Sideropenic anaemia occurring in a patient with severe post-traumatic haemorrhage treatment

W pracy przedstawiono przypadek 20-letniego chorego, który będąc w pełni zdrowia, w następstwie rany zadanej nożem w okolicę nadobojczykową prawą doznał uszkodzenia prawego pnia żylnego ramienno-głowowego. W momencie przybycia zespołu reanimacyjnego chory był we wstrząsie krwotocznym z powodu masywnego krwotoku w hipotensji z szerokimi źrenicami niereagującymi na światło. Podczas transportu do Szpitalnego Oddziału Ratunkowego w Siedlcach rozpoczęto reanimację chorego, wspomagając oddech i podając kroplówkę. W szpitalu w czasie natychmiastowej operacji wykonano sternotomię i naprawiono uszkodzony prawy pień żylny ramienno-głowowy. Stan chorego wymagał doraźnego przetoczenia około 18 j. koncentratu krwinek czerwonych oraz 10 j. FFP, 4000 ml krystaloidów i 1500 ml koloidów. Po operacji u chorego wystąpiła biegunka (kilkanaście wypróżnień śluzowo-krwistych na dobę), jednocześnie nastąpił spadek liczby erytrocytów i obniżyło się stężenie hemoglobiny i żelaza w surowicy. Rozpoznano niedokrwistość wynikającą z zaburzeń wchłaniania żelaza wskutek uszkodzenia kosmków jelitowych. Niezbędne było kilkumiesięczne podawanie żelaza drogą pozajelitową. Wraz z ustąpieniem biegunki stan chorego stopniowo poprawiał się i obecnie przy suplementacji doustnej morfologia i stężenie żelaza utrzymują się na prawidłowym poziomie bez niedokrwistości.The authors report the case of a previously healthy 20-year-old male with right vein angle injury after a stabbing in the right supraclavicular region. The patient was in critical condition at the site of the incident with hypovolemic shock due to massive haemorrhage and wide nonreactive pupils. He was immediately operated on after arrival to the hospital, median sternotomy extending to the right supraclavicular area was performed and the right venous brachiocephalic trunk was repaired, 8000 ml of blood and 10 units of FFP were transfused, and 4000 ml of crystalloids and 1500 ml of colloids were infused. After the operation, the patient had continuous diarrhoea (a dozen haematic and mucous stools daily), and sideropenic anaemia evolved due to iron malabsorption caused by intestinal mucosal ischaemia. Treatment required a few months parenteral iron supplementation. After diarrhoea regression and the patient's recovery, enteral iron supplementation was maintained, keeping the iron serum level within reference range

HPV16 E6 polymorphism and physical state of viral genome in relation to the risk of cervical cancer in women from the south of Poland

The aim of this study was to analyse the correlation between HPV16 E6 variants and the physical status of viral genome (integrated, mixed, episomal) among patients with cervical cancer (n=40) and low-grade squamous intraepithelial lesions - LSIL (n=40). The study was performed on 80 HPV16 positive samples. HPV16 E6 variants were identified using PCR and DNA sequencing. Nucleotide sequences of E6 were compared with the prototype sequence (EUR-350T). The physical state of HPV DNA was determined as the ratio of E2/E6 copy number per cell. Twelve different intratypic variants were identified as belonging to European (in 77 samples) and North-American 1 (in 3 samples) sublineages. The most prevalent non-synonymous variant was EUR-350G, which occurred with similar frequency in cervical cancer and LSIL. The frequencies of additional mutations in variants with EUR-350T or EUR-350G sequences differed significantly. For the first time, missense mutations G122A, C153T and G188A were discovered in EUR-350G variant. The integrated viral genome was predominant in women with cervical cancer. The EUR-350T prototype and EUR-350G without additional mutations variants were prevalent in cervical cancer samples with the HPV16 characterized by integrated DNA. In summary, European variants of HPV16 E6 dominated in both cancer and LSIL group. The presence of EUR-350G favoured the occurrence of additional nucleotide changes. We showed that nucleotide changes occur significantly more often in the mixed form of viral DNA and in LSIL group and that the variants without additional mutations may promote integration of HPV16 genome

Autoimmune-Associated Hemophagocytic Syndrome/Macrophage Activation Syndrome

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Physical state of human papillomavirus type 16 in cervical intraepithelial lesions and cancers determined by two different quantitative real-time PCR methods

The aim of this study was to analyse the correlation between a new multiplex qPCR assay and a reference qPCR assay for assessment of the human papillomavirus (HPV16) load and the viral genome status. The study was performed on 100 HPV16 positive samples containing premalignant lesions and carcinomas. HPV16 E2 and E6 gene loads were assessed by two PCR methods. The load of E2 and E6 was normalized to the cell number by qPCR targeting the RNase P open reading frame. The physical state of the viral genome was determined as a ratio of E2/E6 copies number per cell. Among 100 samples analysed, there were no statistically significant differences in the E2 and E6 viral load evaluated by multiplex qPCR and qPCR, the correlation coefficients were 0.98 and 0.97, respectively. There were 19% of samples with the integrated, 73% with mixed and 8% with episomal state of viral genome detected by multiplex qPCR and 17%, 79%, 4%, respectively, found by qPCR. Prevalence of integrated and episomal forms estimated by multiplex qPCR was higher than the one obtained by qPCR (Chi2, p < 0.0001), but in samples with premalignant and malignant diagnoses no significant differences were demonstrated regardless of the methods used. Sensitivity and specificity of multiplex qPCR were 93.7% and 100% as compared with qPCR, the positive predictive value was 100%. In summary, the multiplex qPCR assay in respect of HPV16 load and the frequency of viral genome status was shown to be a sensitive and specific reference method. Simultaneous estimation of E2 and E6 genes in one reaction tube reduces the cost of testing

Use of silver nitrate for the assessment of sperm measurements in selected farm and free-living animal species

The study was conducted on spermatozoa of selected farm and free-living animal species, isolated post mortem from the tail of the epididymis, and stained with silver nitrate – AgNO3. The material was collected from pigs, goats, wild boar, and European roe deer. Twenty morphologically normal spermatozoa randomly selected from each animal and well visible under the microscope, were analysed. The following measurements were considered: head length, width, perimeter and area, acrosome area, mid-piece length, tail length, and overall sperm length. AgNO3 staining differentiated the acrosomal (light hue) and distal (dark hue) part of the sperm head, and a light-hued mid-piece was visible within the sperm tail. Silver nitrate staining revealed species and variety-related differences, particularly in reference to the sperm head. Clear-cut differentiation within the head and tail area made it possible to perform detailed morphometric measurements of the spermatozoa

Endometrial carcinoma in women under 40 years of age

W oparciu o dostępną literaturę podjęto próbę oceny skuteczności i bezpieczeństwa hormonalnego leczenia niezaawansowanego raka błony śluzowej macicy u młodych kobiet. Około 1,5 do 15% przypadków raka błony śluzowej macicy dotyczy kobiet w wieku prokreacyjnym. Standardowe leczenie polegające na usunięciu macicy z przydatkami z lub bez węzłów chłonnych jest przez wiele z tych kobiet nie do zaakceptowania z uwagi na życzenie urodzenia dziecka. Leczenie gestagenami, poprzedzone szczegółową diagnostyką, pozwala na uzyskanie całkowitej remisji zmian nowotworowych u większości z tej grupy chorych. Gdy po zakończonej terapii nie dochodzi do spontanicznej ciąży, stosowane są techniki wspomaganego rozrodu. Z uwagi na ryzyko nawrotu nowotworu po zakończeniu prokreacji zalecany jest zabieg operacyjny.We evaluate the efficacy and safety of hormonal treatment of non-advanced endometrial cancer in young women. Approximately 1.5-15% of the cases of endometrial cancer affect women of child-bearing potential. Standard treatment involving hysterectomy with adnexectomy, with or without lymphadenectomy, is not accepted by quite a number of these patients due to their desire to preserve child-bearing potential. Gestagen therapy preceded by thorough diagnostics allows to achieve complete remission of neoplastic lesions in the majority of women in this group. If spontaneous pregnancy cannot be achieved after the completion of the therapy, assisted reproduction techniques are applied. Owing to the risk of neoplastic recurrence surgery is recommended after procreation is finished