Medical sciences

Folia Medica Cracoviensia

Content

Folia Medica Cracoviensia | 2020 | Vol. 60 | No 3 |

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Abstract

Common variable immunodeficiency (CVID) is a primary immunodeficiency disorder related to recurrent infections, as well as a range of non-infectious manifestations including autoimmune and inflammatory disorders. We hypothesized that patients with CVID and different clinical phenotypes would demonstrate alterations in lymphocyte T subsets, including T lymphocytes expressing programmed cell death protein 1 (PD-1), and regulatory T lymphocytes. We performed flow cytometry in two CVID groups: group 1 with infections only, and group 2 with infections and concomitant noninfectious manifestations. Patients were 18–59 years old (mean 35.8 years of age). Increased proportions of CD8+PD-1+ T cells and reduced regulatory T cells were associated with lymphadenopathy. Amount of regulatory T cells correlated with CD8+PD-1+ T lymphocytes (r = 0.54; p = 0.013), and with CRP (r = –0.64; p = 0.004). Forty percent of patients expressed manifestations in addition to infections (group 2), and they had reduction in number of regulatory T cells [8 (3–12) vs. 24 (11–26)/μl; p = 0.034), naive CD4+ T lymphocytes [36 (27–106) vs. 149 (81–283)/μl; p = 0.034], and elevated C-reactive protein (CRP) [5.33 (3.15–8.82) vs. 1 (1–2.16) mg/l; p = 0.003] in comparison to group 1. In conclusion, the amount of CD8+ T cells expressing PD-1 is associated with lymphadenopathy and number of regulatory T cells in patients with CVID. Patients with CVID and non-infectious complications have increased level of inflammation and alterations in regulatory T cells.
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Authors and Affiliations

Ewelina Nowak
1
Joanna Sulicka-Grodzicka
2
Magdalena Strach
1
Karolina Bukowska-Strakova
3
Maciej Siedlar
3
Mariusz Korkosz
2
Tomasz Grodzicki
1

  1. Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
  2. Department of Rheumatology, Jagiellonian University Medical College, Kraków, Poland
  3. Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, Kraków, Poland
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Abstract

Early fetal cardiac scan (EFCS) is becoming an increasingly common element of the first trimester ultrasound screening carried out at 11–14 gestational weeks. It offers the first possibility to detect congenital heart defects (CHD) or, in ambiguous cases, to identify those pregnancies where a more detailed cardiac scan would be required later in pregnancy. The size of the fetal heart at the end of the first trimester and the associated relatively low image resolution make it impossible to capture all cardiac data to inform the ultimate picture. However, even at this stage, cues of anatomical and functional abnormalities can be picked up, which suggest not only a CHD, but also a likelihood of cardiovascular symptoms typical of genetic disorders. EFCS should focus on cardiac position, atrioventricular (AV) connections, AV valve function, initial assessment of ventriculo-arterial (VA) connections and the presence of red flag signs in the three vessel and trachea view (3VTV). Proper use of color Doppler mapping makes it possible to overcome the low resolution of B-mode to a certain extent. Here we present our long-term experience in EFCS.
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Authors and Affiliations

Michał Kołodziejski
1
Marcin Wiecheć
1
Agnieszka Nocuń
2
Anna Matyszkiewicz
1
Bartosz Rajs
1
Wojciech Sojka
3
Kazimierz Pityński
1

  1. Chair of Gynecology and Obstetrics, Jagiellonian University Medical College, Kraków, Poland
  2. Department of Rheumatology, Jagiellonian University Medical College, Kraków, Poland
  3. Department of Neonatology, Jagiellonian University Medical College, Kraków, Poland
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Abstract

The absence of the musculocutaneous nerve represents a failure of the nerve to depart from the median nerve during early development. During a routine dissection of a 66-year-old white female cadaver, a bilateral absence of the musculocutaneous nerve was observed in the upper limbs. Muscles of the anterior flexor compartments of the arms including biceps brachii and brachialis were supplied by branches of the median nerve. The lateral cutaneous nerve of the forearm also branched from the median nerve. In a clinical case of a particularly high median nerve injury, a variation of an absent musculocutaneous nerve may not only result in typical median nerve palsy of the forearm and hand, but palsy in the arm that would manifest as deficiencies in both shoulder and elbow flexion as well as cutaneous sensory loss from the lateral forearm.
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Authors and Affiliations

Dawn D. Hunter
1
Janusz Skrzat
2
Matthew J. Zdilla

  1. Department of Pathology, Anatomy, and Laboratory Medicine (PALM), West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, Morgantown, West Virginia, USA
  2. Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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Abstract

B a c k g r o u n d: During COVID-19 pandemic, it is necessary to collect and analyze data concerning management of hospitals and wards to work out solutions for potential future crisis. The objective of the study was to investigate how surgical wards in Poland are managing during rapid development of the COVID-19 pandemic.
M e t h o d s: An anonymous, online survey was designed and distributed to surgeons and surgery residents working in surgical departments during pandemic. Responders were divided into two groups: Group 1 (responders working in a “COVID-19-dedicated” hospital) and Group 2 (responders working in other hospitals).
R e s u l t s: Overall, 323 responders were included in the study group, 30.03% of which were female. Medical staff deficits were reported by 21.15% responders from Group 1 and 29.52% responders from Group 2 (p = 0.003). The mean number of elective surgeries performed weekly prior to the pandemic in Group 1 was 40.37 ± 46.31 and during the pandemic was 13.98 ± 37.49 (p <0.001). In Group 2, the mean number of elective surgeries performed weekly before the start of the pandemic was 26.85 ± 23.52 and after the start of the pandemic, it was 7.65 ± 13.49 (p <0.001). There were significantly higher reported levels of preparedness in Group 1 in terms of: theoretical training of the staff, equipping the staff and adapting the operating theater to safely perform procedures on patients with COVID-19. Overall, 62.23% of responders presume being infected with SARS-CoV-2.
C o n c l u s i o n s: SARS-CoV-2 pandemic had a significantly negative impact on surgical wards. Despite the preparations, the number of responders who presume being infected with SARS-CoV-2 during present crisis is high.


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Authors and Affiliations

Tomasz Stefura
1
Justyna Rymarowicz
1
Michał Wysocki
1
Jacek Szeliga
2
Grzegorz Wallner
3
Michał Pędziwiatr
1
Michał Nowakowski
1
Piotr Major
1

  1. 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
  2. Department of General, Gastroenterological, and Oncological Surgery, Collegium Medicum Nicolaus Copernicus University, Toruń, Poland
  3. 2nd Department of General, Gastrointestinal and Oncological Surgery of the Alimentary Tract, Medical University of Lublin, Lublin, Poland
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Abstract

The aim of the study was to determine the influence of posttraumatic enophthalmos in orbital blow-out fracture on the treatment results. The relationship between time from injury to treatment, type of surgical reconstruction, bone graft site, type of diplopia and treatment results were evaluated. The relationship between the location of the fracture and the degree of enophthalmos was also analyzed. The study included 730 patients, 128 women and 602 men, aged 4 to 77 years, average 28 years, treated because of orbital blow-out fracture in our Department between 1975 and 2015. The study included only patients with an isolated orbital floor or medial wall fracture, so-called „pure blow-out” or „internal blowout”. Fractures of the lower rim, roof or lateral wall of the orbit, as well as the coexistence of other fractures of the facial part of the skull, were excluding citeria from the study. Complete recovery in surgically treated patients was achieved in 405 (58.8%) patients, improvement in 179 (26%) and no improvement in 105 (15.2%) patients. The degree of post-traumatic enophthalmos affects the result of the treatment. The location of the orbital fracture affects the enophthalmos, in our group of patients the largest incidence occurred in the fracture located in the orbital floor combined with medial wall. Patients who underwent surgical treatment up to 14 days after the injury achieved better results than those postponed.
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Authors and Affiliations

Piotr Koryczan
1
Jan Zapała
1
Michał Gontarz
1
Grażyna Wyszyńska-Pawelec
1

  1. Department of Cranio-Maxillofacial, Oncological and Reconstructive Surgery, Jagiellonian University Medical College. University Hospital in Kraków, Poland
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Abstract

The purpose of this study was to examine the height of the main septum (MS) in the sphenoid sinuses and its type, depending on the percentage prevalence of its tissue composition (osseous and membranous) in the adult population.
M a t e r i a l s a n d M e t h o d s: A retrospective analysis of 296 computed tomography (CT) scans (147 females, 149 males) of the paranasal sinuses was conducted. The patients did not present any pathology in the sphenoid sinuses. The CT scans of the paranasal sinuses were carried out with a spiral CT scanner (Siemens Somatom Sensation 16) in a standard procedure, in the option Siemens CARE Dose 4D. No contrast medium was used. Having obtained the transversal planes, a secondary reconstruction tool (multiplans reconstruction — MPR) was used in furtherance of gleaning sagittal and frontal planes.
R e s u l t s: In all cases, the height of the MS was measured by using a straight line running parallel to the course of the septum (when the MS was regarded as straight) or curved (when the MS was regarded as irregularly shaped). The average height of the MS was 2.1 ± 0.41 cm in the whole research group. Completely osseous MS was found in 32.77% of the patients. In 63.85% of them, the MS was partially membranous. The rarest was the MS which was not even partially ossified —a membranous type, that was observed in 3.38% of the patients.
C o n c l u s i o n s: Variant anatomy of the paranasal sinuses may lead to complications encountered during a surgery, hence a CT scan is advised before the planned treatment.

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Authors and Affiliations

Joanna Jaworek-Troć
1 2
Michał Zarzecki
1
Izabela Zamojska
1
Robert Chrzan
2
Anna Curlej- Wądrzyk
3
Joe Iwanaga
4
Jerzy Walocha
1
Andrzej Urbanik
2

  1. Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
  2. Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
  3. Department of Integrated Dentistry, Institute of Dentistry Jagiellonian University Medical College, Kraków, Poland
  4. Department of Neurosurgery, School of Medicine, Tulane University, New Orleans, USA
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Abstract

B a c k g r o u n d: The anatomy of arteries supplying blood to the brain often varies among the population. It applies particularly to posterior cerebral circulation. The impact of its anatomy variabilities on the formation of intracranial aneurysms has not been determined yet. The aim was to find out if posterior cerebral circulation anatomy variations coexist with basilar artery aneurysms (BAAs). We retrospectively analyzed 27 patients with BAA and a group of 30 patients matched by gender and age but without BAA. In both groups together most (66.67%) of patients were female and the average age was 59.75 ± 10.91. All of the patients had Computed Tomography performed. We assessed the occurrence of BAA, basilar artery (BA) diameter, vertebral artery (VA) diameter, posterior cerebral artery (PCA) diameter, and if patients had hypoplastic VA or PCA.
R e s u l t s: The presence of right VA hypoplasia significantly increased the risk of BAA occurrence (48.15% vs. 16.67%; p = 0.011). The occurrence of hypoplastic VA on either side was significantly associated with the risk of BAA formation (59.26% vs. 26.67%; p = 0.013). Patients with BAA had slightly larger left PCA diameter 1cm after division (1.96 ± 0.51 vs. 1.64 ± 0.42; p = 0.014) in comparison to those without BAA. Additionally, hypoplastic right PCA occurred more often in patients with BAA (22.22% vs. 0%; p = 0.022).
C o n c l u s i o n s: We can conclude that the anatomy of PCA and VA affects the occurrence of BAA. Hypoplastic VA, the presence of wider left PCA and hypoplastic right PCA may be factors that coexist with BAA occurrence.

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Authors and Affiliations

Małgorzata E. Czuba
1
Maciej J. Frączek
1
Katarzyna Ciuk
1
Jakub Polak
1
Piotr Gabryś
1
Paweł Brzegowy
2
Andrzej Urbanik
2

  1. Students’ Scientific Group at Department of Radiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
  2. Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
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Abstract

Voice production — emission, raised interest of humans from almost the beginning of the humanity. First written information dates back to the Egyptian times 2500–3000 BC. Practically from early Greek period until XIX century studies of the larynx and the speech apparatus brought new and new facts, both regarding the structures, physiology and clinics. Such ancient researchers as Galen, Morgagni, Eustachii, Casserius created milestones for modern laryngology. Authors hoped to present some facts on the anatomical researches in the field of organs responsible for voice production from historical perspective.
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Authors and Affiliations

Andrzej Żytkowski
1
Jerzy Walocha
2

  1. Faculty of Philology, Department of Polish Dialectology and Logopedics, University of Lodz, Poland
  2. Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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Abstract

I n t r o d u c t i o n: During pregnancy, changes in the oral cavity occur due to fluctuations in hormone levels and changes in eating habits and hygiene.
O b j e c t i v e s: To evaluate pregnant women’s awareness of oral health prophylaxis. Material and Methods: An anonymous questionnaire was completed by 341 pregnant women from Malopolskie Voivodeship. The statistical analysis was carried out in the R program (v. 3.4.3); a p-value <0.05 was considered significant.
R e s u l t s: Over half of the respondents did not receive oral hygiene instruction and did not take part in any prophylactic program. The main sources of oral health knowledge were the internet (66.3%), dentist (43.1%) and gynaecologist (17.9%). Respondents willingly followed the advice of healthcare workers. Approximately 32% of the surveyed women were aware of the most appropriate period for dental treatment (second trimester). Over half of the women admitted that they would receive dental care more often if more procedures were reimbursed. Approximately 71% of the women were aware of the increased susceptibility to tooth decay during pregnancy. The relationship between the presence of caries in parents and that in children was known by 42.1% of respondents, but 45% admitted they did not know how to take care of their child’s teeth properly.
C o n c l u s i o n s: Women with a higher education level had better knowledge in the area of oral health. However, most of the respondents need to increase their knowledge in this area. Prophylactic programs should be broadly propagated, and healthcare workers should deliver essential information in daily practice.

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Authors and Affiliations

Anna Przeklasa-Bierowiec
1
Anna Jakubik
1
Katarzyna Szczeklik
1
Izabela Majewska
2
Antoni Marcinek
3
Jolanta Pytko-Polończyk
1

  1. Department of Integrated Dentistry, Institute of Dentistry, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
  2. University Dental Clinic, Kraków, Poland
  3. “NZOZ Szpital na Siemiradzkiego im. R. Czerwiakowskiego” Hospital, Kraków, Poland
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Abstract

The extremely rare localization of an intramuscular hemangioma (IMH) into the anterior scalene muscle was the motive for the present case report, aiming to highlight major, atypical characteristics. An 11-month-old boy with free medical history presented with a painless and progressively growing lesion 4.5 × 4 cm in diameter, located in the left supraclavicular region over the last 4 months. During physical examination, the presence of a painless, non-pulsating, non-adhesive to the overlying skin lesion was documented. Color Doppler flow ultrasonographic examination demonstrated the increased blood supply to the aforementioned lesion. Thus, we planned an elective surgical excision of the lesion in healthy limits. The postoperative course was uneventful, and the patient was discharged on the second postoperative day in good general condition. Histopathologic examination revealed the presence of hemangioma surrounded by connective tissue bundles and striated muscle fibers. IMHs do not follow the general rule of regression, beyond the age of 6–12 months, with no trend to increase over time. Accurate preoperative diagnosis is challenging. Color Doppler flow ultrasonographic examination is the imaging modality of choice during the preoperative assessment. Surgical excision of the IMH in healthy limits is the most appropriate treatment option.
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Authors and Affiliations

Ioannis Patoulias
1
Ioanna Gkalonaki
1
Magdalini Mitroudi
1
Thomas Feidantsis
1
Constantine Theocharidis
2
Dimitrios Patoulias
3

  1. First Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital “G. Gennimatas”, Greece
  2. Department of Pathology, General Hospital “G. Gennimatas”, Thessaloniki, Greece
  3. Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital “Hippokration”, Greece

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