Treatment of cerebral palsy using stem cells

Cerebral palsy is a wide group of diseases whose common feature are motor disorders. Patients affected by this condition show abnormalities of movement and posture. Various possible causes of damage were identified. Hypoxia, ischemia, infection, injury and congenital defects are one of the conditions that increase the risk of the disease. The first signs of cerebral palsy noted by parents are: incorrect head and torso stabilization, inability to sit and walk at the right age. There are currently no treatments available that would indicate good efficacy. . In recent years, stem cell therapies have enjoyed considerable interest. The encouraging results of many preclinical studies have indicated that stem cell therapy may have benefits in neonatal diseases. Despite many encouraging reports, data on the effectiveness of stem cell therapy in cerebral palsy are still insufficient. Scientists should continue to research the success of the therapy

Moya Moya's disease in a 20-year-old female patient – case report

Introduction Moya-Moya disease is a rare disease of unknown etiology that causes pathological occlusion changes in the large intracranial arteries - the internal carotid artery and the proximal parts of the anterior and middle cerebral arteries. The disease occurs most often among young Asian women, and its most intensive development falls on the first decade of life. In most cases, Moya-Moya occurs in the form of transient ischemic attacks, strokes or cerebral hemorrhages. Case report A 20-year-old woman was admitted to the Neurosurgery Clinic for the surgical treatment of Moya-Moya disease. Patient with paroxysmal paresis of left and right limbs several times since 2016. In CT, MRI and angio-MRI, as well as DSA, critical narrowing of the internal carotid arteries, obstruction of the anterior and central lights of the cerebral arteries, with small vessels around the central arteries and their branches marked - bilaterally, but mainly on the right. The changes create an image resembling "clouds of smoke" that is characteristic of Moya-Moya's disease. The patient was qualified for surgical treatment - revascularization of the cerebral cortex with the use of periosteal strips by multi-hole trepanation in the right fronto-temporo-parietal region. Periosteal stripes were introduced into the subarachnoid space to reproduce vessels of the cerebral cortex. Conclusion Because of the rarity of Moya Moya disease, it is very important to be alert vigilantly to avoid complications such as tetraparesis or mental retardation. Japanese surgery allows revascularization of the cerebral cortex without the need for an arterial bypass. The presented surgical method ensures good treatment effects and is preferred in young people due to the safety of the technique used. Keywords: Moya Moya disease, neurosurgery, hemorrhage

Designer drug poisonings as a growing clinical problem

Introduction and purpose: Designer drugs also known as legal highs, research chemicals or herbal highs become more and more popular not only in Poland but also in other countries around the world. That might have many reasons but the most crucial is their easy availability and rather cheap price in comparison to other psychoactive substances. Material and methods: We analyzed the data of patients hospitalized in years 2013-2018 in the Toxicology Department in Lublin and evaluated patients hospitalized due to psychoactive substance poisoningT40 according to ICD10). Moreover the review of available scientific articles was done. Results: After analysis the data of patients hospitalized in years 2013-2018 we can observe increasing tendency of poisonings. The growing number of designer drug poisonings may be the result of many factors - the phenomenon of these substances is based not only on a wide range of products, but also on various advertising strategies and patterns of use. Conclusions: There can occur big diagnostic difficulties due to unpredictability of the course of poisoning and unpredictability of composition. Therefore it is very important to react quickly and choose the right treatment. Many of these poisonings are really severe and often cause death. It is worth saying that side effects occur more often in combined preparations. It is also very important to educate young people and warn against using NPS, which are particularly dangerous and risky for human organism

Patient with depression poisoned with psychopharmaceutics and ethanol – case report

In Poland in 2016, there were almost 10,000 suicide attempts, in which about 55% ended up with death. Suicidal attempts are more often taken by women, but they are more effective in the case of men. Most of these people are afflicted with mental illness such as depression. A 49 year old man was admitted to Cardiology and Toxicology Department, because of poisoning with antipsychotic drugs and ethanol. It was his second suicide attempt. The day he was admitted to the hospital he was in serious condition. Patient was monitored, symptomatic treatment and pharmacotherapy were initiated. The patient required intubation and the use of respiratory therapy because of breathing problems. In the clinical study and imaging examinations massive pneumonia, was confirmed. His pharmacotherapy was modified and the antibiotics were given because of inflammation of a lungs. For patients poisoned by various substances, respiratory failure often has a complex medium. It may result from the depression itself of the xenobiotics on the respiratory system, the influence of the indirect mechanism of breathing or the result of aspiration and development of pneumonia. In therapy the most important is the monitoring of the patient's condition, electrolyte imbalance and symptomatic treatment. In a few cases and only for some drugs, we can use a specific antidote

A problem of multiple drug overdose by patient with schizophrenia - case report

Introduction Suicidal risk caused by drug overdose is a considerable factor influencing earlier mortality among people with schizophrenia. An adjustment of effective pharmacological treatment is essential to sustain the stability of the patient. Commonly, the treatment divides to two groups: first generation antipsychotics (FGA) and second-generation antipsychotics (SGA). Yet, due to significant risk of depression and possible side effects of the drugs, other medicaments should also be introduced. Case report A 38 years old woman that was repeatedly hospitalized at the local ward, brought by ambulance and admitted to the Clinical Toxicology Department. She was admitted to the department for 20th time in period between April 2013 and May 2019 due to deliberate drug overdoses. During last hospitalization laboratory tests indicated presence of valproic acid (121,41 μg/ml). Moreover, psychiatric consultation revealed that although she was balanced state, she was not critical about her behavior. Patient was diagnosed with schizophrenia and mild intellectual disability. Each time, the intoxication was followed by medications from group of antipsychotics and tranquilizers used in treatment of the illness. Additionally, she confirmed that some of intoxications had suicidal attempt. 60% of hospitalizations of the patient were followed by stay in Neuropsychiatric hospital for further observation and treatment. Conclusion The administration of proper dosage of antipsychotics should be precisely controlled by the psychiatrist that takes care of the patient. For patients with greater suicidal risk, SGA are more recommended than FGA. Moreover, drugs from other groups such as antidepressants should also be introduced. Undoubtedly, efficient pharmacological treatment should be supported by psychotherapy of the patient

The use of tamoxifen in the treatment and prevention of breast cancer

Breast cancer is the most frequently occurring malignant neoplasm among women. Statistically, it constitutes 22,8% of all malignant neoplasms among females. Despite the fact that the causes of the disease remain unknown, a few risk factors are contributing to its development. Age, family history, type of lifestyle, hormones and genetic background have a significant association with occurrence of breast cancer. Due to the fact that time in which female sex hormones affect mammary gland is one of the most important risk factors of breast cancer development, more researchers focused on the use of drugs such as selective estrogen receptor modulators (SERMs) in the disease prevention. Tamoxifen has antiestrogenic effect. That results in the inhibition of both- growth factors release and synthesis by the tumour. Moreover, this drug works as agonist, replacing oestrogen to many tissues, such as the ones in liver, bone, breast and uterus. In the literature there are many reports about the effectiveness of tamoxifen in the prevention of breast cancer. The drug, in addition to using it as adjuvant therapy for breast cancer, can be used as a prophylactic of the disease. Side effects of the drug are rare, but they can not be completely excluded. Breast cancer, which is currently the most common tumour in the globe, is a serious worldwide public health quandary. Tamoxifen is considered to be a pioneering drug as it is used in combined breast cancer therapy and also in chemoprophylaxis ,but every case of using the medicine should be considered individually to assess benefit-risk ratio

Stent fracture as a complication of superficial femoral artery stenting – a case report

Introduction: Peripheral artery disease (PAD) is an atherosclerotic vascular disease that results in obstruction of blood flow in the arteries other than those in the coronary circulation. PAD is often located in lower extremities, with patients presenting symptoms of intermittent claudication or critical lower limb ischemia. Angioplasty and stent implantation are often used in the treatment of PAD. Although these methods are considered as a low invasive and low risk, some factors may limit stent patency in the future. The fracture of the implanted stent may be one of these. Case report: A 68 old man, long-term smoker, with a history of chronic limb ischemia and many vascular surgeries because of PAD was admitted to the hospital with symptoms of the acute limb ischemia. Angiography showed a fracture of the stent implanted during the earlier hospitalization, with a fragment displacement to the left external iliac artery. The patient was successfully treated with catheter-directed thrombolysis. Discussion: Stent fracture is usually asymptomatic, however, it may cause complications, such as restenosis, pseudoaneurysm, perforation of the vessel, and in-stent embolism. The cumulative incidence of the femoropopliteal stent fracture varies from 2 to 65% in several studies. Incidence increases with stent length and is significantly lower in the second generation of nitinol stents, that was designed to have enhanced flexibility and durability

Prevalence and risk factors of abdominal aortic aneurysm among over 65 years old population in Lublin, Poland

Introduction: Abdominal aortic aneurysm (AAA) is a disease exceptionally well suited to screening. Ultrasound- based screening meets all criteria for a screening program according to the WHO, and there is a large evidence supporting its usefulness. Risk factors, mentioned in the available literature, associated with aneurysm formation are advanced age, male gender, tobacco smoking, hypertension, atherosclerotic disease and family or personal history of aortic aneurysms. The aim of the study was to evaluate the incidence of abdominal aortic aneurysms in the population of men and women older than 65 years, in Lublin, Poland and to identify the correlation between risk factors and the AAA incidence. Material and methods: A single-center screening study, for men and women older than 65-years was conducted in Lublin, Poland in May 2018. Patients underwent basic screening ultrasound with measurement of the diameter of abdominal aorta and iliac arteries. Each patient completed anonymous questionnaire to investigate risk factors of developing AAA. Results: 1032 patients, aged 65–91 (median age 71.37) were examined. 569 of them were women and 463 men. 27 aortic aneurysms were detected — 7 in a group of women and 20 in a group of men. The total incidence rate of AAA in our study was 2.62%; 1,23% in women and 4,32% in men. Male gender, cigarette smoking, coronary artery disease and a history of myocardial infarction all appeared to be major risk factors of AAA, with relative risk ranging from 2,75 to 4.53. The median diameter of the abdominal aorta was 19.24 mm and varied in groups of patients with different risk factors. Conclusions: The estimated prevalence of AAA in the screened population is within the range of the values reported in previous publications, however, it may confirm a trend of declining prevalence of AAA showed in some recent studies. The presented study confirms the correlation between the AAA and its major risk factors (male sex, smoking cigarettes, coronary artery disease and history of myocardial infarct) as well as a weak association between AAA and hypertension and a negative correlation with diabetes

Severe ethylene glycol poisoning of 56 years old woman – case report

Backgrounds: Ethylene glycol poisoning is one of the heaviest poisonings in the toxicological practice of. Ethylene glycol is quickly absorbed from the digestive tract. Its toxicity is the result of combining few different mechanisms. Metabolites of decomposition, especially glycolic acid, are responsible for appearance of metabolic acidosis. Precipitated crystals of calcium oxalate additionally impair the function of organs such as kidneys, central nervous system (CNS) and circulatory system. Worldwide, from 2013 to 2018 about 30% of ethylene glycol poisoning cases end in death. Case report: We present the case of 56 years old woman, who was admitted to Toxicology Department because of ethylene glycol poisoning. We could observe presence of metabolic acidosis, respiratory insufficiency and organ damage. The patient has been treated pharmacologically and has been given specific antidote. Due to the ethylene glycol intoxication, metabolic acidosis and increasing parameters of kidney failure the patient also underwent hemodialysis. Conclusions: In pathogenesis of ethylene glycol poisoning toxic metabolits are crucial. The diagnosis of ethylene glycol is often a very hard task. In the clinical aspect it is based on the interview, a set of syndromes and biochemical tests and targeted toxicological tests. This kind of poisoning occur the most often among patients addicted to alcohol. It may lead to multi- organ damage or even death. It is very important to react quickly and implement pharmacotherapy and hemodialysis. The other essential aspect is to improve the level of knowledge of students and doctors about symptoms, diagnostics and proper proceeding with a patient poisoned with ethylene glycol. According to statistics and knowing how often the alcohol poisoning happens it is necessary to have knowledge in this field, be fluent in management and choosing methods of treatment in such cases

Deep vein thrombosis in a 19-year-old patient with thrombophilia - description of the diagnosis and treatment

Introduction: Deep vein thrombosis (DVT) is a condition in which a blood clot forms in one of the body's deep veins, most commonly of the leg or pelvis. Before the fourth decade of life risk of DVT is low (about 1 per 10000). After the age of 45, it rises and approaches about 5 per 1000 by the age of 80. Noteworthy is the fact, that patients with a positive family history have a higher risk of DVT at a young age. Essential risk factors for developing DVT are genetic conditions or acquired thrombophilia and positive family history, but the lack of family predisposition cannot rule out the occurrence of DVT. Standard treatment method of DVT involves intravenous anticoagulation with the use of low molecular weight heparin and compression therapy. Apart from the above-mentioned methods, we can distinguish intermittent pneumatic compression, surgical embolectomy, pharmacomechanical thrombectomy, and venous stenting. Case Report: We present a case report of 19 - year old patient who was first admitted to hospital in April 2017 urgently with symptoms of pulmonary embolism which was confirmed in angio-CT. Moreover, in the Doppler ultrasound, left common iliac vein (LCIV), left external iliac vein (LEIV) and left femoral vein (LFV) thrombosis was diagnosed. During the hospitalization, genetic tests, antibody levels, and antithrombin levels were performed for thrombophilia and systemic diseases conducive to thrombosis. In October 2017 the angio-MR of the pelvis confirmed visible pressure on the LCIV, caused by the common iliac artery, which corresponds to the May-Turner syndrome. In March 2018 he was admitted to the clinic with DVT symptoms of the left lower limb such as swelling, pain, and redness. The patient underwent venous angioplasty and stent implantation for LCIV. The patient was discharged from hospital with recommendations such as compression therapy, Doppler ultrasonography and monitoring of INR. Discussion: Venous thrombosis is a multicausal disease: more than one risk factor needs to be present before thrombosis occurs. Choice of DVT treatment method is aimed at improving the quality of life of patients depending on clinical symptoms. venous stenting for an iliofemoral occlusive disease is a safe and effective method of treatment. It can be done with excellent patency rates expected in cases of idiopathic occlusion and May-Thurner syndrome. On this basis, the legitimacy of using venous stent implantation as an effective method of treatment of recurrent DVT episodes can be confirmed, which has been used in the described case