Leczenie pembrolizumabem w pierwszej linii w uogólnionym czerniaku z wykrytą mutacją w kodonie V600 genu BRAF oraz z izolowaną progresją choroby w mózgu

Nowe terapie stosowane w leczeniu chorych na czerniaka wydłużyły czas przeżycia chorych i wpłynęły na poprawę jakości ich życia. Przedstawiono przypadek chorej, u której w wykonanym rezonansie magnetycznym potwierdzono obecność pojedynczego ogniska przerzutowego czerniaka w prawym płacie czołowym w przebiegu leczenia pembrolizumabem i utrzymującej się odpowiedzi na leczenie we wcześniej zajętych chorobą narządach. Równolegle z radioterapią stereotaktyczną pacjentka otrzymywała pembrolizumab, który następnie kontynuowano. Terapia anty-PD-1 trwa obecnie 18 miesięcy, bez istotnych działań niepożądanych, z bardzo dobrą tolerancją. Kontrolne badania obrazowe potwierdzają utrzymującą się odpowiedź na leczenie we wszystkich narządach

Treatment for advanced metastatic breast cancer, after use the total recommended cumulated dose of doxorubicin

Terapie oparte na antracyklinach należą do jednych z najskuteczniejszych w leczeniu raka piersi. Jednak ze względu na kardiotosyczność zależną od dawki ich zastosowanie jest ograniczone. Alternatywą jest zastosowanie preparatów liposomalnej doksorubicyny. Przedstawiono opis przypadku kobiety z obustronnym rakiem piersi, która wykorzystała całkowitą skumulowaną dawkę doksorubicyny podczas leczenia pierwszego zachorowania na raka piersi. W kolejnym rzucie pacjentkę leczono niepegylowaną liposomalną doksorubicyną, uzyskując spektakularną remisję zmian. Onkol. Prak. Klin. 2010; supl. A: A47–A50Anthracyclines are one of the most effective treatments for breast cancer, but their use is limited by dose- -related cardiotoxicity. Treatment with liposomal doxorubicine is a feasible alternative. We present a case of a patient with bilateral metastatic breast cancer affecting the liver who had already received the total recommended cumulated dose of doxorubicin for the treatment of cancer in the first affected breast. The patient was subsequently treated with non-pegylated liposomal doxorubicin for progression of the disease to the liver and dramatic remission of the liver metastatic sites was achieved. Onkol. Prak. Klin. 2010; supl. A: A47–A5

The role of anthracyclines in the treatment of advanced breast cancer — the place of nonpegylated liposomal doxorubicin

Do leczenia raka piersi wprowadzono wiele nowych leków cytotoksycznych oraz ukierunkowanych molekularnie. Mimo to antracykliny wciąż mają silną pozycję w terapii tego nowotworu, zarówno w leczeniu uzupełniającym, jak i choroby przerzutowej. Najbardziej istotnym działaniem niepożądanym ograniczającym stosowanie antracyklin jest kardiotoksyczność. Jednym ze sposobów ograniczenia ryzyka wystąpienia kardiotoksyczności jest wprowadzenie do leczenia uogólnionego raka piersi specjalnej — liposomalnej postaci doksorubicyny. Modyfikacje związane z budową cząsteczki doksorubicyny mają na celu maksymalne zwiększenie aktywności leku w obrębie tkanki nowotworowej oraz ograniczenie występowania działań niepożądanych, a zwłaszcza zmniejszenie toksycznego działania na mięsień sercowy. Doksorubicyna liposomalna wykazuje się skutecznością w leczeniu uogólnionego raka piersi, przy jednoczesnym niskim ryzyku wystąpienia kardiotoksyczności. W ostatnich latach prowadzone są badania nad leczeniem skojarzonym doksorubicyną liposomalną oraz terapiami ukierunkowanymi molekularnie. Onkol. Prak. Klin. 2010; supl. A: A8–A17Despite of introducing to the therapy of breast cancer many new cytotoxic and molecularly targeted agents anthracyclines still have strong position in treatment of this type of cancer, both adjuvant treatment and treatment of metastatic disease. The most important side effect that limits the use of anthracyclines is cardiotoxicity. To avoid this the special liposomal form of doxorubicin was introduced to the treatment of metastatic breast cancer. The aim of doxorubicin molecule’s modification was to increase activity of drug in cancer cells and to limit non-specific organ toxicity, especially to decrease toxic effect on myocardium. Liposomal doxorubicin is effective in the treatment of metastatic breast cancer and has low cardiac risk. Combined treatment with liposomal doxorubicin and molecularly targeted therapies has been investigated in recent years. Onkol. Prak. Klin. 2010; supl. A: A8–A1

Protozoan diseases – a marginalized threat of modern civilization

Globalization and the intensification of tourism in tropical and subtropical areas as well as journeys within the framework of military missions often cause the spread and persistence of infectious and parasitic diseases in areas where they previously have not been reported. Protozoan diseases may also be introduced along with imported, often illegally, exotic animals. Parasitic diseases transmitted from subtropical and tropical regions include protozoan gastrointestinal disorders, such as amoebiasis, balantidiasis and blood protozoan diseases such as malaria, babesiosis, trypanosomiasis, or protozoan diseases of the skin, e.g. leishmaniasis. The aim of the study is to draw attention to the problem of disregard for the risks caused by the development of tourism to tropical countries. One has to bear in mind that being infected with blood protozoan parasites is particularly important for public health because it permanently or temporarily excludes those infected as potential blood donors; this applies to trypanosoma, babesiosis and malaria infections. One should presume that the number of cases of parasitic blood diseases in Poland has increased significantly in comparison with previous years. It should also be emphasized that in connection with diagnostic difficulties in diseases caused by parasitic protozoa, it is possible that these diseases may fail to be diagnosed, thus resulting in an incorrect treatment or a lack thereof. This applies to Trypanosoma infections, babesiosis and malaria

Value of intraoperative ultrasonography in tonsil cancer

BackgroundThe exact assessment of a tonsil carcinoma's size is often difficult because of the tumour's submucosal extension and deep infiltration.AimThe aim of the study is to assess the usefulness of intraoperative ultrasonography in tonsil cancer.MaterialTwenty patients with carcinoma of the tonsil were included in the study (squamous cell carcinoma keratosis – 12, squamous cell carcinoma akeratosis – 6, diffuse large B cell lymphoma – 1, neoplasma malignum microcellulare – 1).MethodTranscutaneous, endoscopic, and intraoperative ultrasonography were performed using a linear 7.5[[ce:hsp sp="0.25"/]]MHz probe.ResultsThe difference in the results was statistically significant between palpation examination and intraoperative ultrasonographic examination, between transcutaneous ultrasonographic examination and intraoperative ultrasonographic examination, and between endoscopic ultrasonographic examination and intraoperative ultrasonographic examination in tonsil tumours. Generally, tumour size assessed by intraoperative ultrasonography was more advanced than those assessed by other methods.ConclusionsIntraoperative ultrasonography is a safe, non-invasive method, which can be repeated at every stage of surgery. There were no contraindications or side effects. In all cases histological margins corresponded to sonographic margins. Intraoperative ultrasonography provides a quick and reliable orientation during resection of tonsil carcinoma

Post-traumatic stress disorder

Post-traumatic stress is observed in people who have been directly exposed to traumatic mental and physical stimuli in the form of post-traumatic stress disorder of systemic reactions. Not only soldiers returning from military missions are affected by it, but also victims of all kinds of disasters, rescuers, providing the former with assistance, people pursuing the stress-related professions, including firefighters, paramedics, as well as fans of extreme sports and people, who have experienced unusual situations, such as death of a beloved person, divorce or a traffic accident. The stress symptoms follow the triggering factor. Reaction of the limbic system, associated with the circulation of emotional state, which takes place in the Papez area, causing a variety of vegetative symptoms, especially the circulatory ones, has a vital role to play. The consequences of post-traumatic stress affect both mental and emotional changes, as well as the changes in dynamic stereotype, and they also manifest indirect effects in the family life of an entity and its immediate surrounding. It is important to provide the people affected by post-traumatic stress syndrome with psychological and psychiatric care. The purpose of this article is to review the available literature data on both the post-traumatic stress disorder and its consequences as well as to focus on the key issues related to the prevention and assistance provided for people affected by the syndrome

The latest trends in hair composition analysis in toxicological studies

Humans have had to deal with toxic substances since times immemorial, and this remains the case in the present day. In case of forensic toxicology, of interest are those substances whose possession, use or effects of either imply an offense, a crime or a threat to life. Biological materials used in toxicological analyses are usually blood, urine and the vitreous body of the eye. In addition to the above-mentioned classic materials used for tests aimed at determining the presence of a given xenobiotic, alternative materials, such as hair, are increasingly being used. The primary goal of forensic and clinical toxicology is to look for a causal relationship between the presence of a toxic agent in the system and the specific biological effect caused by it. Carrying out the above objective requires the toxicology analyst to choose the appropriate diagnostic material and the appropriate analytical methods. Toxicological analysis can be performed for any type of material, including hair, which is an excellent sample for determination of individual substances. One of the most important tasks in the field of forensic toxicology is the analysis of addictive substances, whose presence or absence in the human body is one of the elements of a medico-legal report

Biosafety and biological factors

Biological threats go beyond infectious disease epidemics. A biological threat should be construed as the effects of deployment of biological warfare or the occurrence of biological events of natural origin, which can have significant impact on the breach of security in the military, social, ecological and biological context. Biological factors are often recognized as an important and increasingly appreciated problem of widely understood public health. Epidemiological data indicates that, worldwide, at least several hundred million people are exposed to them. A fallacious conviction prevails that biological factors generally affect health care workers who are exposed to them as part of their daily professional routine. However, we rarely realize that biological factors affect us as part of many types of work, also in public spaces. Exposure to biological factors in the workplace and out of work has become increasingly frequent, leading to many adverse health effects. Health care authorities should be sensitive to the emergence of disease foci caused by biological factors (bioterrorism), which requires their quick reaction. It is also important to guarantee the security of personnel in all employment areas where contact with these factors is expected. It is estimated that the frequency of use of weapons of mass destruction is directly proportional to the availability of these means and their production costs, as well as their production capacity. These are the main reasons that indicate that a growing number of terrorist organizations can start using them. The purpose of the study is to present the current knowledge on the preparedness of government bodies (administration and health care) to fight biological threats of various origin

Arctic sea-ice proxies: Comparisons between biogeochemical and micropalaeontological reconstructions in a sediment archive from Arctic Canada

Boxcore 99LSSL-001 from the southwest Canadian Arctic Archipelago (68.095°N, 114.186°W), studied by multiproxy approaches (sea-ice diatom biomarker IP25, phytoplankton-based biomarker brassicasterol, biogenic silica, total organic carbon, dinoflagellate cysts = dinocysts, diatoms) and their applications (sea-ice index PBIP25, modern analogue technique (MAT) transfer functions), provides a chronologically constrained (210Pb, 137Cs, two 14C dates) palaeoenvironmental archive spanning AD 1625–1999 with which to compare and evaluate proxies frequently used in sea-ice reconstructions. Whereas diatoms are rare, PBIP25, biogenic silica and qualitative dinocyst approaches show good agreement, suggesting that palaeo sea-ice histories based on biomarker and microfossil techniques are robust in this region. These combined approaches show fluctuating long open water to marginal ice zone conditions (AD 1625–1740), followed by high-amplitude oscillations between long open water and extended spring/summer sea ice (AD 1740–1870). Greater ice cover (AD 1870–1970) precedes recent reductions in seasonal sea ice (AD 1970–1999). Dinocyst-based MAT, however, produces a low-amplitude signal lacking the nuances of other proxies, with most probable sea-ice reconstructions poorly correlating with biomarker-based histories. Explanations for this disagreement may include limited spatial coverage in the modern dinocyst distribution database for MAT and the broad environmental tolerances of polar dinocysts. Overall, PBIP25 provides the most detailed palaeo sea-ice signal, although its use in a shallow polar archipelago downcore setting poses methodological challenges. This proxy comparison demonstrates the limitations of palaeo sea-ice reconstructions and emphasizes the need for calibration studies tying modern microfossil and biogeochemical proxies to directly measured oceanographic parameters, as a springboard for robust quantitative palaeo studies. </jats:p