Organizing a bus depot – selected aspects

Urban transportation problems are particularly noticeable within cities of over 100 thousand inhabitants. In these cities buses are a primary means of transport, but lack of low-floor and poor interior design does not encourage passengers to use them. However, the qualities that give the most negative feedback on the public transpiration are the technical condition of buses, excessive noise and exhaust emission. Technical backsides of the bus depots that constantly maintain the technical readiness of the required number of vehicles play an important role to ensure high quality standards. New European Union legislation is very helpful in such. New laws and regulations deal with the safety issues and environmental protection matters, to which the urban transportation depots must be strictly adjusted. This article refers to these documents and presents depot technical stations, which equipment needs to be upgraded in the first place

Biliary complications after orthotopic liver transplantation in adults

Przeszczepianie wątroby stało się obecnie leczeniem z wyboru w przypadku schyłkowej niewydolności wątroby. Wraz z ciągłym rozwojem transplantologii i immunologii wyniki przeszczepiania wątroby ulegają stopniowej poprawie. Obecnie średnie 5-letnie przeżycie po ortotopowym przeszczepieniu wątroby (OLT) biorców kształtuje się na poziomie 72–77% w zależności od stopnia niewydolności wątroby. Z procedurą transplantacji wątroby nierozerwalnie wiąże się obecność powikłań, które w 80% występują w ciągu pierwszych 6 miesięcy po OLT. Do najczęściej spotykanych należą powikłania dotyczące dróg żółciowych. Najważniejsze i najszerzej opisywane to: wycieki żółci, zwężenia — zarówno w miejscu, jak i poza miejscem zespolenia dróg żółciowych, złogi w drogach żółciowych, dysfunkcja zwieracza Oddiego oraz ucisk na drogi żółciowe. Są one groźne, gdyż niejednokrotnie prowadzą do utraty przeszczepu lub zgonu chorego. Obecnie częstość powikłań żółciowych kształtuje się na poziomie 6–35% wszystkich transplantacji, najczęściej oscylując wokół 20% przy utrzymującej się od wielu lat stałej tendencji spadkowej. Do istotnych czynników prognozujących wystąpienie powikłań żółciowych po OLT należą: przedoperacyjne stężenie bilirubiny w surowicy krwi oraz wskaźnik INR biorcy, zastosowanie drenażu Kehra, liczba przetoczonych podczas operacji jednostek osocza świeżo mrożonego, a także rodzaj graftu wątrobowego. Zmienia się sposób postępowania w przypadku podejrzenia powikłań żółciowych. Referencyjną metodą diagnostyczną stał się magnetyczny rezonans dróg żółciowych (MRCP). W przypadku potwierdzenia rozpoznania powikłań żółciowych leczenie operacyjne w większości zostało zastąpione technikami endoskopowymi i przezskórnymi. Przy nieskuteczności powyższego postępowania konieczna staje się retransplantacja wątroby. Z powodu ciągle niewystarczającej liczby zmarłych dawców wciąż poszukuje się nowszych metod pozyskiwania narządów do przeszczepienia. Wprowadzono metodę pozyskiwania graftów z częściowej hepatektomii od dawców żywych oraz podziału na mniejsze części wątroby pochodzącej od zmarłego dawcy. Cele niniejszego artykułu to analiza i podsumowanie doniesień dotyczących powikłań żółciowych po OLT u dorosłych. Problem ten wydaje się szczególnie istotny z powodu coraz większej liczby transplantacji wątroby w Polsce.Liver transplantation has become at present the treatment of choice in cases of end-stage liver disease. Along with the significant development of transplantology and immunology, the results of liver transplantation have been gradually improving. Currently, the 5-year survival rate in recipients following orthotopic liver transplantation (OLT) is at a level of 72–77%, depending on the stage of liver insufficiency. The presence of complications is inseparably connected with the procedure of liver transplantation, and occur in 80% of cases during the first six months after OLT. One of the most common are complications concerning bile ducts. The most important and widely described are bile leakages, anastomotic and nonmagnetyczanastomotic strictures, bile concrements, sphincter of Oddi dysfunction and compression of the biliary tract. Such complications are dangerous as many times they lead to the loss of the graft or even death. Despite permanent improvements in the surgical technique of performing bile ducts anastomoses and the growing experience of transplantologists, biliary anastomosis is often called the “Achilles heel” of liver transplantation. Nowadays, the prevalence of biliary complications is at a level of 6–35% of all liver transplantations, and most frequently oscillates around 20%, a figure which has been showing a regular downward trend for many years. The most commonly-listed risk factors of biliary complications after OLT are: preoperative serum bilirubin level and INR in recipient, T-tube drainage, the number of fresh frozen plasmas used during the operation and the type of liver graft. Management options, in cases of suspicion of biliary complications, have also changed with Magnetic Resonance Cholangiopancreatography (MRCP) having become a “gold standard” in diagnostics. In the cases of confirmation of the diagnosis of biliary complications, surgical techniques have mainly been replaced by endoscopic or percutaneous techniques. In cases of the ineffectiveness of the above-mentioned treatment, liver re-transplantation becomes necessary. Because of the continuously insufficient number of deceased donors, more and more new methods of expanding the number of grafts for transplantation are being discovered. The methods of gaining the grafts from partial hepatectomy from living donors and division of the liver into smaller parts from a deceased donor have also been introduced. The aim of this article is to be a review and analysis of reports concerning biliary complications after orthotopic liver transplantation in adults. This problem has becomes especially important due to more and more liver transplantations being performed in Poland

Spectroscopic Studies on Organic Matter from Triassic Reptile Bones, Upper Silesia

Fossil biomolecules from an endogenous source were previously identified in Cretaceous to Pleistocene fossilized bones, the evidence coming from molecular analyses. These findings, however, were called into question and an alternative hypothesis of the invasion of the bone by bacterial biofilm was proposed. Herewith we report a new finding of morphologically preserved blood-vessel-like structures enclosing organic molecules preserved in ironoxide-mineralized vessel walls from the cortical region of nothosaurid and tanystropheid (aquatic and terrestrial diapsid reptiles) bones. These findings are from the Early/Middle Triassic boundary (Upper Roetian/Lowermost Muschelkalk) strata of Upper Silesia, Poland. Multiple spectroscopic analyses (FTIR, To F-SIMS, and XPS) of the extracted "blood vessels" showed the presence of organic compounds, including fragments of various amino acids such as hydroxyproline and hydroxylysine as well as amides, that may suggest the presence of collagen protein residues. Because these amino acids are absent from most proteins other than collagen, we infer that the proteinaceous molecules may originate from endogenous collagen. The preservation of molecular signals of proteins within the "blood vessels" was most likely made possible through the process of early diagenetic iron oxide mineralization. This discovery provides the oldest evidence of in situ preservation of complex organic molecules in vertebrate remains in a marine environment

Long-term consequences of surgical excision of cortisol producing adrenocortical adenoma

Wstęp: U chorych z ACTH-niezależnym zespołem Cushinga chirurgiczne usunięcie guza nadnercza umożliwia ich całkowite wyleczenie. Jednak u części pacjentów po adrenalektomii nadal obserwuje się występowanie nadciśnienia tętniczego, otyłości i cukrzycy. Celem pracy była analiza odległych następstw chirurgicznego usunięcia gruczolaka kory nadnercza wytwarzającego kortyzol, ze szczególnym uwzględnieniem wpływu wykonanej adrenalektomii na ciśnienie tętnicze. Materiał i metody: Analizą objęto 15 chorych (śr. wieku 54 lata) z nadciśnieniem tętniczym (n = 15), otyłością lub nadwagą (n = 12) i cukrzycą (n = 7). Czas obserwacji wynosił średnio 45 miesięcy. Wyniki: Poprawę kontroli ciśnienia tętniczego po jednostronnej adrenalektomii obserwowano u 66,7% chorych. Czynnikiem zwiększającym ryzyko niedostatecznej poprawy kontroli ciśnienia tętniczego po operacji był zwiększony wskaźnik masy ciała (BMI, body mass index), wynoszący ponad 30,5 kg/m2 (RR = 4,0 [1,07-14,90]). W okresie obserwacji stwierdzono obniżenie maksymalnych wartości ciśnienia skurczowego o 34 mm Hg (17-50 mm Hg) i rozkurczowego o 25 mm Hg (16-35 mm Hg) (p < 0,01). W całej grupie po adrenalektomii stwierdzono zmniejszenie BMI o 3,4 kg/m2 (p = 0,01). Wskaźnik ten obniżył się o więcej niż 1 kg/m2 u 66,7% chorych. Tylko u 2 pacjentów obserwowano pełne wycofanie się objawów cukrzycy. Steroidy nadnerczowe stale przyjmowało 46,7% chorych w okresie pooperacyjnym. Subiektywne całkowite ustąpienie objawów chorobowych po operacji stwierdziło 40% badanych, zaś częściowe - 46,7%. Wniosek: Chirurgiczne usunięcie gruczolaka nadnercza wytwarzającego kortyzol powoduje poprawę kontroli ciśnienia tętniczego lub ułatwia zmniejszenie masy ciała u znacznego odsetka chorych z zespołem Cushinga. Czynnikiem zmniejszającym szansę na poprawę kontroli ciśnienia tętniczego po operacji jest otyłość chorego występująca przed adrenalektomią. (Endokrynol Pol 2007; 58 (3): 207-212)Introduction: Surgical excision of adrenocortical tumour in patients with ACTH-independent Cushing syndrome gives a chance for their entire cure. However in some patients after adrenalectomy persistent arterial hypertension, obesity and diabetes mellitus is observed. The aim of the study was to analyse long term consequences of surgical excision of cortisol producing adrenocortical adenoma with a special attention on the influence of adrenalectomy on arterial blood pressure. Material and methods: 15 patients (mean age 54 years) suffering from arterial hypertension (n = 15), obesity or overweight (n = 12) and diabetes mellitus (n = 7) were subjected to analysis. Mean follow up time was 45 months. Results: Improvement of blood pressure control after unilateral adrenalectomy was observed in 66.7% of patients. The risk factor of no improvement of blood pressure control was BMI > 30.5 kg/m2 (RR = 4.0 [1.07-14.90]). During the follow up period decrease of maximal values of systolic and diastolic blood pressure was observed (34 [17-50] and 25 [16-35] mm Hg respectively; p < 0.01). In the entire group of patients a 3.4 kg/m2 decrease of BMI was observed p = 0.01. BMI decreased significantly (more than 1 kg/m2) in 66.7% of patients. Only in 2 patients a complete regression of diabetes was observed. 46.7% of patients required supplementation with adrenal steroids. 40% of patients reported a subjective withdrawal of all symptoms of the disease after surgery and 46.7% only partial remission. Conclusion: Surgical excision of cortisol producing adrenocortical adenoma results in improvement of blood pressure control and body weight reduction in a large percentage of patients with Cushing syndrome. Obesity before adrenalectomy is the factor that reduces a chance for improvement of blood pressure control after surgery. (Pol J Endocrinol 2007; 58 (3): 207-212

Regional variations of symptoms of the chronic venous disease among primary health care patients in Poland

Introduction. The diverse social and cultural contexts may cause differences in perceiving symptoms of the chronic venous disease (ChVD), not only in global, European terms, but also in a regional context. The purpose of the study was to find the regional differences of the reported symptoms and the applied conservative treatment methods among patients with ChVD diagnosed by the primary health care (PHC) doctors in Poland. Material and methods. 13 393 patients participated in the multi-centre PHLEBOS-2 research carried out by 330 PHC doctors in 15 voivodeships. Results. In the study group of patients, 31.9% of patients had ChVD symptoms – the C0 stage, telangiec­tasias and venulectasias (C1 stage) occurred among 56.1% of patients, varices without symptoms of venous insufficiency occurred among 6% of patients and venous insufficiency among 6% of patients. Venous ulcers (active or healed) occurred among 0.6% of subjects. Essential differences in the ChVD structure between voivodeships were noted. Among the most frequently reported ChVD ailments were heaviness of legs (72.9%), ankle swelling in the eve­nings (68.4%) and nighttime leg cramps (58.6%). Leg swelling during the night hours occurred less frequently — 39.8%, paraesthesias — 30.4%, restless legs syndrome — 18.6%. The average intensity of calf pain was moderate (3.82 ± 1.86 points in the 10 point scale). The territorial diversity in the prevalence of symptoms was significant and resulted neither from the ChVD seriousness, nor from the age of the patients. Compression therapy was applied on average by 12.5% of patients and 24.8% of patients used phlebotropic drugs with large territorial variations (respectively from 3.4% to 28.8% and from 11.2 to 56.1%). The differences between the voivodeships were greater than the regional differences and did not depend on the ChVD stage. Conclusions. There are significant territorial variations in Poland in the frequency of the reported symptoms and in the conservative therapy of the chronic venous disease

Sztuka tworzenia miejsc

Publikacja recenzowana / Peer-reviewed publicatio

PLASTICITY OF SELECTED METALLIC MATERIALS IN DYNAMIC DEFORMATION CONDITIONS

Characteristics of a modernized flywheel machine has been presented in the paper. The laboratory stand enables to perform dynamic tensile tests and impact bending with a linear velocity of the enforcing element in the range of 5÷40 m/s. A new data acquisition system, based on the tensometric sensors, allows for significant qualitative improvement of registered signals. Some preliminary dynamic forming tests were performed for the selected group of metallic materials. Subsequent microstructural examinations and identification of the fracture type enabled to describe a correlation between strain rate, strain and microstructure

CASE REPORT<br>A 42-year-old patient with alcoholic cardiomyopathy

Introduction: Alcoholic cardiomyopathy represents about 3.8% of all cardiomyopathy cases and it is a result of long-term (>5 years) alcohol consumption (>90 g of alcohol per day). It occurs twice as frequently in men as in women. Case report: We present the case of a 42-year-old patient, not treated for chronic diseases so far, with positive incriminating familiar anamnesis for ischemic heart disease, who was hospitalized in our Department because of progressive reduction of effort tolerance for 2 weeks with squeezing in the chest and dyspnea ("asthma cardiale" type). Basing on the clinical course, anamnesis from family members and additional tests performed, alcoholic cardiomyopathy was diagnosed. Conclusions: Alcoholism is one of the main causes of myocardial damage. Treatment of patients with alcoholic cardiomyopathy should include alcohol abstinence and recommended heart failure pharmacotherapy