Leczenie nowotworów złośliwych żeńskiego narządu rodnego i piersi z zachowaniem możliwości prokreacji

Postponed motherhood is the reason why many women are diagnosed with cancer before they make the decision to conceive a child, but only a small number of the affected patients will receive any information about treatmentrelated infertility. As far as female genital cancer is concerned, cervical cancer continues to be the most frequently diagnosed malignancy in women of childbearing age. In its early stages, it can be treated with surgical procedures which spare the genitals, i.e. surgical conization and vaginal radical trachelectomy with laparoscopic lymphadenectomy. The advantages of these procedures have been observed in our experience. Also, a successful conservative 6-month treatment of endometrial cancer limited to the mucous membrane with progestagens following curettage of the uterine cavity has been reported in the literature. This paper also presents our own experience with fertility-sparing surgical treatment of ovarian cancer with borderline malignancy and invasive IA stage. Breast cancer affects over 7% of all cancer patients under the age of 40. Pregnancy after breast cancer treatment has been shown to develop properly and both, pregnancy and breastfeeding have no influence on cancer relapse. Protective shields for the adnexa or relocation of the ovaries should be used during radiotherapy in patients who wish to preserve their fertility. In case of chemotherapy, application of GnRH analogs has shown promising results in preservation of the ovarian function. Also, the development of new assisted reproductive technology has offered an increasing number of alternatives for young cancer patients who wish to preserve their fertility.Przesuwanie macierzyństwa na późniejsze lata sprawia, że u wielu kobiet wystąpienie choroby nowotworowej często wyprzedza decyzję o macierzyństwie. Niestety, tylko część pacjentek z rozpoznanym nowotworem złośliwym zlokalizowanym nierzadko poza narządem rodnym otrzymuje informację na temat możliwości niepłodności związanej z leczeniem procesu nowotworowego. Wśród nowotworów złośliwych narządu rodnego jednym z najczęstszych występujących w okresie zdolności do prokreacji jest rak szyjki macicy. Jego wczesne postacie można leczyć chirurgicznie oszczędzając narząd rodny tj. wykonując chirurgiczną konizacją lub radykalną pochwową trachelektomię z laparoskopową limfadenektomią. O wartości takiego postępowania świadczą nasze własne doświadczenia. Istnieją także doniesienia o zachowawczym leczeniu progestagenami w sytuacji raka endometrium ograniczonego do błony śluzowej, po uprzednim wyłyżeczkowaniu jamy macicy. W pracy przedstawiono doświadczenia (również własne) w leczeniu chirurgicznym raka jajnika o granicznej złośliwości i w stopniu zaawansowania klinicznego IA zachowując prokreacje. Około 7% raka piersi dotyczy kobiet poniżej 40 roku życia. Wskazano, że ciąża po leczeniu raka piersi rozwija się prawidłowo. Podobnie, zarówno ciąża jak i karmienie zdrową piersią nie mają wpływu na wzrost ryzyka wznowy raka piersi. Przy stosowaniu radioterapii w zależności od lokalizacji nowotworu u kobiet pragnących zachować płodność należy stosować osłony na przydatki lub wykonać relokację jajników. W razie konieczności stosowania chemioterapii obiecujące wyniki w oszczędzeniu funkcji rozrodczych jajników daje zastosowanie w trakcie jej trwania analogów GnRH. Coraz częściej również w tych trudnych sytuacjach bezpieczne rozwiązania oferują nowe techniki medycyny wspomaganego rozrodu

Intraductal papilloma of the breast — management

In light of the growing availability of ultrasound testing and invasive diagnostic methods of the breast in everyday gyneco- logic practice, lesions of uncertain malignant potential, classified histologically as B3, have become a significant health issue. Intraductal papillomas (IPs) are the most common pathology in that group of lesions. Despite their benign histologic appearance, IPs may accompany malignant growths and the diagnosis made on the basis of biopsy material carries the risk of breast cancer (BC) underestimation. The article presents a review of the available literature on the management of patients diagnosed with intraductal papilloma at a standard core needle biopsy or vacuum-assisted core needle biopsy. The management is not uniform and depends not only on the verification technique or the accompanying pathological growths, but also on the result of clinical-pathological correlations. As it turns out, open surgical biopsy should not necessarily be recommended to every affected woman, and a growing number of sources have recently suggested that a control program would be sufficient in many cases. Thus, it is vital for gynecologists to be able to differentiate between those women who may be included in the annual ultrasound control program and those who require further surgical management.

How to restore your voice? - rehabilitation methods after laryngectomy

Introduction: The voice is an unique communication tool, characteristic of each person alone. Lacking the ability to communicate through it, can negatively affect mental health. It turns out that voice and speech rehabilitation after surgery is widely used and allows patients to improve their functioning, giving them a chance to live a normal life.Aim of the study: The purpose of the study was to review the knowledge of voice and speech rehabilitation options for patients after laryngectomy and the results of the methods used. The text is intended to educate professionals and patients who are undergoing surgical treatment and experience concerns about their future functioning.Materials and Methods: Scientific articles were reviewed using the PubMed database using the keywords: voice rehabilitation; total laryngectomy; speech disorders.State of the art: Prevalent methods of voice and speech rehabilitation in patients after total laryngectomy include the teaching of esophageal speech, tracheoesophageal speech and the use of an artificial larynx. Of these, esophageal speech appears to be the least effective method. Under certain circumstances, an artificial larynx may be the optimal choice among certain groups of patients. Numerous studies cited prove tracheoesophageal speech to achieve the best results measurable by commonly used indicators. Summary: Total laryngectomy is not a sentence for patients. Effective rehabilitation significantly improves the quality of life and communication. It is difficult to unequivocally indicate which method of voice and speech rehabilitation is most beneficial for patients - the choice should be tailored to the individual and its preferences and chances. In his work, the specialist should seek a compromise between obtaining the best acoustic results and acceptance of the method by the patient

Von Meyenburg complexes in a patient with chronic gastritis - a case report

Introduction: Bile ducts hamartoma (von Meyenburg complexes) is a common but unknown pathology of the liver. It can lead to the widening of the bile ducts. It is usually detected incidentally in asymptomatic patients. There are indications of transformation into bile duct cancer or hepatocellular carcinoma.Aim of the study: The aim of the study is to draw attention to a little known, but common pathology - von Meyenburg complexes and to sensitize medical professionals to the implications it may cause during the diagnostic process.Material and methods: We conducted a case study. The research material was the patient's medical history.Case report: A 60-year-old man came to the Gastrology Clinic due to chronic epigastric pain and tenderness in the navel area. Colonoscopy ruled out pathology in the large intestine. After six months, the pain worsened. The result of the gastroscopy allowed the diagnosis of chronic gastritis, which was probably the cause of the problem. The abdominal ultrasound showed a suspicion of renal cell carcinoma of the right kidney, but the neoplastic process was excluded on the basis of the abdominal computed tomography. In the same study, for the first time, numerous minor hypodense lesions in the liver were detected. The final diagnosis was made on the basis of magnetic resonance cholangiography, where the disseminated, T2 hyperintense cystic areas were described. This suggested a biliary scythe.Conclusions: Despite the asymptomatic occurrence of biliary hamartoma, it is important to remember about the possible transformation into a malignant neoplasm. It should be considered in the differential diagnosis of disseminated liver lesions. Patients should be treated symptomatically

Angiotensin Receptor Antagonist-Neprilysin Inhibitor (ARNI) therapy as a new hope in the population of people with heart failure with reduced ejection fraction (HFrEF)

Introduction: Heart failure affects an estimated 23 million people, as many as 50% of whom suffer from a heart failure with reduced ejection fraction (HFrEF), in which the left ventricle ejection fraction is <40% and is accompanied by clinical symptoms. Given the high mortality rate in this group of patients and the continuous suboptimal control of the condition, novel pharmacotherapy regimens are needed to slow the progression of the disease. Preliminary studies report a positive effect of including an angiotensin receptor antagonist and neprilysin inhibitors (ARNIs) in this group of patients. Aim of the study: The aim of the study was to summarize the benefits of ARNI in a group of patients with HFrEF. Methods and materials: This article is based on the literature found in PubMed Database with use of keywords such as “ARNI”, “neprilysin inhibition”, HFrEF”, “heart failure” Results: The benefits of ARNI therapy in patients with HFrEF originate from reversing myocardial remodeling and increasing left ventricular ejection fraction. ARNI therapy is associated with reduced number of hospitalizations and a lower need for intensive treatment. In addition, ARNI use reduces the risk of cardiovascular death and is responsible for lower overall mortality rate compared to pharmacotherapy with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor antagonists (ARBs). Conclusion: ARNIs in patients with HFrEF have a positive effect on the rate of cardiovascular hospitalization, as well as reducing cardiovascular-related mortality and total mortality. Future research studies should evaluate the predictive factors of response to treatment with this group of drugs using larger groups of patients

Inositol supplementation - known and possible applications

Introduction: Myo-inositol (MYO) and D-chiro-inositol are chemical compounds known to exert an impact on multiple signaling pathways of a human body. Due to its effects on insulin metabolism and ovaries’ hormone activity their use in polycystic ovary syndrome (PCOS) therapies has been highly recommended in the recent literature. In this article we aim to review the known and possible applications of inositol and its derivatives for treatment of various gynecological and endocrine disorders and to indicate possible directions of further investigations. Methods and materials: This article is based on the literature found in PubMed Database from the period of 2016-2022 with use of keywords such as “inositol”; “myoinositol”; “d-chiro-inositol”; “PCOS”; “insulin”. Results: The applications of myoinositol in the treatment of polycystic ovary syndrome (PCOS) are very well known in recent publications. It is reported that MYO supplementation improves the quality of oocytes, regulates the menstrual cycle and ovulation rates. Prevention of gestational diabetes (GDM) amongst the patients with risk factors is likely another use of inositols. Inositol takes part in phospholipase C pathway, thus its depletion may be the cause for hypothyroidism. Inositol inhibits the expression of aromatase, the enzyme which is responsible for the growth of endometrial tissue - it may constitute a targeting point in the treatment of endometriosis. So far, no adverse effects of inositol isomers have been reported. Conclusion: The use of inositol, its isomers and derivatives represents an interesting direction in the development of the treatment of many conditions associated with endocrine disorders. There is a need for further investigations and studies on larger groups of patients to exploit its potential.

Bupropion - an antidepressant drug with broad therapeutic potential

Introduction: Bupropion is currently mainly used as an atypical antidepressant due to its psychotropic effects. In addition, it shows high potential in reducing withdrawal cravings in addicts, which is also used in the treatment of nicotinism. However, studies in recent years have shown that it may also be useful in other conditions.Aim of the study: Our aim was to review the known usage of bupropion in the fields of psychiatry, neurology and internal medicine, and to identify potential directions for further research. Methods and materials: We reviewed the literature available in the PubMed database, using the key words: "bupropion"; "depression"; "smoking cessation"; "obesity"; "ADHD".Results: Bupropion- an antidepressant drug belonging to the group of selective norepinephrine and dopamine reuptake inhibitors. Bupropion is approved by the FDA(Food and Drug Administration) for the treatment of depression, seasonal affective disorder and nicotinism. The literature shows that it is also effective in off-label indications - treatment of antidepressant-induced sexual dysfunction, attention deficit hyperactivity disorder (ADHD), depression in bipolar disorder, obesity, neuropathic pain and cancer-related fatigue syndrome.Conclusion: Due to the specific effects of bupropion, there are many more usage for the drug than the primary indications for which it is usually used. The usage of the drug described in the literature require additional studies on a larger group of patients

Diagnosis and treatment of mental disorders – a review of the scientific literature

Introduction: Unambiguous definition of mental disorders is difficult, mainly because of          the heterogeneity of this group of diseases and the clarity of the line between pathology and normal. The definition proposed by the World Health Organization (WHO) is widely accepted.                   In practice, definitions from the legislation of a country are also important. Aim of the work: The purpose of this study is to discuss the basic issues of diagnosis                    and treatment of mental disorders. Material and method: A method of non-systematic literature review from databases such           as scientific Google Scholar, PubMed, CinalHl, Scopus, Arianta, Web of Science was used. Results and conclusions: In the treatment of mental disorders, I use pharmacological and        non-pharmacological methods. Psychopharmaceuticals are divided into several groups depending on their mechanism of action. Their selection depends mainly on the diagnosed disease entity and tolerance to treatment. The most widely used group of drugs is the group of non-selective serotonin reuptake inhibitors (SSRIs). Non-pharmacological methods include psychotherapy, electroconvulsive therapy, deep brain stimulation, and psychosurgery

Ormond's disease - the current state of knowledge about diagnosis and treatment

Introduction: Retroperitoneal fibrosis (Ormond's disease; RPF) is a rare condition characterized by chronic inflammation and resulting progressive fibrosis of the retroperitoneal space. Due to its low prevalence and uncharacteristic symptoms, it is often overlooked in the diagnostic process, resulting in a late-stage diagnosis when complications are already present and treatment options are limited. The aim of the study: The purpose of our study was to present, based on the available literature, the latest reports on the diagnosis and treatment of Ormond disease. State of knowledge: The diagnosis of RPF is based on an anamnesis and imaging. Sometimes a surgical biopsy of the fibrous tissue is necessary. The pathogenesis remains partly unclear. There is no characteristic laboratory marker for early diagnosis of the disease. It is important to distinguish the primary form from the secondary form, in which the trigger factors are known. In therapy, steroid therapy is still the standard. Attempts are being made to treat with other immunosuppressants and biologic drugs with good results, which speaks to the autoimmune basis of the disease. In some cases, surgical treatment and removal of fibrous tissue compressing abdominal structures is essential. Summary: Although the state of knowledge about retroperitoneal fibrosis has been greatly expanded in recent years, many questions remain to be clarified, especially about its pathogenesis and possible early clinical clues to facilitate diagnosis