The objective of the study was to create a printable 3D model of the sellar region of the sphenoid bone for demonstrating anatomical variant of the osseous bridging between anterior and posterior clinoid processes. Three-dimensional reconstruction of the middle cranial fossa along with 3D printed model, allow for accurate depicting position of the interclinoid bridge with reference to other basicranial structures.
Introduction: Trauma is one of the leading causes of death in the European Union. The European Trauma Course (ETC) is a training course that focuses on administering aid to trauma patients in a Hospital’s Emergency Department by creating an effective and well-organized trauma team. The purpose of the study is to analyze how the ETC training is evaluated by its participants and whether it is tailored to local needs.
Materials and Methodology: The study includes eight courses conducted between 2010 and 2015, involving 109 medical professionals. Participants were given questionnaires where they could evaluate the various aspects of the course and comment on each of them, using a four-level scale. Finally, 78 surveys were qualified for the study.
Results: The exercises were very highly rated (average 3.79 points), mainly for their interesting scenarios and station preparation. Equally well-evaluated was the short and concise method of instruction. The lowest ranked aspect was the course fee (2.41 points). There were oft en negative comments about the use of English during the training (lectures and manuals).
Discussion: The opinions of Polish students were similar to those of ETC participants in other European countries. There are many interesting advantages of workshop scenarios, while the downside is the time constraint. Nevertheless, the ETC has been very successful. High ratings and positive feedback affirm the high demand for such courses in Poland.
Objective: The aim of this study was to verify if the exposure to the pulsed electromagnetic field (PEMF) infl uenced the release of proinfl ammatory cytokines from adipose-derived stem cells (ADSCs) of normal and overweight rats of various age and sex. Moreover, we compared body temperatures of normal-weight and overweight rats.
Methods: ADSCs of Wistar rats were isolated from the subcutaneous area in females and paratesticular region in males, cultured and exposed to PEMF (7 Hz, 30 mT). Concentrations of proinflammatory cytokines were determined in rat sera and supernatant from ADSCs cultures exposed and non-exposed to PEMF. Body temperature (BT) was measured twice a week, using an infrared and rectal thermometer.
Results: Irrespective of age and sex, animals maintained on low-fat (LF) diet had higher BT than those grown on high-fat (HF) diet. Exposure to PEMF reduced the release of TNF-α and enhanced the production of IL-6 in ADSCs cultures from female pups maintained on LF diet. In contrast, a decrease in IL-6 level was observed in PEMF-exposed ADSCs cultures from female pups grown on HF diet. A similar phenomenon, i.e. a post-exposure increase in IL-6 level was also observed in male pups fed with the LF diet. In the case of ADSCs cultures from adult rats maintained on an HF diet, either males or females, PEMF exposure contributed to a dramatic increase in TNF-α production.
Conclusion: Our findings suggest that PEMF exposure may affect the production of proinflammatory cytokines in ADSCs cultures. The intergroup diff erences in BT may result from the presence of an underlying inflammation in obese rats.
Hypertension constitutes one of the most common diseases leading patients to the Outpatient Departments. Idiopathic hypertension is the prevailing type, but on the other hand, the possible presence of clinical entities responsible for the development of secondary hypertension should never be underestimated. We retrospectively studied 447 subjects aged between 20 and 84 years old and diagnosed with hypertension, who were thoroughly evaluated for secondary hypertension. Our analysis demonstrated that 35 out of the 447 subjects were fi nally diagnosed with secondary hypertension, representing a relative frequency of 7.8%. Most common causes of secondary hypertension identifi ed in our study group were: glucocorticoid intake (n = 14), obesity hypoventilation syndrome (n = 6), obstructive sleep apnea (n = 2) and preeclamspia (n = 2). Several other causes are also reported. Our study, conducted in a single center in Northern Greece, confi rms previous reports concerning the prevalence of secondary hypertension among Greek patients, shedding light on potential pathophysiologic mechanisms. In conclusion, a high proportion of hypertensive individuals still feature have an underlying cause, thus, diagnostic work-up should be thorough and exhaustive, in order the correct diagnosis to be made and the targeted treatment to be initiated.
Congestive heart failure (CHF) is the fi nal stage in several heart diseases. The diagnosis of CHF in older patients is a challenge. Preserved left ventricular systolic function is a characteristic type of CHF in seniors. The purpose of the study was to characterize elderly patients with CHF and to highlight specific features of the conditions in seniors. The most common etiology of HF in this group of patients is hypertension and coronary heart disease. In seniors atypical presentations of chronic heart failure is much more common than in younger patients. Malnutrition, limitations of exercise and sedentary lifestyles or comorbid diseases have an influence on asymptomatic, early stage of HF. Th ere are better outcomes of treatment in obese individuals. It is called the obesity paradox. Open communication with a patient and his/her family may improve their response to therapy. When heart failure becomes an incurable disease and aggressive treatment is ineffective, palliative care should be considered in end-of-life heart failure patients. The goal of treatment in the remaining moments of life last moments of life should be maximizing the patient’s comfort.
Background: In early phase of acute pancreatitis (AP), systemic inflammatory response syndrome may lead to organ failure. The severe form of AP is associated with high mortality that may be prevented by timely diagnosis and treatment of the predicted severe cases. Serum interleukin 6 (IL-6) and urokinase-type plasminogen activator receptor (uPAR) have been proposed as accurate early markers of severe AP. The aim of the study was to assess whether widely available blood count indexes: neutrophil to lymphocyte (NLR), lymphocyte to monocyte (LMR) and platelet to lymphocyte ratios correlate with IL-6 and uPAR and may be utilized to predict organ complications at the early phase of AP.
Methods: The study included 95 adult patients with AP treated at the Surgical Ward Complex of Health Care Centers in Wadowice, Poland. Organ failure was diagnosed according to modified Marshall scoring system, as recommended by 2012 Atlanta classification. Blood samples for laboratory tests were collected on days 1, 2 and 3 following the onset of AP symptoms.
Results: Patients with organ failure presented significantly lower LMR on day 1 and signifi cantly higher NLR on days 2 and 3. Strong positive correlations between NLR and IL-6 and moderate correlations between NLR and uPAR were observed throughout the study. Day 2 and 3 NLR values significantly predicted organ failure at the early phase of AP.
Conclusions: Taking into account the wide availability of NLR, it may be considered as a surrogate of more expensive tests to help the early assessment of organ failure complicating AP.
Background and Aim: Patients with acute pulmonary embolism (APE) associated with hemodynamic instability, i.e. high-risk APE (HR-APE), are at risk for early mortality and require urgent reperfusion therapy with thrombolysis or embolectomy. However, a considerable proportion of HR-APE subjects is not reperfused but only anticoagulated due to high bleeding risk. The aim of the present study was to assess the management of HR-APE in a single large-volume referral center.
Methods: A single-center retrospective study of 32 HR-APE subjects identified among 823 consecutive patients hospitalized for symptomatic APE.
Results: Out of 32 subjects with HR-APE (19 women, age 69 ± 19 years), 20 patients were unstable at admission and 12 subsequently deteriorated despite on-going anticoagulation. Thrombolysis was applied in 20 (62.5%) of HR-APE subjects, limited mainly by classical contraindications in the remainder. Percutaneous pulmonary embolectomy was performed in 4 patients. In-hospital PE-related mortality tended to be higher, albeit insignifi cantly, in the patients who developed hemodynamic collapse during the hospital course compared to those unstable at admission (67% vs. 40%, p = 0.14). Also, survival was slightly better in 22 patients treated with thrombolysis or percutaneous embolectomy in comparison to 10 subjects who received only anticoagulation (54% vs. 40%, p = 0.2). Major non-fatal bleedings occurred in 7 of 20 patients receiving thrombolysis (35%) and in 2 (17%) of the remaining non-thrombolysed 12 HR-APE subjects.
Conclusions: Hemodynamically instability, corresponding to the definition of HR-APE, affects about 4% of patients with APE, developing during the hospital course in approximately one-third of HR-APE subjects. As almost 40% of patients with HR-APE do not receive thrombolytic therapy for fear of bleeding, urgent percutaneous catheter-assisted embolectomy may increase the percentage of patients with HR-APE undergoing reperfusion therapy. Further studies are warranted for a proper identification of initially stable intermediate-risk APE subjects at risk of hemodynamic collapse despite appropriate anticoagulation.
Pigmented villonodular synovitis (PVNS) is a benign disease that rarely undergoes malignant transformation. Th ere are two types of disease: localized (nodular tenosynovitis) and diff used (pigmented villonodular synovitis/tenosynovitis) with intra- or extra-articular locations. Th e second one is limited to synovium of the burse (PVNB) or tendon sheath (PVNTS). Th e intraarticular lesions are usually located in the knee, hip, ankle and elbow joints. Histologically, PVNS is a tenosynovial giant cell tumor, characterized by proliferation of two types of mononuclear cells — predominantly small, histiocyte-like cells and larger cells with dense cytoplasm, reniform or lobulated nucleus, with accompanying multinucleated giant cells and macrophages overloaded with hemosiderin that give typical image on MRI — currently selected as a gold standard for its diagnosis. Th e classic X-ray and CT are non-specifi c but similar to ultrasound should be used to evaluate disease progression and treatment response if radiotherapeutic and pharmacological methods were selected for treatment. An open arthroscopic surgery could also be applied in selected cases.
Introduction: Clostridium difficile (C. difficile) is a Gram-positive, anaerobic rod-shaped bacteria, widely spread in the human environment. In the last decade, the frequency and severity of Clostridium difficile infection (CDI) have been increasing, making this particular disease one of the most significant nosocomial infections. The aim of our study was an analysis of CDI risk factors, its course and consequences.
Materials and Methods: Medical documentation of the patients treated for CDI in the University Hospital in Cracow and St Anne’s Hospital in Miechów has been analysed. The analysis focused on epidemiological data, blood parameters, comorbidities, recurrence rate, and complication rate (deaths included). As part of risk factors analysis, antibiotic use or hospitalisation in a period of 3 months before the episode of infection was considered relevant. Blood tests have been performed using routinely employed, standard methods.
Results: We evaluated data of 168 people infected with C. difficile, out of which there were 102 women (61%) and 66 men (39%). Th e median age of the patients was 74 years for the entire population with 76 years for women and 71 years for male patients. One hundred thirteen people (67%) had been previously hospitalised, and 5 person was a pensioner of a nursing home. 99 people (59%) were treated with antibiotics within 3 months before the first episode of infection. An average length of the hospital stay because of CDI was 11 days. One hundred thirty persons (77%) experienced only 1 episode whereas 38 people (23%) had more than 1 episode of infection. The person with the largest number of recurrences had 9 of them.
Conclusions: The development of CDI is an increasing problem in a group of hospitalised persons, particularly of an old age. The general use of beta-lactam antibiotics is the cause of a larger number of infections with C. diffi cile. Vast majority of patients have had at least one typical risk factor of CDI development.
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