Coronary artery bypass grafting in patients with relatively recent previous stent implantation: Three years follow-up results

Background: An increasing number of patients who undergo coronary artery bypass grafting(CABG) have a history of coronary stent implantation. This study aims to assess perioperative and medium-term follow-up outcomes in patients in whom CABG was preceded by coronary stent implantation within two years before operation. Methods: One hundred and sixty two patients undergoing CABG after previous stent placement (PCI + CABG group) were compared to 149 who had CABG without PCI in the past (CABG group). Clinical, angiographic and perioperative outcome data were compared. The three year follow-up comprised data on number of deaths and the presence of anginal symptoms. Results: In both groups the extent of coronary artery disease was comparable, but more patients in the PCI + CABG group had a history of myocardial infarction. Perioperative outcome data did not differ between the groups except for a higher number of vessels considered infarct-related grafted in the CABG group. Patients operated on up to three months after PCI had more extensive coronary heart disease than those operated on later. They also had a significantly shorter operation time. This group also showed a trend towards less postoperative bleeding, less rethoracotomy and less low cardiac output syndrome. In a three year follow-up, 48 (30%) patients in the PCI + CABG group reported presence of angina compared to 28 (19%) in the CABG group (p = 0.04). Conclusions: Previous PCI does not significantly influence the CABG outcome. In mediumterm follow-up, freedom from anginal symptoms is less likely in patients in whom CABG was preceded by stent implantation

Clinical assessment of the efficacy of photodynamic therapy in the treatment of oral lichen planus

The study objective was clinical assessment of the efficacy of photodynamic therapy (PDT) in the treatment of oral lichen planus (OLP). There were 23 patients aged 31–82 included in the study with oral lichen planus diagnosed clinically and histopathologically. In all patients photodynamic therapy was performed with the use of chlorin e6 (Photolon(®)), containing 20 % chlorin e6 and 10 % dimethyl sulfoxide as a photosensitizer. PDT was performed using a semiconductor laser, with power up to 300 mW and a wavelength of 660 nm. A series of illumination sessions was conducted with the use of superficial light energy density of 90 J/cm(2). Changes of lesion size were monitored at one, two, five, and ten PDT appointments from the series of ten according to the authors' own method. The sizes of clinical OLP lesions exposed to PDT were reduced significantly (on average by 55 %). The best effects were observed for the lesions on the lining mucosa (57.6 %). The therapy was statistically significantly less effective when masticatory mucosa was affected (reduction, 30.0 %). Due to substantial efficacy and noninvasiveness, PDT can be useful in the treatment of OLP lesions

The usefulness of assessing the serum levels of homocysteine in diagnosis of atherosclerosis

Wstęp. Choroby naczyniowe są pierwszą przed chorobami nowotworowymi przyczyną zgonów. Dlatego na całym świecie prowadzi się badania, których celem jest znalezienie łatwo oznaczalnego w płynach ustrojowych czynnika ryzyka miażdżycy. Powinien on być przydatny do badań przesiewowych, mieć znaczenie rokownicze i ułatwiać ocenę stosowanej terapii. Do listy czynników ryzyka chorób układu krążenia niedawno dołączono homocysteinę. Ma ona właściwości cytotoksyczne, a jej podwyższone stężenie we krwi powoduje uszkodzenie komórek śródbłonka, degradację elastyny w błonie wewnętrznej, procesy włóknienia i wapnienia. Celem pracy jest ocena stężenia homocysteiny w surowicy krwi u pacjentów z potwierdzoną klinicznie miażdżycą tętnic. Materiał i metody. Badaniom poddano 68 pacjentów, w tym 26 chorych z miażdżycą tętnic kończyn dolnych, 10 osób po zabiegu pomostowania aortalno-wieńcowego (CABG), 10 chorych z zawałem serca, 15 osób &#8212; z ciężkim udarem niedokrwiennym mózgu, 4 pacjentów &#8212; z tętniakiem aorty brzusznej i 3 osoby &#8212; ze zwężeniem tętnicy nerkowej. Z badań wyłączono pacjentów z niedawno przebytym zawałem serca lub udarem niedokrwiennym mózgu, z niewydolnością nerek, z chorobami autoimmunologicznymi oraz z chorobą nowotworową. Wyniki. U pacjentów we wszystkich badanych grupach schorzeń oprócz grupy z tętniakiem aorty brzusznej (8,71 &#177; 0,77 &#181;mol/l) stwierdzono podwyższone wartości stężenia homocysteiny w porównaniu z grupą kontrolną (stężenie 9,37 &#177; 1,49 &#181;mol/l), przy czym najwyższe wartości odnotowano w grupie chorych po CABG (29,2 &#177; 11,32 &#181;mol/l). Wnioski. Homocysteina jest ważnym, niezależnym czynnikiem ryzyka chorób układu krążenia, a jej oznaczenie powinno być badaniem rutynowym u pacjentów obciążonych genetycznie oraz u osób z innymi czynnikami ryzyka miażdżycy.Background. Cardiovascular diseases are the most common cause of death in Poland. Homocystein has recently been added to the list of atherosclerosis risk factors. Homocystein is an amino acid, which contains sulphur. Homocysteine is toxic for the endothelium. The aim of the study was to assess the plasma levels of the homocysteine in patients with clinical symptoms of atherosclerosis. Material and methods. Sixty-eight patients including 26 with lower extremities atherosclerosis, 10 after CABG, 10 with AMI, 15 with ischemic stroke, 4 with abdominal aortic aneurysm and 3 with renal artery obstruction were enrolled. Patients suffering from acute MI or stroke, kidney failure, autoimmune diseases and neoplasms were excluded from the investigation. Thirty healthy volunteers were the control group. Results. Homocysteine levels in all patient groups were higher than in the control group except patients with abdominal aortic aneurysm. The highest homocysteine concentrations (29.2 &plusmn; 11.32 &micro;mol/l; p < 0.001) were in patients after CABG. Conclusions. homocysteine is an important, independent cardiovascular diseases risk factor and should be routinely examined for in patients with other risk factors

Semantic Segmentation (U-Net) of Archaeological Features in Airborne Laser Scanning&mdash;Example of the Bia&#322;owie&#380;a Forest

Airborne Laser Scanning (ALS) technology can be used to identify features of terrain relief in forested areas, possibly leading to the discovery of previously unknown archaeological monuments. Spatial interpretation of numerous objects with various shapes and sizes is a difficult challenge for archaeologists. Mapping structures with multiple elements whose area can exceed dozens of hectares, such as ancient agricultural field systems, is very time-consuming. These archaeological sites are composed of a large number of embanked fields, which together form a recognizable spatial pattern. Image classification and segmentation, as well as object recognition, are the most important tasks for deep learning neural networks (DLNN) and therefore they can be used for automatic recognition of archaeological monuments. In this study, a U-Net neural network was implemented to perform semantic segmentation of the ALS-derived data including (1) archaeological, (2) natural and (3) modern features in the Polish part of the Bia&#322;owie&#380;a Forest. The performance of the U-Net segmentation model was evaluated by measuring the pixel-wise similarity between ground truth and predicted segmentation masks. After 83 epochs, The Dice-Sorensen coefficient (F1 score) and the Intersect Over Union (IoU) metrics were 0.58 and 0.5, respectively. The IoU metric reached a value of 0.41, 0.62 and 0.62 for the ancient field system banks, ancient field system plots and burial mounds, respectively. The results of the U-Net deep learning model proved very useful in semantic segmentation of images derived from ALS data

Minimally invasive mitral valve surgery - first experience in Poland

Background: Minimally invasive cardiac surgery has been introduced to treat various cardiac disorders, predominantly ischaemic heart disease. Its usage in valvular disorders has been only recently proposed.Aim: To assess safety and efficacy of minimally invasive mitral valve surgery.Methods: The procedure was performed in 10 patients (6 females, 4 males, mean age 59&#177;7 years). All but one had preserved left ventricular ejection fraction. Two patients underwent mitral valvuloplasty, and mitral valve replacement was performed in all remaining cases. One procedure was a redo surgery following mitral commisurotomy.Results: In all patients the procedure was effective. Prolongation of cardiopulmonary bypass and aorta cross-clamping time did not increase the complication rate which included one wound infection, one repeated cannulation of the femoral vessels and one minor stroke. Rehabilitation process seemed to be shorter than after standard procedures.Conclusions: Minimally invasive mitral valve surgery is a safe and alternative method of treatment, and is associated with excellent cosmetic results

Emergency caesarean section delivery and puerperium in a patient with severe idiopathic pulmonary arterial hypertension — a case report

Background: The aim of this paper is to describe the third pregnancy trimester, delivery and puerperium in patient with idiopathic pulmonary hypertension. Case report: a 30-year-old primigravida with idiopathic pulmonary hypertension was qualified for emergency Caesarean section. In the post partum period no improvement in managing pulmonary arterial hypertension was achieved. Because of progressive respiratory and circulatory failure as well as the pulmonary artery pressure exceeding the systemic pressure the AV ECMO was applied on postoperative day 6. During the ECMO period the emergency laparotomy due to bleeding was necessary. The further course of ICU treatment was uneventful. Conclusion: In described case things are left to chance or goodwill of specialists and final outcome depend on happy coincidences