Quality of life in children with cochlear implants and their families (Program Schwarzenberg)--initial report

The aim of the study was to present the results of international evaluation program "Quality of Life in children and their families--Schwarzenberg Initiative". The parents of children under 15 years old was asked to fill out specially prepared questionnaires. 1240 children from 9 countries participated in the study. In Poland 60 families filled out the questionnaires. 80 questions concerned several topics, including reaction of parents to the first information about impaired hearing of their child, using hearing aids before and after implantation, evaluation of behaviour in kindergarten and in school. This initial report describes only a few important topics. In 27.7% of Polish families the impaired hearing of their child was a cause to stop the work of one of the parents, to decrease time of work or to change the place of work in 9.1%. In most of the children the perception of sound was noticed. Only a few families from Austria, Slovenia, Swiss and Italy reported unsatisfactory results after implantation. Implantation increases quality of life of implanted children and their families.     

Clinical presentation and pharmacological therapy in patients with cardiogenic pulmonary oedema

BACKGROUND: Cardiogenic pulmonary oedema is a typical clinical presentation of acute heart failure and is associated with a poor outcome. Therapeutic strategies in patients with this condition have not yet been uniformly developed and are based on expert consensus rather than results of randomised studies. The underlying aetiology seems to be one of the most important factors influencing therapy. AIM: To evaluate treatment of patients with acute cardiogenic pulmonary oedema. METHODS: The analysed group consisted of 276 consecutive patients who were treated due to acute cardiogenic pulmonary oedema in two cardiac centres in the city of ?ód? between 1998 and 2000. Clinical characteristics, aetiology and therapy were retrospectively analysed based on medical records. RESULTS: Fifty nine (21%) patients died in hospital whereas the remaining 218 subjects were discharged. Etiologic Results. Fifty nine (21%) patients died in hospital whereas the remaining 218 subjects were discharged. Etiologic factors included a marked elevation of blood pressure (BP) (29%), acute myocardial infarction (MI) (25%), unstable angina (16%), decompensation of valvular disorder (9%), respiratory tract infection (8%) and paroxysmal atrial fibrillation (4%). The highest in-hospital mortality (35%) was associated with acute MI, and the lowest (6%) - with BP elevation. The most frequently used agents during in-hospital stay were diuretics (89%), followed by antibiotics (84%) and acetylsalicylic acid (81%). Compared with survivors, patients who died during hospital stay were significantly more frequently treated with catecholamines (59% vs 7%, p<0.00001), corticosteroids (71% vs 15%, p<0.00001) and morphine (62% vs 41%, p<0.0015) whereas angiotensin converting enzyme inhibitors, intravenous nitroglycerine, beta-blockers and acetylsalicylic acid were less frequently used in deceased patients (34% vs 89%, p<0.00001; 52% vs 78%, p<0.00001; 14% vs 37%, p<0.001; and 64% vs 86%, p<0.0003, respectively). CONCLUSIONS: In spite of intensive pharmacotherapy, cardiogenic pulmonary oedema is still associated with a high in-hospital mortality. Therapy should be tailored according to aetiology. Differences in pharmacological treatment between survivors and deceased patients depict better prognosis in those who have on admission normal or elevated blood pressure which enables an early administration of vasodilators and beta-blockers.     

The case of a patient with treatment-refractory obsessive-compulsive disorder operated by stereotactic bilateral cingulotomy

This case report presents the first patient in Poland with treatment-refractory obsessive-compulsive disorder, operated by stereotactic bilateral cingulotomy. The patient, aged 38 years, with 20-year duration of illness, despite intensive pharmacological and psychotherapeutic treatment was totally unable to function due to obsessive-compulsive symptoms of extreme intensity. The paper presents the neuroimaging documentation of psychosurgery performed on 3rd December 2002. On the basis of nearly two-year follow-up of the patient, the result of the psychosurgery can be assessed as moderately favorable. The patient's subjective mood and social functioning have improved, as well as his cognitive functions measured by means of neuropsychological tests. In patients with severe, chronic and treatment-refractory obsessive-compulsive disorder psychosurgical treatment may be a therapeutic option.     

Polyoxyethylenated methyl esters of rape oil fatty acids as non-ionic surfactants in a model drug form with albendazole

Systematic research has been conducted on the applying of Rofams (oxyethylathed rape oil methyl esters) as solubilizing agents of albendazole. Homologous series of Rofams containing average amount of oxyethylene units (nTE) ranging between 20 to 60 was used for investigation. An attempt has been made to apply investigated surface active agents as an auxiliary in production of model tablets with albendazole. Basic morphological parameters of granulates (bulk density, tapped density, Carr index, angle of repose) were determined. The dissolution testing procedure, friability and standard deviation from an average tablet mass were conducted to evaluate properties of produced tablets. The solubility of albendazole increases in the presence of Rofams in the aqueous solutions. The highest amount of albendazole was solubilized in the aqueous solution of Rofam containing 20 oxyethylene units. The increase in the content of oxyethylene units in a molecule of surfactant leads to a subsequent decrease in the amount of solubilized albendazole. Studied compounds can be applied in suggested quantities in the formulation of solid dosage forms. Tablets obtained with their content obeyed standards of Polish Pharmacopoeia. Rofams are increasing the amount of albendazole liberated from the tablets what can result in increasing it's bioavailability.     

Cognitive and affective disturbances in children after surgical treatment of cerebellar tumors

BACKGROUND AND PURPOSE: The cerebellum has been associated with motor control, but more recent studies have extended its contribution to other functions, such as modulation of emotions, behavioral organization or language. The cerebellar cognitive affective syndrome was described primarily in adults. In children, cerebellar lesions are relatively frequent and some are due to neoplasm. MATERIAL AND METHODS: Cognitive and emotional functions were studied in 66 children who underwent surgery for cerebellar pilocytic astrocytoma at the Department of Neurosurgery of the Children Memorial Health Institute. 36 children were psychologically examined and parents of 66 children filled in a questionnaire, answering questions about children's linguistic functioning, emotion regulation and ability to initiate, organize and efficiently realize various activities. RESULTS: The disturbances in the initiation and realization of activities were reported most often (77%). Problems in emotional regulation were noticed in 65% of children and were characterized by disinhibition, impulsivity and irritability. Language difficulties were observed in 42%. No significant differences between groups of children with different localization of tumor (vermis or cerebellar hemisphere) were observed. CONCLUSIONS: The present study confirms the psychological deficits following cerebellar lesion in children, similar to the cerebellar cognitive affective syndrome reported in adult patients.     

Microvesicles derived from activated platelets induce metastasis and angiogenesis in lung cancer

The role of platelets in tumor progression and metastasis has been recognized but the mechanism of their action remains unclear. Five human lung cancer cell lines (A549, CRL 2066, CRL 2062, HTB 183, HTB 177) and a murine Lewis lung carcinoma (LCC) cell line (for an in vivo model of metastasis) were used to investigate how platelet-derived microvesicles (PMV), which are circular fragments shed from the surface membranes of activated platelets, and exosomes released from platelet alpha-granules, could contribute to metastatic spread. We found that PMV transferred the platelet-derived integrin CD41 to most of the lung cancer cell lines tested and stimulated the phosphorylation of mitogen-activated protein kinase p42/44 and serine/threonine kinase as well as the expression of membrane type 1-matrix metalloproteinase (MT1-MMP). PMV chemoattracted 4 of the 5 cell lines, with the highly metastatic A549 cells exhibiting the strongest response. In A549 cells, PMV were shown to stimulate proliferation, upregulate cyclin D2 expression and increase trans-Matrigel chemoinvasion. Furthermore, in these cells, PMV stimulated mRNA expression for angiogenic factors such as MMP-9, vascular endothelial growth factor, interleukin-8 and hepatocyte growth factor, as well as adhesion to fibrinogen and human umbilical vein endothelial cells. Intravenous injection of murine PMV-covered LLC cells into syngeneic mice resulted in significantly more metastatic foci in their lungs and LLC cells in bone marrow than in control animals injected with LCC cells not covered with PMV. Based on these findings, we suggest that PMV play an important role in tumor progression/metastasis and angiogenesis in lung cancer.