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OncoReview
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2018
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tom 8
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nr 3
76-79
EN
There is a growing number of elderly patients, so it is necessary to create new standards of oncologic care for such individuals in order to provide them with the best possible treatment. An elderly woman was treated for locally advanced small-cell lung cancer. Due to the suspicion of coronary disease, arterial hypertension and age, anti-cancer treatment with carboplatin and etoposide was recommended. When carboplatin infusion came to a stop, signs of myocardial infarction in ECG as well as elevated levels of troponin I were reported. Originally, non-invasive treatment was introduced, but several days later three DES stents were placed in coronary arteries. An attempt was made to treat the patient with cisplatin and etoposide, after which respiratory failure, tumor lysis syndrome and pancytopenia occurred. That is why chemotherapy was discontinued at the time. The patient’s tumor area and brain was irradiated. 16 months later, she is still alive without signs of disease progression. New oncologic standards should be elaborated in order to ensure appropriate treatment for elderly patients.
2
Content available remote Wzrost po traumie a zadowolenie z życia u osób po zawale serca
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EN
The aim of the study was to investigate the relationship between posttraumatic growth, which was a consequence of experienced traumatic event and the level of satisfaction with life. The study group consists of 86 person (62 men and 24 women), aged 36-87 (M = 60,5; SD = 10,05), who experienced myocardial infarction. Half of them participated in rehabilitation program. Two methods were used in the study: Life Satisfaction Questionnaire and Posttraumatic Growth Inventory. The results revealed poor relationship between positive changes aftermath trauma and life satisfaction. The overall score of Life Satisfaction Questionnaire correlates only with positive changes in relations to others. These changes appeared the main predictor of satisfaction with life among persons with myocardial infarction.
EN
The article presents the results of research on the relationship between social support and self-care of people with myocardial infarction. 127 patients treated in a rehabilitation centre participated in the study. The Inventory of Socially Supportive Behaviours (ISSB) and the Self-care Questionnaire (KTS) developed by the author, were used. The findings suggest that persons receiving little support are characterised by lower level of self-care than people with medium and high level of support. No such difference was noted between people with medium and high support level. This suggests that social support is of considerable importance for the changes in the level of self-care only in the case of people previously receiving little support. The research also indicates that informational support is related to higher level of self-care whereas instrumental support is related to lower level of self-care. Emotional support was significant only for the care for social functioning.
EN
Lymphotoxin-α (LTA) is a cytokine involved in inflammatory reactions. NFKBIL1 is a regulator of the NF-κB complex. The study investigated the associations of LTA 804 C>A and NFKBIL1-63 T>A polymorphisms with the use of statin and acetylsalicylic acid (ASA) treatment in relation to myocardial infarction (MI). The study population comprised of 600 Finnish individuals who underwent coronary angiography volunteering for the Angiography and Genes Study. Genotypes were detected by the TaqMan 5′ nuclease assay. We found a interaction between the LTA genotype (p=0.002) and the NFKBIL1 genotype (p=0.012) and statin treatment in relation to MI. Subjects with the LTA AA or the NFKBIL1 AA genotype were at a 2.77 (95% CI:1.22-6.24) and 2.85 (95% CI:1.22-6.66) times higher risk, respectively, of suffering an MI when compared to other genotypes among statin non-users. ASA treatment also modulated associations between LTA and NFKBIL1 genotypes and MI (p=0.015 and p=0.028 respectively). The NFKBIL1-A-LTA-A haplotype showed a 61% increase in the risk of MI compared to the NFKBIL1-T-LTA-C haplotype among statin non-users. Anti-inflammatory medication modifies the genotype-related risk of MI, suggesting that subjects with LTA and NFKBIL1 AA haplotype might especially benefit from the treatment.
5
Content available Stem cells - a new rescue in cardiology?
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EN
In recent years stem cells have become the object of curiosity for many researchers and clinicians. Interest in the use of these cells is an effect of their specific properties. Their great potential for self-renewal as well as the ability to differentiate into specific cell types is particularly interesting. These unique features allow us to think about stem cells as a possible therapeutic solution in the treatment of damaged tissues. The tissue that is particularly vulnerable to damage is heart muscle, which consists of cardiomyocytes. These cells are extremely vulnerable to lack of the oxygen, what can be observed in the case of temporary cardiac ischemia, e.g. during physical exertion or in stressful situations, which initially manifests as stable angina. Prolonged ischemia and consequent hypoxia of cardiomyocytes lead to their death what is manifested as myocardial infarction. An extensive area of post-infarction necrosis impairs heart functioning as a blood pumping organ what leads to its failure. Researchers are still searching for a therapy that would replace large areas of dead cardiomyocytes with new cells, and thus potentially minimize the negative effects of myocardial necrosis and postpone the impairment of its function. Due to their properties, it seems a good idea to introduce stem cells as a method of treatment, hence many studies are conducted to demonstrate the effectiveness of these cells in the treatment of cardiac patients. This paper presents a literature review of stem cell applications in the aforementioned cardiac diseases, taking into account the obtained results.
EN
Recent evidences indicate that epigenetic changes play an important role in the transcriptional reprogramming of gene expression that characterizes cardiac hypertrophy and failure and may dictate response to therapy. Several data demonstrate that microRNAs (miRNAs) play critical roles both in normal cardiac function and under pathological conditions. Here we assessed, in in vivo rat models of myocardial infarction (MI) and ischemia-reperfusion (IR), the relationship between two miRNAs (miR-29a and miR-30c) and de novo methyltransferase (DNMT3a) which, altering the chromatin accessibility for transcription factors, deeply impacts gene expression. We showed that the levels of members of miR-29 and miR- 30 families were down regulated in ischemic tissues whilst the protein levels of DNMT3a were increased, such a relation was not present in healthy tissues. Furthermore, by an in vitro assay, we demonstrated that both miRNAs are able to down regulate DNMT3a by directly interacting with DNMT3a 3’UTR and that miR-29a or miR-30c overexpression in the cardiac HL1 cell line causes decrease of DNMT3a enzyme both at the mRNA and protein levels. Our data, besides confirming the down regulation of the miR-29a and miR-30c in infarcted tissues, envisage a cross-talk between microRNAs and chromatin modifying enzymes suggesting a new mechanism that might generate the alterations of DNA methylation often observed in myocardial pathophysiology.
EN
Atrial arrhythmias and especially atrial fibrillation in the early phase (first 12 hours) of acute myocardial infarction (AMI) are rare. They are more common in the later stages of AMI and the most of the times as a sign of heart failure. The pathogenesis seems to be an underlined coronary ischemia. Among the causes an ischemia of sinus node artery (SNA) is previously described. SNA arise the most of the times from the initial part of right coronary artery while the remaining from the LCx or in a small proportion of them have double origin from RCA and LCx one. In this case we describe a case of atrial fibrillation in the early phase of AMI promptly resolved in the next one hour after successful percutaneous coronary angioplasty (PTCA) treatment of the culprit lesion in the LCx at site of the origin of SNA.
PL
Zaburzenia rytmu przedsionków, a zwłaszcza migotanie przedsionków we wczesnej fazie (pierwsze 12 godzin) ostrego zespołu wieńcowego (AMI) są rzadkie. Są one bardziej powszechne w późniejszych stadiach AMI i przez większość czasu wustępują jako oznaka niewydolności serca. Patogeneza wydaje się być podyktowana niedokrwieniem wieńcowym. Wśród przyczyn wymienia się niedokrwienie tętnicy węzła zatokowego (SNA). SNA powstają najczęściej z początkowej części prawej tętnicy wieńcowej, podczas gdy pozostałe z LCx lub rzadziej mając podwójne pochodzenie (RCA i LCx). Autorzy omawiają przypadek migotania przedsionków we wczesnej fazie AMI, które natychmiast ustąpiło w ciągu następnej godziny po udanym leczeniu przezskórną angioplastyką wieńcową (PTCA) zmiany w LCx skąd pochodziło SNA.
EN
INTRODUCTION: Cardiovascular diseases, including coronary disease and its complications, are the most common cause of death. Myocardial infarction is usually caused by a blood clot cosing the lumen of a coronary artery at the site of an unstable atherosclerotic plaque. MATERIAL AND METHODS: All the analyzed patients with mechanical complications of acute myocardial infarction (AMI) were hospitalized at the 2nd Department of Cardiology and Department of Anaesthesiology and Intensive Care of the Upper-Silesian Medical Centre in Katowice in 2006–2016 and the database was based on the medical records of the patients. The study group comprised 52 (100%) patients. There were 23 (44.2%) women and 29 (55.8%) men, aged 54 to 84 years with a mean age of 69.8 years. RESULTS: Ventricular septal rupture (n = 36; 69.2%) was the most frequently observed complication but papillary muscle rupture (n = 4; 7.7%) and tendinous chord rupture (n = 4; 7.7%) were the least frequent. Hypertension and hypercholesterolemia were the most common risk factors for coronary heart disease in the study group. An increased mortality rate was observed in patients who received pharmacological treatment compared to surgically treated patients (87.5% vs. 61.4%). The majority of patients had one risk factor for coronary heart disease (28; 53.8%). CONCLUSIONS: 1. In the study group, ventricular septal rupture and the cardiac free wall rupture were the most frequently observed mechanical complications of AMI. 2. Patients with AMI had numerous risk factors for coronary heart disease, of which hypertension and hypercholesterolemia were the most common. 3. Patients with mechanical complications of AMI had both higher mortality rates than survival and they were higher in the pharmacologically treated group.
PL
WSTĘP: Choroby układu krążenia, w tym choroba wieńcowa i jej powikłania, stanowią najczęstszą przyczynę zgonów. Zawał mięśnia sercowego spowodowany jest zwykle pęknięciem blaszki miażdżycowej i zamknięciem tętnicy wieńcowej skrzepliną. MATERIAŁ I METODY: Badaniem objęto 52 chorych (100%) z mechanicznymi powikłaniami ostrego zawału serca, hospitalizowanych w II Oddziale Kardiologii oraz Oddziale Anestezjologii i Intensywnej Terapii Górnośląskiego Centrum Medycznego w Katowicach w latach 2006–2016, wtym 23 kobiety (44,2%) i 29 mężczyzn (55,8%) w wieku 54‒84 lat (średnia wieku 69,8 roku). WYNIKI: Najczęstszym powikłaniem było pęknięcie przegrody międzykomorowej (n = 36; 69,2%), natomiast do najrzadszych należały pęknięcie mięśnia brodawkowatego (n = 4; 7,7%) i pęknięcie ścięgien (n = 4; 7,7%). Nadciśnienie i hipercholesterolemia były najczęstszymi czynnikami ryzyka wystąpienia choroby niedokrwiennej serca w badanej grupie. Zwiększoną śmiertelność zaobserwowano u pacjentów leczonych farmakologicznie (87,5%), podczas gdy śmiertelność pacjentów leczonych operacyjnie wynosiła 61,4%. U większości pacjentów występował jeden czynnik ryzyka choroby wieńcowej (n = 28; 53,8%). WNIOSKI: 1. Najczęstszymi powikłaniami były pęknięcie przegrody międzykomorowej i pęknięcie ściany serca. 2. U pacjentów występowało wiele czynników ryzyka dla choroby niedokrwiennej serca, spośród których najczęstszymi były nadciśnienie i hipercholesterolemia. 3. Śmiertelność w badanej grupie chorych z mechanicznymi powikłaniami ostrego zawału serca znacznie przewyższała przeżywalność i była większa w grupie leczonych zachowawczo.
EN
In recent decades a significant raise in the incidence of myocardial infarction among young women has been recorded. It is presumed that, apart from the classical risk factors, other reasons exist for premature atherosclerosis in young women, related to the homeostasis of gonadal hormones. The aim of the study was to analyze the levels of gonadal hormones (estradiol, progesterone, follicle-stimulating hormone, luteinizing hormone, testosterone and dehydroepiandrosterone) measured in the luteal phase, in 65 normally menstruating women post myocardial infarction (MI) and to investigate a possible relationship between the hormone profile and selected coronary artery disease (CAD) risk factors. The levels of gonadal hormones: estradiol, progesterone, follicle-stimulating hormone, luteinizing hormone, testosterone and dehydroepiandrosterone were measured in the luteal phase. All examined women had normal mean levels of gonadal hormones. In the post MI patients leading a sedentary life style, a significantly lower mean progesterone concentration was observed (16.29 ± 9.11 versus 29.43 ± 21.14 nmol/l, p < 0.05) and significantly higher mean testosterone concentration (2.34 ± 0.98 versus 1.76 ± 1.09 nmol/l, p < 0.05) when compared to patients from the same group, but leading a more active life. In obese post MI women (BMI ≥ 30 kg/m2) a lower mean concentration of progesterone was detected (18.02 ± 8.12 versus 26.16 ± 14.72 nmol/l, p < 0.05), than in slimmer patients from the same group. In post MI women with a positive family history for CAD, a significantly higher mean concentration of testosterone was detected (2.31 ± 1.22 versus 1.67 ± 0.74 nmol/l, p < 0.05) than in patients with no family history. The results suggest a correlation between levels of gonadal hormones and classical CAD risk factors.
10
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EN
Ischemic heart diseases are the leading cause of morbidity and mortality in developed countries, despite advances in cardiac care over the last few decades. Myocardial infarction is a complex, multifactorial disorder that is thought to be due to interactions between genetic and environmental factors. Recent rapid advances in molecular genetics techniques have identified a number of common genetic variants loosely associated with myocardial infarction, and highly promising, newly designed platforms should identify less common genetic variants with an even greater clinical impact. These discoveries have brought us to a stage at which we need to begin to consider how personalised genomic information should be incorporated into clinical practice in order to benefit individuals and society in general.
11
100%
EN
The aim of the study was to investigate the relationship between posttraumatic growth, which was a consequence of experienced traumatic event and the level of satisfaction with life. The study group consists of 86 person (62 men and 24 women), aged 36-87 (M = 60,5; SD = 10,05), who experienced myocardial infarction. Half of them participated in rehabilitation program. Two methods were used in the study: Life Satisfaction Questionnaire and Posttraumatic Growth Inventory. The results revealed poor relationship between positive changes aftermath trauma and life satisfaction. The overall score of Life Satisfaction Questionnaire correlates only with positive changes in relations to others. These changes appeared the main predictor of satisfaction with life among persons with myocardial infarction.
EN
INTRODUCTION: Acute myocardial infarction with ST segment elevation in the inferior leads suggests an acute occlusion of the right coronary artery (RCA). Occlusion of the left anterior descending artery (LAD) usually causes ST segment elevation in the precordial leads and reciprocal ST segment depression in the inferior leads. But ST segment elevation in the inferior leads due to occlusion of the LAD is uncommon. MATERIAL AND METHODS: It’s the clinical case of 60-year-old previously healthy man presented inferior STEMI. Physical examination, urgent coronarography, some laboratory and instrumental tests were performed. RESULTS: A 60-year-old previously healthy man presented to an outpatient clinic with complaints of intensive burning retrosternal chest pain with irradiation to the left hand that had started half an hour before.ECG revealed ST segment elevation in leads II, III, aVR, aVF, V4-V6 and reciprocal ST segment depression in the lead aVL.Coronary angiography was performed: there was left coronary artery dominance, RCA was intact, subocclusion of the proximal LAD was found; “slow flow” phenomenon was noted. A drug-eluting stent was introduced into the proximal LAD. CONCLUSIONS: Inferior acute myocardial infarction can be caused by untypical branch of coronary artery and it’s belongs to rare clinical cases.
PL
WSTĘP: Ostry zespół wieńcowy z uniesieniem odcinka ST w odprowadzeniach znad ściany dolnej sugeruje ostrą niedrożność prawej tętnicy wieńcowej (RCA - right coronary artery). Zwężenie lewej przedniej tętnicy zstępującej (LAD - left anterior descending) zwykle powoduje uniesienie odcinka ST w odprowadzeniach przedsercowych i jednoczesne obniżenie odcinka ST w odprowadzeniach znad ściany dolnej. Ale uniesienie odcinka ST w odprowadzeniach znad ściany dolnej z powodu niedrożności LAD jest rzadkie. MATERIAŁ I METODY: Klinicznym przypadkiem 60-letniego wcześniej zdrowego mężczyzny był OZW STEMI ściany dolnej. Wykonano badanie fizykalne, pilną koronarografię, wybrane testy laboratoryjne i instrumentalne. WYNIKI: 60-letni wcześniej zdrowy mężczyzna zgłosił się do kliniki zgłaszając silny piekący ból w klatce piersiowej promieniujący do lewej ręki, który rozpoczął się pół godziny wcześniej. EKG wykazało uniesienie odcinka ST w odprowadzeniach II, III, aVR , aVF, V4-V6 i obniżenie odcinka ST w odprowadzeniu aVL. Wykonano angiografię tętnic wieńcowych: pozostawiono dominację lewej tętnicy wieńcowej, RCA była nienaruszona, znaleziono niedrożność proksymalneh LAD. Odnotowano zjawisko „wolnego przepływu”. Stent uwalniający i lek wprowadzono do proksymalnej LAD. WNIOSKI: Ostry zespół wieńcowy ściany dolnej może być spowodowany nietypowo niedrożnością gałęzi tętnicy wieńcowej LAD i należy do rzadkich przypadków klinicznych.
13
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EN
Stem cells are self-renewing cells that can differentiate into specialized cell type(s). Pluripotent stem cells, i.e. embryonic stem cells (ESC) or induced pluripotent stem cells (iPSC) differentiate into cells of all three embryonic lineages. Multipotent stem cells, like hematopoietic stem cells (HSC), can develop into multiple specialized cells in a specific tissue. Unipotent cells differentiate only into one cell type, like e.g. satellite cells of skeletal muscle. There are many examples of successful clinical applications of stem cells. Over million patients worldwide have benefited from bone marrow transplantations performed for treatment of leukemias, anemias or immunodeficiencies. Skin stem cells are used to heal severe burns, while limbal stem cells can regenerate the damaged cornea. Pluripotent stem cells, especially the patient-specific iPSC, have a tremendous therapeutic potential, but their clinical application will require overcoming numerous drawbacks. Therefore, the use of adult stem cells, which are multipotent or unipotent, can be at present a more achievable strategy. Noteworthy, some studies ascribed particular adult stem cells as pluripotent. However, despite efforts, the postulated pluripotency of such events like "spore-like cells", "very small embryonic-like stem cells" or "multipotent adult progenitor cells" have not been confirmed in stringent independent studies. Also plasticity of the bone marrow-derived cells which were suggested to differentiate e.g. into cardiomyocytes, has not been positively verified, and their therapeutic effect, if observed, results rather from the paracrine activity. Here we discuss the examples of recent studies on adult stem cells in the light of current understanding of stem cell biology.
EN
INTRODUCTION: Acute coronary syndromes are one of the leading causes of death due to cardiovascular diseases. The diagnosis is made on the basis of the clinical picture, ECG record and laboratory tests. Diagnosis of critical myocardial ischemia in pre-hospital conditions is a challenge for emergency medical teams. MATERIAL AND METHODS: In order to determine the level of knowledge and the ability to recognize and deal with patients with acute coronary syndrome tests were carried out among fifty employees of the emergency medical service (doctors, nurses and paramedics) in the region of central Poland. Statistical analysis was carried out using the normality test of the Shapiro-Wilk distribution and non-parametric chi-square test of independence. The results were considered significant at the level p < 0,05. RESULTS: In the field of diagnostics, doctors obtained the result of 73.20% (SD ± 32.23), paramedics: 52.00% (SD ± 24.51), and nurses: 30.00% (SD ± 13.75). Correct treatment was best implemented by paramedics who obtained an average of 51.11% (SD ± 34.98). In turn, doctors gave 49.33% (SD ± 39.05) correct answers, and nurses 43.22% (SD ± 34.17). There was no statistical dependence of the test results on the profession (ᵡ² = 1.13; p> 0.05), nor being the head of the emergency medical team (ᵡ² = 0,43; p>0,05). CONCLUSIONS: The level of preparation of ambulance service personnel in the field of identifying and dealing with patients with suspected acute coronary syndrome is insufficient. Further research is indicated indicating the greatest substantive deficiencies of emergency doctors, paramedics and emergency nurses to implement the necessary professional development.
PL
WSTĘP: Ostre zespoły wieńcowe są jedną z głównych przyczyn zgonów z powodu chorób sercowo-naczyniowych. Diagnozę stawia się na podstawie obrazu klinicznego, zapisu ekg oraz badań laboratoryjnych. Rozpoznanie krytycznego niedokrwienia mięśnia sercowego w warunkach przedszpitalnych stanowi wyzwanie dla zespołów ratownictwa medycznego. MATERIAŁ I METODY: W celu określenia poziomu wiedzy i umiejętności rozpoznawania oraz postępowania z pacjentem z ostrym zespołem wieńcowym przeprowadzono testy wśród pięćdziesięciu pracowników systemu Państwowego Ratownictwa Medycznego (lekarzy, pielęgniarek i ratowników medycznych) w rejonie centralnej Polski. Analizę statystyczną przeprowadzono za pomocą testu normalności rozkładu Shapiro-Wilka oraz testu nieparametrycznego chi-kwadrat niezależności. Wyniki uznano za istotne na poziomie p < 0,05. WYNIKI: W zakresie diagnostyki lekarze uzyskali wynik 73,20% (SD ± 32,23), ratownicy medyczni: 52,00% (SD ± 24,51), a pielęgniarki: 30,00% (SD ± 13,75). Poprawne postępowanie najlepiej potrafili wdrożyć ratownicy medyczni, którzy uzyskali średnią 51,11% (SD ± 34,98). Z kolei lekarze udzielili 49,33% (SD ± 39,05) poprawnych odpowiedzi, zaś pielęgniarki 43,22% (SD ± 34,17). Nie wykazano zależności statystycznej wyników testu z wykonywanym zawodem (ᵡ² = 1,13; p>0,05), ani pełnieniem funkcji kierownika zespołu ratownictwa medycznego (ᵡ² = 0,43; p>0,05). WNIOSKI: Poziom przygotowania personelu zespołów ratownictwa medycznego w zakresie rozpoznawania i postępowania z pacjentem z podejrzeniem ostrego zespołu wieńcowego jest niewystarczający. Wskazane są dalsze badania wskazujące na największe braki merytoryczne lekarzy systemu, ratowników medycznych i pielęgniarek systemu, aby wdrożyć niezbędne doskonalenie zawodowe.
EN
Relation between depression and myocardial infarction is known, but the mechanism that explains depression occurrence after myocardial infarction (AMI) is still unclear. The objective of this study was to review the literature to better understand the pathogenesis of post-myocardial infarction depression. Using a strategy similar to systematic review, we found experimental and clinical evidences. The post-myocardial infarction depression (PMID) has multiple causes such as psychological, biological dysfunctions or a combination of both. The inflammation of central nervous system and neurons destruction in specific regions of the brain resulted of AMI could be responsible to PMID, and it seems to be the main mechanism.
EN
Pretreatment with cyclosporine (CsA) decreases infarct size 24h after myocardial ischemia/reperfusion (I/R). The goal of this study was to determine effects of CsA pretreatment on long-term cardiac function after I/R-injury. Rats were randomly assigned to group1: vehicle-only, group2: CsA-5mg/kg/day, and group3: CsA-12.5mg/kg/day given orally for three days prior to I/R-injury (30 min of left anterior descending coronary artery occlusion). Post-I/R survival and cardiac function were evaluated 14 days after I/R-injury by echocardiography and invasive hemodynamic measurements. Rats with I/R-injury showed increased left ventricular pressure (LVEDP) compared to rats without I/R-injury (p<0.005). Although CsA initially decreased infarct size, no differences of LVEDP were seen 14 days after I/R-injury (vehicle: 21.2±8.9 mmHg, CsA-5mg/kg/day: 21.5±0.7 mmHg, CsA-12.5mg/kg/day: 20.5±9.4 mmHg). Ejection fraction and fractional shortening were decreased compared to baseline, but showed no differences between groups. On day 14, a dose-dependent increase in left ventricular end diastolic diameter was seen (p<0.001). CsA pretreatment was associated with a dose-dependent decrease in post-I/R-survival (vehicle: 56%, CsA-5mg/kg/day: 32%, CsA-12.5mg/kg/day: 16%; p=0.017). CsA pretreatment did not improve long-term cardiac function despite decreased infarct size 24h after I/R-injury, but increased post-I/R mortality significantly. Poor cardiac function after CsA pretreatment might be caused by left ventricular dilation.
EN
The study presents a case of a 66-year old male patient with coronary heart disease and a history of inferior wall myocardial infarction. During hospitalization the patient suddenly demonstrated symptoms of obstructive jaundice. The increasing intensity of these symptoms augmented the pre-existent coronary insufficiency, which was classified as stage 3 on the CCS scale. We encountered some circumstances, which rendered use of minimally invasive procedures impossible. Therefore, the patient was treated with combined therapy involving coronary artery bypass grafting on a beating heart, and evacuation of biliary stones followed by drainage of the biliary tract with the use of the T-drain (Kehr's method).
EN
Myocardial infarction (MI), usually referred as heart attack, takes place when blood circulation stops to specific portion of the heart resulting permanent damage to the heart muscles. It is an important task to identify the occurrence of MI from the ECG recordings efficiently. Most of the detection procedures include advanced signal processing methods, more ECG features and composite classifiers, making the overall procedure complex. This paper aims at automated identification of MI using modified Stockwell transform (MST) based time-frequency analysis and a phase information distribution pattern method. The morphologi-cal, pathological and temporal alterations in ECG waveforms resulting from the onset of MI are noticed in the phase distribution pattern of the ECG signal. Two discriminating features, utterly reflecting these alterations, are recognized for 12 leads of the MI affected ECG signal. Prior informations regarding the pathological characteristics of the specific disease are required for the correct detection of MI using few numbers of ECG leads. Thus, in this paper 12 lead ECG signals have been considered for identification of MI. The two-class classification problem with MI class and healthy individual class is performed using the threshold based classification regulation. Both healthy control and MI affected ECG signals are collected from the PTB diagnostic ECG database. The accuracy, sensitivity and specificity are found to be 99.93%, 99.97% and 99.30% for detection of MI. The proposed method has got the superiority in terms of simplicity of features, small feature dimension and simpler classification rule ensuring faster, accurate and easier MI detection.
EN
Introduction. Nowadays cardiovascular diseases, including myocardial infarction, are one of the most common disorders not only in Poland but also in highly developed countries. Cardiovascular diseases my lead to decline in quality of life. Aim. The aim of this study is to gain information on the assesment of quality of life in a rural area in people after myocardial infarction. Material and methods. A diagnostic survey and a questionnaire were used . A diagnostic survey on the assesment of the quality of life was used as a tool. The main research techniques in the diagnostic survey were: questionnaire and questionnaire-based interviews. Chi square test (Pearson's correlation test) was used in statistical analisys. Results. Based on the results obtained, it was concluded that the respondents' quality of life was assesed positively. Socio-demographic features such as: marital status, families' support, financial situation, place of residence are directly proportional and have significant impact on the assesment. Conclusions. In this study, patients assessed the quality of life after myocardial infarction positively. Patients who are married , supported by their families and friends presented a better quality of life. Analyses showed that coexistence of diabetes and atherosclerosis have also a great influence on patients' quality of life. However, arterial hypertension and obesity have no impact on the quality of life.
PL
Wstęp. W obecnych czasach choroby układu sercowo – naczyniowego, w tym zawał mięśnia sercowego, są najczęściej występującym schorzeniem zarówno w Polsce, jak i innych krajach wysokorozwiniętych. Może to prowadzić do spadku jakości życia takich chorych. Cel. Celem pracy jest uzyskanie informacji na temat oceny jakości życia osób w środowisku wiejskim po zawale mięśnia sercowego. Materiał i metody. W badaniach zastosowano metodę sondażu diagnostycznego. Jako technikę dla uzyskania zamiarów badawczych wybrano ankietę. Za narzędzie badawcze posłużył dla oceny jakości życia sondaż diagnostyczny. Do głównych technik badawczych stosowanych w metodzie sondażu diagnostycznego należą: technika ankiety i wywiad kwestionariuszowy. Do analizy statystycznej wykorzystano test niezależności chi – kwadrat (zwany inaczej testem Pearsona) służący sprawdzaniu hipotez. Wyniki. Na podstawie otrzymanych wyników i ich analizy stwierdzono, że jakość życia wśród respondentów jest oceniana pozytywnie. Czynniki socjodemograficzne takie jak: stan cywilny, wsparcie od najbliższych, sytuacja materialna, miejsce zamieszkania są wprost proporcjonalne i wywierają na tę ocenę istotny wpływ. Wnioski. Badani pacjenci ocenili pozytywnie jakość życia po zawale mięśnia sercowego. Pacjenci funkcjonujący w związkach, wspierani przez rodzinę i przyjaciół cechowali się lepszą jakością życia. Analizy wykazały, że czynnikami wpływającymi na jakość życia było również współwystępowanie cukrzycy i miażdżycy u chorych. Natomiast współwystępowanie nadciśnienia tętniczego i otyłości nie wykazały wpływu na jakość życia badanych.
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