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Spectacular effect of [177Lu]Lu-PSMA-617 therapy in a patient with hormone-resistant prostate cancer after failure of other therapeutic options
No full textThis research presents the case of a 72-year-old patient with a long history of high-grade prostate cancer (Gleason 8), previously treated with radiotherapy, hormone therapy, and chemotherapy. Due to persistent disease progression and widespread metastases, the patient was enrolled in [177Lu]Lu-PSMA-617 therapy under the Rescue Drug Therapy Access (RDTL) program. Six therapeutic cycles were administered, resulting in marked clinical improvement and a decline in prostate-specific antigen (PSA) levels from 1128.00 ng/mL to 1.68 ng/mL. Positron emission tomography/computed tomography (PET/CT) imaging using [68Ga] Ga-PSMA-11 demonstrated a favorable treatment response, with no significant adverse effects. This case highlights the potential of a theranostic approach in oncology
Utility of elastography of thyroid nodules and effectiveness of their treatment using laser thermal ablation — preliminary results of the first observation of the Polish population
No full textIntroduction: Thyroid nodules comprise the most prevalent endocrinological condition in the general population. Their treatment is usually invasive and includes surgery or radioiodine; nevertheless, minimally invasive method like laser thermal ablation (LTA) are becoming a more widely available alternative.
Material and methods: This prospective study aimed to determine whether there is a correlation between shear wave elastography parameters (SWE) and the effect of LTA. The study included 42 patients with thyroid nodules measuring at least 25 mm in one dimension. Each patient underwent a thermal ablation procedure, preceded by a detailed ultrasound examination in which SWE parameters were measured.
Results: In short-term observation (3 months) the mean volume reduction rate (VRR) was 35.1%. After LTA, the nodule volume and its stiffness significantly changed (p < 0.001 and p < 0.001, respectively). There were no differences in VRR depending on the type of the lesion (p = 0.827), vascularity (p = 0.921), gender (p = 0.665), or age (p = 0.230). None of the aforementioned parameters showed a significant correlation with VRR (p = 0.803, R = 0.21). No significant adverse events were observed.
Conclusions: LTA caused a significant decrease in thyroid nodule volume in short-term observation. The procedure was safe and relatively painless. Significant changes in ultrasonographic parameters were observed. In this first short-term observation of the Polish population, initial nodule characteristics, vascularity, gender, and age did not correlate with LTA effectiveness. Long-term observation is necessary to determine the utility of SWE in LTA qualification and treatment planning
Impact of glycated hemoglobin (HbA1c) on outcomes in differentiated thyroid cancer with type 2 diabetes mellitus
No full textIntroduction: Type 2 diabetes mellitus (T2DM) is a frequent comorbidity in differentiated thyroid cancer (DTC). This study evaluated the impact of glycemic control, particularly glycated hemoglobin (HbA1c) levels, on tumor characteristics and treatment outcomes.
Material and methods: We retrospectively analyzed 302 DTC patients, including 58 (19.2%) with T2DM. Baseline demographic, clinical, and pathological data were collected. Treatment response was assessed as per American Thyroid Association (ATA) guidelines. Logistic regression identified predictors of non-excellent response, and a subgroup analysis was performed among diabetic patients stratified by HbA1c (< 7% vs. ≥ 7%).
Results: T2DM patients were older (p < 0.001), with more bilateral tumors (p = 0.047) and higher tumor foci (p = 0.039). Other tumor features were similar between groups. In multivariate analysis, both HbA1c [odds ratio (OR): 1.307, 95% confidence interval (CI): 1.014–1.683, p = 0.038) and lymph node metastasis (OR: 3.932, 95% CI: 1.000–15.464, p = 0.050] independently predicted non-excellent response. Among diabetics, HbA1c ≥ 7% was associated with higher non-excellent response rates (p = 0.030).
Conclusion: Poor glycemic control, rather than T2DM itself, was linked to suboptimal treatment response. HbA1c may serve as a simple prognostic marker in diabetic patients with DTC
Insulinoma in pregnancy: is diet alone enough to treat insulinoma?
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Long-term recombinant human growth hormone therapy in Dent’s disease type 1
No full textNot required for Clinical Vignette
Stroke through the eyes of a cardiologist
No full textUdar mózgu, według definicji WHO, to zespół objawów charakteryzujący się nagłym, ogniskowym, a czasem również uogólnionym zaburzeniem czynności mózgu, którego objawy utrzymują się dłużej niż 24 godziny, spowodowany wy- łącznie przyczynami naczyniowymi, związanymi z mózgowym przepływem krwi. Udar można również rozpoznać, kiedy objawy trwają krócej niż 24 godziny, ale w badaniach neuroobrazowych udokumentowano jednoznacznie ognisko niedokrwienne, a także w przypadku ustąpienia dolegliwości wskutek skutecznego leczenia przyczynowego. Stanowi trzecią pod względem częstości przyczynę zgonów w krajach wysoko rozwiniętych (po chorobach serca i nowotworach) i główną przyczynę niesprawności u osób dorosłych oraz drugą co do częstości przyczynę zespołów otępiennych. W praktyce klinicznej, w większości przypadków, możliwe jest określenie jedynie prawdopodobnej przyczyny zachorowania. Pomimo zastosowania powszechnie dostępnej diagnostyki, u około 25–30% pacjentów z udarem niedokrwiennym mózgu, jego przyczyna pozostaje nieznana. Kluczową rolę w diagnostyce udaru kardiogennego lub udaru kryptogennego odgrywa badanie echokardiograficzne: przezklatkowe i przezprzełykowe. Wczesne jego rozpoznanie i odpowiednie leczenie są niezbędne, aby nie dopuścić do nawrotu incydentu niedokrwiennego, który na ogół związany jest niepomyślnym rokowaniem.According to the WHO definition, a stroke is a set of symptoms characterized by a sudden, focal damage, and sometimes also generalized brain dysfunction, the symptoms of which persist for more than 24 hours, solely due to causes associated with cerebral blood flow. Stroke can also be recognized when symptoms last less than 24 hours, but in neuroimaging studies an ischemic focus was clearly documented, and in the case of disappearance of the ailments as a result of effective causal treatment. It is the third most common cause of death in highly developed countries (after heart disease and cancer), the main cause of disability in adults, and the second most common cause of dementia syndromes. In clinical practice, in most cases, it is only possible to determine the probable cause of the disease. De- spite the use of commonly available diagnostics, in approximately 25–30% of patients the cause of ischemic stroke remains unknown. A key role in the diagnosis of cardiogenic stroke or cryptogenic stroke is played by echocardiographic examination: transthoracic and transesophageal. Early diagnosis and appropriate treatment are necessary to prevent the recurrence of an ischemic event, which is usually associated with an unfavorable prognosis
An unusual presentation of a case with an acquired storage pool disorder
No full textIntroduction: Acquired storage pool disorder (SPD), is a rare platelet function disorder characterized by abnormal or deficient granules in platelets, leading to impaired clot formation and prolonged bleeding.
Case report: This is the case of a previously healthy 15-year-old girl presenting with unusual bleeding from the nose, eyes, and fingernails, with no family history of bleeding disorder or recent medication use. Initial investigations showed normal hemoglobin, platelet count, and coagulation profile, but bleeding time was at the upper limit of normal. Von Willebrand factor (vWF) deficiency was excluded based on laboratory results. Platelet function testing revealed normal aggregation with ristocetin reduced secondary aggregation with collagen and arachidonic acid, and reduced primary and secondary aggregation with adenosine diphosphate and arachidonic acid, consistent with SPD. Further investigation, including positive antinuclear antibody (ANA) tests, suggested an autoimmune etiology. The patient was treated with steroids, which were gradually tapered over two months. During this period, her bleeding symptoms improved, and follow-up platelet aggregation studies returned to normal, confirming a transient acquired SPD. Despite the autoimmune association, no definitive primary diagnosis was made.
Conclusions: This case highlights the importance of considering acquired SPD in patients with unexplained mucocutaneous bleeding and the potential role of autoimmune mechanisms. The successful use of steroid therapy in this case underscores its relevance in managing autoimmune-related platelet disorder
ChatGPT-3,5 and ChatGPT-4o performance in Specialty Certificate Examination in Diabetology: a comparative study.
No full textObjective: ChatGPT is an AI-powered chatbot that nowadays is becoming a valuable tool in various medical fields. In this study, we compare the effectiveness of ChatGPT-3.5 and ChatGPT-4o in completing the Specialty Certificate Examination in Diabetology.
Materials and methods: A study was conducted by instructing chatbots to complete 3 exams: Autumn 2023, Spring 2023 and Autumn 2024. The questions were divided into 3 difficulty levels, according to the difficulty index. A statistical analysis was carried out.
Results: ChatGPT-3.5 answered correctly 218 out of 359 questions of all exams (60.7%), whereas ChatGPT-4o answered correctly 197 questions (54.8%). Both chatbots performed better in questions assigned as hard (70.7% for ChatGPT-3,5 and 62.5% for ChatGPT-4o) than moderate (52,1% in both chatbots) and easy ones (25.8% and 12.9%, respectively).
Conclusions: There is no statistical significance in differences between ChatGPT-3.5 and ChatGPT-4o in solving the Specialty Certificate Examination in Diabetology. However, ChatGPT-3.5 scored subtly better. Humans perform better at solving exams than chatbots