Colorectal Cancer During Pregnancy – Case Report And Brief Review Of The Literature

Abstract: Malignancies in pregnant women are very rare with colorectal cancer being the eighth most commonly found. Colon cancer during the pregnancy is often diagnosed at an advanced stage because of its symptoms which are attributed to the pregnancy. This paper described a case of a 34-year-old female patient, 22 weeks pregnant, who was admitted to the Department of General and Transplantation Surgery due to deep venous thrombosis (DVT) and bleeding into the lower gastrointestinal (GI) tract. Endoscopy of the lower GI tract revealed an ulcerated polyp in the sigmoid colon. The histopathologic report showed infiltrated adenocarcinoma coli G2. The abdominal ultrasound scan (USS) and the chest X- ray detected hepatic and pulmonary metastases. After consideration, the tumor resection was postponed because it would not significantly improve the patient’s health condition and would endanger the fetus. The medical treatment plan was to wait until the 32nd-34th week of pregnancy and perform a simultaneous C-section, recto-sigmoid resection and hysterectomy. After intrauterine fetal death at 27 gestational week, computer tomography (CT) revealed disseminated metastases in the liver, lungs and peritoneum. The patient was referred to palliative chemotherapy. In conclusion, diagnostics and treatment of colon cancer during pregnancy is a challenge for the obstetrician and oncological team. Read full text »

Fetal Movements Monitoring As a Still Valid Fetal Well-being Assessment Method

Abstract: Fetal movement observation by pregnant women is the oldest and the cheapest way to assess fetal well-being. There is a scientifically confirmed correlation between weaker perception of the movements and increased risk of intrauterine fetal death. The investigated group comprised 154 patients from the Clinic of Obstetrics and Pathology of Pregnancy at the Medical University of Lublin, aged 17-45. Data were collected through the author’s questionnaire. Statistical analysis was performed in SPSS Statistics and Chi2 Test. In the investigated group 70.8% of women would count fetal movements every day and 13% were not doing this at all. Whereas 72% of women declare they have been informed by a doctor about the necessity to count fetal movements, 51.3% did not receive any materials that could facilitate the assessment of the physical activity of the fetus. Almost 50% of the women did not know how fetal movements change throughout pregnancy. Nonetheless, 45.5% of the patients correctly listed the indications for an urgent consultation in a health centre. The women were asked to state if the following sentence was correct: „a decreased number of fetal movements may indicate a fetal disease”. Over half (59.1% ) of the respondents answered the sentence was true. Women who obtained higher education gave the correct answer more frequently than those with secondary education. Patient awareness concerning monitoring fetal movements seems to be insufficient. There is a need for medical staff to pay more attention to education of pregnant women on the benefits resulting from monitoring the physical activity of the fetus. Read full text »

An Innovative Treatment of Endometriosis With the Use of Plasma Technology – Case Report

Abstract: Endometriosis is a condition, in which the endometrial cells grow outside the uterus. It is a cause of chronic pain, which may disturb a woman’s well-being. In addition, women suffering from endometriosis often remain infertile. The treatment is problematic and the disease has a tendency to recur. Case Report. The patient was a 41 – year old woman with diagnosed endometriosis in the scar after caesarean section. The implant caused boring and burning pain (10/10 points in the Visual Analogue Scale for pain). The endometriosis was surgically treated with the use of Plasma Technology. The time of hospitalization was 4 days. During the period of a 6 month observation, the patient did not have any pain complaints and re-surgery was not necessary. Conclusion. The use of innovative argon plasma method enabled to dissect the entire implant of endometriosis with no intraoperative or postoperative complications. The surrounding tissues were undamaged. After 5 years of suffering the patient remained pain-free and her mental condition ameliorated. Read full text »

The Influence of Enteral Nutritional Therapy on Patients’ Condition And Life Quality

Abstract:Diet almost always affects the condition of patients and the quality of their lives. Proper nutrition is extremely important during therapy of all disease entities. For the purpose of this publication a study was conducted which assessed the influence of enteral nutritional therapy (ENT) implementation on overall condition of patients and quality of their lives. Research was based on elaborated survey which assessed number of hospitalizations and medical consultations in patients before and after introduction of ENT. Survey also assessed subjective feels of patients and/or their caregivers connected with ENT. Research showed that ENT is a beneficial therapeutic solution in case of patients suffering from diseases which make normal eating impossible and lead to progressing emaciation of organism. Subjective assessment of life quality also improved. Read full text »

The Importance of Communication In Patient-Doctor Relationship – A Review

Abstract:Patient’s compliance plays an important role in diagnostic and therapeutic process. Enhancing compliance can be easily achieved by adequate communication between a clinician and the patient. The aim of the study was to identify factors which increase effectiveness of patient-doctor communication. Proper management should include providing information using a language understandable by the patient, and with just right amount of details. Awareness of condition increases the level of comfort and decreases anxiety associated with hospitalization. Moreover, satisfactory communication with physician might lower the risk of confronting malpractice claims in case of adverse effects. Lack of understanding of their condition and performed procedures raises patients’ doubts about clinical decisions. Doctors having better relationships with their patients appear as being more interested in their opinions and encouraging further conversations. These are the attributes of a non-hierarchical relationship that focuses on therapeutic partnership. Having identified specific communication behaviours, it is possible to design appropriate communication techniques. Postgraduate training programmes could be beneficial for most physicians, and apart from solving patient-oriented problems they could also improve teamwork among the medical staff. To achieve best effects, the training programme should be individualized and depend on clinician’s specialty. Enhancement of physician’s communication skills leads to mutual advantages for both sides. Read full text »

Diagnosis and Treatment of Lower Limb Arteries True Aneurysms

Abstract:Lower extremities artery true aneurysm is a rare but significant vascular problem. It is usually found in the popliteal artery, seldom femoral artery. Most important symptoms related with this vascular condition are mainly due to peripheral embolization and untreated may lead to a severe limb ischemia. Usually it is very easy to diagnose such an aneurysm, as we can simply palpate a pulsing knob. Aneurysms can be treated conservatively or surgically. Generally surgical procedure is regarded as a safe and effective method of treatment. Despite rapid development of endovascular techniques open surgery still remains a gold standard of treatment. However, there is still lack of data to confirm the advantages of open or endovascular approach. Read full text »

Antenatal Corticosteroid Therapy in Management of Preterm Labor Caused by Preterm Premature Rupture of Membranes – Risks and Benefits

Abstract:Preterm labor is a common complication of pregnancy, in one third of the cases it is caused by preterm premature rupture of membranes (PPROM). Since the crucial article by Liggins and Howie published in 1972, antenatal corticosteroid therapy has played a prominent role in the management of preterm labor. Nowadays plenty of studies have shown the effectiveness of the therapy in reducing neonatal mortality and morbidity. However, there is some ambiguity about the therapy in certain cases, including PPROM. The immunosuppressive activity of steroids is widely known. Even though the corticosteroids generally used in the management of preterm labor (betamethasone, dexamethasone) show very weak immunosuppressive activity, there is still some doubt -regarding the possible increase in risk of neonatal and maternal infection. Other questions concern the effectiveness of the therapy in this group of patients, as well as current recommendation of main obstetricians’ societies and safety of use of repeated doses. The aim of this article is to highlight the latest knowledge in this area. Read full text »

Acute Renal Failure in the Course of Hellp Syndrome

Abstract:HELLP syndrome is a severe pregnancy complication with high mortality among mothers and children. Incidence of HELLP syndrome according to literature is about 1% of all pregnancies. HELLP syndrome is associated with preeclampsia in one- quarter of patients. Current researches on HELLP syndrome address etiology, treatment and prediction of the syndrome. Currently there are no useful predictors and established treatment is the delivery. This study presents the case of HELLP syndrome in 37 year-old patient at 28th week in her first successful pregnancy after in-vitro fertilization technique. Read full text »

Hysterectomy in the 33rd Week of Pregnancy Due to Placenta Praevia – A Severe Obstetric Complication Despite Correct Diagnosis

Abstract:Placenta praevia is one of the leading causes of maternal morbidity and mortality. The incidence of placenta praevia is from 0.1 to 1.0% of all births. Postpartum haemorrhage (PPH) is the most common cause of maternal death and is responsible for one-quarter of maternal deaths globally, approximately for 140,000 deaths annually. Obstetric haemorrhage can occur at any stage of pregnancy. In early pregnancy the major causes of bleeding are ectopic pregnancy, incomplete abortion and trauma. In the second half of pregnancy and during labour the most common causes of bleeding are placenta praevia, placental abruption and uterine rupture, including scar dehiscence after previous operations. The causes of postpartum bleeding are uterine atony, haemorrhage from the space of incorrectly nested placenta, infections, bleeding disorders, injuries and damage to the birth canal. Haemorrhage in the second half of pregnancy relates to 4% of pregnant women and they are most often related to abnormalities of the placenta. More than half of the cases are due to placenta praevia (22%) and improper localization of the placenta (31%). The study presents the case of postpartum haemorrhage and hysterectomy performed in a 30-year-old woman at 33rd week of pregnancy with placenta praevia. Read full text »

Infective endocarditis caused by dental problems correlated with bicuspid aortic valve

Abstract:The aim of the study was to emphasize the importance of prophylaxis of infective endocarditis. Also, the influence of heart failure and bacterial etiology on the treatment was analyzed. This study presents a case report of a patient who was suffering from IE. He was treated in the Cardiology Ward at the Medical University of Lublin. 47-year-old man has resected his tooth in a dental surgery. After a few days at home, he presented non-specific symptoms like fever and chest pain. Bicuspid aortic valve was diagnosed at the Cardiology Ward. Furthermore, vegetation on aortic valve was recorded in echocardiography. That is why IE diagnosis was made. After the therapy with Vancomycin, vegetation on aortic valve was still present. Regurgitation in 3rd state was developed by the patient. New valve was implanted. A few days after operation the patient had subfebrile state. He was treated with Vancomycin and Clindamycin. Currently, he is receiving ciprofloxacin as prophylaxis of IE. Heart failure is a risk factor of IE. These patients should get antibiotic prophylaxis before dental surgery. Patients with heart defect can develop more severe type and treatment in these cases is more difficult. Everyone should undergo non-specific prophylaxis of infective endocarditis. Read full text »