Czy stosowanie dużych dawek metyloprednizolonu w dożylnych pulsach u chorych z orbitopatią Gravesa jest bezpieczne?

High dose intravenous glucocorticoid pulse (i.v. GCS) therapy is a proven approach in patients with active, moderate to severe Graves’ orbitopathy (GO) and dysthyroid optic neuropathy (DON). In moderate to severe GO, the European Group on Graves’ Orbitopathy (EUGOGO) recommends a 12-week course of intravenous methylprednisolone (i.v. MP) pulse therapy with a cumulative dose of 4.5 g. The response rate of i.v. GCS treatment is significantly higher than oral glucocorticoid (oral GCS) therapy and is associated with fewer adverse events. However, a major concern was raised because of reports of fatal side effects which may be associated with this therapy, especially when single and cumulative doses of methylprednisolone (MP) are higher than recommended. The prevalence and severity of adverse effects during treatment have not been fully described. The aim of this review was to summarise the frequency of major adverse effects of i.v. GCS compared to oral GCS and attempt to propose some practical suggestions as to how to monitor and prevent the development of side effects. (Endokrynol Pol 2014; 65 (5): 402–413)Leczenie aktywnej, umiarkowanej do ciężkiej orbitopatii Graves’a (GO, Graves’ orbitopathy) i neuropatii nerwów wzrokowych w przebiegu GO (DON, dysthyroid optic neuropathy) z zastosowaniem dużych dawek glikokortykosteroidów w postaci dożylnych pulsów (i.v. GCS, intravenous glucocorticoid pulse) jest sprawdzonym i skutecznym postępowaniem. Międzynarodowa grupa robocza the European Group on Graves’ Orbitopathy (EUGOGO) zaleca leczenie pacjentów z aktywną, umiarkowaną do ciężkiej GO dożylnymi pulsami metyloprednizolonu (i.v. MP, intravenous methylprednisolone) w dwunastu cotygodniowych pulsach w łącznej dawce 4,5 g. Leczenie i.v. GCS jest skuteczniejsze i związane z mniejszą częstością występowania działań niepożądanych w porównaniu z zastosowaniem doustnych glikokortykosteroidów (oral GCS, oral glucocorticoid). Opublikowane przypadki poważnych, w tym śmiertelnych powikłań leczenia i.v. GCS nakazują zachowanie ostrożności w czasie stosowania powyższego leczenia, szczególnie jeśli pojedyncze oraz skumulowana dawka metyloprednizolonu (MP) przekraczają rekomendowane przez EUGOGO. Częstość występowania poszczególnych działań niepożądanych i.v. GCS, w tym tych najpoważniejszych, nie została dotychczas dokładnie opisana. Celem opracowania jest podsumowanie częstości występowania poważnych działań niepożądanych i.v. GCS w porównaniu do oral GCS oraz próba zaproponowania praktycznych zaleceń dotyczących kwalifikacji, monitorowania w trakcie leczenia oraz prewencji wystąpienia działań niepożądanych wyżej wymienionego leczenia. (Endokrynol Pol 2014; 65 (5): 402–413

Pregnancy-related cardiac non-elective hospitalizations and pregnancy outcomes. A tertiary referral cardiac center experience

Background: Pregnant women with cardiovascular diseases (CVD) and their offspring are at higher risk of morbidity and mortality.Aims: To provide data on pregnancy outcomes among women with different types of CVD requiring non-elective cardiac hospitalization in a tertiary referral cardiac center.Methods: We identified all records of non-elective hospitalizations of pregnant women hospitalized between January 2009 through March 2018, at our institution — a tertiary referral cardiac center. The incidence and types of cardiac complications during pregnancy, as well as the pregnancy and offspring outcomes, were determined.Results: One hundred and sixty-one out of 328 pregnancy-related hospitalizations in 140 pregnancies were non-elective. Cardiac complications occurred in 62 (44%) pregnancies, with the most frequent being episodes of arrhythmia (22.1% pregnancies), followed by heart failure exacerbations (6.4% pregnancies). Maternal mortality reached 2.1% and affected only women with primary cardiomyopathies (CMP). Offspring mortality was 2.8%. Newborns of mothers with cardiac complications had significantly lower Apgar scores and gestational age at delivery, compared to mothers without cardiac complications.Conclusions: In our series mortality and morbidity among pregnant women with CVD hospitalizations were high. An unfavorable maternal outcome mainly affected women with CMP. Offspring of mothers with cardiovascular complications are prone to have a lower gestational age and Apgar score

Giant Intrapericardial Myxoma Adjacent to the Left Main Coronary Artery

A 62-years-old woman was admitted to the hospital because of chronic cough, expectoration of thick mucus, hoarseness and tightness in the precordial area. Computed Tomography (CT) examination revealed the presence of a giant intrapericardial tumor with the dimensions of 80 × 38 × 32 mm. It was located anteriorly and laterally to the left atrium, posteriorly to the pulmonary trunk and the ascending aorta. This hypodense change modeled the left atrium without evidence of invasion. CT coronary angiography and 3-dimensional reconstruction were applied to enable precise planning of cardiac surgery. CT evaluation confirmed that it is possible to remove the tumor without damage to the adjacent left main coronary artery. The patient underwent cardiac surgery with sternotomy and cardiopulmonary bypass. A cohesive, smooth, vascularized tumor pedunculated to the left atrial epicardium was visualized. The location and dimensions corresponded to those determined by CT scan examination. The entire tumor was successfully dissected together with adjacent adipose and fibrous tissue. Histological evaluation revealed the presence of myxoid cells, blood vessels, degenerative changes, and microcalcifications embedded in profuse hyalinized stroma. Those histological features enabled identification of the intrapericardial tumor as a myxoma. Follow-up CT examination did not demonstrate any signs of recurrence of the myxoma. According to our knowledge, a myxoma located inside the pericardial sac has never been described before

Divorce — a challenge against social norms?

The author tries to answer the query whether divorce is a challenge against social norms guarding the stability and indissolubility of marriage. The full and explicit answer can not be offered on account of the lack of complex research in that subject in Poland, particularly there have been no opinion polls on divorce and divorcees. The secondary analysis of the previous research and statistical data still shows the interesting trends in that field. Firstly, it can be indicated that a local control, especially in rural communities is still existing, persons making the divorce decisions must take account of it. It seems to be manifested in the relatively low divorce index in Poland (on the level of 1,1-1,2 per thousand inhabitants), and particularly in villages (0,4). Other tendencies observed are trends to isolate onself and be isolated in course of fostering marriage conflicts, accompanying propensity to create acquaintance and comrade circles constituted of divorced persons, making divorce decisions without consulting them in the closest circles, methods of rationalizing divorce decisions, the mostly quoted motives are unfaithfulness and alcoholism of the spouse, a large proportion of the divorced is taking part in religious practices (63% males and 82% females), majority of women is not concluding the second matrimony, number of suicised is fourth times higher among the divorced ete. At the same time though some symptoms can be observed indicating thai those norms started to be broken. It can be proved by the relatively high dynamics of the divorce increase in Poland (the index has risen 3-times for the last 3© years, in relation to 1950), the indexes for the big cities are 6- times higher in relation to the indexes in villages, a number of women bringing a divorce action tends to increase, too large a number of divorces among persons who received the scientific degree or gratifying the divorcees in the past with possibilities of a promotion to higher office.Digitalizacja i deponowanie archiwalnych zeszytów RPEiS sfinansowane przez MNiSW w ramach realizacji umowy nr 541/P-DUN/201

The Middle-East Region in the Process of Changes

The paper presents the problems connected with the transformation of the Middle-East Region comprising the Lublin, Biała Podlaska, Chełm and Zamość provinces − altogether, the area of nearly 23,000 km2 and 1,858,000 inhabitants. Historically, until the end of World War II it was an ethnically differentiated region: it was inhabited by Polish, Ruthenian and Jewish population. Economically it owed its development to its fertile soils, particularly in its southern part, and to the fact that it was well situated geographically. In the 19th century the region became clearly backward and this condition has prevailed until today. After World War II the area has remained an agricultural one, without major industrial centers (apart from Lublin, Puławy, Chełm and Kraśnik), ranking among the regions with least technical investment in Poland's economic structure; it also has an adverse migration balance. The process of property ownership transformations started in 1989 has been going on much more slowly here than in other, better developed parts of Poland: the Biała Podlaska, Chełm and Zamość provinces are ranked in the category of provinces with the lowest number of economic units in the four-degree scale used by the Chief Statistical Office (the Lublin province ranks in the third group). With respect to the rate of privatization of state-controlled firms the region ranks among the average ones, according to the data from December 1992. The traditional backwardness of these provinces (underdevelopment of the urban network and a low proportion of the population working outside agriculture and providing a natural market for sale of agricultural products) does not allow obtaining proper effects in agriculture despite the very good soils. Along with the process of transformation started in 1990 structural unemployment appeared. Estimated in proportion to the total of the working population it puts the region a little above the average for the whole country. However, if we refer the number of the unemployed to the amount of labor force outside agriculture (the so-called second rate of unemployment), the indices for this rate are considerably higher than the average for second rate of unemployment for the whole country. The present economic problems of the region are to a large extent determined by the breaking of commercial and co-operative contracts with the eastern neighbors. After 1989 the region has not been a particularly attractive area for foreign investors who choose the Warsaw, Gdańsk, Poznań, Szczecin and Katowice regions much more frequently. It is the human potential that gives it a chance for future development: there are about 35 000 students in universities and academies in this region and every year about 7 000 of them take their degrees in various subjects. According to the development strategy prepared for the region its future is connected first of all with the development of agriculture and tourism

Case study of La Grande Arche on the background of functional and spatial structure of La Defense in France

Procesy rozwojowe miast związane są ściśle z uwarunkowaniami ekonomicznymi oraz przestrzenno-społecznymi, które odnoszą się do możliwości terytorialnych prowadzenia ekspansji przestrzennej oraz zgodą społeczną na ich realizację. Procesy te wymagają zatem interdyscyplinarnego podejścia, których efekty powinny być uwzględnione w programach zagospodarowania przestrzennego osiedli. W związku z powyższym, w niniejszym artykule poddano analizie rozwój przestrzenny stolicy Francji w odniesieniu do kreacji nowego ośrodka dzielnicowego – La Defense. Na jego podstawie określono podstawowe zasady kompozycyjno-funkcjonalne wielofunkcyjnych ośrodków usługowych, wskazując m.in. jako cechy pryncypialne: potrzebę zróżnicowania funkcjonalnego, wysoką jakość przestrzeni publicznych oraz wysoką dostępnością komunikacyjną. W odniesieniu do kreacji różnego typu zabudowy wskazano ważność fizjografii w analizach geoprzestrzennych. W tym kontekście poddano weryfikacji aspekty przewietrzenia i nasłonecznienia w ramach budynku La Grande Arche De La Defense projektu Johanna Otto von Spreckelsena oraz wskazano potencjał analityczny w ramach efektu samoczyszczenia miasta wynikającego z logicznego sytuowania względem siebie obiektów wysoko- ściowych. We wnioskach artykułu zwrócono uwagę na potrzebę holistycznego podejścia w projektowaniu urbanistyczno-architektonicznym, jako elementu stymulującego intensyfikację społeczno-gospodarcząDevelopment processes of cities are related to economic, spatial and social conditions, which refer to the territorial possibilities of spatial expansion and social consent for their implementation. Therefore, these processes require an interdisciplinary approach, the effects of which should be included in spatial development programs for housing estates. In connection, this article analyzes the spatial development of the capital of France in relation to the creation of a new district – La Defense. Subsequently, the basic compositional and functional principles of multifunctional service centers were determined, indicating, among the others, as: the need for functional differentiation, high quality public spaces and high communication availability. With reference to creations of various types of buildings, the validity of physiography in geospatial analyzes was indicated. In this context, aspects of airing and insolation of La Grande Arche De La Defense (project by Johann Otto von Spreckelsen) were verified and the analytical potential of the self-cleaning effect of the city resulting from the logical localization of altitude buildings were indicated. The articles’ conclusions draw attention to the need for a holistic approach in urban and architectural design as an element of stimulating socio-economic intensificatio

Family Background in Juvenile Delinquency

The author attempts to prove that juvenile delinquency belongs to the category of social maladjustment of children and adolescents directly and unmistakably resulting from unsuccessful socialization within the family. He agrees that the family continues to play the essential part in educational processes. The author confines himself to the discussion of environmental factors in the process of juvenile delinquency considering the milieu of primary importance in shaping the personality type. These are atmosphere of the family life, demographic structure of the family, desintegration, living conditions, lack of effective control over the children’s behaviour mother’s employment, etc. Among the factors directly influencing atmosphere of the family life and hence the socialization of young people, alcoholism in the family seems to be of crucial importance. Young people of such families constitute according to A. Pawelczyńska 53 per cent of the entire population. The fact can be explained by frequent rows involving bodily harm and mutual accusations which force the child to escape from the drunken parent. Not only does it hinder proper socialization, in the family but also makes easier the influence of criminal groups. Young people seek satisfaction of their needs outside their own home. Children of poorer families often commit theft while those who are better off turn to acts of vandalism. Apart from alcoholism also breaking up of the family destitute of a parent brings about juvenile delinquency. Children of broken up families constitute over 30 per cent of law offenders. Subsequend re-marriage of the parents exercises equally unfavourable influence. Mother’s employment is also a negative factor. Quoting A. Podgbrecki, the author stresses that religious practice influences the attitudes of young people, i.e. „juvenile delinquency is less prevalent among church-goers”

Consumer rights protection in e-commerce

In the first part of this work were presented consumer rights in Poland and the European Union and explains the notion of consumer, business and economic activities in the Polish and EU legislation. The second part explains the concept of e-commerce and the Internet and was made a short description of the development of e-commerce in Poland. Another part is about the modern barriers identified were encountered by consumers in Internet commerce and practical solutions to these problems from the European Union. The third and fourth part of the work is a thorough discussion of the rights available to consumers before and after the contract of sale on the distance. Last part of the work reveals the methods and institutions for the investigation of consumer rights and future directions pro-consumer policy.W pierwszej części niniejszej pracy zostały przedstawione prawa konsumenckie w Polsce i w Unii Europejskiej oraz wyjaśnione zostały pojęcia konsumenta, przedsiębiorcy i działalności gospodarczej w świetle polskich i unijnych przepisów prawnych. W drugiej części pracy wyjaśniono pojęcia handlu internetowego i Internetu oraz dokonana została krótka charakterystyka rozwoju handlu internetowego w Polsce. W dalszej części wskazane zostały współczesne bariery napotykane przez konsumentów w handlu internetowym oraz praktyczne rozwiązania tych problemów ze strony Unii Europejskiej. Trzecia i czwarta część pracy jest wnikliwym omówieniem praw konsumenckich przysługujących przed i po zawarciu umowy sprzedaży na odległość Ostatnia część pracy ukazuje sposoby i instytucje umożliwiające dochodzenie praw konsumenckich i dalsze kierunki rozwoju polityki prokonsumenckiej

Porównanie dokumentów polityki miejskiej w kontekście adaptacji do zmian klimatu na przykładzie Wrocławia

Urban policy has a crucial role in mitigating climate change. The aim of this elaboration is to systematize the knowledge in this area, based on the critical analysis of spatial and sectoral documents of Wrocław. The level of correlation of these documents was verified based on the references to main risks connected with climate change identified in the city. As a result, the references to the adaptation actions that are connected with realisation of integrated spatial policy in the field of adaptation to climate change in urbanised areas were made. In conclusion, the substance of integrated urban planning as the most effective adaptation tool, was underlined.Polityka miejska odgrywa szczególną rolę w łagodzeniu zmian klimatu. Celem niniejszego opracowania jest usystematyzowanie wiedzy z zakresu adaptacji do zmian klimatu na podstawie krytycznej analizy dokumentów planistycznych i sektorowych Wrocławia, weryfikując stopień ich korelacji w odniesieniu do głównych zagrożeń zidentyfikowanych na obszarze miasta. W rezultacie odniesiono się do działań adaptacyjnych, na podstawie których możliwa jest realizacji spójnej polityki przestrzennej odpowiadającej na zmiany klimatu na obszarach zurbanizowanych. We wnioskach wskazano istotę planowania zintegrowanego jako najefektywniejszego w obliczu omawianych zagrożeń