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

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

Przezskórna rewaskularyzacja wieńcowa przewlekle zamkniętej tętnicy wieńcowej u pacjenta z ciężką dysfunkcja skurczową lewej komory. Mądre posunięcie?

Percutaneous coronary intervention (PCI) for chronic total occlusion is a widely-accepted revascularization procedure that accounts for around 10% of PCI procedures. Chronic totally occluded (CTO) coronary artery often is problematic, with the majority of patients managed medically or referred for coronary artery bypass graft surgery (CABG), due to the lack of standardized indication criteria. It has been shown that in patients with ischemic heart failure left ventricular ejection fraction (LVEF) ≤35%, worse long-term outcome was related to the presence of CTO. Several observational studies showed that successful CTO revascularization is related to improved quality of life. However, it seems evident that improvement of survival and symptoms in patients with left ventricular dysfunction undergoing any myocardial revascularization is only achieved when viability is preserved. Here we present a case of CTO of the LAD that was successfully treated with PCI resulting in subsequent left ventricular function improvement.Przezskórna rewaskularyzacja przewlekle zamkniętej tętnicy wieńcowej jest powszechnie akceptowana procedurą, stanowiącą 10% przezskórnych interwencji wieńcowych. Przewlekła okluzja tętnicy wieńcowej, często problematyczna, w większości leczona jest zachowawczo lub kardiochirurgicznie poprzez operacyjne wszczepienie pomostów naczyniowych, ze względu na brak jasnych wytycznych postępowania. Wykazano, że u pacjentów z kardiomiopatią niedokrwienną (frakcja wyrzutowa ≤35%) obecność przewlekłej okluzji tętnicy wieńcowej związana była z gorszym rokowaniem. Kilka badan obserwacyjnych wykazało, że skuteczna rewaskularyzacja przewlekle zamkniętej tętnicy wieńcowej jest związana z poprawą jakości życia. Aczkolwiek, oczywistym jest, że korzyści w odniesieniu do przeżywalności i objawów u pacjentów z dysfunkcją skurczową lewej komory po rewaskularyzacji są osiągalne tylko wówczas, gdy zachowana jest żywotność mięśnia sercowego. Przytaczamy przypadek kliniczny pacjenta po skutecznej rewaskularyzacji przezskórnej przewlekle zamkniętej gałęzi przedniej zstępującej lewej tętnicy wieńcowej i następczej poprawy funkcji skurczowej lewej komory

The effect of lead free cap on the doses of ionizing radiation to the head of interventional cardiologists working in haemodynamic room

Objectives The study aim was to analyse the influence of the lead free cap on doses received by interventional cardiologists. The impact of lead free cap on doses to the head were evaluated in number of studies. As different methods used to assess the attenuation properties of protective cap can lead to ambiguous results, a detailed study was performed. Material and Methods The effectiveness of a lead free cap in reducing the doses to the skin was assessed in clinic by performing measurements with thermoluminescent dosimeters attached inside and outside the cap first during individual coronary angiography (CA) or CA/percutaneous transluminal coronary angioplasty (CA/PTCA) procedures and then cumulated during few procedures of the same type. In order to investigate the effect of the cap on reducing the doses to the brain additional measurements were performed with a male Alderson Rando and polymethyl methacrylate (PMMA) phantoms representing the physician and the patient, respectively for different projections. The brain dose per procedure, annual and cumulated during entire working practice were estimated for both cases working with and without the cap. Results The dose reduction factor (RF) for the skin (the quotient of doses outside and inside the cap) vary from 1.1 up to 4.0 in clinical conditions; on average 2.3-fold reduction is observed in the most exposed left temple. The RFs determined for the part of the head covered by the cap range from 1.4 to 1.8 while for the brain from 1.0 to 1.1 depending on the projection. The estimated annual brain dose for interventional cardiologist performing yearly 550 CA/PTCA procedures without any protective shields is 7.2 mGy and it is reduced with the lead free cap by an average factor of 1.1. Conclusions The study results proved the considerable effectiveness of lead free cap to protect the skin but very limited to protect the brain

Occupational exposure to physicians working with a Zero-Gravity™ protection system in haemodynamic and electrophysiology labs and the assessment of its performance against a standard ceiling suspended shield

A two centre clinical study was performed to analyse exposure levels of cardiac physicians performing electrophysiology and haemodynamic procedures with the use of state of the art Zero-Gravity™ radiation protective system (ZG). The effectiveness of ZG was compared against the commonly used ceiling suspended lead shield (CSS) in a haemodynamic lab. The operator’s exposure was assessed using thermoluminescent dosimeters (TLDs) during both ablation (radiofrequency ablation (RFA) and cryoablation (CRYA)) and angiography and angioplasty procedures (CA/PCI). The dosimeters were placed in multiple body regions: near the left eye, on the left side of the neck, waist and chest, on both hands and ankles during each measurement performed with the use of ZG. In total 29 measurements were performed during 105 procedures. To compare the effectiveness of ZG against CSS an extra 80 measurements were performed with the standard lead apron, thyroid collar and ceiling suspended lead shield during CA/PCI procedures. For ZG, the upper values for the average eye lens and whole body doses per procedure were 4 µSv and 16 µSv for the left eye lens in electrophysiology lab (with additionally used CSS) and haemodynamic lab (without CSS), respectively, and about 10 µSv for the remaining body parts (neck, chest and waist) in both labs. The skin doses to hands and ankles non-protected by the ZG were 5 µSv for the most exposed left finger and left ankle in electrophysiology lab, while in haemodynamic lab 150 µSv and 17 µSv, respectively. The ZG performance was 3 times (p < 0.05) and at least 15 times (p < 0.05) higher for the eye lenses and thoracic region, respectively, compared to CSS (with dosimeters on the apron/collar). However, when only ZG was used slightly higher normalised doses were observed for the left finger compared to CSS (5.88e − 2 Sv/Gym(2) vs. 4.31 e − 2 Sv/Gym(2), p = 0.016). The study results indicate that ZG performance is superior to CSS. It can be simultaneously used with the ceiling suspended lead shield to ensure the protection to the hands as long as this is not obstructive for the work

The inventory, valorization, and geoconservation of caves in the Babia Góra and Przedbabiogórze Ranges

Artykuł przedstawia wyniki inwentaryzacji oraz waloryzacji jaskiń położonych w Paśmie Babiogórskim i Paśmie Przedbabiogórskim. Inwentaryzacja jaskiń prowadzona była przez różnych autorów w latach 1976-2015. W jej rezultacie zinwentaryzowano 104 jaskinie o łącznej długości 1270 m, w tym największą na obszarze badań Jaskinię Oblicę. Obiekty te poddane zostały waloryzacji w celu wytypowania obiektów wartych objęcia ochroną przyrody. Wyniki waloryzacji wykazały, iż najcenniejsze jaskinie znajdują się głównie w Paśmie Babiogórskim (17), podczas gdy w Paśmie Przedbabiogórskim występują jedynie dwie takie jaskinie. Spośród obiektów, które zdobyły największą ilość punktów, większość objęta jest ochroną przyrody w ramach Babiogórskiego Parku Narodowego. Niemniej kilka cennych przyrodniczo jaskiń, położonych w Paśmie Polic oraz Paśmie Jałowieckim, nie została objęta żadną formą ochrony. Zgrupowania jaskiń położonych na Okrąglicy oraz Łysinie powinny zostać w przyszłości objęte ochroną jako stanowiska dokumentacyjne, a najcenniejsze przyrodniczo: Jaskinia Oblica oraz Zbójska Dziura, powinny zostać uznane za pomniki przyrody.This paper refers to the results of taking an inventory and valorization of pseudokarst caves in two mountain areas: the Babia Góra Massif and the Przedbabiogórskie Range. The inventory of the caves was taken by various authors in 1976-2015. Consequently, 104 caves with a total length of 1,270 m were recorded, including the largest one - Oblica Cave. The valorization of the caves was made to determine the most valuable structures, and to select some of them for legal protection. The majority of the most of valuable caves are located in the Babia Góra Massif (17), and only two of them in the other study area (the Przedbabiogórskie Range). However, some of most valuable caves in the Babia Góra Massif (the Polica Range) and the Przedbabiogórskie Range (the Jałowiecki Range) are not legally protected. The groups of caves located in Okrąglica and Łysina landslides should be protected as documentation sites, and the most valuable caves, e.g. Oblica and Zbójska Dziura, should be protected as natural monuments

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