Medical sciences

Folia Medica Cracoviensia

Content

Folia Medica Cracoviensia | 2019 | vol. 59 | No 2 |

Abstract

Ectopic pregnancy constitutes 2% of all pregnancies. In the last decades, due to the rising amount of caesarean sections, new localization of ectopic pregnancy has been observed — caesarean scar pregnancy (CSP). Cesarean scar pregnancy is an iatrogenic disease and a life-threatening condition which frequency will systematically rise. Because of possible serious complications, CSP should be swift ly diagnosed and treated. Th e purpose of this retrospective study was to demonstrate diff erent methods of CSP treatment performed between 2015–2018 in the Clinic of Endocrinological Gynaecology and Gynaecology Jagiellonian University Medical College in Cracow. Th e clinical characteristics, diagnosis, various methods of treatment and clinical outcomes were analysed. Defi nitive algorithm of CSP treatment is still not established. Pharmacological and operative methods are approved while expectant observation is considered unsafe due to possible risk of complications for the patient, including death.

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Abstract

Th is report provides a concise overview of the rendering and utilization of three-dimensional models in the fi eld of anatomy. Anatomical three-dimensional virtual models are widely used for educational purposes, preoperative planning, and surgical simulations because they simply allow for interactive three-dimensional navigation across the human organs or entire body. Virtual threedimensional models have been recently fabricated as accurate replicas of the anatomical structures thanks to advances in rapid prototyping technology.

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Abstract

Tool Like Receptors (TLR) are transmembrane proteins that play an important role in immune reactions associated with the recognition of pathogenic factors that cause infection. However, chronic infl ammatory conditions associated with the activation of these receptors create favorable conditions for the development of cancerous processes. Th e relationship between nuclear PPARγ receptors and TLR receptors is also important, whose role and importance in the process of carcinogenesis is the subject of various studies.

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Abstract

I n t r o d u c t i o n: Hypoplastic left heart syndrome (HLHS) is a congenital heart anomaly that is diagnosed prenatally or postnatally. The prenatal diagnosis leads to limiting the rate of systemic complications in the preoperative period due to optimization of the early therapeutic management.

O b j e c t i v e: The objective of the study is to determine the effect of prenatal diagnostic management of HLHS on the condition of newborns and the frequency of antibiotherapy employment prior to the first stage of surgical treatment.

Me t h o d o l o g y: The study included 95 children with HLHS operated on in the years 2014–2016. The cohort was divided into two groups: newborns with a prenatally diagnosed heart defect (50 children — 52.6%) and neonates with the defect diagnosed after birth (45 children — 47.4%). The data of the patients were analyzed based on their medical records.

R e s u l t s: The mean age of the children upon admission was 3.86 days in the group of patients with the prenatally diagnosed heart defect (PreHLHS) and 7.41 days in the group of newborns without the prenatal diagnosis (PostHLHS) (p = 0.001). In 60% of the PreHLHS group patients (30/50), at least one antibiotic was administered, while in the PostHLHS group, antibiotherapy was employed in 93.3% (42/45) cases (p = 0.001). Bacteriological tests demonstrated pathogen growth in 33 children (36% and 33.3%, respectively), what accounted for 34.7% of the entire cohort. On the average, the first antibiotic was introduced on the 6.55th day of life in the PreHLHS group and on the 2.73th day in the PostHLHS group (p = 0.005). Th e most profound differences in antibiotic employment involved aminoglycosides. The aforementioned type of antibiotic medications was administered to 6% of the children with the prenatal diagnosis and to 17.8% of the children diagnosed postnatally (p = 0.042).

C o n c l u s i o n s: Preoperative antibiotherapy in children with HLHS was employed more frequently than it would be indicated by microbiology tests results. Antibiotics were observed to be introduced more commonly and earlier in the newborns with the postnatally diagnosed congenital heart defect.

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Abstract

Increasing numbers of implanted cardiovascular electronic devices, results in a need for lead extractions, which has increased to an annual volume of over 10,000 worldwide. We present a cadaveric dissection body with a single chamber pacemaker implanted 5y before death.

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Abstract

Malakoplakia is regarded as a chronic granulomatous infl ammatory disease with a good prognosis. It usually aff ects the urinary system, especially the urinary bladder. Bacterial infections, including E. coli are thought to be the main factor in pathogenesis. It frequently coexists with chronic diseases and immunosuppression state. Histopathological examination of aff ected tissue samples is thought to be the best diagnostic method. Th e basic microscopic feature is mixed infl ammatory infi ltration containing foamy histiocytes known as von Hansemann cells, frequently with basophilic inclusions known as Michaelis-Gutmann bodies. Symptoms and the clinical course of malakoplakia depend on location and the extent of the lesions. Th e lesion is treated successfully with antibiotic therapy and surgical excision.

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Abstract

B a c k g r o u n d: Echocardiography is the first exam to establish the myocardial function in patients with takotsubo syndrome (TTS). However, ECG-Gated Myocardial Single-Photon Emission Tomography (G-SPECT) also allows to calculate left ventricular ejection fraction (LVEF) and can be useful in early stadium of TTS.

A i m: To compare LVEF obtained from 99mTc-MIBI G-SPECT and echocardiography in patients with TTS.

M a t e r i a l a n d M e t h o d s: Study population: 20 patients in medium age 77 (62–89) with TTS were included. In all patients 99mTc-MIBI G-SPECT and echocardiography was performed on the same day.

R e s u l t s: LVEF measured by G-SPECT and echocardiography ranged from 34 to 83% and 38 to 69%, respectively. The LVEF values for ECHO were significantly lower than for SPECT. The correlation between the LVEF was r = 0.76. The calculated correlation coefficient (r) for linear regression analysis was 0.64. The following equation shows the approximate interdependence of both LVEF calculations: LVEF GSPECT = 10.35 + 0.93 * LVEF Echo.

C o n c l u s i o n s: G-SPECT tends to overerestimate LVEF compared to echocardiography so these imaging techniques should not be used interchangeably. Calculated equation should be used for comparison of LVEF.

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Abstract

O b j e c t i v e s: Patient-centered care (PCC) is associated with better doctor-patient relationships, resulting in a decrease in symptoms, hospitalizations and health costs. However, studies analyzing factors infl uencing patient-centered attitudes show ambiguous results. The purpose was to assess the impact of the Clinical Communication Course (CCC) in Jagiellonian University, Cracow and other factors on Patient-Centered Attitudes (PCA) and Attitude toward Clinical Skills Learning (CSLA).

M e t h o d s: We retrospectively compared Polish-speakers (CCC+, n = 160), English-speakers (CCCen+, n = 55) aft er the CCC and upperclassmen Polish-speakers without it (CCC–, n = 122). Validated questionnaires to measure PCA (Leeds Attitude Toward Concordance II and Patient-Practitioner Orientation Scale (PPOS)) and for CSLA (Communication Skills Attitude Scale with negative subscale (CSAS-N)) were used. The higher the scores, the more PCA, and negative CSLA respectively. Students completed questionnaires and answered questions regarding age, sex, motivation to study (coded as humanitarian — MotHUM, financial — MotFIN, combination — MotMIX) and considered specialization — coded as with more human contact (family medicine, psychiatry, pediatrics — SpecHUM) and others (SpecNHUM). Statistics were prepared in R.

R e s u l t s: CCC+ scored higher in PPOS (2.91 vs. 2.74; p = 0.003) than CCC– and higher in CSAS-N than CCCen+ (31.22 vs. 28.32; p = 0.004). In CCC+ SpecHUM scored lower than SpecNHUM in PPOS (2.65 vs. 2.94, p = 0.012). MotFIN scored higher then MotMIX in PPOS (3.01 vs. 2.7, p = 0.036). Correlations were statistically significant.

C o n c l u s i o n: CCC improved PCA in CCC+. Th ey showed more negative CSLA than CCCen+. Among CCC+, surprisingly, SpecNHUM presented more PCA than SpecHUM as well as MotFIN compared to MotMIX.

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Abstract

B a c k g r o u n d: Heart failure (HF) is a life-threatening condition which aff ects up to 2% of contemporary populations. Generally, it is a chronic and progressive disease, however in many cases it can be prevented or treated. Nevertheless, effective control of this disease requires awareness of symptoms in the society.

A i m s: The aim of the study was to assess the level of HF knowledge in the Polish population.

M e t h o d s: The questionnaire concerning knowledge about HF prepared by the Competence Network HF under the patronage of the European Heart Failure Association of the ESC, was used. The survey included 534 contributors who formed three groups: medical students — in vast majority at fi rst half of the study course (MS) — 198 (37.1%), HF Awareness Day participants (HFDP) — 134 (25.1%) and other (OP) — 202 (37.8%).

R e s u l t s: Study groups diff ered in terms of gender, age and level of education. As predicted, MS achieved the highest score (22.5 [20.0–24.0]), compared to HFDP (20.0 [17.0–22.0], P <0.001) and OP (19.0 [16.0– 21.0], P <0.001). Knowledge on typical HF symptoms was alarmingly low in the analyzed groups — dyspnea (MS — 96.0%, HFDP — 78.4%, OP — 74.6%), ankle edema (MS — 79.8%, HFDP — 50.6%, OP — 32.2%), body weight gain (MS — 14.1%, HFDP — 17.2%, OP — 4.5%). By multivariate model medical education (β 3.372, 95% CI 2.738–4.005) and own illness or having relatives or friends with HF (β 0.654, 95% CI 0.066–1.242) independently aff ected the score of awareness questionnaire.

C on c l u s i o n s: The basic knowledge on HF in Poland is not sufficient. It is moderately better among MS. Further campaigns improving HF awareness are necessary.

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Editorial office

KOMITET REDAKCYJNY

Redaktor Naczelny
Dr hab. Krzysztof Gil, prof. UJ

Zastępca Redaktora Naczelnego
Prof. Andrzej Surdacki

Sekretarz Redakcji
Prof. Beata Kuśnierz – Cabala

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

Contact

Adres redakcji
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31-121 Kraków
e-mail: folmedcrac@pan.pl

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