Stent development and local drug delivery

Stent implantation has become the new standard angioplasty procedure. Instent re-stenosis remains the major limitation of coronary stenting. Re-stenosis is related to patient-, lesion- and procedure-specific factors. Patient-specific factors can not be influenced to any extent. Procedure-specific factors are affected by implantation technique and stent characteristics. Design and material influence vascular injury and humoral and cellular response. Radiation has been shown to have inhibitory effects on smooth muscle cell growth and neo-intima formation, but in clinical trials the outcome has been hampered by re-stenosis at the edges of the radioactive stent ('candy wrapper'). New approaches target pharmacological modulation of local vascular biology by local administration of drugs. This allows for drug application at the precise site and time of vessel injury. Systemic release is minimal and this may reduce the risk of toxicity. The drug and the delivery vehicle must fulfil pharmacological, pharmacokinetic and mechanical requirements and the application of eluting degradable matrices seems to be a possible solution. Numerous pharmacological agents with antiproliferative properties are currently under clinical investigation, e.g. actinomycin D, rapamycin or paclitaxel. Another approach is for stents to be made of biodegradable materials as an alternative to metallic stents. Their potential long-term complications, such as in-stent resteno

Limitations and Long Term Outcome of Intracoronary Radiation Therapy With Catheter Based Systems and Radioactive Stents

__Abstract__ Balloon angioplasty was the first non-surgical therapeutic modality for coronary artery disease introduced in 1977. It was related with high rates of acute complications and restenosis that limited its application to a minority of patients with coronary artery disease with relatively simple lesion morphology. Continuous developments during the next decade led to the introduction of stents in 1986. They were proven extremely efficient in reducing acute complications, dramatically expanding the indications for percutaneous interventions. In addition they were associated with favourable outcome in reducing restenosis compared to balloon angioplasty but they were also limited by the development of in-stent restenosis. Instent restenosis remained a therapeutic challenge for almost a decade and many mechanistic and pharmacological attempts failed to solve it. Ionic forms of radiation (radioactive stents and localised catheter based intracoronary radiation therapy) were introduced. Radioactive stents showed no benefit compared to conventional stenting. However intracoronary brachytherapy, which was first applied in human coronaries in 1995, was proven effective for the treatment of in-stent restenosis (secondary prevention of restenosis). Its efficiency for treatment of de novo lesions (primary prevention of restenosis) especially in combination with the use of stents is limited. In 2001 drug eluting stents were introduced into clinical practice and they revolutionised the treatment of coronary artery disease. They are the first therapeutic modality in interventional cardiology expected to show equal or superior results in comparison to coronary artery by pass surgery. In Europe were conducted the majority of the human trials with radioactive stents and pioneering and exploratory studies with intracoronary radiotherapy with catheter based systems mainly with beta emitters for de-novo lesions. This thesis addresses issues central to both of these therapeutic modalities

Umiejętności samorealizacji kobiet po radykalnej mastektomii

Cel badań: ocena poczucia własnej skuteczności po radykalnym leczeniu raka piersi. Materiał i metody: Badaniami objęto 82 kobiety w wieku 31 – 63 lata leczonych radykalnie z powodu raka piersi. Grupę kontrolą stanowiły studentki kierunku pielęgniarstwa. Grupa ta liczyła 39 osób w wieku 27 – 49 lat. Obie grupy poddano badaniom z wykorzystaniem Skali Uogólnionej Własnej Skuteczności. Wyniki badań odniesiono do wybranych cech socjo-demograficznych kobiet leczonych radykalnie z powody raka piersi takich jak wiek, wykształcenie, czas jaki upłynął od zakończenia radykalnego leczenia choroby nowotworowej do momentu badań. Wyniki i wnioski: Stwierdzono, że średnia wartość testu GSES dla całej badanej grupy kobiet poddanych radykalnemu leczeniu z powodu raka piersi była znamiennie statystycznie niższa niż grupie kontrolnej. Wykazano, że począwszy od 45 rż. u kobiet leczonych radykalnie z powodu raka piersi znamiennie statystycznie obniża się po-ziom poczucia własnej skuteczności. Najniższy i to istotnie statystycznie w porównaniu do pozostałych dekad życia, jest w przedziale wieku 56 – 65 lat. Ponadto stwierdzono, że w miarę upływu czasu po zakończeniu leczenia radykalnego raka piersi poczucie sensu życia oraz własnej skuteczności u badanych kobiet wrastało, a znamienny statystycznie wzrost poczucia własnej skuteczności nastąpił po upływie roku od zakończenia leczenia i utrzymywał się już na porównywalnym poziomie.The purpose of the research: the estimation of the sense of self-efficiency after a radical treatment of a breast cancer. The material under investigation and methods: The research was conducted on a group of 82 women who have undergone a radical treatment of a breast cancer, their ages varying from 31 to 63. The control group comprised of the nursing faculty students. It was a group of 39 people, aged from 27 to 49. Both groups were tested using the General Self-Efficacy Scale. The relations were found be-tween the results of the research and the selected socio-demographic features of women treated radically for a breast cancer like age, edu-cation and the period of time between the end of the radical treatment and the current research. The results and conclusions: It was stated that the average result of the GSES test for the whole group of women who have undergone a radical treatment for a breast cancer was significantly lower than in the control group. It was indicated that, starting from 45 years of age, the women who were treated for a breast cancer statistically have a significantly dropping level of the sense of self-efficiency. The lowest level, in comparison with the other decades of a lifetime, is between 56 and 65 years of age, which is statistically relevant. Moreover, it was stated that, with the passing of time, after the end of the radical breast cancer treatment the sense of self-efficiency and the meaning of life were increasing and after a year there was a statistically signifi-cant increase of the sense of self-efficiency, plus its level remained stable after that

Niedotrzymanie moczu : wprowadzenie do diagnostyki

Autorzy przedstawili rys historyczny badań urodynamicznych, podkreślili znaczenie dobrze zebranego wywiadzie diagnostyce zaburzeń czynnościowych dolnych dróg moczowych. Scharakteryzowali poszczególne składowe postępowania wstępnego. Przypomnieli o istnieniu szeregu kwestionariuszy np. ICIQ-SF, UDI 6SF, Gaudenza, MESA pomocnych w szczegółowej ocenie zaburzeń.The authors have presented the historical background of urodynamic tests and emphasised the significance of wellcollected medical history to the diagnostics of lower urinary tract functional disorders. They have characterised the initial treatment. They pointed out the helpfulness of the questionnaires to be used: ICIQ-SF, UDI 6SF, the Gaudenz Questionnaire, MESA etc

Czynniki ryzyka inkontynencji i epidemiologia nietrzymania moczu

Autorzy scharakteryzowali czynniki powodujące występowanie nietrzymania moczu, podkreślili ich interferencyjne działanie przyczynowe. Szczegółowo zostały omówione takie czynniki jak czynniki predysponujące: płeć, rasa, czynniki genetyczne, anatomiczne, neurologiczne, związane z tkanką łączną, kulturowe, środowiskowe. Przedstawiono znaczenie czynników promujących: otyłość, wykonywany zawód, rekreacja, przebyte operacje, palenie papierosów, przewlekły kaszel, zakażenia dróg moczowych, nieregularne miesiączkowanie, polekowe, dietetyczne, menopauza, oraz czynników dekompensacyjne: wiek, demencja, niedorozwój umysłowy, inne schorzenia, działanie leków, czynniki środowiskowe.The authors have discussed the factors causing urinary incontinence and emphasised their interferential activity. Such pre-disposing factors as: sex, race, genetics, anatomy, neurology, connective tissue issues, cultural and environmental background have been discussed in detail. The significance of the following promoting factors has been presented: obesity, occupation, recreation, surgeries undergone, smoking, chronic cough, urinary tract infections, irregular menstruation, medication effects, diet, menopause, and decompensation factors (age, dementia, mental handicap, other diseases, medication effects, and environmental factors)

Zaburzenia czynności dolnych dróg moczowych u kobiet

Autorzy przedstawili krótki rys historyczny tworzenia i ewolucji definicji niedotrzymania moczu. Scharakteryzowali kliniczne postacie niedotrzymania moczu u kobiet: wysiłkowe nietrzymanie moczu, naglące nietrzymanie moczu, nietrzymanie moczu z przepełnienia, nietrzymanie moczu pozazwieraczowe.The authors have presented a concise historical overview of the origin and evolution of urinary incontinence. They have characterised the clinical forms of urinary incontinence in women: stress incontinence, urge incontinence, overflow incontinence, extra-urethral incontinence

Niedotrzymanie moczu : badanie laboratoryjne i czynnościowe

Autorzy dokonali szczegółowej analizy badań laboratoryjnych i czynnościowych służących diagnostyce nietrzymania moczu. Omówili szczegółowo m.in. Bridge Fluid Test, test kaszlowy, próbę Sanda, test podpaskowy. Jeszcze jednym niezwykle użytecznym narzędziem umożliwiającym ocenę zaburzeń jest dzienniczek mikcji. Dzienniczek mikcji jest szczególnie przydatny w ocenie poliurii (nadmiernej produkcji moczu) oraz nocnej poliurii (nadmiernej produkcji moczu podczas spoczynku nocnego). Autorzy zwrócili uwagę na zasadnicze elementy prawidłowego prowadzenia dzienniczka. Dokonano także omówienia wybranych badań urodynamicznych.The authors have performed a thorough analysis of laboratory and functional examinations used in the diagnostics of urinary incontinence. They have discussed in detail the Bridge Fluid Test, cough test, Sand’s test, pad test, etc. Yet another tool that is very useful in assessing the disorders is a micturition diary. This diary is especially helpful in diagnosing polyuria (excessive urine production) and night polyuria (excessive urine production during sleep). The authors have emphasised the basic elements of keeping such a diary. Furthermore, selected urodynamic tests have been discussed at length

Il Nordest prima del Nordest

L'articolo introduce un volume monografico dedicato a casi di conflitto sociale (scioperi, occupazioni, vertenze sindacali, ma anche trasformazioni più lente) nel Veneto degli anni settanta, illustrando l'evoluzione del dibattito sul "decentramento produttivo" e sui distretti industriali e come questa prospettiva teorica abbia finito per negare il ruolo determinante svolto dai conflitti sociali (non sempre di classe e non sempre di fabbrica) nel consentire una evoluzione socialmente sostenibile di un modello produttivo inizialmente caratterizzato dal semplice abbassamento dei costi consentito dalla minore regolamentazione ambientale e sociale della piccola impresa e dell'artigianato

Bedsores : pathophysiology, prevention and treatment

Autorzy umówili podstawowe cechy anatomiczno-fizjologiczne skóry i tkanki podskórnej. Przedstawili cechy charakterystyczne odleżyn, rolę czynników sprzyjających ich powstawaniu, oraz sposoby oceny odleżyn oraz leczenia.The authors discuss basic anatomical and physiological features of skin and subcutaneous tissue. They present the characteristic features of bedsores, the significance of the factors that contribute to them and the ways to assess and treat bedsores