University Hospital of Lords Transfiguration

Poznań, Poland

University Hospital of Lords Transfiguration

Poznań, Poland

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Rini B.,Cleveland Clinic | Szczylik C.,Military Institute of Medicine | Tannir N.M.,University of Houston | Koralewski P.,Szpital Specjalistyczny Ludwika Rydygiera | And 12 more authors.
Cancer | Year: 2012

BACKGROUND: This study evaluated the tolerability and antitumor activity of AMG 386, a peptibody (a peptide Fc fusion) that neutralizes the interaction of angiopoietin-1 and angiopoietin-2 with Tie2 (tyrosine kinase with immunoglobulin-like and EGF-like domains 2), plus sorafenib in patients with clear cell metastatic renal cell carcinoma (mRCC) in a randomized controlled study. METHODS: Previously untreated patients with mRCC were randomized 1:1:1 to receive sorafenib 400 mg orally twice daily plus intravenous AMG 386 at 10 mg/kg (arm A) or 3 mg/kg (arm B) or placebo (arm C) once weekly (qw). Patients in arm C could receive open-label AMG 386 at 10 mg/kg qw plus sorafenib following disease progression. The primary endpoint was progression-free survival (PFS). RESULTS: A total of 152 patients were randomized. Median PFS was 9.0, 8.5, and 9.0 months in arms A, B, and C, respectively (hazard ratio for arms A and B vs arm C, 0.88; 95% confidence interval [CI], 0.60-1.30; P =.523). The objective response rate (95% CI) for arms A, B, and C, respectively, was 38% (25%-53%), 37% (24%-52%), and 25% (14%-40%). Among 30 patients in arm C who had disease progression and subsequently received open-label AMG 386 at 10 mg/kg qw, the objective response rate was 3% (95% CI, 0%-17%). Frequently occurring adverse events (AEs) included diarrhea (arms A/B/C, 70%/67%/56%), palmar-plantar erythrodysesthesia syndrome (52%/47%/54%), alopecia (50%/45%/50%), and hypertension (42%/49%/46%). Fifteen patients had grade 4 AEs (arms A/B/C, n = 3/7/5); 4 had fatal AEs (n = 2/1/1), with 1 (abdominal pain, arm B) considered possibly related to AMG 386. CONCLUSIONS: In patients with mRCC, AMG 386 plus sorafenib was tolerable but did not significantly improve PFS compared with placebo plus sorafenib. © 2012 American Cancer Society.


Baraniak A.,Polish National Medicines Institute | Izdebski R.,Polish National Medicines Institute | Fiett J.,Polish National Medicines Institute | Gawryszewska I.,Polish National Medicines Institute | And 11 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2016

Objectives: The objective of this study was to characterize New Delhi metallo-b-lactamase (NDM)-producing Enterobacteriaceae isolates reported in Poland in 2012-14. Methods: Representative isolates were typed by PFGE and MLST. NDM and other b-lactamase geneswere amplified and sequenced. Plasmids with blaNDM genes were analysed by nuclease S1 plus hybridization profiling, by transfer assays and by PCR-based replicon typing. The blaNDM genetic context was studied by PCR mapping assays. Results: Of 374 cases of infection/colonization with NDM-positive Enterobacteriaceae identified in 2012-14, 370 cases in 40 hospitals, 10 outpatient clinics and 1 nursing home were associated with a Klebsiella pneumoniae outbreak with epicentres in Poznań and Warsaw. The outbreak strain of K. pneumoniae ST11 was similar to an isolate from the Czech Republic from 2013. Like the Czech strain, many of the isolates had two blaNDM-1-carrying IncFII- and IncR-type plasmids of variable size, sharing a blaNDM-1-containing segment. The early isolates also produced CTX-M-15 co-encoded by the IncR-type plasmids, and differentiated later by extensive plasmid rearrangements. Four other NDM cases were reported in 2013, three being associated with arrivals from Montenegro, India or Afghanistan. The Indian Escherichia coli ST448 NDM-5 isolate revealed similarity to a recent isolate from Spain, including the blaNDM genetic context observed previously in E. coli strains in Poland and France (of Congolese and Indian origins, respectively). The Afghani Proteus mirabilis was the second isolate of this species with a chromosomal blaNDM-1 location. Conclusions: The largest NDM outbreak in a non-endemic country has been observed, being an alarming phenomenon in resistance epidemiology in Poland. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.


PubMed | Medical University of Warsaw, University Hospital of Lords Transfiguration, ALAB Laboratories, Voivodship Hospital and 2 more.
Type: Case Reports | Journal: The Journal of antimicrobial chemotherapy | Year: 2015

The objective of this study was to characterize New Delhi metallo--lactamase (NDM)-producing Enterobacteriaceae isolates reported in Poland in 2012-14.Representative isolates were typed by PFGE and MLST. NDM and other -lactamase genes were amplified and sequenced. Plasmids with blaNDM genes were analysed by nuclease S1 plus hybridization profiling, by transfer assays and by PCR-based replicon typing. The blaNDM genetic context was studied by PCR mapping assays.Of 374 cases of infection/colonization with NDM-positive Enterobacteriaceae identified in 2012-14, 370 cases in 40 hospitals, 10 outpatient clinics and 1 nursing home were associated with a Klebsiella pneumoniae outbreak with epicentres in Pozna and Warsaw. The outbreak strain of K. pneumoniae ST11 was similar to an isolate from the Czech Republic from 2013. Like the Czech strain, many of the isolates had two blaNDM-1-carrying IncFII- and IncR-type plasmids of variable size, sharing a blaNDM-1-containing segment. The early isolates also produced CTX-M-15 co-encoded by the IncR-type plasmids, and differentiated later by extensive plasmid rearrangements. Four other NDM cases were reported in 2013, three being associated with arrivals from Montenegro, India or Afghanistan. The Indian Escherichia coli ST448 NDM-5 isolate revealed similarity to a recent isolate from Spain, including the blaNDM genetic context observed previously in E. coli strains in Poland and France (of Congolese and Indian origins, respectively). The Afghani Proteus mirabilis was the second isolate of this species with a chromosomal blaNDM-1 location.The largest NDM outbreak in a non-endemic country has been observed, being an alarming phenomenon in resistance epidemiology in Poland.


Magro M.,Erasmus University Rotterdam | Wykrzykowska J.,Erasmus University Rotterdam | Serruys P.W.,Erasmus University Rotterdam | Simsek C.,Erasmus University Rotterdam | And 8 more authors.
Catheterization and Cardiovascular Interventions | Year: 2011

Background: Treatment of bifurcation lesions with the Tryton Sidebranch stent has been shown to be feasible with an acceptable clinical outcome and low side branch late loss in the first in man trial. Objective: To report acute procedural and six month clinical follow-up after the use of the Tryton Sidebranch stent in an "all comer" registry. Methods: The first 100 coronary bifurcation lesions assigned for treatment with the Tryton stent were included in a prospective registry. Procedural and angiographic success rates were determined from patient charts and pre- and postprocedural quantitative coronary angiography. Results: Totally, 96 patients with 100 lesions were included in the study. Seventy-two percent presented with stable angina, 25% with unstable angina/NSTEMI, and 3% STEMI. The bifurcation was located in the left main in 8%. Two lesions were chronic total occlusions. Sixty-nine percent were true bifurcation lesions. One failure of stent delivery occurred. Acute gain in SB was 0.76 ± 0.64mm and three patients had residual stenosis of >30%. Angiographic success rate was 95%; procedural success rate reached 94%. Peri-procedural MI occurred in two and there was one cardiac death during hospitalization. At a median six months follow-up, TLR rate was 4%, MI 3%, and cardiac death 1%. The percentage MACE-free survival at six months was 94%. No cases of definite stent thrombosis occurred. Conclusions: In a real world the use of the Tryton Sidebranch stent is associated with good procedural safety and angiographic success rate and acceptable outcome at six months of follow-up. © 2011 Wiley-Liss, Inc.


Deskur-Smielecka E.,Poznan University of Medical Sciences | Deskur-Smielecka E.,University Hospital of Lords Transfiguration | Kotlinska-Lemieszek A.,Poznan University of Medical Sciences | Kotlinska-Lemieszek A.,University Hospital of Lords Transfiguration | And 3 more authors.
Journal of Palliative Medicine | Year: 2015

Background and Objective: Multiple drugs used in palliative care, including most opioids or their active metabolites may accumulate in patients with abnormal renal function, leading to serious adverse effects. The incidence and severity of renal impairment in palliative care inpatients has not been evaluated. The aim of the study was to investigate the incidence and severity of renal impairment in palliative care inpatients. Methods: A retrospective analysis of medical records of patients admitted to the palliative care ward was performed. Estimated glomerular filtration rate (eGFR) was derived using the Cockcroft-Gault (C-G) and abbreviated Modification of Diet in Renal Disease (aMDRD) equations. Results: Serum creatinine levels (SCr) were determined in 332 subjects aged 66.4 ± 11.80 years (194 women; mean body mass index [BMI] 22.7 ± 5.21 kg/m2). Mean SCr was 107.7 ± 112.31 μmol/L. Elevated SCr (> 115 μmol/L) was found in 20.2% of patients. Mean eGFR calculated with C-G and aMDRD equations was 66.6 ±38.52 mL/min and 78.7 ±43.55 mL/min/1.73 m2, respectively. Between 35.2% and 51.8% of patients had eGFR < 60 mL/min/1.73 m2 (depending on the equation used). More than 10% of patients had eGFR < 30 mL/min/1.73 m2. In patients with normal SCr, between 18.9% and 39.2% had eGFR < 60 mL/min/1.73 m2. Conclusion: Renal impairment is common in palliative care inpatients, including considerable number of subjects with moderately to severely reduced kidney function. © Copyright 2015, Mary Ann Liebert, Inc.


Zaporowska-Stachowiak I.,University Hospital of Lords Transfiguration | Kotlinska-Lemieszek A.,Poznan University of Medical Sciences | Kowalski G.,Poznan University of Medical Sciences | Kosicka K.,Poznan University of Medical Sciences | And 3 more authors.
OncoTargets and Therapy | Year: 2013

Optimal symptoms control in advanced cancer disease, with refractory to conventional pain treatment, needs an interventional procedure. This paper presents coadministration of local anesthetic (LA) via paravertebral blockade (PVB) as the alternative to an unsuccessful subcutaneous fentanyl pain control in a 71-year old cancer patient with pathological fracture of femoral neck, bone metastases, and contraindications to morphine. Bupivacaine in continuous infusion (0.25%, 5 mL hour-1) or in boluses (10mL of 0.125%-0.5% solution), used for lumbar PVB, resulted in pain relief, decreased demand for opioids, and led to better social interactions. The factors contributing to an increased risk of systemic toxicity from LA in the patient were: renal impairment; heart failure; hypoalbuminemia; hypocalcemia; and a complex therapy with possible drug-drug interactions. These factors were taken into consideration during treatment. Bupivacaine's side effects were absent. Coadministered drugs could mask LA's toxicity. Elevated plasma α1-acid glycoprotein levels were a protective factor. To evaluate the benefit-risk ratio of the PVB treatment in boluses and in constant infusion, bupivacaine serum levels were determined and the drug plasma half-lives were calculated. Bupivacaine's elimination was slower when administered in constant infusion than in boluses (t1/2=7.80 hours versus 2.64 hours). Total drug serum concentrations remained within the safe ranges during the whole treatment course (22.9-927.4 ng · mL-1). In the case presented, lumbar PVB with bupivacaine in boluses (≤137.5mg · 24 hours-1) was an easy to perform, safe, effective method for pain control. Bupivacaine in continuous infusion (≤150mg · 12 hours-1) had an acceptable risk-benefits ratio, but was ineffective. © 2013 Zaporowska-Stachowiak et al.


Markowska A.,Poznan University of Medical Sciences | Kasprzak B.,University Hospital of Lords Transfiguration | Jaszczynska-Nowinka K.,University Hospital of Lords Transfiguration | Lubin J.,University Hospital of Lords Transfiguration | Markowska J.,Poznan University of Medical Sciences
Wspolczesna Onkologia | Year: 2015

Worldwide research groups are searching for anticancer compounds, many of them are organometalic complexes having platinum group metals as their active centers. Most commonly used cytostatics from this group are cisplatin, carboplatin and oxaliplatin. Cisplatin was used fot the first time in 1978, from this time many platinum derivatives were created. In this review we present biological properties and probable future clinical use of platinum, gold, silver, iridium and ruthenium derivatives. Gold derivative Auranofin has been studied extensively. Action of silver nanoparticles on different cell lines was analysed. Iridium isotopes are commonly used in brachyterapy. Ruthenium compound new anti-tumour metastasis inhibitor (NAMI-A) is used in managing lung cancer metastases. Electroporation of another ruthenium based compound KP1339 was also studied. Most of described complexes have antiproliferative and proapoptotic properties. Further studies need to be made. Nevertheless noble metal based chemotherapheutics and compounds seem to be an interesting direction of research.


PubMed | Poznan University of Medical Sciences and University Hospital of Lords Transfiguration
Type: Journal Article | Journal: Oncology letters | Year: 2015

The treatment of acute chest pain can be a challenge in palliative care. Firstly, because acute chest pain is a symptom of a paucity of diseases, which makes diagnosis difficult and time consuming, while there is also a time constraint, due to the extreme suffering of the patient. Secondly, the condition of a patient with advanced cancer disease and co-morbidities does not always allow for required diagnostic procedures. The present report describes a case of acute, severe epigastric/chest pain in a patient with dynamic disease progression, who was receiving palliative care. This study also demonstrates that the pathophysiology of pain in a terminal patient may determine the treatment strategy. The patient in the present case was a 41-year-old male, who had previously undergone gastrectomy for stomach cancer, followed by postoperative chemotherapy. The patient was treated with palliative chemotherapy for metastases to the lungs, liver and lymph nodes, which led to the development of iatrogenic peripheral neuropathy. The patient was subsequently admitted to the Palliative Medicine In-patient Unit of the University Hospital of Lords Transfiguration (Poznan, Poland) with the complaint of acute epigastric and chest pain. An electrocardiogram, echocardiogram, chest and abdomen computerized tomography scan, esophagoduodenoscopy and laboratory analyses were performed to determine the source of the pain. The patient was treated with morphine sulfate, metoclopramide, midazolam, diazepam, acetaminophen, ketamine, hyoscine butylbromide, propofol, dexamethasone and amoxycillin, and received parenteral nutrition. As the source of pain remained unclear, a second esophagoduodenoscopy was performed to determine a diagnosis, resulting in pain relief. Thus, in the present case, esophagoduodenoscopy was diagnostic and therapeutic. Furthermore, although the treatment of acute chest pain may be a challenge in palliative care, the present study indicates that pain treatment should be adjusted to anatomical, pathophysiological and pharmacological factors, and may pose risks due to the unavoidable parenteral co-administration of multiple agents with strong therapeutic effects.


PubMed | Poznan University of Medical Sciences and University Hospital of Lords Transfiguration
Type: Journal Article | Journal: Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery | Year: 2015

There has been a growing interest in off-pump coronary artery bypass (OPCAB) grafting in recent years. Beating-heart surgery is believed to be less invasive as it allows the side effects of extracorporeal circulation to be avoided.The aim of the study was to compare blood product transfusion rates between two groups of patients undergoing surgery for ischemic heart disease with either the off-pump technique or using cardiopulmonary bypass (CPB).There were 152 patients enrolled in the prospective randomized study. All procedures were elective. There were 84 patients (62 men and 20 women) at the mean age of 63.74 7 years who underwent OPCAB (group I), and 68 patients (54 men and 14 women) at the mean age of 63.51 6 years who underwent cardiopulmonary bypass (group II).There were no perioperative deaths. The mean number of grafts was 2.27 0.3 (OPCAB group) and 2.63 0.6 (CPB group) (p < 0.05). The mean number of packed red blood cells transfused in the OPCAB group was 2.31 0.18 units/patient and 3.94 0.30 units/patient in the CPB group (p < 0.05). The mean number of fresh frozen plasma units transfused was 1.13 0.13 in the OPCAB group vs. 1.57 0.15 in the CPB group (p < 0.05). There were 12 patients (14%) in the OPCAB group who had no transfusion.One of the most important advantages of the OPCAB technique is that it makes it possible to reduce the rate of blood product transfusions.


PubMed | Poznan University of Medical Sciences and University Hospital of Lords Transfiguration
Type: Journal Article | Journal: Contemporary oncology (Poznan, Poland) | Year: 2015

Worldwide research groups are searching for anticancer compounds, many of them are organometalic complexes having platinum group metals as their active centers. Most commonly used cytostatics from this group are cisplatin, carboplatin and oxaliplatin. Cisplatin was used fot the first time in 1978, from this time many platinum derivatives were created. In this review we present biological properties and probable future clinical use of platinum, gold, silver, iridium and ruthenium derivatives. Gold derivative Auranofin has been studied extensively. Action of silver nanoparticles on different cell lines was analysed. Iridium isotopes are commonly used in brachyterapy. Ruthenium compound new anti-tumour metastasis inhibitor (NAMI-A) is used in managing lung cancer metastases. Electroporation of another ruthenium based compound KP1339 was also studied. Most of described complexes have antiproliferative and proapoptotic properties. Further studies need to be made. Nevertheless noble metal based chemotherapheutics and compounds seem to be an interesting direction of research.

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