Assessment Of The Incidence Of Transplant Renal Artery Stenosis (Tras) In The Early Post-transplantation Period

Abstract: Transplant renal artery stenosis (TRAS) affects 1-23% of recipients and accounts for about 75% of all post- transplantation vascular complications. Objective: The purpose of the work was to evaluate the incidence of TRAS in the period up to 6 months after kidney transplantation and analysis of selected stenosis risk factors in a group of patients transplanted in the Clinic of General and Transplantation Surgery of the Institute of Transplantology of the Medical University of Warsaw. Material and methods: A retrospective analysis of a group of 334 patients treated in the period from January 2014 to December 2015 was performed. The cases of patients in whom a≥50% stenosis of artery lumen was described on imaging studies within 6 months after transplantation were evaluated and selected stenosis risk factors were analysed. Results: The incidence of TRAS in the study (7.2%) is comparable to the results of other centres in Poland and abroad. No statistically significant relationships were found in the TRAS vs. non-TRAS groups for the studied risk factors (p>0.05). In the TRAS CD vs. LD groups, the value of the Phi index (φ=0.318) for the parameter of multiple renal arteries is of note. Conclusions: Multiple renal arteries may represent an important indicator in the diagnosis for TRAS. Read full text »

Obesity and Metabolic Syndrome

Abstract: Obesity is a state of the body, when the amount of energy delivered from food exceeds its consumption by the body. The concept of metabolic syndrome (MS) is determined by the coexistence of the clinical condition with connects risk factors for cardiovascular disease of atherosclerotic character and type 2 diabetes. Metabolic syndrome consists of: increased waist circumference, fasting blood glucose, hyperinsulinemia, lipid disorders, including reduced HDL cholesterol, hypertension, proinflammatory and prothrombotic states. The etiology of metabolic syndrome can be related to two reasons: “adipose-centric” and “diabetes-centric”. The basis of all these metabolic changes is an increased fat mass, a fundamental element of the pathogenesis of insulin resistance. Lack of physical activity, caloric and highly processed diet are not without significance for the development of MS. The paper discusses the influence of adipose tissue in the development of metabolic syndrome and the common denominator that links obesity to insulin resistance, which results in inflammation. In addition, the indicators reveal the prevalence of obesity and metabolic syndrome in Poland and in the world on the basis of the available literature. Additionally, the principles of dietary treatment and its importance in reducing the risk of cardio – vascular patients with metabolic syndrome are discussed. Data from studies conducted around the world confirm that we are dealing with an epidemic of the XXI century in the form of obesity and its complications, including metabolic syndrome. Read full text »

Nasal Septum Deviation In Children – Clinical Presentation And Methods Of Treatment. A Review.

Abstract: The deviation of nasal septum is a common deformity observed in children, with an increasing tendency in older age groups. It can be both, symptomatic and asymptomatic, depending on its size, location and other personal anatomical characteristics; on the other hand it may be an inborn feature or originate from a trauma. Due to the children’s growing process they stand for an exceptional population. Continuous development of the nasomaxillary complex leads to changes in the facial proportions, which may then result in the enhancement of persisting deformities or affect other structures. It has also been questioned for many years, how the proper approach towards such cases should look like and whether it should require an immediate (after trauma or after diagnosis) surgery or pre-planned postponed procedure until the growth ceases or the symptoms are unbearable. In our review we tried to analyse this issue and find the most optimal up-to-date solution to this problem. We also concentrated on clinical manifestation in order to answer the question about the correlation between the deviation and rhinosinusitis. Read full text »

Diabetic Retinopathy – Risk Factors, Pathogenesis, Diagnosis And Treatment

Abstract: Diabetic retinopathy (DR) or diabetic eye disease, is the major long-term complication of diabetes and main cause of vision impairment and vision loss. Major risk factors of the disease are the diabetes duration and glycemia (hyperglycemia and glycemic variations). One can also distinguish high blood-pressure, lipid disorders, pregnancy and puberty, age at diagnosis, ethnicity and genetic disorders among others. Diabetic retinopathy develops as a consequence of long-term accumulation of damage of retinal vessels. Its most advanced, proliferative stage leads to complications that are a direct cause of vision impairment or vision loss. The mechanism of this pathology includes macular oedema, vitreous hemorrhage, neovascular glaucoma and tractional retinal detachment by fibrovascular proliferations. Diabetic eye disease remains asymptomatic at the primary stages. In more advanced phases gradual vision acuity impairment is reported. In some cases, type 2 diabetes is diagnosed at the same moment as diabetic eye disease, which threatening with blindness. Running screening tests (fundus photography) allow to detect early, asymptomatic disease’s stages. Most frequently used diagnostics method to recognize DR ad hoc is direct ophthalmoscopy. Other useful methods are optical coherence tomography (OCT) and fluorescent angiography among others. Regular routine tests play a crucial role in DR diagnose. Pregnant women should be treated with special attention. The most substantial form of treatment and/or prevent from progress is intensification of metabolic control, minimalization of glucose fluctuations and achieve the normoglycemia. Laser coagulation and vitrectomy are also recommended, bearing in mind that their early performance gives better results. Intravitreal application of vascular endothelial growth factor (VEGF) antagonists and steroids has a positive impact on macular oedema. Read full text »

Carcinosarcoma Of The Uterus In A 30-year Old Patient – A Case Report

Abstract: Uterine carcinosarcoma is a very rare type of cancer. In most common cases it has poor prognosis, because it is discovered at an advanced stage. There is no specific test for this type of malignant neoplasm. We present an unusual case of uterine carcinosarcoma in a young patient. It was diagnosed accidentally after the pathological result of a cytological smear. The described case points at the usefulness of prophylactic examinations, as different types of malignancies can be detected in asymptomatic stages. Read full text »

Colorectal Cancer During Pregnancy – Case Report And Brief Review Of The Literature

Abstract: Malignancies in pregnant women are very rare with colorectal cancer being the eighth most commonly found. Colon cancer during the pregnancy is often diagnosed at an advanced stage because of its symptoms which are attributed to the pregnancy. This paper described a case of a 34-year-old female patient, 22 weeks pregnant, who was admitted to the Department of General and Transplantation Surgery due to deep venous thrombosis (DVT) and bleeding into the lower gastrointestinal (GI) tract. Endoscopy of the lower GI tract revealed an ulcerated polyp in the sigmoid colon. The histopathologic report showed infiltrated adenocarcinoma coli G2. The abdominal ultrasound scan (USS) and the chest X- ray detected hepatic and pulmonary metastases. After consideration, the tumor resection was postponed because it would not significantly improve the patient’s health condition and would endanger the fetus. The medical treatment plan was to wait until the 32nd-34th week of pregnancy and perform a simultaneous C-section, recto-sigmoid resection and hysterectomy. After intrauterine fetal death at 27 gestational week, computer tomography (CT) revealed disseminated metastases in the liver, lungs and peritoneum. The patient was referred to palliative chemotherapy. In conclusion, diagnostics and treatment of colon cancer during pregnancy is a challenge for the obstetrician and oncological team. Read full text »

Fetal Movements Monitoring As a Still Valid Fetal Well-being Assessment Method

Abstract: Fetal movement observation by pregnant women is the oldest and the cheapest way to assess fetal well-being. There is a scientifically confirmed correlation between weaker perception of the movements and increased risk of intrauterine fetal death. The investigated group comprised 154 patients from the Clinic of Obstetrics and Pathology of Pregnancy at the Medical University of Lublin, aged 17-45. Data were collected through the author’s questionnaire. Statistical analysis was performed in SPSS Statistics and Chi2 Test. In the investigated group 70.8% of women would count fetal movements every day and 13% were not doing this at all. Whereas 72% of women declare they have been informed by a doctor about the necessity to count fetal movements, 51.3% did not receive any materials that could facilitate the assessment of the physical activity of the fetus. Almost 50% of the women did not know how fetal movements change throughout pregnancy. Nonetheless, 45.5% of the patients correctly listed the indications for an urgent consultation in a health centre. The women were asked to state if the following sentence was correct: „a decreased number of fetal movements may indicate a fetal disease”. Over half (59.1% ) of the respondents answered the sentence was true. Women who obtained higher education gave the correct answer more frequently than those with secondary education. Patient awareness concerning monitoring fetal movements seems to be insufficient. There is a need for medical staff to pay more attention to education of pregnant women on the benefits resulting from monitoring the physical activity of the fetus. Read full text »

An Innovative Treatment of Endometriosis With the Use of Plasma Technology – Case Report

Abstract: Endometriosis is a condition, in which the endometrial cells grow outside the uterus. It is a cause of chronic pain, which may disturb a woman’s well-being. In addition, women suffering from endometriosis often remain infertile. The treatment is problematic and the disease has a tendency to recur. Case Report. The patient was a 41 – year old woman with diagnosed endometriosis in the scar after caesarean section. The implant caused boring and burning pain (10/10 points in the Visual Analogue Scale for pain). The endometriosis was surgically treated with the use of Plasma Technology. The time of hospitalization was 4 days. During the period of a 6 month observation, the patient did not have any pain complaints and re-surgery was not necessary. Conclusion. The use of innovative argon plasma method enabled to dissect the entire implant of endometriosis with no intraoperative or postoperative complications. The surrounding tissues were undamaged. After 5 years of suffering the patient remained pain-free and her mental condition ameliorated. Read full text »

The Influence of Enteral Nutritional Therapy on Patients’ Condition And Life Quality

Abstract:Diet almost always affects the condition of patients and the quality of their lives. Proper nutrition is extremely important during therapy of all disease entities. For the purpose of this publication a study was conducted which assessed the influence of enteral nutritional therapy (ENT) implementation on overall condition of patients and quality of their lives. Research was based on elaborated survey which assessed number of hospitalizations and medical consultations in patients before and after introduction of ENT. Survey also assessed subjective feels of patients and/or their caregivers connected with ENT. Research showed that ENT is a beneficial therapeutic solution in case of patients suffering from diseases which make normal eating impossible and lead to progressing emaciation of organism. Subjective assessment of life quality also improved. Read full text »

The Importance of Communication In Patient-Doctor Relationship – A Review

Abstract:Patient’s compliance plays an important role in diagnostic and therapeutic process. Enhancing compliance can be easily achieved by adequate communication between a clinician and the patient. The aim of the study was to identify factors which increase effectiveness of patient-doctor communication. Proper management should include providing information using a language understandable by the patient, and with just right amount of details. Awareness of condition increases the level of comfort and decreases anxiety associated with hospitalization. Moreover, satisfactory communication with physician might lower the risk of confronting malpractice claims in case of adverse effects. Lack of understanding of their condition and performed procedures raises patients’ doubts about clinical decisions. Doctors having better relationships with their patients appear as being more interested in their opinions and encouraging further conversations. These are the attributes of a non-hierarchical relationship that focuses on therapeutic partnership. Having identified specific communication behaviours, it is possible to design appropriate communication techniques. Postgraduate training programmes could be beneficial for most physicians, and apart from solving patient-oriented problems they could also improve teamwork among the medical staff. To achieve best effects, the training programme should be individualized and depend on clinician’s specialty. Enhancement of physician’s communication skills leads to mutual advantages for both sides. Read full text »