Management of Metastatic Pancreatic Cancer-Comparison of Global Guidelines over the Last 5 Years.

Pancreatic cancer (PC) is usually diagnosed at an advanced stage of its development, which results in lower overall survival (OS). Prognosis is also poor even with curative-intent surgery. Approximately 80% of patients with localized PDAC have micrometastases at the time of diagnosis, which leads to a worse prognosis than in other cancers. The objective of this study is to present the progress in the treatment of metastatic pancreatic cancer based on the recommendations of oncological scientific societies, such as ESMO, NCCN, ASCO, NICE and SEOM, over the last 5 years. Combined FOLFIRINOX therapy is mostly a recommended therapy among patients with good performance statuses, while gemcitabine is recommended for more fragile patients as a first-line treatment. The newest guidelines suggest that molecular profiling of the tumor should be the first step in determining the course of treatment. The use of modern molecular therapies in patients with specific gene mutations should extend the survival of patients with this disease.

Overview of Pancreatic Cancer Epidemiology in Europe and Recommendations for Screening in High-Risk Populations.

Pancreatic cancer is the seventh most common cause of death in the group of oncological diseases. Due to the asymptomatic course, early diagnosis is difficult. Currently, early detection methods are only used in high-risk groups. A literature review based on the available results of observational studies on patients with pancreatic cancer and people from high-risk groups was used to summarize the knowledge on risk factors. The GLOBOCAN 2020 data were used to assess the epidemiological situation in Europe. A summary of screening recommendations was prepared based on the available documents from medical organizations and associations. Pancreatic cancer risk factors are divided into two main groups: non-modifiable factors, e.g., hereditary factors and age, which increase the risk of developing this disease, and modifiable factors-BMI, smoking, and alcohol consumption. Hereditary factors account for 10% of pancreatic cancer cases. The highly specialized methods of early detection, (MRI, CT, or EUS) are used for screening high-risk populations. Of all the imaging methods, EUS is considered the most sensitive for pancreatic cancer and allows an accurate assessment of the size of even small lesions (<30 mm) and the extent of tumour infiltration into blood vessels. The available studies vary on the level of sensitivity and specificity of these methods for the diagnosis of pancreatic cancer. EUS, MRI, and CT are also expensive procedures and in some patients can be invasive, which is one of the arguments against the introduction of population screening programs based on imaging methods. Therefore, it is important to look for viable solutions that would improve early detection. This is important from the point of view of healthcare systems in Europe, where almost 29% of all global pancreatic cancer cases are reported.

Pharmacotherapy of pain in cancer patients - recommendations of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family Medicine, Polish Society of Anaesthesiology and Intensive Therapy and Association of Polish Surgeons.

Guidelines for the pharmacotherapy of pain in cancer patients were developed by a group of 21 experts of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family Medicine, Polish Society of Anaesthesiology and Intensive Therapy and Association of Polish Surgeons. During a series of meetings, the experts carried out an overview of the available literature on the treatment of pain in cancer patients, paying particular attention to systematic reviews and more recent randomized studies not included in the reviews. The search was performed in the EMBASE, MEDLINE, and Cochrane Central Register of Controlled Trials databases using such keywords as "pain", "cancer", "pharmacotherapy", "analgesics", and similar. The overviewed articles included studies of pathomechanisms of pain in cancer patients, methods for the assessment of pain in cancer patients, and drugs used in the pharmacotherapy of pain in cancer patients, including non-opioid analgesics (paracetamol, metamizole, non-steroidal anti-inflammatory drugs), opioids (strong and weak), coanalgesics (glucocorticosteroids, α2-adrenergic receptor agonists, NMDA receptor antagonists, antidepressants, anticonvulsants, topical medications) as well as drugs used to reduce the adverse effects of the analgesic treatment and symptoms other than pain in patients subjected to opioid treatment. The principles of opioid rotation and the management of patients with opioidophobia were discussed and recommendations for the management of opioid-induced hyperalgesia were presented. Drugs used in different types of pain experienced by cancer patients, including neuropathic pain, visceral pain, bone pain, and breakthrough pain, were included in the overview. Most common interactions of drugs used in the pharmacotherapy of pain in cancer patients as well as the principles for the management of crisis situations. In the final part of the recommendations, the issues of pain and care in dying patients are discussed. Recommendations are addressed to physicians of different specialties involved in the diagnostics and treatment of cancer in their daily practice. It is the hope of the experts who took part in the development of these recommendations that the recommendations would become helpful in everyday medical practice and thus contribute to the improvement in the quality of care and the efficacy of pain treatment in this group of patients.

Ondine's Curse - Genetic and Iatrogenic Central Hypoventilation as Diagnostic Options in Forensic Medicine.

In the Nordic mythology a man lost his ability to breathe without remembering it after he was cursed by water nymph - referred to as 'Ondine's curse' - and then he died as soon as he fell asleep. Family medicine specialists are familiar with many sleeping disorders that their patients commonly call by the term Ondine's Curse. In medical sciences this term is historically related to the group of conditions that have as the common denominator seemingly spontaneous onset of life-threatening hypoventilation. The physiology and genetics specialists focus mainly on congenital central hypoventilation syndrome (CCHS), which was proven to be linked to several genetic mutations. Anesthesiologists tend to be more interested in similarly manifesting iatrogenic condition. Typically, patients that were previously subjected to general anesthesia, after temporarily waking up and regaining the spontaneous respiratory drive, later fall back into unconsciousness and develop hypoventilation. Anesthesiologists also call it Ondine's curse because of the sudden and unexpected sleep onset. The iatrogenic Ondine's curse is proven to be precipitated by delayed anesthetics release from patients' fat tissue - where it was deposited at the time general anesthesia was administered - back into bloodstream. Forensic medicine has to consider the latter form of Ondine's curse called scenario more often, as they investigate sudden deaths related to surgery and general anesthesia in the post-operational care period. These cases may also fall into the category of medical malpractice-related deaths.

[Cigarette smoking and immunity disorder]. / Palenie papierosów a zaburzenia odpornosci.

Cigarette smoking addiction is one of the cardinal factors the diseases of respiratory system, cardio-vascular system and neoplasms. A part of them is the effect of immunosupression. It includes both morphologic changes (atrophia of lymphoid tissue) and cell functional disorder of the immune system. Cell-mediated response Th1-type, which is responsible for pathogens invasion, is depleted, whereas Th2-type is increased and has its effect on higher frequency of allergic diseases. Susceptibility to neoplasmatic changes is also augmented.

[Selected respiratory, digestive and urinary system diseases as causes of hospital treatment in the lower Silesia region in aspect smoking-related diseases]. / Wybrane choroby ukladu oddechowego, pokarmowego i wydalniczego jako przyczyny leczenia w szpitalach Dolnego Slaska w aspekcie chorób odtytoniowych.

UNLABELLED: Extensive smoking is impairing function of respiratory, digestive and urinary system. MATERIALS AND METHODS: Analysis was made using data describing hospitalizations in years 2003-2005 caused by respiratory, digestive and urinary system diseases, especially malignant neoplasmas. In analyzed period the count of Lower Silesia region citizens treated in hospitals because of respiratory, digestive and urinary system diseases connected with smoking has dropped. Outside the positive trend stay malignant neoplasms of pancreas, renal pelvis and ureter, lip, oral cavity and pharynx, and bronchiectases. Positive changes in hospitalization because of respiratory, digestive and urinary system diseases could to some extent be assigned as a success of health promotion activities, including anti-smoking actions.

[Analysis of changes in most common circulatory system diseases related hospitalizations in the Lower Silesia region in aspect smoking-related diseases]. / Analiza zmiennosci hospitalizacji z powodu najczestszych chorób ukladu krazenia w województwie dolnoslaskim w aspekcie chorób odtytoniowych.

Cigarette smoking is a risk factor of circulatory system diseases and causes many hospital admissions. Existing data describing hospitalizations because of cardiovascular system diseases in years 2003-2005 were analyzed using statistical methods. In the analyzed years the count of hospitalizations caused by angina pectoris, heart failure, hypertension, atherosclerosis and strokes has dropped, minor changes were visible in frequency of hospital admissions because of acute myocardial infarction and the count of cerebral infarction cases slightly increased. ln the analyzed years in the Lower Silesia region there was visible slight improvement in the area of most main circulatory system diseases. Their hospital treatment is in much extent concentrated in bigger hospitals, because it needs specialized stuff and equipment.

[Epidemiology of tobacco-related diseases in province of Lower Silesia]. / Epidemiologia chorób odtytoniowych w województwie dolnoslaskim.

The aim of the study is to present the epidemiology of tobacco-related diseases in province of Lower Silesia and to determine needs and tasks of medical service at this area. Tobacco use is the leading preventable cause of death in the world, resulting in approximately 4000000 deaths each year (in Poland probably 70.000 deaths). Results of the study can be a ground for planning of health education and health promotion programs. The aim of the education should be to reduce an incidence of tobacco-related diseases. The target groups should be young people and teenagers. It's necessary to create "no smoking" trend. There is an important role of doctor and nurses. They should set a good example.

The impact of neuraminidase on apoptosis in cultures of blood lymphocytes isolated from rats bearing morris hepatoma.

Lymphocytes were obtained by heart-punction from rats bearing Morris hepatoma. In the short term, 18-hour cultures of these lymphocytes exhibited a significantly higher amount of apoptotic cells than lymphocyte cultures from the healthy, control animals. Neuraminidase, injected into the caudal vein of the rats with Morris hepatoma, caused a marked lowering in the amount of apoptotic blood-lymphocytes and an elevation of the amount of viable cells. The possible mechanism of neuraminidase preventing the apoptosis of blood-circulating lymphocytes in tumour hosts is discussed herein.