Chronic Total Occlusion Of Coronary Artery Without Previous History Of Myocardial Infarction: A Role Of Spect

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Physiotherapy in patients after lung parenchyma resection

Resekcja miąższu płuca jest leczeniem z wyboru we wczesnym stadium zaawansowania raka płuca. Zabieg operacyjny wiąże się z utratą powierzchni oddechowej i w konsekwencji prowadzi do obniżenia wydolności fizycznej. Do odtworzenia funkcji i sprawnego działania układu oddechowego niezbędna jest właściwa rehabilitacja. Powinna stanowić integralną część leczenia chirurgicznego, być także odpowiednio wcześnie wdrożona i trwać do pełnego powrotu funkcji oraz sprawności. W pracy zostało omówione postępowanie fizjoterapeutyczne z pacjentami po zabiegu resekcji miąższu płuca. Zgodnie z obowiązującymi wytycznymi postępowanie opisano w kilku etapach. W okresie przedoperacyjnym włączenie programu ćwiczeń fizycznych pozwala lepiej przygotować pacjenta do zabiegu i zmniejszyć ryzyko wystąpienia niektórych powikłań pooperacyjnych. Ze względu na tendencję do skracania okresu pobytu w szpitalu opracowano formę ulotki dla pacjentów z wytycznymi dotyczącymi przygotowania do zabiegu. Szczegółowo opisane postępowanie w okresie okołooperacyjnym przedstawia możliwe działania fizjoterapeutyczne z pacjentem po resekcji miąższu płuca. Tok usprawniania udokumentowano zaproponowaną kartą usprawniania, opisującą podstawowe działania oraz zawierającą dodatkowe miejsce na uwagi, potrzebne na przykład w przypadku powikłań. Poszpitalny etap rehabilitacji opisany zgodnie z aktualnymi wytycznymi uzupełnia całość procesu postępowania po zabiegu operacyjnym. Do realizacji założeń rehabilitacji musi powstać ściśle współpracujący ze sobą zespół specjalistów. W jego składzie oprócz fizjoterapeutów powinni uczestniczyć także lekarze, pielęgniarki, psycholog czy terapeuta zajęciowy. Znaczącą rolę odgrywa również wsparcie najbliższej rodziny. Bardzo istotnym czynnikiem jest odpowiednia edukacja pacjentów i uświadomienie celowości takiego postępowania. Dalsza analiza pozwoliła na stworzenie algorytmu postępowania z pacjentem w niepowikłanym modelu usprawniania po chirurgicznym leczeniu raka płuca.Lung parenchyma resection is the treatment of choice for early-stage lung cancer. The surgery involves the loss of respiratory surface and consequently leads to reduction in exercise capacity. Proper rehabilitation is essential for restoring the function and good performance of the respiratory system. Rehabilitation should be an integral part of surgical treatment. It should be implemented early and maintained until full restoration of function and fitness. The paper discusses the physiotherapeutic procedure in patients after lung parenchyma resection. Under current guidelines, the recommended physiotherapeutic approach has been described as a multi-stage process. A preoperative exercise program can prepare the patient better for surgery and reduce the risk of some postoperative complications. Since there is a tendency to shorten the hospital stay, guidelines in preparation for surgery have been developed in the form of leaflets given to patients. In specifically described perioperative treatment we can see the physiotherapeutic procedures that the patient, after lung parenchyma resection, may undergo. Physiotherapy protocol was documented using a proposed patient’s card that described the basic treatment and included additional space for comments, in case of complications etc. Post-hospital rehabilitation, described in accordance with current guidelines, complements the treatment after surgery as a whole. To achieve the goals of rehabilitation a team of closely cooperating specialists must emerge. It should include physicians, physiotherapists, nurses, psychologists and occupational therapists. Family support plays a significant role as well. Proper education for patients and informing them about the purposefulness of the treatment are very significant factors. Further analysis allowed the creation of an algorithm for physiotherapeutic care in patients without complications after lung cancer surgery

Peptydy angiotensynowe regulują aktywność angiogenną w hodowlach komórkowych szczurzych guzów przedniego płata przysadki

Wstęp: Angiogeneza to niezbędny etap w procesie formowania i progresji guzów litych. VEGF należy do kluczowych cytokin proangiogennych, syntetyzowanych przez komórki wielu badanych dotychczas guzów, włączając różne typy gruczolaków przysadki. Angiotensyna II należy do czynników regulujących ekspresję VEGF w różnych tkankach, zarówno w warunkach fizjologii, jak i patologii. Co więcej, udowodniono związek układu renina-angiotensyna (układu RA) z indukowanym estrogenami wzrostem naczyń w procesie formowania doświadczalnego guza prolaktynowego przysadki u szczura. Celem pracy było zbadanie wpływu peptydów angiotensynowych (ang II, ang III i ang IV) na wydzielanie VEGF w dwóch hodowlach komórkowych gruczolaka przysadki: w ciągłej hodowli linii guza laktosomatotropowego GH3 oraz w pierwotnej hodowli indukowanego dietylstilbestrolem (DES) guza prolaktynowego szczura. Materiał i metody: Komórki GH3 oraz komórki prolactinoma hodowano odpowiednio w mediach F-10 i F-12, a następnie rozsiewano do studzienek 24-dołkowych płytek hodowlanych (105 komórek GH3 na studzienkę i 106 komórek gruczolaka na studzienkę). Po 12 godzinach preinkubacji komórki inkubowano przez 24 godziny w obecności ang II, ang III lub ang IV w stężeniach 10&#8211;12, 10&#8211;10, 10&#8211;8 lub 10&#8211;6M lub, w przypadku komórek GH3, w obecności ang II (10&#8211;10M) w połączeniu ze specyficznym antagonistą receptora AT1 losartanem lub receptora AT2 - PD123319 w stężeniach 10&#8211;8 lub 10&#8211;7M. Stężenie VEGF w medium hodowlanym oznaczano, wykorzystując metodę ELISA. Analizy statystycznej dokonywano przy użyciu testu t-Studenta oraz na podstawie analizy wariancji (ANOVA), dla poziomu istotności p < 0.05. Wyniki: Inkubacja komórek GH3 lub komórek pierwotnej hodowli guza prolaktynowego w obecności ang II, ang III lub ang IV w stężeniach 10&#8211;12 - 10&#8211;8M prowadziła do wzrostu stężeń VEGF w medium hodowlanym. Przeciwnie, po ekspozycji komórek GH3 na działanie ang III lub ang IV w stężeniach 10&#8211;6M dochodziło do zahamowania wydzielania cytokiny, a krzywa korelacji Persona wykazała dodatkowo tendencję do hamowania wydzielania VEGF w pierwotnej hodowli prolactinoma przez ang II w stężeniach przekraczających 10&#8211;6M. Pobudzający wpływ ang II na sekrecję VEGF przez komórki GH3 znoszony był zarówno przez losartan, jak i PD123319. Wnioski: Ang II, ang III i ang IV wpływają na wydzielanie VEGF przez komórki GH3 oraz komórki gruczolaka prolaktynowego szczura. Zarówno receptory AT1, jak i AT2 pośredniczą w proangiogennym efekcie ang II w hodowli GH3. Mechanizm obserwowanego, hamującego oddziaływania peptydów angiotensynowych na sekrecję VEGF pozostaje niewyjaśniony.Introduction: Angiogenesis has been shown to be necessary for the development and progression of solid tumours. VEGF is one of the crucial pro-angiogenic cytokines produced by the cells of many of the tumours examined, including various types of anterior pituitary adenomas. Angiotensin II (Ang II) is known to regulate the expression of VEGF in a variety of tissues both in the physiological and pathological conditions. Moreover, an association of the renin-angiotensin system (RAS) with oestrogen-induced vascular changes during the development of rat pituitary PRL-secreting adenoma has already been demonstrated. The aim of the study was to determine the in vitro effects of angiotensin peptides (Ang II, Ang III and Ang IV) on the secretion of VEGF in two anterior pituitary adenoma cell cultures: the culture of the rat pituitary lactosomatotrope tumour cell line (GH3) and the primary culture of rat PRL-secreting tumour induced by diethylstilbestrol (DES). Material and methods: GH3 and prolactinoma cells were cultured in an F10 and an F-12 medium respectively and then placed into 24 multiwell plates (105 of GH3 cells/well and 106 of rat prolactinoma cells/well). After 12 hours of preincubation the cells underwent 24-hour treatment with Ang II, Ang III or Ang IV at final concentrations of 10&#8211;12, 10&#8211;10, 10&#8211;8 or 10&#8211;6M and, in the case of the GH3 cells, combined treatment with Ang II (10&#8211;10M) and specific AT1 or AT2 receptor antagonist (losartan or PD123319 respectively at a concentration of 10&#8211;8 or 10&#8211;7 M). The concentration of VEGF in the supernatant collected was determined using specific ELISA assay kits. Statistical evaluation was performed using Student&#8217;s test and analysis of variance (ANOVA). Differences were considered significant if p < 0.05. Results: The incubation of both GH3 cells and rat adenoma cells with Ang II, Ang III or Ang IV at concentrations of 10&#8211;12 &#8211;10&#8211;8M resulted in a significant increase in VEGF concentration in the culture medium. Exposure of GH3 cells to Ang III or Ang IV at concentrations of 10-6M led to a significant inhibition of cytokine release, and Pearson&#8217;s correlation curve showed a tendency for Ang II at concentrations of more than 10&#8211;6M to inhibit VEGF secretion in primary prolactinoma cell culture. The stimulatory influence of Ang II on VEGF secretion in GH3 cell culture was negated by losartan or by PD123319 in both concentrations tested. Conclusions: Ang II, Ang III and Ang IV affect the secretion of VEGF in cultures of the rat lactosomatotrope GH3 cell line and primary rat prolactinoma cells. Both AT1 and AT2 receptors mediate the stimulatory action of Ang II on the cytokine release in GH3 cell culture. The mechanism of the observed anti-angiogenic effects of angiotensin peptides remains unexplained

The Involvement of Angiotensin Type 1 and Type 2 Receptors in Estrogen-Induced Cell Proliferation and Vascular Endothelial Growth Factor Expression in the Rat Anterior Pituitary

The aim of our study was to examine the involvement of renin-angiotensin system (RAS) in estrogen-induced lactotropes proliferation and vascular endothelial growth factor (VEGF) expression in rat pituitary. The study was performed on Fisher 344 rats underwent 8-day treatment with diethylstilboestrol (DES). The proliferation index (PCNA) and VEGF expression in pituitary sections were estimated using immunohistochemical methods. Treatment with DES increased the number of PCNA-positive cells, VEGF-positive cells, and VEGF-positive blood vessels in pituitary. Stimulatory effect of estrogen on cell proliferation and VEGF expression in blood vessels was attenuated by losartan, PD123319, and captopril. VEGF immunoreactivity in pituitary cells of DES-treated rats was decreased by AT1 antagonist and not changed by AT2 blocker and ACE inhibitor. Our findings suggest the involvement of RAS in DES-induced cell proliferation and VEGF expression in pituitary. Both the AT1 and AT2 receptors appear to mediate the estrogen-dependent mitogenic and proangiogenic effects in rat pituitary

Incidental finding of [99mTc]Tc-MIBI uptake in a post-radiotherapy breast without recurrence of cancer

The oncophilic nature of [99mTc]Tc-MIBI makes this radiopharmaceutical useful in cancer diagnostics, with particular emphasis on breast cancer. Increased uptake of [99mTc]Tc-MIBI in tests performed for non-oncological indications always raises the suspicion of its neoplasmatic character and requires further clinical diagnostics, which is especially justified in patients with a previous history of cancer. However, the presented case illustrates that focally increased uptake of [99mTc]Tc-MIBI is not always associated with the presence of cancer cells and may result from post-therapeutic changes

The transverse facial artery anatomy : implications for plastic surgery procedures

BACKGROUND:The transverse facial artery (TFA) perfuses the lateral face. Knowledge of topographical anatomy of the lateral face is crucial for safe procedural performance in aesthetic and plastic surgery, especially the face lift flap and face transplant. The aim of the present study was to assess detailed TFA morphometrical features. PATIENTS AND METHODS:One-hundred computed tomography head angiographies were analyzed. TFA numbers and origins were recorded bilaterally (200 cases). TFA diameters and lengths in addition to their positions in relation to neighboring vessels and the zygomatic arches were measured. RESULTS:TFA was present in 96% of cases (192/200, left = 97, right = 95). A single TFA was present in 95.3% and double TFAs were present in 4.7% of cases. In 91.7%, the TFA originated from the superficial temporal artery, and in 3.1%, it originated from the external carotid artery. One left TFA originated from the maxillary artery. The TFA was significantly longer on the right than on the left side (56.6±26.0 versus 47.3±22.2 mm; p = 0.03). The TFA mean diameter was 1.0±0.4 mm (range: 0.4-2.2 mm) with no difference between face sides. TFA length correlated with its diameter (r = 0.46, p <0.05). The TFA always originated below the zygomatic arch, and it should be found in the 8.8 mm wide area beginning 17.0mm below the lower border of the zygomatic arch. CONCLUSIONS:The TFA has a significant role in lateral face vascularization, and absence of this vessel is very uncommon

Sense of happiness in Polish patients with multiple sclerosis

Introduction. Happiness is crucial to patient well-being and their acceptance of their disease. The aim of this study was to assess the sense of happiness in persons with multiple sclerosis (PwMS), compare it to the level of happiness in patients with other neurological conditions, and determine which factors affect the sense of happiness in PwMS. Material and methods. Five hundred and eighty-nine PwMS and 145 control subjects (post-stroke patients with chronic pain syndromes and neuropathies) were included in the study. Due to the differences between the groups in terms of demographic variables, an adjusted group of PwMS (n = 145) was selected from the entire group of PwMS. All patients were assessed using the Oxford Happiness Questionnaire (OHQ), the Satisfaction with Life Scale (SLS), and the Family APGAR Questionnaire. Based on regression analysis, the study examined which variables affected the level of happiness in the groups. Results. Analysis of the OHQ scores showed that PwMS had a lower sense of happiness compared to the control group in the overall score [113.21 (25–42) vs. 119.88 (25–49), respectively; p = 0.031] and the subscales (OHQ subscale 1 — 54.52 vs. 57.84, respectively; p = 0.027; subscale 2 — 35.61 vs. 37.67; respectively; p = 0.044). Based on linear regression analysis, life satisfaction (β = 0.40; p &lt; 0.001), positive orientation (β = 0.32; p &lt; 0.001), and primary education (β = 0.08; p = 0.009) were the most significant predictors of a higher level of happiness in PwMS. Similar results were found in the control group. Conclusions. The sense of happiness in PwMS was lower than in patients with other conditions. The most important factors influencing happiness included life satisfaction and positive orientation. Influencing these predictors should be the aim of psychological interventions, especially in patients with a reduced sense of happiness

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