Dokumentacja brzmieniowa i formy audioprezentacji organów kościołów na Małopolskim Szlaku Architektury Drewnianej

This project aims to record sounds of pipe organ music performed on instruments from Roman-Catholic churches, which lie on the Malopolska Wooden Architecture Route. This historical region is characterized by the five pipe organs chosen because of their artistic value, performance possibility and preferable stylistics. This work contains single stages of the completion of the project including: foreseen project managers, business partners, business plan and funding/ financing sources as well as foreseen sponsors. The album together with the book give an insight into pipe organs of wooden churches This is a high quality promotional reference about cultural, architectural and historical aspects of the Malopolska

Recent trends in international migration in Poland: The 2012 SOPEMI report

This paper is a SOPEMI report for Poland for 2012. It presents the most important recent developments in migration policy and migration trends to and from Poland. It includes a brief analysis of recent economic developments shaping migration from and into Poland, changes in migration policy of Poland, recent trends in the transborder mobility, emigration from Poland and immigration to Poland. It concerns, among others, the newly published results of the 2011 population census. Additional in-depth analysis of the 2011 regularization action in Poland assesses its rationale, application and short- and long-term impacts.The statistical annex includes all data concerning the recent trends in migration from and into Poland

NEN — the role of somatostatin receptor scintigraphy in clinical setting

Detection of neuroendocrine neoplasms (NENs) and monitoring of their response to therapy is still challenging due to huge heterogeneity of that group of tumors. Actually, NENs visualization is mainly based on molecular imaging while in the past it was relied on less effective structural imaging including CT and MRI. Molecular imaging techniques in combination with structural imaging (hybrid imaging), especially in patients with well-differentiated NENs, in addition to morphological provide the functional information about tumor which benefits in a more accurate patient management, including more sensitive visualization of primary tumors, more precise staging and better therapy follow-up. Overexpression of somatostatin receptors (SSTR) on NENs’ cell membrane was a basis for development of somatostatin receptor scintigraphy (SRS) using single photon emission tomography SPECT, which is today a well-established standard in molecular imaging of NENs, and further imaging improvement in the field of positron emission tomography (PET). Use of hybrid imaging (SPECT/CT, PET/CT) increased sensitivity of examination, mainly resulting in better detection of small lesions. Generally, somatostatin receptor imaging with PET/CT is an emerging technique, although still with limited access, but due to several advantages over SSTR SPECT/CT, should be used if available. It is worth mentioning, that both SSTR PET/CT and SSTR SPECT/CT have some limitations, such as relatively low detection rate of benign insulinomas, poorly differentiated GEP-NETs and liver metastases. For that reason further improvement of NETs imaging is necessary. The most promising new tracers’ families are based on SSTR antagonists, 64Cu-radiolabeled ligands and glucagon-like peptide-1 receptor (GLP-1R) imaging. Finally, in case of poor-differentiated neuroendocrine cancers 18F-FDG PET/CT may be beneficial in comparison with molecular imaging based on somatostatin receptor modalities

The long-term follow up of the patient with gastrinoma — the diagnostics and therapeutics problems

Guzy typu gastrinoma należą do wysokozróżnicowanych nowotworów neuroendokrynnych. U około połowy pa­cjentów zmiany przerzutowe w wątrobie i węzłach chłonnych stwierdzane są w momencie rozpoznania. W pracy opisano 46-letnią pacjentkę z dolegliwościami bólowymi jamy brzusznej i biegunkami. W 2005 roku w tomografii komputerowej (TK) uwidoczniono guza okolicy wnęki śledziony. Śródoperacyjnie stwierdzono obecność guza ogona trzustki. Pacjentka przebyła zabieg dystalnej pankreatektomii ze splenektomią. W badaniu histopatologicznym wykazano utkanie guza typu gastrinoma. Do 2007 roku nie stwierdzano zmian w kontrolnych badaniach obrazowych. W wykonanej w 2007 roku scyntygrafii receptorowej odnotowano ognisko patologicznego gromadzenia znacznika w segmencie 6. wątroby oraz obecność zwiększonego wychwytu znacznika w segmentach 2. i 7. W badaniu TK potwierdzono obecność zmiany ogniskowej w segmencie 6. wątroby. Ze względu na rozsiew choroby nowotworowej oraz dodatni wynik scyntygrafii receptorowej pacjentka została zakwalifikowana do leczenia radioizotopowego. Po leczeniu radioizotopowym do leczenia włączono długodziałający analog somatostatyny. Stwierdzana w kontrolnych badaniach scyntygrafii receptorowej oraz TK regresja opisywanych wcześniej zmian przerzutowych w wątrobie utrzymywała się przez 5 lat po zakończeniu leczenia radioizotopowego. Z uwagi na pojawienie się nowego ogniska przerzutowego w wątrobie pacjentka została zakwalifikowana do zabiegu przezskórnej termoablacji zmiany. Obecnie w badaniu ultrasonograficznym w wątrobie widocznych jest kilka zmian poniżej 1 cm średnicy — zaplanowano poszerzenie diagnostyki obrazowej. Opisany przypadek prezentuje wieloletni przebieg choroby u pacjentki z guzem trzustki typu gastrinoma. Wskazuje na konieczność stosowania różnych uzupełniających się metod diagnostyki obrazowej. Przedstawia również różne, także zwykle uzupełniające się, opcje postępowania terapeutycznego w przypadku pacjentów z guzami typu gastrinoma. Gastrinomas are well differentiated neuroendocrine neoplasms. About fifty percent of patients present with liver and lymph nodes metastases at the time of diagnosis. 46 years old woman with abdominal pain and diarrhea. In computed tomography (CT) performed in 2005 tumor of the hiatus of the spleen was revealed. Intraoperatively tumor of the pancreatic tail was found. Patient underwent distal pancreatectomy with splenectomy. Histopathological examination confirmed gastrinoma. There were no pathological findings on imaging examinations till 2007. Somatostatin receptor scintigraphy (SRS) performed in 2007 revealed pathological focal uptake in the 6th segment of the liver and increased uptake of the tracer in segments 2 and 7. CT confirmed the presence of the lesion in the 6th segment. Due to dissemination of the disease and positive result of SRS patient underwent peptide receptor radionuclide therapy (PRRT). Thereafter therapy with long-acting somatostatin analogue was started. Remission of the disease observed in SRS and CT lasts for five after PRRT. Due to the presence of the new metastatic lesion in the liver patient underwent thermal ablation of the lesion. The latter ultrasound examination revealed few small (less than 1 cm in diameter) lesions in the liver — further imaging examinations are planned. Presented case shows long time course of the disease in a patient with gastrinoma. We would like to emphasize the necessity of the use of different, usually complementary, imaging methods. We wanted also to present differ­ent, also usually complementary, therapeutic options in case of such a patients

Diagnosis and treatment of patients with endocrine pancreatic cancer, including cases of mixed adenoneuroendocrine origin

Guzy neuroendokrynne trzustki (PNT) należą do grupy neuroendokrynnych guzów (NET) przewodu pokarmowego (guzy żołądkowo-jelitowo-trzustkowe, GEP-NET). Są one rzadkimi nowotworami, jednak w ostatnich latach obserwuje się rosnącą częstość ich występowania. Poza przypadkami o mieszanym utkaniu histologicznym, w których komponenta egzokrynna nowotworu jest czynnikiem prognostycznym i warunkuje również wybór metody leczenia, przebieg guzów neuroendokrynnych trzustki jest zwykle mniej agresywny niż raka gruczołowego trzustki. Rokowanie w dużej mierze zależy jednak od stopnia zaawansowania choroby w momencie rozpoznania. Stąd ogromny nacisk kładzie się na rozwój metod stosowanych w diagnostyce guzów neuroendokrynnych — zarówno diagnostyce histopatologicznej i immunohistochemicznej, jak i biochemicznej i obrazowej (obrazowanie anatomiczne oraz metaboliczne), ponieważ właściwe rozpoznanie histopatologiczne oraz ocena stopnia zaawansowania choroby warunkują dalsze decyzje terapeutyczne. Postęp widoczny jest również w zakresie metod terapeutycznych, szczególnie w odniesieniu do wykorzystania charakterystycznych cech komórek guzów neuroendokrynnych, takich jak ekspresja receptorów somatostatynowych. Obiecujące są również wyniki kolejnych badań klinicznych z zastosowaniem leczenia celowanego, ukierunkowanego w głównej mierze na hamowanie angiogenezy nowotworowej, indukcję apoptozy oraz hamowanie proliferacji komórek guza, jak również nowych schematów chemioterapii systemowej. Jest to bardzo istotne szczególnie dla pacjentów, u których rozpoznanie nowotworu neuroendokrynnego trzustki nastąpiło w momencie, kiedy — ze względu na nieresekcyjny charakter ogniska pierwotnego lub rozsiew nowotworowy — leczenie chirurgiczne nie jest możliwe lub nie przynosi spodziewanych rezultatów. Onkol. Prak. Klin. 2011; 7, 2: 49–57Pancreatic neuroendocrine tumours (PNT) belong to the group of gastroenteropancreatic neuroendcorine tumours (GEP-NET). Pancreatic neuroendocrine tumours are relatively rare tumours, but recently their incidence has been increasing. Except the mixed adenoneuroendocrine carcinoma, where the exocrine part is the prognostic factor and also determines the treatment method, PNT have usually better prognosis than adenocarcinoma of the pancreas. But prognosis depends mainly on the stage of the disease at the time of diagnosis. Therefore the diagnostic methods — histopathological, immunohistochemical, biochemical and imaging (both anatomical and metabolic) are still improving. The proper diagnosis and staging of the disease determine further decisions on therapeutic options. We can observe also the improvement of treatment methods used in case of PNT. This is visible in the field of use of characteristic klasyfeatures of neuroendocrine cells such as somatostatin receptors’ expression. Promising are also the results of clinical trials with new agents — inhibitors of angiogenesis and proliferation of the tumour cells (targeted therapy) and new schemes of systemic chemotherapy. This development is particularly important in the cases where the diagnosis is made at the advanced stages of the disease and due to inoperable primary tumour and/or dissemination of the process surgical treatment is not possible or the effect of this treatment is worse than expected. Onkol. Prak. Klin. 2011; 7, 2: 49–5

Case report of a patient with initially inoperable well- differentiated midgut neuroendocrine tumor (WDNT) - PRRT and long-acting somatostatin analogs as the neoadjuvant therapy

A 43-year-old man was admitted to Surgery Department because of abdominal pain, vomiting, weight loss and flushes. Computed tomography (CT) examination revealed upper and middle abdomen tumor of about 110 × 110 mm. Histopathological analysis of the tissues obtained during the exploratory laparotomy confirmed WDNT (well-differentiated neuroendocrine tumor according to the WHO classification 2000). The patient received 5 doses of chemotherapy without any response. A positive result of 99mTc- [EDDA/Hynic] Octreotate scintigraphy (SRS) gave the possibility of PRRT (peptide receptor radionuclide therapy). The patient was treated with the total dose of 400 mCi of 90Y-DOTA-TATE. CT performed after the PRRT revealed regression of the tumor size to 72 × 94 mm. A decrease of CgA level and release of symptoms were also observed. Aiming at the removal of the considerable diminished tumor the patient was qualified for the second laparotomy. “Cytoreduction” surgery with partial excision of the tumor was performed. Additionally tumor-affected appendix was removed. The second focus of WDNT (according to the WHO classification 2000) with Ki67 < 1% was found in the appendix. Pathologists confirmed the above-mentioned lesions as independent (an extremely rare clinical situation). The following treatment with long-acting somatostatin analogs and 300 mCi of 90Y-DOTA-TATE resulted in further regression of the tumor size to 25 × 35 mm. Consecutive laparotomy is considered. If complete tumor removal might be achieved is an open question. The above case report shows the efficacy of combined therapy with the use of “hot” and “cold” somatostatin analogs not only in controlling the symptoms of the disease but also in obtaining tumor size regression making surgical intervention possible. Such a neoadjuvant therapy seems to be a promising tool in the management of patients with initially inoperable neuroendocrine tumors