IntroductionLifestyle-associated factors like physical activity (PA) play an important role in cancer prevention and oncology treatment outcomes. The aim of the study is to investigate the level of kinesiophobia (fear of movement) in breast cancer (BC) patients undergoing surgical treatment depending on socio-demographic variables, lifestyle before cancer diagnosis, stage and type of BC and comorbidities.MethodsWe interviewed 285 women (132 patients from Greater Poland Cancer Center – age: 55.7 ± 12.4; BMI: 26.7 ± 4.7 and 153 healthy women from control group – age: 49.0 ± 15.7; BMI: 25.7 ± 4.0) using Polish adaptation of the Tampa Scale of Kinesiophobia (TSK).ResultsResearch results show that women with BC suffer from kinesiophobia (>37 points) signi!cantly. Approximately 3/4 of the surveyed women with BC did not know the World Health Organization (WHO) recommendations regarding the weekly dose of PA for healthy people and for people with cancer. Before cancer diagnosis more than a half of women (60%) performed PA in accordance with WHO recommendations. 7% less women performed PA during oncology treatment. Almost a half of patients are not physically active during cancer treatment and 1/5 of the respondents declared that they do not know yet if they will be physically active after oncology treatment. The level of kinesiophobia in BC women with comorbidities was the same as in the group of BC women without comorbidities. However, the highest levels of fear of movement have been observed among women with BC suffering also from osteoporosis, obesity and diabetes. In general, higher levels of kinesiophobia were reported among women in less advanced stages of the disease. There were no differences in the level of kinesiophobia depending on the type of BC (hormonally dependent luminal cancers vs. other types). The level of kinesiophobia did not differ between women who were physically active before BC diagnosis and women who were not. In terms of socio- demographic variables, we found one direct association between the level of kinesiophobia (pain) with age – the greater age, the higher level of pain kinesiophobia.DiscussionResearch on fear of movement in female oncology requires further research (including also chemotherapy, radiotherapy, immunotherapy and hormonal therapy) and in order to effectively eliminate hypokinetic attitudes at every stage of cancer treatment.

The aim of this study was to create a Polish adaptation of the Tampa Scale of Kinesiophobia considering fatigue, and to verify the usefulness of the scale in the context of pain in cancer patients. The study was conducted at the Breast Cancer Unit, operating at the Greater Poland Cancer Centre, and at the Poznan Centre for Specialist Medical Services in Poznan. After considering the exclusion criteria, 100 people qualified for the interviews for the final study: 50 breast cancer patients and 50 healthy respondents (without cancer). Statistical analysis of the CFA score showed that the chi-square test was not significant (χ2 = 10.243, p = 0.332), indicating an acceptable fit of items across scales. The reliability of the internal consistency of the scales was tested by examining the Cronbach’s alpha scores for each question/statement. The mean values for this indicator were 0.74 for the pain-related scale and 0.84 for the fatigue-related scale. Construct validity was confirmed for the scales; AVE for the pain-related scale was 0.64 and for the fatigue-related scale was 0.68. The results suggest the validity of examining kinesiophobia in the context of pain- and fatigue-related mobility anxiety among breast cancer patients in Poland, and that the Tampa Scale of Kinesiophobia can be adapted for different dimensions of the condition. Both versions of the scale demonstrated adequately prepared parametric constructs, and all correlations showed a statistically significant relationship (p < 0.05). The use of the Tampa Scale of Kinesiophobia in oncology patient studies in Poland may ultimately improve rehabilitation programs and enable the development of strategies to assist patients in supporting treatment to reduce movement anxiety.

Invasive oncological procedures affect the remaining tumor cells by increasing their survival, proliferation, and migration through the induction of wound healing response. The phenomena of local relapse after breast-conserving surgery (BCS) has resulted in a series of research and clinical trials with the aim of assessing whether localized intraoperative radiotherapy (IORT), may be beneficial in inhibiting local recurrences. Therefore, it is essential to assess the impact of intraoperative radiotherapy in modulating the immunological response and wound healing process. Thus, we decided to perform a quantitative analysis of the composition of surgical wound fluids (SWF) in two groups of breast cancer (BC) patients: those treated with BCS followed by IORT, and those who underwent BCS alone. We found that several cytokines, which are believed to have anti-tumor properties, were highly expressed in the luminal A breast cancer subtype in the IORT treatment group. Interestingly, we also found significant differences between IORT patients with tumors of different molecular subtypes. Based on these findings, we hypothesized that IORT treatment might be beneficial in changing the tumor bed microenvironment, making it less favorable for tumor recurrence due to decreased concentration of tumor-facilitating cytokines, especially in the luminal A subtype of BC.

AIM:The aim of this study was to evaluate the method and present one center's experience in applying the SNOLL technique to patients with non-palpable suspicious breast lesions.MATERIALS AND METHODS:371 patients with suspected malignant lesions or diagnosed non-palpable breast cancer were subjected to a preoperative SNOLL procedure. The day before the surgery, they were administered two radiotracers to localize the tumor in the breast and the sentinel node. The following day, with the help of a handheld gamma probe the breast conserving surgery was performed.RESULTS:All 371 patients (100%) had their suspected occult breast lesions resected. Histo-pathological examination revealed cancer in 339 patients all these patients had their sentinel nodes examined. The intraoperative tests showed the sentinel node to be metastatic in 35 patients, who were then given a simultaneous axillary lymphadenectomy. Another 7 patients were diagnosed with positive lymph nodes in the final pathology and had to undergo a second operation. Reoperations compelled by positive surgical margins were performed in 26 cases.CONCLUSIONS:SNOLL as a good technique of intraoperative localization, enables to remove a nonpalpable breast cancer together with sentinel lymph node in a single surgical procedure. It seems to be a optional method to be used in patients treated with breast conserving therapy.

Clinical data are dynamic in nature, often arranged hierarchically and stored as free text and numbers. Effective management of clinical data and the transformation of the data into structured format for data analysis are therefore challenging issues in electronic health records development. Despite the popularity of relational databases, the scalability of the NoSQL database model and the document-centric data structure of XML databases appear to be promising features for effective clinical data management. In this paper, three database approaches – NoSQL, XML-enabled and native XML – are investigated to evaluate their suitability for structured clinical data. The database query performance is reported, together with our experience in the databases development. The results show that NoSQL database is the best choice for query speed, whereas XML databases are advantageous in terms of scalability, flexibility and extensibility, which are essential to cope with the characteristics of clinical data. While NoSQL and XML technologies are relatively new compared to the conventional relational database, both of them demonstrate potential to become a key database technology for clinical data management as the technology further advances.

Myositis ossificans (MO) may be included in the group of lesions described as pseudosarcomas. Its clinical and histological picture frequently mimics a malignant neoplasm and therefore, ultimate diagnosis and implementation of adequate treatment requires the cooperation of interdisciplinary team of physicians. The paper presents the case of 20-year old female patient suffering from severe pain in the right thigh. The patient was initially diagnosed with the lower limb overload. Rest and administration of non-steroidal anti-inflammatory drugs (NSAID) were recommended. Due to the lack of the efficacy of the recommended conservative treatment and detection of tumorous mass on ultrasound examination, the patient was referred to the cancer centre. The diagnostic procedures were extended and an open biopsy of the lesion was performed which revealed the presence of MO. The patient underwent a surgical procedure during which the pathological mass was entirely removed. Follow up examinations conducted upon the conclusion of the rehabilitation indicate no pathologies in the operated area.

Introduction: Breast cancer is still the most common cancer among women in Poland. The basic treatment is surgery of the breast. More and more attention is paid to quality of life of these patients. Every year the number of patients interested in breast conserving treatment and in breast reconstructive surgery increases. Surgery also has much more to offer in this issue of reconstruction. We are able to offer a wide range of different surgical procedures, including breast implants and autologous tissue breast reconstruction. Aim: Review of the literature on breast reconstructive surgery in patients with breast cancer, it compares surgical techniques which use implants or autologous tissues. The authors indicate the advantages and disadvantages of each surgical breast reconstruction method. Conclusion: The number of patients undergoing breast reconstructive surgery is increasing. When choosing the best option for surgery, the patient should be informed about all possibilities of breast reconstruction, advantages and disadvantages of each technique, and optimal time of reconstruction connected with cancer treatment.

Aim: Sentinel node biopsy (SNB) is an accepted alternative to lymphadenectomy in the case of invasive breast carcinoma, although the sentinel node's role in ductal carcinoma in situ (DCIS) diagnosed on core needle biopsy has not been well defined nevertheless guidelines recommend this procedure. The purpose of this study was to determine the diagnostic value of sentinel nodes in female patients with primary DCIS using core needle stereotactic biopsy.Material and methods: Between the years 2000 and 2005, 261 patients were diagnosed with DCIS by core needle biopsy. In this group, 183 patients underwent SNB to determine lymph node involvement. Those patients with metastases to the sentinel node underwent axillary lymphadenectomy.Results: In the group Of 183 patients that underwent SNB, 10 patients (5.5%) showed metastases to the sentinel lymph node. Histopathological studies of the primary lesions of these 10 patients revealed invasive ductal carcinoma in 6 cases (3.5%) and 1 case (0.5%) of invasive lobular carcinoma. Only 3 of the patients (1.5%) were given a final diagnosis of DCIS with metastases to sentinel lymph nodes, of which 2 cases were DCIS and I case was DCIS with microinvasion. Axillary lymphadenectomy performed on patients with abnormal SNB showed involvement of other axillary lymph nodes in 4 patients.Conclusions: SNB as a diagnostic tool in DCIS remains controversial as the number of cases of axillary lymph node metastases is minuscule. The biggest clinical challenge in this situation is a group of patients with primary diagnosis of DCIS in which invasive components are seen by mammotomic biopsy. (c) 2008 Elsevier Ltd. All rights reserved.

Patient with hypopharyngeal cancer are difficult to treat because they usually present with advanced disease, poor general health status and severe nutritional problems. Because of the poor prognosis, careful consideration has to be given regarding the choice of the correct surgical approach for respirato-digestive tract reconstruction. The authors present a case of recurrent hypopharyngeal cancer with cervical esophagus infiltration successfully treated with total laryngectomy and esophagectomy and gastric pull up reconstruction. Indications for technique, method of reconstruction and complications are, discussed. As most authors we consider the gastric transposition method as the preferred approach to restore digestive continuity after total esophagectomy. As the method is the single stage procedure it provides the best palliation of dysphagia and allows early resumption of an oral diet.

THE AIM: The aim of the study was to assess the quality of life in patients with a stoma, created for various reasons in the course of rectal cancer treatment.MATERIAL AND METHODS: The study included 50 patients in the early post-surgery follow-up period, visiting the Stoma Outpatient Clinic in the Great Poland Centre in Poznan. All patients underwent surgery due to rectal cancer. Quality of life was assessed using anonymous questionnaires. Participation in the study was voluntary, and patients were informed about the proceedings. Standardized EORTC QLQ-C30 questionnaire for quality of life assessment in cancer patients and QLQ-CR38 module for colorectal cancer patients were used.RESULTS: In all domains assessed, stoma patients showed significant impairment of functioning, which negatively influenced their quality of life. In our study group scores in all functional scales (physical -70.6, role -71.0, emotional -61.8, cognitive -75.6, social -65) differed significantly from the reference values for the healthy population. QLQ-CR38 questionnaire was used to assess which symptoms were most disturbing for the patients. Negative influence of stoma on sexual functioning in men (mostly erectile and ejaculation dysfunctions) turned out to be the most signifi cant (54.6). In women sexual dysfunctions were significantly less expressed (26.8). Another large group of symptoms having an unquestionable influence on level of functioning comprised direct stoma-related symptoms (47.8).CONCLUSIONS: Creation of a stoma still has a large negative impact on patients' quality of life. Influence of the stoma is most pronounced in the area of social functioning. In spite of improvement in support, the problems pertaining directly to the fact of having a stoma bag remain signifi cant for this group of patients.

Patient with hypopharyngeal cancer are difficult to treat because they usually present with advanced disease, poor general health status and severe nutritional problems. Because of the poor prognosis, careful consideration has to be given regarding the choice of the correct surgical approach for respirato-digestive tract reconstruction. The authors present a case of recurrent hypopharyngeal cancer with cervical esophagus infiltration successfully treated with total laryngectomy and esophagectomy and gastric pull up reconstruction. Indications for technique, method of reconstruction and complications are discussed. As most authors we consider the gastric transposition method as the preferred approach to restore digestive continuity after total esophagectomy. As the method is the single stage procedure it provides the best palliation of dysphagia and allows early resumption of an oral diet.

Potwierdzenie wiarygodności biopsji węzła wartowniczego (WW) w ocenie stanu regionalnych węzłów chłonnych w czerniaku skóry (CS). W okresie od stycznia 1997 do kwietnia 2003 r. ogółem wykonano 225 biopsji WW u 206 chorych w I stopniu zaawansowania klinicznego CS. W tej grupie znajdowało się 125 kobiet i 81 mężczyzn (K:M 1,54:1), w wieku 14–85 (śr. 55,2). Lokalizacja zmiany pierwotnej: kończyna dolna 88 (42,7%), tułów 75 (36,4%), kończyna górna 42 (20,4%), głowa 1 (0,5%) Stopień zaawansowania: wg Breslow'a 3,45 mm (0,3–20 mm), poziom naciekania wg Clark'a CII 6 (2,9%), C III 128 (62,1%), C IV 47 (22,8%), C V 16 (7,8%), NSKL 9 (4,4%). Wyłącznie barwnikowa (Patent Blau V -PBD) – 18. Barwnikowo-izotopowa (PBD + Nannocol znaczony Technetem 99 + limfoscyntygrafia) – 150. Wyłącznie izotopowa (Nannocol znaczony Technetem 99 + limfoscyn-tygrafia) – 38. U 206 pacjentów stwierdzono 225 spływów – 2 lokalizacje u 19 pacjentów (9,2%). Identyfikacja WW w 98,5% przypadków, w 44 przypadkach (21,4%) stwierdzono przerzut w WW i wykonano limfadenektomię przy czym w 30 przypadkach (68,2%) WW był jedynym zwierającym przerzut. Wyniki fałszywie ujemne- 3 przypadki (1,45%). 1. Biopsja WW jest metodą wiarygodną w ocenie stanu regionalnych węzłów chłonnych w CS. 2. Stwierdzenie w limfoscyntygrafii pojedynczego WW pozwala na zastosowanie wyłącznie metody izotopowej. 3. W 68,2% stwierdzano przerzuty tylko w węźle wartowniczym, co świadczy o wartości biologicznej tego badania w ocenie stopnia zaawansowania.

Celem pracy jest ocena wyników laseroterapii w paliatywnym leczeniu nowotworów przełyku, wpustu, odbytnicy i fotokoagulacji w krwawieniach błony śluzowej odbytnicy jako powikłania po radioterapii raka szyjki macicy.

Przerzuty do węzłów chłonnych (W Ch) są najistotniejszym czynnikiem prognostycznym w raku jelita grubego. Rutynowe badanie histologiczne we wczesnych przypadkach przeacza niewielkie ogniska przerzutowe w 15–20% przypadków.

Przedstawienie własnych doświadczeń w zakresie leczenia chirurgicznego guzów wątroby. Guzy przerzutowe wątroby są najczęstszą złośliwą postacią nowotworu tego narządu, a zmiany wtórne w przebiegu raka jelita grubego stanowią ich większość. U 20–30 % stwierdza się obecność przerzutu przed lub w czasie operacji (synchroniczne), a u 40 % w okresie obserwacji, po wycięciu guza pierwotnego (metachroniczne). W ostatnich dwóch dekadach zauważono wzrost zainteresowania chirurgicznym usuwaniem guzów wątroby, zarówno na świecie jak również w Polsce. W tej pracy przedstawiamy nasze doświadczenie w tym zakresie. Równocześnie podkreślamy, że leczenie chirurgiczne jest najskuteczniejszą metodą w leczeniu guzów wątroby. W okresie od stycznia 1998 do czerwca 2003r w I Oddz. Chir. WCO operowano 71 chorych z rozpoznaniem guza wątroby. U 9 chorych (12.67%) z ogniskiem pierwotnym, a u 41 chorych (59.15%) z ogniskami wtórnymi. U 21 chorych (29.57%) stwierdzono zmiany niezłośliwe spośród chorych operowanych było 43 kobiet (60,6%) i 28 mężczyzn (39.4%). Średnia wieku 54 lata. U 28 (68,3%) chorych z przerzutami do wątroby pierwotne ognisko znajdowało się w jelicie grubym. U 6 chorych z ogniskiem pierwotnym stwierdzono rak wątrobowo-komórkowy. Resekcję wątroby początkowo wykonano metodą Finger fracture; (ręczne rozdzielenie miąższu na tępo, a w ostatnich latach resekcję wykonano za pomocą aparatu Cusa. U 57 chorych operowanych (80,3%) nie obserwowaliśmy poważnych powikłań śród – i pooperacyjnych. Powikłanie w okresie pooperacyjnym po resekcji wątroby obserwowano u 14 chorych (19,7%) w tym u 3 chorych po jednoczasowej operacji guza pierwotnego jelita grubego i przerzutu do wątroby. Należały do nich niewydolność wątroby, ropień podprzeponowy, zapalenie płuc,zapalenie żył kończyń dolnych, wytrzewienie i zakażenie rany pooperacyjnej. W okresie pooperacyjnym zmarł 1 chory z powodu niewydolności wątroby i niewydolności oddechowokrążeniowej. Z obserwacji roczne przeżycie uzyskano u 80% chorych, a 2-letnie u 54 % chorych, a 3-letnie u 38 % chorych. 1. Resekcja wątroby z powodu guzów wtórnych i pierwotnych jest operację bezpieczną. 2. Monitorowanie chorych po resekcji raka jelita grubego pozwala na wczesną wykrywalność przerzutów i poprawę wyników leczenia.

Do chwili obecnej w przypadku raka piersi usunięcie układu chłonnego pachy jest obowiązkowym elementem postępowania chirurgicznego. Zajęcie węzłów chłonnych w przypadku raka piersi jest jednym z czynników rokowniczych jak i wpływa na podjęcie dalszego leczenia uzupełniającego i dlatego usunięcie pachowych węzłów chłonnych jest bardzo ważnym elementem leczenia operacyjnego raka piersi. Technika biopsji węzła wartowniczego (WW) rozwinęła się w przypadkach czerniaka złośliwego skóry i ma na celu precyzyjną ocenę stanu całego dorzecza węzłów chłonnych przy użyciu barwnika Paten Blau V, radioizotopu Tc99 ręcznej sóndy gamma kamery oraz małoinwazyjnej techniki chirurgicznej.

Cel pracy obejmuje analizę chirurgicznego leczenia raka przełyku z uwzględnieniem różnych metod leczenia resekcyjnego i leczenia paliatywnego w oparciu o materiał własny. Całkowita liczba chorych operowanych w okresie 1998–2003 wyniosła 287 pacjentów. Mężczyźni – 251, a kobiety 36 osób [M/K 6,9], wiek 37 – 79 [śr. 55,8]. U 264 chorych rozpoznano carcinoma planoepithelialae, u 6 carcinoma solidum, u 2 adenocarcinoma, u 15 brak rozpoznania mikroskopowego. Wykonano 82 resekcje [45 resekcji metodą bez otwarcia klatki piersiowej (b.o.kl.p.) i 37 resekcji metodą trzyetapową (m.t.)] i 205 zabiegów paliatywnych nieresekcyjnych [99 gastrostomii, 91 laseroterapii, 5 endoprotez Haringa, 10 zabiegów zwiadowczych]. Stopień zaawansowania w grupie resekcji bez otwarcia klatki piersiowej – st. I – 5, st. II a – 19, st. II b – 11, st. III – 10. Stopień zaawansowania w resekcji trzyetapowej – st. I – 2, st. II a – 15, st. II b –9, st. III – 11. Śmiertelność okołooperacyjna dla całej grupy 3,8%, dla poddanych resekcji 13,4%. W resekcji b.o.kl.p. −6,5%, w resekcji m.t. −22%. Wskaźnik resekcyjności – 28,5%. Radykalność resekcji: RO – 42%, R1 – 31%, R2 – 27%. Powikłania w zależności od rodzaju resekcji: resekcja b.o.kl.p. versus resekcja m.t. Odma opłucnowa 10 – 0, zapalenie płuc 7–14, nieszczelność zespolenia 8-2, porażenie n. krtaniowego 2–2, krwawienie w kl. piersiowej 0–2, krwawienie w jamie brzusznej 0–1, zwężenie w miejscu zespolenia 2–3. Przeżycia odległe [Kaplan-Meier] 36 miesięcy i więcej – 25% bez istotnej różnicy statystycznej w zależności od rodzaju metody resekcji. Pacjenci poddani laseroterapii – 91. llość wykonanych zabiegów laseroterapii – 273 [średnio 3 zabiegi]. Średnia dawka energii – 5600 J/G. Zmniejszenie stopnia dysfagii u 81% pacjentów. 41% – całkowita poprawa [pokarmy stałe]. 40% – częściowa poprawa [pokarmy papkowate]. 19% – brak poprawy [Pokarmy płynne]. Powikłanią: bez śmiertelności, przetok, perforacji i krwawienia. Przeżycia odległe po laseroterapii dłuższe niż po założeniu gastrostomii. Leczenie neoadjuwantowe zastosowano w grupie 43 pacjentów. Uzyskano odpowiedź na leczenie: regresja nowotworu – 25 [58,2%], stabilizacja nowotworu – 17 [39,5%], progresja nowotworu – 1 [2,3%]. Całkowita odpowiedź patologiczna 6 [26%] chorych. Przeżycia odległe powyżej 36 miesięcy 29.5% w grupie poddanej leczeniu neoadjuwantowemu i resekcji.