Paraneoplastic syndromes in rheumatology

Zespoły paranowotworowe są to objawy lub zespoły objawów towarzyszące chorobie nowotworowej, które często ustępują po skutecznym wyleczeniu nowotworu. Przyczyny zespołów paranowotworowych nie zostały w pełni poznane. Mechanizmy związane są z nieprawidłowym wydzielania hormonów lub cytokin, a także z wytwarzaniem przeciwciał skierowanych przeciw nowotworowi. Najczęstsze zespoły paranowotworowe objawiają się pod postacią zespołów neurologicznych, zaburzeń hematologicznych, zmian skórnych. Artykuł przedstawia związek nowotworów złośliwych z autoimmunologicznymi chorobami tkanki łącznej

Analytical electron microscopy investigation of topologically close-packed phases in CMSX-4 single crystal superalloy

In this work the topologically close-packed phases precipitated during annealing of CMSX-4 single-crystal superalloy at temperature 1100°C were investigated. Microstructural analyses were carried out by means of scanning- and transmission electron microscopy as well as scanning-transmission electron microscopy in high angle annular dark field mode. Chemical composition in nanoareas was determined using energy dispersive X-ray spectroscopy. Scanning electron microscopy investigation has shown that the topologically close-packed precipitates were formed already after 50 h of annealing at temperature 1000°C. With prolongation of the annealing time up to 2500 h the change of the morphology of topologically close-packed particles from blocky to needle-like occurred. Selected area electron diffraction analysis indicated that the topologically close-packed precipitates are the orthorhombic P phase. Quantitative energy dispersive X-ray spectroscopy analysis revealed that the topologically close-packed precipitates are enriched mostly in Re and W

Analytical electron microscopy studies of the CMSX–4 single crystal superalloy subjected to high temperature annealing

The aim of the present work is to investigate the development of the γ/γ' microstructure and the changes in chemical composition of γ and γ' phases during high temperature annealing of CMSX-4 superalloy at a temperature of 1100°C in the time range from 500 to 2500 h. The studies were performed by means of scanning electron microscopy and the modern scanning-transmission electron microscopy with Super-X EDS system of four SDD detectors. Results of scanning electron microscopy and scanning-transmission electron microscopy analyses have shown that the microstructure of CMSX-4 superalloy is unstable during ageing at high temperature and the coalescence of cuboidal γ' precipitates was observed. Energy dispersive X-ray microanalysis revealed the distribution of particular alloying elements in the γ and γ' phases and the differences in their concentration in the function of the annealing time

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Paraneoplastic syndromes in rheumatology

Zespoły paranowotworowe są to objawy lub zespoły objawów towarzyszące chorobie nowotworowej, które często ustępują po skutecznym wyleczeniu nowotworu. Przyczyny zespołów paranowotworowych nie zostały w pełni poznane. Mechanizmy związane są z nieprawidłowym wydzielania hormonów lub cytokin, a także z wytwarzaniem przeciwciał skierowanych przeciw nowotworowi. Najczęstsze zespoły paranowotworowe objawiają się pod postacią zespołów neurologicznych, zaburzeń hematologicznych, zmian skórnych. Artykuł przedstawia związek nowotworów złośliwych z autoimmunologicznymi chorobami tkanki łącznej. Forum Reumatol. 2018, tom 4, nr 2: 108–11

Calciphylaxis — pathogenesis and clinical picture

Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is a rare vascular disease caused by deposition of calcium salts in vessel walls, accompanied by coagulation disorders, which leads to extensive skin ulceration and soft tissue necrosis. Typical cases of calciphylaxis are usually described in patients with renal failure, though it is currently known that approx. 1/10th of all cases stem from other causes, including systemic inflammation, metabolic disorders and endocrine disorders. This article shows an overview of the most important pathophysiological phenomena which accompany calciphylaxis, characterizes the clinical picture of the disease and presents available approaches to therapeutic management. Forum Reumatol. 2019, tom 5, nr 1: 14–2

Comparison of radiation dose exposure in patients undergoing percutaneous coronary intervention vs. peripheral intervention

Introduction: Most endovascular techniques are associated with patient and personal exposure to radiation during the procedure. Ionising radiation can cause deterministic effects, such as skin injury, as well as stochastic effects, which increase the longterm risk of malignancy. Endovascular operators need to be aware of radiation danger and take all necessary steps to minimise the risk to patients and staff. Some procedures, especially percutaneous peripheral artery revascularisation, are associated with increased radiation dose due to time-consuming operations. There is limited data comparing radiation dose during percutaneous coronary intervention (PCI) with percutaneous transluminal angioplasty (PTA) of peripheral arteries. Aim: To compare the radiation dose in percutaneous coronary vs. peripheral interventions in one centre with a uniform system of protection methods. Material and methods: A total of 352 patients were included in the study. This included 217 patients undergoing PCI (single and multiple stenting) and 135 patients undergoing PTA (in lower extremities, carotid artery, renal artery, and subclavian artery). Radiation dose, fluoroscopy time, and total procedural time were reviewed. Cumulative radiation dose was measured in gray (Gy) units. Results: The total procedural time was significantly higher in PTA (PCI vs. PTA: 60 (45–85) min vs. 75 (50–100) min), p < 0.001. The radiation dose for PCI procedures was significantly higher in comparison to PTA (PCI vs. PTA: 1.36 (0.83–2.23) Gy vs. 0.27 (0.13–0.46) Gy), p < 0.001. There was no significant difference in the fluoroscopy time (PCI vs. PTA: 12.9 (8.2–21.5) min vs. 14.4 (8.0–22.6) min), p = 0.6. The analysis of correlation between radiation dose and fluoroscopy time in PCI and PTA interventions separately shows a strong correlation in PCI group (r = 0.785). However, a weak correlation was found in PTA group (r = 0.317). Conclusions: The radiation dose was significantly higher during PCI in comparison to PTA procedures despite comparable fluoroscopy time and longer total procedure time in PTA. Fluoroscopy time is a reliable parameter to control the radiation dose exposure in coronary procedures. The increasing complexity of endovascular interventions has resulted in the increase of radiation dose exposure during PCI procedures

Wyniki odległe przezskórnych interwencji obwodowych w zakresie tętnic kończyn dolnych u chorych z ostrym zespołem wieńcowym i współistniejącą cukrzycą

Wstęp: Współwystępowanie cukrzycy i ostrych zespołów wieńcowych (OZW) jest częstym zjawiskiem. Obecność cukrzycy jest predyktorem niekorzystnego rokowania chorych po zabiegach przezskórnej angioplastyki tętnic kończyn dolnych (ang. percutaneous transluminal angioplasty, PTA). Cel: Porównanie bezpośrednich wyników leczenia chorych z cukrzycą i bez cukrzycy metodą przezskórnej interwencji wieńcowej (ang. percutaneous coronary intervention, PCI) oraz PTA w czasie tej samej hospitalizacji oraz określenie wyników leczenia w 12-miesięcznej obserwacji. Materiał i metody: Stu szesnastu chorych z OZW bez uniesienia odcinka ST zostało włączonych do prospektywnego rejestru w czasie badania w latach 2003–2009 w jednym centrum akademickim w Krakowie. Wyniki: Analizowano dane chorych, którzy przebyli procedury PCI i PTA w czasie jednego pobytu szpitalnego. Spośród tych chorych 16 (14%) miało rozpoznaną cukrzycę, pozostali nie byli leczeni z tego powodu [100 (86%)]. Obie grupy różniły się istotnie statystycznie ze względu na płeć i wywiad. W ciągu rocznej obserwacji 12,5% osób zmarło w grupie chorych na cukrzycę w przeciwieństwie do 2% zgonów w grupie chorych bez cukrzycy (p = 0,033). Cukrzyca okazała się również silnym czynnikiem konieczności wykonania ponownych interwencji przezskórnych w ciągu 12-miesięcznej obserwacji. Wnioski: Pacjenci z cukrzycą mieli bardziej obciążający wywiad chorobowy z licznymi chorobami towarzyszącymi. Obecność cukrzycy u chorych z OZW leczonych metodą PCI i PTA jest związana z istotnie pogorszonym przeżyciem w 12-miesięcznej obserwacji. Cukrzyca jest ponadto silnym predyktorem konieczności ponownych rewaskularyzacji przezskórnych.Background: Diabetes mellitus is a quite frequent comorbidity among patients with acute coronary syndromes (ACS). The presence of diabetes has also predicted poor outcome after lower limb percutaneous transluminal angioplasty (PTA). Aim: To determine outcomes of patients with and without diabetes mellitus treated with PCI and PTA at index hospital stay during a 12-month follow-up. Material and methods: There were 116 NSTACS (non ST elevation acute coronary syndromes) patients gathered in this prospective registry study in 2003-2009 in one academic center in Krakow, Poland. Results: Data on consecutive patients who underwent PTA and PCI procedure during the same hospital stay were analyzed. Of these, 16 (14%) had diabetes mellitus, the other 100 (86%) had no history of diabetes. Both groups differed significantly with regard to gender and past medical history. During one-year observation 12.5% patients died in diabetes group vs. 2% in non-diabetes group (p = 0.033). Diabetes mellitus has turned out to be a strong predictor of outcome measured by the occurrence of repeated percutaneous peripheral procedure in 12-month observation. Conclusions: Patients with diabetes mellitus have more aggravating past medical history with more frequently coexisting comorbidities. Diabetes mellitus in patients with ACS treated by PCI and PTA is associated with impaired 1-year survival. Diabetes itself is a strong predictor of repeated PTA procedures

Predictors of coronary and carotid atherosclerosis in patients with severe degenerative aortic stenosis

Background. Patients with degenerative aortic stenosis (AS) exhibit elevated prevalence of coronary artery disease (CAD) and internal carotid artery stenosis (ICAS). Our aim was to investigate prevalence of significant CAD and ICAS in relation to demographic and cardiovascular risk profile among patients with severe degenerative AS. Methods. We studied 145 consecutive patients (77 men and 68 women) aged 49-91 years (median, 76) with severe degenerative AS who underwent coronary angiography and carotid ultrasonography in our tertiary care center. The patients were divided into two groups according to the presence of either significant CAD (n=86) or ICAS (n=22). Results. The prevalence of significant CAD or ICAS was higher with increasing number of traditional risk factors (hypertension, hypercholesterolemia, diabetes, smoking habit) and decreasing renal function. We found interactions between age and gender in terms of CAD (p=0.01) and ICAS (p=0.06), which was confirmed by multivariate approach. With the reference to men with a below-median age, the prevalence of CAD or ICAS increased in men aged >76 years (89% vs. 55% and 28% vs. 14%, respectively), whereas the respective percentages were lower in older vs. younger women (48% vs. 54% and 7% vs. 17%). Conclusions. In severe degenerative AS gender modulates the association of age with coronary and carotid atherosclerosis with its lower prevalence in women aged >76 years compared to their younger counterparts. This may result from a hypothetical “survival bias”, i.e., an excessive risk of death in very elderly women with severe AS and coexisting relevant coronary or carotid atherosclerosis

Myśl i polityka: księga pamiątkowa dedykowana profesorowi Jackowi Marii Majchrowskiemu T. 3

Publikacja jubileuszowa z okazji 40-lecia pracy naukowej profesora Jacka Majchrowskieg