Games of architecture in the recent past

Architectural design takes place in a certain cultural space. I f the space is not expressive enough for the artist, observer or passer-by, architects create their individual worlds where original artworks shaping space appear. And the audience accepts it with understanding

Two faces of high tech architecture

Pewien wąski nurt późnomodernistycznej architektury eksponujący rozwiązania techniczne jako elementy formy architektonicznej określa się – high tech, co jednoznacznie wskazuje na technologię zaawansowaną. W świetle purystycznych form architektury wczesnego modernizmu idee high tech jawią się raczej jako poszukiwania oryginalności przez odkrywanie współczesnej ornamentyki

Statyny w praktyce klinicznej - komu? jaka?

Hiperlipidemia stanowi schorzenie często bezobjawowe, jednak o niezaprzeczalnym znaczeniu w etiopatogenezie jawnej klinicznie choroby wieńcowej lub choroby tętnic obwodowych. Lekami z wyboru w terapii mającej na celu normalizację stężenia cholesterolu frakcji LDL oraz zmniejszenie chorobowości i śmiertelności sercowo-naczyniowej są statyny. Stanowią one grupę inhibitorów reduktazy HMG-CoA, głównego enzymu szlaku syntezy cholesterolu, prowadząc do zwiększenia liczby receptorów dla LDL, a tym samym spadku jego stężenia w osoczu. Pod koniec XX wieku statyny powszechnie wprowadzono do praktyki klinicznej. Mimo że wszystkie obniżają stężenie cholesterolu, to nie wszystkie jednak mają taki sam profil farmakologiczny, a co ważniejsze - kliniczny. Efektywność leczenia tą grupą leków była przedmiotem wielu badań klinicznych. W niektórych z nich, określanych obecnie jako przełomowe, dokładnie sprecyzowano docelowe grupy pacjentów, które mogą osiągnąć największe korzyści ze stosowanej terapii. W niniejszym artykule przedstawiono analizę głównych statyn (atorwastatyna, simwastatyna, rosuwastatyna) stosowanych w praktyce klinicznej ze szczególnym odniesieniem do prewencji pierwotnej (czynniki ryzyka) i wtórnej (stabilna choroba niedokrwienna serca i ostre zespoły wieńcowe). Wspomniano również o leczeniu skojarzonym w przypadkach, gdy osiągnięcie docelowego stężenia cholesterolu frakcji LDL, na podstawie monoterapii statyną, nie jest możliwe. (Folia Cardiologica Excerpta 2010; 5, 4: 196–205

Morphology of the tendon of Todaro within the human heart in ontogenesis

The tendon of Todaro, found in the right atrium of the heart, has considerable clinical importance in the fields of both cardiac surgery and invasive cardiology. The goal of this study is to examine the occurrence and degree of development of the tendon of Todaro in humans. Research was conducted on material consisting of 160 human hearts of both sexes from the age of 14 Hbd to 87 years of age. Classical anatomical methods were used and histological sections were prepared from 100 hearts of various age groups stained in Masson’s method with Goldner’s modification. The tendon of Todaro occurred in all examined hearts. In foetal hearts, in the area typical of the course of the tendon of Todaro, a very well-developed, “white-like” structure was observed, convexed into the lumen of the atrium. Histologically, this was young fibrous tissue with a characteristically large number of fibroblasts. Evenly in infants and newborns, a visible convex structure was also observed extending into the lumen of the right ventricle, however, to a lesser degree than in foetuses. In the group of hearts of young adults, it was also possible to follow the course of the tendon of Todaro macroscopically. However, the older the heart was, the less the convex was visible, and in older adults it was completely invisible. In histological sections, it was observed that with ageing the number of connective tissue cells decreased, and fibres forming the lining increased. In the hearts of older adults the tendon of Todaro formed very small ribbons of connective tissue. Histologically, only small numbers of cellular elements were noticed. In the adult heart the examined tendon was located the deepest and did not connect to the endocardium. We can conclude that tendon of Todaro is a stable structure, occurring in all examined hearts even when it is not macroscopically visible. Due to the morphological changes that affect the tendon of Todaro in human ontogenesis, for the cardiac surgeon, its relevance as an important topographical structure in the hearts of older adults is minimal

Echocardiographic morphometry of the right chambers of the heart in permanent cardiac pacing

Permanent cardiac pacing is a method of choice in the treatment of specific arrhythmias and conduction disturbances. Clinical studies show that cardiac performance diminished at the site of impulse spreading. It determines local hypotrophy below the position of the pacing lead (early electric activation) with hypertrophic changes in the opposite lying myocardium (late electric activation). It seems that morphological changes, especially research by intravital methods, so relevant in permanent pacing to today™s invasive cardiologist, are not understood in full. In connection with this we decided, on the basis on the echocardiographic examination, to evaluate in detail the morphology of the right ventricle and atrium in patients with permanent pacing. Research was carried out on a group of 124 patients (68 males, 56 females) from 40±93 years of age (avg. 68 ± 14 yrs): 86 patients had implanted pacemakers or AICD (group I), the control group consisted of 38 patients with other cardiac diseases without any pacemaker devices (group II). We measured echocardiographically the following diameters: end-diastolic and systolic diameters of the right ventricle/atrium in short and long axis, diameter of the tricuspid orifice valve and calculated area of the tricuspid orifice based on a special formula. Regarding the morphometric parameters of the right ventricle and right atrium, we confirmed that all diameters of group I were overshooting in correlation to group II. Those differences, such as RVd-short and -long, RVs-long, RVinflow, RA-long and -short, TRId, were statistically significant. Regarding the area of the tricuspid orifice (TRIa), we did not observe any changes in the two examined groups. We concluded that patients with implanted devices have changes in the morphometric parameters of the right ventricle, atrium and orifice, but they do not depend on the duration of pacemaker implantation

Development of the atrioventricular junctional area in the human heart

The structure of the heart has been the subject of many observations since the beginnings of medical research. The first information regarding the existence of the conduction system of the heart was described by Purkinje and regarding the a-v node by Tawara. From the history regarding this structure it seems that this special system, so relevant to today™s invasive cardiologist, is not understood in full. With regards to the interventional electrophysiology on the basis of histological study we decided to evaluate in detail the morphology and the topography of the various portions of the a-v junction. In order to confirm this hypothesis we made observations on the autopsy material of 100 normal human hearts, both sexes from 16 weeks of foetal life to 105 years of age, in which no pathological changes or inborn faults were found. Sections were done containing the heart™s septum, stained using Masson™s method with Goldner™s modification. This research proves that the atrioventricular junction is a stable structure occurring in all hearts, undergoing involutionary changes with age, in which two main parts can be differentiated: the node and the bundle. The morphology of the node is very complex, because it is composed of three zones: the prenodal, the perinodal and the main, differing in cell structure and position. The topography of the node is generally stable, as it lies in the interatrial septum and always above the septal leaflet of the tricuspid valve. The structure of the bundle, in contrast to the node, is more stable and consists of the following parts: the penetrating, the non-branching and the branching. Its topography is also stable, as it lies in the membranous septum, mainly below the septal cusp of the tricuspid valve

Permanent cardiac pacing and its influence on tricuspid valve function

Implantation of transvenous devices is a widespread procedure in clinical cardiology. It is well known that the presence of the electrodes in the cardiovascular system can induce fibrosis or fibrous adhesions between them and cause tricuspid regurgitation. Moreover there are suggestions that the placement of the electrode in the tricuspid orifice may also play a role in the development of tricuspid insufficiency because of the thickening of reactive leaflets and the impairment of their mobility in morphological studies. There are no papers regarding the topography of the electrode in the right ventricle judged by means of transthoracic echocardiography. Moreover in literature we did not meet reports comparing the localisation of the lead on the tricuspid valve function. Therefore we decided to describe the detailed topographic relations between the lead and the structures of the right ventricle in a larger population and we compared the influence of the lead location for tricuspid valve function. Research was carried out on a group of 86 patients (52 M, 34 F), with a mean age of 64.7 ± 14.9 years with permanent cardiac pacemaker or implantable cardioverter-defibrillator (ICD). On the basis of echocardiograms performed we assessed the position of the lead regarding the tricuspid valve leaflets or commissure, and judged the course of the lead beneath the tricuspid valve level. Moreover special attention was focused on the placement of the tip of the electrode. We qualified its position into three categories: apex of the right ventricle, right ventricle outflow tract, and “para-apex” position. The degree of the tricuspid valve insufficiency was assessed by means of semiquantitative method based on the Color-flow Doppler echocardiography. We measured the extension and the area of the tricuspid regurgitant jet using four-gradual scale. We compared the topography of the lead at the level of the valve with its function by means of the presence and degree of its regurgitation. We stated that in 35% of cases the pacing lead was located at the level of the anterior leaflet of the tricuspid valve, in 23% at the level of the septal leaflet and in 12% at the posterior one. Besides in 10% the electrode was placed between the leaflets just over the commissures. On the other hand in the remaining 20% the lead was positioned centrally in the right atrioventricular orifice without adherence to any leaflet. Next we assessed the course of the lead beneath the tricuspid valve level and stated that most frequently (45%) it run just across the centre of the right ventricle, and in other cases was lying along the interventricular septum (in 39% of cases) or along the anterior wall of the right ventricle(in 16%). The tip of the lead was positioned exactly in the apex of the right ventricle in 74%, in the right ventricular outflow tract in 9% and in 17% its position was “para-apical”. We did not see any statistically significant differences between the presence and intensification of valve regurgitation and topography of the lead. We concluded that at the level of the tricuspid valve the lead was positioned in the anteroseptal part of tricuspid annulus and the proper apical position of the electrode’s tip occurred in approximately 75% of cases. Localisation of the electrode at the level of the tricuspid orifice does not influence its insufficiency as detected by Doppler echocardiography