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Skin is the most common localization of primary melanoma, however in 2–6% of patients a metastasis of melanoma without a detectable primary tumor is found [1]. This is referred to as melanoma of unknown primary origin (MUP). It usually presents as cutaneous or subcutaneous nodules or lymph node metastases [2]. The theories concerning the etiology of MUP include the presence of a melanoma that was misdiagnosed and excised without the further histopathological examination, a regressed melanoma; or a primary nodal melanoma connected with malignant transformation of a nevus cell in a lymph node or other non-skin tissue. In support of the last two theories, in melanomas a partial spontaneous regression connected with immunological mechanisms frequently occurs, moreover ectopic melanocytes may be found in lymph nodes and the other tissues, being a potential reservoir of the cells, which may undergo a neoplastic transformation [2]. In patients with MUP metastases may be found primarily in the skin, subcutaneous tissue, internal organs, bones and brain [1]. In more than 50% of MUP cases, similarly to sporadic melanomas with a known primary origin, a mutation of the gene encoding kinase protein BRAF (V600E) is found. The coexistence of melanoma with the other skin cancers may be connected with the presence of genes encoding the factors regulating the cell cycle, e.g. p53 protein. A female patient with metastasis of melanoma to the lymph node of the right groin of unknown primary origin, with a coexistence of three basal cell carcinomas is presented in the report. A 33-year-old female patient, generally healthy, with a positive history of drug abuse in the past, presented with a few centimeters’ large, painless nodule within the right inguinal region. Ultrasound examination revealed a longitudinal tumor, partly solid and partly polycystic with vascularized septa. The nodule was surrounded by the capsule and revealed no features of infiltration of the adjacent tissues (Figure 1). Histopathological examination of an excised lesion showed the presence of nodal tissue with the metastasis of melanoma with HMB45 positive, S-100 positive, Melan-A positive, V-9 positive, MIB-1 (a proliferation marker which recognizes the Ki-67 antigen) locally positive (Figures 2 A, B). Keratin AE1/AE3, CG30 and leucocyte common antigen (LCA) were negative in neoplastic cells. There was no history of any surgically excised melanocytic or pigmented lesions. The patient declared extensive exposure to ultraviolet in the past, but without any episodes of sun burns. Family melanoma history was negative, however the patient's mother had a history of one basal cell carcinoma (BCC) at the age of 62. Figure 1 An ultrasound picture of an enlarged lymph node within the right inguinal region Figure 2 Histopathological examination of an excised tumor presenting nodal tissue with the metastasis of melanoma. A – 40×. B – 400× Lymphadenectomy of the whole group of lymph nodes within the right inguinal region revealed no metastases to the other nodes. Dermatological examination, performed after the diagnosis of MUP, revealed the presence of numerous solar lentigines and melanocytic nevi on the trunk and extremities with features of atypical lesions in macroscopic and dermoscopic evaluation in some of them. Moreover, the existence of two nodular lesions without dermoscopic features of melanocytic nevi were diagnosed on the abdomen, as well as a single erythematous patch in the left scapular area. Seventeen suspected skin lesions were qualified for surgical removal. The excised nevi revealed histopathological features of benign lesions, no melanoma cells were found in the biopsy specimens. Two nodular lesions on the abdomen and the macular one within the left scapular area showed histopathological features of basal cell carcinoma. Laboratory analyses were within the normal range. The activity of lactate dehydrogenase was within the normal range. A detailed diagnostic imaging, including whole-body positron emission tomography-computed tomography (PET-CT) screening, computed tomography of the abdomen, pelvis, chest and head, endoscopy of the gastrointestinal tract, ultrasound examination of breast and the female genital organ, gynecological and ophthalmic evaluation, examination of the anal region confirmed neither the presence of primary melanoma nor metastases in the other localizations. A mutation in codon V600 of the gene encoding BRAF kinase protein was confirmed in the patient. Further genetic evaluation (assessment of mutations in BRCA1 and CHEK2 genes) confirmed no features of high hereditary cancer susceptibility. Regarding the absence of primary origin of melanoma, differentiation between regional and distant metastases, as well as an evaluation of clinical staging (stage IIIb or IV according to AJCC/UICC staging system) and prognostic factors could not be performed. No indications for the further complementary adjuvant treatment were established. The first exclusion criteria for diagnosis of a true unknown primary melanoma were defined by Das Gupta et al. in 1963 [3]. They included the history of orbital enucleation or exenteration, history of a skin lesion removed, the presence of a scar of previous local treatment in the area drained by the involved lymph node and lack of a thorough physical assessment, including ophthalmic, anal and genital examination. Our patient confirmed the presence of some skin lesion on the right buttock that was mechanically removed by scratching a few years ago. Skin biopsy from the remaining slightly pigmented macule at this site revealed only a scant inflammatory infiltration with lymphoid cells. No other evidence of potential regression was found. The hypothesis of primary origin of melanoma in the lymph node was also considered. No evidence of primary tumor in thorough physical assessment could confirm this assumption in the presented case [4, 5]. Unfortunately, there are no clear criteria defining the diagnosis of this variant of melanoma. Moreover, the literature data lack certain descriptions with histological confirmation of primary nodal melanoma. Another unusual observation was the coexistence of MUP with multifocal BBC in the presented female. Melanoma patients may develop a second malignancy. The most common are second skin tumors, with the highest incidence of BCCs and multiple melanomas [6]. In one study, second malignancies were seen in 11.0% of all melanoma patients, BCCs accounted for one-fourth of all cases. However, the mean age at the time of melanoma and BBC diagnosis was over 60 years [6]. The incidence of BCC in the population younger than 40 years is low, however it is increasing, most likely due to the coexistence of multiple risk factors, with extensive exposure to UV as the most important one [7]. Also genetic defects, as in basal cell nevus syndrome, Muir-Torre syndrome and xeroderma pigmentosum are risk factors for the accelerated development of early-onset BCC. A decrease in DNA repair may determine the genetic susceptibility of non-melanoma skin cancer at a young age [7]. The presented patient had no noticeable symptoms of any genetic syndrome coexisting with a higher risk of BCC development. However, she declared a cumulative sun exposure in the past and that, with concomitance of defects in DNA repair, could have resulted in the development of melanoma and non-melanoma skin cancer. To the best our knowledge, this is the first description of MUP coexisting with early-onset multifocal BCC diagnosed at the same time.

Five new eriophyoid mite species (Eriophyidae) from Turkey are described and illustrated in this paper: Aceria vanensis n. sp., Aceria onosmae n. sp., Aculus lydii n. sp., Aculus gebeliae n. sp. and Aculus spectabilis n. sp.. The descriptions are based on the morphology of females collected from weedy plants, respectively: Amaranthus retroflexus L. (Amaranthaceae), Onosma isauricum Boiss. et Heldr. (Boraginaceae), Hypericum lydium Boiss. (Hypericaceae), Lotus gebelia Vent. (Fabaceae) and Stachys spectabilis Choisy ex DC. (Lamiaceae). The new species were found to be vagrant on their host plants with no visible damage symptoms observed.

The article discusses the problem of risk management in the context of safety of an organization's information assets. Assuming system of information risk management as a basic element of organization management in the aspect of information safety of modern organizations, this document focuses on methods and techniques of qualitative risk estimates. Basic standards and good practice from areas of risk management and ensuring information safety in the organization were recalled.

Risk is an inherent part of the functioning of every organization therefore the risk management should be a natural activity at each level of management. A common mistake in the management process of an organization is separating the security system, including the risk management system, and treating it as an isolated element. The article presents the place and role of the risk management system in the context of safety of the IT resource of an organization. A model of the risk management system was developed as the basic element of the organization management system and function supporting the continued operation in terms of IT safety of modern organizations.

The paper presents business processes in the RFID-equipped restricted access administrative office. The presented diagrams are the result of the analytical work performed by the multidisciplinary team of experts. The team was composed of IT specialist, security systems specialists and employees of the secret office. The presented models include the fact that the facilities in the secret office (cabinet, sluice, photocopier, desks) are equipped with the RFID reader, which allows to immediately read the documents that are within their reach.

The study is devoted to the issue of optimization of the document placement in a single RFID cabinet. It has been assumed that the optimization problem means the reduction of archivization time with respect to the information on all documents with RFID tags. Since the explicit form of the criterion function remains unknown, for the purpose of its approximation, the regression analysis method has been used. The method uses data from a computer simulation of the process of archiving data about documents. To solve the optimization problem, the modified gradient projection method has been used.

The study outlines the method for examining the properties of the RFID-tagged document management system. The system is composed of computers, where the software for supporting processes of the RFID-tagged doc-uments was installed. Furthermore, the system cooperates with many other elements of the secret office (cabinets, sluices, photocopiers, desks). The examination of the properties of the RFID-tagged document management system is, in this case, complex due to the number of a possible examination scenarios. The simulation method for examining the system properties was proposed. It allows to conduct the examination of the properties in a short period of time for numerous testing scenarios.

The paper presents models of data flow between RFID devices in a modern restricted access administrative office. The presented diagrams are the result of the analytical work performed by the multidisciplinary team of experts. The team was composed of IT specialist, security systems specialists and employees of the secret office. The presented models include the fact that the facilities in the secret office (cabinet, sluice, photocopier, desks) are equipped with the RFID reader, which allows to immediately read the documents that are within their reach.

The current work describes the development and validation of a simple, efficient, and fast method using solid phase microextraction coupled to liquid chromatography-tandem mass spectrometry (SPME-LC-MS/MS) for the concomitant measurement of eight beta-blockers and bronchodilators in plasma and urine. The presented assay enables quantitative determination of acebutolol, atenolol, fenoterol, nadolol, pindolol, procaterol, sotalol, and timolol. In this work, samples were prepared on a high-throughput platform using the 96-well plate format of the thin film solid phase microextraction (TFME) system, and a biocompatible extraction phase made of hydrophilic-lipophilic balance particles. Analytes were separated on a pentafluorophenyl column (100mm×2.1mm, 3μm) by gradient elution using an UPLC Nexera coupled with an LCMS-8060 mass spectrometer. The mobile phase consisted of water-acetonitrile (0.1% formic acid) at a flow rate of 0.4mLmin(-1). The linearity of the method was checked within therapeutic blood-plasma concentrations, and shown to adequately reflect typically expected concentrations of future study samples. Post-extraction addition experiments showed that the matrix effect ranged in plasma from 98% for procaterol to 115% for nadolol, and in urine, from 85% for nadolol and pindolol to 119% for atenolol. The method was successfully validated using Food and Drug Administration (FDA) guidelines, and met all acceptance criteria for bioanalytical assays at five concentration levels for all selected drugs. The final protocol can be successfully applied for monitoring concentrations of the selected drugs in both plasma and urine matrices obtained from patients or athletes.

A 75-year-old woman without structural heart disease presented with incessant regular monomorphic atrial tachycardia (AT). Spontaneous arrhythmia termination was repeatedly followed by a single sinus beat before reinitiation. Variations in tachycardia cycle length (CL) between 200 and 400 ms were frequently observed. The P-wave morphology was consistent with a focal origin from the crista terminalis; however, electroanatomic mapping (CARTO 3 system, Biosense Webster Inc., Diamond Bar, CA) demonstrated centrifugal activation of the right atrium originating from the atrial septal wall near the fossa ovalis. Further mapping at the site of the earliest atrial activation during AT revealed a rapid, regularly discharging focus (Figure 1, blue dot) at fixed 100-ms CL represented by the low-amplitude (0.17 mV) spike electrograms (↓) with an isoelectric interval between successive spikes. The accompanying local atrial potential (▼) during firing was clearly sharper, higher (0.75 mV), and well separated from the preceding spike at fixed 30-ms conduction delay but of lower amplitude (0.95 mV) than that during sinus beats (*). The recorded abnormal activity could not be detected when the catheter tip was moved a few millimeters. The initiation and termination of firing at the site of interest were recorded during catheter manipulation. The onset of AT on the surface electrocardiogram did not always coincide with the initiation of local, high-frequency activity but did terminate immediately with cessation of local firing. The first tachycardia P wave and subsequent discernible P waves were identical. Alterations in the degree of atrial capture by the focal activity (from 2:1 to

We describe a case of a patient with the history of a monomorphic postinfarction ventricular tachycardia that exhibited a right bundle branch block morphology and a superior axis. Because of electrical and hemodynamic instability of arrhythmia, classical mapping techniques were not applied. An electroanatomic voltage map during sinus rhythm was performed. A Purkinje potential (PP) preceding the QRS complex was recorded at posteroseptal area of a scar. Radiofrequency energy delivery at sites where a PP was detected resulted in a successful ablation.

Standard pre-operative diagnosis of nodular goitre is not always conclusive. The decision about nodular goitre surgery is increasingly based on molecular methods. The aim of the study was to determine BRAF T1799A mutation and KRas proto-oncogene mutation, and the analysis of RASSF1A promoter methylation level in cytological material obtained from FNAB specimens of thyroid nodules.The study population consisted of 85 women and 12 men. The study material was genomic DNA isolated from peripheral blood and thyroid bioptates. Pyrosequencing was used for the evaluation of RASSF1 methylation level. KRas mutation was investigated with Sanger sequencing. BRAF mutation was analysed by standard methods of real-time amplification detection (real-time PCR) with the use of specific starters surrounding the mutated site.A significant positive correlation was demonstrated between mean methylation of four CpG islands of RASSF1A gene and thyroid tumour volume and its largest diameter (p0.05). KRas mutation was not detected in any of the 97 patients. In 7/85 subjects (8.2%) BRAF mutation was observed. In 6/7 patients with BRAF mutation, FNAB of thyroid nodules confirmed a benign nature of the lesions; the material was non-diagnostic in one patient, and papillary thyroid cancer was diagnosed on the basis of postoperative histopathology assessment.The results of genetic tests reported in our study indicate that the presence of BRAF mutation or higher RASSF1A methylation levels in FNAB cytology specimens of benign lesions may be useful in the assessment of oncological risk, while the evaluation of KRas proto-oncogene mutation is not a valuable test in pre-operative diagnosis of nodular goitre.

The aim of this study was to analyze treatment and outcomes in children with glaucoma secondary to diode laser photocoagulation in retinopathy of prematurity.The group of 1507 newborns, examined as outpatients between 2008 and 2013, were retrospectively analyzed. Five patients (0.3%) (nine eyes) with glaucoma following laser treatment for retinopathy of prematurity were identified. Demographic and clinical data was obtained from medical records and compared with corresponding results in the group of glaucoma-free children subjected to diode laser photocoagulation for retinopathy of prematurity. The statistical analysis included Shapiro-Wilk test and U-Mann-Whitney test with statistical significance level p0.05.The following data was collected - mean post-menstrual age at the moment of photocoagulationwas 42 Hbd (38-42) and it was 49.9 (43-54) weeks at the moment of diagnosis of angle-closure glaucoma. The intraocular pressure was significantly elevated in nine in ten eyes which was confirmed objectively and the mean intraocular pressure was 32.0 mmHg (21.6-42.4). The mean corneal diameter was 11.25 mm (10-13) and it was associated with the decreased corneal thickness in pachymetry (p0.05). Six eyes (66.6%) required surgical intervention and intraocular pressure normalization was achieved in all patients. Additionally, the affected eyes tended to be myopic (mean spherical equivalent -1.625 diopter) and have a greater axial length (p0.05).Secondary glaucoma can develop following laser treatment for severe retinopathy of prematurity. Topical treatment and surgical intervention provide effective management.

Psoriasis is a chronic inflammatory dermatosis leading to the development of systemic inflammatory reaction. Previous data indicated the coexistence of psoriasis and the occurrence of metabolic disorders, with the common background of both processes determined by a chronic inflammation. The coexisting disorders, including type 2 diabetes, hypertension, heart ischemic disease, dislipidemia and obesity may have an important impact on intensity of psoriasis activity.The analysis comprised of 82 randomly matched patients with various clinical forms of psoriasis, aged 17 to 81 years. In patients PASI and BSA indexes, BMI value and laboratory parameters of metabolic status (glucose and ureic acid levels, lipid fractions and CRP level in the serum) were evaluated.An average age in examined group was 54,3 years, an average time of presence of psoriasis symptoms was approximately 20 years. An average PASI value was 21,4; an average BSA value was 39.7%. The coexistence of type 2 diabetes was found in 14.6% of patients, hypertension in 42.7% and heart ischemic disease in 17%. Particularly large group of examined patients comprised persons with overweight (34.1%) and obesity (30.5%). Positive correlation between BSA and body weight, BSA and BMI value, BSA and abdominal circumference as well as positive correlation between PASI and body weight, PASI and BMI value, PASI and abdominal circumference were observed. Abnormal serum glucose levels were observed in 19.5% persons, ureic acid level in 2.9%, total cholesterol in 37.8% LDL cholesterol in 48.8%, and HDL cholesterol in 46.3%. CRP level was elevated in 43.9% patients. Positive correlation between BSA and ureic acid level, as well as PASI and ureic acid level was estimated. No correlation between PASI and the other laboratory parameters was found.The occurrence of metabolic syndrome is more common in patients with psoriasis in comparison to the general population. The extent and severity of psoriatic lesions correlate with high body weight, BMI and the level of ureic acid.

The case of a 62-year-old female patient diagnosed with an extremely rare clinical variant of pemphigoid--nodular pemphigoid, imitating prurigo nodularis, is presented in the paper. In connection with the existence of the typical prurigo nodularis-like appearance in the patient, the diagnosis was maintained for several months. However, because of no response to the treatment and the remarkably chronic course of the disease, the patient was admitted to the Department in order to extend the diagnostics and verify the previous diagnosis. The direct and indirect immunofluorescence examinations performed on the patient enabled the final diagnosis of a rare variant of pemphigoid without typical blisters, and effective treatment was carried out.

Summary Background Despite the progress in contemporary medicine comprising diagnostic and therapeutic methods, lung cancer is still one of the biggest health concerns in many countries of the world. The main purpose of the study was to evaluate the detection rate of pulmonary nodules and lung cancer in the initial, helical low-dose CT of the chest as well as the analysis of the relationship between the size and the histopathological character of the detected nodules. Material/Methods We retrospectively evaluated 1999 initial, consecutive results of the CT examinations performed within the framework of early lung cancer detection program initiated in Szczecin. The project enrolled persons of both sexes, aged 55–65 years, with at least 20 pack-years of cigarette smoking or current smokers. The analysis included assessment of the number of positive results and the evaluation of the detected nodules in relationship to their size. All of the nodules were classified into I of VI groups and subsequently compared with histopathological type of the neoplastic and nonneoplastic pulmonary lesions. Results Pulmonary nodules were detected in 921 (46%) subjects. What is more, malignant lesions as well as lung cancer were significantly, more frequently discovered in the group of asymptomatic nodules of the largest dimension exceeding 15 mm. Conclusions The initial, low-dose helical CT of the lungs performed in high risk individuals enables detection of appreciable number of indeterminate pulmonary nodules. In most of the asymptomatic patients with histopathologically proven pulmonary nodules greater than 15 mm, the mentioned lesions are malignant, what warrants further, intensified diagnostics.