Background Echinococcosis multilocularis (Hydatid Disease - HD) is a zoonotic disease caused by the larval form of Echinococcus multilocularis (EM). The main sites for this zoonosis are the Middle East, China, India, Alaska, and Siberia. It is rather rare in Europe. In Poland, the Warmian-Masurian Province is the endemic region for Echinococcus multilocularis. The clinical manifestation of the disease is dependent on the location, the size of the cyst and the development stage of the parasite. Considering the uncommon character of echinococcosis in Central Europe, especially such located in the areas outside the liver and lungs, the authors would like to present a case of coexistence in one patient of two EM foci in the liver and the head of the pancreas. Case presentation We present a clinical case of a 32-year-old man who was diagnosed with a cystic lesion with septa and calcification in the sixth segment of the liver and a suspicious change in the head of the pancreas. ELISA Em 2 plus test was positive, Western Blot method - the P-5 pattern showed an image that is characteristic of an EM infection. The sixth liver segment with a tumour and a tumour from the head of pancreas were excised by means of laparotomy. On the 6th day after the surgery the patient was discharged from hospital without complications and in good condition. Currently, he is under the control of a parasitic and zoonotic clinic. He takes an 800 mg daily dosage of Albendazole. Conclusions The presented clinical case shows that if we have a patient with cystic / tumour change in the pancreas and positive immunological tests, CT and MRI of the abdominal cavity are usually sufficient in order to fully diagnose and to qualify such a person for surgery. The most effective treatment is surgical treatment supplemented with pre- and postsurgical treatment with Albendazole.
Introduction: Malaria is still a huge social and economic health problem in the world. It especially affects the developing countries of Africa. A particular problem is the misuse and abuse of over-the-counter antimalarials. This problem could lead to the emergence of drug-resistant strains and the subsequent elimination of more antimalarials from the list of effective antimalarials in Ghana. Methods: During the implementation of the study, an original questionnaire was used to collect data among Ghanaians on their knowledge of malaria, attitude towards antimalarials and their use of antimalarials. Results: The proportion in the analyzed subgroups was compared using the chi-square test. The analysis was conducted using TIBCO Software Inc., Krakow, Poland (2017) and Statistica (data analysis software system), version 13. In total, 86.29% of respondents knew the symptoms of malaria (p = 0.02) and 57.2% knew the cause of malaria (p < 0.001). Respondents with higher education were significantly more likely to know the symptoms of malaria (96%) p < 0.001. In the study group, only 74.59% of the respondents consulted medical personnel before taking the antimalarial drug (p = 0.51) and only 14.2% of the remaining respondents performed a rapid diagnostic test for malaria. Conclusions: The awareness of Accra and Yendi native inhabitants about the causes and symptoms of malaria and alternative ways of prevention is quite high. People’s education very significantly influences the way Accra residents deal with suspected malaria. Widespread public education and awareness and accessibility to places where antimalarial drugs are sold play a very important role in the proper use of antimalarial drugs.
Introduction: The swallowing of foreign bodies is a common clinical disorder. Aim: The aim of this study is to present the case of a swallowed foreign body and discuss the possible endoscopic approaches. Case study: We present a case of a 56-year-old woman who had a stuck chicken bone in a divertic sigmoid colon. In CT the presence of the bone in the sigmoid colon with edema and thickening of a wall around the foreign body was confirmed. The bone was removed in a hospital setting during colonoscopy with the use of ‘rat teeth’ forceps without complications. Results and discussion: Swallowed foreign bodies are usually excreted from the gastrointestinal tract without any complications, however, sometimes they can lead to serious clinical problems such as obstruction, perforation or bleeding. Most stapled foreign bodies in a large intestine can be removed endoscopically without complications. About 5% of patients require surgical treatment. Conclusions: The bone removal performed in the hospital setting ensured the possibility of appropriate procedure in case of complications, such as intestinal perforation or bleeding. The endoscopic bone removal prevented the development of complications requiring surgical treatment.
Background: The problem of smoking and its influence on the occurrence of precursors and advanced colorectal cancer is often discussed in the medical literature. Tobacco smoke can provide a non-nutritional source of polycyclic hydrocarbons and other substances which, when combined with an incorrect diet, may play a role in promoting carcinogenesis at the level of the genetic control mechanism. The aim of our study was to assess the effect of smoking on the frequency and type of aberrant crypt foci (ACF) in the rectum and polyps in the large intestine in people who smoke more than 20 cigarettes a day for more than 20 years. Methods and Findings: A colonoscopy combined with rectal mucosa staining with 0.25% methylene blue was performed in 131 patients. Each of the study participants gave informed consent to participate in the study. Three bioptates were collected from the foci defined macroscopically as ACF; in cases where there were fewer foci, the number of collected foci was respectively lower. On the colonoscopy day, patients completed the questionnaire regarding epidemiological data used for analysis of factors affecting the occurrence of ACF in the study group. The number of ACF in the colon was divided into three groups: −ACF < 5, 5 < ACF < 10, ACF > 10. In the statistical analysis, numerical data were presented and real numbers, range of arrhythmic means, mean standard deviation, and results of probability distribution. The Student’s test, U test, and chi2 were applied in order to determine the significance of differences of means and frequency of events in both groups. The level of significance was set at α = 0.05. Statistica 7.1 and Excel 2010 were used. Most smokers are in the age groups between 51–70 years. In the youngest (31–40 years), single ACF appear first (ACF <5) ACF in the number of 5–10 appear a little later (around 50 years of age) and dynamically increase, reaching a maximum at the age of 60–65.ACF in the number >10 appear at the latest age (55 years old) and their number gradually increases with age (linear growth). The probability of occurrence of ACF in all groups is greater in smokers, and the difference for the ACF group 5-10 and ACF >10 is statistically significant with a significance level of p < 0.05. Apart from ACF normal, all types of ACF are more likely in this group than in non-smokers and these differences are statistically significant with p < 0.05. Conclusions: Smoking has a significant impact on the number and type of rectal ACF. Smokers have a greater number of ACFs in the rectum than non-smokers, and the most common type is hyperplastic ACF. Smokers are more likely to develop polyps in all sections of the colon compared to non-smokers.
Background Hepatocellular carcinoma (HCC) is a primary liver tumor that generally develops in a marsh-altered liver. Local ablation using radio frequency waves is the first-line treatment for patients with early onset of this cancer who cannot undergo radical surgery. This is a painful procedure and must be performed under deep intravenous analgosedation or general anesthesia. The method that appears to meet the anesthesiological and surgical requirements is thoracic paravertebral block.Aim of the study The main purpose of the study was to determine the efficacy and safety of paravertebral block compared to local perioperative anesthesia in patients who had percutaneous thermoablation as a treatment for HHC.Methods 30 patients enrolled in the treatment of hepatocellular carcinoma by percutaneous thermoablation were enrolled in the study. Two groups of patients were compared: group PVBpatients under paravertebral block anesthesia, group BB -patients under local anesthesia, without paravertebral block. ResultsThe use of paravertebral blockade (PVB) did not significantly reduce the patient's concerns about the postoperative period, the ability to ask questions to the doctor, receive understandable information about anesthesia, reduce stress levels or increase the level of satisfaction with pain therapy in the postoperative period (p> 0.05). Patients significantly more often experienced pain during surgery without paravertebral block (p <0.001). Side effects of anesthesia occurred in both compared groups. They mainly concerned nausea and vomiting, which significantly more often occurred in the group without blockade (BB) and affected up to 60% of the respondents (p = 0.008).Significantly more often any painkillers were used among BB patients compared to PVB, respectively: immediately after surgery 53% vs 13% (p = 0.02), 1 hour after surgery 80% vs 27% (p = 0.003), 3h after surgery 80% vs 14% (p <0.001), 6h after surgery 60% vs 14% (p = 0.008), after 24h 47% vs 20% (p = 0.12). ConclusionsThe paravertebral block has proved to be a safe and well-tolerated and effective method of treating postoperative pain in patients with liver cancer treated by percutaneous thermoablation.Patients with PVB during the surgery and in the postoperative period had significantly less pain than HCC -Hepatocellular Carcinoma -hepatocellular carcinoma PEI -Percutaneous Ethanol Injection -percutaneous ethanol injection RA -Regional Anaesthesia -regional anesthesia RFA -Radiofrrequency Ablation -ablation using radio frequency waves PRFA -Percutaneus Radiofrrequency Ablation -transcutaneous ablation using radio frequency waves SBP -Systolic Blood Pressure SpO2 -Oxygen Saturation -oxygen saturation of arterial blood TPVB -Thoracic ParaVertebral Block -chest block Declarations Ethics Approval and Consent to Participate -all patients gave written consent for participation, in addition, Consent of the Bioethics Committee: Resolution No. 46/2017 of 9/11/2017 issued by the LG -collecting clinical materials; clinical material analysis; substantive supe...
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