Fungal endocarditis complicated by shock in the course of long-term permanent cardiac pacing

The case is presented of a 52-year-old female patient who was diagnosed as having fungal endocarditis due to the Mucor species infection. The patient had had permanent cardiac pacing for 23 years. She was admitted to the hospital with symptoms of sepsis, and TTE revealed the development of vegetations on the pacemaker leads. Cardiac surgery with removal of the infected system was performed and a new pacemaker with an epicardial lead was implanted. After the surgery the patient’s clinical course was complicated by multiple organ dysfunction syndrome and septic shock, which was resistant to traditional treatment. Administration of human recombinant activated protein C (Xigris) improved organ function and enabled selective antifungal therapy to be continued. The patient was discharged from hospital 48 days later in a good condition

Grzybicze zapalenie wsierdzia w przebiegu wieloletniej stymulacji serca powikłane wstrząsem septycznym

W niniejszej pracy przedstawiono przypadek 52-letniej kobiety z grzybiczym zapaleniem wsierdzia wywołanym grzybami pleśniowymi z gatunku Mucor species. Pacjentce 23 lata wcześniej wszczepiono układ stymulujący serce. Chorą przyjęto do szpitala z objawami posocznicy, a w przezprzełykowym badaniu echokardiograficznym stwierdzono wegetacje na elektrodach stymulatora. Wykonano zabieg kardiochirurgiczny; usunięto cały układ stymulujący oraz implantowano nowy z elektrodami nasierdziowymi. Po zabiegu operacyjnym rozwinął się wstrząs septyczny z objawami dysfunkcji wielonarządowej opornej na tradycyjne leczenie. Zastosowanie ludzkiego rekombinowanego białka C (Xigris) poprawiło czynność niewydolnych organów i umożliwiło dalsze celowane leczenie przeciwgrzybicze. Po 48 dniach leczenia pacjentkę wypisano do domu w stanie dobrym

Freedom of Information

OBJECTIVE: It has previously been shown that a combination of inhaled nitric oxide (iNO) and intravenous (IV) steroid attenuates endotoxin-induced organ damage in a 6-hour porcine endotoxemia model. We aimed to further explore these effects in a 30-hour model with attention to clinically important variables. DESIGN: Randomized controlled trial. SETTING: University animal laboratory. SUBJECTS: Domestic piglets (n = 30). INTERVENTIONS: Animals were randomized into 5 groups (n = 6 each): 1) Controls, 2) LPS-only (endotoxin/lipopolysaccharide (LPS) infusion), 3) LPS + iNO, 4) LPS + IV steroid, 5) LPS + iNO + IV steroid. MEASUREMENTS AND MAIN RESULTS: Exposure to LPS temporarily increased pulmonary artery mean pressure and impeded renal function with elevated serum creatinine and acidosis compared to a control group over the 30-hour study period. Double treatment with both iNO and IV steroid tended to blunt the deterioration in renal function, although the only significant effect was on Base Excess (p = 0.045). None of the LPS + iNO + IV steroid treated animals died during the study period, whereas one animal died in each of the other LPS-infused groups. CONCLUSIONS: This study suggests that combined early therapy with iNO and IV steroid is associated with partial protection of kidney function after 30 hours of experimental LPS infusion

The usefulness of optical coherence tomography in a patient on antiplatelet therapy and requiring surgery

Establishing a balance between the risk of stent thrombosis and the risk of perioperative bleeding in patients treatedwith dual antiplatelet therapy remains a major therapeutic challenge. We report a case of 60-year-old man after stent implantation in left main coronary artery and requiring urgent operative treatment. The result of optical coherence tomography helped us to decide about further proceeding and is an example of a very helpful application of this new imaging technique in everyday practice.Establishing a balance between the risk of stent thrombosis and the risk of perioperative bleeding in patients treatedwith dual antiplatelet therapy remains a major therapeutic challenge. We report a case of 60-year-old man after stent implantation in left main coronary artery and requiring urgent operative treatment. The result of optical coherence tomography helped us to decide about further proceeding and is an example of a very helpful application of this new imaging technique in everyday practice

Przypadkowe umieszczenie elektrody stymulatora w lewej komorze serca - powikłanie rzadkie, czy rzadko rozpoznawane?

Przypadkowe umieszczenie elektrody stymulatora w lewej komorze serca jest rzadko rozpoznawanym powikłaniem elektrostymulacji. Najczęściej elektroda wewnątrzsercowa przemieszcza się przez przegrodę międzyprzedsionkową lub przetrwały otwór owalny do lewego przedsionka i przez zastawkę dwudzielną do lewej komory serca. W zapisie EKG stymulacja lewej komory prowadzi do powstania wystymulowanych zespołów QRS o kształcie całkowitego bloku prawej odnogi pęczka Hisa. Na podstawie zdjęcia RTG klatki piersiowej można podejrzewać nietypowy przebieg elektrody, ale decydujące znaczenie dla rozpoznania ma badanie echokardiograficzne, zwłaszcza przezprzełykowe. Nieprawidłowe położenie elektrody w lewej komorze serca wiąże się z dużym ryzykiem powikłań zakrzepowo-zatorowych. Leczenie polega na usunięciu nieprawidłowo położonej elektrody z lewej komory lub zastosowaniu przewlekłej terapii przeciwzakrzepowej. W pracy opisano 2 przypadki nieprawidłowego umieszczenia elektrody komorowej stymulatora w lewej komorze serca. (Folia Cardiol. 2003; 10: 231–236

Przypadkowe umieszczenie elektrody stymulatora w lewej komorze serca - powikłanie rzadkie, czy rzadko rozpoznawane?

Przypadkowe umieszczenie elektrody stymulatora w lewej komorze serca jest rzadko rozpoznawanym powikłaniem elektrostymulacji. Najczęściej elektroda wewnątrzsercowa przemieszcza się przez przegrodę międzyprzedsionkową lub przetrwały otwór owalny do lewego przedsionka i przez zastawkę dwudzielną do lewej komory serca. W zapisie EKG stymulacja lewej komory prowadzi do powstania wystymulowanych zespołów QRS o kształcie całkowitego bloku prawej odnogi pęczka Hisa. Na podstawie zdjęcia RTG klatki piersiowej można podejrzewać nietypowy przebieg elektrody, ale decydujące znaczenie dla rozpoznania ma badanie echokardiograficzne, zwłaszcza przezprzełykowe. Nieprawidłowe położenie elektrody w lewej komorze serca wiąże się z dużym ryzykiem powikłań zakrzepowo-zatorowych. Leczenie polega na usunięciu nieprawidłowo położonej elektrody z lewej komory lub zastosowaniu przewlekłej terapii przeciwzakrzepowej. W pracy opisano 2 przypadki nieprawidłowego umieszczenia elektrody komorowej stymulatora w lewej komorze serca. (Folia Cardiol. 2003; 10: 231–236

The analgesic efficiency of transversus abdominis plane (TAP) block after caesarean delivery

Objectives: The ultrasound-guided transversus abdominis plane (TAP) block is a supporting method of pain relief after different types of surgical and gynecological procedures. The aim of the present study was to evaluate the analgesic effects of the TAP-block in patients undergoing caesarean section. Material and methods: 88 women undergoing elective caesarean section under spinal anaesthesia were prospectively randomized into two groups. In the first group, an ultrasound-guided bilateral TAP block was performed using 40 mL 0.25% bupivacaine, while the second group was treated without a regional nerve block. Both groups received a standard analgesia protocol with intravenous paracetamol administered every 6 hours and intravenous tramadol on-demand, delivered using the Patient Controlled Analgesia (PCA) method. Pain intensity was assessed according to the visual analogue scale (VAS) directly after the TAP block and at 3, 6 and 12 hours postoperatively. Any patient complaints and side-effects during the postoperative period were recorded. Results: The TAP block resulted in a significant reduction of pain intensity using the visual analogue scale after 3, 6 and 12 hours (p < 0.05) and a significant decrease in tramadol administration (p < 0.05) during the first 12 hours postoperatively. No significant differences in the heart rate and blood pressure were noted between groups (p > 0.05). There were no complications related to the TAP block. Conclusions: The TAP block is a safe and effective adjunctive method of pain relief after caesarean delivery

Exploring combinations of different color and facial expression stimuli for gaze-independent BCIs

Background: Some studies have proven that a conventional visual brain computer interface (BCI) based on overt attention cannot be used effectively when eye movement control is not possible. To solve this problem, a novel visual-based BCI system based on covert attention and feature attention has been proposed and was called the gaze-independent BCI. Color and shape difference between stimuli and backgrounds have generally been used in examples of gaze-independent BCIs. Recently, a new paradigm based on facial expression changes has been presented, and obtained high performance. However, some facial expressions were so similar that users couldn't tell them apart, especially when they were presented at the same position in a rapid serial visual presentation (RSVP) paradigm. Consequently, the performance of the BCI is reduced. New Method: In this paper, we combined facial expressions and colors to optimize the stimuli presentation in the gaze-independent BCI. This optimized paradigm was called the colored dummy face pattern. It is suggested that different colors and facial expressions could help users to locate the target and evoke larger event-related potentials (ERPs). In order to evaluate the performance of this new paradigm, two other paradigms were presented, called the gray dummy face pattern and the colored ball pattern. Comparison with Existing Method(s): The key point that determined the value of the colored dummy faces stimuli in BCI systems was whether the dummy face stimuli could obtain higher performance than gray faces or colored balls stimuli. Ten healthy participants (seven male, aged 21–26 years, mean 24.5 ± 1.25) participated in our experiment. Online and offline results of four different paradigms were obtained and comparatively analyzed. Results: The results showed that the colored dummy face pattern could evoke higher P300 and N400 ERP amplitudes, compared with the gray dummy face pattern and the colored ball pattern. Online results showed that the colored dummy face pattern had a significant advantage in terms of classification accuracy (p < 0.05) and information transfer rate (p < 0.05) compared to the other two patterns. Conclusions: The stimuli used in the colored dummy face paradigm combined color and facial expressions. This had a significant advantage in terms of the evoked P300 and N400 amplitudes and resulted in high classification accuracies and information transfer rates. It was compared with colored ball and gray dummy face stimuli

The relationship between the time of cerebral desaturation episodes and outcome in aneurysmal subarachnoid haemorrhage: a preliminary study.

In this preliminary study we investigated the relationship between the time of cerebral desaturation episodes (CDEs), the severity of the haemorrhage, and the short-term outcome in patients with aneurysmal subarachnoid haemorrhage (aSAH). Thirty eight patents diagnosed with aneurysmal subarachnoid haemorrhage were analysed in this study. Regional cerebral oxygenation (rSO2) was assessed using near infrared spectroscopy (NIRS). A CDE was defined as rSO2 < 60% with a duration of at least 30 min. The severity of the aSAH was assessed using the Hunt and Hess scale and the short-term outcome was evaluated utilizing the Glasgow Outcome Scale. CDEs were found in 44% of the group. The total time of the CDEs and the time of the longest CDE on the contralateral side were longer in patients with severe versus moderate aSAH [h:min]: 8:15 (6:26-8:55) versus 1:24 (1:18-4:18), p = 0.038 and 2:05 (2:00-5:19) versus 0:48 (0:44-2:12), p = 0.038. The time of the longest CDE on the ipsilateral side was longer in patients with poor versus good short-term outcome [h:min]: 5:43 (3:05-9:36) versus 1:47 (0:42-2:10), p = 0.018. The logistic regression model for poor short-term outcome included median ABP, the extent of the haemorrhage in the Fisher scale and the time of the longest CDE. We have demonstrated that the time of a CDE is associated with the severity of haemorrhage and short-term outcome in aSAH patients. A NIRS measurement may provide valuable predictive information and could be considered as additional method of neuromonitoring of patients with aSAH