Technika „rota−DES” u pacjenta z ostrym zespołem wieńcowym bez uniesienia odcinka ST

Rotational atherectomy is a valuable technique complementary to PCI in complex calcified coronary artery stenoses. A case of a 65 year-old man with non-ST elevation acute myocardial infarction (NSTEMI) treated with PCI with rotational atherectomy followed by two drug eluting stents (DES) implantation is presented. Kardiol Pol 2011; 69, 8: 854–85

Microvascular abnormalities in capillaroscopy correlate with higher serum IL-18 and sE-selectin levels in patients with type 1 diabetes complicated by microangiopathy

Microvascular abnormalities are one of the most important causes of persistent diabetic complications. The aim of this study was to compare microvascular changes examined by nailfold capillaroscopy with serum concentrations of soluble E-selectin (sE-selectin) and IL-18 in type 1 diabetic patients with and without microangiopathy. Serum levels of sE-selectin and IL-18 were determined by an enzyme-linked immunosorbent assay in 106 patients with type 1 diabetes and in 40 healthy controls. All diabetic patients were evaluated by extensive clinical, laboratory and capillaroscopic studies. Morphological changes were observed by nailfold capillaroscopy in 86 out of 106 (81%) diabetic patients. Severe capillaroscopic changes were seen in 32 out of 54 (59%) patients with microangiopathy, but in only seven out of 52 (13%) patients without microangiopathy. Higher serum levels of sE-selectin (p < 0.001) and IL-18 (p < 0.05) were demonstrated in diabetic patients compared to controls. Significant differences of sE-selectin (p < 0.001) and IL-18 (p < 0.01) serum concentrations were observed between diabetic patients with microangiopathy and controls. Moreover, comparison between patients with and without microangiopathic complications showed a significantly higher capillaroscopic score and sE-selectin serum concentration in the group with microangiopathy (p < 0.001). Furthermore, diabetic patients with severe microvascular changes in capillaroscopy showed significantly higher IL-18 (p < 0.001) and sE-selectin (p < 0.05) serum levels than subgroups without changes or with mild abnormalities. Our findings suggest that abnormalities in nailfold capillaroscopy may reflect the extent of microvascular involvement and are associated with higher sE-selectin and IL-18 serum levels, as well as with microangiopathic complications in diabetic patients. <i>(Folia Histochemica et Cytobiologica 2011; Vol. 49, No. 1, pp. 104–110

Ostry zespół wieńcowy a epidemia COVID-19 — przypadek 85-letniej pacjentki ze świeżym zawałem ściany dolnej

85-year-old woman with a history of myocardial infarction treatedwith percutaneous left anterior descending intervention withdrug eluting stent (DES) implantation in 2004, was admitted tothe Department of Cardiology due to acute coronary syndrome.For about 10 days the patient has complained recurrent pain inthe right hypochondrium, radiating toward chest. Symptomswere accompanied by diarrhea. Moreover, the day beforehospital admission, patient developed fever up to 39˚C. Dueto the current epidemiological situation, the woman was afraidof coronavirus infection from the healthcare professionals aswell as other patients and she did not want see a doctor. Basedon the results of the additional tests, inferior wall myocardialinfarction was diagnosed. Coronary angiography revealed 90%stenosis within the right coronary artery, which was treatedwith angioplasty and DES implantation. There was no complicationsduring the procedure and the post-operative period.This clinical case shows a problem frequently encountered inthe recent months – patients’ fear of reporting to health carefacilities due to SARS-CoV-2 pandemic.Osiemdziesięciopięcioletnia pacjentka, po przebytym zawale serca, leczona angioplastyką gałęzi przedniej zstępującej z implantacją stentu DES w 2004 roku, została przyjęta do kliniki kardiologii z powodu ostrego zespołu wieńcowego. W wywiadzie chora podawała nasilające się od około 1,5 tygodnia bóle w prawym podżebrzu promieniujące do klatki piersiowej. Objawom towarzyszyła biegunka; ponadto dzień przed przyjęciem do szpitala pacjentka zagorączkowała do 39˚C. Z uwagi na panującą sytuację epidemiologiczną chora nie zgłaszała się do lekarza, obawiała się zakażenia koronawirusem od pracowników ochrony zdrowia oraz innych pacjentów. Na podstawie wyników badań dodatkowych rozpoznano świeży zawał ściany dolnej. W koronarografii uwidoczniono 90-procentowe zwężenie prawej tętnicy wieńcowej i jednoczasowo wykonano angioplastykę zwężonego naczynia z implantacją stentu uwalniającego lek. Zabieg i okres pozabiegowy przebiegły bez powikłań. Opisany przypadek kliniczny pokazuje często spotykany w ostatnich miesiącach problem – obawę pacjentów przed zgłaszaniem się do placówek ochrony zdrowia oraz zakażeniem SARS-CoV-2