Band 7, Heft 2

Children with malignancy present an important alteration of the immune system functionality caused by the illness itself and by the therapy they undergo. Therefore, they are at high risk of contracting vaccine-preventable diseases and of developing important complications. Vaccinations represent valid devices against these infections but this condition involves two main problems: are vaccines safe in these patients? Are vaccines effective in these patients? The aim of this review is to discuss the principles of vaccination management in children with cancer.

The authors present the case of a girl with Frasier syndrome that was diagnosed at the age of 4 years. At 3.5 years, she was diagnosed a steroid-resistant nephrotic syndrome associated with focal segmental glomerulosclerosis. The girl presented with female phenotype and male genotype (46XY) as well with gonadal dysgenesis. Genetic analysis confirmed the +2T>C mutation in the intron 9 of the WT1 gene. She developed end-stage renal disease at 14 years, culminating in renal transplantation. The liver biopsy revealed a post-transplantation lymph-proliferative disease.

Verrucous carcinoma is a slow growing, well demarcated, exophytic variant of squamosus cell carcinoma with a characteristic verrucous presentation. It is a rare tumour and in 75% of cases it is localised in the oral cavity, and sporadically within the tongue. HPV infection is identified in 40% of patients. Good prognosis is characteristic for this tumour, since the 5-year survival is 93%. The authors describe a case of verrucous carcinoma localised in the tongue of a 62-year old patient. The clinical course, diagnostics and proposed treatment was described and discussed with the existing literature data.

Erysipelas is a bacterial cellulitis usually associated with Streptococcal infection. It may appear as a complication following mastectomy and radiotherapy for breast cancer. The study involved 17 cases of erysipelas of the upper limbs with a median age of 62 years. Here we described the clinical, therapeutic and evolutionary aspects of erysipelas. Our results indicated that the erysipelas appeared with an average of 9 years after mastectomy and was recurrent in three patients (17.64%). It is associated with obesity in 42% and arterial hypertension in 52.9% of patients with breast cancer after radical mastectomy. Breast cancer patients in advance stages of disease at presentation (T2+ T3) are significantly more subject to erysipelas in comparison to those patients with locoregional stage of disease at presentation (T1), Mann Whitney U-test, (p<0.05). All patients had complete response to antibiotics. The recurrence occurred in 2 patients (11.76%) who underwent radiotherapy with adjuvant tamoxifen and in one patient who underwent chemotherapy and radiotherapy combined. Based on these results it is possible to suggest that patients who received radiotherapy may have an additional risk factor for developing lymphedema and erysipelas

The aim of this study was to describe the musculoskeletal manifestations of mucopolysaccharidosis VI and to assess the effectiveness of enzyme replacement therapy (ERT) with recombinant human arylsulfatase B on the bone and joint involvement in a patient with a severe phenotype of the disease. Before the initiation of ERT, the patient presented with significant range of motion (ROM) limitations at multiple joints. Flexion contractures were noticeable in all joints. After 48 weeks of ERT, improvement in active and passive shoulder flexion, as well as passive elbow and wrist flexion, was noticed. ROM improvements were reflected in patient’s enhanced self-care.

Non-invasive measurement of intracranial pressure (ICP) reduces the complications and cost for both patient and health care systems. Improvement of non-invasive methods has led to development of systems for reproducing continuous, real-time non-invasive ICP signals. So far, non-invasive methods have been tailored for the patients with head trauma. We have used Schmidt’s auto-adaptive method to assess the accuracy of this method for patients after surgery for supratentorial brain tumors. Data from forty patients with the diagnosis of brain tumor operated from 2008 to 2010 were used to estimate the accuracy of Schmidt’s method in our patients. We obtained the model parameters from 30 recordings. We determined the ICP wave form for the remaining patients by both invasive and non-invasive techniques. In the test group, by invasive method, the mean ICP±2SD was 17.1 ± 6.6 mmHg and using non-invasive method, the mean ICP ± 2SD was 16.5 ± 5.4 mmHg. The calculated error was 4.6 mmHg using root mean square errors. The average Pearson correlation between the estimated and real waveforms was 0.92. We believe that application of this method is acceptable for post-operative assessment of ICP in brain tumor patients.

The aim of the research was to evaluate the results of NDT-Bobath method in gait re-education of adult patients after ischemic stroke using normalized parameters of gait. The investigation group consisted of 60 patients, all sufferers of an ischemic stroke, and participated in a rehabilitation program: 10 sessions of NDT-Bobath therapy through 2 weeks (ten days of the therapy). Normalized parameters of gait were calculated based on anthropometric measures of patients and their gait parameters (gait velocity, cadence and stride length) measured in every patient on admission (before the therapy) and after the last session of the therapy to assess rehabilitation effects. Results among patients involved in the research were as follows: in normalized gait velocity: recovery in 42 cases (70 %), relapse in 10 cases (16,67 %), no measurable changes in 8 cases (13.33 %)in normalized cadence: recovery in 39 cases (65 %), relapse in 16 cases (26.67 %), no measurable changes in 5 cases (8.33 %)in normalized stride length: recovery in 50 cases (83.33 %), relapse in 4 cases (6.67 %), no measurable changes in 6 cases (10 %). Observed statistically significant and favourable changes in health status of patients, described by normalized gait parameters, confirm effectiveness of the NDT-Bobath method.

The paper presents a comparative study of selected recognition methods for the medical decision problem -acute abdominal pain diagnosis. We consider if it is worth using expert knowledge and learning set at the same time. The article shows two groups of decision tree approaches to the problem under consideration. The first does not use expert knowledge and generates classifier only on the basis of learning set. The second approach utilizes expert knowledge for specifying the decision tree structure and learning set for determining mode of decision making in each node based on Bayes decision theory. All classifiers are evaluated on the basis of computer experiments.

Informed consent in today’s medical practice has become a cornerstone and a routine ethical component playing a major role in forming a therapeutic alliance with the patient. The present study sought to analyse the effectiveness of the consent forms and the consenting process in Otorhinolaryngology. This three month questionnaire-based study covered varying operations which ranged from tonsillectomies, grommet insertions to pharyngeal pouch stapling. Twenty-nine percent of consent forms were signed on the day of the operation. Of the patients who received leaflets (51%) during the process of informed consent, a majority (88%) found it useful. The respondents were satisfied with the explanation of the procedure, benefits and complications (70–74%). Majority kept their consent forms at home (60%) and did not bother engaging in further search with regards to the information in the consent form (81%). Majority of the patients agreed that they had enough time to make an informed consent. Patients were satisfied with the consent process but more can be done to improve the consenting process.

The purpose of this study was to evaluate self-rated musculoskeletal complaints and their association with computer use time in the adolescent population in Lithuania. The cross-sectional study done in 2008–2009 in Lithuania. 1806 students aged 13–18 years from randomly selected schools were questioned (response rate 95.8%). Logistic regression analysis results show that musculoskeletal complaints in adolescence are associated with duration of computer use as related to age and gender. Compared with adolescents using computer <2 hours daily, a statistically significant probability of experiencing back pain was determined for younger boys and girls groups (13–15 years) who reported working on a computer >4 hours (OR=2.36 and OR=2.50, respectively) in older age groups (16–18 years); in girls only the ORs of back pain significantly increased with increased time of computer use. the probability of experiencing the neck-shoulder pain was determined only in girls aged 16–18 years who reported working on a computer 2–4 hours (OR=1.62, p=0.020). Musculoskeletal complaints in adolescence are related to duration of computer use. Increasing the time spent at the computer increased complaints of musculoskeletal pain among Lithuanian adolescents. The main guidelines for prevention point to restriction of time of computer use.

Oral health-related quality of life (OHRQoL) is multifaceted and involves many factors. One of them is the use of dental implants. It was the aim of our study to assess whether implant therapy might improve OHRQoL. We consulted patients with at least one Astra Tech implant. Each patient completed oral health questionnaires, which were then statistically evaluated using the Wilcoxon signed-ranks test and Analysis of Covariance from a functional and aesthetic point of view. Differential response on individual scales was assessed using multivariate approach. All twelve marginal Wilcoxon tests showed an overall improvement in OHQoL (α = 0.05). On the aesthetic scale, OHRQoL was found to be associated with marital status, aesthetic reasons for undergoing surgery and number of front teeth replaced by implants. On the functional scale, three covariates were statistically significantly and appeared to have affected the levels of OHRQoL. The most significant explanatory effect was observed for the number of front teeth replaced via implantation, followed by the presence of chewing problems. Marital status was also found to have significantly affected the OHRQoL functional scale. Significant implant-related improvements in both scales were observed in patients with at least one implant in the front dental area.

The aim of this study was to develop and validate a linguistically and culturally appropriate version of the Edinburgh Postnatal Depression Scale (EPDS) for use with women attending antenatal care in Romania. We translated and tested a Romanian version of the EPDS (EPDS-R) in four hospitals in three Romanian cities: Cluj-Napoca, Satu Mare, and Sighetu-Marmatiei. The study population included third-trimester women attending antenatal clinics (n=418); 364 subjects were included in the analytic sample. We used the Center for Epidemiologic Studies Depression Scale (CES-D) as a “gold standard”. We assessed reliability, validity, and conducted sensitivity analysis to establish an EPDS-R cutpoint. We found that reliability was robust (α=0.89) and there was a significant linear relationship between EPDS-R and CES-D scores (r=0.77; p<0.001). We established an EPDS-R cutpoint of >12 to balance sensitivity and specificity. Principal component analysis revealed a two-factor solution. We detected antenatal depressive symptoms prevalence rates of 32% (CES-D) and 38% (EPDS-R). This is the first study to report exclusively on antenatal depression and the use of the EPDS in Central and Eastern Europe. The EPDS-R is easy to administer, reliable, and valid for screening depression among antenatal women in Romania.

The purpose of this study was to investigate the relationship between weight status and recreational drug use in Korean adolescents. A total of 72,399 adolescent students (38,152 boys and 34,247 girls) from the middle first to high third grade participated in the 5th Korea Youth Risk Behaviour Web-based Survey (KYRBWS-V) project in 2009. They were assessed for body mass index (BMI) and recreational drug abuse. The associations between BMI and recreational drug use were examined using multivariable logistic regression analysis after adjusting for the covariate variables of age, smoking frequency and cigarette consumption, frequency of alcohol consumption and severe alcohol intoxication, amount of alcohol consumed, parents’ education level, economic status, sedentary activities during the week, mental stress, sleep duration, frequency of vigorous and moderate physical activities, and muscular strength exercises during the week. For boys, the odds ratio (OR) (95% confidence interval [CI]) between overweight and drug use were 0.990 (0.723–1.356; p = 0.950) for almost none, 0.939 (0.521–1.693; p = 0.834) for past use, and 0.791 (0.385–1.624; p = 0.523) for present use. The OR (95% CI) between obesity and drug use was 0.731(0.508–1.052; p = 0.091) for almost none, 0.755 (0.389–1.465; p = 0.407) for past use, and 0.701 (0.314–1.565; p = 0.386) for present use. For girls, the OR (95% CI) between overweight and drug use was 1.112 (0.702–1.763; p = 0.650) for almost none, 1.103 (0.464–2.619; p = 0.825) for past use, and 0.927 (0.267–3.218; p = 0.905) for present use. The OR (95% CI) between obesity and drug abuse was 0.594 (0.261–1.352; p = 0.215) for almost none, 1.318 (0.462–3.764; p = 606) for past use, and <0.001(<0.001–<0.001; p = 0.998) for present use. We concluded that recreational drug use had no correlation with overweight and obesity in Korean adolescents.

Ovarian metastatic malignant melanoma is a rare form of disseminated malignant melanoma. We present a rare case of acute abdomen due to rupture of ovarian metastatic malignant melanoma seven years after removal of a primary cutaneous malignant melanoma lesion, followed by reexcision of the cicatrix and axillary dissection (Clark III, Breslow IV), one year after osteoplastic parietal craniotomy for removal of recidiv metastatic lesions, and excision of the cutaneous malignant melanoma lesion on the upper leg were performed. During laparotomy because of acute abdomen, 4 L of free liquid (blood and ascites) were evacuated. The right adnexal mass was loose tumor, size 110x75 mm, with rupture on the posterior wall and hemorrhage. Unilateral adnexectomy was performed. Pathohystologic evaluation revealed tumor cells with eosinophilic, clear cytoplasm, intracytoplasmatic melanotic pigment and a great number of mitosis.Immunohistochemical results supported positivity for protein S-100, whereas results for cytoceratin 7, cytoceratin 20, pancytoceratin, epithelial membrane antigen and HMB-45 were negative. Three months after the surgery the patient died due to disseminated cerebral melanoma. An adnexal mass and the history of previous MM should be suspected to be ovarian metastatic malignant melanoma and the patient should be seen by gynecologist at least for active treatment.

We present a 42-year-old female admitted for a 4 month history of increasing pelvic discomfort and pain. Clinical examination revealed a large tumor obstructing the vagina. Tumor markers (CA 125, CEA, AFP and CA 19-9), white blood cells and biochemical tests were all within the normal limits. Pelvic ultrasound and magnetic resonance imaging scan confirmed the presence of a large retroperitoneal/pelvic mass. The tumor was surgically excised and pathohistologically diagnosed as a well differentiated leiomyosarcoma, staged IB. Six years after surgery the patient is well and disease free.

The implementation of new markers of bacterial infection into clinical practice is hindered by their costs. We assessed the potential use of the neutrophil to lymphocyte count ratio (NLCR) to discriminate between bacterial and viral infections. NLCR was evaluated in 45 patients with bacterial infections: 24 patients with viral infections and 18 healthy adults. The medians of NLCR were 11.73 in bacterial infections, 2.86 in viral infections and 1.86 in controls. The NLCR cut-off value of 6.2 exhibited a sensitivity value of 0.91 and a specificity value of 0.96 for bacterial infection. These results suggest a diagnostic potential for NLCR.