Patient exposure to X-ray radiation during abdominal aorta and lower limb digital subtraction angiography

Background: The main aim of this study was to find out what is the risk caused by ionizing radiation during digital subtraction angiography (DSA) for abdominal aorta and lower limb examinations. Material\Methods: The study is based on a large group of patient data subjected to a complex analysis of fluoroscopy time, exposure time, air kerma values, and dose-area product (DAP). Measurements were performed on 449 patients with intra-arterial (IA DSA) contrast administration. Results and Median DAP value for fluoroscopy was 5.4 Gy-cm2 and for exposure 51.7 Gy-cm2. On exposure the patients received 94% of the total DAP although this examination takes only 0.1% of the total examination time. For this reason, small changes in the exposure time may result in a considerable reduction in the radiation received by the patient. There was good correlation between DAP values and the fluoroscopy time (r=0.78), while the correlation between DAP and the exposure time was much poorer (r=0.39). It was also found that gender was a differentiating factor neither both fluoroscopy (F[1, 449]=0.01, p>0.05) nor exposure time (F[1, 449]=0.42, p>0.05)

Evaluation of the criteria influencing certification regarding the ability to work on patients after open or endovascular operations on the arterial system of lower limbs

Background. Evaluation of the criteria influencing certification regarding the ability to work on patients after operation on the arterial system of lower limbs. Material and methods. Thirty-two patients took part in the study in production age (from 39 to 61 years, median 49) after lower limb arterial reconstruction (open or endovascular). In selected patients, atherosclerotic lower limb ischaemia was the only disease diagnosed and treated by physicians. 12&#8211;48 month postoperative follow-up was without complications. Claudication, measured on a treadmill test, varied from 120 to 1100 metres. Mean ankle-brachial index (ABI) was 0.7. After six months, patients were reassessed for reevaluation of the ABI and claudication with analysis of the certification decision made by welfare doctors. Statistical analyses of the data were performed using the Mann Whitney, &#967;2 and t-Student tests for justification of the decision of welfare doctors. Results. All patients, after open surgery, received positive welfare decisions. In 12 patients, complete inability to work was certified and in 10, partial inability to work. In patients who underwent endovascular surgery, partial inability to work was certified in five patients and negative welfare decision was found in another five patients. The difference in positive and negative welfare certification was statistically significant between open and endovascular surgery groups (p < 0.005). No difference in claudication distance and ABI value was observed between groups. The distance of claudication and ABI value had no influence on the welfare decision (p = 0.3). The type of open surgery and location of endovascular procedure were insignificant regarding certification of ability to work (p = 0.2). Certification of complete inability to work after surgery was not related to the ABI value or claudication distance for either type of open surgery (p = 0.02). Conclusions. Certification after vascular reconstruction has thus far been based on the subjective impressions of welfare doctors and depends only on the presence of open surgery history with no relation to objective status of the patient or stage of the disease. The obtained results reveal the poor knowledge at present regarding atherosclerotic ischaemia of lower extremities diagnostic criteria - something which should be changed through obligatory scholarship of medical welfare doctors.Wstęp. Celem pracy była ocena kryteriów, na podstawie których podejmowane są decyzje orzecznicze o niezdolności do pracy u chorych po interwencjach w obrębie układu tętniczego kończyn dolnych. Materiał i metody. Do analizy wyselekcjonowano 32 chorych w wieku produkcyjnym (39-61 lat, mediana 49 lat) po operacjach naprawczych (otwartych i wewnątrznaczyniowych) w obrębie układu tętniczego kończyn dolnych. U wybranych chorych miażdżycowe niedokrwienie kończyn dolnych było jedyną jednostką chorobową, rozpoznaną i leczoną przez lekarzy prowadzących. Nie odnotowano powikłań w przebiegu pooperacyjnym w obserwacji 12-48-miesięcznej. Dystans chromania przestankowego oceniany w teście na bieżni wynosił 120-1100 m. Wartość wskaźnika kostka&#8211;ramię (ABI) wynosiła średnio 0,7. Po 6 miesiącach wzywano chorych w celu stwierdzenia, jakie orzeczenie wydali lekarze Zakładu Ubezpieczeń Społecznych (ZUS) oraz ponownie analizowano dystans chromania i wartość ABI. Otrzymane wyniki poddawano analizie statystycznej (w testach Manna-Whitneya, &#967;2 oraz t-Studenta) i oceniano zasadność decyzji lekarza ZUS. Wyniki. Wszyscy chorzy po zabiegach otwartych rewaskularyzacji otrzymali pozytywne decyzje rentowe, u 12 pacjentów orzecznicy ZUS orzekli całkowitą niezdolność do pracy, a u 10 badanych - niezdolność częściową. Spośród chorych po zabiegach endowaskularnych u 5 badanych orzeczono częściową niezdolność do pracy, a u 5 pacjentów nie stwierdzono niezdolności do pracy. Wśród chorych operowanych i poddawanych zabiegowi przezskórnej angioplastyki (PTA) stwierdzano statystycznie istotną różnicę w liczbie przyznanych świadczeń rentowych (p < 0,005). Grupy chorych nie różniły się pod względem dystansu chromania czy wartości wskaźnika ABI. Nie stwierdzano zależności pomiędzy stopniem niezdolności do pracy a przechodzonym dystansem oraz wartością wskaźnika ABI w grupie operacji otwartych i PTA (p = 0,3). Również rodzaj operacji otwartej i miejsce wykonanej angioplastyki nie wpływały na orzeczenie stopnia niezdolności do pracy (p = 0,2). Orzeczenie o całkowitej niezdolności do pracy nie zależało od przechodzonego dystansu i wartości ABI ani od rodzaju przeprowadzonej operacji otwartej (p = 0,02). Wnioski. Obecnie decyzje orzecznicze podejmowane są arbitralnie na podstawie subiektywnej analizy ciężkości przebytego zabiegu operacyjnego, bez uwzględnienia rzeczywistego stopnia zaawansowania schorzenia po rewaskularyzacji. Otrzymane wyniki świadczą o braku znajomości podstawowych kryteriów zaawansowania choroby u orzeczników ZUS i wymagają zmiany podstaw poprzez obowiązkowe szkolenia dla orzeczników

Simultaneous endovascular treatment of abdominal aortic aneurysm and renal artery stenosis

Tętniak aorty brzusznej (AAA) często współwystępuje ze zwężeniem tętnicy nerkowej (RAS). Wybór optymalnego postępowania terapeutycznego powinien być w takich okolicznościach zindywidualizowany. Leczenie wewnątrznaczyniowe AAA stało się akceptowalną alternatywą dla operacji otwartych, a angioplastyka RAS prawie całkowicie wyparła rewaskularyzację chirurgiczną. W artykule przedstawiono przypadek pacjenta z wysokim ryzykiem powikłań okołooperacyjnych oraz opornym nadciśnieniem tętniczym, u którego wykonano skuteczną wewnątrznaczyniową operację naprawczą AAA nieobejmującą tętnic nerkowych z jednoczasową angioplastyką RAS z wszczepieniem stentu. Nadciśnienie Tętnicze 2011, tom 15, nr 3, strony 184&#8211;187.Abdominal aortic aneurysm (AAA) often coexists with renal artery stenosis (RAS). Such patients need an individualized approach in choice of treatment. Endovascular repair of infrarenal AAA has become in recent years a generally accepted alternative to open surgery. In treatment of RAS, percutaneous techniques have largely replaced surgical revascularization. In the article a case of patient witha high level of perioperative risk and refractory hypertension is presented, who was successfully treated with simultaneous endovascular repair of AAA and RAS. Arterial Hypertension 2011, vol. 15, no 2, pages 184&#8211;187

Single Crystalline Films of Ce3+-Doped Y3MgxSiyAl5−x−yO12 Garnets: Crystallization, Optical, and Photocurrent Properties

This research focuses on LPE growth, and the examination of the optical and photovoltaic properties of single crystalline film (SCF) phosphors based on Ce3+-doped Y3MgxSiyAl5−x−yO12 garnets with Mg and Si contents in x = 0–0.345 and y = 0–0.31 ranges. The absorbance, luminescence, scintillation, and photocurrent properties of Y3MgxSiyAl5−x−yO12:Ce SCFs were examined in comparison with Y3Al5O12:Ce (YAG:Ce) counterpart. Especially prepared YAG:Ce SCFs with a low (x, y 1000 °C in a reducing atmosphere (95%N2 + 5%H2). Annealed SCF samples exhibited an LY of around 42% and similar scintillation decay kinetics to those of the YAG:Ce SCF counterpart. The photoluminescence studies of Y3MgxSiyAl5−x−yO12:Ce SCFs provide evidence for Ce3+ multicenter formation and the presence of an energy transfer between various Ce3+ multicenters. The Ce3+ multicenters possessed variable crystal field strengths in the nonequivalent dodecahedral sites of the garnet host due to the substitution of the octahedral positions by Mg2+ and the tetrahedral positions by Si4+. In comparison with YAG:Ce SCF, the Ce3+ luminescence spectra of Y3MgxSiyAl5−x−yO12:Ce SCFs greatly expanded in the red region. Using these beneficial trends of changes in the optical and photocurrent properties of Y3MgxSiyAl5−x−yO12:Ce garnets as a result of Mg2+ and Si4+ alloying, a new generation of SCF converters for white LEDs, photovoltaics, and scintillators could be developed

Procedure for the election of members of the management board and the election of delegates of Polish sports associations

The term of office of the authorities of a Polish sports association may not be longer than 4 years, and the function of the president of the association’s management board may be held for no more than two consecutive terms. The Act on Sport also sets out a catalogue of prohibitions and restric‑ tions aimed at persons holding positions on the association’s management board. Recommendations and guidelines on the procedure for the election of the bodies of Polish sports associations, including the election of delegates, are set out in the “Code of Good Governance for Polish Sports Associations”, developed by the Ministry of Sport and Tourism

Assessment of the proposal to amend the Criminal Code and the Code of Criminal Procedure

The author assesses a draft amendment, which, in the opinion of its sponsor, assumes an improvement of the substantive and legislative level of the legal acts in question. In the view of the author of the opinion, some of the proposed amendments to the Criminal Code raise doubts and may cause a limitation of the hitherto judicial discretion and penal reaction of the court. Amendments to the statutory definitions set forth in the Criminal Code may also translate into depenalization of certain types of criminal offences. With regard to the amendments to the Code of Criminal Procedure, the author assesses that allowing the appointment of a court-appointed attorney in the application of consensual procedures may improve the actions undertaken in consensual proceedings and ensure that the interests of the suspect are properly represented

Amendment to the provisions regarding of the crime of espionage and changes in the functioning of special services in the Deputies’ Bill amending the Criminal Code and certain other Acts (Sejm’s paper no. 3232)

The author analyses the modifications proposed in the Bill to amend the Criminal Code, consisting, inter alia, in the aggravation of the penalty for the offence of espionage, the addition of new qualified types of that crime, extending the penalty to the stage of preparation, as well as the introduction of the definition of an act of aggression. The amending Bill provides for a number of amendments to the statutes regulating the functioning of the Internal Security Agency, the Foreign Intelligence Agency, the Central Anticorruption Bureau, the Military Counterintelligence Service and the Military Intelligence Service