Introduction : Intraductal papillary mucinous neoplasia (IPMN) is a benign cystic neoplasm that has the potential to transform into pancreatic cancer over time. These lesions are usually asymptomatic. A main pancreatic duct IPMN is usually symptomatic and may present as an emergency when occlusion of the common bile duct with thick mucinous secretion and jaundice develop. This complication is hard to manage pharmacotherapeutically or by endoscopic procedure and may require surgical treatment. Purpose : This is a case report of a complicated main pancreatic duct IPMN that required an urgent, two-stage operation. A review of the literature on the topic was carried out. Case description : A 67-year-old male patient with symptoms of jaundice was diagnosed with acute cholangitis, cholecystitis, and pancreatitis as complications of the mucinous obstruction of the main pancreatic duct and of the common bile duct (CBD) caused by IPMN. The condition was confirmed by cholangio-pancreatoscopy and biopsy. Stenting of CBD was attempted, but the procedure turned out unsuccessful, and we proceeded to an emergency two-stage operation. The first operation consisted of the clearance of the bile ducts from infected mucinous secretion, cholecystectomy, and hepatico-jejunostomy. A Whipple procedure was performed as a second-stage operation. Discussion : Cases of emergency are not common in patients with IPMN. However, obstructive jaundice by mucinous secretion due to the disease is hard to treat only by endoscopy because of the high risk of obstruction of the endoprosthesis. On the other hand, emergency pancreatic resections are associated with a high risk of perioperative complications. Conclusion : Sometimes, the complicated main pancreatic duct IPMNs can pose a challenge for the interdisciplinary team of invasive gastroenterologists and surgeons, and the key to a successful outcome is surgical interventions in two- or three stages that include complications management as the first stage, followed by surgical resection as a second stage operation. Biliary drainage improvement is usually only temporarily successful with the insertion of biliary stents because of the rapid mucinous occlusion and the remaining risk of cholangitis and cholecystitis.
The cytokine storm has been identified as one of the leading causes of the severe course and, in some cases, the fatal outcome of COVID-19 infection. Other factors aggravating the course of the disease are accompanying disorders such as cardiovascular diseases, diabetes mellitus, diseases of the respiratory system, and oncological diseases. In this article, we present the course of the coronavirus infection in patients with an accompanying malignant disease, chronic lymphocytic leukemia (CLL), namely. The study included 8 patients with proven PCR-positive tests for SARS-CoV2 and confirmed chronic lymphocytic leukemia as a comorbidity. The course of the coronavirus infection in the CLL group was compared with that in the control group of 100 patients. In both groups, we compared subjective complaints such as tiredness, fatigue, and joint and muscle pain with objective criteria such as temperature, laboratory markers of inflammation, X-ray imaging, and frequency of necessary intubation. Despite the expected poor prognosis in patients with concomitant oncological disease, in the case of chronic lymphocytic leukemia, our results showed a quite different milder coronavirus infection course. Obviously, patients with CLL cannot develop a pronounced cytokine storm, most probably due to certain immunosuppression related to the pathogenesis and drug treatment options for the comorbidity of CLL.
In this article, we present a clinical case of a 63-year-old patient who was treated in the COVID unit of the Clinic for Internal Diseases of UMBALSM (University General Hospital for Active Care and Emergency Medicine) “N. I. Pirogov” on the occasion of a proven coronavirus infection with a PCR positive test for SARS-CoV2-virus, clinical symptoms of severe coronavirus pneumonia, and with accompanying disease - lymphoma with skin localization, condition after lower right lobectomy, chemotherapy and checkpoint therapy for squamous cell carcinoma of the lung. We also examined the role of the transcription factor NF-kB in the course of the coronavirus infection in a patient with the indicated lymphoproliferative disease and a history of active smoking. We tried to clarify questions such as “Do severe forms of coronavirus infection and the relatively rare disease lymphoma with cutaneous localization have a common pathogenesis?” Is it possible to effectively pharmacotherapeutically influence two, at first glance, so heterogeneous diseases?’’ The conclusions drawn can help us to specify certain nosological units as “more vulnerable” to severe forms of COVID19 infection.
Anxiety conditions and disorders are common in the general population, and patients suffering from them often seek the services of emergency departments. Anxiety is a psychopathological symptom that accompanies not only psychiatric conditions, but a wide range of somatic diseases, and a combination of both. The biochemical and pathophysiological mechanisms of psychosomatic interrelationship and comorbidity are complex and multi-layered. Thus, diagnosing the root cause of anxiety is a clinical challenge. Early, and on time, recognition of an anxiety disorder helps to avoid unnecessary investigations, ensures correct treatment and saves hospital resources. Careful use of medications, psychoeducation and referral to a specialist improves patient outcome with this potentially debilitating disease. In this article, the authors aim to present in a synthesized form the main epidemiological data on the prevalence of anxiety symptoms and disorders, anatomical localization and biochemical mechanisms and relationships in the pathogenesis of anxiety symptoms, as well as to derive the main guidelines for recognizing and differentiating clinicopathological constellations in somatic conditions in emergency medical practice. Materials and methods. Existing published studies from an international database, related to the subject of the article, have been thoroughly studied. Results. Anxiety symptoms, in particular panic attacks and disorders, are widespread in primary care and occupy a significant part of the work process, especially at times of peak loads, natural disasters and situations of mass traumatism. Conclusions. Timely training and good preparation for recognition and adequate assessment of anxiety conditions in primary and emergency medical care significantly shorten the therapeutic route of patients. They receive competent help on time, and the cost of their treatment is significantly reduced. Discussion. Modern medical science, including psychiatric, offers advanced drug and non-drug methods for the treatment and prevention of anxiety conditions and disorders.
The aim of this study is to assess the risk for immune and hematologic adverse events in perioperative transfusion of blood components. Our second goal is to propose methods for the selection of an optimally compatible donor in order to limit the negative impact of complications following blood component transfusion on the hospital outcome of patients admitted to clinics of general, gastrointestinal, thoracic, and vascular surgery. The largest group of patients included in this study were patients with gastrointestinal disorders (614 patients; 31%) and patients with diseases of the organs of the blood and lymphatic system (589 patients; 30%). This was followed by patients with diseases of the skin and subcutaneous tissue (368 patients; 18%) and patients with benign and malignant neoplasms (365 patients; 18%). The remaining 65 patients (3%) were diagnosed with diseases of the endocrine system, trauma patients, and patients with genitourinary disorders. The methods used for optimal selection of compatible blood components in this study are enzyme tests, Coombs tests, and tests in agglutinating medium. The study shows that clinically significant antibodies, which could provoke a post-transfusion hemolytic reaction, were detected in 4.3% of the screened patients. In the majority of patients, the specificity of antierythrocyte antibodies cannot be established. For those patients where the specificity of anti-erythrocyte antibodies could be established, the type of antibody and the antigen system to which it belonged were as follows (in descending order): 1. Anti-erythrocyte antibodies belonging to the Rh system: 37% (n = 17) of all screened patients (1.6% of all patients), including anti-E type (5 patients), anti-D (8 patients), anti-C-1, anti-C (2 patients), and anti-Cw (1 patient). 2. In 3 (6% or anti-erythrocyte antibodies belonging to other erythrocyte antigen systems—Kidd-1 patients, Lewis-2 patients—6% of the screened patients (0.3% of all patients). 3. In 57% (n = 26) of those screened (2.4% of all patients), alloantibodies without any known specificity were identified. The largest number of identified antibodies were directed against the D antigen belonging to the Rh system. Most of the anti-D alloantibodies found in Rhesus D (-) negative patients with no history of prior transfusion of D (+) positive red blood cell (RBC) concentrate possibly have resulted from prior Rh isoimmunization during pregnancy, provided that anti-D antibodies persist for a long time after birth—in some of the studied patients, 15–20 or more years. A greater number of alloimmunizations were found in women—28 (61%), compared to men—18 (39%), due to previous sensitization with different blood group antigens during pregnancy. This study shows that timely diagnosis is essential for the selection of appropriate RBC concentrate, for the avoidance of adverse reactions, and for the improvement of hematological parameters after transfusion of blood components. Graphical abstract :
Triple negative breast cancer (TNBC) continues to be the breast cancer subtype with the highest recurrence and mortality rates. Treatment of TNBC can be challenging because the disease has different molecular subtypes. Various treatment options are available, such as chemotherapy, immunotherapy, radiation therapy, and surgery. Chemotherapy is the most common of these options. The serious side effects of chemotherapy significantly limit its use. Long-term toxicity can affect the majority of breast cancer survivors, significantly reducing their quality of life. Immunotherapy causes a wide variety of toxic effects called immune-related adverse events (IRAEs). This necessitates the search for alternative methods of treatment for triple negative breast cancer. More and more research in this field is focused on single or combination therapy based on compounds obtained from natural sources. Natural products such as curcumin, resveratrol, and epigallocatechin-3-gallate, with their mechanisms of action and antineoplastic properties, are the subject of numerous studies.
The nuclear factor kappa B (NF-kB) signaling module is a complex and highly interconnected molecular network with important functions in all nucleated cells. Most chronic diseases caused by lifestyle factors appear to be related to inflammation. The NF-kB plays a major role in the pathogenesis of the inflammation and its intimate molecular mechanism. This transcription factor participates in the evolution of diabetes and its complications. In T1D (Type 1 Diabetes), proinflammatory cytokines such as interleukin-1β (IL-1β), tumor necrosis factor (TNF), and CD40L secreted by immune cells in islets induce the activation of NF-kB in β-cells through both canonical and noncanonical roads. NF-kB activation increases the expression of genes, including TNF-α, IL-1β, IL-6, MCP-1, and ICAM-1, that initiate and promote atherosclerosis. In particular, the severity and lethality of acute lung injury or acute respiratory distress syndrome (ALI/ARDS) caused by pneumonia or sepsis is primarily associated with an NF-kB-mediated “cytokine storm,” in which massive polymorphonuclear (PMN) extravasation and the subsequent release of cytokines cause rapid deterioration due to widespread inflammation and coagulation. Nuclear translocation of NF-kB p65 can induce the transcription of several genes involved in the induction of EMT (epithelial-to-mesenchymal transition). This has been confirmed in various types of cancer, including brain, breast, lung, and gastric cancer. Cutaneous T-cell lymphoma (CTCL) encompasses a group of lymphoproliferative disorders characterized by invasive neoplastic T cells in the skin and various clinical prognoses. In the early stages of CTCL, NF-kB activation and cell proliferation are stimulated by the autocrine production of TNFα, leading to increased NF-kB activation and resistance to apoptosis. Bladder cancer is the second most common genitourinary cancer and is often recurrent and/or chemoresistant after tumor resection. NF-kB is a transcription factor that plays a critical role in normal physiology and bladder cancer. Bladder cancer patients have pathologically active NF-kB induced by proinflammatory cytokines, chemokines, and hypoxia, enhancing carcinogenesis and progression of the disease.
Background : Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is a relatively new method of inguinal hernia surgical repair that, at theory, provides a good view of the inguinal anatomy and sac contents and, as a laparoscopic procedure, is considered less invasive and with fewer complications compared to total extraperitoneal (TEP) inguinal hernia repair. Purpose : This study aims to assess the short-term outcome of laparoscopic transabdominal preperitoneal inguinal hernia (TAPP) repair. Material and methods : The retrospective clinical data for 138 patients with unilateral and bilateral hernia, operated in the Department of General, Visceral, and Emergency Surgery of the University Emergency Medicine Hospital ‘N. Pirogov’ from 01 January 2022, to 01 January 2023, were included. The risk profile of the patients, the intraoperative and postoperative complications, the duration of hospital stay, the frequency, and the type of analgesics used were analyzed. Results : Forty-one women (29.7%) were included; men comprised 97 (70.29%) of the cohort. Of the selected group, 63 (45.7%) patients had indirect inguinal hernias, 34 (24.6%), and 25 (18.1%) were diagnosed with direct inguinal hernia and accreta inguinal hernia, respectively. A history of repeatedly occurring hernias was found in 16 patients (11.6%). The average hospital stay was 32 hours (or 1.3 days) and ranged from 24 hours (1 day) to 48 hours (2 days). Complications occurred in 11 (7.97%) patients. The need for analgesics and anti-inflammatory agents was reliably reduced compared to the patients undergoing conventional surgical treatment of inguinal hernia. The patients were followed for three months post-discharge for the occurrence of surgical morbidity associated with the TAPP hernia repair. None of the patients used an antimicrobial agent, as indicated by a possible complicating bacterial infection. Rehabilitation was started within the first 12 hours after the operation, thus contributing to a significantly shorter hospital stay compared to patients undergoing conventional surgical repair of an inguinal hernia. Conclusion : Our results demonstrate that TAPP inguinal hernia repair is a safe procedure with reduced postoperative pain. It has fewer complications, with no significantly longer operative time and a shorter overall hospital stay.
Introduction : Primary tumor resection can prevent future tumor-related complications in patients with stage IV colorectal cancer. This may influence the quality of life and prevent colostomies associated with the emergency surgery. Laparoscopic approach plays an important role in attempts to reduce perioperative complications in this specific group of patients. Purpose : The aim is to assess early perioperative results in a group of 17 patients with stage IV colorectal cancer—multiple incurable liver metastases and/or pulmonary/peritoneal metastases of the disease. On the other hand, postoperative complications may delay administration of chemotherapy and influence survival. Materials and methods : We analyze retrospectively the perioperative results in a group of 17 patients with laparoscopic palliative colorectal resections for stage IV colorectal cancer. Assessment includes perioperative complications, median hospital stay, perioperative blood loss, need for blood transfusion, operative time, and type of surgical procedure. Results : We performed totally laparoscopic 10 sigmoid resections, five left colectomies, and two right colectomies. Fourteen simultaneous liver biopsies were performed during laparoscopy. No perioperative deaths were registered. Perioperative mortality rate is 0%. Perioperative morbidity rate is 0%. No perioperative complications. The median perioperative stay is 5.3 days. Median blood loss is 47.9 mL. Overall, three units of blood were transfused. The median transfusion rate is 0.17 units per patient. The median operative time is 130.2 minutes. Conclusion : The laparoscopic approach is associated with very good perioperative results in patients with stage IV colorectal cancer and palliative resection of the primary tumor. Early hospital discharge and minimal operative trauma may not influence early administration of chemotherapy.
