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Centrum, Poland

Czyzykowski R.,University of Lodz | Polowinczak-Przybylek J.,University of Lodz | Janiak A.,University of Lodz | Herman J.,Oddzial Chirurgii | Potemski P.,University of Lodz
Przeglad Menopauzalny

Tamoxifen is a selective estrogen receptor modulator used for the treatment of oestrogen/progesterone receptor positive breast cancer. It has antagonistic or agonistic activity depending on the tissue location. Generally it causes mild and reversible side effects, however more serious ones including cardiovascular and thromboembolic adverse events, uterine cancer or acute pancreatitis can also occur. Tamoxifen, like oestrogens, increases the plasma level of TG and liver secretion of VLDL. Moreover, it inhibits the key enzymes of triglyceride metabolism. In this report we present a case of a 55-year-old woman with a history of a poorly controlled hypertriglyceridaemia diagnosed with breast cancer. She was treated with surgery and adjuvant chemotherapy, radiotherapy and hormonotherapy with tamoxifen. About three months after hormonal treatment, her triglyceride level increased. Five months later she developed an acute necrotic pancreatitis that required hospitalization. Her serum samples on admission were highly lipemic. An abdominal ultrasound showed no evidence of gallstones or dilation of the bile ducts. There was no history of alcohol abuse or abdominal trauma. Tamoxifen was suspected as a trigger factor for pancreatitis. After the drug withdrawal and administration of the conservative management the patient's medical condition improved. Due to a postmenopausal status of the patient and no harmful effect on serum lipids, an adjuvant hormonotherapy with aromatase inhibitor was started. Source

Vesicoureteral reflux (VUR) is the phenomenon of retrograde urine flow from the bladder towards the kidney. The term is in use from the end of XIX century, nevertheless reasons of its formation and treatment modalities are still discussed. We still do not have treatment standard as well. Aggressive methods are nowadays less popular and we can find in the literature opinions about lack of advantage from VUR surgical treatment. What's more some authors have doubts if we should use any treatment at all. The aim of the study is retrospective analysis of results of three treatment methods in grade III-V VUR in terms of reflux disappearance. We analysed 68 children treated in our centre between 2005-2008. Three methods are compared: conservative by which we mean antibiotic prophylaxis, endoscopic and open surgery. Forty patients were treated conservatively, 16 by endoscopic injection and 12 by open surgery. At the beginning of treatment and at the end of observation period all children had correct renal function and normal blood pressure. Mean observation time was 18 months. Improvement, by which we understand VUR disappearance or reducing it to I grade, we do not observed in 14% of conservatively treated and 8% of endoscopic treated patients. In all children treated by open surgery improvement was achieved. Although the differences are statistically significant, it is worth of notice that there were so many conservatively treated children, in which improvement of VUR was obtained. © Pediatr Med Rodz 2010. Source

Jobs K.,Klinika Pediatrii | Jurkiewicz B.,Oddzial Chirurgii | Bochniewska V.,Klinika Pediatrii | Straz-Zebrowska E.,Klinika Pediatrii | Jung A.,Klinika Pediatrii
Przeglad Pediatryczny

Urolithiasis is the most ancient and common disease of man. Its frequency increases with civilization progress. It has been estimated that it concerns about 5-10% of adult population in Europe and about 2% of children. The disease has a recurrent character and complicated pathogenesis. In most patients with urinary stones the recurrence rate is high. The probability of next stone formation is estimated at 15% in 3 years and 30-50% in 15 years. Open surgery is nowadays replaced by less invasive methods. They have proven their effectiveness and safety. These popular methods are: extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopic lithotripsy (URS) and percutaneous nephrolithotripsy (PNL). In clinical practice it is often necessary to perform the procedure many times or to use combined methods. We present here three patients treated with a combination of two methods. Source

Janota B.,Oddzial Psychiatrii | Papierska L.,Klinika Endokrynologii i Oddzial Chorob Wewnetrznych | Zaluska M.,IV Klinika Psychiatrii | Janota K.,Klinika Endokrynologii i Oddzial Chorob Wewnetrznych | And 2 more authors.
Postepy Psychiatrii i Neurologii

Background. The aim of the paper was to outline anxiety and depression symptoms and well as other somatic ailments in the course of pheochromocytoma of adrenal glands. This type of tumor is relatively rare, mostly benign, and hormonally active. Secreting excessive amounts of catecholamines the tumor may manifest itself in elevated blood pressure, tachycardia, nonspecific abdominal complaints, and sometimes symptoms of anxiety and depression. Early diagnosis and surgical removal of pheochromocytoma lead to full recovery in a majority of cases. Case report. A female patient, not stressed and with no hypertension, had been unsuccessfully pharmacologically treated for anxiety and depression on the outpatient basis. Following an episode of acute abdominal pain and nausea her USG examination revealed a tumor in the right adrenal gland. Elevated urinary metoxycatecholamines suggested the diagnosis of pheochromocytoma, confirmed histopathologically. After surgical removal of the tumor and discontinuation of pharmacotherapy the patient's depressive and anxiety symptoms completely abated. No recurrence of the tumor was found within a 2-year follow-up period. Commentary. Pheochromocytoma should always be taken into account in the differential diagnosis of anxiety and depression causes, since this condition if not recognized in time and left untreated may be fatal due to vascular complications and metastases. The reported case highlights the necessity of including pheochromocytoma in the differential diagnosis of anxiety and depressive disorders in the absence of hypertension, particularly if pharmacotherapy is ineffective and there are no significant stress factors. It should be remembered that signs and symptoms of pheochromocytoma include not only tachycardia, elevated blood pressure and headaches, but also abdominal complaints (pain, nausea, dyspepsia). The latter, interpreted as anxiety symptoms, may be actually manifestations of pheochromocytoma, and therefore require relevant screening procedures. © Instytut Psychiatrii i Neurologii. Source

Cichocki A.,Oddzial Chirurgii | Nawrocki G.,Oddzial Chirurgii | Roszkowska-Purska K.,Zaklad Patologii Centrum Onkologii | Jozwiak M.,Oddzial Chirurgii | And 2 more authors.

The study presents a single center experience in the treatment of solid pseudopapillary neoplasms (SPN) - rare, potentially malignant tumors of the pancreas. The prognosis in pancreatic SPNs is relatively good, with surgical treatment being the method of choice. Between 2003 and March 2010, we had treated 6 women (age: 19-28) with SPNs. All tumors were situated in the pancreatic tail. In five asymptomatic patients, the tumor diameter ranged from 5 to 10 cm. In the sixth patient, multiple synchronous liver metastases led to epigastric pain. All cases were treated with distal pancreatic resection and splenectomy. 18-months follow-up of the patient with metastases showed no extrahepatic dissemination and she underwent allogenic liver transplantation. Up to this day all the patients are disease-free and remain in good clinical condition. The significant value of our paper is the high number of relatively young patients treated within a short period of time at one institution and the particularly high percentage of asymptomatic cases. Source

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