Medical sciences

Folia Medica Cracoviensia

Content

Folia Medica Cracoviensia | 2018 | vol. 58 | No 2 |

Abstract

I n t r o d u c t i o n: Complications occurring aft er neurosurgical procedures which lead to reoperations are associated with poor treatment outcomes. Th e aim of our study was to establish predictive factors of unplanned early reoperations aft er intracranial meningioma removal.

Ma t e r i a l s a n d M e t h o d s: We retrospectively analyzed 177 patients who underwent craniotomy due to an intracranial meningioma. Early reoperation was defi ned as reoperation during the same hospital stay. We used a χ2 test for proportional values and t-test and Mann-Whitney U tests as appropriate for continuous variables. To determine the potential predictors of early reoperation we used univariate and multivariate logistic regression analyses.

R e s u l t s: A total of 13 (7.34%) patients underwent unplanned early reoperation. Th ese patients underwent retrosigmoid craniotomies (25.00% vs. 6.40%; p = 0.047), suff ered from ischemic heart disease (66.67% vs. 6.64%; p <0.01) and atrial fi brillation (60.00% vs. 6.25%; p <0.01), were receiving heparin (50.00% vs. 6.74%; p <0.01) and anticoagulants (66.67% vs. 6.21%; p <0.01) signifi cantly more oft en than the general study population. In multivariate logistic regression analysis anticoagulant use (OR: 31.463; 95% CI: 1.139–868.604; p = 0.04) and retrosigmoid craniotomy (OR: 6.642; 95% CI: 1.139–38.73; p = 0.034) remained independently associated with a higher risk of early reoperation.

C o n c l u s i o n s: Patients who underwent retrosigmoid craniotomy, those with a history of ischemic heart disease or atrial fi brillation and those who take heparin or anticoagulants are more likely to require early reoperation. Retrosigmoid craniotomy and anticoagulant use are independent risk factors for early reoperation.

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Abstract

Neonatal sepsis, defi ned as sepsis occurring within the fi rst 28 days of life, is associated with signifi cant morbidity and mortality. It is undeniable that fi nding and appliance of biomarkers in clinical practice is of great importance, aiming at the early recognition of the impending clinical deterioration and the prompt and targeted therapeutic intervention. Aft er systematic and thorough research of the limited relevant literature, we attempt to present a documented point-of-view on the diagnostic value of TREM-1 and its soluble form both in early and late onset neonatal sepsis.

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Abstract

Autonomic nervous system of the pelvis is still poorly understood. Every year more and more pelvic procedures are carried out on patients suff ering from diff erent pelvic disorders what leads to numerous pelvic dysfunctions. Authors tried to review, starting from historical and clinical background, the most important reports on anatomy of the pelvic autonomic plexuses. We also pay attention to complete lack of knowledge of students of medicine on the autonomic nervous structures in the area studied. We present anatomical description of the pelvic plexuses including their visceral branches and anatomy of surrounding pelvic tissues which still remains unclear. More and more attention is paid to the topography of the plexuses specially because of new pain releasing techniques — neurolysies.

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Abstract

B a c k g r o u n d: A novel paradigm of diastolic heart failure with preserved ejection fraction (HFpEF) proposed the induction of coronary microvascular dysfunction by HFpEF comorbidities via a systemic pro-infl ammatory state and associated oxidative stress. Th e consequent nitric oxide deficiency would increase diastolic tension and favor fi brosis of adjacent myocardium, which implies not only left ventricular (LV), but all-chamber myocardial stiff ening. Our aim was to assess relations between low-grade chronic systemic infl ammation and left atrial (LA) pressure-volume relations in real-world HFpEF patients.

Me t h o d s: We retrospectively analyzed medical records of 60 clinically stable HpEFF patients in sinus rhythm with assayed high-sensitive C-reactive protein (CRP) during the index hospitalization. Subjects with CRP >10 mg/L or coexistent diseases, including coronary artery disease, were excluded. LV and LA diameters and mitral E/E’ ratio (an index of LA pressure) were extracted from routine echocardiographic 46 Cyrus M. Sani, Elahn P.L. Pogue, et al. records. A surrogate measure of LA stiff ness was computed as the averaged mitral E/e’ ratio divided by LA diameter.

R e s u l t s: With ascending CRP tertiles, we observed trends for elevated mitral E/e’ ratio (p <0.001), increased relative LV wall thickness (p = 0.01) and higher NYHA functional class (p = 0.02). Th e LA stiffness estimate and log-transformed CRP levels (log-CRP) were interrelated (r = 0.38, p = 0.003). On multivariate analysis, the LA stiff ness index was independently associated with log-CRP (β ± SEM: 0.21 ± 0.07, p = 0.007) and age (β ± SEM: 0.16 ± 0.07, p = 0.03), which was maintained upon adjustment for LV mass index and relative LV wall thickness.

C o n c l u s i o n s: Low-grade chronic infl ammation may contribute to LA stiff ening additively to age and regardless of the magnitude of associated LV hypertrophy and concentricity. LA stiff ening can exacerbate symptoms of congestion in HFpEF jointly with LV remodeling.

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Abstract

T h e a i m: The aim of the study is to present the initial experience with continuous flow left ventricle assist device (CF-LVAD) in pediatric patients with BSA below 1.5 m2.

M a t e ri a l a n d M e t h o d s: Between 2016 and 2017, CF-LVAD (the Heartware System) have been implanted in three pediatric patients in the Department of Pediatric Cardiac Surgery, Jagiellonian University, Krakow, Poland. The indications for initiating CF-LVAD were end-stage congestive heart failure due to dilated cardiomyopathy in all children.

R e s u l t s: Implanted patients have had BSA of 1.09, 1.42, 1.2 m2, and 37, 34, 34 kg of body weight and the age 12, 11, 12 years, respectively. The time of support was 550 days in two patients and 127 in another one, and is ongoing. The main complication has been driveline infection.

C o n c l u s i o n: The outcomes from our single-center experience using the HeartWare CF-LVAD have been excellent with a low incidence of complication and no necessity to reoperation in our patients. Children could be successfully and safely discharged home.

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Abstract

Papillophlebitis is an uncommon disease in clinical practice. We would like to present a case of a 29-year-old patient with atypical orbital pain and fl ashings, presenting relative aff erent pupillary defect and already typical of the disease entity: ophthalmoscopic picture of the fundus and big blind spot in perimetry. We present a complex and interdisciplinary diagnostic process that excludes general diseases such as hypertension, diabetes, coagulation disorders and neurological causes. We leave the only identifiable abnormality and potential source in the infl ammatory process of periodontal infl ammation and sinus jaw changes. We also describe the process of remitting the changes and fi nally a favorable end result of the primarily a very disturbing clinical picture that this disease may present.

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Abstract

Pancreatic ductal adenocarcinoma (PDAC) is characterized by very poor prognosis. It is caused by asymptomatic course of the disease at early stage. Symptomatic PDAC means usually advanced stage of the disease, making radical treatment impossible. Finding of biological PDAC marker could improve PDAC treatment through early diagnosis. In our study, we investigated two adipokines: omentin and chemerin concentration in PDAC, chronic pancreatitis (CP) and healthy individuals. We examined 27 PDAC patients, 10 CP patients and 36 controls. To determine concentration of adipokines we used ELISA immunoenzymatic assay. Level of both adipokines was increased when comparing control group to PDAC patients. Additionally, chemerin concentration in CP group was elevated comparing to control. To evaluate both adipokines as potential PDAC biomarkers we performed ROC analysis. Chemerin (AUC = 0.913) displayed better discriminant ability than omentin-1 (AUC = 0.73). Some authors believe that chemerin may promote tumour growth by stimulating angiogenesis and is supposed to be a factor recruiting mesenchymal stroma cells (MSC) in tumour regions. Omentin-1 can inhibit tumourigenesis by TP53 stimulation. On the other hand, according to some studies, omentin-1 may promote cancer proliferation via Akt signalling pathway. Results from our study showed signifi cantly elevated level of chemerin and omentin-1 in PDAC patients. Th erefore, w e believe that both investigated adipokines may provide promising and novel pharmacological insights for oncological diagnosis in the near future.

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Abstract

Anaphylaxis is an increasing problem in public health. Th e food allergens (mainly milk, eggs, and peanuts) are the most frequent cause of anaphylaxis in children and youth. In order to defi ne the cause of anaphylaxis, skin tests, the determination of the concentration of specifi c IgE in the blood and basophil activation test are conducted. In vitro tests are preferred due to the risk of allergic response during in vivo tests. Component-resolved diagnosis (CRD) is an additional tool in allergology, recommended in the third level of diagnostics when there are diagnostic doubts aft er the above mentioned tests have been carried out. The paper presents 3 cases of patients with anaphylactic response, and the application of CRD in these patients helped in planning the treatment. Patient 1 is a 4-year-old boy with diagnosed atopic dermatitis and bronchial asthma reported an anaphylactic shock at the age of seven months caused by cow’s milk and the exacerbation of bronchial asthma aft er eating some fruit. Patient 2 is a 35-year-old woman who has had anaphylactic shock three times: in June 2015, 2016, and 2017 and associates these episodes with the consumption of dumplings with a caramel, bun, and the last episode took place during physical exertion few hours aft er eating waffl e. Patient 3 is a 26-year-old man with one-time loss of consciousness after eating mixed nuts and drinking beer. CRD off ers the possibility to conduct a detailed diagnostic evaluation of patients with a history of anaphylactic reaction.

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Abstract

The prevalence of vitamin D deficiency in the American and European population is estimated to be extremely high. Although fewer people today suff er from serious health problems related to calcium and phosphate metabolism resulting from vitamin D deficiency, there are more and more studies suggesting that calcitriol may play an important role in the pathogenesis of other diseases in virtually every body system. A growing body of research shows that through its ubiquitously expressed receptor, calcitriol displays potent anti-angiogenic an anti-inflammatory activity. Th is review summarizes recent discoveries regarding these non-classical eff ects of vitamin D and their clinical implications. Data collection focused on the prevention and treatment of ocular diseases as well as on the underlying mechanisms.

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Abstract

Oxidative stress (OxS) has been implicated in the pathogenesis of Crohn’s disease (CD). The aim of this study was to examine whether nonenzymatic antioxidants are associated with active CD, by using the FRAP and GSH assay in plasma. Additionally, we measured bilirubin and albumin levels as two individual components of the plasma antioxidant system. A total of 55 patients with established CD, 30 with active CD and 25 with inactive disease, and 25 healthy individuals were prospectively enrolled in this study. We evaluated CD activity index, BMI and blood morphology, platelet count, serum CRP level, and bochemical parameters of OxS: ferric reducing ability of plasma (FRAP), reduced glutathione (GSH) in plasma and bilirubin and albumin levels in serum. Plasma FRAP and GSH concentrations were decreased in both CD groups compared to controls and negatively correlated with CDAI values (FRAP: r = –0.572, p = 0.003; GSH: r = –0.761, p = 0.001), CRP and platelet count. Bilirubin and albumin levels were lower in the serum of active CD patients than inactive CD patients and controls and negatively correlated with the CD activity index (r = –0328, p = 0.036, r = –0.518, p = 0.002) and CRP (r = –0.433, p = 0.002). The decreased FRAP and GSH levels in plasma and bilirubin and albumin levels in serum of patients with active CD compared to inactive CD and controls underlines the importance of OxS in the pathophysiology and activity of CD.

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Abstract

O b j e c t i v e: The main goal of our studies was to investigate the eff ect exerted by pulsed electromagnetic filed (PEMF) on adipocytokines secretion in cell culture supernatants from rat adipose derived stem cells (ADSCs) grown on varied energy-rich diet. Off spring and adult animals were randomly selected for two types of experimental diets: low (LF) or high fat (HF) diet for 7 weeks. After the diet period, serum glucose level was measured, ADSCs were isolated from adipose tissues from different locations. ADSCs from all experimental groups were exposed to PEMF, supernatants collected and adipokines level was determined.

R e s u l t s: HF diet feed in pups/adult animals elevated blood glucose level and increased the level of adiponectin (Apn) and leptin of both genders and age measured in serum. ADSCs cell cultures originated from female pups on LF diet and exposed to PEMF released large amounts of Apn. PEMF effect exerted on Apn release was also observed in ADSCs isolated from male pups HF diet. ADSCs from female pups on LF diet exposed to PEMF released smaller amounts of leptin in comparison to cell cultures without PEMF treatment. PEMF exposure of ADSCs cell cultures originated from female adults on LF diet decreased release of Apn, contrary adult male on LF diet ADSCs under PEMF treatment produced more leptin. PEMF treated male HF diet-originated ADSCs cultures released significantly more leptin than controls.

C o n c l u s i o n: Our results suggest that PEMF exposure is responsible for metabolic physiological balance effects obtained in ADSCs cultures originating from adult animals on HF diet.

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Editorial office

KOMITET REDAKCYJNY

Redaktor Naczelny
Dr hab. Krzysztof Gil, prof. UJ

Zastępca Redaktora Naczelnego
Prof. Andrzej Surdacki

Sekretarz Redakcji
Dr hab. Beata Kuśnierz – Cabala, prof. UJ

Członkowie
Prof. Benjamin Chain (London, UK),
Prof. Paul Enck (Tübingen, Germany),
Prof. Tomasz Grodzicki (Kraków, Poland),
Prof. Kalina Kawecka-Jaszcz (Kraków, Poland)
Prof. Maciej Małecki (Kraków, Poland),
Prof. Janusz Marcinkiewicz (Kraków, Poland),
Prof. Franz H. Messerli (New York, USA),
Prof. Jacek Musiał (Kraków, Poland),
Prof. Wiesław Pawlik (Kraków, Poland),
Prof. Jacek J. Pietrzyk (Kraków, Poland)
Prof. Władysław Sułowicz (Kraków, Poland)
Prof. Piotr Thor (Kraków, Poland)
Prof. Jerzy A. Walocha (Kraków, Poland)

Redaktor techniczny
Danuta Ambrożewicz

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