries included 4680 patients. Data on COVID-19 were available for 55.1% of patients. The cumulative incidence of infection was 9.6% in the total group and ranged from 0% to 21.9% in the cohorts of individual countries. Infection severity was reported as: asymptomatic 26.7%, mild 32.0%, moderate 36.0%, severe 5.3%. Vaccination status was unknown in 62.0% of patients, non-vaccinated 25.2%, vaccinated 12.8%. Patient outcome was reported as: still on HPN 78.6%, weaned off HPN 10.6%, deceased 9.7%, lost to follow up 1.1%. A higher incidence of infection (p = 0.04), greater severity of infection (p < 0.001) and a lower vaccination percentage (p = 0.01) were observed in deceased patients. In COVID-19 infected patients, deaths due to infection accounted for 42.8% of total deaths.In patients on HPN for CIF, the incidence of COVID-19 infection differed greatly among countries. Although the majority of cases were reported to be asymptomatic or have mild symptoms only, COVID-19 was reported to be fatal in a significant proportion of infected patients. Lack of vaccination was associated with a higher risk of death

Home parenteral nutrition with an omega-3-fatty-acid-enriched MCT/LCT lipid emulsion in patients with chronic intestinal failure (the HOME study):study protocol for a randomized, controlled, multicenter, international clinical trial

BACKGROUND: Home parenteral nutrition (HPN) is a life-preserving therapy for patients with chronic intestinal failure (CIF) indicated for patients who cannot achieve their nutritional requirements by enteral intake. Intravenously administered lipid emulsions (ILEs) are an essential component of HPN, providing energy and essential fatty acids, but can become a risk factor for intestinal-failure-associated liver disease (IFALD). In HPN patients, major effort is taken in the prevention of IFALD. Novel ILEs containing a proportion of omega-3 polyunsaturated fatty acids (n-3 PUFA) could be of benefit, but the data on the use of n-3 PUFA in HPN patients are still limited. METHODS/DESIGN: The HOME study is a prospective, randomized, controlled, double-blind, multicenter, international clinical trial conducted in European hospitals that treat HPN patients. A total of 160 patients (80 per group) will be randomly assigned to receive the n-3 PUFA-enriched medium/long-chain triglyceride (MCT/LCT) ILE (Lipidem/Lipoplus® 200 mg/ml, B. Braun Melsungen AG) or the MCT/LCT ILE (Lipofundin® MCT/LCT/Medialipide® 20%, B. Braun Melsungen AG) for a projected period of 8 weeks. The primary endpoint is the combined change of liver function parameters (total bilirubin, aspartate transaminase and alanine transaminase) from baseline to final visit. Secondary objectives are the further evaluation of the safety and tolerability as well as the efficacy of the ILEs. DISCUSSION: Currently, there are only very few randomized controlled trials (RCTs) investigating the use of ILEs in HPN, and there are very few data at all on the use of n-3 PUFAs. The working hypothesis is that n-3 PUFA-enriched ILE is safe and well-tolerated especially with regard to liver function in patients requiring HPN. The expected outcome is to provide reliable data to support this thesis thanks to a considerable number of CIF patients, consequently to broaden the present evidence on the use of ILEs in HPN. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03282955. Registered on 14 September 2017

Results of home parenteral nutrition in patients with severe inflammatory bowel disease – an alternative for surgery of malnourished patients

Introduction: In the world, the inflammatory bowel disease affects an increasing number of younger and younger patients, and in some of them parenteral nutrition is an alternative to high-risk surgical intervention due to advancement of the disease and malnutrition. Aim: The aim of the study was to assess the results of home parenteral nutrition in patients with severe bowel inflammatory disease, in whom surgical treatment is associated with high risk of complications. Materials and methods: A retrospective analysis was conducted on 46 patients, who received home parenteral nutrition instead of another surgical intervention. The inclusion criteria included home parenteral nutrition and diagnosis of Crohn’s disease or ulcerative colitis. Results: Mean number of complications requiring hospital admission per patient was 1.76, the BMI increased by 4.3 on average [kg/m2]. During parenteral nutrition, the percentage of patients, in whom anti-inflammatory or immunosuppressant drugs were completely discontinued, was 17.4%. In the whole group, at least one immunosuppressive drug was discontinued in onefifth of patients. Mean albumin level increased by 2.4 g/L, lymphocyte count dropped by 474 lymphocytes/mm3, and leukocyte count increased by 747.6/mm3. The patients described their condition as good in 87%, and 7.4% of patients were able to work. Conclusions: Home parenteral nutrition positively affects patient’s general condition by increasing BMI and normalizing biochemical test results. The results indicate the need to consider this method as an alternative to surgical intervention in severe bowel inflammatory disease with high perioperative risk, which could reduce the complication rate

Results of home parenteral nutrition in patients with severe inflammatory bowel disease – an alternative for surgery of malnourished patients

Introduction: In the world, the inflammatory bowel disease affects an increasing number of younger and younger patients, and in some of them parenteral nutrition is an alternative to high-risk surgical intervention due to advancement of the disease and malnutrition. Aim: The aim of the study was to assess the results of home parenteral nutrition in patients with severe bowel inflammatory disease, in whom surgical treatment is associated with high risk of complications. Materials and methods: A retrospective analysis was conducted on 46 patients, who received home parenteral nutrition instead of another surgical intervention. The inclusion criteria included home parenteral nutrition and diagnosis of Crohn’s disease or ulcerative colitis. Results: Mean number of complications requiring hospital admission per patient was 1.76, the BMI increased by 4.3 on average [kg/m2]. During parenteral nutrition, the percentage of patients, in whom anti-inflammatory or immunosuppressant drugs were completely discontinued, was 17.4%. In the whole group, at least one immunosuppressive drug was discontinued in onefifth of patients. Mean albumin level increased by 2.4 g/L, lymphocyte count dropped by 474 lymphocytes/mm3, and leukocyte count increased by 747.6/mm3. The patients described their condition as good in 87%, and 7.4% of patients were able to work. Conclusions: Home parenteral nutrition positively affects patient’s general condition by increasing BMI and normalizing biochemical test results. The results indicate the need to consider this method as an alternative to surgical intervention in severe bowel inflammatory disease with high perioperative risk, which could reduce the complication rate