Antipsychotic plasma levels in the assessment of poor treatment response in schizophrenia.

OBJECTIVE: Treatment resistance is a challenge for the management of schizophrenia. It is not always clear whether inadequate response is secondary to medication ineffectiveness, as opposed to medication underexposure due to non-adherence or pharmacokinetic factors. We investigated the prevalence of subtherapeutic antipsychotic plasma levels in patients identified as treatment-resistant by their treating clinician. METHOD: Between January 2012 and April 2017, antipsychotic plasma levels were measured in 99 individuals provisionally diagnosed with treatment-resistant schizophrenia by their treating clinicians, but not prescribed clozapine. Patients were followed up to determine whether they were subsequently admitted to hospital. RESULTS: Thirty-five per cent of plasma levels were subtherapeutic, and of these, 34% were undetectable. Black ethnicity (P = 0.006) and lower dose (P < 0.001) were significantly associated with subtherapeutic/undetectable plasma levels. Individuals with subtherapeutic/undetectable levels were significantly more likely to be admitted to hospital (P = 0.02). CONCLUSION: A significant proportion of patients considered treatment-resistant have subtherapeutic antipsychotic plasma levels, and this is associated with subsequent admission. The presence of subtherapeutic plasma levels may suggest a need to address adherence or pharmacokinetic factors as opposed to commencing clozapine treatment. While antipsychotic levels are not recommended for the routine adjustment of dosing, they may assist with the assessment of potential treatment resistance in schizophrenia.

[The value of evaluating tumor markers: CA 15-3 and ferritin in blood serum of patients grouped as "high risk" for breast cancer]. / Wartosc kliniczna oznaczen markerów nowotworowych: CA 15-3 oraz ferrytyny w surowicy krwi chorych grupy "wysokiego ryzyka" zachorowania na raka sutka.

We studied 127 patients. 35 patients (group I) with mastopathy disease (average 44.3 years old) included 9 patients with a breast cancer family history (subgroup I A), 26 patients without a breast cancer family history (subgroup I B) and 92 patients (group II) with a breast cancer of I-IV grade (average 49.25 years old). The results of the study revealed statistically significant higher level of CA 15-3 in serum of patients with mastopathy compared to patients with a breast cancer of I grade (p < 0.05). CA 15-3 level in patients with a breast cancer of III, IV grade in serum, was considerably higher and there was significant difference comparing to the patients with a breast cancer of I, II grade (p < 0.001) and patients with mastopathy disease. There were also higher average levels of CA 15-3 in patients with mastopathy disease with a breast cancer family history (subgroup I A) compared to patients without an oncological risk (subgroup I B), however there were not significant differences. There were also higher average levels of ferritin revealed in patients with a breast cancer of III, IV grade and which shows significant difference between patients with breast cancer of I, II grade and with mastopathy patients (p < 0.001). It seems that determination of CA 15-3 and ferritin in patients of a high risk group of a breast cancer could be a useful diagnostic tool for early determination of a breast cancer.

[Adrenal gland diseases--results of surgical treatment]. / Choroby nadnerczy--wyniki leczenia chirurgicznego.

The aim of the study is presentation of own remarks, related to surgical treatment of 183 patients with adrenal glands pathology in the years 1976-1996. The diagnosis was based on typical clinical symptoms and hormonal studies. The localisation of lesion was determined initially by X-ray examinations, mostly arteriography, later by ultra-sound and computer tomography, recently also by nuclear magnetic resonance and scintigraphy. The paper discusses methods of preparing the patients for surgery, tactics of surgical treatment, intra- and postoperative complications (8.2%), problem of incidentalomas.

[Abdominal resection of rectal cancer]. / Wyciecie brzuszne odbytnicy z powodu raka.

Preservation of anal sphincters in the surgical treatment of rectal cancer is often controversial as far as an extent of surgery, incidence of complications and an increase in mortality rate in perioperative period are concerned. The study was aimed at results of the retrospective analysis of patients, who undergone abdominal excision of the rectum for malignant tumours. Totally 136 patients were operated. Perioperative mortality rate was 5.14%. Totally 26.4% of patients survived for at least 5 years, including 80% of patients operated in A stage of cancer, according to Duke, and 43.3% of patients with tumour in B stage. An emphasis is on the necessity to leave a 2-centimeter margin of healthy tissues around the tumour, provided, that the result of intraoperative histological examination was negative. Such a margin is sufficient for anastomosis. Low anastomoses do not produce early complications and recurrences.