Embolizacja tętnic macicznych – zagadnienia kliniczne

The aim of the study was to present clinical issues concerning uterine artery embolization (UAE) in women with uterine fibromas. In order to ensure high clinical efficiency of UAE and prevent subsequent complications, it is necessary to carefully select patients eligible for the procedure. Patients with intramural fibromas, who do not plan to conceive, are the best candidates for the procedure. Fibroma necrosis, with following infection, and premature ovarian failure remain to be the most common complications after UAE. UAE may cause amenorrhea and increase FSH levels, what is typical for menopause. Thus, it may be responsible for problems with conception as well as optimal development of a pregnancy. It may also cause premature, iatrogenic menopause. This complication significantly more frequently occurs in women over the age of 45 as compared to younger patients. UAE is considered as an alternative therapeutic procedure, available to women who do not desire the surgery or wish to preserve the uterus. Patients subject to this procedure should be informed about the possible side effects.Celem pracy było przedstawienie zagadnień klinicznych związanych z zabiegami embolizacji tętnic macicznych (UAE) w przypadku objawowych mięśniaków macicy. Zwrócono uwagę, że odpowiednia kwalifikacja chorych do zabiegu ma kluczowe znaczenie dla wysokiej skuteczności klinicznej oraz zapobiegania powikłaniom po UAE. Kandydatkami powinny być kobiety z objawowymi mięśniakami położonymi śródściennie, które w przyszłości nie planują zachodzić w ciążę. Przedwczesne wygasanie czynności jajników, obok martwicy mięśniaka z następową infekcją stanowi jedno z najczęstszych powikłań embolizacji. Może być przyczyną przedwczesnej, jatrogennej menopauzy oraz trudności w zajściu i donoszeniu ciąży. UAE może niekorzystnie wpłynąć na funkcję jajników, powodując czasowe lub stałe zatrzymanie miesiączki, a także typowy dla okresu menopauzy wzrost poziomu FSH. Znacznie częściej to powikłanie UAE obserwuje się u kobiet po 45 roku życia, niż młodszych. Embolizacja tętnic macicznych przeprowadzana w celu leczenia objawowych mięśniaków macicy stanowi alternatywną opcję terapeutyczną, istotną dla kobiet, które nie chcą poddawać się operacji lub pragnących zachować macicę. Chore poddawane tego typu leczeniu powinny być poinformowane o możliwych skutkach ubocznych

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

Experimental Study on the Mass Flow Rate of the Self-Pressurizing Propellants in the Rocket Injector

High vapor pressure propellants such as nitrous oxide are widely used in experimental hybrid and liquid rockets as they can be used in a self-pressurization mode, eliminating the need for external pressurization or pumps and simplifying the design of the rocket system. This approach causes the two-phase flow in the feed system and the injector orifices, which cannot be easily modeled and accounted for in the design. A dedicated test stand has been developed to better understand how the two-phase flow of the self-pressurizing propellant impacts the mass flow characteristics, enabling the simulation of the operating conditions in the rocket engine. The injectors have been studied in the range of ΔP. The flow regimes have been identified, which can be predicted by the SPI and HEM models. It has been shown that the two-phase flow quality upstream of the injector may impact the discharge coefficient in the SPI region and the accuracy of the HEM model. It has been found that the transition to the critical flow region depends on the L/D ratio of the injector orifice. A series of conclusions can be drawn from this work to design the rocket injector with a self-pressurizing propellant to better predict the mass flow rate and ensure stable combustion

Quality of nurses’ work as assessed patients with ovarian cancer undergoing chemotherapy

Ovarian cancer is the second most common cause of mortality due to female genital malignancies in Poland and thus a considerable problem in gynecologic oncology. In spite of introduction of novel therapies and new diagnostic modalities, treatment outcome is far from satisfactory. Therapeutic failures are associated first and foremost with detection of the disease at a late clinical stage in most patients. Treatment of ovarian cancer, characterized by a high recurrence rate, is prolonged and cumbersome for the female organism, due mainly to multiple side effects associated with administration of cytostatics. The purpose of this study was to evaluate the work of nurses and midwives, caring for patients undergoing chemotherapy at the Department of Gynecologic Oncology. In 2009 and 2010, 100 hospitalized patients filled-in a custom-designed questionnaire. The questionnaire included a general part, devoted to sociodemographic and clinical data, and a detailed part, consisting of 6 sections, assessing particular aspects of nursing care stemming from nurses’ and midwives’ professional functions. Results obtained have led us to conclude that patients’ level of satisfaction concerning the quality of nursing care is in fact very high. Not a single negative mark appeared in the study, evidencing good quality of services provided. Only a few aspects of care assessed by the patients require institution of reparative action. These include patients’ education and sense of intimacy during examination and nursing procedures. Comparative analysis included results of studies performed at Center of Oncology in Warsaw, at two oncologic departments in Lublin and at the Regional Center of Oncology in Kielce. Results obtained demonstrate that the highest level of satisfaction with quality of nurses’ work was obtained at the Department of Gynecologic Oncology in Poznań.Rak jajnika stanowi drugą co do częstości przyczynę zgonów z powodu nowotworów narządów rodnych w Polsce i jest dużym problemem dla onkologii ginekologicznej. Mimo wprowadzania do terapii nowoczesnych leków oraz nowych badań diagnostycznych efekty są bardzo niezadowalające. Niepowodzenia w postępowaniu terapeutycznym wynikają przede wszystkim z rozpoznawania choroby w znacznym stopniu zaawansowania u większości pacjentek. Leczenie raka jajnika, cechującego się dużą skłonnością do nawrotów, jest długotrwałe i obciąża organizm kobiety z powodu wielu skutków ubocznych występujących podczas leczenia cytostatykami. Celem przeprowadzonych badań była ocena jakości pracy pielęgniarek i położnych świadczących opiekę chorym leczonym chemioterapią w Klinice Onkologii Ginekologicznej. Opracowane na potrzeby pracy ankiety wypełniło 100 pacjentek hospitalizowanych na oddziale w latach 2009 i 2010. Kwestionariusz podzielono na część ogólną, zawierającą dane socjodemograficzne i kliniczne, oraz szczegółową, składającą się z 6 części, w których wystawiane oceny dotyczyły różnych aspektów opieki wynikających z funkcji zawodowych pielęgniarek i położnych. Uzyskane wyniki pozwalają wnioskować, iż poziom satysfakcji pacjentek oceniających jakość pracy zespołu jest bardzo wysoki. W badaniu nie pojawiła się ani jedna ocena negatywna, co świadczy o dobrym poziomie świadczonych usług. Tylko nieliczne aspekty opieki opiniowane przez chore wymagają wprowadzenia działań naprawczych. Należą do nich edukacja pacjentów i poczucie intymności w trakcie badań i zabiegów pielęgniarskich. Do analizy porównawczej użyto wyników badań przeprowadzonych w warszawskim Centrum Onkologii – Instytucie, w dwóch oddziałach onkologicznych w Lublinie i Świętokrzyskim Centrum Onkologii. Uzyskane dane jednoznacznie wykazały, iż najwyższy poziom satysfakcji pacjentów z oceny jakości pracy pielęgniarek i położnych uzyskano w Klinice Onkologii Ginekologicznej w Poznaniu

Prevalence of Lower Extremity Arterial Disease as Measured by Low Ankle-Brachial Index in Patients with Acute Cerebral Ischemic Events

Background: Low ankle–brachial index (ABI) of ≤0.9 is diagnostic of lower extremity arterial disease (LEAD). It is also a strong marker of generalized atherosclerosis. The objective of this study was to assess the prevalence of low ABI in patients with acute cerebral ischemic events (ACIE): ischemic stroke (IS) or transient ischemic attack (TIA). Methods: We compared 150 inpatients with ACIE to 50 inpatient controls and assessed risk factors, ABI measurements, and Duplex ultrasound of the cervical vessels. Results: Low ABI was seen in 69 patients (46%) in the ACIE group and in 8 (16%) in the control group; p < 0.01. The mean and median ABI values in the ACIE group were 0.88 (SD = 0.22) and 0.91 (0.24–1.33), which were significantly lower than in the control group: 1.04 (SD = 0.16) and 1.0 (0.66–1.36); p < 0.0001, respectively. Coronary artery disease, carotid stenosis of ≥50% and smoking were risk factors, which were associated with significantly lower ABI in the study group; the ABI with risk factors vs. without was 0.85 vs. 0.92 (coronary artery disease); p < 0.05, 0.7 vs. 0.92; (carotid stenosis) p < 0.001 and 0.83 vs. 0.98; (smoking) p < 0.001, respectively. Conclusion: Our study demonstrated that patients with ACIE have significantly higher involvement of another vascular bed as LEAD. Coronary artery disease, carotid stenosis ≥50% and smoking were main risk factors associated with coexistence of LEAD and ACIE

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 99 min. 90.3% of the studied patients had MT within 6 h 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 guideline