Bladder-conserving Approach in Radical Treatment of Patients With Bladder Cancer - A Single-institution Experience.

AIM: To evaluate our experience with radical radiotherapy and chemotherapy in patients with muscle-invasive bladder cancer. PATIENTS AND METHODS: The study consisted of 27 patients treated with cisplatin-based chemoradiation (CCRT), 48 treated with radiation alone (RT), and 42 with locally advanced disease treated with neoadjuvant chemotherapy and radiation (neoCRT). RESULTS: The incidence of acute grade 3 or more genitourinary (GU) toxicity in the RT, CCRT and neoCRT groups was: 25%, 11% and 19%, respectively (p=0.029). The 3-year freedom from grade 2 or more GU toxicity was: 81%, 89%, 54%, respectively (p=0.36). The long-term outcomes of 3-year local control, overall survival, and disease-free survival were as follows: RT group: 74%, 61% and 55%; CCRT group: 76%, 76% and 56%; neoCRT group: 31%, 43% and 18%, respectively. CONCLUSION: The preferable bladder-conserving approach is CRT, however RT alone might also be an option for appropriately selected patients. NeoCRT for those with locally advanced tumors remain unsatisfactory; adequate selection of patients for radical treatment is of importance.

The impact of the patient's condition, diagnostic procedures and treatment on the survival of carcinoma of unknown primary site patients.

INTRODUCTION: Carcinoma of unknown primary site (CUP) refers to 1-5% of all head and neck neoplasms. Very often, the primary site remains difficult to determine. Squamous cell carcinoma is the most frequent histopathological type diagnosed in the head and neck region. According to statistics, a primary site is usually located in the oropharynx. STUDY OBJECTIVE: The study presents diagnostic difficulties and the methods of diagnosing and the therapy of CUP and primary sites in patients treated in the region of Lower Silesia and Silesia. The aim of the study was to show a retrospective analysis of 233 CUP patients to assess how clinical features, diagnosis and treatment affect the survival of patients. MATERIAL AND METHODS: The diagnostics of patients included panendoscopy with specimen collection (nasoendoscopy, laryngoscopy, esophagoscopy, brochoscopy), computed tomography examination of the neck, chest, abdomen and pelvis minor, as well as positron emission tomography examination. Tonsilletomy was performed in 37 patients. Neck dissection was carried out in 109 subjects and 165 patients were treated bt radiotherapy, and 135 by chemotherapy. CONCLUSIONS: Tonsillectomy is required in CUP patients with the negative results of biopsy and imaging tests. It gives a possibility of detecting the primary site and improves the results of treatment and survival of CUP patients.Combination therapy, including surgical treatment and chemoradiotherapy, gives the best therapeutic results in CUP patients. The general condition of patient and younger age have an impact on prognosis and survival.

Alpha/beta (α/ß) ratio for prostate cancer derived from external beam radiotherapy and brachytherapy boost.

OBJECTIVE: There is disagreement regarding the value of the α/ß ratio for prostate cancer. Androgen deprivation therapy (ADT) may dominate the effects of dose fractionation on prostate-specific antigen (PSA) response and confound estimates of the α/ß ratio. We estimate this ratio from combined data on external beam radiation therapy (EBRT) and brachytherapy (BT)-treated patients, providing a range of doses per fraction, while accounting for the effects of ADT. METHODS: We analyse data on 289 patients with local prostate cancer treated with EBRT (2 Gy per fraction) or EBRT plus one or two BT boosts of 10 Gy each. The timing of ADT was heterogeneous. We develop statistical models to estimate the α/ß ratio based upon PSA measurements at 1 year as a surrogate for the surviving fraction of cancer cells as well as combined biochemical + clinical recurrence-free survival (bcRFS), controlling for ADT. RESULTS: For the PSA-based end point, the α/ß ratio estimate is 7.7 Gy [95% confidence interval (CI): 4.1 to 12.5]. Based on the bcRFS end point, the estimate is 18.0 Gy (95% CI: 8.2 to ∞). CONCLUSION: Our model-based estimates of the α/ß ratio, which account for the effects of ADT and other important confounders, are higher than some previous estimates. ADVANCES IN KNOWLEDGE: Although dose inhomogeneities and other limitations may limit the scope of our findings, the data suggest caution regarding the assumptions of the α/ß ratio for prostate cancer in some clinical environments.

[Role of amylin in glucose homeostasis and its perspective use in diabetes management]. / Rola amyliny w utrzymaniu homeostazy glukozy i perspektywy jej zastosowania w terapii cukrzycy.

In response to hyperglycemia, beta-cells release insulin and C-peptide, as well as islet amyloid pancreatic polypeptide - amylin. In diabetgic patients beta-cell destruction does not only result in deficiency of insulin, but also a deficiency of C-peptide and amylin. Amylin is clearly involved in glucose homeostasis through the inhibition of gastric emptying and postprandial hepatic glucose production, eventually reducing postprandial glucose excursions. Most recently, the synthetic amylin analog pramlintide was shown to improve glycemic control in diabetic patients. Amylin replacement with pramlintide as an adjunct to insulin therapy is a novel physiological approach toward improved long-term glycemic and weight control in patients with type 1 and type 2 diabetes.

Cardiovascular system disease in youth patients with various forms of glucose metabolism impairment - diagnosis and treatment.

For many years chronic complications of diabetes in adolescent patients were linked mainly to microangiopathy. New, more and more accurate, diagnostic methods, making noninvasive diagnosis of very early lesions in the vascular wall possible, allowed to find out that microangiopathic lesions may be present even in very young patients. Maintenance of increased blood glucose levels initiates a number of mechanisms which lead to damage of blood vessels and nerves. Early detection and treatment of these abnormalities may help to prevent the natural progression of the disease. Effective early prevention of cardiovascular disease will involve the lifestyle modification.

Alterations of blood glucose homeostasis in critically ill children - hyperglycemia.

Hyperglycemia is common in critically ill children. It does not appear to be associated with a particular diagnostic category but is significantly associated with the severity of illness. Severe hyperglycemia may be associated with complications, this in turn could result in end-organ dysfunction. A prospective, randomized trial of strict glycemic control in this subset of critically ill children who are at high risk of mortality is both warranted and feasible. Continuous insulin infusion can rapidly and safely improve intravenous glucose tolerance.

[Continuous subcutaneous insulin infusion (CSII) in treating young diabetic patients]. / Doswiadczenia w zastosowaniu ciaglego podskórnego wlewu insuliny (CPWI) w leczeniu cukrzycy u mlodocianych chorych.

Continuous subcutaneous insulin infusion (CSII) is used in selected type 1 diabetic subjects to achieve strict blood glucose control. A quarter of a century after its introduction, worldwide use of CSII is increasing. Review of controlled trials shows that, in most patients, mean blood glucose concentrations and glycated hemoglobin percentages are either slightly lower or similar on CSII versus multiple insulin injections. However, hypoglycemia is markedly less frequent than during intensive injection therapy. Ketoacidosis occurs at the same rate. Nocturnal glycemic control is improved with insulin pumps, and automatic basal rate changes help to minimize a pre-breakfast blood glucose increase (the "dawn phenomenon") often seen with injection therapy. Patients with "brittle" diabetes characterized by recurrent ketoacidosis are often not improved by CSII, although there may be exceptions. Insulin pump therapy has been shown to be beneficial in pediatric patients with type 1 diabetes. Our experience with insulin pump therapy in young children, has been positive. Our young patients have had a reduction in HbA1c, mean blood glucose levels, and glycemic excursion; a decrease in episodes of severe hypoglycemia; and an increase in family functioning around diabetes. We believe the success of pump program in young patients can be attributed to the fact that we have employed appropriate criteria for patient selection and have a standardized method to initiate pump therapy and to follow and support our patients/ families. Experience with insulin-pump therapy indicates that candidates for CSII must be strongly motivated to improve self-monitoring of blood glucose, they must also understand and demonstrate use of the insulin pump.

[Glucagon-like peptides--synthesis, biological actions and some clinical implications]. / Bialka glukagonopodobne--ich synteza i dzialanie oraz niektóre implikacje kliniczne.

Glucagon and the glucagon-like peptides (GLPs) are derived from single proglucagon gene and exhibit an increasing number of biologically important actions. As a counter-regulatory hormone for insulin, glucagon plays a critical role in maintaining glucose homeostasis in vivo in both animals and humans. To increase blood glucose, glucagon promotes hepatic glucose output by increasing glycogenolysis and gluconeogenesis and by decreasing glycogenesis and glycolysis in a concerted fashion via multiple mechanisms. The glucagon-like peptides GLP-1 and GLP-2 are produced in enteroendocrine L cells of the small and large intestine and secreted in a nutrient-dependent manner. GLP-1 regulates nutrient assimilation via inhibition of gastric emptying and food intake. GLP-1 controls blood glucose following nutrient absorption via stimulation of glucose-dependent insulin secretion, insulin biosynthesis, islet proliferation, and neogenesis and inhibition of glucagon secretion. Glucagon-like peptide-1 (GLP-1 is an insulinotropic hormone, GLP-1 also inhibits glucagon secretion. GLP-1 lowers blood glucose in normal subjects and in patients with type 2 diabetes. The major biological action of GLP-2 appears to be the stimulation of small-bowel hyperplasia, manifested by an increases in both villous height and small-bowel weight. A pilot study of GLP-2 administration in human subjects with short bowel syndrome demonstrated significant improvements in energy absorption, bone density, increased body weight, which correlated with increased crypt plus villus height on intestinal biopsy sections. The biological actions of two of these glucagon-related peptides, suggest that they may have therapeutic relevance for the treatment of human diseases such as diabetes, selective intestinal disorders and cardiac diseases.

[The role of skeletal muscle in the regulation of glucose homeostasis]. / Miesnie szkieletowe i ich rola w utrzymaniu homeostazy glukozy.

Muscle tissue has been considered to be a major regulator of systemic glucose homeostasis. Glucose normally provides energy sources for tissues of the body. Its uptake by muscle requires a secretion of insulin. The initial step of glucose utilization requires the transport of glucose into the cells. The insulin-receptor complex stimulates the cellular uptake of glucose. In the well-fed state muscle contains about 1% of its weight as glycogen. Because of its mass, muscle contains almost four times as much glycogen as the liver. Muscle glycogen is not directly available as a source of blood glucose because muscle lacks glucose-6-phosphatase. During muscular activity, glycogen is converted to lactate and then into blood glucose in the liver.