Intracranial Rosai-Dorfman Disease: pathophysiology, diagnosis and treatment

Introduction and purpose: ​Rosai-Dorfman Disease (RDD), known also as sinus histiocytosis with massive lymphadenopathy(SHML) is a benign histiocytic proliferative syndrome. The etiology and pathogenesis of RDD remains unclear. Central nervous system involvement is a rare event and concerns approximately 7.8% of RDD cases, whereas intracranial lesions constitute almost 90% of CNS-RDD cases. The aim of this literature review was to summarize current knowledge about the diagnosis and treatment of intracranial manifestation of RDD. We also described possible hypotheses regarding the pathophysiology of this disorder. State of knowledge: ​Even though Rosai-Dorfman disease was thought to be a reactive process, recent evidencedemonstrate the presence of clonality, which means that in this histiocytosis the process that underlies the pathology is neoplastic. Intracranial lesions caused by RDD can be easily misdiagnosed with many diseases such as meningiomas, malignant gliomas or metastatic tumors. The final diagnosis of Rosai-Dorfman disease should be made based on histologic and immunohistochemical examinations. Current therapeutic options for this condition include surgery, radiotherapy, chemotherapy, corticosteroids and immunotherapy. Surgical treatment often constitutes the first-line treatment for intracranial RDD and is the most beneficial treatment option. However, the implementation of adjuvant therapies is very important to avoid the recurrence of lesions, which appear in approximately 14% of subjects after about 10 years from surgery. Conclusion: ​This literature review presents current data about pathophysiology, diagnosis and treatment of intracranial involvement of Rosai-Dorfman disease. Further studies on this topic should focus on exploring etiologic mechanisms underlying on this pathology and comparing available treatment methods

Metalloproteinase-2 in failed back surgery syndrome caused by epidural fibrosis: can it play a role in persistent pain?

PurposeFailed Back Surgery Syndrome (FBSS) occurs in 10–40% of patients treated surgically due to disk herniation (DH). There are several factors that can cause a predisposition to FBSS, but the exact pathomechanism has not been elucidated. The aim of this study was to investigate Metalloproteinase-2 (MMP-2) and Tissue Inhibitor of Metalloproteinase-2 (TIMP-2) activities in a homogeneous group of FBSS patients with epidural fibrosis in comparison to its activity in patients with surgically treated DH.MethodsDH, FBSS, and control (CG) groups consisted of 30 subjects. The patients were assessed clinically by the Numerical Rating Scale (NRS), McGill Pain Questionnaire (SF -MPQ), Oswestry Disability Index (ODI), and Beck Depression Inventory (BDI). Serum concentrations of MMP-2 and TIMP-2 were measured by using the immunoenzymatic method.ResultsThere was a significantly higher MMP-2 expression (medians: 4797.49 vs. 2656.65; p < 0.0001) and TIMP-2 concentration (medians: 166.40 vs. 109.60; p < 0.0001) in the DH compared to the CG. Significantly higher MMP-2 expression (4219.95 vs. 2656.65; p < 0.0001) and TIMP-2 concentration (medians: 150.17 vs. 109.60; p = 0.0003) were also found in the FBSS compared to the CG. The activity of MMP-2, measured as MMP-2/TIMP-2, did not significantly change between the DH, FBSS, and CG. MMP2 expression (p < 0.0001) and TIMP-2 concentration (p < 0.0001) were significantly higher in the DH than FBSS.ConclusionResults indicate the presence of a contribution of MMP-2 and TIMP-2 in DH and FBSS. Unchanged activity of MMP-2 can indicate an insufficiency in the MMP-2 repair system in both diseases. Lower MMP-2 expression and TIMP-2 concentration in the FBSS group can reflect the chronicity of the process

Carpal Tunnel Syndrome - treatment

Litak Jakub, Grochowski Cezary, Litak Joanna, Szmygin Paweł, Kulesza Bartłomiej, Kamieniak Piotr. Carpal Tunnel Syndrome – treatment. Journal of Education, Health and Sport. 2017;7(1):141-146. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.238710 http://ojs.ukw.edu.pl/index.php/johs/article/view/4160 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 754 (09.12.2016). 754 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Author (s) 2017; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 05.12.2016. Revised 20.12.2016. Accepted: 11.01.2017. Zespół cieśni nadgarstka – leczenie Jakub Litak [1], Cezary Grochowski [2], Joanna Litak [3], Paweł Szmygin [1], Bartłomiej Kulesza [1], Piotr Kamieniak [1] [1] Klinika Neurochirurgii i Neurochirurgii Dziecięcej SPSK-4 w Lublinie [2] Katedra i Zakład Anatomii Prawidłowej Człowieka Uniwersytetu Medycznego w Lublinie [3] Centrum Onkologii Ziemii Lubelskiej im. Jana z Dukli Carpal Tunnel Syndrome – treatment Jakub Litak [1], Cezary Grochowski [2], Joanna Litak [3], Paweł Szmygin [1], Bartłomiej Kulesza [1], Piotr Kamieniak [1] [1] Department of Neurosurgery and Pediatric Neurosurgery SPSK-4 in Lublin [2] Department of Human Anatomy Medical University of Lublin [3] St. John`s Cancer Center in Lublin Słowa kluczowe: Zespół cieśni nadgarstka Key words: Carpal Tunnel Syndrome Abstrakt Zespół cieśni nadgarstka jest częstym schorzeniem spotykanym w praktyce lekarskiej. Obraz kliniczny i diagnostyka przewodnictwa nerwowego są podstawą rozpoznania. Leczenie dobrane adekwatnie do nasilenia dolegliwosci daje ulgę w bólu . Zaniki mięśniowe w obrębie kłębu kciuka są wskazaniem do zabiegu operacyjnego . Abstract Carpal Tunnel Syndrome is a common disease in General Practice. Clinical symptoms and Nerve Conduction Evaluation are crucial for proper diagnosis. Adequate treatment leads to pain relief. Thenar dystrophy indicates surgical treatment

Ból kręgosłupa szyjnego w przebiegu radikulopatii = The cervical spine pain in radiculopathy

Litak Jakub, Grochowski Cezary, Kulesza Bartłomiej, Kamieniak Piotr. Ból kręgosłupa szyjnego w przebiegu radikulopatii = The cervical spine pain in radiculopathy. Journal of Education, Health and Sport. 2016;6(11):500-510. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.189567http://ojs.ukw.edu.pl/index.php/johs/article/view/4025   The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015).755 Journal of Education, Health and Sport eISSN 2391-8306 7© The Author (s) 2016;This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, PolandOpen Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium,provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License(http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercialuse, distribution and reproduction in any medium, provided the work is properly cited.The authors declare that there is no conflict of interests regarding the publication of this paper.Received: 02.11.2016. Revised 22.11.2016. Accepted: 30.11.2016.   Ból kręgosłupa szyjnego w przebiegu radikulopatii Jakub Litak¹, Cezary Grochowski², Bartłomiej Kulesza¹, Piotr Kamieniak¹ ¹Oddział Neurochirurgii i Neurochirurgii Dziecięcej SPSK-4 w Lublinie²Katedra i Zakład Anatomii Prawidłowej Człowieka Uniwersytetu Medycznego w Lublinie  The cervical spine pain in radiculopathyJakub Litak¹, Cezary Grochowski², Bartłomiej Kulesza¹, Piotr Kamieniak¹ ¹Department of Neurosurgery and Pediatric Neurosurgery SPSK-4 in Lublin²Department of Human Anatomy  Medical University of Lublin  Key words: cervical discopathy, radiculopathy, neck pain    AbstraktBóle kręgosłupa szyjnego stanowią poważny problem diagnostyczny w praktyce lekarskiej . Są najczęstszą przyczyną zgłaszania się do lekarza i mają znaczący wymiar ekonomiczny. W związku z rozwojem cywilizacyjnym, stresem , siedzącym trybem życia i ograniczeniem aktywności procesy  degeneracyjno - wytwórcze w kręgosłupie szyjnym stają się bardziej powszechne. Radikulopatia szyjna jest neurologicznym stanem wywołanym kompresją lub uszkodzeniem korzeni nerwowych szyjnego odcinka kręgosłupa. Stan ten generuje ból w obrębie szyi  nie rzadko promieniuje do obręczy barkowej i kończyn górnych. Postępowanie diagnostyczne jest procesem wieloetapowym. Wywiad i badanie fizykalne pełnia znaczącą rolę a badania obrazowe uzupełniają pełną diagnozę. Farmakoterapia i ograniczenie obciążeń redukują ból w ostrej fazie.W przypadku nieskuteczności leczenia zachowawczego , przewlekłego bólu czy tez postępujących deficytów neurologicznych przeprowadzenie zabiegu operacyjnego obarczającego uciśnięte struktury nerwowe staje się jedynym słusznym postępowaniem . Słowa kluczowe: szyjna dyskopatia, radikulopatia, ból kręgosłupa szyjnego  AbstractThe cervical spine pain represents serious diagnostic medical problem .It is the most common reason for visiting the doctor and has economic dimension . According to Development of Civilization , stress , sitting lifestyle and limitation of physical  activity  Degenerative and Osteoarthritic  syndromes become more common. Cervical radiculopathy  is a neurological condition caused by compression or damage of the nerve roots ofthe cervical spine.  This leads to the occurrence of the neck pain  radiating  to the shoulders and upper extremities. Diagnostic path is a multistage process. Medical interview and physical examination perform essential role . Imaging tools complete proper diagnosis . Pharmacotherapy and short term immobilization reduce pain in a acute phase of disease . However when conservative treatment fails and the patient reports chronic  pain, progressive neurological deficits appears  , surgery may be considered  in order to decompress constricted neurological structures,  as a best relieving pain treatment . Key words: cervical discopathy, radiculopathy, neck pai

Multiple sclerosis and pregnancy as a significant social problem in modern neurology

Along with the increasing number of reported cases, multiple sclerosis, one of the main causes of disability among young adults, is nowadays an increasingly common health problem. Considering the fact that it occurs mainly between 20 and 40 years and affects women more often, the question of the impact of the disease on pregnancy becomes obvious. In view of the wide selection of drugs for various purposes and often highly individualized forms of therapy, it seems also important to determine the safety profile of these agents in relation to the health of the pregnant woman and the fetus. All of this is a significant challenge for neurologists and obstetricians and is the subject of many research and studies. The awareness of society, especially women, in the face of the growing problem seems to be equally important. This paper summarizes the current state of knowledge on these issues

Effect of botulinum toxin on improving quality of life in patients with chronic migraine

Introduction and purpose: Migraine is a chronic condition affecting up to 10% of the adult population in Poland. Migraine pain is severe and may be accompanied by nausea or vomiting, as well as hypersensitivity to light, sounds or smells. Chronic form of migraine means the occurrence of headache a minimum of 15 days per month, for a period of at least three months, of which eight days or more of pain meet the criteria for migraine pain. The chronic form of migraine is targeted for treatment with botulinum toxin, a neurotoxin secreted by the bacteria Clostridium botulinum. Brief description of the state of knowledge: The pathogenesis of migraine is still unknown. There are many hypotheses explaining the origin of migraine pain, of which the most plausible seems to be the theory involving the trigeminal nerve system, as well as trigger points in the head and neck area. Their activation leads to the triggering of pain. Botulinum toxin has been used to treat migraine for several years. The only registered drug is Botox, the effectiveness of which has been confirmed in clinical studies. The preparation is administered by injection into the muscles of the head and neck region in cycles with an interval of 12 weeks. Botulinum toxin works by blocking the release of inflammatory and pain mediators from the trigeminal nerve endings. Summary: Chronic migraine refers to the occurrence of headache for more than half of the month, which significantly reduces the quality of life of people worldwide. Migraine headaches often refractory to pharmacological treatment may respond well to botulinum toxin type A. Therapy should be under the supervision of a neurologist, who will familiarise the patient with the expected effects of botulinum toxin treatment before starting treatment

Rozwój i nowe perspektywy leczenia choroby moyamoya

Choroba moyamoya jest niezwykle rzadką chorobą naczyń mózgowych, występującą głównie u dziecii młodych dorosłych. Charakteryzuje się przewlekłym jedno- lub obustronnym zarastaniem i zwężaniemkońcowego odcinka tętnic szyjnych wewnętrznych i ich gałęzi końcowych, co prowadzi do udaru mózguoraz zaburzeń neurologicznych. Podstawą leczenia choroby moyamoya jest chirurgiczna rewaskularyzacjanaczyń, mająca na celu przywrócenie prawidłowego krążenia mózgowego i zmniejszenie częstościwystępowania objawów klinicznych. Chirurgiczne metody rewaskularyzacji stosowane w leczeniu chorobymoyamoya obejmują techniki bezpośrednie, pośrednie oraz metody łączące techniki bezpośredniez pośrednimi. Pośrednie metody rewaskularyzacji są bezpieczniejszym i łatwiejszym w przeprowadzeniusposobem leczenia niż metody bezpośrednie, zwłaszcza u pacjentów młodszych i u pacjentów z chorobamiwspółistniejącymi. Metody bezpośrednie, mimo większego ryzyka powikłań w postaci udaru czy przemijającejhiperperfuzji mózgowej, cechują się natychmiastowym przywróceniem prawidłowego przepływukrwi w zwężonych naczyniach. Ostatnio zauważa się wyraźną przewagę stosowania metod łączonych, naco wskazują liczne badania

Diagnosis and Management of Neuropathic Pain in Spine Diseases

Neuropathic pain is generally defined as a non-physiological pain experience caused by damage to the nervous system. It can occur spontaneously, as a reaction to a given stimulus, or independently of its action, leading to unusual pain sensations usually referred to as firing, burning or throbbing. In the course of spine disorders, pain symptoms commonly occur. According to available epidemiological studies, a neuropathic component of pain is often present in patients with spinal diseases, with a frequency ranging from 36% to 55% of patients. Distinguishing between chronic nociceptive pain and neuropathic pain very often remains a challenge. Consequently, neuropathic pain is often underdiagnosed in patients with spinal diseases. In reference to current guidelines for the treatment of neuropathic pain, gabapentin, serotonin and norepinephrine reuptake inhibitors and tricyclic antidepressants constitute first-line therapeutic agents. However, long-term pharmacologic treatment often leads to developing tolerance and resistance to used medications. Therefore, in recent years, a plethora of therapeutic methods for neuropathic pain have been developed and investigated to improve clinical outcomes. In this review, we briefly summarized current knowledge about the pathophysiology and diagnosis of neuropathic pain. Moreover, we described the most effective treatment approaches for neuropathic pain and discussed their relevance in the treatment of spinal pain

PD-L1/PD-1 Axis in Glioblastoma Multiforme

Glioblastoma (GBM) is the most popular primary central nervous system cancer and has an extremely expansive course. Aggressive tumor growth correlates with short median overall survival (OS) oscillating between 14 and 17 months. The survival rate of patients in a three-year follow up oscillates around 10%. The interaction of the proteins programmed death-1 (PD-1) and programmed cell death ligand (PD-L1) creates an immunoregulatory axis promoting invasion of glioblastoma multiforme cells in the brain tissue. The PD-1 pathway maintains immunological homeostasis and protects against autoimmunity. PD-L1 expression on glioblastoma surface promotes PD-1 receptor activation in microglia, resulting in the negative regulation of T cell responses. Glioblastoma multiforme cells induce PD-L1 secretion by activation of various receptors such as toll like receptor (TLR), epidermal growth factor receptor (EGFR), interferon alpha receptor (IFNAR), interferon-gamma receptor (IFNGR). Binding of the PD-1 ligand to the PD-1 receptor activates the protein tyrosine phosphatase SHP-2, which dephosphorylates Zap 70, and this inhibits T cell proliferation and downregulates lymphocyte cytotoxic activity. Relevant studies demonstrated that the expression of PD-L1 in glioma correlates with WHO grading and could be considered as a tumor biomarker. Studies in preclinical GBM mouse models confirmed the safety and efficiency of monoclonal antibodies targeting the PD-1/PD-L1 axis. Satisfactory results such as significant regression of tumor mass and longer animal survival time were observed. Monoclonal antibodies inhibiting PD-1 and PD-L1 are being tested in clinical trials concerning patients with recurrent glioblastoma multiforme