Extremely Rare Pulmonary Metastases of Skin Basal Cell Carcinoma: Report of Two Cases with Clinicopathological Features.

Basal cell carcinoma (BCC) is the most frequent human skin cancer, but metastasizing BCC (MBCC) is extremely rare, developing in approximately 0.0028% to 0.55% of BCC patients. Herein, we report two cases of pulmonary MBCC. The first one developed in a 72-year-old male who underwent surgical resection due to multiple recurrences and adjuvant radiotherapy. Immunohistochemistry showed that neoplastic cells expressed Ber-EP4, CK5/6, p63, EMA (focally), BCL-2, and CD10, but were negative for CK7, CK20, S100, estrogen and progesterone receptors, and TTF-1. The second case is a 64-year-old female treated with vismodegib. Clinicopathological features and differential diagnoses are described.

Benign Metastasizing Leiomyoma of the Lung: Diagnostic Process and Treatment Based on Three Case Reports and a Review of the Literature.

Uterine leiomyomas may occasionally spread to the lungs forming nodular lesions detectable on chest X-ray. This condition known as benign metastasizing leiomyoma (BML) usually occurs in females with a history of hysterectomy or myomectomy. We present three cases of BML demonstrating the diagnostic process and treatment approaches. Two patients presented with the more common multiple-nodule variant while the other had a single mass, but all were symptom-free. The age of presented patients at diagnosis of BML ranged from 46-53. The first patient was diagnosed with BML at the age of 50, and 12 years prior to the diagnosis, underwent a supracervical hysterectomy. The second patient had a myomectomy at 36, and BML was diagnosed 17 years later at the age of 53. The third patient had a hysterectomy with bilateral salpingo-oophorectomy at the age of 46, with lung lesions present before the hysterectomy. Immunohistochemical studies of postoperative materials showed positive staining of spindle cells with antibodies against desmin and smooth muscle actin, as well as estrogen and progesterone receptors. The final histopathological diagnoses were pulmonary BML. All patients are stable and symptom-free: two at two years follow-up and one at six months follow-up.

Assessment of postoperative pain management and comparison of effectiveness of pain relief treatment involving paravertebral block and thoracic epidural analgesia in patients undergoing posterolateral thoracotomy.

BACKGROUND: TEA (thoracic epidural analgesia) is considered a basic method of analgesia used in thoracic surgeries. PVB (paravertebral block) is an alternative method. The thesis compares effectiveness of both methods in postoperative analgesia with particular focus on assessment of the postoperative pain management quality. METHODS: The study involved 2 groups of patients, each consisting of 30 patients undergoing posterolateral thoracotomy. The study group involved patients anesthetized applying PVB method, while the control group involved patients anesthetized with TEA. Hemodynamic and respiratory parameters as well as severity of pain assessed using NRS (numeric rating scale) during the first 3 days after the surgery, number of days of hospitalization, and the need to use additional pain relievers were taken into account in both groups. Evaluation of postoperative pain management quality was performed applying Clinical Quality Indicators in Postoperative Pain Management. RESULTS: No statistical significance was demonstrated between the groups in respect of hemodynamic and respiratory parameters values, the need to use additional pain relievers and the number of days of hospitalization. There was no statistically significant difference between the groups in respect of general assessment of pain management quality, except for the assessment of the lowest level of pain within the last 24 h of measurement. This result in TEA group was statistically significantly lower than the one in PVB group (p = 0.019). CONCLUSIONS: In the assessment of postoperative pain management quality both analyzed methods are statistically significantly different only in the category of "lowest level of pain within the last 24 hours of measurement", to the benefit of TEA group. No statistically significant difference has been observed between the two study groups with respect to the remaining parameters. TRIAL REGISTRATION: KB-0012/71/15. Date of registration 22 June 2015.

Clinicopathological comparison and therapeutic approach to Castleman disease-a case-based review.

Castleman disease (CD) is a rare, B-cell lymphoproliferative disorder affecting lymph nodes and extranodal anatomical locations. Four types of clinical presentations can be distinguished after exclusion of mimics. The first division is into unicentric CD (UCD) and multicentric CD (MCD). MCD is classified further as HHV-8-negative (idiopathic), MCD associated with HHV-8 infection, and POEMS associated MCD. From the histological standpoint, UCD and MCD can be classified as hyaline-vascular (HV), plasma cell (PC), or mixed cellularity (MC) type, with a spectrum of histopathological manifestations. We present clinical and histopathological features and grading of 25 cases of CD classified according to CDCN histological criteria and according to this clinical algorithm, along with outcomes. Here we provide a fine-resolution description of the histological features of CD. We review and discuss the current diagnostic algorithm, grading system, and recently recommended treatment options. In the presented group of 25 patients with CD there were 14 women and 11 men in the age range 15-79 years. UCD was identified in 15 patients and it was most often located in mediastinum. MCD most frequently occurred as generalized lymphadenopathy. The most common type of CD was HV. All patients with UCD underwent complete surgical resection with a positive outcome. Patients with MCD had diagnostic partial surgical excision of the lesions, later followed by different types of treatment (corticosteroids, chemotherapy, radiotherapy, immunomodulatory agents) or 'watch and wait'. In four cases CD was associated with other malignancies (laryngeal cancer, small lymphocytic lymphoma, gallbladder cancer with hepatic metastases, primary squamous cell lung cancer). The accuracy of histopathological examination is essential and re-evaluation has to be performed in case of relapse or unexpected course of CD. Treatment tailored to fit the disease type and severity should follow the novel recommendations, including anti-IL-6 treatment in the case of MCD.

Serum adiponectin and markers of endothelial dysfunction in stable angina pectoris patients undergoing coronary artery bypass grafting (CABG).

PURPOSE: It has been established that endothelial dysfunction (ED) occurs after coronary artery bypass grafting (CABG). The aim of the study was to assess whether adiponectin may act as a novel marker of ED and its potential relations with new markers of ED: novel cell adhesion molecule CD146, a natural anti-thrombin glycoprotein - thrombomodulin (TM) and the well-established ED marker - Von Willebrand factor (VWF) in coronary artery disease (CAD) patients undergoing CABG. MATERIAL/METHODS: 45 CAD patients undergoing elective CABG were included in the study. RESULTS: In the study group the concentration of adiponectin and CD146 before the surgery were significantly lower than in the control group - 6.06 µg/ml ± 3.06 vs. 19.0 µg/ml ± 6.4 and 303.2 ng/ml ± 28.7 vs. 328.1 ng/ml ± 22.6 (p<0.05). Significant increase of adiponectin and CD146 concentration 3 months after CABG vs. before the surgery was found. Adiponectin concentration 3 months after CABG correlated with VWF, TM, CD146, and a number of grafts. CD146 before and 3 months after CABG correlated significantly with adiponectin, VWF activity as well as the statins therapy after the surgery. CONCLUSIONS: In CAD patients undergoing CABG new markers of endothelial cell dysfunction as adiponectin and CD146 are significantly lower compared to healthy volunteers. Significant increase in adiponectin and CD146 concentration 3 months after CABG vs. before the surgery was found. However adiponectin concentrations 3 months after CABG were still significantly lower compared to healthy individuals, whereas CD146 concentration returned to the values comparable to the control.

Microfluidic Paper-Based Analytical Devices (µPADs) and Micro Total Analysis Systems (µTAS): Development, Applications and Future Trends.

Microfluidic paper-based analytical devices and micro total analysis systems are relatively new group of analytical tools, capable of analyzing complex biochemical samples containing macromolecules, proteins, nucleic acids, toxins, cells or pathogens. Within one analytical run, fluidic manipulations like transportation, sorting, mixing or separation are available. Recently, microfluidic devices are a subject of extensive research, mostly for fast and non-expensive biochemical analysis but also for screening of medical samples and forensic diagnostics. They are used for neurotransmitter detection, cancer diagnosis and treatment, cell and tissue culture growth and amplification, drug discovery and determination, detection and identification of microorganisms. This review summarizes development history, basic fabrication methods, applications and also future development trends for production of such devices.

Mercury in the body of the most commonly occurring European game duck, the mallard (Anas platyrhynchos L. 1758), from northwestern Poland.

The aim of this study was to determine the concentration of mercury (Hg) in liver (L), kidney (K), breast muscle [BM (musculus pectoralis major)], breast feathers (BF), and stomach contents (SC) of mallard (Anas platyrhynchos L. 1758). Among the edible parts of mallard, the greatest concentrations of Hg were observed in K and L, although they did not exceed 1.5 mg/kg dry weight (dw). Average concentrations in K, L, and BM were 0.27, 0.25, and 0.13 mg/kg dw, respectively. Significant correlations were observed between Hg concentrations in BM and K and in BM and L (r s = 0.92) as well as between Hg concentrations in these tissues and BF. In addition, we found significant correlations between Hg concentrations in SC and BM (r s = 0.72) and in L and K (r s = 0.55). In conclusion, mallard exhibits a measurable response to environmental Hg pollution and meets the requirements of a bioindicator.

Red fox Vulpes vulpes (L., 1758) as a bioindicator of mercury contamination in terrestrial ecosystems of north-western Poland.

In this study, we determined the concentrations of total mercury (Hg) in samples of liver, kidney and skeletal muscle of 27 red foxes Vulpes vulpes (L., 1758) from north-western Poland, and examined the morphometric characteristics of the collected specimens. The analysis also included the relationship between Hg concentration and the fox size, and the suitability of individual organs as bioindicators in indirect evaluation of environmental mercury contamination. Determination of Hg concentration was performed by atomic absorption spectroscopy. In the analysed samples, the Hg concentration was low and the maximum value did not exceed 0.85 mgHg/kg dry weight (dw). There were no significant differences in Hg concentrations in the analysed material between males and females or between immature and adult groups. The median concentrations of Hg in the liver, kidney and skeletal muscle were 0.22, 0.11 and 0.05 mgHg/kg dw, respectively. The correlation coefficients were significant between the concentrations of mercury in the liver, kidney and skeletal muscle (positive) and between the kidney Hg concentration and kidney mass (negative). Taking into account our results and findings of other authors, it may be argued that the red fox exhibits a measurable response to mercury environmental pollution and meets the requirements of a bioindicator.

The incidence and prognostic significance of cardiac arrhythmias and conduction abnormalities in patients with acute coronary syndromes and renal dysfunction.

BACKGROUND: The incidence of cardiac arrhythmias, including atrial fibrillation (AF) in chronic kidney disease, is unknown, although AF is several times more common in patients with end-stage kidney disease than in the general population. AIM: To assess the incidence, types and management of cardiac arrhythmias and conduction abnormalities in patients with acute coronary syndromes (ACS) and renal dysfunction. We also evaluated the prognostic significance of arrhythmias in this patient group. METHODS: We analysed 86 patients with renal dysfunction (GFR < 60 mL/min) out of 1005 patients hospitalised in our department between 2008 and 2009 for unstable angina and ST-elevation and non-ST-elevation myocardial infarction. RESULTS: Cardiac arrhythmias were observed in 44 (51.1%) patients with AF being the most common (27 patients, 31.4%), predominantly in the paroxysmal form (21.4%). A total of 14 (16.3%) patients had cardiac arrhythmias requiring temporary or permanent pacing. Only 4 (4.6%) patients showed transient conduction abnormalities due to hyperkalaemia in the course of renal failure, while the remaining 10 (11.6%) patients demonstrated conduction abnormalities due to ACS. A total of 3 (3.5%) patients had other arrhythmias (atrial tachycardia, ventricular arrhythmias). During the follow-up period (mean duration: 14.3 months) 7 out of 44 patients (15.9%) with renal dysfunction and arrhythmia and 2 out of 42 patients (4.7%) without arrhythmia died (p < 0.05). CONCLUSIONS: Cardiac arrhythmias occur more often in patients with ACS if renal dysfunction is also present and are associated with poor prognosis.

The influence of renal function and selected cardiovascular risk factors on the thickness of the intima-media complex in the peripheral arteries.

BACKGROUND: Measurement of the intima-media thickness (IMT) in the peripheral arteries leads to better stratification of cardiovascular risk. This is of great importance in patients with chronic renal insufficiency, who are particularly vulnerable to developing atherosclerotic lesions. The aim of the study was to evaluate whether parameters of renal insufficiency and selected risk factors of atherosclerosis influence IMT in the peripheral arteries. METHODS: The study population comprised 231 patients submitted to coronary angiography with ultrasonographic assessment of the common carotid artery (CCA), carotid artery bulb (CB) and common femoral artery (CFA) made contemporaneously with evaluation of IMT and atherosclerotic plaques. Renal function as well as selected clinical and biochemical risk factors of atherosclerosis were assessed. Two subgroups were analysed: 200 patients with coronary heart disease confirmed angiographically (study group) and 31 patients without coronary lesions (control group). RESULTS: Significant negative correlation was found between glomerular filtration rate and IMT values in CCA (p < 0.001) as well as in CB (p < 0.05). Patients with abnormal glucose metabolism had significantly higher IMT values in CCA (0.95 +/- 0.30 vs. 0.87 +/- 0.20; p = 0.034). Hypercholesterolaemia did not influence the IMT values in CCA and CFA. There was no correlation between body mass index and IMT. CONCLUSIONS: Patients with chronic renal insufficiency presented higher values of IMT in CCA. The measurement of IMT appears to be a valuable non-invasive method of diagnosing preclinical stages of atherosclerosis in the described group of patients. (Cardiol J 2007; 14: 59-66).

[Rupture of the sinus of Valsalva aneurysm complicated by infective endocarditis -- diagnosis difficulties]. / Perforacja tetniaka zatoki Valsalvy powiklana infekcyjnym zapaleniem wsierdzia -- trudnosci diagnostyczne.

Aneurysm of the sinus of Valsalva is a rare congenital heart disease. It constitutes about 0.14%-1.5% of congenital heart surgery cases. Aneurysm of the sinus of Valsalva can be asymptomatic for many years. Only rupture of the sinus of Valsalva aneurysm leads to hemodynamic disturbances which in turn causes rapid deterioration of patient clinical condition. Some of the congenital heart diseases can be complicated by of infective endocarditis. This case report concerns the rupture of the sinus of Valsalva aneurysm in a 45 year old woman, which caused infective endocarditis on the tricuspid valve, which has been initially diagnosed as a complication of congenital heart disease in the form of the intraventricular defect.

[The comparison of ascorbic acid concentration in smokers with diabetes mellitus type II scheduled for coronary artery bypass grafting (CABG) to ascorbic acid concentration during postoperative and convalescence period]. / Por6ównanie poziomów kwasu askorbowego u palaczy chorych na cukrzyce typu 2 oczekujacych na operacje pomostowania tetnic wiencowych (CABG) z poziomami kwasu askorbowego w okresie pooperacyjnym i rekonwalescencji.

Cardiovascular disease is the main cause of increased mortality in diabetes patients. Myocardial infraction and stroke is in 60% to 80% causes reason of death in patients with type 2 diabetes mellitus. The main risk factor of cardiovascular disease is hyper-glycemia, hyperinsulinaemia and hypertension. The other arteriosclerosis risk factors are for example smoking. We measure the concentration of ascorbic acid in smokers' diabetes patients with type 2 diabetes mellitus with stable coronary disease scheduled for coronary artery bypass grafting (CABG). Vitamin C is assumed to be a basic antioxidant although its role in pathological conditions is controversial. However, it seems that the complexity of the oxidant-antioxidant system makes the question of participation of ascorbic acid in pathogenesis of diseases still open. Determination of the role of ascorbic acid concentration in pathogenesis of diabetic angiopathy may be of significant importance in the their effective therapy.

[Evaluation test of cadmium concentration influence on selected lipid metabolism parameters in smokers with stable coronary artery disease scheduled for coronary artery bypass grafting (CABG)]. / Próba oceny wplywu stezenia kadmu na wybrane parametry metabolizmu lipidów w krwi palaczy tytoniu ze stabilna choroba wiencowa zakwalifikowanych do zbiegu pomostowania tetnic wiencowych (CABG).

The influence of cadium from cigarette intoxication on selected lipid metabolism parameters in smokers with stable coronary artery disease scheduled for coronary artery bypass grafting (CABG) was studied. It has been shown that concentration of cadmium leads to an increase in the lipid peroxidation and changes in the lipid metabolism. In our study, there was a significant higher cadmium concentration in smokers with stable angina pectoris (20.90+/-0.18) compared to stable angina pectoris non-smokers (7.71 +/-0,45), p<0.0001. We have not found correlations between cadmium concentration in smokers and non-smokers with stable angina pectoris patients and total cholesterol, LDL, HDL, and triglicerydes concentrations. Total cholesterol, LDL, HDL and TG concentrations in smokers scheduled for CABG were respectively: 221.60+/-10.26 mg/dl; 148.40+/-8.71 mg/dl; 41.16+/-2.12 mg/dl, 159.10+/-14.49 mg/dl. All of these lipid parameters in stable angina pectoris smokers did not differ significantly from non-smokers.

[Determination of ascorbic and dehydroascorbic acid concentration using HPLC method in smokers with stable coronary artery disease scheduled for coronary artery bypass grafting (CABG)]. / Oznaczenie stezenia kwasu askorbowego i dehydroaskorbowego metoda HPLC u palaczy ze stabilna choroba wiencowa zakwalifikowanych do operacji pomostowania tetnic wiencowych (CABG).

Ascorbic acid is a vitamin soluble in water and its deficiency in human body causes scurvy. Its symptoms in adults are gingivitis, susceptibility of blood vessels to damage and bleeding, changes in bones and cartilage and retarded wound healing. Ascorbic acid is necessary in redox processes taking place in cell. It is reversibly oxidized to dehydroascorbic acid and partially metabolized to inactive sulphide and oxalic acid, which is expelled in urine. It is well absorbed from the digestive system and easily reaches the tissues. Healthy organism contains 1.5 g of ascorbic acid and daily requirement for ascorbic acid is estimated for 30-100 mg. Ascorbic acid is not synthesized by humans, but it is an essential dietary vitamin for the species. Ascorbic acid is used in treatment deficiency in daily demand for vitamin C, caused by improper diet, poor absorption or cigarette smoking. It is used in large doses in general weakness, infectious diseases and during the recovery period. Positive results have been obtained after therapy with vitamin C of Mollera-Barlowa disease, Schonlein-Henoch disease, Werlhof disease, haemophilia and also in patients with stable coronary artery disease. Vitamin C is assumed to be a basic antioxidant, although its role in pathological conditions is controversial. However, it seems that the complexity of the oxidant-antioxidant system makes the question of participation of vitamin C (and other scavengers of free radicals) in pathogenesis of diseases still open.

[Long-term smoke-cadmium concentration in smokers seniors with stable coronary artery disease scheduled for coronary artery bypass grafting (CABG)]. / Wieloletnie palenie tytoniu a kumulacja kadmu u osób w podeszlym wieku ze stabilna choroba wiencowa, zakwalifikowanych do zbiegu pomostowania tetnic wiencowych (CABG).

Cadmium is one of the many toxic components of inhaled tobacco smoke. The amount of cadmium inhaled from each pack of 20 cigarettes is approximately 16 microg. Cadmium has a long elimination time (estimated at 10 to 30 years). It provides possible of the accumulation of substantial amounts of cadmium during the lifetime of a smoker. We know reports that cadmium alters the metabolism of cultured human smooth muscle cells and the processing of collagen. Cadmium also blocks calcium channels and inhibits ATPases, other ion transport systems. The concentration of cadmium probably has an influence on selected lipid metabolism parameters. Smoking is the most consistent risk factor for patients with stable coronary artery disease scheduled for coronary artery grafting. Cadmium was measured by atomic absorption spectrometry in humans blood from 19 seniors (patients: 70-76 years old) with stable coronary artery disease scheduled for coronary artery grafting. Total cadmium content was associated with smoking. The level of cadmium in smokers blood plasma was 19.02+/-0,96 microg/l; the level of cadmium in no-smokers blood plasma was 5.96+/-0,69 microg/l. We also measured total concentration of cholesterol, LDL, HDL, triglicerydes, creatinine and glucose.

Influence of low molecular weight heparin preparations on human internal thoracic artery contraction.

OBJECTIVE: Low molecular weight heparins (LMWHs) offer practical and potential pharmacological advantages over unfractionated heparin in multiple applications but have not been studied as vasoactive agents. The purpose of this study was to investigate the effects of two commercial preparations of LMWHs, enoxaparin sodium and nadroparin calcium, on vasoconstriction in the human internal thoracic artery (ITA) in vitro. METHODS: Samples of redundant ITA segments obtained from 36 patients who underwent coronary artery bypass surgery were cut into 3mm wide rings and suspended in 20 ml organ bath. Activity of ITA rings precontracted with 80 mM KCl, 0.1 microM endothelin-1 (ET-1) and 1 microM norepinephrine (NE) after administration of enoxaparin and nadroparin in accumulative concentration ranging from 0.1 to 13.2 UI AXa/ml were recorded under isometric conditions by means of force transducers with digital output. The contraction after 80 mmol KCl, 0.1 microM ET-1 and 1 microM NE administration was treated as a control. RESULTS: Both studied LMWHs in concentration ranging from 0.12 to 13.2 UI AXa/ml did not change basal tonus and KCl precontracted ITA rings. When used in concentrations higher than 13.2 UI AXa/ml nadroparin but not enoxaparin significantly increased the tension in KCl precontracted arterial rings. In NE and ET-1 precontracted rings enoxaparin and nadroparin caused dose dependent relaxation without significant differences between both preparations. Incubation with nitric oxide blocker-Nomega-NITRO-L-ARGININE (L-NNA) in concentration 0.2 mM caused a significant attenuation of relaxant responses to both studied LMWHs in NE and ET-1 precontracted rings. CONCLUSION: LMWHs can have vasorelaxant effects on the receptor-mediated ITA vasoconstriction. The results suggest that LMWHs-induced relaxation in the human ITA is at least partially caused by nitric oxide release. Although the vasoactive effects are not the primary advantage of these drugs used as antithrombotics, such effects might have some clinical importance in the treatment and prophylaxis of graft spasm.

[Role of the hemostatic system in pathogenesis of atherosclerosis as the main etiology of coronary ischemia] [corrected]. / Rola ukladu hemostazy w patogenezie glównej przyczyny choroby niedokrwiennej serca w patogenezie miazdzycy [corrected]

Coronary artery disease is a leading cause of mortality in highly developed societies. This occurs in spite of growing therapeutic opportunities. Atherosclerosis begins as a functional or/and structural damage of endothelium, which in turn causes its discontinuation and impairs humoral and secreting function. Haemostasis plays an important role in the progression of atherosclerosis and development of cardiac complications--acute coronary syndromes. Research still continues to determine precisely role of each of haemostasis disorders in increased risk of coronary artery disease and its complications. The aim of this paper is to review the literature data concerning haemostatic risk factors and their role of development of coronary artery disease. Fibrinogen, thrombocytes, factor VII, factor VIII, von Willebrand factor (vWF), thrombomodulin (TM), plasminogen activator inhibitor--type 1 (PAI-1), tissue-plasminogen activator (t-PA) and other haemostatic factors, were described as more or less helpful in estimation of risk of occurrence of coronary artery disease and its cardiovascular complications. Only some of the described hematologic factors were verified so far in large prospective studies, and were recognized as independent risk factors of cardiovascular diseases.

[Role of the hemostasis in unstable angina pectoris]. / Rola ukladu hemostazy w niestabilnej chorobie wiencowej.

Haemostasis plays an important role in the development of cardiac complications--acute coronary syndromes. The thrombus formation in coronary arteries, related to unstable atherosclerotic plaque rupture is the basic pathogenesis of acute coronary syndromes. The balance between coagulation and fibrinolytic system influences on ruptured atherosclerotic plaque and following acute coronary syndrome. Critical narrow or total occlusion of the coronary artery could be a consequence of this interaction. Researches are continued to determine precisely role of haemostasis disorders in unstable angina pectoris. The aim of this paper is to review the literature data concerning haemostatic risk factors in unstable angina pectoris. Fibrinogen, thrombocytes, factor VIII, von Willebrand factor (vWF), thrombomodulin (TM), plasminogen activator inhibitor--type 1 (PAI-1), tissue-plasminogen activator (t-PA) and other haemostatic factors, play more or less essential role in unstable angina pectoris. However further investigations are needed to determine their utility and to search for new and better haemostatic factors of acute coronary syndromes.