187. Powikłania wczesne u chorych na raka piersi leczonych metodą skojarzoną po zabiegu oszczędzającym

Cel pracyAnaliza wczesnych powikłań u chorych leczonych uzupełniająco, po zabiegu oszczędzającym, metodą radioterapii z lub bez chemioterapii.Materiał i metodaGrupa badana obejmowała 132 kobiety chore na raka piersi leczone metodą oszczędzającą z uzupełniającą radioterapią w WCO. 32 kobiety miały napromieniany włącznie gruczoł piersiowy, 100 dodatkowo lokoregionalny układ chłonny. Napromienianie całej piersi odbywało się promieniami Co 60 lub fotonami X o energii 4–6 MeV (dobór energii zależnie od rozmiaru piersi) dwoma polami stycznymi. Dawka frakcyjna wynosiła 1.82 Gy a całkowita 50 Gy/ 25 frakcji/ 5 tygodni. Podwyższenie dawki na lożę pooperacyjna z 2 cm marginesem (boost) miało miejsce u 74 pacjentek, przy czym u 60 chorych stosowano elektrony w dawce 2 Gy/5 frakcji, u 14 kobiet metodą brachyterapii HDR. U 6 zwiększono dawkę boostu z powodu wątpliwych marginesów do 16–20 Gy. Chemioterapii poddano chore z przerzutami do pachowych węzłów chłonnych oraz chore bez przerzutów, które spełniały jeden z warunków: miały poniżej 35 lat, stopień złośliwości nowotworu G wynosił 2 lub 3, wymiar guza przekraczał 2 cm lub stwierdzono brak receptorów dla hormonów sterydowych w komórkach raka.WynikiZ pośród 78 kobiet poddanych chemioterapii 35 (45%) prezentowały wczesne objawy niepożądane związane z radioterapią takie jak obrzęk piersi i popromienne zapalenie skóry, któremu czasem towarzyszyło złuszczanie wilgotne. 54 chore leczone bez chemioterapii manifestowały powyższe objawy w 18 (33%) przypadkach.WnioskiChore otrzymujące chemioterapię są bardziej narażone na obrzęk i popromienne zapalenie skóry

Corporativismo representativo : representação política nos anos 90 e o corporativismo fascista

O corporativismo é uma forma de organização social usado pelo regime fascista italiano, em que a representação política é feita em grupos e por iguais. A representação política é um processo político que obedece a soberania popular, durante os anos 90 surge através deça a preocupação com os grupos minoritários, sendo considerado necessário que a representação tenha um caratér identitário. Surge, então, a questão: a representação política dos anos 90 possuí base fascista? O objetivo é entender tanto as teorias corporatistas quanto as de representação política e também investigar suas possíveis similaridades. Para desenvolver esse trabalho foram usados métodos de pesquisa bibliográfica. A conclusão obtida diz respeito as suas possíveis similaridades, principalmente no que se relaciona a representação feita por iguais e por grupos.Corporatism is a form of social organization used by the Italian fascist regime, in which political representation is made in groups and by equals. Political representation is a political process that obeys popular sovereignty. During the 1990s, a concern with minority groups emerged, and it was considered necessary for representation to have an identity character. The question then arises: did the political representation of the 1990s have a fascist basis? The aim is to understand both corporatist and political representation theories and also to investigate their possible similarities. To develop this work, bibliographic research methods were used. The obtained conclusion concerns their possible similarities, mainly regarding the representation made by equals and by groups

Um algoritmo de recolora??o de arestas de grafos

The problem to ?nd the minimum of colors that are necessary to color all edges on a graph G, known as Classi?cation Problem, is an NP-complete problem. As stated by the Vizing?s Theorem, we have only two classes for all graphs, that is, the chromatic index of G (the minimum number of colours needed to colour the edges of G) is either ?, in that case G is Class 1, or ? +1, in that case G is Class 2. For some graph classes some polynomial algorithms had been found to determine its chromatic index. This workshowsastudyonapolynomialtimerecolouringproceduretoconstructa ?-edgecolouring of graphs which belong to the class X , that is, the class of graphs whose majors (vertices of degree ?) have local degree sum (the local degree sum of some vertex u is the sum of the degrees of all neighbors of u) at most ?2 ? ?. We conclude showing some ideas for future works which consist of an extension of the class X .O problema de determinar o m?nimo de cores necess?rias para colorir todas as arestas de um grafo G, chamado de Problema da Classi?ca??o de Grafos, ? um problema NP-completo. Como enunciado pelo Teorema de Vizing, existem apenas duas classes que abrangem todos os grafos, o que implica que todo grafo G tem ?ndice crom?tico (menor quantidade de cores necess?rias pala colorir todas as arestas de G) ?, em que ? denominado Classe 1, ou ?+1, em que ? denominado Classe 2. Para algumas classes de grafos foram encontrados algoritmos polinomiais para determinar o seu ?ndice crom?tico. Este trabalho apresenta um estudo de um procedimento de tempo polinomial para construir uma ?-aresta-colora??o para as arestas dos grafos pertencentes ? classe X , que ? a classe dos grafos cujos ?-v?rtices (v?rtices com grau m?ximo) t?m soma de grau local (a soma de grau local de um v?rtice u ? a soma dos graus de todos os seus vizinhos) no m?ximo ?2 ? ?. Por ?m s?o apresentadas algumas propostas para trabalhos futuros que consistem em ampliar a classe X

Cultural and psychological determinants of pain assessment during lower limb angioplasty

Introduction. It is a common unofficial perception of surgeons performing endovascular operations thatpatients living in the different social and economic environment assess pain differently during peripheral angioplastyprocedures.The objective was to examine the differences in assessing pain experienced during endovascular arterial interventionson lower limbs, by Polish and German patients, and to analyse the psychological determinants of theassumed differences, by referring to mental dispositions such as optimism and satisfaction with own life quality. Material and methods. 101 patients were qualified for endovascular intervention on lower limbs arteries— 51 Germans (M = 67.31; SD = 9.82) and 50 Poles (age M = 67.88; SD = 8.4). 37 women and 64men were classified as Rutherford category 2–3.Three scales were applied:1. Life Orientation Test-Revised2. Satisfaction With Life Scale3. Pain Appraisal Scale which comprises emoticons showing subsequent degrees of sustained pain and thecorresponding Visual Analogue Scale. Results. The patients from Poland graded their life quality lower than the German patients (M = 23.44; SD= 5.977 and M = 25.94; SD = 5.584). The Poles presented a lower level of optimism (M = 15.04; SD =3.703 vs M = 15.8; SD = 3.516). The Polish patients classified the level of pain during lower limb angioplastyas higher than in German patients (M = 4.22; SD = 2.999 and M = 2.88; SD = 2.215) (p < 0.012). Conclusions. Resistance to pain experienced during endovascular procedures probably depends on theassessment of the patient’s current life situation, determined by satisfaction with own life quality and relatedoptimism. With great caution, it might also be supposed that resistance to pain depends on the life standardtypical of a given populatio

Feasibility and accuracy of new insertion technique of S1 transpedicular screw. Computed tomography-based morphometric analysis

Objective To assess feasibility and accuracy of a new insertion technique of S1 transpedicular screw. Summary of background data Transpedicular stabilization in the first sacral vertebra (S1) is a technically demanding surgical procedure with inherent risk of loosening of the implant. A modification of the technique was recently proposed, along with the analytical verification which was performed based on the available literature. In the study, we performed radiological assessment of screws inserted into the S1 using the classical and modified techniques. Methods The analysis was performed in two parts. The first part was performed on eight cadaver specimens after implantation of the screws. In the second part, we used computed tomography images of patients with degenerative disk disease with a superimposed representation of screws. The thickness of the posterior cortex adherent to the screws, screw trajectory and their position with regard to the spinal canal was measured. The area of posterior cortex in contact with the screws was also calculated. Results The contact length and area was found to be two times greater for screws introduced with the modified technique. The convergence angle was comparable between the techniques, despite the shift of entry point. There was no canal breach, although with the modified technique the screws passed closer to the spinal canal. Conclusions The modified technique is considered safe. In this technique, the screws pass through a thicker portion of the posterior cortex compared to the classical technique that aims at improving the stability of the fixation

Analysis of trace element in intervertebral disc by Atomic Absorption Spectrometry techniques in degenerative disc disease in the Polish population

Objective Although trace elements are regarded crucial and their content has been determined in number of tissue there are only few papers addressing this problem in intervertebral disc in humans. Most of the trace elements are important substrates of enzymes influencing metabolism and senescence process. Others are markers of environmental pollution. Therefore the aim of the research was to analyzed of the trace element content in the intervertebral disc, which may be a vital argument recognizing the background of degenerative changes to be the effect of the environment or metabolic factors. Material and Methods Material consist of 18 intervertebral disc from 15 patients, acquired in surgical procedure of due to the degenerative disease with Atomic Absorption Spectrometry content of Al, Cd, Co, Pb, Cu, Ni, Mo, Mg, Zn was evaluated. Results Only 4 of the trace elements were detected in all samples. The correlation analysis showed significant positive age correlation with Al and negative in case of Co. Among elements significant positive correlation was observed between Al/Pb, Co/Mo, Al/Mg, Al/Zn Pb/Zn and Mg/Zn. Negative correlation was observed in Al/Co, Cd/Mg, Co/Mg, Mo/Mg, Co/Zn and Mo/Zn. Conclusions This study is the first to our knowledge that profiles the elements in intervertebral disc in patients with degenerative changes. We have confirmed significant differences between the trace element contents in intervertebral disc and other tissue. It can be ground for further investigation

The Act amending the Prevention of Drug Abuse Act 3 years after its enforcement – a report on application

Niniejsze opracowanie stanowi próbę oceny, jak w praktyce funkcjonują instytucje wprowadzone nowelizacją ustawy o przeciwdziałaniu narkomanii z 1 kwietnia 2011 r. Najważniejszą zmianą nowelizacji było dodanie do ustawy art. 62a, dającego prokuratorowi oraz sądowi możliwość umorzenia postępowania karnego wobec sprawcy posiadającego nieznaczne ilości środków odurzających lub substancji psychotropowych, przeznaczonych na jego własny użytek. Ponadto, nowelizacja rozszerzyła katalog alternatywnych środków o charakterze leczniczym, realizując zasadę „leczyć zamiast karać”. Raport sporządzony został na podstawie wszelkich dostępnych danych statystycznych, przekazanych przez: sądy, Prokuraturę Generalną i – przede wszystkim – Ministerstwo Sprawiedliwości. W ramach prac nad raportem przeprowadzone zostały także wywiady z praktykami stosującymi przepisy nowelizacji (policjantem, prokuratorem i adwokatem) oraz przedstawicielką Ministerstwa Sprawiedliwości. Przedstawione dane statystyczne wskazują, że liczba umorzeń spraw o posiadanie narkotyków, w tym umorzeń na podstawie art. 62a u.p.n., jest wciąż stosunkowo mała. Głównym postulatem płynącym z niniejszego raportu jest zatem konieczność opracowania przez Prokuratora Generalnego stosownych wartości granicznych dla poszczególnych substancji psychoaktywnych, definiujących pojęcie ich „nieznacznej ilości”.This study is an attempt to evaluate how the institutions, established by the amendment to the Act on prevention of drug abuse of 1 April 2011, perform in practice. The most important change to the act amended was the addition of Article 62a to the Act. This Article gives a prosecutor and court an option to discontinue criminal proceedings against individuals in possession of small amounts of intoxicants and psychotropic substances intended for private use. Furthermore, the amendment extended a scope of alternative medicinal substances implementing the principle of “treat rather than punish”. The report was compiled basing on any available statistical data provided by: courts, the Prosecution General and most of all by the Ministry of Justice. During the work on the report, a few interviews were done with the people who apply the provisions of the amended act (a policeman, a prosecutor and an advocate) and with a representative of the Ministry of Justice. The presented statistical data show that the number of discontinued proceedings connected with drug possession including those ones discontinued under Article 62a, is still relatively small. The main requirement arising from this report is the necessity for the Prosecutor General’s Office to develop proper limit values for individual psychoactive substances defining the notion of “small amounts”