Metody profilaktyki żylnej choroby zakrzepowo-zatorowej u chorych w ostrej fazie udaru mózgu – aktualny stan wiedzy

Deep venous thrombosis (DVT) and its sequel, pulmonary embolism (PE), are serious complications of stroke. There are pharmacological and physical methods to prevent these complications. The authors review the literature and present the current state of knowledge regarding the effectiveness of each of the DVT and PE prevention methods in stroke patients and cite current Polish, European and American recommendations regarding this issue. Heparins are the method of choice for the prevention of venous thromboembolism in both ischaemic and haemorrhagic stroke patients.Zakrzepica żył głębokich kończyn i jej konsekwencja – zatorowość płucna, są poważnymi powikłaniami udaru mózgu. Istnieją farmakologiczne i fizyczne metody zapobiegania tym powikłaniom. Autorzy dokonują przeglądu piśmiennictwa i prezentują aktualny stan wiedzy na temat skuteczności każdej z metod stosowanych w profilaktyce zakrzepicy żył głębokich kończyn i zatorowości płucnej u chorych po udarze mózgu, a także cytują aktualne zalecenia polskie, europejskie i amerykańskie. Stosowanie heparyn jest metodą z wyboru w zapobieganiu powikłaniom zakrzepowo-zatorowym u unieruchomionych chorych z udarem mózgu, zarówno niedokrwiennym, jak i krwotocznym

Physical methods in the prophylaxis of thromboembolic complications in post-stroke patients

Wstęp. Powikłania zakrzepowo-zatorowe stanowią poważne następstwa unieruchomienia po udarze mózgu. Metody fizyczne stanowią skuteczną alternatywę dla antykoagulantów w prewencji zakrzepicy w niektórych grupach pacjentów. Celem artykułu jest przedstawienie aktualnych poglądów dotyczących tego zagadnienia. Poglądy. W prewencji zakrzepicy żył kończyn dolnych u pacjentów po udarze mózgu stosuje się różne metody farmakologiczne i mechaniczne. Pozycja metod farmakologicznych jest dobrze ugruntowana, jednak nie u wszystkich pacjentów po udarze metody te można zastosować. U pacjentów, u których nie można wykorzystać metod farmakologicznych zapobiegania zakrzepicy żył kończyn dolnych i jej kontinuum - zatorowości płucnej, techniki fizyczne mogą stanowić skuteczną alternatywę. Wnioski. Należy zapobiegać powikłaniom zakrzepowo-zatorowym u pacjentów po udarze mózgu. Znajomość i prawidłowe stosowanie metod fizycznych zapobiegania powikłaniom zakrzepowo-zatorowym pozwala zmniejszyć śmiertelność u pacjentów po udarze mózgu.Aim. Thromboembolic complications constitute a serious sequel to immobilisation after stroke. In some groups of patients, the physical methods used in the prevention of thrombosis have proven an effective alternative to anticoagulants. This article aims to present the current views on this issue. Views. Deep vein thrombosis in post-stroke patients may be prevented by both physical and pharmacological methods. The latter are well established, although they cannot be used in some post-stroke patients. Physical methods may be an effective alternative in the prevention of deep vein thrombosis and its sequel - pulmonary embolism - in patients for whom pharmacological methods are contraindicated. Conclusions. Prevention of thromboembolic complications is necessary in post-stroke patients. The knowledge and proper use of physical methods for the prophylaxis of thromboembolic complications in post-stroke patients facilitate a reduction in the mortality rate in this group of patients

Noninfectious complications of acute stroke and their impact on hospital mortality in patients admitted to a stroke unit in Warsaw from 1995 to 2015

Background Medical complications often worsen the prognosis after stroke. Our aim was to investigate the association between particular noninfectious complications and hospital mortality of acute stroke patients admitted to an urban Polish stroke center, and changes in their occurrence from 1995 to 2015. Methods This is a retrospective analysis of 5174 consecutive patients admitted for acute ischemic stroke or cerebral hemorrhage to a Polish urban stroke center between 1995 and 2015. The occurrence of complications was reported for years 1995–2000 (n=883), 2001–2006 (n=1567), 2006–2010 (n=1539) and 2011–2015 (n=1183). Odds ratios (OR) with 95% confidence interval (95% CI) for stroke unit death were calculated after adjustment for age, congestive heart failure (CHF), pre-existing disability, stroke type and baseline neurological deficit in three different time periods. Results Over time there was a significant decrease in the occurrence of myocardial infarction (MI) (2.2%, 1.4%, 1.0% and 0.3%, respectively), exacerbated CHF (4.6%, 5.1%, 2.6% and 2.0%) and deep vein thrombosis (DVT) (4.6%, 2.7%, 1.2% and 1.1%). Adjusted odds for stroke unit death were increased by myocardial infarction (MI) (OR 17.5, 95% CI: 8.5–35.7), exacerbated CHF (OR 15.0, 95% CI: 9.8–23.0), pulmonary embolism (PE) (OR 11.5, 95% CI: 6.1–21.6), gastrointestinal bleeding (OR 9.2, 95% CI: 4.4–18.9) and recurrent stroke (OR 5.4, 95% CI: 3.1–9.3). Conclusions Over the last two decades Polish urban stroke units may have achieved a significant reduction of the occurrence of some noninfectious complications (i.e. MI, exacerbated CHF and DVT). However, the list of conditions associated with stroke unit mortality includes not only MI and exacerbated CHF but also PE, gastrointestinal bleeding and recurrent stroke

Olfactory dysfunction in patients with Wilson’s Disease

Introduction. Many neurodegenerative disorders are associated with olfactory dysfunction (OD), but little is known about OD in Wilson’s Disease (WD). We evaluated olfactory function in patients with WD. Material and methods. OD was examined in 68 patients with WD and 70 sex- and age-matched healthy controls using subjective testing with ‘Sniffin Sticks’. Threshold discrimination identification (TDI) score and its three components (odour detection threshold, discrimination, and identification) were assessed. Results. Compared to controls, patients with WD had a significantly weaker sense of smell in terms of TDI (p < 0.01), odour discrimination (p < 0.01), and identification (p < 0.01), but not in terms of odour detection threshold (p = 0.27). Patients with predominantly neurological symptoms were characterised by greater OD by TDI (p < 0.01), odour detection threshold (p = 0.01), and discrimination (p = 0.03). The presence of pathological lesions (p = 0.04) in brain magnetic resonance imaging and generalised brain atrophy (p = 0.02) predisposed to worse TDI. In the WD group, weak inverse correlations between age and TDI score (r = –0.27), odour detection threshold (r = –0.3), and discrimination (r = –0.3) were found. Male gender was a risk factor for abnormal TDI in both WD and controls (both p = 0.02). Conclusions. Patients with WD, particularly older individuals, more frequently had OD than healthy volunteers. Predominantly neurological symptoms, and the presence of typical brain MRI changes, predisposed patients with WD to smell disorders

Early stroke-related deep venous thrombosis: risk factors and influence on outcome

Deep venous thrombosis (DVT) is a serious complication of various medical conditions including acute stroke. Our aim was to identify the occurrence of early stroke-related DVT, risk factors for its development and the influence on outcome. The study involved consecutive patients admitted to our center due to acute ischaemic (n = 278) or haemorrhagic (n = 12) stroke during a 16-month period. We collected data on their pre-stroke health status, neurological deficit on admission and baseline serum CRP and fibrinogen level. Ultrasonographic imaging was performed at the 3rd (IQR: 2–4) and 9th (IQR: 8–9) day after stroke. Patients thrombosis occurring between the first and second examination comprised the newly developed early stroke-related DVT group. We found DVT in 8.0% (24/299) of patients at initial evaluation. Newly developed DVT was present in 3.0% (9/299) of patients, and was predominantly distal (7 of 9 cases). It was associated with elevated serum CRP level (OR 8.75; 95%CI: 1.61–47.6), which was verified in a model adjusted for stroke severity and pre-stroke dependency (3–5 pts. in mRS). In a multivariate model, newly developed DVT significantly increased the risk of 3-month mortality (OR 12.4; 95%CI: 1.72–89.4), without affecting the combined risk of dependency and death (OR 2.57; 95%CI: 0.39–17.0). Early stroke-related DVT is an infrequent complication. However, it may be an independent risk factor for 3-month mortality. Increased serum CRP level combined with normal fibrinogen level seems predictive for development of DVT. It may be reasonable to provide those patients with additional DVT prophylaxis

The influence of micrometastases on prognosis and survival in stage I-II colon cancer patients: the Enroute⊕ Study

<p>Abstract</p> <p>Background</p> <p>The presence of lymph node metastases remains the most reliable prognostic predictor and the gold indicator for adjuvant treatment in colon cancer (CC). In spite of a potentially curative resection, 20 to 30% of CC patients testing negative for lymph node metastases (i.e. pN0) will subsequently develop locoregional and/or systemic metastases within 5 years. The presence of occult nodal isolated tumor cells (ITCs) and/or micrometastases (MMs) at the time of resection predisposes CC patients to high risk for disease recurrence. These pN0_micro+patients harbouring occult micrometastases may benefit from adjuvant treatment. The purpose of the present study is to delineate the subset of pN0 patients with micrometastases (pN0_micro+) and evaluate the benefits from adjuvant chemotherapy in pN0_micro+CC patients.</p> <p>Methods/design</p> <p>EnRoute+ is an open label, multicenter, randomized controlled clinical trial. All CC patients (age above 18 years) without synchronous locoregional lymph node and/or systemic metastases (clinical stage I-II disease) and operated upon with curative intent are eligible for inclusion. All resected specimens of patients are subject to an <it>ex vivo </it>sentinel lymph node mapping procedure (SLNM) following curative resection. The investigation for micrometastases in pN0 patients is done by extended serial sectioning and immunohistochemistry for pan-cytokeratin in sentinel lymph nodes which are tumour negative upon standard pathological examination. Patients with ITC/MM-positive sentinel lymph nodes (pN0_micro+) are randomized for adjuvant chemotherapy following the CAPOX treatment scheme or observation. The primary endpoint is 3-year disease free survival (DFS).</p> <p>Discussion</p> <p>The EnRoute+ study is designed to improve prognosis in high-risk stage I/II pN0 _micro+CC patients by reducing disease recurrence by adjuvant chemotherapy.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01097265">NCT01097265</a></p

The Role of Chemical Composition of High-Manganese Cast Steels on Wear of Excavating Chain in Railway Shoulder Bed Ballast Cleaning Machine

The main task for a ballast bed is to transmit the sleeper pressure in a form of stress cone to the subsoil, provide proper drainage and resist the sleeper displacement. Poorly maintained ballast could severely limit the maximum speed capacity and create further problems with the structural integrity, possibly leading to a complete failure of a given rail line. To prevent the unwanted corollaries, the ballast bed has to be periodically cleaned with an appropriate machinery. In this paper the authors investigated the effect of the chemical composition on the physical properties of the ballast excavating chains made of high-manganese steels. The authors focused on the wear mechanism, work hardening ability and hardness in the cross-sections areas. A microstructure analysis was performed as well, and observations revealed divergent morphology of precipitations at the grain boundaries, which influenced the size of austenite grains. The deformation twins formed as a result of operation were noticed in the samples. Research has shown that less carbon and chromium reduces the hardness of cast steel, and it specifically affects the ability to strain hardening. The authors explained the role of adjustments in chemical composition in the operational properties of high-manganese cast steels. It has been shown in the paper that different chemical compositions affect the properties of the alloys, and this causes different types of wear. The high content of chromium increases the hardness of materials before and after plastic deformation hardening, which in the conditions of selector chains results in greater dimensional stability during wear of holes in pin joints and will be more susceptible to abrasive wear in the presence of dusts from the ballast than creep

Successful treatment with intravenous recombinant tissue plasminogen activator in an acute stroke patient presenting with hemiballism

A 79-year-old woman with hypertension was evaluated 3 hours and 20 minutes after the sudden onset of left-sided weakness which lasted about 15 minutes and was followed by involuntary, coarse, flinging movements of the left extremities (hemiballistic), occurring every few minutes, and facial asymmetry. Brain computed tomography revealed no abnormalities. The patient received intravenous thrombolysis with 0.9 mg/kg of alteplase 4 hours after the symptom onset. Involuntary movements and central facial nerve paresis subsided within 48 hours of the thrombolysis. Magnetic resonance imaging at day 5 revealed restricted diffusion within the right globus pallidus, which was a new ischemic lesion. Thrombolysis should be considered in hemiballism as a presenting symptom of acute stroke

The Volumetric Wear Assessment of a Mining Conical Pick Using the Photogrammetric Approach

The rapid wear of conical picks used in rock cutting heads in the mining industry has a significant economic impact in cost effectiveness for a given mineral extraction business. Any mining facility could benefit from decreasing the cost along with a substantial durability increase of a conical pick; thus, the hardfacing method of production and regeneration should be taken into account. In order to automatize the regeneration, the wear rate assessment is necessary. This paper presents a methodology used to create a 3D photogrammetric model of most of the commercially available tangential-rotary cutters in their before and after abrasive exploitation state. An experiment of three factors on two levels is carried out to indicate the proper setup of the scanning rig to obtain plausible results. Those factors are: light level, presence of polarizing filter and the distance from the scanned object. The 3D scan of the worn out specimen is compared to the master model via algorithm developed by the authors. This approach provides more detailed information about the wear mechanism and can help either in roadheader cutting head diagnostics or to develop a strategy and optimize the toolpath for the numerically controlled hardfacing machine