Anomalies in biliary tree anatomy - own observations

Kamica pęcherzyka żółciowego jest jedną z najczęstszych przyczyn operacji w obrębie jamy brzusznej. W trakcie tego zabiegu może dojść do powikłań związanych z występowaniem nietypowego przebiegu zewnątrzwątrobowych dróg żółciowych. W pracy dokonano przeglądu niektórych wariantów anatomicznych występujących w budowie zewnątrzwątrobowych dróg żółciowych. Autorzy opisali także przebieg diagnostyki i leczenia chorej po laparoskopowym wycięciu pęcherzyka żółciowego, u której doszło do powikłań na tle następstw uszkodzenia przewodu zbaczającego, drenującego żółć z V segmentu wątroby. Badaniem pomocnym w ustaleniu źródła powikłania była cholangiografia rezonansu magnetycznego. Znajomość odchyleń w budowie zewnątrzwątrobowych dróg żółciowych, wiedza o istnieniu przewodów zbaczających i przewodów dodatkowych są niezbędne każdemu chirurgowi operującemu w obrębie dróg żółciowych.Cholelithiasis is one of the most frequent causes of operative treatment in the abdominal region. Intraoperative complications caused by an atypical course of the extrahepatic biliary tree may occur. In this study some of anatomical variations of the extrahepatic biliary system are reviewed. The authors describe the diagnostic and therapeutic process of a patient who underwent a laparoscopic cholecystectomy, complicated by the injury of the aberrant bile duct, draining bile from the 5th hepatic segment. A CholangioMRI examination was helpful to determine the diagnosis. Bile duct surgery demands a wide knowledge of the different variations of biliary tree anatomy and an awareness of the possible presence of accessory and aberrant ducts

On-Pump vs Off-Pump coronary artery bypass surgery in atrial fibrillation : analysis from the polish national registry of cardiac surgery procedures (KROK)

BackgroundNo single randomized study has ever before addressed the safety of On-Pump coronary artery bypass grafting (CABG) vs Off-Pump CABG in the setting of atrial fibrillation (AF) and data from small observational samples remain inconclusive.Methods and findingsProcedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. Of initial 188,972 patients undergoing CABG, 7,913 presented with baseline AF (76.0% men, mean age 69.1±8.2) and underwent CABG without concomitant valve surgery between 2006-2019 in 37 reference centers across Poland. Mean follow-up was 4.7±3.5 years (median 4.3 IQR 1.7-7.4). Cox proportional hazards models were used for computations. Of included patients, 3,681 underwent On-Pump- (46.52%) as compared to 4,232 (53.48%) who underwent Off-Pump CABG. Patients in the latter group less frequently were candidates for complete revascularization (PConclusionsOff-Pump CABG offered 30-day survival benefit to patients undergoing CABG surgery and presenting with underlying AF. On-Pump CABG was associated with significantly improved survival at long term

Long-term survival following surgical ablation for atrial fibrillation concomitant to isolated and combined coronary artery bypass surgery-analysis from the polish national registry of cardiac surgery procedures (KROK)

The current investigation aimed to evaluate long-term survival in patients undergoing isolated and combined coronary artery bypass grafting (CABG) with concomitant surgical ablation for atrial fibrillation (AF). Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. Eleven thousand three hundred sixteen patients with baseline AF (72.4% men, mean age 69.6 ± 7.9) undergoing isolated and combined CABG surgery between 2006–2019 in 37 reference centers across Poland and included in the registry were analyzed. The median follow-up was four years (3.7 IQR 1.3–6.8). Over a 12-year study period, there was a significant survival benefit (Hazard Ratio (HR) 0.83; (95% Confidence Interval (CI): 0.73–0.95); p = 0.005) with concomitant ablation as compared to no concomitant ablation. After rigorous propensity matching (LOGIT model, 432 pairs), concomitant surgical ablation was associated with over 25% improved survival in the overall analysis: HR 0.74; (95% CIs: 0.56–0.98); p = 0.036. The benefit of concomitant ablation was maintained in the subgroups, yet the most benefit was appraised in low-risk patients (EuroSCORE < 2, p = 0.003) with the three-vessel disease (p < 0.001) and without other comorbidities. Ablation was further associated with significantly improved survival in patients undergoing CABG with mitral valve surgery (HR 0.62; (95% CIs: 0.52–0.74); p < 0.001) and in patients in whom complete revascularization was not achieved: HR 0.43; (95% CIs: 0.24–0.79); p = 0.006. View Full-Text

Tricuspid intervention for less-than-severe regurgitation at time of minimally invasive mitral valve surgery in patients with AF

Background: While to address moderate tricuspid regurgitation (TR) at time of left-side heart surgery is recommended by the guidelines, the procedure is still seldom performed and especially in the minimally invasive setting. Atrial fibrillation (AF) is known marker of both mortality and TR progression after mitral valve surgery. Aims: The current study aimed to address the safety of adding a tricuspid intervention to minimally invasive mitral valve surgery (MIMVS) in patients with preoperative AF. Methods: We retrospectively analyzed data from Polish National Registry of Cardiac Surgery Procedures between 2006 and 2021. We included all patients who underwent MIMVS (mini-thoracotomy-, totally thoracoscopic- or robotic surgery) and presented with moderate tricuspid regurgitation and AF preoperatively. The primary endpoint was death from any cause at 30 days and at longest available follow between MIMVS with tricuspid intervention vs MIMVS alone. We used propensity score matching to account for baseline differences between groups. Results: We identified 1,545 patients with AF undergoing MIMVS, 54.7% were men aged 66.7±9.2years. Of those, 733 (47.4%) underwent concomitant tricuspid valve intervention. At 13 years, addition of tricuspid intervention was associated with 33% higher mortality as compared to MIMVS alone. HR 1.33; 95 CIs (1.05-1.69); P=0.02. PS matching resulted in 565 well-balanced pairs. Concomitant tricuspid intervention did not influence long-term follow-up: HR, 1.01; 95 CIs (0.74-1.38); P=0.94. Conclusions: After adjusting for baseline cofounders the addition of tricuspid intervention for moderate tricuspid regurgitation to MIMVS did not increase perioperative mortality nor influence long-term survival

Architektura Miasto Piękno tom 2

"Wydział Architektury Politechniki Krakowskiej zawsze był miejscem pełnym osobowości, indywidualności, talentów. Gdy profesorowie i mistrzowie odchodzili z Wydziału, mieliśmy świadomość, że tu nigdy już nie będzie tak samo. Wydział jednak trwał i trwa jak piękno miasta, które jest przecież dziełem zbiorowym, o nakładających się warstwach, wzmacniających i tworzących jego tożsamość. Tak też kolejne pokolenia kontynuują i budują historię Wydziału. Wydział pełen jest wspomnień i anegdot. W fotografiach, księgach, obrazach, meblach kryją się opowieści."(...

The Applications of Plasma Techniques

This Special Issue “The Applications of Plasma Techniques” in the section “Optics and Lasers” of the journal Applied Sciences intends to provide a description of plasmas, plasma devices and processes related to plasma applications in a broad sense [...

The Applications of Plasma Techniques II

This Special Issue &ldquo;The Applications of Plasma Techniques II&rdquo; in the section &ldquo;Optics and Lasers&rdquo; of the journal Applied Sciences is intended to provide a description of devices and processes related to plasma applications in the broad sense [...