Radiojodoterapia w chorobie Gravesa-Basedowa — czynniki wpływające na skuteczność leczenia w oparciu o analizę retrospektywną

Introduction: Radioiodine (131I) isotope therapy is the method of choice in the treatment of Graves’ disease relapse. The efficiency of this method is dependent on many factors; therefore, the present paper aims to identify the parameters that have a crucial impact on the efficacy of radioiodine therapy for Graves’ disease.Material and methods: The authors performed a retrospective analysis of the medical documentation of 700 Graves’ disease sufferers treated with131I. The patients were divided into three groups depending on the thyroid-absorbed dose of 131I: group I — 100 Gy, II — 150 Gy, and III — 200 Gy. The authors assessed the influence of gender, age, presence of orbitopathy, TRab titres, thyroid mass, iodine uptake after 24 and 48 hours, and the absorbed dose on the treatment efficacy at one year post-131I administration.Results: The volume of thyroid gland (P < 0.002) and the thyroid-absorbed dose (P < 0.001) were the only factors that had a significant impact on the outcome of the treatment. The likelihood of hyperthyroidism persisting (odds ratio: 3.71, 95% confidence interval: 2.4–5.87) was greatest in patients from group I. In group II, with thyroid volume amounting both to 25 mL and to 25–50 mL, the percentage of hyperthyroidism was lowest (1 and 0%). However, with thyroid volume > 50 mL, the percentage of hyperthyroidism was lowest in group III (10%).Conclusions: The absorbed dose of 131I and the volume of the thyroid gland are two parameters that have a significant influence on the efficacy of radioiodine therapy for Graves’ disease. 150 Gy is the optimal dose for glands < 50 mL. A goitre > 50 mL requires an absorbed dose of 200 Gy in order to minimise the risk of recurrent hyperthyroidism. (Endokrynol Pol 2015; 66 (2): 126–131)Wstęp: Metodą z wyboru w leczeniu nawrotów choroby Gravesa-Basedowa jest terapia izotopowa radiojodem (131I). Efektywność tego leczenia zależy od wielu czynników, dlatego też celem pracy było wskazanie parametrów mających decydujący wpływ na skuteczności radiojodoterapii choroby Gravesa-Basedowa.Materiał i metody: Przeanalizowano retrospektywnie dokumentację medyczną 700 pacjentów z chorobą Gravesa leczonych 131I. Ze względu na dawkę pochłoniętą 131I w tarczycy, pacjentów podzielono na trzy grupy (grupa I — 100 Gy, II — 150 Gy, III — 200 Gy). Zbadano zależność płci, wieku, obecności orbitopatii, miana TRAb, masy tarczycy, jodochwytności tarczycy po 24 i 48 godzinach, dawki pochłoniętej na efektywność leczenia, po roku od podania 131I.Wyniki: Objętość tarczycy (P < 0,002), dawka pochłonięta w tarczycy (P < 0,001) miały jedynie istotny wpływ na wyniki terapii. Największe ryzyko utrzymywania się hipertyreozy (iloraz szans [OR] 3,71, 95% przedział ufności [CI] 2,4–5,87) wystąpiło u pacjentów z grupy I. W grupie II przy objętości tarczycy 25ml jak i 25-50ml odsetek hiperytreozy był najmniejszy (1 i 0%). Natomiast przy objętości tarczycy > 50 ml odsetek hipertyreozy był najmniejszy w grupie III (10%).Wnioski: Dawka pochłonięta 131I, objętość tarczycy to parametry mające istotny wpływ na skuteczności radiojodoterapii choroby Gravesa-Basedowa. Optymalną dawką pochłoniętą w tarczycy z objętością < 50 ml jest 150Gy. Wole (> 50 ml) wymaga dawki pochłoniętej 200Gy celem zminimalizowania nawrotu hipertyreozy. (Endokrynol Pol 2015; 66 (2): 126–131

Krytyczne niedokrwienie kończyn dolnych. Niedokrwienna rana przewlekła stopy u chorych bez cukrzycy — zalecenia leczniczo-pielęgnacyjne. Część II

Authors presented management of a chronic foot wound in non-diabetic patients with peripheral atherosclerosis who have chronic and critical lower limb ischemia. Management of these patients is typically different from the one recommended in diabetic patients. In available literature, an issue of the chronic wound/necrosis of the foot in usually addressed in the context of diabetic complications and “diabetic foot” in particular. Authors proposed different approaches to management, dividing patients into groups based on severity of the condition and ABI value. Special focus of the authors was on basic nursing care which, one might think, is an obvious and well-known element of the treatment. Negligence in that area may still lead to limb amputation in some patients.Autorzy przedstawiają metodę postępowania z pacjentem z raną przewlekłą stopy u chorych na miażdżycę obwodową z przewlekłym niedokrwieniem kończyn dolnych (PNKD) oraz krytycznym niedokrwieniem kończyn dolnych (KNKD), nieobciążonych cukrzycą. Zalecenia lecznicze u wyżej wymienionych pacjentów są zwykle odmienne od zaleceń dla chorych na cukrzycę. W dostępnym piśmiennictwie problem rany przewlekłej/martwicy stopy poruszany jest w kontekście powikłań cukrzycy, szczególnie stopy cukrzycowej. Autorzy zaproponowali sposób postępowania, uzależniając go od stopnia zaawansowania choroby, kierując się w podziale na poszczególne grupy oznaczeniem wskaźnika ABI. Autorzy zwrócili szczególną uwagę na podstawową opiekę pielęgniarską — wydawać by się mogło, rzecz ogólnie znaną i poznaną. Zaniedbania po stronie opieki pielęgniarskiej u części chorych mogą prowadzić do konieczności wykonania zabiegów amputacji kończyny

Polycarbonate polymer surface modication by extreme ultraviolet (EUV) radiation

The degree of the biocompatibility of polycarbonate (PC) polymer used as biomaterial can be controlled by surface modification for various biomedical engineering applications. In the past, PC samples were treated by excimer laser for surface reorganization however associated process alteration of bulk properties is reported. Extreme ultraviolet radiation can be employed in order to avoid bulk material alteration due to its limited penetration. In this study, a 10 Hz laser-plasma EUV source based on a double-stream gas-pu_ target irradiated with a 3 ns and 0.8 J Nd:YAG laser pulse was used to irradiate PC samples. The PC samples were irradiated with different number of EUV shots. Pristine and EUV treated samples were investigated by scanning electron microscopy and atomic force microscopy for detailed morphological characterization of micropatterns introduced by the EUV irradiation. Associated chemical modifications were investigated by X-ray photoelectron spectroscopy. Pronounced wall-type micro- and nanostructures appeared on the EUV modified surface resulting in a change of surface roughness and wettability

Single, very low dose (0.03 mg) of recombinant human thyrotropin (rhTSH) effectively increases radioiodine uptake in the I-131 treatment of large nontoxic multinodular goiter

BACKGROUND: Radioiodine therapy (RIT) in patients with large nontoxic multinodular goiter (MNG) recently becomes more common method in comparison to surgery (especially in elderly patients and with contraindications because of severe chronic diseases other systems). Repeatedly low thyroid radioactive iodine uptake (RAIU) decreases effectiveness of RIT or makes it impossible. The recombinant human thyrotropin can increase RAIU and improve the results of RIT. The aim of the study was to assess the influence of a single very low dose (0.03 mg) of rhTSH on RAIU and thyroid function in euthyroid (MNG-EU) and subclinical hyperthyroid (MNG-SC) patients with a large multinodular goiter. MATERIAL AND METHODS: 40 patients (14 male, 26 female, age 57–80 yr) with large non-toxic MNG over 80 grams and with baseline RAIU < 40% were included into the double-blind randomized study and divided into two groups: rhTSH-group and control group. First group received the single intramuscular injection of 0.03 mg rhTSH and the second received placebo. The RAIU were measured 24 and 48 hours after the rhTSH and then all the patients were administered therapeutic doses of I-131. TSH and free thyroxine levels were measured at 1st and 2nd day after the injection of rhTSH and later, at 4 and 8 weeks after the RIT. RESULTS: The mean RAIU increased significantly from 30.44 ± 7.4% to 77.22 ± 8.7% (p < 0.001). There were no statistically significant differences in RAIU between euthyroid (MNG-EU) and subclinically hyperthyroid (MNG-SC) patients. The peak of serum TSH was noticed 24 hours after rhTSH injection and in MNG-EU patients it has remained within normal range, similarly as fT4. In the MNG-SC group the administration of rhTSH resulted in a significant increase in the TSH values after 24 hours, whose mean level slightly exceeded the upper limit of the normal range with normalization at 48 hours. 8 weeks after the RIT, the TSH and fT4 levels did not exceed the normal range and did not differ in a statistically significant way. Conclusions: Even the single very low dose of rhTSH increases the values of RAIU in significant way, in euthyroid and subclinically hyperthyroid patients. The administration of rhTSH is well-tolerated. Neoadjuvant administration of a low dose (0.03 mg) of rhTSH before I-131 seems to be an optimal method of management which may increase the effectiveness of RIT and decrease the exposure of the patients to absorbed doses of ionizing radiation.BACKGROUND: Radioiodine therapy (RIT) in patients with large nontoxic multinodular goiter (MNG) recently becomes more common method in comparison to surgery (especially in elderly patients and with contraindications because of severe chronic diseases other systems). Repeatedly low thyroid radioactive iodine uptake (RAIU) decreases effectiveness of RIT or makes it impossible. The recombinant human thyrotropin can increase RAIU and improve the results of RIT. The aim of the study was to assess the influence of a single very low dose (0.03 mg) of rhTSH on RAIU and thyroid function in euthyroid (MNG-EU) and subclinical hyperthyroid (MNG-SC) patients with a large multinodular goiter. MATERIAL AND METHODS: 40 patients (14 male, 26 female, age 57–80 yr) with large non-toxic MNG over 80 grams and with baseline RAIU < 40% were included into the double-blind randomized study and divided into two groups: rhTSH-group and control group. First group received the single intramuscular injection of 0.03 mg rhTSH and the second received placebo. The RAIU were measured 24 and 48 hours after the rhTSH and then all the patients were administered therapeutic doses of I-131. TSH and free thyroxine levels were measured at 1st and 2nd day after the injection of rhTSH and later, at 4 and 8 weeks after the RIT. RESULTS: The mean RAIU increased significantly from 30.44 ± 7.4% to 77.22 ± 8.7% (p < 0.001). There were no statistically significant differences in RAIU between euthyroid (MNG-EU) and subclinically hyperthyroid (MNG-SC) patients. The peak of serum TSH was noticed 24 hours after rhTSH injection and in MNG-EU patients it has remained within normal range, similarly as fT4. In the MNG-SC group the administration of rhTSH resulted in a significant increase in the TSH values after 24 hours, whose mean level slightly exceeded the upper limit of the normal range with normalization at 48 hours. 8 weeks after the RIT, the TSH and fT4 levels did not exceed the normal range and did not differ in a statistically significant way. Conclusions: Even the single very low dose of rhTSH increases the values of RAIU in significant way, in euthyroid and subclinically hyperthyroid patients. The administration of rhTSH is well-tolerated. Neoadjuvant administration of a low dose (0.03 mg) of rhTSH before I-131 seems to be an optimal method of management which may increase the effectiveness of RIT and decrease the exposure of the patients to absorbed doses of ionizing radiation

Regional variations of symptoms of the chronic venous disease among primary health care patients in Poland

Introduction. The diverse social and cultural contexts may cause differences in perceiving symptoms of the chronic venous disease (ChVD), not only in global, European terms, but also in a regional context. The purpose of the study was to find the regional differences of the reported symptoms and the applied conservative treatment methods among patients with ChVD diagnosed by the primary health care (PHC) doctors in Poland. Material and methods. 13 393 patients participated in the multi-centre PHLEBOS-2 research carried out by 330 PHC doctors in 15 voivodeships. Results. In the study group of patients, 31.9% of patients had ChVD symptoms – the C0 stage, telangiec­tasias and venulectasias (C1 stage) occurred among 56.1% of patients, varices without symptoms of venous insufficiency occurred among 6% of patients and venous insufficiency among 6% of patients. Venous ulcers (active or healed) occurred among 0.6% of subjects. Essential differences in the ChVD structure between voivodeships were noted. Among the most frequently reported ChVD ailments were heaviness of legs (72.9%), ankle swelling in the eve­nings (68.4%) and nighttime leg cramps (58.6%). Leg swelling during the night hours occurred less frequently — 39.8%, paraesthesias — 30.4%, restless legs syndrome — 18.6%. The average intensity of calf pain was moderate (3.82 ± 1.86 points in the 10 point scale). The territorial diversity in the prevalence of symptoms was significant and resulted neither from the ChVD seriousness, nor from the age of the patients. Compression therapy was applied on average by 12.5% of patients and 24.8% of patients used phlebotropic drugs with large territorial variations (respectively from 3.4% to 28.8% and from 11.2 to 56.1%). The differences between the voivodeships were greater than the regional differences and did not depend on the ChVD stage. Conclusions. There are significant territorial variations in Poland in the frequency of the reported symptoms and in the conservative therapy of the chronic venous disease

Postępy w leczeniu krytycznego niedokrwienia kończyn dolnych — przegląd piśmiennictwa

The authors present modern diagnostic approaches and capabilities in critical limb ischemia diagnostic, including the modifications of DSA. They evaluate the role of angioCT, MRI in the diagnostic of arteriosclerotic patients and the limitations in choosing the best revascularization (by-pas anastomosis or angiosome orientated endovascular procedure). They present description and results of the best surgical treatment; with bypass revascularisation, endovascular approach with PTA as well as with stent implantation. They also discuss the retrograde arterial recanalization in infrapopliteal area.Autorzy przedstawiają problem krytycznego niedokrwienia kończyn dolnych pod kątem możliwych do zastosowania nowoczesnych metod diagnostycznych, obejmujących modyfikację tradycyjnego DSA. Ustosunkowują się do wykonania badań angio-TK i MRI u chorych na miażdżycę i ograniczeń w doborze „najlepszego” badania w planowaniu zabiegu rewaskularyzacji naczynia lub „najlepszego” angiosomu. Przedstawiają opis i wyniki metod leczenia operacyjnego za pomocą pomostu naczyniowego, leczenia wewnątrznaczyniowego z pomocą PTA i wszczepienia stentu oraz dyskusyjną metodę wstecznego udrażniania naczyń podudzia

Krytyczne niedokrwienie kończyn dolnych. Niedokrwienna rana przewlekła stopy u chorych bez cukrzycy — zalecenia leczniczo-pielęgnacyjne. Część I

Authors proposed a management method of a non-diabetic patient with atherosclerosis. In authors’ opinion, this group of patients, although usually discussed together with diabetic patients in literature, require a different approach. This is related to a different pressure distribution on foot level in non-diabetic patients which more often correlates with dry necrosis caused by chronic influx impairment. Prognosis following surgical or intravascular procedure seems much better in this group which, in authors’ opinion, warrants sharing their opinion on the matter.Autorzy przedstawiają propozycję postępowania z chorym na miażdżycę niepowikłaną cukrzycą. W przekonaniu Autorów ta grupa pacjentów zwykle omawiana jest razem z pacjentami, u których miażdżyca jest powikłana cukrzycą. Tymczasem stanowi ona oddzielną grupę, wymagającą specyficznego postępowania związanego z leczeniem rany przewlekłej uformowanej na podłożu przewlekłego, w konsekwencji krytycznego, niedokrwienia w stosunku do chorych z makro- i mikroangiopatią cukrzycową. Inny rozkład ciśnień na poziomie stopy u pacjentów bez cukrzycy charakteryzuje się znacznie częstszym występowaniem suchej martwicy spowodowanej przewlekłym zaburzeniem napływu „wysychaniem” dystalnej części kończyn. Rokowanie po naprawie chirurgicznej lub wewnątrznaczyniowej napływu jest znacznie lepsze, tym samym przedstawienie własnego poglądu na wyżej wymieniony problem wydaje się być ze wszech miar celowe

Swelling of biocompatible polymer films.

The incorporation of drugs into phosphorylcholine (PC) polymers coated onto coronary stent surfaces is one potential method of treatment for reducing restenosis, the reclosure of the artery after angioplasty treatment. This work on the characterisation of the swelling performance of thin PC polymer films represents a further extension of the study on biocompatible polymers. The broad aim of this work is to relate the PC polymer structure and film processing conditions to their swelling, drug loading and release kinetics. As the two highly sensitive and powerful techniques in film structure determination, both ellipsometry and neutron reflection have proved to be useful in characterising PC polymer films and drug release processes. Following an established ellipsometry measurement method, a two stage process consisting of diffusion and relaxation has been observed during the PC film swelling: this suggests an anomalous mechanism, and this performance is well described by the coupled diffusion and relaxation model developed by Berens and Hopfenberg. Furthermore, the swelling of PC polymer films was investigated as a function of cross-linking, annealing temperature, chemical composition, hydrophilic/hydrophobic ratios, film thickness and environmental conditions by ellipsometry measurements, and their effects on swelling kinetics well quantified. The structures of the PC polymer films (PC100B) with cross-linking groups have been further characterised by neutron reflection. The segregation of hydrophobic and hydrophilic domains was found in the PC films with different dimensions. The PC100B with deuterated dodecyl chains was used to highlight the interfacial structures of the PC films. The hydrophilic segments, including phosphorylcholine groups and hydroxypropyl groups, are preferentially adsorbed at the polymer/substrate interface. The hydrophobic dodecyl chains are expelled away from the silicon oxide surface. The main part of PC100B films is the middle uniform region with 40% of water in the sample annealed at 150°C, and 55% of water in the sample annealed at 50°C. The combination of the ellipsometry results and the drug release profiles from UV measurements indicates that the drug release pattern is strongly affected by the film swelling kinetics when the drug molecules and polymer matrix interact weakly. Otherwise, a strong interaction between the drug and the polymer will dominate the drug release behaviour from the PC polymer films

Z dziejów katedr skarbowości i prawa skarbowego oraz katedr prawa finansowego w Polsce

Praca recenzowana / peer-reviewed pape

Impact of the heated water discharge on the water quality in a shallow lowland dam reservoir

The purpose of the work was to determine the relationship between the of the water quality parameters in an artificial reservoir used as cooling ponds. Factor analysis were applied to analyze eighteen physico- -chemical parameters such as air and water temperature, dissolved oxygen concentration, visibility of the Secchi disk, concentrations of total nitrogen, ammonium, nitrate, nitrite, total phosphorus, phosphate, concentrations of calcium, magnesium, chlorides, sulfates and total dissolved salts, pH, chemical oxygen demand and electric conductivity from 2002-2019 to investigated cooling water discharge. Exploratory factor analysis allowed identified four factors were obtained from 54.1% (in discharge zone) to 56.7% (in dam zone). In discharge and pelagic zones confirmatory factor analysis showed that four latent variables: salinity, temperature, nitrogen and phosphorus provide good fit, but in the dam zone the better fit was obtained for the latent variables salinity, temperature, nutrient and eutrophic. Correlations between latent variables temperature, nitrogen, phosphorus or nutrient and eutrophic show a significant effect of temperature on the transformation of nitrogen and phosphorus compounds