Advanced COPD in a patient treated in the Intensive Care Unit

Chronic obstructive pulmonary disease (COPD) is the 3rd leading cause of death worldwide and 7th inthe classification of years of life lost or lived with disability. Indeed, COPD prevalence is still increasing.Moreover, chronic respiratory failure in advanced COPD is one of the most common indications for palliativecare. The deterioration of general health, including respiratory failure, raises many doubts as to theneed for hospitalization, prognosis and medical interventions. The decision to start palliative care provisionin COPD patients is based on poor prognosis, but it is not clear when it should be started. Properand specialized palliative care in this patient population can limit hospital, Intensive Care Unit (ICU), andemergency admissions.A case of a patient with advanced COPD receiving palliative care and the treatment in the ICU is presented.Due to pneumonia with permanent respiratory hypercapnia, the patient was hospitalized and qualified totracheostomy and invasive ventilation. In bronchofiberoscopy granulation tissue narrowing the airwaysbelow the tracheotomy tube, confirmed by the CT scan. The patient was qualified for rigid bronchofiberoscopyto widen the trachea. Antibiotic therapy with multidirectional pharmacological treatment wasprovided at the ICU. The patient was discharged home in a fairly good general condition, on his breathingwith passive oxygen therapy, periodically requiring assisted mechanical ventilation, without carbon dioxideretention, and with effective cough reflexes. Mechanical causes of respiratory failure in ventilated advancedCOPD patients should be considered. Short–time-intensive therapy treatment may improve the generalcondition of ventilated advanced COPD patients

Contrast-enhanced ultrasonography versus computed tomographic angiography in the monitoring of patients after endovascular repair of abdominal aortic aneurysm - preliminary experience

BACKGROUND: Computed tomographic angiography (CTA) is routinely used in the monitoring of patients after endovascular repair of abdominal aortic aneurysm. The aim of the study was to determine if contrast-enhanced ultrasonography (CEUS) provides equivalent results to CTA in detection of endo-leaks in patients after abdominal aortic stentgraft placement. MATERIAL AND METHODS: In a group of 7 patients (6 men and 1 woman; aged 71±7 years) after repair procedure, 16 CTA and 16 CEUS follow-up examinations were performed. Second-generation contrast agent (Sonovue) and low-mechanical index technique were used for ultrasonography imaging. RESULTS: Computed tomographic angiography showed seven cases of type I, five cases of type II, and no endo-leaks in four examinations. In 15 out of 16 studies, the results of CEUS were consistent with the results of CTA. In one discrepant study, type II endo-leak was detected with CEUS while CTA was negative. CONCLUSIONS: Contrast-enhanced ultrasonography and CTA examinations in patients after endovascular repair of abdominal aortic aneurysm provide comparable results. CEUS may be considered an alternative technique to CTA

Wolumetryczne badania struktur mózgowia metodą rezonansu magnetycznego u dzieci z zespołem Downa

Background and purpose Down syndrome (DS) is the most common genetic cause of mental retardation with deficits in language and memory. Mental retardation of varying degrees is the most consistent feature of DS. The objective of this study was to use high-resolution magnetic resonance imaging (MRI) techniques to investigate the volumes of the hippocampus, amygdala, and temporal and frontal lobes in children with DS compared with healthy children. Material and methods MRI of 49 patients was reviewed prospectively. The study included 23 children with DS (9 girls and 14 boys, mean age 6.7 ± 3.7 years) and 26 healthy children (11 girls and 15 boys, mean age 8.3 ± 2.4 years). Volumes of the right and left hippocampus, the right and left amygdala, temporal and frontal lobes and the total brain volume were measured by a radiologist who was unaware of the diagnosis. Results Total brain volume in children with DS was significantly lower compared with controls. It was associated with significantly lower volume of the frontal and temporal lobes. Children with DS had a significantly smaller right and left hippocampus volume and a significantly smaller right and left amygdala volume than did the control group. We also found a negative correlation between mental retardation and volume of the right hippocampus. Conclusions The presence of these abnormalities from an early age contributes to the specific cognitive and developmental deficits seen in children with DS.Wstęp i cel pracy Zespół Downa (ZD) jest najczęstszą genetyczną przyczyną upośledzenia umysłowego, deficytów mowy i pamięci. Upośledzenie umysłowe różnego stopnia to najbardziej stała cecha zespołu Downa. Celem pracy było wykorzystanie techniki badania rezonansu magnetycznego (RM) wysokiej rozdzielczości do porównania objętości hipokampów, ciał migdałowatych, płatów skroniowych i czołowych dzieci z ZD w porównaniu z dziećmi zdrowymi. Materiał i metody Ocenie poddano 49 badań RM. Badaniem objęto 23 dzieci z ZD (9 dziewczynek i 14 chłopców, średnia wieku: 6,7 ± 3,7 roku). Grupę kontrolną stanowiło 26 dzieci zdrowych (11 dziewczynek i 15 chłopców, średnia wieku: 8,3 ± 2,4 roku). Objętość prawego i lewego hipokampa, prawego i lewego ciała migdałowatego, płatów skroniowych i czołowych oraz całkowita objętość mózgu były mierzone manualnie przez radiologa nieznającego rozpoznania. Wyniki Całkowita objętość mózgu w grupie dzieci z ZD była istotnie mniejsza w porównaniu z grupą kontrolną. Wiązało się to z istotnie mniejszą objętością płatów czołowych i skroniowych. Grupa dzieci z ZD miała istotnie mniejszą objętość prawego i lewego hipokampa oraz prawego i lewego ciała migdałowatego w porównaniu z dziećmi zdrowymi. Wykazano jednocześnie ujemną korelację pomiędzy stopniem upośledzenia umysłowego a objętością prawego hipokampa. Wnioski Obecność opisanych zaburzeń od najmłodszych lat przyczynia się do konkretnych deficytów poznawczych i rozwojowych u dzieci z ZD

Porównanie przydatności 3D angio-TK z innymi metodami oceny morfologii tętniaka aorty brzusznej przed planowanym zabiegiem przezskórnej implantacji stent-graftu

Background: The purpose of this study was to examine the accuracy of diagnostic methods in the preoperative evaluation of abdominal aortic aneurysm before endovascular treatment. Material/Methods: During the period of January 2002-December 2004, 67 patients with AAA (42 diagnosed in the Department of Radiology of the Central Clinical Hospital of the Ministry of Internal Affairs and Administration and 25 patients diagnosed the in the Department of Radiology of Medical Academy in Bialystok) underwent ultrasonography, spiral CT with 3D reconstructions (3D CTA), and digital subtraction angiography (DSA) following treatment of aortoiliac aneurysms with endoluminal stentgrafts in 36 and 12 patients, respectively. Results/Conclusions: Our experience suggests that spiral computerized tomographic angiography with three-dimensional reconstruction (3D CTA) is a reliable, relatively noninvasive technique to assess the feasibility of endovascular aneurysm repair. DSA allows verification of the measurements from spiral computed scans, but it is a more invasive method than CTA. However, CTA with 3D reconstruction shows a diagnostic effectiveness similar to that of DSA. Thus it may be sufficient as a preoperative imaging technique when evaluating a patient for an endovascular graft procedure

Kardiomiopatia tako-tsubo - problem kliniczny

Kardiomiopatia tako-tsubo (KT) charakteryzuje się przejściową dysfunkcją skurczową koniuszka i środkowych segmentów ściany lewej komory, zmianami elektrokardiograficznymi jak w ostrych zespołach wieńcowych i brakiem zmian w tętnicach wieńcowych w badaniu koronarograficznym. Kardiomiopatia tako-tsubo stanowi 1-2% wstępnie rozpoznanych ostrych zespołów wieńcowych. Może być wywołana przez czynnik psychiczny lub fizyczny. W pracy przedstawiono przypadek KT u 58-letniej pacjentki w przebiegu zapalenia wyrostka robaczkowego. (Folia Cardiologica Excerpta 2010; 5, 5: 298-30

Przydatność kliniczna tomografii komputerowej w diagnostyce ubytku w przegrodzie międzyprzedsionkowej typu sinus venosus

We present a case of 51-year-old patient after surgical closure of atrial septal defect several years ago. Enlarged right ventricle, right atrium and pulmonary hypertension were found on routine transthoracic echocardiography. Transesophageal echocardiography revealed sinus venosus atrial septal defect. Partial anomalous pulmonary venous drainage was suspected. Only the computed tomography with contrast agent let us establish final diagnosis

Przydatność badania perfuzyjnego TK (p-TK) w ocenie przepływu mózgowego i autoregulacji u pacjentów ze zwężeniem tętnicy szyjnej wewnętrznej przed i po zabiegu operacyjnym lub stentowaniem : doniesienie wstępne

Background: Improvement of brain perfusion and disappearance o f neurological symptoms are the objective indicators of successful treatment of carotid stenosis. The perfusion CT technique is a component of a comprehensive evaluation o f blood flow in cerebropetal arteries and brain perfusion. Material/Methods: In the period of 2002-2004, perfusion CT exams were performed in 40 symptomatic patients being treated at our Surgery or Radiology Departments because o f one-sided internal carotid stenosis (more than 70%). The exams were performed before and after the surgical procedure (23 patients) or stenting (17 patients). rCBV, rCBF, MTT, and TTP were evaluated. Results: In a subgroup of 16 patients with carotid stenosis (less then 90%), a significant prolongation of MTT and a decrease in rCBF were observed in preoperative perfusion CT. In another subgroup of 24 patients with tight stenosis (more than 90%), changes in perfusion parameters ipsilateral to the stenosis were observed in every patient; MTT prolongation (by 35%) was the most profound change. In 14 patients in the critical stenosis subgroup which presented clinical symptoms (for at least 5 years), exams were performed after acetazolamide (Diamox) provocation to assess vascular autoregulation. The additional parameter of cerebrovascular reserve capacity (CRC) was introduced. In the evaluated group, 5 of the 14 patients presented complications, of which intracranial hemorrhage was the most severe. Mild symptoms of reperfusion syndrome in the subgroup of moderate stenosis occurred in one case only. Analysis of preoperative perfusion parameters revealed statistically significant increases in CBV and CBF as well as shortening of MTT and TTP ipsilaterally to the carotid stenosis. Conclusions: Perfusion CT is of significant importance in the evaluation of the effectiveness of procedures to restore carotid patency. Perfusion evaluation by means of autoregulation test (test with acetazolamide) enables prognosis of the course of the postoperative period in patients at risk of reperfusion syndrome

Surowce polifenolowe. Zastosowania i perspektywy

PRZEDMOWA: "Polifenole są metabolitami wtórnymi roślin i grzybów. Powszechnie występują w kwiatach, korze, korzeniach, łodygach, liściach i owocach roślin. Ich strukturę chemiczną charakteryzuje obecność dwóch lub więcej grup –OH przyłączonych do pierścieni aromatycznych. Do polifenoli zaliczamy lignany, kurkuminoidy, taniny, stilbenoidy, kwasy fenolowe oraz flawonoidy. Ta ostatnia klasa obejmuje: flawony (np. apigenina), flawanony (np. naringenina), flawonole (np. kwercetyna), flawanole (np. katechiny), izoflawony (np. genisteina), antocyjanidyny (np. malwidyna), chalkony (np. buteina), aurony (np. aureuzydyna) i ksantony (np. α-mangostyna). Do tej pory opisano ponad dziesięć tysięcy związków polifenolowych i wciąż nie poznano ich wszystkich. Właściwości polifenoli to temat intensywnie badany na całym świecie ze względu na możliwe wykorzystanie związków polifenolowych w medycynie, farmakologii, kosmetologii, rolnictwie, dietetyce i przemyśle."(...

Professional burnout among teachers. Causes of interest in the subject of burnout

Problem wypalenia zawodowego, stanowiący przedmiot licznych badań pedagogiki, psychologii i psychologii społecznej, dotyka znaczną część naszego społeczeństwa. Problematyka ta domaga się postawienia pytania o przyczyny tego stanu rzeczy, a zarazem o szukanie skutecznych, innowacyjnych sposobów zniwelowania jego patogennych dla życia indywidualnego i społecznego skutków. Przyczyn zjawiska wypalenia można upatrywać zarówno po stronie jednostki, jak i po stronie otoczenia. Najczęściej wymienia się tu: specyfikę własnych oczekiwań, doświadczenie kryzysu wartości, cechy osobowości, staż pracy, sytuację domową i ekonomiczną oraz inne. Istotne znaczenie dla niwelowania symptomów wypalenia ma poczucie optymizmu i poczucie humoru, poczucie własnej wartości i samoocena należące do cennych zasobów osobowych jednostki i strategii zaradczych w sytuacjach stresu zawodowego.The problem of occupational burnout, which is the subject of numerous studies in pedagogy, psychology and social psychology, affects a large part of our society. This issue calls for a question about the reasons for this state of affairs and, at the same time, for seeking effective and innovative ways to overcome its pathogenic effects on individual and social life. The reasons for the burnout phenomenon can be seen both on the side of the unit and on the side of the environment. The most frequent reasons are: specificity of own expectations, experience of the crisis of values, personality traits, seniority, domestic and economic situation, and others. The sense of optimism and sense of humor, self-esteem and self-esteem belonging to the valuable personal resources of the individual and remedial strategies in situations of occupational stress are important to minimizing symptoms of burnout

Tight Vector Bin Packing with Few Small Items via Fast Exact Matching in Multigraphs

We solve the Bin Packing problem in $O^*(2^k)$ time, where $k$ is the number of items less or equal to one third of the bin capacity. This parameter measures the distance from the polynomially solvable case of only large (i.e., greater than one third) items. Our algorithm is actually designed to work for a more general Vector Bin Packing problem, in which items are multidimensional vectors. We improve over the previous fastest $O^*(k! \cdot 4^k)$ time algorithm. Our algorithm works by reducing the problem to finding an exact weight perfect matching in a (multi-)graph with $O^*(2^k)$ edges, whose weights are integers of the order of $O^*(2^k)$. To solve the matching problem in the desired time, we give a variant of the classic Mulmuley-Vazirani-Vazirani algorithm with only a linear dependence on the edge weights and the number of edges, which may be of independent interest. Moreover, we give a tight lower bound, under the Strong Exponential Time Hypothesis (SETH), showing that the constant $2$ in the base of the exponent cannot be further improved for Vector Bin Packing. Our techniques also lead to improved algorithms for Vector Multiple Knapsack, Vector Bin Covering, and Perfect Matching with Hitting Constraints.Comment: ICALP 202