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- Janusz, Frey, 1975-
(författare)
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Liczba i rozmieszczenie komórek Cajala w ścianie esicy u chorych z uchyłkowatością jelita grubego
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Diverticulosis is one of the most common morphologic changes of the colon observed in citizens of highly-developed countries. So far, in spite of numerous observational and experimental trials, not all etiopathogenetic factors of diverticulosis have been defined. It is assumed that one of the most common reasons of colonic diverticulosis is the increase in intracolonic pressure, mainly in the sigmoid colon, resulting from disturbance of colonic motility. One of the important factors responsible for gastrointestinal tract motor function are interstitial cells of Cajal (ICCs). It was confirmed, that in such gastrointestinal tract disorders as infantile hypertrophic pyloric stenosis, slow transit constipation, megacolon, diabetic gastro- and gastroenteroparesis, internal anal sphincter achalasia and Hirschprung’s disease there is a marked decrease of the interstitial cells of Cajal number. On the basis of published observations, the following aims of the study were established:1. Assessment of the quantity and distribution of interstitial cells of Cajal in a transverse section of the sigmoid colon wall of patients with colonic diverticular disease, and in the control group (patients with non-obturative colon cancer).2. Determination of the relationship between the number and distribution of interstitial cells of Cajal in the sigmoid colon in patients with diverticulosis, and age, duration of disease, type of symptoms and concomitant diseases.3. Determination of the correlation between the number and distribution of the interstitial cells of Cajal in the sigmoid colon, and anorectal functions as recorded using anorectal manometry.A total of 101 patients, operated in IIIrd Department of the General Surgery, Jagiellonian University Medical College between 2001 and 2006, were enrolled into the study. 34 patients operated for colonic diverticular disease were enrolled into the study group. The control group consisted of 67 patients operated electively for non-obturative colorectal cancer. The study has been conducted, with the Jagiellonian University Bioethical Committee’s consent, according to the Declaration of Helsinki guidelines.The primary goal of this study was to assess the quantity and determine the localization of the interstitial cells of Cajal in the transverse sections of the sigmoid colon wall in patients with diverticular disease, and in patients from the control group. The secondary goals were to determine the correlations between the number and distribution of the ICCs in the sigmoid colon of patients with diverticulosis, and age, duration of disease, diverticular disease symptoms, concomitant disorders and anorectal manometry results.The distribution and the quantity of the ICCs constituting particular subpopulations were assessed, after performing immunohistochemical assay using anti c-kit antibody (DAKO), using the light microscope conjoined with an image analysis system (Image Analysis System; ProGres C 12 Plus camera (Jenoptik)).The cells with positive reaction to anti c-kit antibody were identified using the method described above. Positive reaction revealed interstitial cells of Cajal as well as mast cells. Interstitial cells of Cajal had a characteristic fusiform shape, and in some preparations its branches were also visualized. Mast cells observed in the preparations had round and oval shape, and round, centrally located nucleus. Cajal cells, present in the circular and longitudinal muscle layer of sigmoid colon, were oriented parallel to the smooth muscle cells.The following subpopulations of interstitial cells of Cajal were identified and assessed: ICC-SM – interstitial cells of Cajal, localized on the submucosal and circular muscle border of the sigmoid colon and in the region of the submucosal plexus, ICC-CM – interstitial cells localized in the sigmoid colon circular muscle layer, ICC-MP – interstitial cells localized between the circular and longitudinal muscle layers of the sigmoid colon and in the neighbourhood of the Auerbach’s plexus and ICC-LM – interstitial cells localized in the longitudinal sigmoid colon muscle layer. The quantity and distribution of particular ICCs subpopulations were assessed.The number of interstitial cells was statistically significantly lower in patients with diverticulosis as compared to patients from the control group (15.53 vs 19.45 / breadth of 1 visual field respectively; p<0.001). The decrease of interstitial cells number was significantly higher in the neighbourhood of the Auerbach's plexus and in the area between the circular and longitudinal sigmoid colon wall muscle layers (ICC-MP). The mean number of interstitial cells observed in 1 visual field of 0,2756 mm2 in area in patients from the studied and control groups, divided into particular subpopulation, amounted respectively: ICC-SM 1.28 vs 1.67, ICC-CM 3.94 vs 4.69, ICC-MP 6.71 vs 10.08 and for ICC-LM subpopulation 2.85 vs 4.09.No differences in size, morphology and distribution of interstitial cells of Cajal in the previously described sigmoid colon wall layers were found between the control and study groups.Moreover a positive correlation between the number of ICC-MP interstitial cells of Cajal and the presence of flatulence as well as mucous in the stool was demonstrated. A negative correlation between the number of ICC-LM cells of Cajal and the presence of pain, as reported by patients prior to the surgery, was also determined. The analysis of correlation between the number of interstitial cells of Cajal in the sigmoid colon obtained from patients with diverticulosis, and the presence of selected concomitant diseases, revealed a relationship between the quantity of the ICC-SM cells and the presence of the neurologic and thyroid gland disorders.The analysis also revealed a correlation between interstitial cells of Cajal (ICC-CM subpopulation), and the presence of the thyroid gland diseases (nodular goiter, hyperthyreosis).A correlation was also found between the number of interstitial cells of Cajal localized in the sigmoid colon circular muscle layer (ICC-CM) and the presence of the normal anorectal reflexes, as well as between the quantity of ICC-MP cells and the anorectal manometry values (BAP and MVSP).Obtained results confirm the observations, published in other publications, concerning the decrease in number of interstitial cells of Cajal in patients with colonic diverticulosis.In summary, the number of the interstitial cells of Cajal is decreased in the sigmoid colon of patients with diverticulosis. It is particularly distinct in the ICC-MP, ICC-CM and ICC-LM groups. Taking into consideration the role of interstitial cells of Cajal in the regulation of gastrointestinal motility, it appears that a reduction of their number may be an important etiopathogenetic factor of colonic diverticulosis. These cells may also play a role in the pathophysiology of the symptoms of diverticular disease by modulating enteric nervous system (ENS) impulsation. The study revealed the negative correlation between the number of ICC-MP subpopulation cells and some subjective symptoms, as well as the relationship between abdominal pain and the decrease in the number of ICC-LM cells. Obtained results do not allow an unambiguous determination of the order and sequence of events leading to diverticula formation. There is no positive correlation between the duration of disease and its stage of advancement, and the number of the particular interstitial cell subpopulations. It seems that the number of Cajal cells may be influenced by the stage of local diverticular disease advancement, for example the increased quantity of collagen in the colonic wall, and not by the duration of symptoms. Diverticular disease is in most cases asymptomatic, and only patients operated with a high stage of local advancement of the disease following inefficacious conservative treatment and dietary modifications were enrolled into the study. The results of this study may contribute to the practical application of interstitial cells of Cajal detection methods in preoperative and intraoperative diagnostics, decision making regarding the extent of operative procedures, and reduction of recurrence after operative treatment. Progress concerning the role of interstitial cells of Cajal in the sigmoid colon of patients with diverticulosis may also contribute to the indications for modification of elective operative treatment, allowing more objective qualification of patients than currently possible.
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- Lorenz, Fryderyk, et al.
(författare)
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Wartosc diagnostyczna i zastosowanie kliniczne biomarkerów oraz ferrytynemii w chorobie Gauchera : [Diagnostic and clinical value of biomarkers and ferritinemia in Gaucher disease]
- 2014
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Ingår i: Acta Haematologica Polonica. - : Elsevier. - 0001-5814. ; 45:2, s. 149-154
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Forskningsöversikt (refereegranskat)abstract
- Gaucher disease is a progressive, multisystem lysosomal storage disorder caused by the deficient activity of the lysosomal enzyme, glucocerebrosidase (GBA), arising from autosomal recessive mutations in the GBA1 gene (1q21). There are several biomarkers used in Gaucher disease (i.e., chitotriosidase, CCL18/PARC, tartrate resistant acid phosphatase, angiotensin-converting enzyme), however, all of them have some disadvantages. It is believed that none of these biomarkers has a significant correlation with the clinical severity of Gaucher disease. A high proportion of patients with type 1 Gaucher disease present with hyperferritinemia, however, the pathophysiology of the high ferritin serum levels in Gaucher disease has not yet been elucidated and different mechanisms are possible. This review presents a current knowledge on biomarkers useful for diagnostic and monitoring of Gaucher disease with a focus on ferritinemia.
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- Markuszewska-Kuczymska, Alicja, et al.
(författare)
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Długotrwała pancytopenia po chemioterapii jako objaw demaskuja̧cy chorobȩ Gauchera u pacjentki z rakiem płuca : [Long-lasting pancytopenia after chemotherapy as a disclosing symptom of Gaucher disease in a patient with lung cancer]
- 2014
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Ingår i: Acta Haematologica Polonica. - : Elsevier. - 0001-5814. ; 45:3, s. 294-300
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Tidskriftsartikel (refereegranskat)abstract
- The diagnosis of congenital metabolic disease can be very difficult and often extends in time. This applies particularly to metabolic diseases of milder phenotype, such as an adult form (type 1) of Gaucher disease caused by the inherited (autosomal recessive) deficiency of the lysosomal enzyme glucocerebrosidase. In this work, we present a case of 48-year-old Polish patient (living in Sweden) with lung cancer, who developed a prolonged pancytopenia complicated by sepsis after each cycle of chemotherapy. These symptoms led to initiation of hematological diagnostic work-up and the assumption that the complications are caused by Gaucher disease. Definitive diagnosis of Gaucher disease was confirmed by results of enzymatic analyses, which revealed reduced activity of glucocerebrosidase in peripheral blood lymphocytes to 0.44 μkat/kg protein (ref.: 2.1-3.8), increased activity of plasma chitotriosidase to 1241 nkat/L (ref.: <40), and elevated plasma concentrations of chemokine CCL18/PARC to 1228 μg/L (ref.: <100). Direct DNA sequencing of the GBA1 gene revealed the presence of heterozygous mutation c.604C>T (R163X) and c.1226A>G (N370S), confirming diagnosis of type 1 Gaucher disease in the patient. The presence of the mutation c.604C>T has never been previously reported in a Polish patient with Gaucher disease. Administration of enzyme replacement therapy with imiglucerase (Cerezyme™) led to a rapid improvement of peripheral blood counts and enabled further continuation of intensive chemotherapy for lung cancer. In conclusion, the authors would like to emphasize that knowledge of the symptoms and the principles of diagnosis of Gaucher disease among hematologists is very important for efficient diagnostics of patients affected by this rare disease.
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- Steffel, Jan, et al.
(författare)
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The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation : executive summary
- 2018
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Ingår i: Kardiologia polska. - : VIA MEDICA. - 0022-9032 .- 1897-4279. ; 76:9, s. 1283-1298
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Tidskriftsartikel (refereegranskat)abstract
- Poniższy tekst jest streszczeniem drugiej aktualizacji oryginalnego praktycznego przewodnika opublikowanego w 2013 roku. Leki przeciwkrzepliwe niebędące antagonistami witaminy K (NOAC) stanowią cenną alternatywę dla antagonistów witaminy K (VKA) w zapobieganiu udarom u pacjentów z migotaniem przedsionków (AF) i uznano je za leki preferowane, szczególnie dla osób rozpoczynających leczenie przeciwkrzepliwe. Zarówno lekarze, jak i pacjenci przyzwyczajają się do ich stosowania w praktyce klinicznej, istnieje jednak wiele nierozwiązanych kwestii dotyczących optymalnego stosowania tych leków w określonych sytuacjach klinicznych. Europejskie Stowarzyszenie Zaburzeń Rytmu Serca (EHRA, European Heart Rhythm Association) podjęło się koordynacji opracowania jednolitego sposobu komunikowania się z lekarzami na temat stosowania różnych preparatów NOAC. Grupa określiła 20 tematów zawierających konkretne scenariusze kliniczne, w odniesieniu do których sformułowano praktyczne wskazówki na podstawie dostępnych dowodów. Do problemów klinicznych należą: 1) odpowiednia kwalifikacja pacjentów do leczenia; 2) praktyczne schematy rozpoczynania oraz monitorowania terapii za pomocą NOAC; 3) zagwarantowanie przestrzegania zaleceń przyjmowania doustnych leków przeciwkrzepliwych; 4) zmiana schematów leczenia przeciwkrzepliwego; 5) farmakokinetyka oraz interakcje lekowe; 6) stosowanie NOAC u osób z przewlekłą chorobą nerek i zaawansowaną chorobą wątroby; 7) sposoby pomiaru efektu przeciwkrzepliwego NOAC; 8) pomiar stężenia NOAC w surowicy: rzadkie wskazania, środki ostrożności, potencjalne „pułapki”; 9) postępowanie w przypadku pomyłki w dawkowaniu; 10) postępowanie w przypadku (podejrzenia) przedawkowania bez krwawienia lub badania krzepnięcia wskazujące na potencjalne ryzyko krwawienia; 11) postępowanie w przypadku krwawienia w trakcie terapii za pomocą NOAC; 12) postępowanie u pacjentów poddanych planowym zabiegom chirurgicznym, procedurom inwazyjnym czy ablacji; 13) postępowanie u pacjentów wymagających pilnej interwencji chirurgicznej; 14) pacjenci z AF oraz chorobą wieńcową; 15) unikanie pomyłek w dawkowaniu NOAC w różnych wskazaniach; 16) kardiowersja u pacjenta leczonego NOAC; 17) AF u pacjentów z ostrym udarem mózgu leczonych NOAC; 18) NOAC w sytuacjach szczególnych; 19) leczenie przeciwkrzepliwe w przypadku AF u pacjentów z nowotworami złośliwymi; 20) optymalizacja leczenia za pomocą VKA. Dodatkowe informacje oraz materiały do pobrania, jak również karty leczenia przeciwkrzepliwego w kilku językach można znaleźć na stronie internetowej EHRA (www.NOACforAF.eu).
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- Wilczek-Rużyczka, Ewa, et al.
(författare)
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Jak pogodzić życie zawodowe i prywatne? – stres zawodowy i zaangażowanie a konflikt praca - dom wśród pielęgniarek [How to balance professional involvement with private life? – job-related stress and professional responsibilities in the light of the conflict between job and private life in the nursing profession].
- 2012
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Ingår i: Conference "Patient-friendly medicine", Warsaw, 19-20.05.2012. ; , s. 2-
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Konferensbidrag (refereegranskat)abstract
- Wprowadzenie: Większość pielęgniarek to kobiety, które tradycyjnie często godzą profesjonalne obowiązki z życiem rodzinnym. Konflikt pomiędzy sferą prywatną i zawodową ma dwustronną naturę. Negatywny wpływ pracy na życie prywatne jest odnotowywany częściej niż relacja odwrotna (Greuters et al., 2003).Celem pracy była ocena konfliktu praca – dom i dom – praca na percepcję stresu zawodowego i zaangażowania w pracę. Wymagania zawodowe zdefiniowano jako przeciążenie pracą i konflikty interpersonalne (Spector & Jex, 1998). Zaangażowanie charakteryzowano jako wigor i poświęcenie (Schaufeli et al., 2002).Metody: Zastosowano następujące metody: Skala Konfliktu Interpersonalnego i Ilościowego Przeciążenia Pracą (Spector & Jex, 1998), Utrechtska Skala Zaangażowania w Pracę – wersja skrócona (Schaueli, Bakker, & Salanova, 2006), Skale Konflikt Praca – Rodzina i Rodzina Praca (Netemeyer, Boles, & McMurrian, 1996).W badaniu wzięło udział 98 pielęgniarek (średnia wieku 41 lat SD = 5,9) pracujące w zawodzie przeciętnie od 19 lat (zakres1,5 – 33). Większość byłą zamężna (85%), a ich partnerzy pracowali zawodowo (82%).Wyniki: Konflikt praca – rodzina był silniejszy niż konflikt rodzina – praca wśród badanych pielęgniarek. Negatywne oddziaływania pracy na życie prywatne, różnicuje percepcję stresu zawodowego (przeciążenie pracą i konflikty interpersonalne) i zaangażowania w pracę (wigor i poświęcenie). Pielęgniarki, które odczuwały większy konflikt na linii dom – praca doświadczały większego konfliktu praca dom.
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