Concern contracts

Publikacja recenzowana / Peer-reviewed publicationThe aim of this paper is to briefly describe concern contracts. In view of dynamic development of economic relations, there is a variety of contractual relations. The first part of the paper analyzes the causes of making corporations. Article describes internal and external economic objectives, contributing to the formation of koncernowych structures. Economic factors like development of enterprises result to concentration of capital within the framework of concern. The second part of the paper refers to division of concern contracts on vertical concern contracts and horizontal concern contracts. Content both type of contracts is analyzed with special regard into german law. Elaboration in next part presents character of concern contracts. It takes consideration in problem with residual polish regulation of concern contracts, included article 7 Code of Commercial Companies. In Poland concern contract is an unspecified agreement, meaning that it is not regulated by any legal act. The summary of the paper, based on the analysis of concern contracts, presents conclusions to form legal relations based on the principle of freedom of contract, favouring development of entrepreneurs. Considerations at this point lead to the conclusion that not every innominate contract is of a transitory nature. Certain innominate contracts are of a permanent nature and there is no need to put them in the statutory framework. Evolution of the economy leads to creation of new needs of entrepreneurs, for whom it is more convenient to be able to form binding relationship in a flexible way, which is in turn possible thanks to the freedom to contract

Skórne reakcje nadwrażliwości wywołane przezskórnymi systemami terapeutycznymi – nadal aktualny problem kliniczny

Transdermal therapeutic systems (TTS) belong to the widely used methods of drug administration, which allow rate-controlled drug delivery and avoidance of first-pass metabolism in the liver. Beside scopolamine, nitroglycerin (glyceryl trinitrate), nicotine, clonidine and fentanyl, also transdermal delivery of sex steroids for hormone replacement therapy and contraception is a well-known and popular method in daily clinical practice. It is estimated that approximately 20% of patients using transdermal estradiol may complain of adverse cutaneous side effects. Most of those reactions are mild or moderate, usually limited to the area of drug application. However, prolonged use may increase the chance of developing sensitization. The purpose of this review is to provide up-to date information on the spectrum of cutaneous reactions caused by TTS and the characteristics of potential contact allergens, including sex hormones. Proper management and prophylactic measures were also included.Przezskórne systemy terapeutyczne (TTS) są szeroko stosowaną metodą podawania leków, która pozwala w sposób kontrolowany, ze stałą szybkością uwolnić substancję leczniczą i uniknąć efektu pierwszego przejścia w wątrobie. Oprócz skopolaminy, nitrogliceryny (trójazotanu glicerolu), nikotyny, klonidyny i fentanylu, uznaną i popularną metodą w codziennej praktyce klinicznej jest wykorzystanie przezskórnych systemów do podawania hormonów płciowych stosowanych w hormonalnej terapii zastępczej i antykoncepcji. Szacuje się, że około 20% pacjentów stosujących przezskórne systemy zawierające estradiol może skarżyć się na niekorzystne skutki uboczne dotyczące skóry. Większość z tych reakcji jest łagodna lub umiarkowana i zwykle ograniczona do miejsca aplikacji leku. Jednak długotrwałe stosowanie TTS może zwiększyć w przyszłości prawdopodobieństwo rozwoju uczulenia. Celem niniejszego doniesienia jest dostarczenie aktualnych informacji na temat spektrum możliwych reakcji skórnych spowodowanych stosowaniem TTS oraz charakterystyka alergenów kontaktowych, z uwzględnieniem hormonów płciowych. W pracy przedstawiono ponadto ogólne zasady postępowania w przypadku pojawienia się zmian skórnych oraz działania profilaktyczne

Estimation of Cutoff Values of Cotinine in Urine and Saliva for Pregnant Women in Poland

Setting appropriate cutoff values and the use of a highly sensitive analytical method allow for correct classification of the smoking status. Urine-saliva pairs samples of pregnant women in the second and third trimester, and saliva only in the first trimester were collected. Offline SPE and LC-ESI-MS/MS method was developed in the broad concentration range (saliva 0.4–1000 ng/mL, urine 0.8–4000 ng/mL). The mean recoveries were 3.7±7.6% for urine and 99.1±2.6% for saliva. LOD for saliva was 0.12 ng/mL and for urine 0.05 ng/mL; LOQ was 0.4 ng/mL and 0.8 ng/mL, respectively. Intraday and interday precision equaled, respectively, 1.2% and 3.4% for urine, and 2.3% and 6.4% for saliva. There was a strong correlation between salivary cotinine and the uncorrected cotinine concentration in urine in the second and third trimesters of pregnancy. The cutoff values were established for saliva 12.9 ng/mL and urine 42.3 ng/mL or 53.1 μg/g creatinine with the ROC curve analysis. The developed analytical method was successfully applied to quantify cotinine, and a significant correlation between the urinary and salivary cotinine levels was found. The presented cut-off values for salivary and urinary cotinine ensure a categorization of the smoking status among pregnant women that is more accurate than self-reporting

Przetoka kałowa odbytniczo- skórna jako powikłanie niskiej przedniej resekcji z powodu raka odbytnicy i radioterapii

Faecal fistula is an abnormal passage which communicates with anus, bladder or vagina. Fistulas are usually caused by inflammatory diseases, surgery or radiation therapy. We present a patient with rare manifestation of faecal fistula with fluctuation above left knee and with sepsis. His past medical history includes anal cancer surgical management of and adjuvant radiation therapy 5 years prior the admittance. He was unsuccessfully treated in other hospital. After subcutaneous and intramuscular drainage and after conversion from loop- into end colostomy fistulae lost their communication. The patient has fully recovered.Przetoki kałowe najczęściej łącza się z odbytem, pęcherzem, pochwą. Są powikłaniem chorób zapalnych , leczenia operacyjnego i radioterapii. Bardzo rzadko zdarzają się przypadki jak opisany poniżej chory ze spektakularnym chełbotaniem stolca tuz nad kolanem lewym, w sepsie. Chory 5 lat po leczeniu chirurgicznym raka odbytnicy i uzupełniającej radioterapii, leczony nieskutecznie w równoległym ośrodku. Drenaż zmian podskórnych i śródmięśniowych oraz zamiana kolostomii pętlowej na końcową definitywnie odłączyły zasilanie przetoki co przyczyniło się do pełnego wyzdrowienia chorego

Wybrane dermatozy sromu

Abstract Numerous cutaneous lesions are located in the region of the female genital organs, occasionally presenting a diagnostic and therapeutic challenge. The most common cases include: eczema vulvae, lichen simplex chronius, lichen sclerosus et atrophicus or lichen planus. Clinical presentation of these lesions is not always characteristic for certain dermatoses. Thus, it is important to conduct proper tests, including histopathological or contact allergy examination. Only thorough diagnostics allows to implement correct therapy. This paper shows a detailed description of dermal lesions located in the region of the female genital organs of the allergic and lichenoid origin, together with the literature review on diagnosis and treatment.W okolicach narządów płciowych u kobiet możne wystąpić wiele zmian skórnych, niekiedy trudnych do zdiagnozowania w szczególności stanowiących wyzwanie terapeutyczne. Wśród tych najczęściej obserwowanych znajduje się wyprysk sromu, liszaj prosty przewlekły, liszaj twardzinowy i zanikowy czy liszaj płaski. Obraz kliniczny tych dermatoz nie zawsze jednoznacznie wskazuje na daną dermatozę, dlatego tak ważne jest wykonanie diagnostyki w tym badania histopatologicznego czy testów w odniesieniu do alergii kontaktowej. Dopiero po wnikliwiej ocenie możemy podjąć próbę terapii. W niniejszej pracy przedstawiamy szczegółowy opis dermatoz alergicznych i z grupy liszaja okolic narządów płciowych u kobiet oraz przegląd literatury w odniesieniu do możliwości diagnostyki i leczenia

The significant impact of age on the clinical outcomes of laparoscopic appendectomy : results from the Polish Laparoscopic Appendectomy multicenter large cohort study

Acute appendicitis (AA) is the most common surgical emergency and can occur at any age. Nearly all of the studies comparing outcomes of appendectomy between younger and older patients set cut-off point at 65 years. In this multicenter observational study, we aimed to compare laparoscopic appendectomy for AA in various groups of patients with particular interest in the elderly and very elderly in comparison to younger adults. Our multicenter observational study of 18 surgical units assessed the outcomes of 4618 laparoscopic appendectomies for AA. Patients were divided in 4 groups according to their age: Group 1- 8 days. Logistic regression models comparing perioperative results of each of the 3 oldest groups compared with the youngest one showed significant differences in odds ratios of symptoms lasting >48hours, presence of complicated appendicitis, perioperative morbidity, conversion rate, prolonged LOS (>8 days). The findings of this study confirm that the outcomes of laparoscopic approach to AA in different age groups are not the same regarding outcomes and the clinical picture. Older patients are at high risk both in the preoperative, intraoperative, and postoperative period. The differences are visible already at the age of 40 years old. Since delayed diagnosis and postponed surgery result in the development of complicated appendicitis, more effort should be placed in improving treatment patterns for the elderly and their clinical outcome

Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy : results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study

Laparoscopic appendectomy (LA) for treatment of acute appendicitis has gained acceptance with its considerable benefits over open appendectomy. LA, however, can involve some adverse outcomes: morbidity, prolonged length of hospital stay (LOS) and hospital readmission. Identification of predictive factors may help to identify and tailor treatment for patients with higher risk of these adverse events. Our aim was to identify risk factors for serious morbidity, prolonged LOS and hospital readmission after LA. A database compiled information of patients admitted for acute appendicitis from eighteen Polish and German surgical centers. It included factors related to the patient characteristics, peri- and postoperative period. Univariate and multivariate logistic regression models were used to identify risk factors for serious perioperative complications, prolonged LOS, and hospital readmissions in acute appendicitis cases. 4618 laparoscopic appendectomy patients were included. First, although several risk factors for serious perioperative complications (C-D III-V) were found in the univariate analysis, in the multivariate model only the presence of intraoperative adverse events (OR 4.09, 95% CI 1.32-12.65, p = 0.014) and complicated appendicitis (OR 3.63, 95% CI 1.74-7.61, p = 0.001) was statistically significant. Second, prolonged LOS was associated with the presence of complicated appendicitis (OR 2.8, 95%CI: 1.53-5.12, p = 0.001), postoperative morbidity (OR 5.01, 95% CI: 2.33-10.75, p < 0.001), conversions (OR 6.48, 95% CI: 3.48-12.08, p < 0.001) and reinterventions after primary procedure (OR 8.79, 95% CI: 3.2-24.14, p < 0.001) in the multivariate model. Third, although several risk factors for hospital readmissions were found in univariate analysis, in the multivariate model only the presence of postoperative complications (OR 10.33, 95% CI: 4.27-25.00), reintervention after primary procedure (OR 5.62, 95% CI: 2.17-14.54), and LA performed by resident (OR 1.96, 95%CI: 1.03-3.70) remained significant. Laparoscopic appendectomy is a safe procedure associated with low rates of complications, prolonged LOS, and readmissions. Risk factors for these adverse events include complicated appendicitis, postoperative morbidity, conversion, and re-intervention after the primary procedure. Any occurrence of these factors during treatment should alert the healthcare team to identify the patients that require more customized treatment to minimize the risk for adverse outcomes

Wokół rekodyfikacji prawa cywilnego. Prace jubileuszowe

Praca recenzowana / Peer-reviewed paperPrezentowana książka to głos w debacie nad stanem naszej kodyfikacji cywilnej. Jubileusz 50-lecia uchwalenia Kodeksu cywilnego, Kodeksu rodzinnego i opiekuńczego oraz Kodeksu postępowania cywilnego zbiega się z jubileuszem Profesora Janusza Szwai1. Profesor, wybitny cywilista, obchodzi swoje 80. urodziny, mija także 50 lat od obrony przez Niego doktoratu. Jest to doskonała okazja by przyjrzeć się propozycjom zmian prawa cywilnego płynących z różnych środowisk akademickich. Wszak dużą część swojego życia Profesor Szwaja poświęcił pracom legislacyjnym, ich komentowaniu czy krytykowaniu. Sam aktywnie w zmianach różnych kodyfikacji uczestniczył. Jego poglądy zawsze były wyważone. Dziś właśnie taki wyważony głos w dyskusji nad kształtem polskiego prawa cywilnego stał się niezbędny

Children’s residential exposure to selected allergens and microbial indicators: endotoxins and (1→3)-β-D-glucans

Objectives: The study was aimed at assessment of exposure to endotoxins, (1→3)-β-D-glucans and mite, cockroach, cat, dog allergens present in settled dust in premises of children as agents which may be significantly correlated with the occurrence of allergic symptoms and diseases in children. Materials and Methods: The study covered 50 homes of one- or two-year-old children in Poland. Samples of settled dust were taken from the floor and the child's bed. The levels of (1→3)-β-D-glucans (floor), endotoxins (floor) and allergens of mite, cat, dog and cockroach (floor and bed) were analyzed. Results: Average geometric concentrations (geometric standard deviation) of endotoxins, (1→3)-β-D-glucans, Der p1, Fel d1, Can f1 and Bla g1 in children homes were on the floor 42 166.0 EU/g (3.2), 20 478.4 ng/g (2.38), 93.9 ng/g (6.58), 119.8 ng/g (13.0), 288.9 ng/g (3.4), 0.72 U/g (4.4) and in their beds (only allergens) 597.8 ng/g (14.2), 54.1 ng/g (4.4), 158.6 ng/g (3.1) 0.6 U/g (2.9), respectively. When the floor was covered with the carpet, higher concentrations of endotoxins, (1→3)-β-D-glucans and allergens (each type) were found in the settled dust (p < 0.05). The trend was opposite in case of allergens (except dog) analyzed from bed dust and significantly higher concentrations were found in the rooms with smooth floor (p < 0.05). Conclusions: Among the analyzed factors only the type of floor significantly modified both the level of biological indicators and allergens. The results of this study could be the base for verifying a hypothesis that carpeting may have a protective role against high levels of cockroach, dog and cat allergens

Immunodeficiency in children with dysmorphic disorders

Ataxia telangiectasia, Nijmegen breakage syndrome and DiGeorge syndrome are congenital disorders belonging to the category of primary immunodeficiencies. They are characterised by remittent infections as well as predisposition to cancer and autoimmune diseases. An important sign of ataxia telangiectasia and Nijmegen breakage syndrome is an increased sensitivity of cells to ionising radiation, while DiGeorge syndrome is additionally characterised by heart defects and endocrine disorders. What all these diseases have in common are dysmorphic features of different severity, which complement the clinical picture. The signs and symptoms of the diseases may be inconclusive, they appear at various stages of life and their course is unique for every individual. The aim of the study was to present the characteristics of each syndrome while drawing special attention to dysmorphic features occurring in patients. It is important for doctors to be able to diagnose characteristic disorders of the phenotype and immune system and to match them to the right genetic syndrome. Therefore, they should take the patient’s medical history properly, perform thorough physical examination and use multiple diagnostic tools. Despite the fact that these syndromes are rare and incurable disorders, fast and accurate diagnosis gives patients a chance for an improved quality and length of life. The treatment is only symptomatic, but proper prevention can help to avoid the development of a cancer. Therefore, it is of vital importance for the general practitioners, paediatricians and other specialists to know the characteristic signs and symptoms of these syndromes and to cooperate closely with the patients’ parents.Zespół ataksja-teleangiektazja, zespół Nijmegen i zespół DiGeorge’a to wrodzone zaburzenia należące do pierwotnych niedoborów odporności. Charakteryzują się one występowaniem nawracających infekcji, a także skłonnością do nowotworów i chorób autoimmunologicznych. W zespole ataksja-teleangiektazja oraz zespole Nijmegen istotna jest zwiększona wrażliwość komórek na promieniowanie jonizujące, natomiast zespół DiGeorge’a cechuje się dodatkową obecnością wad serca i zaburzeń endokrynologicznych. Cechę wspólną wszystkich trzech zaburzeń stanowi występowanie cech dysmorficznych o różnym nasileniu, które dopełniają obraz kliniczny. Objawy mogą być niejednoznaczne, pojawiają się w różnych okresach życia, a przebieg choroby jest indywidualny. Celem pracy było przedstawienie cech charakterystycznych dla poszczególnych zespołów ze szczególnym zwróceniem uwagi na cechy dysmorficzne występujące u chorych. Lekarze powinni potrafić rozpoznać znamienne zaburzenia fenotypowe i dysfunkcje układu immunologicznego i na tej podstawie zdiagnozować odpowiedni zespół genetyczny. Istotne jest więc odpowiednie zebranie wywiadu, przeprowadzenie dogłębnego badania fizykalnego oraz wykorzystanie licznych narzędzi diagnostycznych. Mimo że schorzenia te należą do rzadkich i są nieuleczalne, to szybkie prawidłowe rozpoznanie daje chorym szansę na znaczną poprawę jakości oraz długości życia. Wdraża się, co prawda, tylko leczenie objawowe, ale odpowiednia profilaktyka może zapobiegać rozwojowi chorób nowotworowych. Stąd kluczowa jest dobra znajomość objawów towarzyszących opisywanym zespołom przez lekarzy rodzinnych, pediatrów i innych specjalistów oraz ich współpraca z rodzicami pacjentów