Carcinoid Heart Disease: How to Diagnose and Treat in 2020?

Neuroendocrine tumors (NETs, originally termed "carcinoids") create a relatively rare group of neoplasms with an approximate incidence rate of 2.5 to 5 cases per 100 000 persons. Roughly 30% to 40% of subjects with NETs develop carcinoid syndrome (CS), and 20% to 50% of subjects with CS are diagnosed with carcinoid heart disease (CaHD). The long-standing exposure to high serum serotonin concentration is one of the crucial factors in CaHD development. White plaque-like deposits on the endocardial surface of heart structures with valve leaflets and subvalvular apparatus thickening (fused and shortened chordae; thickened papillary muscles) are characteristic for CaHD. NT pro-BNP and 5-hydroxyindoleacetic acid are the 2 most useful screening markers. Long-acting somatostatin analogs are the standard of care in symptoms control. They are also the first-line treatment for tumor control in subjects with a metastatic somatostatin receptor avid disease. In cases refractory to somatostatin analogs, several options are available. We can increase a somatostatin analog to off-label doses, add telotristat ethyl or administer peptide receptor radionuclide therapy. Cardiac surgery, which mainly involves valve replacement, is presently the most efficient strategy in subjects with advanced CaHD and can relieve unmanageable symptoms or be partly responsible for better prognosis.

[Current treatment of neuroendocrine tumors].

Neuroendocrine neoplasms (NEN) are group of rare neoplasms, which frequency is estimated on about 35 cases/100000. Though, during last 30 years the number of NEN new cases increased five-times. Nowadays the only method which allows to cure NEN is surgical treatment. Laparoscopic surgery and endoscopic treatment are also used. These neoplasms are usually diagnosed in advanced stadium, with distant metastases, when surgery is not an option. In this group of patients systemic and local therapies are used, such as somatostatin analogues, chemotherapy or targeted therapy. The choice of proper method is determined not only by neoplasm's localization or its size, but also clinical symptoms caused by tumor itself or by substations released by it. One place hopes in novel molecular-based therapies and currently investigated therapies using i.a. oncolytic viruses.

Diagnostic difficulties of neurological complications after surgical treatment of acute ascending aorta dissection - a case report.

Adverse drug reactions deteriorate patient state, delay proper diagnosis and therapy. Drug-induced extrapyramidal syndromes caused by use of receptor D2 antagonists are relatively rare. We present a case of acute dystonia with upper limbs tremors after medication with metoclopramide and neuroleptic drugs in young patient operated on acute aortic dissection. Besides a rare comlication in the shape of right temporo-maxillary joint luxation and somatic symptoms of anxiety reaction occured, what made difficult the proper diagnosis and fast treatment.

[Emotional regulations among benzodiazepines dependent patients--preliminary results]. / Regulacja stanów emocjonalnych u pacjentów uzaleznionych od benzodiazepin--doniesienia wstepne.

BACKGROUND: The aim was to examine emotional states among benzodiazepine dependent patients who have been recently successfully detoxified and their coping strategies. METHOD: 32 patients dependent from benzodiazepines had been chosen to participate in the study and they were examined with State-Trait Anxiety Inventory (STAI), The Coping Inventory for Stressful Situations (CISS), The UWIST Mood Adjective Checklist (UMACL). RESULTS: Detoxified benzodiazepine-dependent patients experience symptoms such as: high levels of anxiety (both state and trait), tense arousal, unpleasant mood and low body energy level. CONCLUSIONS: In the examined group, the most common coping strategy has been the emotions oriented style which does not affect sources of emotional problems. Presented results point towards necessity of psychological therapy, based around strengthening of coping resources and anxiety removal (relaxation) techniques.

[Emotional identification and management disorders among benzodiazepine dependent patients as a factor leading towards interpersonal relations problems]. / Zaburzenia rozpoznawania i rozumienia emocji u osób uzaleznionych od benzodiazepin jako czynnik prowadzacy do trudnosci w relacjach interpersonalnych.

BACKGROUND: The aim was to examine an ability to identify and manage the emotions defined as Emotional Intelligence Quotient (EQ) among benzodiazepine-dependent patients. METHOD: 32 benzodiazepine-dependent patients had been chosen to participate in the study. They were examined by the following EQ measurement surveys: INTE, SIE-T. Personality traits and anxiety levels have been studied using NEO-FFI and State-Trait Anxiety Inventory (STAI). RESULTS: Research points toward EQ decrease among benzodiazepine dependent patients, particularly in face expression recognition ability. Most characteristic results are the neurotic trait (high results), extrovert and scrupulous. CONCLUSIONS: Improving abilities enabling proper use of emotional intelligence in problem-solving and effective social functioning is apparently an important component of therapeutic programmes for benzodiazepine dependent patients.

[Contradiction model to prevent addictions in university students from Kraków]. / Krakowski model przeciwdzialania uzaleznieniom wsród studentów.

Students' community is a peculiar environment where the problems of psychoactive substance using has been raised for many years, whereas the real scale and extent of the phenomenon has not been appreciated enough so far. Results of the preliminary research carried on in 2000 and 2004 indicate a considerable degree of the popularity both of alcohol and drugs among students. Therefore both the continuation and widening of the activity of Polish Anti Drug Action "University Free from Abuse" is necessary. In October 2004 the Council of the Rectors of Krakow Universities came to a decision about the necessity of the beginning of an action which aims at the diagnosis and counteraction of the problems in question. In December the outpatient clinic was established with the help of the Clinic of Toxicology. It aims at the prophylaxis, diagnosis and treatment of the addiction. As to prophylaxis, lectures for the first year students have been provided. Their role is to inform about the ethanol, psychoactive substance impact as well as the action of addiction. Lectures have been connected with a public-opinion poll which led to the estimation of the scale of the problem. At the same time the Clinic has rendered both diagnostic and therapeutic service for drug users and alcoholics and their relatives from the above-mentioned environment. There are plants to spread the prophylaxis among more students. Among others the secondary prophylaxis and the creation of consulting points is our aim.

Drug free universities--trends in illicit drugs use among Kraków university students.

Social survey by questioning people is a significant source of information, valuable for planning and developing of prophylactic strategies. An illicit drugs use among a first-year students of Kraków's universities and factors determining the usage were analysed. The research by completing the questionnaire designed by National Bureau for Drug Prevention, Poland was performed in 725 a first-year students of six Kraków's universities. The students were asked to complete the questionnaire confidentially, while the lecture on psychoactive substances. 83.6% of those polled know some students who use a drugs, 38.3% already initiated into drugs, 61.9% reported that they needed at least one day to get drugs. The male students reach for drugs more often then females, and those first-year students being already 20 years old compared to the younger. The greater risk was also noted among students who rent apartments or when a parents earned together more than 3500 PLN. The medical students reached for drugs more rarely than the others. Our survey is one of the first source of information about trends in the drugs usage by Kraków's students. The results will help to develop a preventive standards and creation of effective anti-drugs campaign to be accomplished by college authorities and the Kraków Environmental Diseases Out-patient Clinic for students and academic teachers. The clinic was organised in 2004.

[Assessment of legal awareness regarding illicit drug use among Kraków university students]. / Badanie swiadomosci prawnej dotyczacej zjawiska narkomanii wsród studentów krakowskich wyzszych uczelni.

Social survey is a very important source of information concerned with planing the preventive strategy and protecting against problems relevant to the use of psychoactive substances. The survey covered a group of 211 first-year students from five colleges in Kraków. The students showed weak awareness of law. The respondents are of the opinion that the rules dealing with the addiction issue have been too liberal thus far. The emphasis should be put on enforcing the anti-drug law. Otherwise it will not became a powerful weapon to counteract the drug addiction. According to the opinion of respondents the trade and delivery of drugs are highly disapproving and they require inflicting stringent punishments. The results of our analysis are the integral part of Kraków model to help addicted to psychoactive substances and of prevention activities referred to the students of colleges.

[Assessment of socio-demographic factors in alcohol-addicted patients recurrently treated in a detoxification unit]. / Ocena czynników socjodemograficznych u osób uzaleznionych od alkoholu wielokrotnie leczonych w oddziale detoksykacji.

The aim of the presented study was the assessment some socio-demographic factors of alcohol dependent patients more times hospitalized in Department of Toxicology in Kraków in the years 1999-2004. The repeatedly hospitalization of 334 patients (298 men and 36 women), aged from 17 to 71 years (mean 45.1 years) due the alcohol problem on the basis of clinic documentation were established. The following socio-demographics traits were taken in analysis: age, sex, marital status, place of living, education, kind of jobs, employment and others sources of money. The patients were admitted from 2 or more 29 times during 6 years. Medical history of addiction of mentioned patients was from 1 to 40 years, mean 25 years. 43.7% persons live single and 53.6% was married. The most patients live in Kraków (80%) and others near the town. The education of them: 15.0% ended high school, 28.7% "medium", 30.5% "low professional" and elementary school--13.8% of them. This factor was similar like regional data. Amount mentioned persons 25.8% worked for salary, 11.7% had own business, and 25.4% was retired, and 29.0% was unemployed. This last factor was worse liked similar from mentioned region. The kind of jobs of persons on the aspect of "social safety" was described. Among the mentioned chronic alcohol addicted persons about 18.8% of them with machines in traffic was worked (bus drivers i.e.) and 7.5% described persons in special jobs was worked (policemen, physician i.e.). The authors were suggested that mentioned factors due health services cost in Poland and propose integration of treatment of alcohol-addicted patients.

[Results of the psychological examination of patients--alcohol-addicted drivers, treated in a detoxification unit]. / Wyniki badania psychologicznego pacjentów--kierowców uzaleznionych od alkoholu, leczonych w oddziale detoksykacji.

There are many studies on problems related to alcohol abuse in many aspects from many countries. As a preventive strategy a few years duration programs for numerous populations are being conducted for tightening of social interrelation, to prevent juvenile drinking, to avoid drinking and driving etc. USA study on drinking and driving people indicate on different psychiatric disorders and needs for deeper psychiatric insight. Analysis of different source information on alcohol related traffic collisions is a basis for prevention strategy programs. Our study may contribute in small number of psychology publications related to psychometric testing on motor skills, cognition ability and social condition of people who drive and drink. There were 50 ethanol dependent patients treated at the Department of Clinical Toxicology detoxification unit. All of them had a driving license; majority had access and opportunity to drive a car. A structured interview and psychometric tests were used to evaluate psychology functioning. It can be assumed that deficits revealed in the examination may be detrimental factors to proper and efficient driving ability.

Successful treatment of giant right coronary artery aneurysm mimicking right atrium thrombus--a case report.

Coronary artery aneurysms are very rare abnormalities in patients undergoing coronary angiography. Clinical manifestation is usually that of coronary artery disease, and acute myocardial infarction. We present the case of a patient admitted to the Department of Cardiac Surgery due to coronary artery disease and the presence of thrombus in right atrium of the heart diagnosed by transthoracic echocardiography. Coronary angiography showed occlusion of the right coronary artery (RCA) in its middle portion, 20% stenosis of the stem of the left coronary artery in distal portion and occlusion of circumflex coronary artery (CX) and the second obtuse marginal branch (OM 2). During surgery no tumor was found within the right atrium, but right coronary artery giant aneurysm was revealed. The totally thrombosed aneurysm was removed with additional performance of two venous grafts to RCA and OM 2. The postoperative course was uneventful.

Abdominal complications after cardiac surgery in cardiopulmonary bypass.

UNLABELLED: Gastrointestinal problems are an infrequent but serious consequence of cardiac surgery that includes cardiopulmonary bypass. Predictors of these complications are not well developed, and the role of fundamental variables remains controversial. Between July 1998 and August 2002, 1,552 patients (1,106 male and 446 female), mean age 56 years, underwent heart surgery with cardiopulmonary bypass. Among those 1,552 patients, 21 (1.35%) had gastrointestinal complications, mainly because of gastrointestinal bleeding due to gastritis and five of them required surgery. We present these five patients, three with intestinal ischemia, two with intestinal bleeding. There Hoffmeister-Finsterer operation, Rydygier resection, hemicolectomy, appendectomy with cecum sewing and sigmoid resection were performed. The mortality in this group was 60% (three of five), and the cause of death was multiorgan insufficiency. CONCLUSION: Careful monitoring and physical examination of these high-risk patients following cardiac surgery is required for early detection and effective treatment.