THE EFFECT OF A MULTIMODAL APPROACH ON THE RESULTS OF TREATMENT IN SURGERY: INTEGRATION OF CHEMOTHERAPY, SURGERY, AND RADIOTHERAPY

This study investigates the safety and efficacy of a multimodal approach, integrating radiotherapy, chemotherapy, and surgery for the management of cancer patients. This review systematically reviewed English-language literature from digital repositories, namely Web of Science, Scopus, Google Scholar, PubMed, and the Cochrane Library. The search strategy employed a targeted selection of keywords: "chemotherapy," "radiotherapy," "multimodal," and "surgery," encompassing publications published before January 2024. This comprehensive approach was designed to encapsulate the breadth of existing research on the integration of these therapeutic modalities in cancer treatment, ensuring a robust analysis of their collective efficacy and safety. While existing literature has examined the efficacy and safety of the multimodal approach in various cancer types, each study typically focuses on a single type, such as breast, brain, or bladder cancer. This review is distinguished by its evaluation of the approach's efficacy across different cancer types, including but not limited to breast, bladder, esophageal, salivary gland, and cervical cancers. The integration of chemotherapy, surgery, and radiotherapy emerges as the optimal strategy for cancer management, irrespective of cancer type or location. This approach is linked to the highest rates of disease-free survival, overall survival, and the lowest complication rates. However, further high-quality randomized trials are necessary to accurately assess the efficacy of this integrated approach in managing various cancer types.

Effect of Bear Garlic Addition on the Chemical Composition, Microbiological Quality, Antioxidant Capacity, and Degree of Proteolysis in Soft Rennet Cheeses Produced from Milk of Polish Red and Polish Holstein-Friesian Cows

This study aimed to assess the effect of milk source and bear garlic addition on the selected properties of soft rennet cheese. Cheeses were produced from cow milk derived from two sources: Polish Red cows (PR) and Polish Holstein-Friesian cows (PHF) with a 0.5% (w/w) addition of bear garlic (Allium ursinum L.) dried leaves. Chemical composition and fatty acid profiles (GC) were determined in fresh cheeses. Fresh and stored for two weeks cheeses were subjected to microbiological studies, i.e., total aerobic bacteria count (TABC); count of Lactococcus sp., yeast and molds; coliforms; analysis of the proteolysis extension by means of o-phthaldialdehyde (OPA) assay and free amino acids content (HPLC); antioxidant capacity as 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity and ferric reducing antioxidant power (FRAP); as well as pH and water activity. Cheeses with bear garlic herbs were more prone to proteolysis but this was not accompanied by any effect on the microbial counts, water activity or pH. Cheeses produced from PR milk contained less monounsaturated fatty acids (MUFA) but were richer in n-3 PUFA and had a lower n-6/n-3 FA ratio than cheeses from PHF milk. Bear garlic addition increased DPPH anti-radical power but had less of an effect on the FRAP values.

Nutritional value and organoleptic assessment of traditionally smoked cheeses made from goat, sheep and cow's milk

The use of small ruminant milk for smoked cheese production makes it possible to incorporate valuable nutrients into the diet, especially as the consumption of unprocessed sheep or goat's milk is low compared to that from cows. Smoking of food not only prolongs its shelf-life but also improves its flavour. Taking the fact that many consumers do not accept some organoleptic properties of milk from small ruminants into account, the aim of the study was to assess and compare the organoleptic and nutritional properties of traditionally smoked cheeses made from goat, sheep and cow's milk. The analysed cheeses differed in terms of dry matter content and its components such as protein and fat. Their acidity was comparable, except for the sample made of raw goat's milk, which was characterised by a relatively high pH value (6.12 ± 0.06). The highest content of CLA (2.30 ± 0.04%), as well as the highest share of unsaturated and polyunsaturated fatty acids, was determined in the cheese made from sheep's milk. Moreover, the content of butyric and caproic free fatty acids in cheeses made from goat's milk was found to be several times higher than in the other analysed cheeses. The organoleptic assessment did not reveal any significant differences between the cheeses produced at small, private farms and in industrial conditions, or between different types of cheese, regardless of the type of milk from which they were produced.

Red Arils of Taxus baccata L.-A New Source of Valuable Fatty Acids and Nutrients

The aim of this study, focused on the nutritional value of wild berries, was to determine the contents of macronutrients, profiles of fatty (FAs) and amino acids (AAs), and the contents of selected elements in red arils (RA) of Taxus baccata L., grown in diverse locations in Poland. Protein (1.79–3.80 g/100 g) and carbohydrate (18.43–19.30 g/100 g) contents of RAs were higher than in many cultivated berries. RAs proved to be a source of lipids (1.39–3.55 g/100 g). Ten out of 18 AAs detected in RAs, mostly branched-chain AAs, were essential AAs (EAAs). The EAAs/total AAs ratio approximating were found in animal foods. Lipids of RA contained seven PUFAs, including those from n-3 family (19.20–28.20 g/100 g FA). Polymethylene-interrupted FAs (PMI-FAs), pinolenic 18:3Δ5,9,12; sciadonic 20:3Δ5,11,14, and juniperonic 20:4Δ5,11,14,17, known as unique for seeds of gymnosperms, were found in RAs. RAs may represent a novel dietary source of valuable n-3 PUFAs and the unique PMI-FAs. The established composition of RAs suggests it to become a new source of functional foods, dietary supplements, and valuable ingredients. Because of the tendency to accumulate toxic metals, RAs may be regarded as a valuable indicator of environmental contamination. Thus, the levels of toxic trace elements (Al, Ni, Cd) have to be determined before collecting fruits from natural habitats.

The range of protein hydrolysis and biogenic amines content in selected acid- and rennet-curd cheeses

The aim of this experiment was to assess the range of proteolysis and biogenic amine content in the selected rennet- and acid-curd cheeses available on the Polish market, randomly chosen for the analyses: three ripened hard with eyes cheeses, three ripened hard smooth cheeses, three ripened soft moulded cheeses, three fresh unripened acid-curd cheeses, three ripened acid-curd cheeses with slimming bacteria-fried, and three ripened acid-curd cheeses with smear bacteria. The results allowed calculating the subsequent indexes and depth of proteolysis. It was found that the acid-curd short ripened cheese (harzer) was characterized by the greatest range of proteolysis and the biogenic amine content in comparison to other rennet- and acid-curd cheeses. In the assessed acid- and rennet-curd cheeses, the dominant amines were as follow, cadaverine, tyramine, and putrescine, with the exception of cheddar in which the histamine was predominant.

[McKittrick-Wheelock syndrome: complication of rectal mucinous adenoma]

The McKittrick-Wheelock syndrome is a very rare complication of rectal villous adenoma, characterized by fluid and electrolyte hypersecretion from a rectal tumour, which can lead to acute renal failure. We present a case review of a 67-year-old male patient hospitalised for profuse secretory diarrhea, with electrolyte dysbalance and progressive renal failure. A rectoscopic finding of massive rectal adenoma contributed to establishing the correct diagnosis. Resection of the affected part of the rectum resulted in rapid restoration from mineral imbalance and improvement of renal functions. The reported case shows the necessity of interdisciplinar management and the importance of surgical treatment in patients with this rare diagnosis.

Endoscopic transsphenoidal treatment in recurrent and residual pituitary adenomas--first experience

AIM OF THE STUDY

The aim of the study has been the assessment of the endoscopic method in the surgical management of recurrent and residual pituitary adenomas, as concerns treatment efficiency, substantial complications, and its possible advantages for the operating surgeon and patient.

MATERIAL AND METHODS

In Department of Neurosurgery, Silesian University School of Medicine in Katowice, between October 2001 and June 2004, 125 patients underwent endoscopic surgery due to pituitary adenoma. The analysis comprised 20 patients, who were operated on due to recurrent adenomas or residual tumour not completely removed during the first surgical procedure. The group of patients was composed of 9 women and 11 men. The youngest patient was 32 years of age, the oldest 79. The average age was 53.9 years. The analysed group had 14 non-functioning adenomas, 4 GH-secreting adenomas, 1 PRL-secreting adenoma and 1 ACTH-secreting adenoma. 19 of them were macroadenomas while 1 was a microadenoma. 11 of the 20 adenomas infiltrated the cavernous sinuses. The surgical procedures were performed by a stable team, composed of 2 neurosurgeons, a laryngologist and an anaesthesiologist. The surgery method was based upon the technique developed by Jho and Carrau, with own modifications of the operators. A rigid neuroendoscope having the diameter of 4 mm with 0 degrees and 30 degrees optics by Storz was used. The follow-up period after surgery was between 12 and 42 months, 24.2 months on average.

RESULTS

Of the 20 cases, complete recovery was achieved in 40% of patients undergoing secondary surgical procedures. In the group of 11 patients with adenomas not infiltrating the cavernous sinuses, recovery was reported for 8 of them, that is 73%. No fatalities occurred. 7 cases of liquorrhoea occurred during operation, requiring reconstruction and sealing of the sella by means of tissue glue and artificial dura or freeze-dried human dura. In 1 case, despite the application of post-operative lumbar drainage, rhinorrhoea occurred one month after the procedure, which required endoscopic reconstructive treatment. In the same patient, a pneumoencephalocele was observed. The average time of the repeat surgical procedure using endoscopic techniques was shorter by 18 minutes than the repeat procedure using microscopic techniques.

CONCLUSIONS

The endoscopic method is a safe, hardly invasive and efficient surgical technique in the treatment of recurrent and residual pituitary adenomas. Advantages which add to its attractiveness are also reduction of the procedure duration, very good visualisation of the operative field, absence of serious complications, less pain experienced after the surgery.

Endoscopic Transnasal Transsphenoidal Treatment of Pathology of the Sellar Region

From October 2001 to the end of November 2002 in Department of Neurosurgery, Silesian University School of Medicine in Katowice 70 explorations of the sella turcica were executed using the endoscopic method. In 63 cases the operation was done because of pituitary gland adenomas. In one case the diagnosis was craniopharyngioma, in 1 chordoma of the clivus, in one glioma of the optic nerve, in 1 the reason for an operation was an empty sella syndrome and in 3 cases the pathological diagnosis was an amorphous masses. Patients were operated using the 4-mm diameter endoscope with 0- and 30-degree angled lenses, using the method according to Jho and Carrau with our own modifications. In all cases of adenomas the total removal of the tumour was obtained in 71.4 %. Permanent diabetes insipidus occurred in 4.3 % of all operated patients. In our series of patients we did not observe any postoperative CSF leak or rhinological complications. One patient died, corresponding to 1.4 % of all cases. We the recommend transsphenoidal transnasal endoscopic approach for use in the cases of sellar region pathology because of the advantages of the method for surgeon and for comfort of the patient.

Endoscopic third ventriculostomy for hydrocephalus: early and late efficacy in relation to aetiology

OBJECTIVES

The aim of the study was to analyse the effectiveness and usefulness of treatment of hydrocephalus by Endoscopic Third Ventriculostomy (ETV). We sought to relate rates of failure to the cause of hydrocephalus, distinguishing between early and late outcome.

PATIENTS AND METHODS

Between September 1999 and April 2001, 30 patients underwent ETV. In 23 patients hydrocephalus was caused by an expansive mass (tumour). Three groups of patients were distinguished, according to the different aims of ETV. Thus in group T--ETV was carried out to eliminate hydrocephalus prior to the main surgery (53%), in C--ETV was the definite treatment of choice (30%), and in group P--ETV was a palliative treatment (17%). The results were assessed in the early postoperative period and in long term follow-up using clinical relief of symptoms, and radiological criteria (pre- and postoperative computed tomography and/or magnetic resonance scans).

RESULTS

In the early postoperative period ETV was rated to be effective by clinical criteria in 29 patients, and by radiological criteria in 27. According to late assessment the method was successful in 25 patients using clinical criteria, and in 21 using radiological criteria. There was no peri-operative mortality. A transient complication (wound CSF leak) occurred in two patients.

CONCLUSIONS

ETV is effective in well chosen patients in relieving symptoms of hydrocephalus. It is valuable before a definitive major operation to remove the cause of hydrocephalus, as a palliative treatment, and in itself as a method of definitive management when indications are correct.