Bladder rapture as commonly misdiagnosed pathology - case report

The non-traumatic urine bladder rapture is a very rare life-threatening condition. The diagnosis of this pathology provides many difficulties as the signs and symptoms are not specific and the role of some diagnostic methods is insufficient. We describe the case of 77-year-old male patient admitted to the Emergency Department due to dyspnea, breathing difficulties, urinary difficulties and significantly distended abdomen. The patient had numerous cardiovascular diseases, moreover the interview disclosed recently diagnosed stage III prostate cancer. The laboratory tests results suggested an acute kidney failure. Due to severe condition patient was transferred to the Intensive Care Unit (ICU), where intravenous treatment with ceftriaxone and metronidazole was done for the first 2 days. Afterwards therapy was modified by introducing tienam and vancomycin. On the 4th day of hospitalization the sudden deterioration in the patient's condition occurred and the abdominal US revealed free fluid in peritoneal cavity, which was not visible in previous examinations. The CT-cystography revealed connection between the bladder and the retroperitoneal space in the right part of anterior wall. Despite the urgent laparotomy, the patient died due to multiple organ dysfunction syndrome in the course of neoplastic process as cause

Nose cavity and paranasal sinus tumors

Introduction and purpose of paper: The aim of this paper was to present diagnostic and therapeutic difficulties in management of sinonasal tumors, which are extremely rare. First symptoms are not specific, that is why patients usually present with advanced tumors at the moment of diagnosis. Optimal treatment depends upon extent or stage of disease. State of knowledge: Tumors of nose cavity and paranasal sinuses affecting less than 1 in 100 000 people per year. They are result of abnormal proliferation of variety of structures in the nose. Tumors in sinonasal region grow slowly and may invade local structures, for example the skull base, orbit, or brain. Symptoms of tumors of this region are not specific. This is reason why they are often misdiagnosed by the doctors. Proper detection and diagnostic examination require histopathology examination and imaging test such as computed tomography and magnetic resonance imaging. Due to type and stage of tumor, the treatment options are surgery, radiation therapy and chemotherapy, used separate or in combination. Summary: Nasal cavity and paranasal sinus tumors are rare, with a wide spectrum of histological differentiation. The accurate diagnosis of tumor plays a significant role influencing the therapeutic conduct and prognosis

Pulmonary Embolism: Diagnosis and Treatment

Pulmonary embolism is occlusion of one or more pulmonary artery . Deep vein thrombosis is responsible for most cases of PE. Pulmonary embolism is in 50% cases asymptomatic. Risk factors are: surgery, trauma, venous catethers, superficial vein thrombosis,, immobilization, obesity, policythemia vera, infection, cancer, hormonal contraceptives. The aim of this paper is to present available diagnostic tools and treatment method of pulmonary embolism. Nowadays, there are many tools, such as ECG, laboratory markers or imaging technique, which help us in diagnosis of pulmonary embolism. They consist of: ECG, laboratory markers and imaging techniques. D-dimer are standard laboratory test in diagnosis of PE. D-dimer has high diagnostic sensivity and is usually used to exlude PE. Ultrasonography is also useful for detection of PE. Ultrasound is non-invasive technique, which can be performed by the bed or during surgery. More advanced techniques of imaging, such as ventilation-perfusion scan or computed tomography pulmonary angiogram (CPTA) are also used in diagnosis of pulmonary embolism. Method of treatment depends on patients state and comorbidities: anticoagulation, thrombolysis, surgical embolectomy and cathether-directed thrombolysis, Pulmonary embolism is often diagnosis of exclusion. Nowadays, with development of imaging techniques and laboratory tests, diagnosis of PE and proper treatment may be implemented quickly

Precocious puberty in children - diagnosis, causes and treatment

Physiological sexual maturation begins with pulsatile gonadoliberin (GnRH) secretion by neurons in the arcuate hypothalamic nuclei. GnRH affects the synthesis and pulsatile secretion of the anterior pituitary gonadotropic hormones - LH and FSH, which through stimulation of the gonads lead to the production and secretion of sex hormones - estrogens and testosterone. Sex hormones are responsible for the development of secondary and tertiary sexual characteristics. The mechanisms responsible for inhibiting GnRH secretion in pre-pubertal children have not been fully understood, but they are most likely the result of homeostasis prevailing between neuronal excitatory and inhibitory systems. The entire course of puberty in children is a complex process and is influenced by a wide range of environmental and individual factors. This translates into a large range of physiological age limits for the onset of puberty: in girls between 8 and 13 years of age (on average 10 years), while for boys between 9 and 14 years of age (on average 12 years). Many factors are responsible for precocious puberty in children. The course of the disease affects both the physical and psychological sphere of the child. In order to compensate for the distant effects of this disease, it is necessary to detect symptoms early and implement effective treatment to avoid long-term complications. Emphasis should also be placed on health education to raise public awareness

Postoperative nausea and vomitting – prevention and treatment

Postoperative nausea and vomitting is a complication, which occurs in 30% of patients undergoing anesthesia and surgery. Moreover, large numer of risk factors may result in PONV in up to 80% patients. Risk factors can be devided into patient-dependent and anesthesia dependent. Nowadays, prophylaxis and treatment of PONV is multimodal. Using agents affecting different types of receptors, results in decreasing frequency of postoperative nausea and vomitting. Dexamethasone is a corticosteroid used for prevention in patients with intermediate and high risk of PONV. Ondansetron is 5HT3 receptor antagonist. Ondansetron is more effective for post-operative vomitting than nausea. Side effects inculude: headaches, dizziness, diarrhea and contstipation, prolonged QT interval and cardiac arrythmias. Aprepitant, tachykinin 1 (NK1) receptor antagonist is used in prevention of PONV. This antiemetic drug is recommended for patients with high risk of PONV and for whom PONV may result in serious complications. Scopolamine is a selective competitive antagonist of muscarinic cholinergic receptor. Besides sedative and amnestic effect, scopolamine has antiemetic effect, which is used for treatment of PONV. Postoperative nausea and vomitting may result in dehydratation, electrolyte imbalance, suture disruption and bleeding, aspiration of gastric content and pneumonia. Complications mentioned above result in longer hospital stay and increased medical costs. Assessment of risk factor, avoiding ematogenic anesthetics and analgesics, multimodal prophylaxis and treatment is the best solution to decrease risk of PONV

Tobacco smoking as risk factor of laryngeal cancer

Introduction: Laryngeal cancer is one of the most common type of head and neck cancers. It develops due to spontaneous mutation or influence of external factors (physical, biological and chemical). Cigarette smoking is primary chemical risk factor of laryngeal cancers. Purpose: The aim of the review was to present a role of tobacco smoking in the causation of laryngeal cancer. State of knowledge: Many of studies performed past years confirmed the correlation between tobacco addiction and head and neck cancers. 75% of all head and neck cancers are caused by cigarette smoking, which contains thousands of chemicals. More than 60 of them are known as carcinogens. Summary: Laryngeal cancer is the most common head and neck cancer. The prevalence of laryngeal cancer is increased by several carcinogens including tobacco smoking, which is known as the major risk factor of this type of cancers

Musculoskeletal manifestations of inflammatory bowel disease

Musculoskeletal manifestations are one of the most frequent extraintestinal manifestations of inflammatory bowel disease (IBD). Inflammatory of joints in IBD, both peripheral and axial arthopathies, belong to the spondyloarthritis group (SpA). The prevalence of the arthritis varies in different studies concerning around 5-14% patient with UC and 10-20% in CD. According to the Assessment in the Spondyloarthitis International Sociaty, SpA are divided into axial and peripheral SpA based on the predominant symptoms. Two main patterns of peripheral arthritis of IBD were distinguished with different clinical presentation. Type 1 is characterized by acute and self-limiting symptoms such as pain, swelling or effusion affecting less than five, preferentially large joints, usually correlating with IBD flares. Management of the underlying disease is treatment of choice. Type 2 is characterized by polyarticular symmetric arthritis mainly affecting small joints of upper limbs. Symptoms of type 2 are often persistent for months or even years, independent of disease activity, requiring long-term treatment. Both types should be differentiated from commonly occurring arthralgia also associated with corticosteroid withdrawal. In addition to SpA, enthesitis, tenosynovitis and dactylitis may be diagnosed in IBD ranging from 7% to 50% of cases. Osteoporosis is also important complication observed in IBD with multifactorial pathogenesis i.e., corticosteroid and immunosuppressive treatment, extensive small-bowel disease or resection, age, low physical activity, nutritional deficiencies. The overall prevalence of osteoporosis in IBD is approximately 10-20%

Psychiatric manifestations of Lyme disease

Introduction: Lyme disease is an infectious disease caused by Borrelia bacteria. Characteristic symptoms are erythema migrans, facial nerve palsy, aseptic meningitis, acquired heart blocks, chronic arthritis and radiculitis. The psychiatric manifestations of Lyme disease are known. They include cognitive, emotional and behavioral symptoms and syndromes. Purpose: The aim of the review was to present psychiatric disorders caused by Borrelia infection. State of knowledge: There are three basic types of infections causing neuropsychiatric symptoms: the meningovascular form associated with cerebrovascular infarcts; infection within the central nervous system which is the atrophic form of Lyme meningoencephalitis and is associated with cortical atrophy, gliosis and dementia and the last is infection outside the CNS causing immune and other effects within the CNS that contribute to neuropsychiatric symptoms. A range of psychiatric manifestations of borreliosis include psychosis, sleep disorders, anxiety disorders, depression, obsessive-compulsive disorder, intrusive symptoms, cognitive impairments and rapidly developing dementia. Summary: Lyme disease is a common problem in medical practice of many health professionals. It is important that physicians of different specialties, including psychiatrists, consider Lyme disease in differential diagnosis. Appropriate pharmacotherapy can stop the progression of the disease and improve the patient's quality of life

The efficacy of art therapy in psychiatric patients

Introduction: Art therapy is a form of psychotherapy that uses art media as its primary mode of expression and communication and enables individuals to use art to creatively express themselves. Art therapy is used to improve cognitive and sensorimotor functions, foster self-esteem and self-awareness, cultivate emotional resilience, promote insight, enhance social skills, reduce and resolve conflicts and distress. Purpose: The purpose of the review is to present the different uses of art therapy in psychiatric patients. State of knowledge: National Institute for Health and Clinical Excellence identifies that arts therapies, including art therapy or art psychotherapy, dance movement therapy, body psychotherapy, drama therapy and music therapy, are considered to improve negative symptoms of psychosis. Improved social skills are likely to be associated with increases in prosocial behaviours. Art therapy interventions are effective in reducing trauma symptom severity and anxiety in traumatized adults. Art and music therapy programs were effective in reducing the degree of depression. Summary: Art therapy is a part of therapy in many psychiatric diseases, including depressive disorders, post-traumatic stress disorder and psychotic disorders. Although the effectiveness of art therapy has been confirmed by some studies, this topic should still be investigated so that art therapy can become more effective and available for bigger group of patients

Available treatment methods for endometriosis

Introduction and and purpose of paper: The aim of this paper was to present modern methods of treatment for endometriosis. Endometriosis is a chronic inflammatory condition of women that is characterized by the implementation of endometrial tissue outside the uterus. It affects 7 to 15% of menstruating women, and 35 to 50% of women treated for infertility. State of knowledge: Diagnosis of endometriosis is made on the basis of well-collected gynecological history, clinical examinations and imaging techniques. The golden standard for diagnostics is laparoscopy with subsequent histological examination of the material collected during the procedure. Among the methods of treatment in women with endometriosis, pharmacological and surgical treatment is applied. The pharmacological agents most commonly used in endometriosis are: combined hormonal contraceptives, progestins and anti-progestins, GnRH agonists and antagonists, aromatase inhibitors, Danazol and non-steroidal anti-inflammatory drugs (NSAIDs). Pharmacological treatment is only symptomatic, not cytoreductive, therefore, to remove endometriosis lesions, surgery should be performed. There are two ways to perform surgery: laparotomy and laparoscopy. Surgical treatment of endometriosis may be associated with local excision of lesions and sometimes even removal of the entire organ. Treatment should be conducted in consultation with the patient and her wishes. Conservative treatment is most commonly used among women of reproductive age. Summary: The pharmaceutical or surgical treatment require an individual approach and deliberated informed consent of patient. Pharmacological treatment is only symptomatic, not cytoreductive, therefore, to remove endometriosis lesions, surgery should be performed