Pierwotny nowotwór zarodkowy śródpiersia : opis przypadku

Background: The medastinum is the most common location of primary germinal cell tumor and it accounts for about 10-15% of mediastinal masses in adults. Most patients are men- male to female ratio is 9:1. Malignant tumors include seminomas and nonseminomas tumors. Nonseminomatous GCTs respond to chemotherapy but the prognosis is poorer than in case of seminomas. Primitive embryonic tumors situated in mediastinum give early clinical symptoms connected with quick growth and pressure on organs important for life. Prognoses for these locations are worse than for others. Case report: We report a case of a 32-year-old male patient with shortness of breath and superior vena cava syndrome. Chest radiograph revealed an enlargement of the mediastinum. Multislice CT scan showed heterogeneous mass in the anterior mediastinum with solid components and central necrosis. The biopsy of nodule revealed Primary Germinal Cell Tumor with increased AFP and hCG markers. After the first course of chemotherapy the patient's condition had improved, but after four courses they decided on thoracotomy and resection of residual mass. The final histopathologic diagnosis was Teratoma Mature and Teratoma Immature with suspicion of positive surgical margin. Consequently, they decided on two courses of chemotherapy, gaining the regression of mediastinal mass. Patient remains under observation. Conclusions: Large size of Primary Germinal Cell Tumor implies malignancy. After chemotherapy the tumor may reflect residual mass with fat and fibrous component. The MSCT is a necessary method for monitoring dynamics of changes in the course of chemical treatment

Urban-rural differences in social capital in relation to self-rated health and subjective wellbeing in older residents of six regions in Poland

The aim of the study was to assess the differences between rural and urban areas as regards the role of social capital and its effect on self-rated health and subjective well-being among older people in Poland. The sample was selected on the basis of multi-stage clustered design from the non-institutionalized adult population. Analysis was based on 1,299 elderly people aged 65 and over from the general Polish population who participated in the COURAGE in Europe project. Six regions of Poland were distinguished according to first level of Nomenclature of Units for Territorial Statistics (NUTS) classification. As an indicator of social capital, the COURAGE Social Network Index, the OSLO-3 Social Support Scale, and the three item UCLA Loneliness scale were used, as well as social participation and trust was assessed. Self-rated health (SRH) was measured by WHO-Europe recommended version (ranging from ‘very good’ to ‘very bad’). Well-being was assessed by the Day Reconstruction Method. Results: The results showed that in urban areas, social network and social participation supported positive self-rated health; in rural, older residents the number of years of education and social support played the same role, while self-rated health decreased with an increasing level of loneliness. Self-rated health decreased in both groups of older people with a growing number of diseases. The multivariate linear regression model of predictors of well-being in older age also confirmed differences between urban and rural elderly residents. In rural residents, subjective well-being significantly increased with the positive effect of the social network. In both urban and rural areas, poor assessment of subjective well-being in older age increased with a higher level of loneliness and growing number of chronic diseases

Sleep duration and mortality among older adults in a 22-year follow-up study : an analysis of possible effect modifiers

The aim of this study was to assess the relationship of sleep duration and all-cause mortality among 2,449 Polish community-dwelling older citizens of Krakow observed during 22 years of follow-up. In particular, the role of some demographic, psychosocial and health-related conditions were investigated in terms of modification effect. In the prospective study, background information was gathered by face-to-face interview. Vital data were obtained from the population registry. Cox regression models were used to assess the role of sleep duration in mortality, in the analyses of potential effect modifiers and the shape of the relationship. Sleep duration was observed to be a significant predictor of all-cause mortality. Life-weariness, functional activity, total number of chronic diseases and age (65–79, 80+) were found to be effect modifiers for the relationship between sleep duration and mortality. Further investigation showed a U-shaped mortality risk associated with the duration of sleep among individuals with a high level of life-weariness, high functional activity and in individuals aged 80 and over. On the other hand, a linear relationship between longer sleep duration and mortality was observed among older people with no experience of life-weariness, without chronic diseases, with medium functional activity and aged 65–79, but also among those who reported three and more chronic conditions. Results of our study support available evidence showing the relationship between sleep duration and mortality among older adults and suggest that any public health intervention in this area should consider also other coexisting modifiable psychosocial and functional determinants

Stress and hypertension in married couples

Występowanie i rozwój chorób układu krążenia, w tym nadciśnienia tętniczego, związane może być ze stresem. Wyniki licznych badań wykazują, że relacje interpersonalne, w tym związki małżeńskie, mogą być zarówno źródłem wsparcia emocjonalnego, jak i silnym stresorem. Uczucia złości, wrogości, lęku czy depresyjność są nieodłącznie związane z sytuacją konfliktową, jaką jest kłótnia małżeńska. Udowodniono, że czynniki te mają wpływ na chorobowość i umieralność z powodu chorób układu krążenia. Jakkolwiek istnieje wiele dowodów na to, że osoby zamężne są zdrowsze od osób niezamężnych - konflikty małżeńskie zwykle wiążą się z gorszym stanem zdrowia. Styl radzenia sobie z konfliktowymi interakcjami w związku może prowadzić w konsekwencji do wystąpienia różnic między płciami w fizjologicznych odpowiedziach na stres. Zależności patofizjologiczne pomiędzy rozwojem nadciśnienia tętniczego a cechami osobowości tłumaczone są miedzy innymi nadmierną reaktywnością układu krążenia.Prevalence and progress of cardiac diseases, including hypertension, can be related with stress. Numerous studies show that interpersonal relationships, also marriages, could be the source of emotional support as well as strong stressor. The feelings of anger, hostility, anxiousness or depression are inseparably related with conflict situation such as marital conflict discussion. It is proved that these factors have an influence on morbidity and mortality rates caused by cardiovascular diseases. There are evidences that married persons are healthier than unmarried people, however marital conflicts are usually related with worse health state. Style of coping with stress in conflict interactions can lead to gender differences in physiological reactions to stress. Physiological relationships between progress of hypertension and personality traits are explained by i.a. excessive cardiovascular reactivity

Urazy układu moczowego u dzieci

Background: As shown by literature data, abdominal trauma in children is responsible for 14% of deaths, whereas in adults for 10%. Although abdominal traumas in children can be severe and lead to massive blood loss, most children die because of accompanying traumas of the thorax and head. It validates the surgical rule concerning abdominal traumas "investigate aggressively, manage conservatively". Posttraumatic injury of the urinary system is not frequent in children and its specificity (compared with adults), depends on greater susceptibility to external aggressive factors. Blunt trauma is the cause of renal parenchyma injury and acceleration/deceleration injury affects the excretory system and vessels. Extension mechanism is the cause of ureter avulsion and/or thrombus formation in stretched renal vessels - it is characteristic in children with non-accidental traumas. Bladder and urethra injuries are rare in children. During car accidents, a rupture of full bladder (seat belt injury) or bladder perforation by fractured bones of the pelvis is possible. Material/Methods: We analyzed all hospitalizations of abdominal trauma in our surgical ward in the year 2004 (70 cases). Renal injuries were found in 6 children (8.6%). Thanks to five-year clinical experience of our hospital, on the average only 1-2 cases per annum needed operation. The management of renal injuries involves first of all conservative treatment. This publication has educational character and may serve as a valuable reminder of the useful knowledge in daily cooperation between the emergency room, radiology department and surgical ward. Based on available literature from recent few years, we quote suggested renal injuries classifications and procedures.This publication contains only images from our department of radiology archives. Results/Conclusions: Clinical symptoms are often not appropriate for blunt abdominal traumas diagnosis. Owing to clinical status, which is difficult to interpret, fast and complete radiological diagnosis is necessary for proper treatment of children after abdominal trauma. Further complications of renal injuries may affect the further growth of the child

Validity and reliability of the quality of life questionnaire (EORTC QLQ C30) and its breast cancer module (EORTC QLQ BR23)

Summary Objectives: The aim of this study was to assess validity and reliability of the EORTC QLQ C30 and BR23 questionnaires among patients with breast neoplasm in Poland. Material and methods: Analysis was done on the basis of research conducted at the First Department of General Surgery, JUMC, Krakow, among 105 women. Two aspects of questionnaire validity have been analyzed: construct validity using principal component analysis and criterion validity evaluated by comparison of two clinical subgroups of patients. Reliability analysis was done by estimating internal consistency using Cronbach’s alpha coefficient and correlations between items and hypothesized scales. In addition, test-retest reliability was evaluated by calculating the correlation coefficient between two assessments, done 6 and 12 months after treatment. Results: All scales met Nunnally’s criterion except for the scale of nausea and vomiting. Almost all variables met Kline’s criterion, except for two variables: one from the scale of physical functioning and the other a part of the scale of systemic therapy side effects. High correlations obtained by the test-retest method confirmed the reliability of all scales. Analysis showed some fault in the theoretical validity of the scale of systemic therapy side effects. Nonetheless, criterion validity was confirmed for all scales. Conclusions: Results have confirmed the validity and reliability of the EORTC QLQ C30 and BR23 tests as instruments for quality of life evaluation in Polish patients