Cardiac defibrillator implantation via persistent left superior vena cava – sometimes this approach is facile. A case report

We report a case of persistent left superior vena cava (PLSVC) incidentally recognized during the implantation of a cardioverter-defibrillator. PLSVC is the most common venous anomaly of the thorax and drains into the right atrium. There are a lot of publications reporting success of pacemaker or defibrillator lead implantations via PLSVC. In this article we present the technique of approaching the right ventricle and right atrium via PLSVC; sometimes this method can be as straightforward as the classical way. Therefore, if PLSVC is recognized intra-operatively, we suggest continuing left-sided implantation, and considering a right venous access only in case of failure

Kobieta w wieku 58 lat z bólem w klatce piersiowej

We present the case of a 58-year-old woman with suspected myocardial infarction. Coronarography did not reveal changes in coronary arteries. Laboratory tests revealed increases in troponin and inflammation parameters, and therefore MRI was performed. This showed subendocardial ischaemic necrosis with organ viability preservation in the heart muscle. As a result, myocardial infarction with non obstructive coronary arteries (MINOCA) was diagnosed.Przedstawiono opis przypadku 58-letniej pacjentki z podejrzeniem zawału serca. Weryfikacja koronarograficzna niepotwierdziła zmian w naczyniach wieńcowych. Ze względu na wzrost parametrów stanu zapalnego i markerów martwicymięśnia sercowego w badaniach laboratoryjnych wykonano badanie rezonansu magnetycznego serca, na którym uwidoczniono podwsierdziowe ogniska martwicy z zachowaniem żywotności w mięśniu sercowym, co pozwoliło rozpoznaćzawał serca bez zmian w naczyniach wieńcowych (MINOCA)

Nuclear Pedigree Criteria for the Identification of Individuals Suspected to be at Risk of an Inherited Predisposition to Renal Cancer

Renal clear cell carcinomas represent about 3% of all visceral cancers and account for approximately 85% of renal cancers in adults. Environmental and genetic factors are involved in the development of renal cancer. Although to date there are 19 hereditary syndromes described in which renal cell cancer may occur, only four syndromes with an unequivocal genetic predisposition to renal cell carcinoma have been identified: VHL syndrome (mutations in the VHL gene), hereditary clear cell carcinoma (translocations t(3:8), t(2:3)), hereditary papillary carcinoma (mutations in the MET protooncogene) and tuberous sclerosis (mutations in the TSC1 and TSC2 genes). Little is known genetically about the other forms of familial renal cell cancer. Since there is a growing awareness about the necessity of early intervention, clinical criteria have been developed that aid in the identification of hereditary forms of renal cancer. The aim of the current study was to identify minimal inclusion criteria so that nuclear pedigree families can be ascertained for risk assessment and/or kidney tumour screening. The results reveal that inclusion features described herein, such as (a) renal clear cell cancer diagnosed before 55 years of age, and (b) renal clear cell cancer and gastric cancer or lung cancer among first degree relatives, are useful in identifying suspected hereditary clear cell renal cancer patients

Idiosynkratyczna reakcja na kontrast podczas koronarografii pod postacią hipertermii oraz afazji czuciowo-ruchowej

The paper presents a case of 67-year-old man in whom coronarography was performed after positive exercise electrocardiography. During the angiography, extremely rare contrast reaction occured. Within the next few hours patient’s clinical condition deteriorated significantly, so that he required special and atypical treatment. Finally, the patient recovered completely without any neurological or other deficits.W pracy zaprezentowano przypadek 67-letniego pacjenta, poddanego badaniu koronarograficznemu poprzedzonemu dodatnią elektrokardiograficznie próbą wysiłkową. Po badaniu angiograficznym u chorego wystąpiła niezwykle rzadko spotykana reakcja uczuleniowa na środek kontrastowy. W ciągu kilku godzin doszło do znacznego pogorszenia stanu klinicznego, który po zastosowaniu niestandardowego leczenia wycofał się, nie pozostawiając neurologicznych ani innych ubytków na zdrowiu

The assessment of reversibility in airway obstruction

In the medical literature there have been described some methods to determine bronchodilator response. They are different because of the required percentage increase in FEV1 and /or FVC and the way of expressing results -as the percent of predicted or initial value. This study on 38 subjects evaluated that there is better bronchodilator responses when the results are presented as the percentage of the initial value compared with the predicted value. The intensivity of impovement in FEV1 depends on the baseline airway obstruction. There are more meaningfull responses in subjects with ’poor’ initial value when using the criteria of change in FEV1 as a percentage of initial value. About 10% of positive responses are misunderstood as ‘poor’ when it was considered improvement only in FEV1 (they are positive with reference only to FVC). Pneumonol. Alergol. Pol. 2004, 72, 499:50

Geometry of the X-ray source 1H 0707–495

Aims. We investigate the constraints on the size and location of the X-ray source in 1H 0707–495 determined from the shape of the relativistically smeared reflection from the accretion disc. Methods. We developed a new code to model an extended X-ray source and we applied this code to all archival XMM observations of 1H 0707–495. Results. In contrast to earlier works we find that the relativistic reflection in this source is not consistent with an extended uniform corona. Instead, we find that the X-ray source must be very compact, at most a gravitational radius in size, and located at most a few gravitational radii from the black-hole horizon. A uniform extended corona produces an emissivity that is similar to a twice-broken power-law, but the inner emissivity is fixed by the source geometry rather than being a free parameter. In 1H0707–495, the reflection from the inner disc is much stronger than expected for a uniformly extended source. Including the effect of ionised absorption from the wind does not change this conclusion, but including scattered emission (and more complex absorption) from the wind can dramatically change the reflection parameters