Working environment of health care professionals - focus on occupational stress.

INTRODUCTION AND OBJECTIVE: Healthcare professionals most often encounter occupational stress. The aim of the study was to investigate the working environment of health care professionals with the focus on expression of occupational stress, and oversee the possibilities of stress management and prevention. MATERIAL AND METHODS: 326 representatives from five different healthcare institutions were surveyed in Siauliai city, Lithuania. The validated questionnaires HSE Management Standards Indicator Tool and the SF-36 questionnaire were used. RESULTS: The study revealed that the most important organizational factors were lack of communication, inappropriate relations with authorities and colleagues, big workload and long working hours, quick decision-making, and manifestations of mobbing. Financial support was reported as one of the main motivators in stress management. The most frequent individual factors were emotional relations with patients and their relatives. The healthcare professionals who experienced stress at work more often felt aches that disturbed their work routine, and their health interfered more their ordinary social activities. The main stress prevention measures are involvement of employees in decision-making, annual interviews with authorities, education, assurance of a safe work environment, and elimination of manifestations of mobbing. CONCLUSIONS: More attention must be paid to occupational stress management. It appeared that there is a lack of knowledge by institutions about the models of occupational stress management and internal stress management policy of organization. Therefore, this stimulates the search for measures that could help to change the situation.

Cutaneous Melanoma with Tonsillar Metastasis: Treatment with Cryoablation.

Metastasis of cutaneous melanoma to the oral cavity is a rare condition. Male patient with cutaneous melanoma metastasis to right tonsil 2 years after radical skin lesion resection was treated with surgery: tonsillectomy and later resection of soft palate were performed. Two years later the patient was diagnosed with progressive disease to right tonsil and soft palate. Rapid inoperable relapse was detected six months later. The patient underwent two procedures of palliative cryoablation of the metastasis. Postoperative course was uneventful. Patient died 7 months later due to progression of the disease. Cryoablation alone or together with surgery may be a relatively safe option for treatment of inoperable disease of head and neck tumours.

Sulforaphane has an additive anticancer effect to FOLFOX in highly metastatic human colon carcinoma cells.

Colorectal cancer (CRC) is one of the most common malignancies worldwide. Patients with CRC may need chemotherapy (CTx) in a neoadjuvant, adjuvant or palliative setting through the course of the disease. Unfortunately, its effect is limited by chemoresistance and chemotoxicity. Novel more effective and non­toxic CTx regimens are needed to further improve CRC treatment outcomes. Thus, the present study was designed to test the hypothesis that non­toxic sulforaphane (SF) is effective against CRC and has additive effects in combination with conventional 5­fluorouracil, oxaliplatin and folinic acid (FOLFOX) CTx in vitro. Highly metastatic human colon cancer cells, CX­1, and fibroblasts were treated with FOLFOX ± SF. Cell viability was assessed using an MTT assay. The level of apoptosis and the expression of apoptotic proteins were measured by TUNEL assay and quantitative PCR analysis. Aldehyde dehydrogenase isoform 1 (ALDH1) and multidrug resistance protein 2 (MRP2) levels were evaluated. The ability of cells to form spheroids was measured in three­dimensional cell culture. SF alone and in combination with FOLFOX effectively decreased the viability of the CX­1 cells, promoted apoptosis within the CX­1 cells, prevented cellular spheroid formation and decreased ALDH1 activity. However, SF promoted MRP2 expression and protein levels. In conclusion, SF together with conventional FOLFOX has additive anticancer effects against highly metastatic human CRC in vitro.

Thigh phlegmon as a first sign of a ruptured pelvic presacral abscess caused by ileal diverticulum fistula: A case report.

INTRODUCTION: Ileal diverticula usually remain asymptomatic. If complicated, they may present as intra-abdominal or pelvic abscess. Abscess formation in the presacral space is very rare. The rupture of abscess and spread of pus to extra-pelvic sites through anatomical structures of the pelvis is extremely rare. It carries high mortality if not diagnosed on time. CASE PRESENTATION: We report a case of 52-year-old woman presented with thigh phlegmon and septic condition. The CT scan revealed free air in the left leg and pelvic presacral fluid collection descending to extra-pelvic direction through the greater sciatic notch. Moreover, ileal fistula to presacral abscess was suspected. Multiple incisions and fasciotomies were urgently performed to treat thigh phlegmon. Subsequently, laparotomy was carried out and ileal fistula was excised. Histological examination of the surgical specimen demonstrated that the fistula to presacral abscess has formed due to perforated ileal diverticulum. 3 years after the surgery the patient remains healthy without recurrence. DISCUSSION: Rupture of presacral abscess to extra-pelvic site due to ileal diverticulum fistula is an extremely rare case, to our best knowledge, never reported in literature. Due to a rare occurrence and early septic complications if diagnosed late, this condition carries a high mortality rate. CONCLUSION: Intrapelvic pathology must be considered in patients with thigh phlegmon in order to prevent complications and associated mortality.