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Background. The aim of this study was to assess the influence of starting insulin therapy in patients with type 2 diabetes on revealing psychic disturbances. Methods. The study was conducted on 54 outpatients suffering from type 2 diabetes, examined after 3 to 6 weeks from the start of insulin therapy with Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Bizon' Neuroticism Rating Scale (BNRS). Results. The mean value of scores obtained in 17-item HDRS was 7.2 ± 5.1, mild depression was found in 9.2% and severe depression in 7.4%. The mean value of scores obtained in HARS was 8.1 ± 5.02. Scores indicating moderate intensification of anxiety were recorded in 12.9% (all patients with severe depression and 2 patients with mild depression). The mean value of scores obtained in BNRS was -20.4 ± 18. Scores indicating pathological intensification of neuroticism were obtained only in patients presenting anxiety symptoms in HARS (12.9%). Conclusions. Obtained results suggest that beginning treatment with insulin is not a factor increasing the risk of depression in patients with type 2 diabetes. It also doesn't enhance anxietic and neurotic disturbances. Therefore up to now opinion about unfavorable influence of insulin therapy on psychic state should be revised and encourage to more fearless hypoglycemic treatment. [ABSTRACT FROM AUTHOR]

Gynecomastia is a benign, abnormal, growth of the male breast gland which can occur unilaterally or bilaterally, resulting from a proliferation of glandular, fibrous and adipose tissue. Gynecomastia is characterised by the presence of soft, 2-4 cm in diameter, usually discusshaped enlargement of tissues under the nipple. It is estimated that this pathology occurs in 32-65% of men over the age of 17. Gynecomastia is a psychosocial problem and may lead to a perceived lowering of quality of life. The main cause of gynecomastia is a loss of equilibrium between oestrogens and androgens. Increased sensitivity for oestrogens of the breast gland, or local factors (e.g. an excessive synthesis of oestrogens in breast tissues or changes in oestrogen and androgen receptors) may cause gynecomastia. Also, prolactin, thyroxine, cortisol, human chorionic gonadotropin, leptin and receptors for human chorionic gonadotropin, prolactin and luteinizing hormone localised in tissues of the male breast may participate in the etiopathogenesis of gynecomastia. Usually three types of gynecomastia are distinguished: physiological, idiopathic and pathological gynecomastia. The latter is the consequence of relative or absolute excess of oestrogens. In this paper, frequent as well as casuistic causes of gynecomastia will be described. A diagnosis of gynecomastia is usually possible after a palpation examination. Ultrasonographic, mammographic or histopathological examinations are useful in aiding diagnosis. The five degree scale devised by Tanner and Marshall is useful in estimating disease progression.

One of the solutions aimed at improving the functioning of the healthcare system in Poland is to introduce patients' co-payment for public healthcare services. In all countries where the healthcare system is at a high level there already exists a co-payment system and it is regarded by many specialists as a necessary and indispensable condition for the proper functioning of healthcare. The aim of this study was to show respondents' attitudes and opinions regarding the proposal of introduction co-payments as and additional form of financing medical care. The questionnaire survey covered a group of 2,409 persons (50.7% men and 49.3% women). Most respondents, despite the overall rising dissatisfaction with the quality and availability of medical services do not see the need for co-payments. The opinion about the implementation of co-payments. The opinion about the implementation of co-payments depends on many factors, to the most important belong age, education, place of residence and income. More often, the co-payments is in favour of young people in good health condition, who live in big cities, having a university degree and determining their financial situation as good. Before the introduction of co-payment - certain social groups, which would be exempt from additional fees, should be specified. To the highest costs that patients are able to carry belong: paying for a home visit of family doctor or specialist, for surgical procedures, and for complex tests performed during the hospital stay (including computed tomography, magnetic resonance imaging).

The examination of cognitive function is not the part of the basic set of tests which is carried out in patients with chronic obstructive pulmonary disease (COPD). However there are some theoretical reports and sparse publications indicating the impairment of these functions among patients with COPD. These impairments are related to the patients with hypoxemia. In non-hypoxemic patients with COPD cognitive performance should be studied because of controversial reports. The influence of COPD on cognitive performance is partially reversible using oxygen therapy and/or physical activity which, in our opinion, is not appreciated enough. It seems that evaluation of cognitive performance with selected tests can be helpful in the assessment of severity of the disease. Moreover, it can be useful in estimation and prognostication of the self-dependence degree as well as the patients life span. The use of such methodological tools as corresponding tests analyzing cognitive performance in patients with COPD could lead to better care. It could also minimize the risk of transition of mild cognitive impairment into dementia which results in significant quality of life deterioration. It appears that patients with present impaired cognitive performance with or without recognized dementia should remain under special care providing adequate treatment. We assumed that due to properly managed treatment it may be possible to retain the process of increasing cognitive impairment what would effect in long-term self-reliance.