42P Zastosowanie ultrasonografii w diagnostyce układu chłonnego szyi u chorych z nowotworami głowy i szyi

Układ chłonny szyi jest najważniejszą droga szerzenia się komórek nowotworowych raków głowy i szyi a przerzuty do regionalnych węzłów chłonnych najczęstszym żródłem niepowodzeń leczenia onkologicznego. Stąd niezwykle ważna jest dokładna ocena układu chłonnego szyi zarówno w okresie przedoperacyjnym jak i podczas kontroli ambulatoryjnych po zakończeniu leczenia. Ultrasonografia jest powszechnie znaną i szeroko stosowaną metodą badawczą we wszystkich niemal dziedzinach medycyny.Celem badań było wykazanie wyższości ultrasonografii nad badaniem palpacyjnym w diagnostyce przedoperacyjnej i w monitorowaniu układu chłonnego chorych operowanych i napromienianych z powodu nowotworów głowy i szyi. US przedoperacyjna pozwala na wykrycie palpacyjne niewyczuwalnych węzłów, ocenę rozległości i topografii guzów wyczuwalnych oraz ich stosunku do ważnych struktur szyi, pozwalające tym samym na uściślenie cechy N i planowania zabiegu operacyjnego lub radioterapii. kolejnym niezwykle ważnym zadaniem jest monitorowanie i stała kontrola układu chłonnego szyi u chorych po zakończonym leczeniu chirurgicznym lub skojarzonym. Dotychczas chorzy z póżnymi przerzutami lub wznowa na szyi zgłaszali się do kontroli z bardzo zaawansowanymi zmianami, dlatego u niewielkiego odsetka spośród nich (30%) można było opanować proces nowotworowy ponownym zabiegiem chirurgicznym.Określano wartość kliniczną wczesnego wykrycia zmian przerzutowych, co w praktyce oznacz możliwość zastosowania bardziej oszczędnych typów reoperacji przy równoczesnym wzroście odsetka zabiegów radykalnych bądź zastosowaniu radioterapii.MateriałU 1479 chorych leczonych w Klinice Otolaryngologii AM w Poznaniu w latach 1990–1997 przed zabiegiem operacyjnym wykonywano badania ultrasonograficzne szyi. Przeprowadzono następnie konfrontację sonograficzno-śródoperacyjną i sonograficzno-histologiczną wykrytych węzłów chłonnych. Korelacje były rzędu odpowiednio 92% i 85%. Wszystkich chorych poddawano badaniom kontrolnym. U chorych zgłaszających się do kontroli w odstępach 1–2 miesięcznych przeprowadzono badanie laryngologiczne, badanie palpacyjne oraz ultrasonograficzne szyi. Przeprowadzono blisko 7000 kontrolnych badań USG. U 177 chorych stwierdzono wznowę w węzłach chłonnych i poddano ich reoperacji. U 79 chorych zmiany na szyi były palpacyjnie nie wyczuwalne, u 48 bardzo dyskretne, trudne do zróżnicowania klinicznego z bliznami lub obrzękiem popromiennym. W tej grupie 127 chorych ze zmianami subkliniczmymi u 100 potwierdzono przerzuty badaniem histologicznym. Przeprowadzone reoperacje szyi były radykalne u 142 chorych (80%), w tym u 99% chorych z grupy subklinicznej, wykrytej sonograficznie

Use of a DVD to provide dietary and lifestyle information to pregnant women who are overweight or obese: a nested randomised trial

Background: We conducted a nested randomised trial to evaluate the effect of an educational DVD, providing information about healthy food choices and exercise during pregnancy, on diet and physical activity, among pregnant women who were overweight or obese. Methods: We conducted a nested randomised trial within the context of the LIMIT randomised trial. Women were eligible with a singleton pregnancy between 10 and 20 weeks gestation, and body mass index at the time of their first antenatal appointment of ≥25 kg/m2. All women who were randomised to the Lifestyle Advice Group of the LIMIT trial received a series of consultations with both research dieticians and research assistants, in addition to standard written dietary and exercise materials (Standard Materials Group). Women randomised to the DVD Group received the same consultations and written materials, and additionally received an educational DVD (DVD Group). The primary study outcome was the Healthy Eating Index. Other study outcomes included physical activity, and gestational weight gain. Women completed a qualitative evaluation of all the materials provided. Results: 1,108 women in the LIMIT Lifestyle Advice Group participated in the nested trial, with 543 women randomised to the DVD Group, and 565 women to the Standard Materials Group. Women who received the DVD compared with those who did not, had a higher mean Healthy Eating Index at 36 weeks gestation (73.6 vs 72.3; adjusted mean difference 1.2; 95% CI 0.2 to 2.3; p = 0.02), but not at 28 weeks gestation (73.2 vs 73.5; adjusted mean difference −0.1; 95% CI −1.1 to 0.9; p = 0.82). There were no statistically significant differences in physical activity or total gestational weight gain. While most women evaluated the materials positively, frequency of utilisation was poor. Conclusions: Ongoing attention to the delivery of information is required, particularly with the increased use and availability of digital and multi-media interactive technologies.Malgorzata A Szmeja, Courtney Cramp, Rosalie M Grivell, Andrea R Deussen, Lisa N Yelland and Jodie M Dod

The cost-effectiveness of providing antenatal lifestyle advice for women who are overweight or obese: the LIMIT randomised trial

Background: Overweight and obesity during pregnancy is common, although robust evidence about the economic implications of providing an antenatal dietary and lifestyle intervention for women who are overweight or obese is lacking. We conducted a health economic evaluation in parallel with the LIMIT randomised trial. Women with a singleton pregnancy, between 10+0-20+0weeks, and BMI ≥ 25 kg/m2were randomised to Lifestyle Advice (a comprehensive antenatal dietary and lifestyle intervention) or Standard Care. The economic evaluation took the perspective of the health care system and its patients, and compared costs encountered from the additional use of resources from time of randomisation until six weeks postpartum. Increments in health outcomes for both the woman and infant were considered in the cost-effectiveness analysis. Mean costs and effects in the treatment groups allocated at randomisation were compared, and incremental cost effectiveness ratios (ICERs) and confidence intervals (95%) calculated. Bootstrapping was used to confirm the estimated confidence intervals, and to generate acceptability curves representing the probability of the intervention being cost-effective at alternative monetary equivalent values for the outcomes avoiding high infant birth weight, and respiratory distress syndrome. Analyses utilised intention to treat principles. Results: Overall, the increase in mean costs associated with providing the intervention was offset by savings associated with improved immediate neonatal outcomes, rendering the intervention cost neutral (Lifestyle Advice Group 11261.19±14573.97 versus Standard Care Group 11306.70±14562.02; p=0.094). Using a monetary value of $20,000 as a threshold value for avoiding an additional infant with birth weight above 4 kg, the probability that the antenatal intervention is cost-effective is 0.85, which increases to 0.95 when the threshold monetary value increases to$45,000. Conclusions: Providing an antenatal dietary and lifestyle intervention for pregnant women who are overweight or obese is not associated with increased costs or cost savings, but is associated with a high probability of cost effectiveness. Ongoing participant follow-up into childhood is required to determine the medium to long-term impact of the observed, short-term endpoints, to more accurately estimate the value of the intervention on risk of obesity, and associated costs and health outcomes

The Silesian struggle for recognition : emancipation strategies of silesian ethnic leaders

Silesians, according to the number of declarations collected during the 2002 and 2011 censuses, are the most numerous ethnic minority in Poland. Since the early 1990s, they have been demanding state recognition and legal protection. Silesian leaders have chosen to pursue these aspirations through legal channels. They have established organizations that unite representatives of Silesians. They have contributed to draft bills to the Polish parliament aimed at having Silesian recognized as a regional language, and a citizens' initiative calling for an amendment to the law on national minorities proposing the addition of the Silesian minority to the list of ethnic minorities. These efforts have met with opposition from the state, which treats Silesians as part of the Polish nation and refuses to recognize their distinctness. The pursuit of ethnic minority status also has adversaries among Silesians who have chosen other identities (Polish or German). This chapter presents the identity politics of Silesian ethnic leaders. I examine external and internal political strategies, highlighting both the actions undertaken as part of the ongoing campaign for state recognition, and those addressed to members of their own community

Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy

Abstract Background and purpose: The aim was to verify whether preoperative conventionally fractionated chemoradiation offers an advantage in sphincter preservation in comparison with preoperative short-term irradiation. Patients and methods: Patients with resectable T3-4 rectal carcinoma without sphincters' infiltration and with a lesion accessible to digital rectal examination were randomised into: preoperative 5 £ 5 Gy short-term irradiation with subsequent total mesorectal excision (TME) performed within 7 days or chemoradiation to a total dose of 50.4 Gy (1.8 Gy per fraction) concomitantly with two courses of bolus 5-fluorouracil and leucovorin followed by TME after 4-6 weeks. Surgeons were obliged to base the type of operation on the tumour status at the time of surgery. Results: Between 1999 and 2002, 316 patients from 19 institutions were enrolled. The sphincter preservation rate was 61% in the 5 £ 5 Gy arm and 58% in the radiochemotherapy arm, P ¼ 0:57: The tumour was on average 1.9 cm smaller ðP , 0:001Þ among patients treated with chemoradiation compared with short-term schedule. For patients who underwent sphincter-preserving procedure, the surgeons generally followed the rule of tailoring the resection according to tumour downsizing; the median distal bowel margin was identical (2 cm) for both randomised groups. However, in the chemoradiation group, five patients underwent abdominoperineal resection despite clinical complete response. Conclusions: Despite significant downsizing, chemoradiation did not result in increased sphincter preservation rate in comparison with short-term preoperative radiotherapy. The surgeons' decisions were subjective and based on pre-treatment tumour volume at least in clinical complete responders