Mechanical thrombectomy in acute stroke – Five years of experience in Poland

Objectives Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. Methods and results We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. Results Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250±99min. 90.3% of the studied patients had MT within 6h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% – emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b–TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization – in 30.7%, mRS of 0–2 – in 31.4% and mRS of 6 in 22% of cases. Conclusion Our results can help harmonize standards for MT in Poland according to international guidelines

The functioning of the patient in the mental aspect and interpersonal relationship after Laryngectomy Surgery

Introduction. The most radical way to get rid of the cancer of the larynx is total laryngectomy. Laryngectomy involves the complete removal of the voice organ, which is the larynx, as a result of extensive laryngeal cancer categorized according to the TMN classification as T3 and T4, so this is a social problem that needs attention and should be taken into account in scientific research. Goal. Assessment of the results of the functioning of people after laryngectomy in the patient's psyche and interpersonal relations. Material and methods. A literature review was made using PubMed, Google Scholar databases based on keywords. Results. On the percentage scale, the highest results achieved for patients without function, 63% reported physiological tests of depression, and 26% revealed mental disorders. Patients may also have anxiety disorder, phobias, panic disorder, and anxiety concentration syndromes that are able to manifest themselves in the results of stress levels. Women demonstrate that more often than men, lower initial values as a result of laryngectomy mutilation, and because of the results in the use analysis, they use substitute speech, which may sound like a male voice.When it comes to data related to the age of users, younger users (under 65 years of age) are more likely to solve mental problems. Low income, unemployment, lack of a permanent job associated with an increased risk of depression or mental treatment. Conclusions. In patients with laryngectomy after larynx cancer, they include a significant reduction in quality of life, an increase in depressive reactions, and communication difficulties in a larger group of people. This is a significant social problem that requires research. </p

Mechanical thrombectomy in acute stroke : five years of experience in Poland

Objectives: Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. Methods and results: We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. Results: Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250 99 min. 90.3% of the studied patients had MT within 6 h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% - emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b–TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization - in 30.7%, mRS of 0–2 - in 31.4% and mRS of 6 in 22% of cases. Conclusion: Our results can help harmonize standards for MT in Poland according to international guideline