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Depression is a common psychiatric disorder, characterized by a persistent lowering of mood, loss of interest in routine activities and diminished ability to experience pleasure. There are several depression classification systems and diagnostic tools based on clinical symptoms, i.e. the International Classification of Diseases (ICD-10), the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the Hamilton Depression Rating Scale, the Montgomery-Asberg Scale and Beck's Depression Inventory. Depression frequently occurs in patients with heart failure, as similar pathophysiological mechanisms of neurohormonal activation, arrhythmia, inflammation and hypercoagulation are present in both these diseases. Prognosis in patients with depression is also affected by insufficient cooperation between a patient and his doctor as regards the lifestyle and medication intake of a patient. Depression is usually accompanied by remission and relapse periods which might be related to the current heart failure status of a patient and despite intensive medical treatment they may recur. Depression is often difficult to diagnose or even left undiagnosed and thus untreated, because its symptoms: fatigue, apathy and decreased exercise tolerance, are common in the general population. Furthermore, safety and efficacy of antidepressant therapy in patients with cardiovascular diseases are not well established. Evidence from clinical trials evaluating the influence of depression behavioral and pharmacological treatment on morbidity and mortality in patients with heart failure is also limited. Taking into account that depression affects prognosis in patients with variety of disorders and common pathological mechanisms present both in depression and heart failure, screening tests for depression should be considered not only in patients with diagnosed heart failure but also those at risk of heart failure development.
Pol Arch Med Wewn
PMID:Is depression a problem in patients with chronic heart failure? 1840 73

A hiccup is involuntary, paroxysmal inspiratory movements of the chest wall associated with diaphragm and accessory respiratory muscle contractions, with the synchronized closure of glottis. The mechanism underlying this common primitive reflex plays an important role in protecting airways against esophageal aspiration. The hiccup reflex mechanism is based on the afferent pathway (vagus and phrenic nerve and sympathetic fibers innervating chest organs, the abdomen, the ear, the nose and the throat stimulation, and the stimulation of hiccup center in the central nervous system, mainly reflecting psychogenic or metabolic disorders) and the efferent pathway (phrenic nerves). An incidental hiccup is a common problem, usually resolves spontaneously and does not present a clinical issue. The clinical issue arises in the case of pathologic persistent hiccups or symptomatic secondary hiccups which may lead to significant fatigue, insomnia or depression. Generally, pathologic hiccups are associated with considerable discomfort concerning both the "stigmatized" person and his or her personal surroundings in which it evokes different emotions, from amusement through impatience to uneasiness and the suggestion of a medical visit as an expression of concern for a given person. The most common causes of pathologic symptomatic hiccups are nervous system diseases, either the central nervous system (proliferative, angiogenic, inflammatory disorders), or the peripheral nervous system: the irritation of the phrenic nerve (proliferative disorders, goitre) and the vagus nerve (otolaryngologic diseases, meningitis, esophageal, stomach and duodenal diseases, hepatitis, pancreatitis, enteritis). The vagus nerve irritation with subsequent hiccups may be caused by chest disorders (injury, surgery) and heart diseases (myocardial infarction). In the present paper we describe the case of a 62-year-old male with recurrent hiccups associated with exertion as a secondary symptom of myocardial ischemia.
Pol Arch Med Wewn 2008 Mar
PMID:Hiccups as a myocardial ischemia symptom. 1847 62

Non-alcoholic fatty liver disease (NAFLD) covers a wide spectrum of liver pathology--from steatosis alone, through the necroinflammatory disorder of non-alcoholic steatohepatitis (NASH) to cirrhosis and liver cancer. NAFLD/NASH is mostly related with visceral adiposity, obesity, type 2 diabetes melitus (DM t.2) and metabolic syndrome. Pathogenetic concepts of NAFLD include overnutrition and underactivity, insulin resistance (IR) and genetic factor. The prevalence of NAFLD has been estimated to be 17-33% in some countries, NASH may be present in about 1/3 of such cases, while 20-25% of NASH cases could progress to cirrhosis. NAFLD is now recognized as one of the most frequent reason of liver tests elevation without clinical symptoms. Insulin resistance is considering as having a central role in NAFLD pathogenesis. In hepatocytes, IR is related to hyperglycaemia and hyperinsulinaemia, formation of advanced glycation end-products, increased free fatty acids and their metabolites, oxidative stress and altered profiles of adipocytokines. Early stages of fatty liver are clinically silent and include elevation of ALT and GGTP, hyperechogenic liver in USG and/or hepatomegaly. Among clinical symptoms, abdominal discomfort is relatively common as well as chronic fatigue. NAFLD/NASH is not a benign disease, progressive liver biopsy have shown histological progression of fibrosis in 32%, the estimated rate of cirrhosis development is 20% and a liver--related death is 12% over 10 years. No treatment has scientifically proved to ameliorate NAFLD or to avoid its progression. The various therapeutic alternatives are aimed at interfering with the risk factors involved in the pathogenesis of the disorder in order to prevent the progression to end-stage liver disease. The most important therapeutic measure is increasing insulin sensitivity by an attempt to change a lifestyle mostly by dieting and physical activity in order to loose weight. The most used agent is metformin, the others are under controlled trials or their effectiveness is low. NASH is not a common indication for liver transplantation because of the older age distribution of patients and high prevalence of comorbidity, related to metabolic syndrome. Recurence of NASH in the grafted liver is also a relatively frequent complication.
Pol Merkur Lekarski 2008 Jun
PMID:[Non-alcoholic fatty liver disease--new view]. 1870 46

The idiopathic interstitial pneumonias are a heterogeneous group of diseases that have similar clinical symptoms. The new classification is based mainly on differences in histologic patterns, however high-resolution computed tomography is a significant tool that helps in making a firm diagnosis. Desquamative interstitial pneumonia is relatively rare form idiopathic interstitial pneumonia. It affects mainly men in their fourth or fifth decade of life who have a history of smoking. We report a case of 50-years-old man admitted to hospital for further diagnosis of prolonged bilateral pneumonia. His main complaints were fatigue, productive cough and subfebrile body temperature. Having performed additional diagnostic procedures including videothoracoscopy, what was in accordance with contemporary guidelines, we achieved a final diagnosis of desquamative interstitial pneumonia. Treatment with systemic corticosteroids resulted in disease remission.
Pneumonol Alergol Pol 2008
PMID:[A patient with desquamative interstitial pneumonia as a rare case of idiopathic interstitial pneumonia]. 1884 35

Hepatitis C is caused by the hepatitis C virus (HCV) infection. According to World Health Organization data, 3% of the world population (approximately 170 million people) is infected with HCV; in Poland there are over 700,000. Over 70% of those infected manifest no symptoms in the acute phase of the disease, and in about 70-80% the acute phase progresses into a chronic form. Patients with symptoms in the acute phase of HCV infection most commonly present with unspecific signs and symptoms that may develop in other viral liver infections, e.g. malaise, fatigue, abdominal pain, mild hepato- and splenomegaly and arthralgia. These symptoms usually persist for 2 to 12 weeks. In the chronic phase a subset of patients complain of malaise, nausea, abdominal pain and itching. With time, chronic hepatitis C may develop into liver cirrhosis. The basic diagnostic methods in HCV infection involve determination of anti-HCV antibodies using the ELISA immunoassay and examination of HCV-RNA with the RT-PCR method. The current treatment of HCV infection involves administration of pegylated interferon a and ribavirin over a period of 48 weeks in HCV-1 genotype infection, and 24 weeks for HCV-2 and 3 genotypes. Effectiveness of therapy depends on the HCV genotype. HCV elimination can be achieved in 78% of patients with HCV-2 and 3 genotypes, and in 55% of patients with HCV-1 genotype.
Pol Arch Med Wewn 2008 Dec
PMID:Viral hepatitis C. 1920 52

Fatigue is one of the most common symptoms of multiple sclerosis (MS) and is associated with reduced quality of life. The fatigue syndrome is characterized by uncontrollable apathy, exhaustion, fatigability and lack of energy. The mechanisms underlying fatigue in MS are still poorly understood but studies suggest that immune and neuroendocrine factors may play a causative role in the development of fatigue. The first step in management of MS-related fatigue is identifying and eliminating any secondary causes (adverse effects of drugs, infections, sleep disorders, metabolic diseases). As the fatigue syndrome in patients with MS cannot be evaluated objectively in the routine clinical setting, a number of scales have been developed. The Fatigue Severity Scale is a general scale. Additional scales that have been tested in MS include the Fatigue Impact Scale. Therapy of fatigue syndrome consists of modafinil, amantadine, pemoline and non-pharmacological management.
Neurol Neurochir Pol
PMID:[Fatigue in multiple sclerosis]. 1935 46

Lyme disease is a chronic tick borne disease, caused by spirochetes B. burgdorferi. The condition influences mostly on skin, nervous system, skeletal system and circulatory system. Recently more and more reports of so called "Post Lyme syndrome (PLS)" have appeared. PLS is a new clinical, diagnostic and therapeutic problem connected with patients with a history of Lyme disease (with proper antibiotic treatment). The symptoms of Post Lyme Syndrome may be present throughout months or even years. These are: fatigue, widespread musculoskeletal pain, dysmnesia, concentration difficulties. Pathogenesis of PLS is unknown. It is suspected that main factors responsible for PLS are: slow regression of infection, its turning into chronic process and permanent destruction of tissues or induction of immunological response against B. burgdorferi. Diagnostic of PLS is difficult. Mostly results of serological examination are negative. In some cases antibodies titer is positive as a sign of past disease. So far there is no causative treatment of PLS. Antidepressants, painkillers and anti-inflammatory medicines are recommended.
Pol Merkur Lekarski 2009 Mar
PMID:[Post Lyme syndrome as a clinical problem]. 1938 38

Polymyalgia rheumatica is a rheumatic disease which mainly affects the elderly, and is seldom diagnosed in patients <50 years of age. The prevalence of polymyalgia rheumatica is approximately 16.8 to 53.7 per 100,000 of the population >50 years of age. Patients may present with spiking fever, malaise, fatigue, weight loss and other features suggesting inflammation, which in each case requires differential diagnosis from malignancies. Neoplastic disease in turn can manifest itself in symptoms resembling those of polymyalgia, which are named "polymyalgia-like syndrome" and are in fact paraneoplastic syndromes presenting as polymyalgia rheumatica. These observations suggest that a careful clinical evaluation and a long term follow-up are necessary for a correct diagnosis of polymyalgia rheumatica.
Pol Arch Med Wewn 2008
PMID:[Polymyalgia rheumatica mimicking neoplastic disease--significant problem in elderly patients]. 1956 70

Rhabdomyoma is a rare tumor in the posterior mediastinum. We present a case of adult rhabdomyoma that occurred multifocally in the head, neck and mediastinum. There have been as few as four previous reports on rhabdomyoma in the posterior mediastinum. An 80-year-old white man was admitted to the Division of Pulmonary Diseases because of dyspnea, hemoptysis and fatigue. Physical examination revealed a tumor in the left submandibular area. Computed tomography (CT) of the head and neck showed a mass which caused a marked prominence of the left posterolateral wall of the pharynx. Chest CT revealed a contrast-enhancing tumor. The mass was 20 x 19 x 55 mm in size and was in contact with the lateral wall of the esophagus. Histological examination showed that the tumor was composed of cells typical of adult rhabdomyoma. The patient has been followed in our outpatient clinic for more than the last 7 years. To our knowledge, this is the fifth case of adult mediastinal rhabdomyoma. We believe that rhabdomyoma is a rare tumor which should be considered in a differential diagnosis of tumors detected in the posterior mediastinum.
Pol Arch Med Wewn 2009 Sep
PMID:Rhabdomyoma as a tumor of the posterior mediastinum. 1977 7

Relapsing polychondritis (RP) is a rare connective tissue disease which affects cartilaginous tissues of the nose, earlobes, respiratory tract, and joints, as well as proteoglycan-rich tissues including the media of the arteries, the conjunctiva and sclera of the eye. The disease is most common in patients aged 40-60 years. It may for a long time cause unspecific signs (fever, malaise), which may cause a significant delay in establishing the diagnosis and initiating the ppropriate treatment. The mean time from symptom onset to diagnosis is 2.9 years. Steroids are the mainstay of therapy, but methotrexate and dapsone may also be beneficial in some patients. A case of RP presenting with fever, anemia, fatigue, arthritis, conjunctivitis, and auricular deformation is described. There were signs and symptoms suggestive of an infectious disease but no infection had been found, and despite tentative administration of antibiotics, the patient's condition steadily deteriorated. Eventually, the diagnosis was established based on McAdam's criteria. After intiating steroid therapy, the patient's condition improved significantly. We discuss the diagnostic criteria and treatment of this rare disease.
Pol Arch Med Wewn 2009 Oct
PMID:Relapsing polychondritis: case report and literature review. 1984 47


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