The analysis of risk factors for fetal macrosomia and the complications in the course of pregnancy and delivery of macrosomic baby

Newborns weighing 4000g or heavier, are defined as macrosomic. Objectives: The puprose of this study was to present the risk factors of macrosomia, the course of pregnancy and the frequency of maternal outcomes associated with the delivery of macrosomic fetuses. Materials and Methods: The retrospective analysis included 670 gravidas hospitalized at The Department of Reproduction and Obstetrics, Medical University of Wroclaw, between 1999 and 2004, who delivered babies weighing at least 4000g. Results: The majority of macrosomic neonates (80%) were given birth to by women over the age of 25, who gained over 15 kilos in the course of the pregnancy. Macrosomy tends to affect primiparas most frequently. The medium duration of macrosomic pregnancy was 40,61 +/-1,15 weeks. The percentage of deliveries by cesarean section amounts to 38,5%. Vaginal deliveries are burdened with significant risk of maternal complications. Conclusions: Women over 30, medium height or tall, who gain over 15 kilos during the pregnancy, tend to deliver macrosomic babies. Multiparas who had given birth to the marosomic babies once before, are predisposed to deliver macrosomic neonate in the following pregnacy. On the basis of our studies, we have determined 4kg as a borderline birth weight for increased frequency of parturient canal injuries

Hospitalizacja pacjentów ze schorzeniami nienowotworowymi w hospicjum stacjonarnym — doświadczenia ośrodka w Białymstoku

 Background. Current epidemiological observations indicate an increasing need for palliative care for patients with non-cancer diseases, including end-stage heart failure. One of the forms of palliative care are medical services provided in stationary hospice. The aim of the study was to present the characteristics of patients hospitalized in hospice stationary care, and in particular to determine the proportion of non-cancer patients. Patients and methods. The study consisted in analyzing the annual medical records of patients hospitalized in the stationary hospice and recording information on referrals, diagnoses determining admission to the hospice and time of hospitalization. The obtained data was analyzed with non-parametric tests, assuming p &lt; 0.05 as the level of statistical significance. Results. During the study period, 708 patients were hospitalized in the stationary hospice, significantly more often patients with a diagnosis of a cancer (74%), p &lt; 0.05. Patients diagnosed with cardiology accounted for 12% of the group of non-cancer patients and 2.5% of all hospitalized patients. In the group of cancer patients end-stage heart failure was noticed in 34% cases. In the diagnosis of chronic respiratory failure, 28% of patients had a potential end-stage heart failure cause as a co-morbid diagnosis. The age of patients and their hospitalization time in the stationary hospice did not differ significantly between patients with cancer and non-cancer diseases. Conclusions. The dominant group in palliative care in the stationary hospice are still oncological patients. End-stage heart failure is the primary indication in palliative care and associated diagnosis in patients with cancer and chronic respiratory failure.Wstęp. Aktualne obserwacje epidemiologiczne wskazują na wzrastającą potrzebę prowadzenia zasad opieki paliatywnej wobec pacjentów z schorzeniami inne niż nowotworowe, w tym schyłkową niewydolność serca. Jedną z form prowadzenia opieki paliatywnej są świadczenia medyczne realizowane w ramach Hospicjum Stacjonarnego. Cel. Celem pracy była aktualizacja charakterystyki pacjentów hospitalizowanych w hospicyjnej opiece stacjonarnej, a szczególnie określenie udziału pacjentów nienowotworowych w tym pacjentów z rozpoznaniem schyłkowej choroby kardiologicznej. Metodyka i pacjenci. Badanie polegało na analizie rocznej dokumentacji medycznej pacjentów hospitalizowanych w Hospicjum Stacjonarnym i odnotowaniu informacji dotyczących skierowań, rozpoznań warunkujących przyjęcie do hospicjum oraz czasu hospitalizacji. Uzyskane dane poddano analizie testami nieparametrycznymi, przyjmując p < 0,05 za poziom istotności statystycznej. Wyniki. W badanym okresie hospitalizowano w Hospicjum Stacjonarnym 708 pacjentów, znamiennie częściej pacjentów z rozpoznaniem choroby nowotworowej (74%), p < 0,05. Pacjenci z rozpoznaniem kardiologicznym stanowili 12% grupy pacjentów nienowotworowych i 2,5 % wszystkich hospitalizowanych. W obrębie rozpoznania niewydolności oddechowej 30% pacjentów miało potencjalną przyczynę kardiologiczną jako rozpoznanie współistniejące. Łącznie pacjenci z głównym i współistniejącym rozpoznaniem kardiologicznym stanowili 4% badanej populacji. Wiek chorych i czas ich hospitalizacji w Hospicjum Stacjonarnym nie różnił się znamiennie pomiędzy pacjentami z schorzeniami nowotworowymi i nienowotworowymi. Wnioski. Dominującą grupą korzystającą z opieki paliatywnej w Hospicjum Stacjonarnym są nadal chorzy onkologiczni. Niewydolność serca jest rozpoznaniem głównym kwalifikującym do prowadzenia opieki paliatywnej oraz rozpoznaniem towarzyszącym u pacjentów z chorobą nowotworową i przewlekłą niewydolnością oddechową

Skuteczne usunięcie cewnika Swana-Ganza zapętlonego w prawej komorze serca. Opis przypadku

Invasive monitoring in anesthesia and cardiac surgery indispensablyaccompany complications of cardiac catheterization. Thepossibility of eliminating these complications and the ability tosolve the problems are the most important condition for successand value the cooperation between the anesthesiologist, cardiacsurgeron, radiological team and invasive cardiologists. In thispaper, we present a case of removal of a looped Swan-Ganzcatheter in the right ventricle around the papillary muscle usingintravascular manipulation.Powikłania cewnikowania serca nieodzownie towarzyszą monitorowaniu inwazyjnemu stosowanemu podczas anestezji u chorych kardiochirurgicznych. Możliwość eliminacji tychże powikłań, oraz umiejętność rozwiązania zaistniałych problemów są najistotniejszym warunkiem powodzenia i wartościują współpracę pomiędzy zespołem anestezjologicznym, kardiochirurgicznym, radiologicznym oraz kardiologów inwazyjnych. W niniejszej pracy przedstawiamy przypadek skutecznego usunięcia zapętlonego cewnika Swana Ganza w prawej komorze serca wokół mięśnia brodawkowatego za pomocą manipulacji wewnątrznaczyniowej. Słowa kluczowe: kardioanestezjologia, cewnik swana ganza, powikłania, funkcje poznawcz

Off-pump versus on-pump coronary artery surgery in octogenarians (from the KROK Registry)

BackgroundAccording to the medical literature, both on-pump and off-pump coronary artery surgery is safe and effective in octogenarians.ObjectivesThe aim of our study was to examine the epidemiology, in-hospital outcomes and long-term follow-up results in octogenarians undergoing off-pump and on-pump coronary artery surgery utilizing nationwide registry data.MethodsAll octogenarians (≥ 80 years) enrolled in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), who underwent isolated coronary surgery between January 2006 and September 2017 were identified. Preoperative data, perioperative complications, hospital mortality and long-term mortality were analyzed. Unadjusted and propensity-matched comparisons were performed between octogenarians undergoing off-pump and on-pump coronary artery bypass surgery.ResultsOctogenarians accounted for 4.1% of the total population undergoing coronary artery surgery in Poland during the analyzed period (n = 152,631) and this percentage is increasing. Among 6,006 analyzed patients, 2,744 (45.7%) were operated on-pump and 3,262 (54.3%) were operated off-pump. Propensity-matched analysis revealed that patients operated on-pump were more often reoperated due to postoperative bleeding and their in-hospital mortality was higher (6.6% vs 4.5%, p = 0.006 and 8.7% vs 5.8%, p = 0.001, respectively). Long-term all-cause mortality was lower among patients operated off-pump (p = 0.013).ConclusionOn the basis of our findings we suggest that off pump technique should be considered as perfectly acceptable in octogenarians

The use of modern telemedicine technologies in an innovative optimal cardiac rehabilitation program for patients after myocardial revascularization: Concept and design of RESTORE, a randomized clinical trial

Despite proven efficacy of cardiac rehabilitation (CR) in reducing the all-cause mortality in patients after myocardial revascularization, the penetration of CR, due to patient-related factors and referral rates remains limited. To improve the outcomes, home-based tele-rehabilitation (TR) has been proposed recently. In theory TR enhances the effects of standard CR procedures due to implementation of an intelligent monitoring system designed to ensure optimal training through on-demand transmission of vital signs, aimed at motivating the patients through daily schedule reminders, setting daily goals and creating a platform for mutual feedback. Several meta-analyses assessing various studies comparing these two methods (CR and TR) have proven that they are at least equally effective, with some of the research showing superiority of TR. Although there was a small sample size, lack of long-term follow-up, reporting effects of TR itself, no integration with tools designed for coaching, motivating and promoting a healthy lifestyle constitutes an important limitation. The latter carries a hopeful prognosis for improvement when utilizing a broad-spectrum approach, especially with use of dedicated technological solutions exploiting the fact of a large and yet rapidly increasing penetration of smartphones, mobile PCs and tablets in the population. The above-mentioned findings worked as the basis and rationale for commencing the RESTORE project aimed at developing and delivering state-of-the-art, comprehensive TR for patients after myocardial revascularization and evaluating its molecular aspect in view of how it influences the atherosclerosis progression attenuation. This paper presents the current state and rationale behind the project based on up-to-date TR efficacy data

Actual status and future directions of cardiac telerehabilitation

Telerehabilitation (TR) was developed to achieve the same results as would be achieved by the standard rehabilitation process and to overcome potential geographical barriers and staff deficiencies. This is especially relevant in periodic crisis situations, including the current COVID-19 pandemic. Proper execution of TR strategy requires both well-educated staff and dedicated equipment. Various studies have shown that TR may have similar effects to traditional rehabilitation in terms of clinical outcomes and may also reduce total healthcare costs per participant, including rehospitalization costs. However, as with any method, TR has its advantages and disadvantages, including a lack of direct contact or prerequisite, rudimentary ability of the patients to handle mobile devices, among other competencies. Herein, is a discussion of the current status of TR, focusing primarily on cardiac TR, describing some technical/organizational and legal aspects, highlighting the indications, examining cost-effectiveness, as well as outlining possible future directions

Effectiveness of surgical closure of left atrial appendage during minimally invasive mitral valve surgery

Background: Left atrial appendage closure (LAAC) reduces the risk of stroke in patients with atrialfibrillation. It can be performed surgically from the inside of the left atrium or from the outside. Stapling or clipping devices can also be used from the outside. Despite providing an excellent interior view of the appendage, those techniques cannot be implemented during minimally invasive mitral valve surgery conducted through right‑sided minithoracotomy. Aims: This study aimed to assess the effectiveness of surgical closure of the left atrial appendage from the inside during minimally invasive mitral valve surgery. Methods: A total of 50 patients with mitral valve disease and atrial fibrillation who underwent minimallyinvasive mitral valve surgery and LAACbetween 2012 and 2017 were included in this study. The appendagewas closed from the inside using a continuous suture. After a median follow‑up of 1.6 years after surgery, 19 patients were examined by transthoracic and transesophageal echocardiography (TEE). Transesophageal echocardiography was performed to assess whether the appendage had been effectively closed. When any leakage was suspected, cardiac computed tomography was performed. Results: In 19 patients, TEE was performed at 0.5 to 5 years after the surgery. A single patient did not tolerate TEE, and minimal leakage was suspected in 2 patients. All 3 individuals underwent computed tomography examination, which confirmed leakage in a single patient. Conclusions: Surgical LAACduring minimally invasive mitral valve surgery through right minithoracotomyis an effective technique that provides durable results

Trombocytopenia i powikłania okołooperacyjne po implantacji biologicznej protezy bezstentowej Freedom Solo

Background: Freedom Solo (FS) stentless bioprostheses have superior haemodynamic performance compared to stentedvalves; however, the data of thrombocytopenia after FS implantations is disturbing.Aim: To compare platelet count and perioperative complications between stentless and stented biological valves in patientsundergoing aortic valve replacement.Methods: In 29 patients, FS bovine valves (Sorin Group, Saluggia, Italy) were implanted. Platelet counts were analysed beforesurgery, on the day of operation, on four consecutive postoperative days (POD) as well as at discharge, and compared to 29 controlpatients with biological stented porcine valves (Labcor Laboratorios TLBP-A Supra). The analysis of the perioperative variables extracorporealcirculation (ECC), aortic cross clamping (XC) and mechanical ventilation times, as well as blood supply, was performed.Results: Initial platelet counts were comparable in both groups. In the FS group, platelet levels on the four consecutive PODwere significantly lower. The lowest platelet value (13 × 103/μL), related to fatal thrombotic thrombocytopenic purpura, wasfound in one patient from the FS group. ECC as well as XC and mechanical ventilation times, were significantly longer in theFS group, and more blood transfusions in these patients were required. In multiple regression analysis, ECC and XC times didnot correlate with platelet count.Conclusions: Implantations of FS stentless bioprostheses are related to significantly lower platelet counts. Severe perioperativecomplications and their relation to thrombocytopenia need further evaluation.Wstęp: Biologiczne protezy bezstentowe Freedom Solo (FS) implantowane w miejsce zastawki aortalnej mają lepszą wydajnośćhemodynamiczną w porównaniu z protezami stentowymi. Jednak dane dotyczące trombocytopenii obserwowanej poimplantacji FS są bardzo niepokojące.Cel: Celem pracy była ocena liczby płytek krwi i powikłań okołooperacyjnych u pacjentów po implantacji bezstentowychprotez FS w porównaniu z chorymi, u których wszczepiano protezy stentowe.Metody: Dwudziestu dziewięciu kolejnym pacjentom implantowano protezy bezstentowe FS (Sorin Group, Saluggia, Włochy).Liczbę płytek krwi oceniano przed operacją, w dniu operacji, w kolejnych 4 dniach przebiegu pooperacyjnego i w dniuwypisu. Wartości te były porównywane z grupą kontrolną, którą stanowiło 29 pacjentów z implantowanymi biologicznymiprotezami stentowymi (Labcor Laboratorios TLBP-A Supra). W okresie okołooperacyjnym analizowano następujące parametry:czas krążenia pozaustrojowego (ECC), czas zaklemowania aorty (XC), a także czas wentylacji mechanicznej oraz koniecznośćtransfuzji krwi i preparatów krwiopochodnych.Wyniki: Wyjściowe liczby płytek krwi były porównywalne w obu grupach. W grupie FS w kolejnych 4 dniach obserwacjiliczba płytek krwi była istotnie statystycznie niższa niż w grupie kontrolnej. Najniższą wartość trombocytów (13 × 103/μl)zaobserwowano w grupie FS u 1 pacjenta ze śmiertelnym przebiegiem zakrzepowej plamicy małopłytkowej. Czasy ECC, XCi wentylacji mechanicznej były istotnie dłuższe w grupie FS. W analizie regresji wielokrotnej czasy ECC i XC nie korelowałyz liczbą płytek krwi. Ponadto pacjenci z grupy badanej wymagali większej liczby transfuzji.Wnioski: Implantacja bezstentowych protez FS wiąże się z istotnym spadkiem liczby płytek krwi. Potencjalny związek trombocytopeniii gorszego przebiegu okołooperacyjnego wymaga przeprowadzenia dalszych badań

Chorzy trudni nietypowiWszczepienie protezy zaopatrzonej w zastawkę pomiędzy koniuszkiem lewej komory a aortą zstępującą jako alternatywna metoda operacji zwężenia zastawki aortalnej &#8211; opis przypadku

A case of a 73-year-old patient with critical aortic stenosis, porcelain aorta and occluded femoral arteries is presented. We performed apico-aortic valved conduit (A-AVC) without cardiopulmonary bypass (CPB). Hegar dilator inserted through the apex into the left ventricle allowed anastomosis of dacron tube to the apex. Valved conduit was anastomosed to the descending aorta. Both tubes were connected. Before the operation, maximal gradient through the valve was 95, after operation dropped to 33 mmHg. This method of apical anastomosis allowed to perform A-AVC without CPB in a patient with extremly high peri-operative risk while using CPB