Palliative care as an active and comprehensive patient care in the terminal stage of cancer

The main assumption of the work is to show the important role played by health care, palliative care. Palliative care is a specific field,which aims to provide the highest level of quality of life of terminally ill, end-stage disease. Most patients want the latter period of his life spent athome, among his relatives.The best form of care in such cases, home hospice care is carried out by the hospices. A comprehensive, holistic nature of care for theterminally ill person is a prerequisite for its effectiveness. The main objective of this care is not prolonging life, but with dignity and without painexperience as possible of the remaining time. In view of impending death and the continuity of the full co-operation team caring for patients becomesextremely important, Nurse owned the team must make every effort to help the patient get through this tough period in his life. In addition to extensiveknowledge and practical skills should have a set of individual characteristics to a good relationship with the patient.In the paper the case study. The research method used in the interview and observation. The most important problems of the patient locatedin the terminal stage of disease.Nurse together with people from the immediate surroundings became the source of patient support. She does not feel lonely, and decides onthe action taken

Analysis of metallothionein and vimentin immunoreactivity in pharyngeal squamous cell carcinoma and its microenvironment

Metallothionein (MT) has been shown to have pro-proliferative anti-apoptotic activity and to be involved in microenvironment remodeling. The aim of this study has been to determine whether the changes in MT and vimentin immunoreactivity observed in cancer and its microenvironment are related to the local spread of the disease. The immunoreactivity levels of both MT and vimentin were evaluated together with CD56 and CD57 antigens in 49 tissue samples taken from patients with squamous cell carcinoma originating from the palatine tonsils and in 20 tissue samples derived from patients with chronic tonsillitis (the reference group). MT immunoreactivity levels were statistically significantly higher in the tissue samples from squamous cell carcinoma than in those of the reference group and also higher in the squamous cell carcinoma samples compared with the stromal samples. Moreover, stromal fibroblasts exhibited high vimentin and MT immunoreactivity levels. Statistically significantly higher MT immunoreactivity levels within the tumor cells were identified in patients with the presence of lymph node metastases in contrast to those patients without such metastases. Vimentin was detected in both the tumor and the stromal tissue samples and presented an interesting pattern of staining strongly expressed within the stroma and the septal architecture of the tumor. The number of CD56- and CD57-positive lymphocytes identified in tissue samples both from squamous cell carcinoma and from the stroma was statistically significantly lower than that in the reference group. MT expression by tumor cells is thus associated with an aggressive phenotype of the tumor and the ability to create metastases

The quality of life and the occurrence of dysphagia in patients with head and neck cancer following combined oncological treatment

Introduction. The localisation of head and neck carcinomas influences the functions of speech, breathing, and swallowing, which, in turn, directly affect the patient’s quality of life. The poor prognosis associated with tumours of this type indicates that aggressive combined therapy protocols, including surgery, chemotherapy, and radiotherapy, should be implemented. Such treatments commonly cause acute toxicity and short- and long-term swallowing complications. Therefore, even though they can contribute significantly to survivorship, these treatments reduce the quality of life. The aim of this study was to analyse the influence of applied combined oncological treatments on the occurrence of dysphagia in patients with head and neck cancer and on their quality of life. Methods. A group of 135 patients with head and neck carcinomas treated with combined protocol (surgery, chemotherapy, and radiotherapy) in the Lukaszczyk Oncological Centre in Bydgoszcz between 2010 and 2014 was analysed. The quality of life and subjective evaluation of the swallowing function was assessed using the MDADI (M.D. Anderson Dysphagia Inventory). Results. A statistically significantly worse subjective evaluation of the quality of life was observed in the patients with dysphagia, who had undergone surgery with radiotherapy, compared to those who had not had surgery (p = 0.03). A statistically significantly worse subjective quality of life evaluation was found in patients who had the most locally advanced tumours (T4) (p = 0.04) as well as the highest stages of the disease (S3 and S4) (p = 0.04). A statistically significantly worse subjective quality of life with dysphagia was also seen in patients who had chemoradiotherapy in comparison to those who had radiotherapy alone (p = 0.01). A statistically significantly worse subjective quality of life with dysphagia was observed in the patients whose tumours were localised in the oral part of the pharynx and larynx compared to those patients with other tumour localisations (p = 0.02). A statistically significantly worse subjective quality of life with dysphagia was identified in the patients who had a higher dose of radiation (exceeding 45 Gy) in the upper oesophageal sphincter compared to those patients who had a lower dose (below 45 Gy) in the UES (p = 0.01). Conclusions. In patients with dysphagia, surgical treatment negatively impacts their subjective quality of life. Moreover, the pattern of radiation therapy affects the quality of life in patients with dysphagia. A radiation therapy plan that spares the upper oesophageal sphincter by using a dose of less than 45 Gy may prevent dysphagia. Dysphagia is also associated with tumour localization, tumour stage, and local advancement of the disease

The biological role of Treg cells in ectopic endometrium homeostasis

Although retrograde menstruation is observed in up to 90% of women, endometriosis actually develops in only15% of women. There is considerable evidence in the literature that ectopic endometrial cells are able to evade immune surveillance and that the immune response in the microenvironment of ectopic lesions is limited. Endometriosis develops when a deficiency in the local immune response has been generated, and progression of the disease is related to the intensity of this process. Over the last couple of decades it has been well known that T regulatory lymphocytes (Tregs) play a crucial role in controlling a variety of physiological and pathological immune responses. In this review we have focused on the physiological alteration of Treg cell infiltration into the endometrium during the reproductive processes of women. We discuss how a disturbance in Treg cell expansion is involved in generating such pathological processes as miscarriage and ectopic pregnancy development. We hypothesize about the role Treg cells might play in the survival of endometriosis foci in ectopic localization and in the evasion of such lesions from host immune surveillance

The biological role of Treg cells in ectopic endometrium homeostasis

Although retrograde menstruation is observed in up to 90% of women, endometriosis actually develops in only15% of women. There is considerable evidence in the literature that ectopic endometrial cells are able to evade immune surveillance and that the immune response in the microenvironment of ectopic lesions is limited. Endometriosis develops when a deficiency in the local immune response has been generated, and progression of the disease is related to the intensity of this process. Over the last couple of decades it has been well known that T regulatory lymphocytes (Tregs) play a crucial role in controlling a variety of physiological and pathological immune responses. In this review we have focused on the physiological alteration of Treg cell infiltration into the endometrium during the reproductive processes of women. We discuss how a disturbance in Treg cell expansion is involved in generating such pathological processes as miscarriage and ectopic pregnancy development. We hypothesize about the role Treg cells might play in the survival of endometriosis foci in ectopic localization and in the evasion of such lesions from host immune surveillance

Management of bleeding or urgent interventions in patients treated with direct oral anticoagulants (DOACs) - 2017 management proposals in Poland

Direct oral anticoagulants (DOACs) such as apixaban, dabigatran, edoxaban, and rivaroxaban are mainly used in the prevention of thromboembolic complications in patients with atrial fibrillation (AF) and in the treatment of venous thromboembolism. As compared with vitamin K antagonists (VKAs), they are characterized by at least similar efficacy and better safety profiles, especially with respect to intracranial hemorrhages. Moreover, they are more convenient therapeutic agents. The 2016 European Society of Cardiology guidelines clearly favor DOACs over VKAs in patients with AF. However, DOAC therapy is also associated with the risk of bleeding complications. The aim of this review was to provide recommendations for the management of bleeding complications during DOAC therapy in the Polish setting. The recommendations were based on the most important documents concerning this issue and were developed by representatives of different medical specialties. Experience in managing cases of bleeding on DOAC therapy is still limited. Therefore, we hope that this publication will be helpful in everyday clinical practice and that it will be useful for developing in‑hospital recommendations for the management of patients with DOAC‑related bleeding