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131 entries in total
Selected differences in nutrition of children during oncological treatment. Nutrition therapy - editorial cycle.
Oncological treatment is associated with a high risk of malnutrition in children. Complications of treatment often prevent oral intake of food, which requires proper dietary modification and consideration of parenteral nutrition.
Mastectomy and immediate reconstruction at woman with breast sarcoma following breast connserving treatment due to cancer
Breast sarcomas are rare, accounting for 1% of malignant gland tumors and less than 5% of all tumors mesenchymal neoplasms.1 The low incidence makes it difficult to conduct trials randomized clinical trials, and available data include descriptions of retrospective series and single cases. The number of known factors that increase risk of developing the disease is small. A genetic predisposition in the form of syndrome Li-Fraumeni (TP53 gene mutation) increases the risk of primary sarcomas also in the thoracic location.2 Chronic lymphedema occurring in some patients after axillary lymphadenectomy and axillary irradiation predisposes to lymphangiosarcoma in the affected arm (Stewart syndrome and Treves syndrome).3 Secondary sarcomas occasionally occur in breasts previously irradiated after breast conserving treatment (BCT), performed for breast cancer, the most common malignancy in women, and after radiation therapy administered for malignant granuloma.4 The cumulative risk of of radiotherapy-induced sarcoma (RIS) is 3.2 per 1,000 over 15 years vs. compared to 2.3 per 1,000 for primary sarcoma in a population without radiation therapy.5 Compared to women who were not irradiated, patients treated with radiation therapy for breast cancer, the risk of developing radiotherapy-induced hemangiosarcoma (radiotherapy-induced angiosarcoma, RIA) is five times higher 6 , in general, however, the possibility of of developing angiosarcoma after radiation therapy is low and, according to the literature literature, it is 0.03 - 0.2% in more than 10 years of follow-up.7,8 It should be clearly emphasized the benefits enjoyed by women with breast cancer due to radiation, an obligatory part of breast-saving treatment.9 There has been no correlation of the incidence of RIS with the use of chemotherapy.10 For the The diagnosis of radiotherapy-induced sarcoma can be made using criteria proposed by Cahan in 1948,11 as interpreted by Kirova15 (At that time, Cahan described more than a dozen cases of bone sarcomas in patients irradiated according to the treatment standards of the time for benign lesions and bone tuberculosis, the first point in the original description was the non-neoplastic nature of the lesion treated with radiation therapy)11: 1. History of treatment with irradiation 2. asymptomatic latency period between two cancers lasting several years 3. occurrence of sarcoma in a previously irradiated area, 4. Histopathologic confirmation of sarcoma as a second neoplasm.10,11,15 However Cahan described the latency period as "relatively long," amounting to more than 5 years in his paper, the literature a case has been described that appeared before a year, also described as a RIS (RIA).12 Among the histopathological types diagnosed among secondary sarcomas include angiosarcoma, hemangiosarcoma, leiomyosarcoma, malignant fibrous histiocytoma, liposarcoma, and fibrosarcoma. Also described were chondrosarcoma and osteosarcoma. RIS develop most often in the chest wall, less often in the parenchyma of the of the irradiated breast.10 The method of choice for patients with for breast sarcomas is excision of the tumor with a margin of healthy tissue. While in the case of primary sarcomas, follow-up treatment after sparing surgery often consists of irradiation of the operated area, when treating patients with for sarcoma occurring in a previously irradiated area, repeat radiotherapy of the of the same area is not recommended. The optimal type of treatment in such a case is mastectomy in this case.
SARS-CoV-2 infection in a patient with adenocarcinoma with a mutation in the EGFR gene treated with erlotinib - a case report
Lung cancer accounts for the largest number of cancer deaths worldwide [1]. Despite advances in treatment, incidence and mortality rates continue to rise. A 2018 GLOBOCAN analysis reported 2.09 million new cases of lung cancer and 1.76 million deaths from lung cancer worldwide [2]. There are two main histological types: small cell lung cancer (DRP) and non-small cell lung cancer (NDRP). NDRP accounts for about 85% of all lung cancer cases. It includes various subtypes such as adenocarcinoma, squamous cell carcinoma and large cell carcinoma. The most common subtype is adenocarcinoma accounting for 45% of NDRP cases. The most important risk factor for developing lung cancer is smoking, especially among the male population. The use of filtered cigarettes, which reduce the amount of tar entering the lungs, correlates with an increase in the incidence of lung adenocarcinoma, which is associated with stronger inhalation of carcinogens into the fine airways. Other compounds that may have an effect on cancer development are asbestos, radon, nickel, cadmium, chromium, silica and arsenic. The development of molecular studies at the beginning of the 20th century made it possible to identify the genetic basis of the disease by demonstrating the presence of mutations or rearrangements of TP53, MYC, BCL2 genes in small cell carcinoma and EGFR, KRAS, MET, BRAF, NTRK, ROS1, ALK, RET, PIK3CA genes in non-small cell carcinoma [3]. The percentage of non-squamous NDRP patients with mutations in the gene for the epidermal growth factor receptor (EGFR) is 10-15 (in Caucasian patients) to more than 40% (in Asian patients) [4]. A deletion in exon 19 and a substitution at codon 858 (L858R) in exon 21 account for 80-90% of mutations within the tyrosine kinase coding domain of the EGFR gene [4]. Lung cancer manifests as cough, hemoptysis, chest pain, shortness of breath and/or hoarseness. In the case of adenocarcinoma, brain metastases manifesting as headache, vomiting, visual field disturbances, seizures or neurological deficits are common. After appropriate laboratory and imaging tests and histopathological evaluation, it is possible to assess the histological type and stage of the cancer. Depending on the patient's general condition, tumor stage and concomitant diseases, different treatment methods are used. For low-grade cancer (stages I, II and IIIA), surgery is used, often in combination with chemotherapy and radiation therapy. For stage IIIB patients, the therapy of choice is chemoradiotherapy, and if chemoradiotherapy is not available, the treatment is the same as for patients with generalized NDRP. Therapy for patients with distant metastases (stage IV) is aimed at reducing the discomfort and symptoms of progressive disease and prolonging life. For this purpose, chemotherapy, immunotherapy or molecularly targeted therapy are used [5]. Molecularly targeted therapy for lung cancer with EGFR gene mutations is made possible by the use of tyrosine kinase inhibitors (IKTs). IKTs inhibit intracellular phosphorylation of EGFR which leads to the arrest of cell differentiation, proliferation and angiogenesis. EGFR IKTs are divided into three generations. Erlotinib and gefitinib are the first-generation reversible IKTs. They are effective in the presence of the most common mutations in exon 19 and 21. Second-generation irreversible IKTs, which include afatinib and dacomitinib, show a broader spectrum of action. They block the transmission of signals formed by ErbB1 (EGFR), ErbB2 (HER2), ErbB3 and ErbB4 receptors, and can be effective in the presence of rare mutations in exons 18, 19, 20 and 21. It is possible to acquire resistance to first- and second-generation IKTs. Ozymertinib, an irreversible third-generation IKT, by acting on cells with the T790M mutation in exon 20 of the EGFR gene, overcomes resistance to treatment with older-generation EGFR IKTs, but can also be used in 1st-line treatment in NDRP patients regardless of the type of mutation in exons 18-21 of the EGFR gene [6]. The global COVID-19 pandemic poses a therapeutic challenge to healthcare, especially among oncology patients. A retrospective analysis from Wuhan showed that the risk of COVID-19 infection was 2.31 times higher among cancer patients than in healthy individuals. Smoking, age, male gender, cancer status, poor performance status (≥2 on the ECOG scale) and treatment with hydroxychloroquine with azithromycin were risk factors for increased 30-day mortality among COVID-19 patients [7]. Hospital visits during the pandemic and the use of immunosuppressive medications are major contributors to COVID-19 infection in lung cancer patients [8]. A study conducted in China, showed that NDRP patients over 60 years of age are particularly vulnerable to COVID-19 infection and a more severe course of the disease. Many respiratory symptoms in COVID-19 i.e. shortness of breath, cough, fever overlap with those of lung cancer. This creates a difficulty in differential diagnosis between the two disease entities. The diagnosis of COVID-19 is usually made on the basis of clinical history and PCR test and/or antigen test in a sample from nasopharyngeal secretions. Recognition of typical lesions seen on chest CT scan is also helpful. Multifocal opacities of the frosted-glass type with predilection for the lower lobes are present in 75% of patients [9]. A study conducted in New York among lung cancer patients with concurrent SARS-CoV2 infection showed the need for hospitalization in 62% of patients, 21% of whom required ICU hospitalization. Of the 102 patients participating in the study, 25% died. Survival was more dependent on the comorbidity of COPD (chronic obstructive pulmonary disease) and smoking than on tumor histology or PD-L1 (programmed death ligand 1) expression on tumor cells [10].
Example of management of metatarsal bone II tumor originally suspected of having metastatic thyroid follicular cancer 40 and 20 years after total thyroidectomy
Known There are many causes causing discomfort and nodular lesions in the metatarsal area and forefoot. They include These include traumatic soft tissue injuries i bones (e.g., sole plate tears, toe arthritis, arthritis, fractures fatigue, Freiberg fracture), tendon diseases (e.g. tendinosis, tendon sheath inflammation, tendon rupture), non-cancerous soft tissue lesions (e.g., ganglion, bursitis bursitis, granuloma, Morton's neuroma), and, less commonly, tumors and their metastases to soft tissues and bone [1]. Focal bone lesions are often an incidental result of imaging. Alternatively, they may be the cause of pain, a palpable mass or a fracture pathological [2].Most often patients associate these symptoms with trauma. In fact, trauma only draws attention to the the affected area, but does not cause the formation of a tumor. [5] In all these cases, especially in the early stages, accurate diagnosis is crucial, to establish further differential diagnosis and treatment strategy, so when confronted with a focal bone lesion, it is necessary to follow a logical management algorithm. First, it should provide description of the lesion in correlation with the patient's age, location, type of bone, cortical involvement, periosteal reactions, the condition of the adjacent soft tissue. W this for this purpose, it is necessary to x-ray of the involved area in two projections with adjacent joints. A deeper diagnosis is achieved by CT examination, assessing the advancement of the bone lesions and MRI, infiltrating adjacent soft tissues . If imaging studies show more advanced disease, an important diagnostic element is to obtain material for pathomorphology, taken during open biopsy or oligobiopsy, and establish the histological diagnosis [11]. W case of confirmation of a neoplastic process, it is always necessary to perform a examination X-RAY/CT chest, ultrasound/ CT of the abdomen, or even PET to exclude metastases [5]. The second step of the implemented algorithm dictates that treatment should be planned based on the answers to the following questions: - Is the lesion likely to be a normal variant, That is, "leave me alone, don't touch me," a lesion of a benign type, requiring no further imaging or supplies, but only observation? [3] - Does the lesion have features suggestive of an aggressive nature, and then whether further imaging is necessary, which technique best to use, whether a biopsy of the lesion is required and advanced treatment? [4]. Heterogeneity clinical picture of unidentified focal nodular lesions w metatarsal and forefoot, the variety of available methods of diagnosis do not make the task any easier, both at the stage of making the initial diagnosis, as well as during communication between members of the interdisciplinary team, which many times should deal with address treatment. The purpose of of this article is to present a similar situation using the case of a tumor of the distal epiphysis of the second metatarsal bone as an example, suspected of late, distant metastasis of thyroid cancer, never not confirmed in further studies, and suggestions for management diagnostic and therapeutic management. Cancer Follicular The thyroid gland (FTC - Follicular Thyroid Carcinoma) accounts for 10-20% of of all cancers of the thyroid gland. It is the second most common encountered thyroid cancer [6], and metastasis to the metatarsal bones and fingers are extremely rare.
Radical conformal radiotherapy in treatment of recurrent, extramammary Paget disease - case report.
Disease Paget's disease is a rare neoplastic process originating in the glands of the apocrine and eccrine glands of the skin [1]. A distinction is made between the mammary Paget disease (MPD) form and the extramammary Paget disease (EMPD), accounting for 90% and 10% of all cases, respectively Paget disease [2]. The incidence of EMPD in the European population is estimated to be is estimated at 0.7 per 100,000 people/year [3]. EMPD is more often diagnosed in women, particularly Caucasian, between the ages of 50 and 80. [4], in whom it mostly localizes on the vulva and perineum and in the perianal area, while in men on the penis and scrotal sac [5,6]. The symptoms of the disease are uncharacteristic, which in most cases makes it difficult to make a correct diagnosis and thus prolongs the time to start treatment. Only histopathologic examination of the excised lesion allows a correct diagnosis and an assessment of the degree of invasiveness of the process [6]. The primary method of treatment remains radical surgery [7]. Due to the high recurrence rate [4,8], some patients require follow-up treatment [6]. In cases ineligible for surgery, local or systemic chemotherapy or radiation therapy is used [9,10].Given the very rare occurrence of the disease, the lack of established treatment regimens, observed failures and subsequent attempts at surgical intervention, the case presented here is an example of the possibility of treating EMPD with ionizing radiation.
When your patient sleeps too much, disturbance of consciousness in the case of a geriatric patient – case report
In The world, including Poland, has seen a systematic increase in the share of the general population of elderly people. The aging of the population and the associated increase in the number of geriatric patients now represents another of the challenges to be met by 21st century medicine. Patient A geriatric patient, as defined by the WHO (World Health Organization Organization), is a patient who has reached at least 60 years of age. The person under study is usually accompanied by a significant amount of illness, which is typical of old age and coexists with the risk of sudden deterioration of health or death [1]. In line with the need, a number of solutions are being implemented around the world, leading to the to improve the branch of medicine that is geriatrics. Comprehensive assessment geriatric assessment (Comprehensive geriatrc assessment, CGA) is a tool that consists of a set of scales and tests that allow a holistic assessment of patients facilitating the detection of the cause of deterioration and the selection of optimal therapy. A complete patient assessment, depending on the patient's clinical condition, takes between 30 to 60 minutes [2]. Comorbidities and medications taken by geriatric patients geriatric patients often require significant modification of generally accepted standards of treatment. A large number of emergencies in elderly patients proceed with disturbances of consciousness. Difficulties in correctly perceiving the of the surrounding world that patients encounter greatly complicate the the ability to accurately take a medical history, as well as conduct a physical examination and implement appropriate diagnostic and therapeutic measures.
Possibilities of systemic treatment in patients with NSCLC after organ transplantation - case report and literature review
The introduction of antibiotics, mass vaccinations to prevent infectious diseases and organ transplants can be considered the greatest achievements of 20th century medicine. Solid organ transplants save the lives of patients suffering from organ failure and improve their quality of life. The life expectancy of transplant patients has improved significantly over the past two decades. Successful transplantation improves survival in patients on chronic dialysis and in patients with irreversible liver, heart and lung disease and end-stage failure of these organs. The percentage of transplants performed is steadily increasing, but is still insufficient [1]. According to data reported to the Global Observatory on Donation and Transplantation (GODT), 106,879 organ transplants were performed in 95 countries worldwide in 2010, including:73,179 kidney transplants (46% from living donors), 21,602 liver transplants (15% from living donors), 5582 heart transplants, 3927 lung transplants, 2362 pancreas transplants and 227 small bowel transplants. This activity increased by 2.12% compared to 2009 [2].Unfortunately, it is estimated that the number of transplants performed is insufficient. At the same time, there are huge geographic differences in the number of transplants per million population: from 70 per million population in developed countries to 0-2.4 in developing countries [3]. As transplantation prolongs patients' lives, cancers are becoming an increasing threat to long-term survival, especially in patients who have undergone liver transplantation for hepatocellular carcinoma (HCC)[4].The risk of cancer in transplant patients is higher than in the general population. This is due to three reasons. Immunosuppressive treatment accompanying organ transplantation causes a decline in immunity, which can promote infection with oncogenic viruses such as humanpapillomavirus (HPV) or humanherpesvirustype 8 (HHV-8), and can allow emerging cancer cells to escape from weakened immune surveillance. In addition, immunosuppressive drugs have a cytotoxic effect, which can induce the formation of mutations and the transformation of normal cells into cancer cells. Therefore, patients undergoing organ transplantation most often develop hemato-oncologic malignancies, cancers associated with infection with potentially oncogenic viruses: Kaposi's sarcoma (infection with human herpes viruses), cervical cancer and squamous cell carcinomas of the head and neck region (infection with human papillomavirus), liver cancer (infection with hepatitis B and C viruses) and skin cancers. Lung cancer, cancers of the gastrointestinal tract or urinary tract occur in no more than 1% of transplant recipients. The feasibility of using systemic cancer treatment in organ transplant patients has yet to be explored. The most controversial is the use of immunotherapy in cancer patients previously undergoing organ transplantation and immunosuppressive treatment. Modern cancer immunotherapies targeting immune checkpoints are designed to enhance the immune response, and thus may increase the risk of transplant rejection. Lung cancer is one of the leading causes of death from malignant tumors worldwide. There are two main types of lung cancer: non-small cell lung cancer (NDRP) and small cell lung cancer (DRP). NDRP is much more common, accounting for 80-85% of lung cancer cases. Thoracic surgery, chemotherapy and radiation therapy have been used to treat lung cancer [5]. Due to unsatisfactory treatment results, the search for new therapies began. The use of immunotherapy and molecularly targeted therapies proved to be a breakthrough. These therapies have been successfully used in selected patients with locally advanced and metastatic NDRP. These therapies have led to an increase in disease progression-free time and overall survival of patients, allowing lung cancer to be classified as a chronic disease [6].
Thermosemiotics of chronic tonsillitis
Research Objective – to develop thermosemiotics of chronic tonsillitis by determining specifics of infrared waves in the submandibular region and on the palms, knees and in the center of foot vault in healthy people and comparison of the obtained results with the corresponding indices of patients with chronic tonsillitis. Most common pathogens in infectious tonsillitis are Streptococcus spp. Tonsillitis infrequently develops on the background of acute respiratory disease, but usually manifests itself as a separate disease. Suppression of local immune response on cold exposure, malnutrition, physical exhaustion, blockage of nasal pathways by adenoid tissue, chronic sinusitis, deviation of the nasal septum, chronic rhinitis are favorable set ssup for tonsillitis formation [1-3]. In clinical practice, it is often necessary to distinguish acute tonsillitis from chronic, because they are fundamentally different diseases. Recurrent acute tonsillitis that is frequently undertreated is commonly seen as preceding factor in development of chronic tonsillitis. Follicular form of tonsillitis is considered most unfavorable as it leads to scar formation in lymphoid tissue therefore diminishing its protective properties. Tonsillolith are formed consisting of desquamated epithelium, microbes, inflammatory exudate. They are difficult to evacuate and causing lacunar expansion, formation of retention cysts [4, 5]. Tonsilitis is notorious for its complications, such as myocarditis, rheumatic diseases, nephritis. Exacerbation may occur on the background of chronic inflammatory process. Therefore, special attention needs to be directed to patient reported history, particularly frequency and duration of exacerbations. Exacerbation of chronic tonsillitis is accompanied by symptoms of general intoxication – subfebrile temperature, pain in joints, decreased tolerance to physical exertion, fatigue. The tonsils, as a rule, are enlarged, have submucosal purulent follicles (however, in the absence of signs of acute tonsillitis, hyperemia and inflammatory infiltration may be present), caseosus-purulent masses in cicatricial lacunae. Regional lymph nodes are enlarged, dense, sometimes painful. Tonsil-cardial syndrome is often observed with subjective sensations of pain in the region of the heart, heart intermission, palpitation. There may be vasomotor symptoms – pallor or hyperemia of the skin, xerodermia or increase perspiration functional heart murmurs, myocarditis [4].Research Objective – to develop thermosemiotics of chronic tonsillitis by determining specifics of infrared waves in the submandibular region, on the palms, in the projection of kneecaps, and in the center of foot vault both in patients with chronic tonsillitis and healthy persons.
Can the etiology of acute pancreatitis always be identified? A rare case of acute pancreatitis in a patient with primary erythromelalgia
APD is the most common pancreatic disease and also a quite frequent cause of hospitalization of patients presenting to the hospital for due to abdominal pain. There has been an increasing incidence in recent years in developed countries and mortality in this disease reaching 5%. [1, 2]. Accurate diagnostics should make it possible to determine the etiology of UTI in more than 96% of cases [3] this, however, is still not achieved in many patients this is not achieved. Thus, relapse may occur with reoccurrence of a previously unrecognized etiologic factor. Many authors raise the role of drugs as a potential causative factor of ICS of unclear etiology[4]. There is no strictly defined regimen for effective yet safe treatment of pain in ICS. To date, it has not been established to what extent the drugs used for pain relief in this disease may simultaneously be a causative factor in pancreatitis[5, 6]. Primary erythromelalgia (EM), is a rare, genetically determined disease manifested by pain in the extremities, their increased heat and redness [7] [Image 1 - Painful erythema of the extremities lower extremities is the most common symptom in patients with Primary Erythromelalgia]. Treatment pharmacological treatment of this disease is not always effective. Various physical and invasive methods, including neurolysis of the lumbar segment of the sympathetic trunk sympathetic trunk [8]. This causes patients with EM often overuse pain medications, some of which are also used in the symptomatic treatment of pain in EM. We present the case of a 25- year-old EM patient who developed symptoms of ICS 10 days after unsuccessful pharmacological neurolysis of the lumbar sympathetic trunk and was preceded by the use of several analgesics, later also used in the treatment of during treatment of pancreatitis. Despite thorough diagnostics, it was not possible to determine the cause of the OST
Patient with multivessel coronary artery disease and end-stage renal disease treated with multiple percutaneous coronary interventions.
End-stage renal failure (SNN) is a growing problem in developed countries [1]. Although diabetes remains the most common cause of dysfunction of these organs [2], chronic nephropathy can also be caused by autoimmune diseases, particularly from the vasculitis group. In the United States, the number of patients with SNN requiring dialysis therapy already reaches nearly 500,000, and more than 200,000 are living with an active kidney transplant [3]. Chronic kidney disease (CHD) is a significant cardiovascular problem, contributing to the rapid development of coronary artery disease coronary artery disease, especially the multivessel form. The more severe course of coronary artery disease coronary artery disease in patients with PChN is influenced by impaired calcium metabolism and a tendency to diffuse arterial calcification [4]. Patients with PChN and high CRP levels are at particularly high risk of cardiovascular incidents [5,6]. Currently, there are no guidelines for the surgical treatment of coronary artery disease in patients with PChN. However, they have a higher risk of death after revascularization than in the population without PChN [7]. Opinions on the effectiveness of of using percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are divided, and there are no conclusive data in this regard. There are also no recommendations suggesting the development of a long-term strategy for treating coronary artery disease in patients with SNN, although it has been it has been described that they require multiple repeat PCI (if this method is chosen method) [8].