Left main disease management strategy: Indications and revascularization methods in particular groups of subjects

Surgical revascularization with coronary artery by-pass grafting is still recommended in vast majority of patients with unprotected left main disease. The aim of the paper was to analyze optimal treatment of left main disease in selected groups of patients, on the basis of current guidelines and information gained from literature data. We focused on data in relation to treatment of elderly patients, diabetics and those hemodynamically unstable. Additionally we discussed the issue of anti-platelet therapy and informed consent. As far as efficacy of treatment is concerned, not only method of revascularization but also general condition of the patient, the factors influencing peri-operative risk and optimal pharmacotherapy should be taken into account. Therefore establishment of the heart team is crucial when choosing the most suitable method of invasive treatment of left main disease

Certain subphenotypes of aspirin-exacerbated respiratory disease distinguished by latent class analysis

Background: Aspirin-exacerbated respiratory disease (AERD) is recognized as a distinct asthma phenotype. It usually has a severe course accompanied by chronic hyperplastic eosinophilic sinusitis with nasal polyps, blood eosinophilia, and increased concentrations of urinary leukotriene E4 (LTE4). More insightful analysis of individual patients shows this group to be nonhomogeneous. Objective: We sought to identify any likely subphenotypes in a cohort of patients with AERD through the application of latent class analysis (LCA). Methods: Clinical data from 201 patients with AERD (134 women) were collected from questionnaires. Standard spirometry, atopy traits, blood eosinophilia, and urinary LTE4 concentrations were evaluated. LCA was applied to identify possible AERD subphenotypes. Results: Four classes (subphenotypes) within the AERD phenotype were identified as follows: class 1, asthma with a moderate course, intensive upper airway symptoms, and blood eosinophilia (18.9% of patients); class 2, asthma with a mild course, relatively well controlled, and with low health care use (34.8% of patients); class 3, asthma with a severe course, poorly controlled, and with severe exacerbations and airway obstruction (41.3% of patients); and class 4, poorly controlled asthma with frequent and severe exacerbations in female subjects (5.0% of patients). Atopic status did not affect class membership. Patients with particularly intensive upper airway symptoms had the highest levels of blood eosinophilia and the highest concentrations of urinary LTE4. Conclusions: LCA revealed unique AERD subphenotypes, thus corroborating the heterogeneity of this population. Such discrimination might facilitate more individualized treatment in difficult-to-treat patients

Neointima development in externally stented saphenous vein grafts

Introduction : The main limitation of coronary artery bypass grafting (CABG) is rapid neointimal hyperplasia leading to graft failure. Aim : To assess plaque formation in saphenous vein grafts (SVG) covered by an external Dacron stent in comparison with the classical technique. Material and methods : In the study group vein grafts covered by external stent mesh made of Dacron were implanted. An intravascular ultrasonography (IVUS) study was performed in 35 aorto-coronary SVG covered by an external Dacron stent and in 64 normal SVG during the first year after CABG. In each SVG 25 mm of good quality IVUS image, volumes of lumen, plaque (neointima), outer border of the vein graft (external SVG) and adventitia were calculated in three time periods: 0–130 days, 130–260 days and 260–390 days. Results : Between the first and second time period, lumen volume (mm3) was reduced from 10.33 ±4.4, to 6.80 ±2.23 in the second period and 5.69 ±1.26 in the third one. This effect was much less marked in normal grafts. The corresponding lumen volume (mm3) was: 10.90 ±3.9, 9.15 ±2.94 and 8.92 ±2.93 in consecutive time periods. Plaque volume (mm3) did not change in control grafts during the course of the study, but it increased very significantly in stented grafts from 0.86 ±1.24 in the first period to 2.70 ±1.58 in the second and 3.29 ±2.66 in the third one. Conclusions : The experimental technique of implanting SVG covered with an external elastic Dacron stent seems to be inferior to traditional ones. This is probably due to the more complicated process of vein implantation and higher micro-injury occurrence during the surgery

Control of construction projects using the Earned Value Method - case study

Planning, controlling, monitoring progress are key management functions for effective implementation of construction projects. Commonly used instruments enabling performance of these functions include schedules and budgets, often in the form of a cost estimate. They are created at the initial planning stage to monitor and control cost and time deviations. Moreover, popular monitoring techniques are, for example, observation of milestones and comparative analysis of actual versus planned costs. This article presents a work progress control tool - the Earned Value Method (EVM) - which, despite its benefits, remains relatively unused in construction projects. The impact of the planning phase on the results obtained during the monitoring and control phase when utilizing EVM is discussed. This case study provides practical examples of using EVM in the implementation of construction projects and with the use of computer software. The novelty of the article results from the introduction of additional sensitivity analysis illustrating the impact of factors, such as an increase in costs or a change in delivery dates to the course of deviation curves. Use of sensitivity analysis in relation to the results of the CPI and SPI calculations affords combining control of costs and time with risk monitoring in the project. The findings reveal significant benefits in using EVM to implement construction projects but also highlight some important limitations

Porównanie wczesnej rehabilitacji szpitalnej chorych leczonych metoda pomostowania naczyń wieńcowych bez krażenia pozaustrojowego, z tzw. małego dostępu, z chorymi po klasycznej rewaskularyzacji serca – doświadczenia własne

There is some evidence that focused and intense rehabilitation improve clinical outcome following conventional open-heart surgery. Recent developments in surgical techniques, which focused on the improvement in patient comfort, reduction in hospital stay and costs, has resulted in minimally invasive techniques, including Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) and Endoscopic Atraumatic Coronary Artery Bypass (EACAB). EACAB is safer than on-pump coronary artery bypass graft (CABG), especially in high risk patients. Its use, however, is limited to a small subgroup of patients: those with suitable anatomy of coronary pathology, younger patients with rapidly progressing coronary artery disease or elderly patients with substantial co-morbidities, whom sternotomy and cardiopulmonary bypass pose significant risks to. In this latter group of patients, effective rehabilitation is, therefore, even more important. Prevention of disturbances in homeostasis resulting from reduced physical activity, and thus rate of recovery and effectiveness of cardiac surgery, are not dependent on early physical activity and the intensiveness of the inpatient rehabilitation only but also on psychological therapy, dietary advice and health-promoting education. In this study, we explore differences in inpatient rehabilitation methods and outcomes between the groups of patients who underwent on-pump CABG and MIDCAB operations. Our data show that inpatient rehabilitation following MIDCAB operations may be shorter than after on-pump CABG by 2 days on average