Medicine In Warsaw Research Articles

Jak leczymy pacjenta z nowo rozpoznaną amyloidozą łańcuchów lekkich pośredniego ryzyka? Rola doksycykliny w terapii amyloidozy z zajęciem serca

Treatment of patients with light chain amyloidosis (AL amyloidosis) is a challenge in routine clinical practice. Although deep and durable hematologic response is crucial for the success of the therapy, in this group of patients the proper conduct of supportive care becomes particularly important. Because AL amyloidosis is an interdisciplinary disease entity, the therapeutic process should be coordinated by an interdisciplinary team consisting of a hematologist, cardiologist, nephrologist, gastroenterologist, neurologist and clinical dietician. In this paper, we present a strategy for treating a patient with a newly diagnosed systemic intermediate-risk AL amyloidosis with cardiac involvement in the Department of Hematology of the Institute of Hematology and Transfusion Medicine in Warsaw, in which, apart of standard chemotherapy, doxycycline was used.

Usefulness of Cryoprobe in Office Hysteroscopy for Removal of Polyps and Myomas.

Hysteroscopy is a gold standard in 21st-century gynaecology for both diagnosis and treatment procedures of intrauterine pathologies. Miniaturisation of the equipment and better techniques of performing this procedure allowed it to become the gold standard. Nevertheless, hysteroscopy has its limitations, which is the size of the endometrial polyps or submucous myomas. We have invented a new device for the 5Fr working channel hysteroscopes for possessing and resecting intrauterine structures: the cryoprobe. The retrospective cryobiopsy study presented here was conducted at the Department of Gynaecology and Oncological Gynaecology, Military Institute of Medicine in Warsaw, Poland, from October 2017 to January 2018. Its purpose was to assess the usefulness of the new device in office hysteroscopy for the removal of polyps and myomas with a diameter over 10 mm. Thirteen patients with an initial diagnosis of an endometrial polyp or submucous myoma were enrolled in the trial. All procedures took place in day-surgery settings, with a total resection of the pathological intrauterine structure, without complications. The application of the cryoprobe may enhance the usefulness of office hysteroscopy, without extending the procedure. The cryoprobe efficiency is still under research in a bigger group.

Enukleacje w materiale Kliniki Okulistyki Wojskowego Instytutu Medycznego w Warszawie w latach 2014–2018

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Różycki R, Chojnacka E, Rękas M. Enucleation in the material of the Department of Ophthalmology of Military Institute of Medicine in Warsaw in 2014–2018. Klinika Oczna / Acta Ophthalmologica Polonica. 2018;120(4):221-226. doi:10.5114/ko.2018.82895. APA Różycki, R., Chojnacka, E., & Rękas, M. (2018). Enucleation in the material of the Department of Ophthalmology of Military Institute of Medicine in Warsaw in 2014–2018. Klinika Oczna / Acta Ophthalmologica Polonica, 120(4), 221-226. https://doi.org/10.5114/ko.2018.82895 Chicago Różycki, Radosław, Ewelina Chojnacka, and Marek Rękas. 2018. "Enucleation in the material of the Department of Ophthalmology of Military Institute of Medicine in Warsaw in 2014–2018". Klinika Oczna / Acta Ophthalmologica Polonica 120 (4): 221-226. doi:10.5114/ko.2018.82895. Harvard Różycki, R., Chojnacka, E., and Rękas, M. (2018). Enucleation in the material of the Department of Ophthalmology of Military Institute of Medicine in Warsaw in 2014–2018. Klinika Oczna / Acta Ophthalmologica Polonica, 120(4), pp.221-226. https://doi.org/10.5114/ko.2018.82895 MLA Różycki, Radosław et al. "Enucleation in the material of the Department of Ophthalmology of Military Institute of Medicine in Warsaw in 2014–2018." Klinika Oczna / Acta Ophthalmologica Polonica, vol. 120, no. 4, 2018, pp. 221-226. doi:10.5114/ko.2018.82895. Vancouver Różycki R, Chojnacka E, Rękas M. Enucleation in the material of the Department of Ophthalmology of Military Institute of Medicine in Warsaw in 2014–2018. Klinika Oczna / Acta Ophthalmologica Polonica. 2018;120(4):221-226. doi:10.5114/ko.2018.82895.

Parotid gland tumors. Results of retrospective analysis of 149 patients treated at the Clinical Department of Cranio-Maxillofacial Surgery, Clinic of Otolaryngology and Oncologic Laryngology of Military Institute of Medicine in Warsaw in years 2006-2016.

Wstęp: Nowotwory mające swoją etiologię w gruczołach ślinowych występują rzadko i stanowią ok. 3-10% wszystkich guzów w obrębie głowy i szyi. Materiał i metody: W latach 2006-2016 w Klinicznym Oddziale Chirurgii Czaszkowo-Szczękowo-Twarzowej Wojskowego Instytutu Medycznego w Warszawie z powodu nowotworów ślinianek przyusznych hospitalizowano i leczono 149 pacjentów. Podstawą do analizy były historie chorób pacjentów, wyniki badań histopatologicznych oraz protokoły zabiegów operacyjnych. Wyniki: W 126 przypadkach guzy były łagodne, natomiast w 26 guzy złośliwe. Analizując wyniki można stwierdzić, że nowotwory - zarówno łagodne, jak i złośliwe - częściej występowały u mężczyzn. Średni wiek całej grupy badanych wynosił 58,3 lat, dla zmian złośliwych - 65,5 lat, a dla zmian łagodnych był nieznacznie niższy i wynosił 56,9 lat. Wśród pacjentów objętych analizą szczyt zachorowalności przypadał na przedział wiekowy 60-69 lat. Ponadto zwraca uwagę, iż przedział ten był taki sam dla ogólnej liczby guzów, jak i nowotworów łagodnych, natomiast dla nowotworów złośliwych był nieznacznie wyższy i wynosił 70-79 lat. Z analizy zebranego materiału wynika, że guzy łagodne występowały znamiennie częściej, stanowiąc 84,56% wszystkich guzów. Najczęstszymi rozpoznaniami wśród nowotworów łagodnych były gruczolak wielopostaciowy (adenoma pleomorphicum) oraz gruczolak limfatyczny (adenolymphoma), które stanowiły łącznie 93,66%. Rezultaty badań wskazują, że wśród nowotworów złośliwych dominowały: gruczolakorak polimorficzny o niskiej złośliwości (polymorphous low-grade adenocarcinoma) występujący w 26,07% przypadków, gruczolakorak inaczej nieokreślony (adenocarcinoma NOS) oraz rak zrazikowokomórkowy (acinic cell carcinoma). Każdy z nich stanowił po 13,04% rozpoznań. Jak wynika z przeprowadzonej analizy najczęstszą metodą leczenia było leczenie chirurgiczne jako metoda stosowana samodzielnie. Wnioski: Uzyskane z retrospektywnej analizy dane korelują z piśmiennictwem krajowym i światowym.

The meaning and classification of tattoos in the context of their suitability to identify corpses of unknown identity.

To present the most popular types of tattoos, their meaning and classification, and to assess the suitability of different forms of tattoos in the process of identification of corpses of unknown identity. The tattoos found on 729 cadavers who underwent post mortem examinations at the Department of Forensic Medicine in Warsaw in the years 2012-2015 were analyzed. The tattoos were photographed and identified in terms of their meaning domain and classified into groups. Tattoos belonging to all groups were found, according to the most popular tattoo classification, which is based on their nature and includes: criminal and prison tattoos (defining the prison hierarchy, criminal profession as well as intentions and goals, erotic tattoos, environmental, penitentiary), military and artistic. The novel classification, focusing on the utility of certain kinds of tattoos for identyfying corpses of unknown identity, was also developed. According to the above mentioned classification the following kinds of tattoos are distinguished: individual (artistic), group (e.g. penitentiary - indicating the fact of being imprisoned in a penitentiary institution or belonging to a "prison kites" subculture, or presenting criminal profession; group confined tattoo (indicating a staying in a specific penitentiary institution), group tattoo with individual data (indicating the fact of staying in a penitentiary institution as well as dates of imprisonment), and others (e.g. names of relatives, military tattoo, etc.). Analysis of individual types of tattoo can accelerate the process of identification of the cadavers. The proposed classification allows to quickly determine whether a particular tattoo can be helpful in initial individual identification (in the case of individual tattoos) or whether it can be used to reduce the group of people considered (in cases of different types of group tattoos).

Combined Use of Pyelolithotomy and Endoscopy: An Alternative Surgical Treatment for Staghorn Urolithiasis in Children.

To present a combining pyelolithotomy and endoscopy, an alternative approach for treating staghorn calculi in children. We treated 1414 children (age, 10 months to 17 years) with urolithiasis between 2009 and 2013 in the Pediatric Surgery Department and in the Pediatrics and Nephrology Department, Military Institute of Medicine in Warsaw. Most patients were treated conservatively. In 162 cases, an extracorporeal shockwave lithotripsy (SWL) procedure was needed. Surgery was only used in patients who had failed SWL. We performed minimally invasive procedures, ureterolithotripsy using semi-rigid and flexible ureterorenoscopes or percutaneous nephrolithotomy (PCNL) in 126 patients. In the most serious cases of staghorn or multifocal calculi, we performed a combined operation of pyelolithotomy with endoscopic removal of concrements from all calyces of the diseased kidney. In 15 out of the 18 combination treatments (83.3%), concrements were completely removed from the kidney in a single procedure. In three cases, fine concrements (5 to 6 mm) remained after the procedure, and these were candidate for SWL. In one case, a boy aged 4 years, symptoms of infection in the urinary tract occurred 2 days after the procedure. Combining pyelolithotomy with endoscopy to remove concrements clears the diseased kidney without causing parenchymal damage in one procedure. The method is safe in children, does not require blood transfusion, and helps maintain kidney function.

Studying veterinary medicine in Warsaw.

Katy Drummond is a few months from qualifying as a vet having studied at SGGW – Szkoła Główna Gospodarstwa Wiejskiego w Warszawie – the Warsaw University of Life Sciences

Mutation of the PIK3CA gene as a prognostic factor in patients with colorectal cancer.

Colorectal cancer (CRC) is one of the most common cancers worldwide, with ~700,000 mortalities occurring due to CRC in 2012. The treatment options are effective in a small percentage of patients, and it is important to identify specific biomarkers in order to determine patients for whom the available therapies will be beneficial. It has been hypothesised that the PIK3CA gene mutation may affect the response to therapy of patients with metastatic CRC. In the present study, primary tumour specimens were collected from 156 patients with CRC who were treated in the Military Institute of Medicine in Warsaw (Warsaw, Poland). Codons 12 and 13 of exon 1 of KRAS, exons 11 and 15 of BRAF and exons 9 and 20 of PIK3CA were analysed for mutation using direct sequencing. The prognostic value of each mutation and the clinical and pathological variables of these tumours were estimated. The results revealed that PIK3CA mutations were present in 15 patients (9.6%), of whom seven (46.7%) possessed mutations in codon 9 and eight (53.3%) possessed mutations in codon 20. Mutation in the PIK3CA gene was detected in six patients with KRAS gene mutations, which accounted for 40% of PIK3CA-mutated tumours, and in one patient with BRAF mutations, which accounted for 6.6% of PIK3CA-mutated tumours. No significant differences were identified between the overall survival (OS) rates of patients with PIK3CA mutations (median OS, 56.7 months) and those with wild-type PIK3CA genes (median OS, 47.6 months) (P=0.1270). Univariate analysis identified that the following prognostic factors affected the OS rate in the current patient cohort: Gender, female patients survived for 57.5 months compared with 39.3 months for male patients (P=0.0111); and lymph node involvement grade, as survival of patients without lymph node metastases was 61.4 months compared with 45.4 months in patients presenting with metastases (P=0.0122). The findings of the present analysis indicate that PIK3CA mutation status is not a prognostic factor in CRC patients. In addition, no statistically significant association exists between tumours with PIK3CA mutations and clinical or pathological factors.

DR AVRAM JOZEF VINAVER (1862-1915) - PIONEER OF RADIOLOGY IN SERBIA.

Dr Abraham Joseph Vinaver (1862-1915), a Jew from Poland, was a pioneer of radiology in Serbia. He graduated from the Faculty of Medicine in Warsaw (1887), but lived and worked in abac (the Kingdom of Serbia) since 1890. Dr Abraham Joseph Vinarev - Career Development. He procured the first X-ray machine and developed radiological service in Sabac five years after the discovery of X-rays. These were the beginnings of radiology in Serbia. He introduced the application of artesian wells. Dr Abraham Joseph Vinarev - a Participant at the First Congress of Serbian Physicians and Naturalists, Belgrade 1904. "The diagnostic importance of X-rays in lung disease, especially in initial tuberculosis" and "Five Years of Treatment by X-Ray Machines" were the first works in the field of radiology in Serbia by this author. Dr Abraham Joseph Vinaver - Reserve Medical Officer in the Serbian Army. During the Balkan Wars, he was a volunteer with the rank of major engaged in military corps and he participated in the First World War as well. He died of malaria in 1915 in Gevgelija. "Dr Avram Vinaver"- Stanislav Vinarev. His dedication to work during the typhus epidemics was put into verses of a poem by his son Stanislav Vinarev. Dr Avram Vinaver Joseph was a noble man with a great heart, who selflessly sacrificed himself for the Serbian people and Serbia. He gave his contribution to the development of health services in Serbia, both in peacetime and wartime conditions. Dr Abraham Joseph Vinaver laid the foundations for today's radiology in Serbia.

Lymphatic complications after vascular interventions.

IntroductionLymphorrhea due to classical and mini-invasive surgical interventions on femoral and popliteal arteries is a serious hindrance to patient treatment. Depending on the experience of a particular center, the incidence and frequency of this type of complication may constitute a serious clinical problem. While the level of lymphorrhea intensity and its duration result in certain foreseeable consequences, their treatment can be a time-consuming and multistep procedure.AimTo compare different types of vascular interventions with lymphorrhea occurrence.Material and methodsThe authors conducted a retrospective analysis of lymphatic complications based on the material collected between 2005 and 2012 at the Department of Vascular and Endovascular Surgery of the Military Institute of Medicine in Warsaw and in the Department of Interventional Cardiology and Angiology of the Institute of Cardiology in Anin, Warsaw, in 2009–2012.ResultsMaintaining due thoroughness when dissecting tissues and treating the cutting line in this area with ligatures and tissue puncture are the most reliable methods of minimizing the risk of lymphatic leakage after surgical procedures performed in a classical way. The lymphatic complication under analysis is far less likely to occur when procedures are performed as planned and an endovascular technique is used – statistical significance p < 0.05. Minimally invasive and fully percutaneous procedures performed via needle puncture, including the use of the fascial closure technique to close the femoral artery, eliminate the likelihood of the occurrence of this vascular complication – statistical significance was found with p value less than 0.05.ConclusionsWe concluded that in every case by minimizing the vascular approach we protected the patient against lymphatic complications.

Etiological factors causing lower respiratory tract infections isolated from hospitalized patients.

Lower respiratory tract infections (LRTI) account for 20-30 % of all hospital-acquired contagions. They are characterized by high mortality of hospitalized patients. The most serious form of LRTI is pneumonia, and the most common etiological factors in such cases are bacteria. The article gives the analysis of bacterial flora samples obtained from lower respiratory tract of hospitalized patients. In vitro susceptibility of pathogens to selected antibiotics has also been assessed. We carried out a retrospective analysis of 1,171 bacterial strains isolated from 1,171 patients treated in clinics of the Military Institute of Medicine in Warsaw, Poland. In most cases the samples were collected from an endotracheal or tracheostomic tube (71.5 %) and from bronchoalveolar lavage (21.7 %). The most commonly isolated pathogens included Acinetobacter baumannii (35.8 %), Staphylococcus aureus (27.6 %), Klebsiella pneumoniae (19.4 %), and Pseudomonas aeruginosa (16.2 %). Multidrug-resistant gram-negative bacteria exhibited 100 % susceptibility to colistin only. Klebsiella pneumoniae ESBL+ and Acinetobacter baumannii were most susceptible to carbapenems, while Pseudomonas aeruginosa strains to ceftazidime. Methicillin-resistant Staphylococcus aureus were 100 % susceptible to vancomycin, linezolid, and tigecycline. In conclusion, identifying the etiological factors causing infections of the lower respiratory tract and determining their drug-susceptibility is of key importance in empirical treatment.

Porównanie skuteczności in vitro ertapenemu, imipenemu i meropenemu w zakażeniach wywołanych przez Enterobacteriaceae

The members of the bacterial Enterobacteriaceae family play an important role in the aetiology of many hospital infections. Some of them are able to produce β-lactamase, an enzyme which induces the resistance of those bacteria to penicillins, cephalosporins and, in severe infections, to penicillins with β-lactamase inhibitors. In this situation, the carbapenems become the drugs of choice. The objective of this study was to analyse the in vitro efficacy of three carbapenems: ertapenem, imipenem and meropenem against bacterial species of the Enterobacteriaceae family. A total of 99 bacterial species (including ten bacterial species producing the ESBL mechanism), isolated between September 2011 and March 2012 from diagnostic material collected from patients of surgical clinics in the department of motoskeletal system infections and the critical care unit, hospitalised in the Military Institute of Medicine in Warsaw, were analysed. The values of MIC 50 and MIC 90 were recorded. All isolated bacterial species were susceptible to meropenem. One strain of Morganella morganii was resistant to imipenem, while one strain of Enterobacter cloaceae and one strain of Klebsiella pneumoniae were resistant to ertapenem. In the Enterobacteriaceae ESBL(-) group, the values of MIC 50 were 0.006 μg mL-1 for ertapenem, 0.19 μg mL⁻¹ for imipenem, and 0.032 μg mL⁻¹ for meropenem, and the MIC 90 values were: 0.25 μg mL⁻¹, 0.5 μg mL⁻¹ and 0.125 μg mL⁻¹, respectively. In the Enterobacteriaceae ESBL(+) group, the values of MIC 50 were 0.38 μg mL⁻¹, 0.25 μg mL⁻¹, 0.064 μg mL⁻¹, and the values of MIC 90 were 0.5 μg mL⁻¹, 0.25 μg mL⁻¹ and 0.125 μg mL⁻¹, respectively. All analysed carbapenems had high in vitro efficacy against both Enterobacteriaceae ESBL(-) and Enterobacteriaceae ESBL(+) bacterial species.

Effect of Tai Chi on Body Balance: Randomized Controlled Trial in Elderly Men with Dizziness

The purpose of this study was to assess the effect of 18-week Tai Chi training on body balance in a dynamic trial among elderly men with dizziness. The study covered subjects aged 60 to 80 years. We identified 40 men who reported a history of dizziness. The subjects were recruited using direct mailings and a community information campaign. The participants were randomly assigned to either the exercise intervention (n = 20) or control group (n = 20). The Tai Chi group participated in an 18-week exercise class held for 45 minutes twice a week. Body balance was studied in two ways: using the "8 foot up and go test" (Rikli and Jones 2001) and using a Computer Posturographic System PE 90 (manufactured by Military Institute of Aviation Medicine in Warsaw and outfitted with Pro-Med modified software). The ability to perform specific tasks (maximal deflections in four directions) was measured on the posturographic platform. The variation in results obtained on the first and second date of tests in the experimental and control groups was confirmed statistically using four parameters, i.e. "8 foot up to and go test (H = 8.21;p = 0.003), forward deflection (H = 3.70;p = 0.050), backward deflection (H = 5.04;p = 0.024) and maximum sway area (H = 8.86;p = 0.002). Consequently, we found that the 18-week period of Tai-Chi exercises, with a frequency of twice a week for 45 minutes, is beneficial for dynamic balance, which is important for the reduction of fall risk factors among elderly men with dizziness.

Elektrogustometr uniwersalny EG-2

Electrogustometry is a method for taste diagnosis and measurement. The EG-2 project is being developed in cooperation between Warsaw University of Technology and Military institute of Medicine in Warsaw. The device is an evolution of the recent universal electrogustometer EG-1 prototype. Due to considerations and experiences acquired during prototype usage, many enhancements have been incorporated into device. The aim was to create an easy-to-use, portable, battery powered device, enabled for fast measurements. Developed electrogustometer is using innovative, low-power microprocessor system, which control whole device. User interface is based on 5.7" graphical LCD (Liquid Crystal Display) and touchscreen. It can be directly operated by finger or with optional stylus. Dedicated GUI (Graphical User Interface) offers simple, predefined measurements and advance settings of signal parameters. It is also possible to store measurements results and patients data in an internal memory. User interface is multilanguage. Signals for patients examinations, supplied with bipolar electrode, are generated by an on-board circuit using DDS (Direct-Digital Synthesis) and DAC (Digital-to-Analog Converter). Electrogustometer is able to generate DC, sinus, triangle or rectangle signals with current amplitude from 0 to 500 pA and frequency form 0 to 500 Hz. Device is designed for manual and automeasurement modes. By using USB (Universal Serial Bus) port it is possible to retrieve data stored in internal memory and charging of built-in Li-lon battery as a source of power.

Elektrogustometr uniwersalny EG-1

Summary Electrogustometry has been used as a clinical tool for diagnosis and assessment of a variety of conditions. Since the lack of versatile electrogustometer for research and diagnosis, the new electrogustometer EG-1 was developed in 2006. It was done in cooperation between Warsaw University of Technology and Military Institute of Medicine in Warsaw. EG-1 allows quantitative estimation of taste perception threshold using both static and impulse electrogustometry with bipolar electrode. It is a fully autonomous, battery powered and portable instrument. Because of small size and weight, it can be easily placed in any environment. Microprocessor controlled measurement system and user-friendly interface (LCD display with simple keyboard) make EG-1 electrogustometer very handy and flexible in operation. Data obtained during measurements is stored in the internal device memory. After taste examinations measurement data can be transferd to a personal computer via inbuilt USB port for further analysis and storage. EG-1 can generate three predefined variously shaped current impulses: sinus-, saw- and rectangleshaped. There is an optional possibility of creating own shapes of stimulus puls by the user. The electrical parameters of generated pulses are as follow: current amplitude 1–2000 μ A regulated with 1 μ A step, stimulus frequency 0(DC)-500 Hz regulated with 5 Hz step, controlable fulfillment factor and signal rise time (optional for automatic measurements). The operator can trigger the stimuli via a hand switch on the bipolar electrode (with goldplated endings), via keyboard or via additional independent hand switch. Three years of experience collected during EG-1 exploitation allowed to design a new version of electrogustometer EG-2 with a touch panel and color graphical display.

Effect of Tai Chi on Body Balance: Randomized Controlled Trial in Men with Osteopenia or Osteoporosis

The purpose of this study was to assess the effect of 18-week Tai Chi training on body balance in dynamic trial among elderly men. The study covered 49 subjects from age 60 to 82.1 years, who had osteopenia or osteoporosis. The subjects were recruited from the community by direct mailings and community efforts to participate in studies. The participants were randomly assigned to either the exercise intervention (n = 25) or control groups (n = 24). The Tai Chi group participated in an 18-week exercise class held for 45 min, twice a week. Body balance was assessed using a Computer Posturographic System PE 90 produced by the Military Institute of Aviation Medicine in Warsaw with modified software made in Pro-Med. During the measurement of body balance, the capacity to perform specific tasks was analyzed (deflections in the set scope and direction). In the Tai Chi group, an increase (p < or = 0.01) in effectiveness of balance task performance was noted from 80.95% to 84.45% after the training. In the control group, no statistically significant improvement in the level of body balance was found in the same period. Thus, an 18-week period of Tai Chi exercises twice a week for 45 min is beneficial for dynamic balance. It can be important for reducing fall risk factors.

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A CASE OF LIVER ANGIOSARCOMA CAUSED BY 22 YEARS OF OCCUPATIONAL EXPOSURE TO VINYL CHLORIDE MONOMER

International Institute of Universalistic Medicine in Warsaw, Department in Tarnów, Tarnów, Poland.

The use of unprescribed medicine in Warsaw during the years 1970-1980.

The author discusses the results of surveys conducted in Warsaw, concerning the extent of use of unprescribed medicine from 1970-1980. Drug use did not increase over the decade studied, and most respondents took the medication to treat particular complaints. No correlation was found between self-medication and social or occupational status. Respondents often began using unprescribed drugs on the recommendation of a doctor; self-medication, while widespread, does not imply a negative attitude toward health professionals or the existing system of medical care.