Self-diagnosis of hyperparathyroidism during pregnancy resulting in parathyroidectomy and uncomplicated delivery.

Primary hyperparathyroidism is a condition with hypercalcemia and elevated parathyroid hormone (PTH). Typically, treating patients with such disease does not pose a problem for doctors, unless the patient is pregnant. Firstly, pregnancy may mask signs of hypercalcemia. Secondly, treatment should be applied with special care for immature fetus. If undiagnosed and untreated, it is life-threatening for the mother and the baby. The main cause of primary hyperparathyroidism is parathyroid adenoma, which should be removed surgically in second trimester. If the patient is monitored by a multidisciplinary team, the risk of mortality and pregnancy loss is reduced.

The craniofacial necrotizing fasciitis after a minor trauma in an elderly white woman.

The term necrotizing fasciitis /NF/ was probably first described by Jones in 1871 as "hospital gangrene". NF, with its fast spreading from the local infection to massive necrosis of the underlying tissues, ie. superficial fascia and subcutaneous layers, is a potentially fatal disease, unless diagnosed early and properly treated. NF is more frequent in frail patients with chronic debilitating illnesses, immune deficiencies or from a poor social background. Sixty percent of NF cases occur in females. Here we present a case of necrotizing fasciitis of the head and neck region after a minor trauma (phenol blocks due to severe neuropathic pain) in an 82-year-old female with the history of trigeminal neuralgia. Key words:Necrotizing fasciitis, craniofacial infection, tissue necrosis.

Psychometric properties of the Polish version of the Multidimensional Fatigue Inventory-20 in cancer patients.

CONTEXT: Multidimensional questionnaires estimating cancer-related fatigue (CRF) as a symptom cluster or a clinical syndrome primarily have been used and validated in English-speaking populations. However, cultural issues and language peculiarities can affect CRF assessment OBJECTIVES: The main aims of this study were to evaluate the psychometric properties of the Polish version of the Multidimensional Fatigue Inventory-20 (MFI-20) and to deliver to clinicians a multidimensional tool for CRF assessment in Polish-speaking patients with cancer. METHODS: After forward-backward translation procedures, the Polish version of MFI-20 was administered to 340 cancer patients. The Polish MFI-20 was appraised in terms of acceptability, reliability, and validity. Internal consistency was assessed by calculating Cronbach's alpha coefficients. Structural validity was evaluated with confirmatory factor analysis. RESULTS: The translated MFI-20 was well accepted; 90% of subjects fully completed the questionnaire. The overall Cronbach's alpha coefficient was 0.9, ranging from 0.57 to 0.81. All correlation coefficients among Numeric Rating Scale-fatigue, fatigue-related items from the European Organization for Research and Treatment of Cancer Quality of Life Core-30 questionnaire, and the MFI--20 were statistically significant (P < 0.001). Confirmatory factor analysis demonstrated good structural validity and revealed only three dimensions in the Polish version of the MFI-20-physical and mental fatigue as well as reduced motivation. CONCLUSION: The Polish version of the MFI-20 is well accepted by patients, reliable, and a valid instrument to assess CRF in Polish cancer patients.

Opioid-induced endocrinopathy in cancer patients: an underestimated clinical problem.

The impact of both endogenous and exogenous opioids on the endocrine system has been known for many years. With the increased use of opioids in chronic pain treatment, the research focuses mainly on their effects on the endocrine system in patients with chronic non-malignant pain. Despite the wide dissemination of cancer, there has been little research on the possible effects of opioids on the endocrine system in cancer patients. For the growing number of cancer survivors and patients in long-term remission who take opioids, other aspects of endocrine disorders caused or exacerbated by opioids will have practical and clinical importance. Conversely, this problem may be less relevant for patients in active cancer treatment or in the advanced stage of disease. This article presents the available research on the effects of opioids on the endocrine system and the clinical consequences resulting from opioid use in cancer patients. Clinicians who use opioids in clinical practice should be aware of the existence of the endocrine symptoms of opioid therapy. There is still a need for more research in this area to maintain the best possible quality of life for cancer patients treated with opioid analgesics.

Strategy of coping with end-stage disease and cancer-related fatigue in terminally ill patients.

UNLABELLED: The aim was to investigate whether there is a relationship between strategy of coping with end-stage disease and cancer-related fatigue. The study was conducted using the Rotterdam Symptom Checklist, Brief Fatigue Inventory, and Mini-Mental Adjustment to Cancer scale to specify patient's strategy of coping. Finally, 51 hospice care patients with cancer were analyzed. MAIN FINDINGS: The majority of responders adopted 1 of the 2 styles; avoidance (belongs to adaptive coping) or anxious preoccupation (destructive or maladaptive). Less often moderate fatalism and helpless/hopeless (H/H) or fighting spirit were observed. Significant correlation has been found between H/H or fatalism strategy and fatigue. CONCLUSIONS: High level of fatigue had a negative impact on almost all aspects of daily living among people with H/H or fatalism strategy.

The role of corticosteroids in the treatment of pain in cancer patients.

Pain is one of the most frequent and most distressing symptoms in the course of cancer. The management of pain in cancer patients is based on the concept of the World Health Organization (WHO) analgesic ladder and was recently updated with the EAPC (European Association for Palliative Care) recommendations. Cancer pain may be relieved effectively with opioids administered alone or in combination with adjuvant analgesics. Corticosteroids are commonly used adjuvant analgesics and play an important role in neuropathic and bone pain treatment. However, in spite of the common use of corticosteroids, there is limited scientific evidence demonstrating their efficacy in cancer patients with pain. The use of corticosteroids in spinal cord compression, superior vena cava obstruction, raised intracranial pressure, and bowel obstruction is better established than in other nonspecific indications. This review aims to present the role of steroids in pain and management of other symptoms in cancer patients according to the available data, and discusses practical aspects of steroid use.

Kinesitherapy alleviates fatigue in terminal hospice cancer patients-an experimental, controlled study.

PURPOSE: The study was focused on the influence of the kinesitherapy on fatigue and the quality of life in the terminal hospice cancer patients. PATIENTS AND METHODS: Forty-nine patients were included into the study and divided into experimental group A (with kinesitherapy) with 30 subjects and control group B (without kinesitherapy) with 19 subjects. Patients from group A did the exercises three times a week, for 20-30 min, for the period of 3-4 weeks. The exercises were individually supervised by a physiotherapist, following a carefully worked out pattern. In both groups, the changes in the intensity of fatigue and the quality of life were observed by means of using Rotterdam symptom checklist, brief fatigue inventory, and visual analogue fatigue scale. RESULTS: In group A, the intensity of fatigue decreased significantly after 3 weeks of kinesitherapy. In group B, fatigue deteriorated significantly in comparison with the initial measurement. The intensity of physical symptoms in group A decreased significantly after 2 weeks of kinesitherapy, whereas in group B, increased after 2 weeks of observation. The quality of life in group A remained stable throughout the study. A tendency towards the deterioration of the quality of life with the time passing in group B was noticeable. CONCLUSION: Our analysis showed that, on average, after 3 weeks of kinesitherapy, a significant decrease of the intensity of fatigue was observed, while in the control group, it increased after 2 weeks of observation. The obtained results provide evidence that a planned set of exercises decreases cancer-related fatigue effectively.

[Quality of life in elderly, terminally ill cancer patients]. / Ocena jakosci zycia osób w wieku podeszlym w terminalnym okresie choroby nowotworowej.

In the last few years many researches have emerged in which quality of life of terminally ill patients has been a main focus of attention. Some evaluation methods have been used in elderly population too. Our paper presents results of a study concerning the problem of QL of patients in the terminal state in institutional care for elderly people. The terminally ill over the age 65 were compared with those of the same aged men and women without cancer and those aged 64 and younger suffering from cancer too. Self-assessment of health and QL was compared with objective evaluation of the health state. We hope this study will give the opportunity to make the QL of our patients better and quality of care more effective.

The religiousness as a way of coping with anxiety in women with breast cancer at different disease stages.

BACKGROUND: Anxiety is an unpleasant emotion affecting patients with cancer, and there are various ways of coping with it. Little is known about the relationship between the anxiety level and physical, somatic or spiritual (e.g. religiousness) factors in breast cancer patients at different stages of the disease. OBJECTIVES: The purpose of the study was to assess the intensity of anxiety at different stages of breast cancer, to define the relationship between religiousness and physical (somatic) condition and anxiety in the study subjects and to find out if religiousness is an effective coping strategy at any breast cancer stage. MATERIALS AND METHODS: The study involved 180 women aged between 28 and 77, who were qualified to one of five study groups, according to their disease stage. The following research instruments were used: the State-Trait Anxiety Inventory (STAI), Scale of Personal Religiousness, the Rotterdam Symptom Checklist as well as medical history and data from patients' medical records. RESULTS: There is a significant correlation between state anxiety and trait anxiety measured by STAI in study groups. Breast cancer stage differentiates the study groups in respect of revealed anxiety level. Somatic condition has no significant impact on the intensity of anxiety in terminal breast cancer patients. Amongst the studied variables, only religiousness is an important factor that influences the anxiety level of end-stage cancer patients. CONCLUSIONS: The obtained results allow us to conclude that: (a) religiousness is an effective factor of coping with anxiety only of the end-stage breast cancer patients; (b) cancer stage is a differentiating factor in respect of revealed anxiety level in study subjects; (c) exacerbation of somatic symptoms does not influence the anxiety level in terminal cancer patients and at disease-free period.

[Palliative care in chronic obstructive pulmonary disease]. / Opieka paliatywna w przewleklej chorobie obturacyjnej pluc (POChP).

Traditionally focusing on terminally ill cancer patients, palliative care services have recently attempted to involve patients with other chronic, life - threatening diseases, e.g. chronic obstructive pulmonary disease (COPD). In this group of patients both quality of life and life expectancy is poor. Unfortunately, patients with COPD don't receive adequate special medical service, although this progressive disease causes almost as many deaths as lung cancer. The suffering of patients dying from COPD is not smaller than cancer patients. The major symptoms are usually dyspnoe, cough, fatigue, depression, emotional and psychosocial problems. In fact, their needs are really palliative, so we try to pay attention to the quality of life of people suffering from COPD. It is important to underline that medical palliation of these patients falls not only to the management of the main clinical symptoms, but also to adopt a holistic, multiprofessional approach and working with their families and caregivers.

[Cancer-related fatigue. II. Causes and management of the problem]. / Zmeczenie w chorobie nowotworowej. II. Przyczyny i sposoby zwalczania.

Fatigue is often related to cancer, and is related to its treatment. Fatigue is the most commonly reported side effect of cancer treatment. It differs from fatigue induced by other causes, because doesn't decrease after period of rest. The fatigue reported by cancer patients is usually described as an unusual, excessive, whole-body experience that is disproportionate or unrelated to activity or exertion and is not relieved by rest or sleep. Cancer related fatigue is multidimensional, subjective experience that has profoundly negative effect on patients' quality of life. Fatigue today is the most commonly reported symptom, for some patients the most unpleasant symptom, and the most distressing side-effect in connection with cancer and/or its treatment. The prevalence of fatigue in patients receiving anti-cancer treatment has been estimated to be more than 80 per cent. The fatigue can be pervasive: patients report that fatigue begins with treatment, continues during the course of chemotherapy or radiation treatment, and declines somewhat--but frequently sustains at a higher-than-baseline rate- after treatment is over. It may also persist for several years even in patients with no apparent disease. Despite of the prevalence of fatigue and its profoundly negative effect on patients quality of life, little is known about the specific mechanisms that underline fatigue in cancer patients or how to prevent it and treat it effectively.

[Cancer related fatigue. I. Prevalence and attempt to define the problem]. / Zmeczenie w chorobie nowotworowej. I. Czestosc wystepowania i próba zdefiniowania problemu.

Fatigue is often related to cancer, and is related to its treatment. Fatigue is the most commonly reported side effect of cancer treatment. It differs from fatigue induced by other causes, because doesn't decrease after period of rest. The fatigue reported by cancer patients is usually described as an unusual, excessive, whole-body experience that is disproportionate or unrelated to activity or exertion and is not relieved by rest or sleep. Cancer related fatigue is multidimensional, subjective experience that has profoundly negative effect on patients' quality of life. Fatigue today is the most commonly reported symptom, for some patients the most unpleasant symptom, and the most side-effect in connection with cancer and/or its treatment. The prevalence of fatigue in patients receiving anti-cancer treatment has been estimated to be more than 80 per cent. The fatigue can be pervasive: patients report that fatigue begins with treatment, continues during the course of chemotherapy or radiation treatment, and declines somewhat--but frequently sustains at a higher-than-baseline rate-after treatment is over. It may also persist for several years even in patients with no apparent disease. Despite of the prevalence of fatigue and its profoundly negative effect on patients quality of life, little is known about the specific mechanisms that underline fatigue in cancer patients or how to prevent it and treat it effectively.