ASSESSMENT OF DIRECT RESULTS OF CERVICAL CANCER COMBINED TREATMENT.

The aim of the study was to evaluate the immediate results of combined treatment of cervical cancer. This study included 177 patients with cervical cancer. The mean age of patients was 48.0±1.9 years. According to stages the patients were divided as follow: IIA - 56 patients, IIB - 67, III - 54 patients. All patients with cervical cancer are divided into 3 groups: one control and two investigative. Patients of the control group (55 people) received only radiotherapy (RT). The investigative group 1 of 77 patients received RT in combination with ftorafur per os at a dose of 1200 mg in days of EBRT (800 mg in the morning and 400 mg in the evening) No. 23, total dose of 27,600 mg. The investigative group 2 included 45 patients in whom RT was performed in combination with cisplatin at a dose of 40 mg/m2 every 7 days during the entire course of radiation therapy. The effectiveness of combined treatment was assessed according to standard WHO criteria (1978). The combination of radiotherapy with cisplatin allowed to increase the incidence of complete and clinical responses of the cervical tumor by 28.3% compared with only radiation therapy, and also, statistically significant increase in the degree of regression of cervical cancer to 26.7% compared with patients of the control group and to 24.1% compared with patients receiving combination therapy with ftorafur. The most pronounced hematological toxicity was observed in patients with cervical cancer who received SLT with cisplatin, which did not require interruption of radiation treatment and reduction of chemotherapy dosages, the lowest hematological toxicity was in patients receiving radiation therapy alone.

EPIDEMIOLOGY OF NEUROPATHIC CHRONIC PAIN IN ONCOLOGY PATIENTS.

The aim of the study was to analyze the primary prevalence of chronic neuropathic pain syndrome in oncology patients of Karaganda (Kazakhstan), to estimate the structure of pain syndrome in randomly chosen patients, to assess the effectiveness of analgesic therapy in oncology patients. All the patients with confirmed cancer admitted to hospital in Karaganda regional oncologic dispensary were studied. The study period was limited to 60 consecutive days. The results were statistically processed using 6.0 «STATISTICA¼ program. In 11,2±1,6% of the cases, oncology patients that got combined modality treatment suffered from the chronic neuropathic pain syndrome; 66,7±7,3% patients of them had the III cancer stage. 2. While studying the chronic neuropathic pain structure it was revealed that: 52,4±7,7% of the patients suffered from a mild pain, from average - 38,1±7,5% of the patients, from severe pain - 9,5±4,5%. Neuropathic pain syndrome in the form of numbness occurred in 47,6±7,7% of the respondents, tingling - in 38,1±7,5% of the patients and 14,3±5,4% of the respondents described it as «electric shock¼. 52,4±7,7% of the patients described temperature changes of the skin, 28,6±7,0% of them told about allodynia. The given pain can be correctly diagnosed on rare occasions. It brings about the low efficiency of currently prescribed standard pain treatment. It was 20%-effective only for » of the patients. In sum, it can be brought into focus that each 10th oncology patient of the II clinical group in Kazakhstan may potentially suffer from the chronic neuropathic pain syndrome. The given syndrome in cancer patients requires selective differential diagnostics and constant management of the pain treatment regimen because of occurrence of standard regimens incapacity, progression of tolerance to the actual pain treatment and significant deterioration of oncology patients' life quality.

THE IMPORTANCE OF IMMUNOHISTOCHEMICAL STUDIES IN THE DIAGNOSIS OF CANCER OF UNKNOWN PRIMARY ORIGIN.

The purpose of the research is to give a comparative diagnostic characteristic to tumors of unknown primary origin by admission diagnosis and morphological diagnosis. 162 treated cases with tumors of unknown primary at Oncologic Dispensary for 5 years were analyzed in details. Besides clinical, instrumental, cytological, morphological methods, immunnohistochemical research of tumors was carried out by avidin-biotin-peroxydase tecnics. The cases with poorly differentiated carcinoma (33,3±4,3%) and lymphoproliferative disorders (27,2±3,5%) prevailed among the cases with tumors of unknown primary by histological research. High degree of noncoincidence of cytologic and histological diagnoses (χ2=515, р=0,00001), histological and immunohistochemical diagnoses (χ2=378, р=0,00001), cytologic and immunohistochemical diagnoses (χ2=556, р=0,00001) were revealed. Cytologic overdiagnosis of undifferentiated carcinoma by 13,6% (р<0,05) and hypodiagnosis of benign diseases by 4,4% (р<0,05) and histological overdiagnosis of poorly differentiated carcinoma by 11,1% (р<0,05) and hypodiagnostics of tumors of nerve tissue by 8,0% (р<0,05) are marked, that points to the necessity of making immunohistochemical research in the cases of given pathology. Statistically significant connection of mean degree between diagnoses of poorly differentiated tumors made by cytologic, histological and immunohistochemical investigation is revealed.

Bone metastases from gynaecological epithelial cancers.

The aim of this study was to investigate the clinical features and prognosis in patients with gynaecological epithelial cancers metastasised to bones. A total of 26 patients were studied retrospectively. Clinical and pathological data were analysed along with a follow-up. It was found that the interval from primary diagnosis of cancer until bony relapse varied between 0 and 163 months (31.4 ± 36.8). Bone metastases were solitary in 11 cases and multifocal in 15 cases. A total of 14 patients demonstrated only bony metastases while 12 had both bony and non-bony metastases. The time to follow-up from the diagnosis of osseous relapse varied between 1 and 43 months (10.0 ± 10.4). During follow-ups, 13 patients died and 13 patients survived. In both univariate and multivariate analyses, synchronous non-bony metastases and symptomatic treatment without oncological therapy impaired prognosis. It was concluded that even in the presence of multiple bone metastases, some patients may benefit from radiotherapy, chemotherapy or a combination of both, rather than palliative care alone, providing they do not have additional soft tissue metastases.

An extremely rare presentation of relapse in endometrioid endometrial adenocarcinoma: isolated metastases to the tibia and humerus. Case report and review of the literature.

In endometrial carcinoma patients, metastases to bones are rare and isolated metastases to extremities are extremely rare. We describe the case of a 59-year-old patient who underwent surgery followed by adjuvant radiotherapy due to endometrioid endometrial adenocarcinoma (grade 2, FIGO Stage II). After intervals of nine and 18 months respectively, she was diagnosed with metastatic tumours located in the right tibia and in the left humerus. The metastases were confirmed by biopsy. Following irradiation of metastatic lesions, the relief of symptoms was observed, and the patient remains under observation. We conclude that patients presenting a history of endometrial carcinoma with chronic pain in the extremities should be carefully evaluated, because although extremely rare, the carcinoma can metastasize to bones. Treatment of bone metastasis from endometrioid endometrial carcinoma by irradiation may increase quality of life and prolong survival.

[Surgical outcome of temporal lobe epilepsy]. / Wyniki operacyjnego leczenia padaczki skroniowej.

Results of the surgical treatment of temporal lobe epilepsy--Authors present their own experience in the surgical treatment of temporal lobe epilepsy. 403 patients were operated upon. The age of the patients was not limited. The beginning of the epilepsy was in most cases in early childhood, however the conservative treatment was continued for a very long time, usually over 10 years. The modern diagnostic tools, especially MRI, make it possible to diagnose the temporal epileptic focus more often, than previously, especially in cases with morphological substrate. Temporal lobectomy with amygdalo-hippocampectomy was performed. The follow-up was at least 3 years after surgery. Outs of 343 patients examined in this period 175 were cured, without seizures after surgery. Next 61 patients had no more than 2 small attacks a year. So in 69% of patients the result was very good or satisfactory. The neuropsychological investigation revealed that in most patients the IQ improved. Their quality of life improved markedly according to their own opinion.

[The value of structural neuroimaging in the selection of patients for epileptic surgery]. / Znaczenie strukturalnych badan neuroobrazujacych, w kwalifikacji chorych do leczenia operacyjnego padaczki.

UNLABELLED: The aim of this study was to investigate the value of structural neuroimaging with MRI in the selection of patients for epilepsy surgery. We sought to determine whether MRI influenced decision concerning resective surgery and whether MRI provided much more useful information than enhanced CT. MATERIALS AND METHODS: Neuroimaging studies, MRI and CT, of 300 patients; 265 with partial and 35 with primary generalized seizures, evaluated for surgical treatment of epilepsy were analysed. The MRIs and CTs were interpreted using visual diagnostic criteria and findings were correlated with the EEG changes and clinical semiology. RESULTS: MRIs identified structural lesions in 142, CTs in 96 of all patients. The clinical semiology (partial seizures), MRI, CT and EEG focal findings were concordant in 72 cases. The group of 34 patients had resective surgery. The 7 patients were also operated with MRI and CT focal abnormalities discordant with EEG changes. Also one patient with primary generalized epilepsy and temporal lobe lesion (glioma) had resective surgery. MRI studies revealed structural lesions in 48 patients with normal CT studies. The 43 patients with partial epilepsy had normal CTs and lesions in MRIs; the 34 cases revealed correlation with the EEG findings in 29 temporal and 5 extratemporal regions. Surgery were performed in 23 cases. Also one with partial seizures and MRI detected hippocampal atrophy was operated, despite of generalized EEG patterns. In contrast CT revealed two patients with normal MRI and focal changes. The patients with partial seizures and only CT abnormalities (focal calcifications) were not operated due to discordant EEG findings. In group of 132 patients with normal neuroimaging studies and EEG identified seizure focus only 27 had anterior temporal lobectomy. CONCLUSION: MRI studies gave additional information in case of 16% patients with intractable epilepsy in comparison with CT findings. Resective epilepsy surgery was almost twice as often performed when MRIs revealed structural abnormality. In operated patients, diagnostic sensitivity of structural MRI, CT and EEG to neurophatology were 70.6%, 46.7 and 92.4% respectively.

[The comparison of ketamine with methohexital and thiopental in the intraoperative EEG in drug-resistant epilepsy]. / Porównanie ketaminy z methohexitalem i thiopentalem w aktywacji sródoperacyjnej elektrokortykografii, w lekoopornej padaczce.

UNLABELLED: The acute (ECoG) was examined in 291 patients with intractable epilepsy, without structural brain lesion--from 1971 to 1997. Temporal lobectomy was performed in 198 cases and extratemporal (frontal, parietal or occipital) in remaining 93 cases to achieve seizure control. Epileptic foci was activated during acute ECoG by i.v. administration of ketamine (154 cases) or short-acting barbiturates--methohexital (110 cases) and thiopental (27 cases). RESULTS: Ketamine significantly more often caused ECoG identified electrographic seizures than methohexital: p = 0, 00001 or thiopental, which in no cases resulted in seizures. Also electrographic seizures occurred more frequently after administration of ketamine in patients with the extratemporal seizure focus localisation in comparison with temporal focus (p < 0.05). Electrographic seizures provoked after administration of ketamine improved the localisation of the area to be resected, more often in extratemporal epileptic foci. CONCLUSIONS: The results of our investigations indicate that ketamine more effectively activated epileptic focus than short-acting barbiturates.

[Effect of phenytoin and carbamazepine on evoked potentials in patients with newly diagnosed epilepsy. Part I. Visual evoked potentials]. / Wplyw fenytoiny i karbamazepiny na potencjaly wywolane u chorych z nieleczona padaczka. Czesc I. Wzrokowe potencjaly wywolane.

Pattern-reversal visual evoked potentials (VEPs) were recorded in 64 patients with newly diagnosed epilepsy. Before starting medication the patients with partial and primary generalized epilepsy, had prolonged latencies of the VEPs component P100, as compared with controls. VEPs were repeated after 3 months in 43 patients with focal epilepsy, during carbamazepine (22 cases) or phenytoin (21 cases) treatment. The plasma concentration of the drugs were within therapeutic levels. Carbamazepine but not phenytoin, was associated with prolongation of the P100 peak latency and induced increase of its amplitude, as compared with the baseline condition. The VEPs abnormality was most pronounced in patients whose seizures were poorly controlled. We conclude, that administration of carbamazepine or phenytoin, at therapeutic serum level, have minimal effect on the VEPs.

[Effect of phenytoin and carbamazepine on evoked potentials in patients with newly diagnosed epilepsy. Part II. Brainstem auditory evoked potentials]. / Wplyw fenytoiny i karbamazepiny na potencjaly wywolane u chorych z nieleczona padaczka. Czesc II. Sluchowe pniowe potencjaly wywolane.

Brainstem auditory evoked potentials (BAEPs) were studied in 64 untreated epileptics with partial (58) and primary generalized seizures (6). Patients were randomized to have either phenytoin (PHT) or carbamazepine (CBZ) monotherapy. Follow-up recordings were made 3 months after PHT (21) or CBZ (22) monotherapy in 43 patients with partial seizures. Before treatment epileptic patients and controls did not differ in BAEPs results. All patients had therapeutic PHT or CBZ levels. PHT prolonged I-III and I-V interpeak latencies (IPL), and central conduction time (I-V) changes were correlated with the patients age. CBZ increased the latency of wave I and the central conduction time. The prolongation of I-III IPL was significant only for the group with partial secondarily generalized seizures and the III-V for the group with partial seizures without generalization. These results suggest similar effects of CBZ and PHT on BAEPs within serum therapeutic range.

[Effect of monotherapy with phenytoin or carbamazepine on somatosensory evoked potentials in patients with newly diagnosed epilepsy]. / Wplyw monoterapii fenytoina lub karbamazepina na somatosensoryczne potencjaly wywolane u chorych ze swiezo rozpoznana padaczka.

Somatosensoric evoked potentials produced during a stimulation of median nerve have been recorded in 64 patients with untreated seizures, including 9 patients with partial seizures, 27 patients with partial complex seizures, partial secondary generalized seizures (22 patients), and 6 patients with primary generalized seizures. Higher mean amplitude of N13 wave has been noted in patients with simple partial seizures and complex seizures whereas a mean amplitude of wave N20 has been higher in case of partial primary generalized seizures. Measurements have been repeated in 45 patients with focal epilepsy within approximately 3 months. These patients have been given either phenytoin (22 individuals) or carbamazepine (21 individuals). Phenytoin prolonged mean proximal conduction time (N9-N13) while carbamazepine prolonged mean central conduction time (N13-N20). Both therapies prolonged mean peripheral conduction time in both groups but only in the group treated with carbamazepine observed changes were statistically significant.

[Effect of hemodialysis on somatosensory evoked potentials of medium and long latency]. / Wplyw hemodializ na somatosensoryczne potencjaly wywolane o sredniej i dlugiej latencji.

In 16 patients with terminal renal failure aged from 21 to 74 years maintained on haemodialysis programmes for 2 to 60 months somatosensory evoked potentials were studied after stimulation of the median nerve immediately before and after haemodialysis. The central conduction time, the P 45-N 60, P 100-N 140-P 200 complexes and the P 300 wave were evaluated. The results were compared with those in 16 healthy volunteers aged 20 to 66 years. In the patients on haemodialyses the evoked somatosensory potentials of medium and long latency differed statistically significantly from those in the control group, but not direct effect of haemodialysis on these potentials was found.

[Surgically treated epidural hematoma of the spinal cord at the Th1-Th2 levels associated with arachnoid cyst]. / Krwiak nadtwardówkowy rdzenia kregowego na poziomie Th1-Th2 skojarzony z torbiela pajeczynówki, leczony operacyjnie.

In a man aged 28 clinical picture, myelography and computerized myelotomography demonstrated epidural haematoma at the level of Th1-Th2 vertebrae with associated arachnoidal cyst. Owing to initially erroneous diagnosis of transverse myelitis the haematoma was diagnosed only after 7 days and removed surgically with simultaneous evacuation of the cyst. The therapeutic result was minimal.

[A preliminary assessment of the incidence of atopy at a workplace in Cracow]. / Wstepna ocena czestosci wystepowania atopii w jednym z krakowskich zakladów pracy.

Skin tests, IgE level and eosinophils percentage were determined in 337 employees of the "Hydrokop" Works in Cracow. These investigations aimed at seeking more specific markers of allergy than anamnesis and skin tests. Allergy was reported by 108 individuals (38%). Some features of atopy were confirmed in 7.5%. Skin tests were positive in 36 individuals and were related to atopy in 55%. IgE levels were 10 IU/ml--greater than 1000 IU/ml with the distribution similar to log-normal. Mean IgE concentration was relatively high (202 IU/ml, in the individuals with confirmed congenital allergy. Percentage of eosinophils exceeded 3% in 39 subjects out of which 17 reported the symptoms of allergy. IgE level and percentage of eosinophils are controversial as the markers of atopy due to the contribution of various non-allergic factors while skin tests correlate well with allergic diseases which were relatively frequent in the examined group.

[Familial occurrence of calcinosis of the basal ganglia]. / Rodzinne wystepowanie zwapnien jader podstawy mózgu.

In two sisters aged 36 and 38 years symmetrical calcifications were found in the vicinity of the pallidum in brain CT. In the younger sister epileptic seizures and transient focal signs were due to arrhythmias of the heart caused by mitral valve leaflet prolapse. In the second case no neurological signs were found. The calcifications were probably genetically determined suggesting an autosomal recessive inheritance. The described cases are another example of familial calcifications in basal ganglia without neurological changes.

[Familial cerebellar ataxia: clinical, radiological and electrophysiological findings]. / Rodzina z bezladem mózdzkowym. Ocena kliniczna, radiologiczna i elektrofizjologiczna.

A family with cerebellar ataxia of late onset occurring in four generations was observed. Neurological abnormalities included signs of cerebellar ataxia, pyramidal tract damage and damage to the peripheral motor neuron. Computerized tomography demonstrated in five out of six studied patients an image suggesting olivo-ponto-cerebellar atrophy. In the cerebellar structures, brainstem and cerebral hemispheres evidence of atrophy was detected. No correlation was demonstrated between the intensity of the clinical signs and the progression of changes in CT image. Electrophysiological investigations demonstrated changes compatible with damage to the motor and sensory fibres in the peripheral nerves and signs suggesting damage to the spinal motor neurons and pyramidal tract. These observations confirm the multilevel development of the process. The use of similar diagnostic methods will permit a more accurate classification of cerebellar ataxia and obtaining of better information for prognostication of individual cases.

[Neurologic symptoms in lithium poisoning]. / Objawy neurologiczne w przebiegu zatrucia litem.

A 69-year-old female patient is reported who had been treated with lithium salts for bipolar affective disease. During hospital stay due to myocardial infarction in cardiology department signs of intoxication with lithium carbonate developed. Parkinsonian syndrome and amnesia with abnormal EEG tracings were observed. After withdrawal of lithium and correction of water and electrolyte disturbances as well as pharmacological treatment gradual disappearance of neurological abnormalities was observed, with full normalization of EEG tracings.

[Favorable results of the treatment of the hyperkalemic form of periodic paralysis with salbutamol]. / Pomyslne wyniki leczenia salbutamolem hyperkalemicznej postaci porazenia okresowego.

Two cases of hyperkalaemic periodic paralysis with myotonic symptoms were treated successfully with salbutamol. The methods of managing the hyperkalaemic form of periodic paralysis are discussed in brief.