Znaczenie hipertermii w leczeniu onkologicznym

In oncology, hyperthermia is known as the procedure of raising the temperature of a part or the wholebody to damage cells of the neoplasm or significantly suppress tumour growth. It is applied with othermodalities such as radiotherapy, chemotherapy, immunotherapy and gene therapy. The article provides anoverview of biological mechanisms of heat-induced cell death as well as radio- and chemo-sensitizationand presents clinical benefits and risks of using hyperthermia in combination with other methods ofoncological treatment. It also discusses various types of hyperthermia and heating devices. The paperconcludes with a summary of current trials connected with the issue and future research directions.W onkologii, hipertermia rozumiana jest jako planowa, kontrolowana technika nagrzewania zmian nowotworowych w celu bądź zniszczenia ich komórek, bądź zahamowania ich wzrostu.W praktyce klinicznej, hipertermia stosowana jest w leczeniu skojarzonym z radioterapią, chemioterapią, terapią immunologiczną czy terapią genową. W poniższym artykule, w oparciu o dostępną literaturę przedmiotu, przedstawiono biologiczno-molekularne mechanizmy działania wysokich temperatur, korzyści z klinicznego zastosowania hipertermii, jak również idące za nią ryzyko. Omówiono różne znane obecnie rodzaje hipertermii,  podjęto także próbę podsumowania najnowszych badań i dokonań dotyczących tego tematu oraz wskazano przewidywane przyszłe kierunki doświadczeń

Difficulties in the diagnosis and treatment of malignant paraganglioma of the urinary bladder

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Difficulties in the diagnosis and treatment of ruptured pheochromocytoma

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Ectopic ACTH syndrome of different origin-Diagnostic approach and clinical outcome : experience of one Clinical Centre

PurposeEctopic Cushing Syndrome (EAS) is a rare condition responsible for about 5-20% of all Cushing syndrome cases. It increases the mortality of affected patients thus finding and removal of the ACTH-producing source allows for curing or reduction of symptoms and serum cortisol levels. The aim of this study is to present a 20-year experience in the diagnosis and clinical course of patients with EAS in a single Clinical Centre in Southern Poland as well as a comparison of clinical course and outcomes depending on the source of ectopic ACTH production-especially neuroendocrine tumors with other neoplasms.MethodsTwenty-four patients were involved in the clinical study with EAS diagnosed at the Department of Endocrinology between years 2000 and 2018. The diagnosis of EAS was based on the clinical presentation, hypercortisolemia with high ACTH levels, high dose dexamethasone suppression test and/or corticotropin-releasing hormone tests. To find the source of ACTH various imaging studies were performed.ResultsHalf of the patients were diagnosed with neuroendocrine tumors, whereby muscle weakness was the leading symptom. Typical cushingoid appearance was seen in merely a few patients, and weight loss was more common than weight gain. Patients with neuroendocrine tumors had significantly higher midnight cortisol levels than the rest of the group. Among patients with infections, we observed a significantly higher concentrations of cortisol 2400 levels in gastroenteropancreatic neuroendocrine tumors. Chromogranin A correlated significantly with potassium in patients with neuroendocrine tumors and there was a significant correlation between ACTH level and severity of hypokalemia.ConclusionEAS is not common, but if it occurs it increases the mortality of patients; therefore, it should be taken into consideration in the case of coexistence of severe hypokalemia with hypertension and muscle weakness, especially when weight loss occurs. Because the diagnosis of gastroenteropancreatic neuroendocrine tumor worsens the prognosis-special attention should be paid to these patients

Differences in clinical characteristics, treatment, and outcomes of sporadic and MEN-1-related insulinomas

Introduction: Although in most cases insulinomas are small, benign, sporadic tumours, they can also be associated with hereditary syndromes, most commonly multiple endocrine neoplasia type 1 (MEN-1). Such a diagnosis significantly affects patient management. The objective was to elucidate the clinical differences between sporadic and MEN-1-linked insulinoma. Material and methods: Comparison of clinical and histopathological characteristics, types of surgery, and outcomes of patients with sporadic and MEN-1-related insulinoma diagnosed between 2015 and 2022. Results: There were 17 cases of insulinomas that underwent MEN-1 genetic testing (10 women and 7 men). In 7 cases, the mutation in the menin gene was confirmed. The median age at the time of diagnosis of sporadic insulinoma related to MEN-1 was 69 years (range 29–87) and 31.5 years (16–47), respectively. Primary hyperparathyroidism (PHP) was found in 6 of 7 patients with MEN-1-related insulinoma, while in none of the patients without MEN-1 mutations. Multifocal pancreatic NETs were found in 3 patients with MEN-1 syndrome, while in all sporadic cases there was a single pancreatic tumour. Two patients with insulinoma related to MEN-1 had a positive familial history of MEN-1-related diseases, while none with sporadic form. Dissemination at diagnosis was found in 4 cases, including 3 patients with insulinoma related to MEN-1-related insulinoma. Patients with sporadic and MEN-1-related insulinoma did not differ in tumour size, Ki-67 proliferation index, and outcome. Conclusions: Of all the features evaluated, only the multifocal nature of pancreatic neuroendocrine tumour (PanNET) lesions and a positive family history differentiated between patients with sporadic and MEN-1-related insulinomas. An age of insulinoma diagnosis of less than 30 years may be a strong indicator of an increased risk of MEN-1 syndrome

Vaginal and cervical bacterial colonization in patients with threatening preterm labor

Objectives: The aim of the following work was to evaluate vaginal and cervical colonization in patients with threatening preterm labor and comparing the frequency of colonization of the term and preterm labor groups. Material and methods: 532 pregnant women with threatening preterm labor were included into the clinical trial. The frequency of colonization was established and the frequency of colonization depending on the duration of pregnancy was checked. Results: Positive vaginal cultures were found in 29.5% of patients. The most frequent were: Escherichia coli and Streptoccocus agalactiae. There was no relationship between the duration of pregnancy, the frequency of colonization or the type of bacterial culture. Conclusions: 30% of positive vaginal and cervical cultures may indicate about the deficiency of the used method. The most frequent microorganisms remain to be Candida, Escherichia coli and GBS. However, the frequency of colonization with rare bacteria increases. Not only bacterial colonization but a group of different factors may be the reason of preterm labor

CT Characteristics of Pheochromocytoma: Relevance for the Evaluation of Adrenal Incidentaloma.

BACKGROUND: Up to 7% of all adrenal incidentalomas (AIs) are pheochromocytomas (PCCs). In the evaluation of AI, it is generally recommended that PCC be excluded by measurement of plasma-free or 24-hour urinary fractionated metanephrines. However, recent studies suggest that biochemical exclusion of PCC not be performed for lesions with CT characteristics of an adrenocortical adenoma (ACA). AIM: To determine the proportion of PCCs with ACA-like attenuation or contrast washout on CT. METHODS: For this multicenter retrospective study, two central investigators independently analyzed the CT reports of 533 patients with 548 histologically confirmed PCCs. Data on tumor size, unenhanced Hounsfield units (HU), absolute percentage washout (APW), and relative percentage washout (RPW) were collected in addition to clinical parameters. RESULTS: Among the 376 PCCs for which unenhanced attenuation data were available, 374 had an attenuation of >10 HU (99.5%). In the two exceptions (0.5%), unenhanced attenuation was exactly 10 HU, which lies just within the range of ≤10 HU that would suggest a diagnosis of ACA. Of 76 PCCs with unenhanced HU > 10 and available washout data, 22 (28.9%) had a high APW and/or RPW, suggestive of ACA. CONCLUSION: Based on the lack of PCCs with an unenhanced attenuation of <10 HU and the low proportion (0.5%) of PCCs with an attenuation of 10 HU, it seems reasonable to abstain from biochemical testing for PCC in AIs with an unenhanced attenuation of ≤10 HU. The assessment of contrast washout, however, is unreliable for ruling out PCC

Evaluation of Knowledge and Self-Awareness of Polish Soldiers Regarding Exposure to Chemical and Physical Factors in Their Place of Service/Work

Introduction: Soldiers constitute a professional group carrying out their duties in variable, often challenging environmental conditions, including harmful and burdensome ones. Materials and Methods: This study was conducted on a nationwide sample of 1331 soldiers. The research tool was an anonymous questionnaire comprising 48 questions. Descriptive statistics were used to describe the characteristics of the studied group. The chi-square test was employed to examine the relationship between variables. A 95% confidence interval was adopted, with a significance level of p = 0.05. Results: One in four soldiers work with low and one in five with moderate exposure to harmful chemical factors. Almost 10% of respondents lack knowledge about the types of chemical factors present during their service. One in five soldiers work with low and one in eight with moderate exposure to ionizing radiation. Approximately 5% of survey participants lack knowledge about the types of physical factors. One in three soldiers are unaware of the carcinogenic and mutagenic effects of the aforementioned factors. Conclusions: The systematic enhancement of knowledge and awareness among army members will help minimize the consequences of exposure to harmful conditions