Center for Postgraduate Medical Education

Warsaw, Poland

Center for Postgraduate Medical Education

Warsaw, Poland
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Kawiak J.,Nalecz Institute of Biocybernetics and Biomedical Engineering | Hoser G.,Center for Postgraduate Medical Education | Domagala-Kulawik J.,Medical University of Warsaw
Advances in Cell Biology | Year: 2017

Various processes, taking place both in cells and in their environment, are linked to carcinogenesis. This paper aims at recalling the complex mechanisms of oncogenesis, with particular attention paid to responses of the immune system. In development of solid tumours, leukaemias and lymphomas several common stages can be noted. A neoplastic disease cannot be understood considering only phenomena of genetic mutations. Neoplastic cells are characterised by an extensive antigenic variability and resistance to apoptosis. The cells create around them a microenvironment which protects them from defensive activity of the host. In the paper we present the recognised mechanisms of anti-neoplastic defense as well as several elements allowing the solid tumours and leukaemias to escape from the immune surveillance. The generally accepted treatment of tumours aims at reducing numbers of tumour cells. Following resection of a tumour, radiotherapy or chemotherapy, the parallel or consecutive stage of treatment was found to involve an increase in number of clones of immune system cells. One of the ways in which the immune system can be activated involves autovaccination of the host with own neoplastic cells in an apoptosis. However, attempts of such a therapy frequently brought no expected results due to blocked activity of cytotoxic cells. Therefore, the subsequent stage in activation of the immune system should involve elimination of the tumor-mobilized blockade of the system. Attempts toward this aim include neutralization of the tumour-blocked cytotoxic properties of defensive cells, first of all T lymphocytes. The recognized mechanisms of blocking T cells activity in the PD-1/PD-L1 system or due to inhibition of activation by CTLA-4 molecule provided rationale for development of effective tumour immunotherapy approaches. © by Jerzy Kawiak 2017.

Michalowska I.M.,Institute of Cardiology | Kruk M.,Center for Postgraduate Medical Education | Kwiatek P.,Institute of Cardiology | Hryniewiecki T.,Center for Postgraduate Medical Education | And 5 more authors.
Journal of Thoracic Imaging | Year: 2014

PURPOSE:: The aim of the study was to assess thoracic aorta pathologies coexisting with bicuspid aortic valve (BAV) using dual-source computed tomography. MATERIALS AND METHODS:: A total of 102 patients with BAV diagnosed by electrocardiogram-gated computed tomography angiography of the thoracic aorta were analyzed retrospectively. The morphology of BAV was characterized on the basis of the presence and orientation of cusps and raphes as "pure BAV" (ie, without raphe) or "BAV with raphe." The assessment included aortic diameters and pathologies such as dilatation, aneurysm, dissection, or coarctation (CoA). RESULTS:: Of the 102 patients, 75 (73.5%) had BAV with raphe, and 27 patients (26.5%) had pure BAV. The analysis revealed significant differences in the diameter of the annulus, the sinuses of Valsalva, the tubular portion of the ascending aorta, and the part of the aorta proximal to the innominate artery between patients with pure BAV and BAV with raphe (respectively 27.18±4.33 vs. 29.88±4.18 mm, P=0.005; 38.11±7.2 vs. 41.77±6.9 mm, P=0.022; 39.07±8.3 vs. 46.31±7.8 mm, P=0.0001; 30.85±6.7 vs. 34.89±5.08 mm, P=0.02). There was a significant difference in prevalence of dilatation and aneurysm of the thoracic aorta between patients with pure BAV and BAV with raphe [58.06% vs. 84.5% (18/31 vs. 60/71), P=0.004]. The prevalence of aortic CoA was higher in patients with pure BAV than in patients with BAV with raphe [44.4% vs. 13.3% (12/27 vs. 10/75), P=0.001]. CONCLUSIONS:: BAV with raphe is more common than pure BAV and is more often associated with dilatation and aneurysm of the ascending aorta. Pure BAV is more commonly associated with CoA. ©ght 2013 by Lippincott Williams & Wilkins.

Kacprzak M.,Nalecz Institute of Biocybernetics and Biomedical Engineering | Liebert A.,Nalecz Institute of Biocybernetics and Biomedical Engineering | Staszkiewicz W.,Center for Postgraduate Medical Education | Gabrusiewicz A.,Center for Postgraduate Medical Education | And 3 more authors.
Journal of Biomedical Optics | Year: 2012

Recent studies have shown that time-resolved optical measurements of the head can estimate changes in the absorption coefficient with depth discrimination. Thus, changes in tissue oxygenation, which are specific to intracranial tissues, can be assessed using this advanced technique, and this method allows us to avoid the influence of changes to extracerebral tissue oxygenation on the measured signals. We report the results of time-resolved optical imaging that was carried out during carotid endarterectomy. This surgery remains the "gold standard" treatment for carotid stenosis, and intraoperative brain oxygenation monitoring may improve the safety of this procedure. A time-resolved optical imager was utilized within the operating theater. This instrument allows for the simultaneous acquisition of 32 distributions of the time-of-flight of photons at two wavelengths on both hemispheres. Analysis of the statistical moments of the measured distributions of the time-of-flight of photons was applied for estimating changes in the absorption coefficient as a function of depth. Time courses of changes in oxy- and deoxyhemoglobin of the extra- and intracerebral compartments during cross-clamping of the carotid arteries were obtained. A decrease in the oxyhemoglobin concentration and an increase in the deoxyhemoglobin concentrations were observed in a large area of the head. Large changes were observed in the hemisphere ipsilateral to the site of clamped carotid arteries. Smaller amplitude changes were noted at the contralateral site. We also found that changes in the hemoglobin signals, as estimated from intracerebral tissue, are very sensitive to clamping of the internal carotid artery, whereas its sensitivity to clamping of the external carotid artery is limited. We concluded that intraoperative multichannel measurements allow for imaging of brain tissue hemodynamics. However, when monitoring the brain during carotid surgery, a single-channel measurement may be sufficient. © 2012 Society of Photo-Optical Instrumentation Engineers (SPIE).

Witek P.,Center for Postgraduate Medical Education | Zgliczynski W.,Center for Postgraduate Medical Education | Zielinski G.,Military Institute of Health Services | Jeske W.,Center for Postgraduate Medical Education
Endokrynologia Polska | Year: 2010

Cushing's disease is related to a significant increase in mortality due to chronic hypercortisolaemia complications. It is known that 50% of non-treated subjects die within 5 years. Transsphenoidal selective adenomectomy is the treatment of choice. The incidence of relapses, even following a successful surgical procedure, is high and reaches 20-25% during the 5-year follow-up period. The authors discuss the case of a patient, currently aged 60, after repeat pituitary surgery, with progressive cardiovascular complications, in whom persistent Cushing's disease was diagnosed. The diagnosis was determined despite normal plasma ACTH, serum cortisol levels, and 17-OHCS concentrations in daily urine. There was also a lack of obvious pituitary adenoma features in the magnetic resonance imaging (MRI). Persistent Cushing's disease was diagnosed based on the combined dexamethasone desmopressin test. The presented case points to the role of provocative testing, including the desmopressin test following 1 mg of dexamethasone, for diagnostically difficult cases of Cushing's disease.

Slapa R.Z.,Medical University of Warsaw | Kasperlik-Zaluska A.A.,Center for Postgraduate Medical Education | Migda B.,Medical University of Warsaw | Jakubowski W.S.,Medical University of Warsaw
Endokrynologia Polska | Year: 2014

Introduction: The aim of this study was to evaluate the feasibility and usefulness of supersonic shear wave elastography (SSWE) in the diagnosis of nonmalignant adrenal masses. Material and methods: 13 patients with a total number of 16 adrenal masses were enrolled in the study. In each case, both conventional ultrasound imaging and SSWE for stiffness assessment were performed. The final diagnosis was based on CT, MRI, biochemical studies, surgery or more than one year of follow up. Results: The final diagnosis: nodular hyperplasia in six masses, six adenomas, three cysts, and one myelolipoma. All solid adrenal masses presented the elastography signal in contrast to cystic lesions that were devoid of it, as shear waves do not propagate through fluids. Conclusions: SSWE is a feasible technique that can be applied during ultrasound of the abdomen and retroperitoneum. SSWE presents potential for the differentiation of solid and cystic adrenal lesions. Further large scale studies evaluating the possibility of differentiation of adrenal and other retroperitoneal masses with SSWE are warranted.

Slapa R.Z.,Medical University of Warsaw | Piwowonski A.,NZ0Z Almed | Jakubowski W.S.,Medical University of Warsaw | Bierca J.,Solec Hospital | And 4 more authors.
Journal of Thyroid Research | Year: 2012

Although elastography can enhance the differential diagnosis of thyroid nodules, its diagnostic performance is not ideal at present. Further improvements in the technique and creation of robust diagnostic criteria are necessary. The purpose of this study was to compare the usefulness of strain elastography and a new generation of elasticity imaging called supersonic shear wave elastography (SSWE) in differential evaluation of thyroid nodules. Six thyroid nodules in 4 patients were studied. SSWE yielded 1 true-positive and 5 true-negative results. Strain elastography yielded 5 false-positive results and 1 false-negative result. A novel finding appreciated with SSWE, were punctate foci of increased stiffness corresponding to microcalcifications in 4 nodules, some not visible on B-mode ultrasound, as opposed to soft, colloid-inspissated areas visible on B-mode ultrasound in 2 nodules. This preliminary paper indicates that SSWE may outperform strain elastography in differentiation of thyroid nodules with regard to their stiffness. SSWE showed the possibility of differentiation of high echogenic foci into microcalcifications and inspissated colloid, adding a new dimension to thyroid elastography. Further multicenter large-scale studies of thyroid nodules evaluating different elastographic methods are warranted. © 2012 Rafal Z. Slapa et al.

PubMed | Warsaw School of Economics, Medical University of Warsaw, Institute of Rural Health in Lublin and Center for Postgraduate Medical Education
Type: | Journal: Medical science monitor : international medical journal of experimental and clinical research | Year: 2016

BACKGROUND The goal of this study was to investigate the relationship between cognitive functions and the level of endogenous estradiol in postmenopausal women, according to which estrogen receptor (ER) polymorphism the woman carries. MATERIAL AND METHODS The study group consisted of 210 women. The inclusion criteria were: minimum 2 years after the last menstruation, FSH concentration 30 U/ml, and no dementia signs on Montreal Cognitive Assessment (MoCA). A computerized battery of Central Nervous System Vital Signs (CNS VS) test was used to diagnose cognitive functions. Genotyping of the ERa polymorphism was performed using a polymerase chain reaction and restriction enzymes (PCR-RFLP). Blood plasma was tested for FSH and estradiol (E2). Statistical analysis was performed using STATISTICA software. RESULTS A relationship was confirmed between standard scores for 3 cognitive functions: general memory, verbal memory, and processing speed, and the XbaI polymorphism in the women in the study. In the group of women with genotype TT PvuII, significant positive relationships were observed between the concentration of E2 and the standard scores of 3 cognitive functions: general memory, verbal memory, and processing speed. In the group of women with genotype TC PvuII, significant negative correlations were found between the concentration of E2 and the standard scores of 4 cognitive functions: NCI, general memory, verbal memory, and processing speed. CONCLUSIONS ER polymorphism exerted an effect on the interaction between the concentration of estradiol and the results for cognitive functions. The concentration of estradiol did not depend on Xba1 and PvuII polymorphisms. The results for cognitive functions depended on which Xba1 polymorphism the woman carried.

Kasperlik-Zaluska A.A.,Center for Postgraduate Medical Education
Expert Review of Endocrinology and Metabolism | Year: 2010

A classical description of a postadrenalectomy syndrome in Cushings disease, described in 1958 by Don Nelson, included a deep skin hyperpigmentation, presence of a large pituitary tumor, high plasma adrenocorticotropic hormone levels and visual field deficits. The main pathophysiological mechanism of Nelsons syndrome development is a loss of feedback control of hypercortisolemia on corticotroph as a consequence of the removal of hyperactive adrenal glands. Modern techniques of imaging, computed tomography and MRI, made early detection of pituitary tumor at the stage of microadenoma possible. Determinations of plasma adrenocorticotropic hormone concentration during replacement therapy are the next essential diagnostic element. Absolute temporal scotomas in visual field examination are an early sign of Nelsons syndrome. Sufficient hydrocortisone therapy is very important to avoid hypocortisolemia, which stimulates corticotroph cells. Methods of treatment include neurosurgery, radiation therapy and pharmacotherapy. Prognosis in Nelsons syndrome depends on the stage of the disease; it may be poor in invasive pituitary tumors. © 2010 Expert Reviews Ltd.

Fichna M.,Poznan University of Medical Sciences | Fichna M.,Polish Academy of Sciences | Zurawek M.,Polish Academy of Sciences | Bratland E.,University of Bergen | And 6 more authors.
Autoimmunity | Year: 2015

Autoimmune Addison's disease (AAD) results from T cell-mediated destruction of the adrenal cortex, commonly accompanied by autoantibodies to 21-hydroxylase (21OH). In order to gain insight into the obscure aetiology of this disease, we investigated the roles of the IL2 and IL2RA genes, encoding interleukin-2 and subunit alpha of its receptor (IL2Ra), respectively. The association of AAD with IL2 and IL2RA polymorphisms (rs6822844, rs2069762, rs3136534, rs11594656, rs3118470 and rs2104286) was tested in 223 patients and 672 healthy controls. Functional studies consisted of gene expression analysis in cultured PBMCs exposed to 21OH and evaluation of serum interleukin by ELISA assays. The frequency of the minor C allele of rs3136534 was significantly decreased in AAD subjects compared to controls (OR 0.71; 95%CI 0.561-0.887; p=0.003). Only AAD cells responded to 21OH with an elevated IL2 and IL2RA mRNA synthesis (p=0.004 and p=0.009 versus controls, respectively), paralleled by increased supernatant levels of both cytokines (p=0.031 and p=0.001 versus controls). IL2 mRNA level in 21OH-stimulated AAD PBMCs correlated negatively with age (p=0.036) and positively with serum antibodies to 21OH (p=0.006). Carriers of the rs2104286 AA genotype demonstrated higher IL2RA mRNA (p0.022) and soluble IL2Ra secretion (p=0.029) upon 21OH stimulation. Serum interleukin-2 in AAD subjects was significantly higher compared to controls (4.61±4.3 versus 1.71±3.2pg/mL, p<0.001), whereas sIL2Ra levels remained similar in both groups (p=0.885). In conclusion, the study reveals an association between AAD and IL2 locus. It confirms specific 21OH-directed reactivity of the peripheral AAD lymphocytes, which display increased synthesis of interleukin-2 and sIL2Ra. © 2014 Informa UK Ltd. All rights reserved.

PubMed | Center for Postgraduate Medical Education
Type: Case Reports | Journal: Kardiologia polska | Year: 2012

We present the case of a 60 year-old woman with a stage III fallopian tube cancer submitted to hysterectomy and bilateral salpingo-oophorectomy with partial omenectomy, followed by six courses of chemotherapy and revision surgery. After each course of chemotherapy (paclitaxel + carboplatin) preceded by premedication with dexamethasone, she suffered from side- -effects, of which the most unpleasant was severe dizziness appearing on the third, fourth and fifth day following the listed combination of drugs. It was revealed that dizziness with concomitant sweating and rapid pulse, noted in the standing position, was combined with marked postural hypotension. Considering the possibility of a temporary pituitary-adrenal axis suppression caused by premedication with a very large dose of dexamethasone, during those three days she was supplemented with small doses of hydrocortisone, which caused almost complete disappearance of the mentioned symptoms. Our conclusion is that postural hypotension causing severe dizziness initially linked with chemotherapeutic drugs can be eliminated or markedly reduced by three days supplementation with hydrocortisone applied after the expected wash out of the dexamethasone.

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