The gradation of constitutional violations

Naruszenia konstytucji mogą przybierać różną formę: od naruszeń mniejszej wagi aż po naruszenia rażące. Zależy to od dwóch zasadniczych czynników: 1) znaczenia (wagi) normy naruszonej na tle struktury konstytucji; 2) intensywności naruszenia normy konstytucyjnej, przez co należy rozumieć zakres zniesienia jej konsekwencji normatywnych przez niekonstytucyjny akt stanowienia lub stosowania prawa. Ad 1) Chociaż normy konstytucyjne nie podlegają formalnej hierarchizacji, niektóre z nich muszą być zrealizowane łącznie, aby osiągnięty został pożądany przez konstytucję stan rzeczy. Naruszenie zasady niezależności sądów nie ogranicza się do przepisu wyrażającego tę zasadę, lecz także rzutuje na sposób wywiązywania się przez sądy z ich konstytucyjnych zadań. Niewykonanie wbrew konstytucji kompetencji kreacyjnej przez upoważniony organ stanowi nie tylko naruszenie przepisu zawierającego kompetencję kreacyjną, lecz także prowadzi do paraliżu nieobsadzonego organu i „wyłącza” cały kompleks przepisów określających jego zadania i kompetencje. Ad 2) Postępowanie organu państwa może w mniejszym lub większym stopniu oddalać się od pożądanego przez konstytucję wzorca. Zachowanie wadliwe, lecz urzeczywistniające zasadniczy cel normy, jest po prostu niezgodne z konstytucją, natomiast zachowanie całkowicie nierealizujące tego celu lub dążące do celu przeciwstawnego jest rażąco niekonstytucyjne. W tym sensie podpisanie ustawy jeden dzień po upływie terminu jest naruszeniem konstytucji, ale mniej poważnym niż niepodpisanie jej w ogóle.The constitution can be breached in many ways, from minor infringements to flagrant violations. How serious a violation is depends on two factors: (i) the importance of a violated norm in the structure of the Constitution; (ii) the intensity of the violation (the range of consequences following from that norm, yet eliminated by an unconstitutional act or action). (Ad i) Even though constitutional norms are not arranged in a hierarchical order, some of them need to be respected together so that a particular goal set by the Constitution can be achieved. If the principle of judicial independence is not respected, such a violation affects not only that principle but also the way in which the courts perform their constitutional tasks. If an authorised state body refuses, against the Constitution, to exercise its right to appoint another body, such an action violates a provision determining the appointment procedure, but also leads to the shutdown of the latter body and ‘deactivates’ the whole set of provisions determining its powers and duties. (Ad ii) Actions taken by a state body may be distant from the pattern desired by the Constitution to a lesser or greater extent. An action which is flawed but pursues the right objectives may be simply unconstitutional, while an action which neglects these objectives or even promotes adverse ones is flagrantly unconstitutional. From that perspective, signing a bill one day after the constitutional period has expired is a violation, but it is a less serious  one than not signing it at all

Interventional radiology treatments for iatrogenic severe bleeding during percutaneous coronary interventions

Purpose: Interventional cardiology and interventional radiology are separate medical disciplines in which intra-arterial contrast media are used. Interventional cardiology has resigned from many types of treatment techniques that are now used and developed in the field of interventional radiology. In the event of iatrogenic bleeding during coronary interventions, there is an urgent need to use safe and efficient rescue procedures that are as efficient as cardiosurgery but use simpler treatment options. Serious perforations require immediate endovascular interventions. Medical history may reveal risk factors for artery perforation. Medicines, location of artery perforation, and extent of bleeding are directly associated with the prognosis. Most often, arterial perforations are due to inappropriate wire manipulation or use of oversized balloons or cutting balloons. Prolonged, artery-occluding balloon inflation, covered stent implantation, and embolisation with different agents are among the available treatment options for artery ruptures. Material and methods: A retrospective analysis was carried out among selected patients with iatrogenic vascular complications during procedures involving either coronary or non-coronary arteries. Results: Only representative cases were selected and presented in the patient subsection. Conclusions: Artery perforation during cardiac catheterisation can lead to dire consequences. To manage this complication, clinicians need pre-established procedures, adequate resources, and knowledge. Interventional radiology can be used as a salvage therapy in such cases

Non-destructive study of non-equilibrium states of cold, trapped atoms

Highly sensitive, non-destructive, real-time spectroscopic determination of the 2D kinetic momentum distribution of a cold-atom sample is performed with the three-beam measurement of the recoil-induced resonances. The measurements performed with an operating magneto-optical trap reveal slow velocity drifts within a stationary atomic cloud and strong anisotropy and asymmetry of the non-Maxwellian momentum distribution. The developed method can be easily extended to 3D.Comment: 4 pages, 5 figures, submitted to PR

Diuretyki w leczeniu niewydolności serca — wciąż nie wszystko wiadomo

Fluid retention is one of the most important clinical problems in patients with heart failure (HF). The reason the majority of hospitalizations in patients with HF is overhydration which may cause a number of clinical symptoms, such as dyspnoea, oedema, limitation of physical activity. Diuretic therapy is one of the basic elements of HF therapy. Diuretics have been used for decades and it seems that their use should not wake up in the moment, no doubt. It turns out, however, that knowledge of diuretic therapy in this difficult group of patients is still incomplete. The following article discusses the basic information on the use of diuretics in patients with HF, and specifically discusses the causes of resistance to diuretics, the issue of combining diuretics with different mechanisms of action and metabolic alkalosis, which is underestimated side effect of long-term use of diuretics.Retencja płynów jest jednym z najważniejszych problemów klinicznych chorych z niewydolnością serca (HF). Powodem większości hospitalizacji tych chorych pozostaje przewodnienie będące przyczyną występowania wielu objawów klinicznych, takich jak: duszność, obrzęki, ograniczenie wydolności fizycznej. Leczenie moczopędne stanowi jeden z podstawowych elementów terapii HF. Leki moczopędne stosuje się od kilkudziesięciu lat i wydaje się, że ich wykorzystanie nie powinno obecnie budzić żadnych wątpliwości. Okazuje się jednak, że wiedza dotycząca leczenia moczopędnego w tej trudnej klinicznie grupie pacjentow nadal jest niepełna. W artykule zawarto podstawowe informacje dotyczące stosowania leków moczopędnych u chorych z HF, natomiast dokładniej omówionoprzyczyny oporności na leki moczopędne, zagadnienie łączenia diuretyków o różnych mechanizmach działania oraz alkalozę metaboliczną, będącą niedocenianym działaniem niepożądanym długotrwałego stosowania diuretyków

Ionization spectroscopy in cold rubidium atoms

We demonstrate photoionization spectroscopy in cold rubidium atoms trapped in a working magneto-optical trap. Three-photon ionization with two-photon resonance proceeds along various channels, with the step-by-step 5S-5P-5D transition and with the two-photon excitation of the 5D or 7S state. The processes are monitored by measuring ion signals which allow sensitive spectroscopy of weak transitions in a cold-atom sample

Zastosowanie robotów medycznych w kardiologii — przegląd obecnych rozwiązań technicznych

The constant development of Information and Communication Technologies (ICTs) and the growing demand for highly specialized medical procedures, as well as striving to increase the precision of these procedures caused, that support by robotic devices is sought. The article presents the main directions of development of robotic application in cardiac surgery and cardiology with special emphasis on projects conducted in Poland. Currently, first commercial robotic systems for applications in cardiac surgery, interventional cardiology and ablation of cardiac arrhythmias are available. Plenty of research and development projects, which intend to introduce new robotic systems for other invasive procedures and non-invasive cardiology, is ongoing.Stały rozwój technologii informacyjno-komunikacyjnych (ICT) oraz rosnące zapotrzebowanie na wysoko specjalistyczne procedury medyczne, jak również dążenie do zwiększania precyzji tych procedur, doprowadziła do poszukiwania wsparcia w urządzeniach robotycznych. Artykuł prezentuje główne kierunki rozwoju robotyki w kardiochirurgii i kardiologii ze szczególnym uwzględnieniem projektów prowadzonych w Polsce. Obecnie są już dostępne komercyjne systemy robotyczne do zastosowań w kardiochirurgii, kardiologii interwencyjnej oraz ablacjach zaburzeń rytmu serca. Prowadzonych jest wiele projektów badawczo- rozwojowych mających na celu wprowadzenie nowych systemów robotycznych do innych procedur zabiegowych oraz kardiologii nieinwazyjnej

Warfarin-related nephropathy — a new disease entity?

Nefropatia związana z przyjmowaniem warfaryny (WRN) to opisana w ostatnim czasie jednostka chorobowa, w której nadmierna antykoagulacja warfaryną powoduje niemożliwe do wytłumaczenia innymi czynnikami ostre uszkodzenie nerek lub progresję przewlekłej choroby nerek (CKD). Patogeneza WRN pozostaje niejasna, jednak prawdopodobnie najważniejszym mechanizmem jest obstrukcja kanalików nerkowych wałeczkami erytrocytarnymi wskutek mikrokrwawień do kłębuszków nerkowych oraz toksyczny wpływ żelaza. Wystąpienie WRN wiąże się ze zwiększoną odległą śmiertelnością całkowitą, sercową, a także niekorzystnym rokowaniem dotyczącym funkcji nerek. Chociaż CKD stanowi najważniejszy czynnik predysponujący doWRN, to powikłanie to występuje również u osób z prawidłową funkcją nerek. Ustalenie wartości międzynarodowego wskaźnika znormalizowanego związanego z ryzykiem wystąpienia WRN wymaga dalszych badań, jednak wydaje się, że wartości zbliżone do górnych terapeutycznych mogą zwiększać ryzyko jego wystąpienia.Warfarin-related nephropathy (WRN) is a recently described disease entity caused by excessive anticoagulation with warfarin, cause unexplained byother factors acute kidney injury or progression of chronic kidney disease (CKD). WRN pathogenesis is unclear, but probably the most important mechanism is the obstruction of renal tubules by erythrocyte casts due to microhemorrhages to glomeruli, and toxic effects of iron. WRN is associated within creased all-cause mortality, cardiac mortality, and poor prognosis on renal function. Although chronic kidney disease is the most important predisposing factor for WRN, it also can occurs in subjects with normal renal function. Determination of international normalized ratio values-associated with the increased risk of WRN requires further study, but it seems that values close to the upper can increase the risk of its occurrence

Lead dependent tricuspid dysfunction: Analysis of the mechanism and management in patients referred for transvenous lead extraction

Background: Lead-dependent tricuspid dysfunction (LDTD) is one of important complicationsin patients with cardiac implantable electronic devices. However, this phenomenon isprobably underestimated because of an improper interpretation of its clinical symptoms. Theaim of this study was to identify LDTD mechanisms and management in patients referred fortransvenous lead extraction (TLE) due to lead-dependent complications.Methods: Data of 940 patients undergoing TLE in a single center from 2009 to 2011 wereassessed and 24 patients with LDTD were identifi ed. The general indications for TLE, pacingsystem types and lead dwell time in both study groups were comparatively analyzed. Theradiological and clinical effi cacy of TLE procedure was also assessed in both groups with precisionestimation of clinical status patients with LDTD (before and after TLE). Additionally,mechanisms, concomitant lead-dependent complications and degree (severity) of LDTD beforeand after the procedure were evaluated. Telephone follow-up of LDTD patients was performedat the mean time 1.5 years after TLE/replacement procedure.Results: The main indications for TLE in both groups were similar (apart from isolatedLDTD in 45.83% patients from group I). Patients with LDTD had more complex pacing systemswith more leads (2.04 in the LDTD group vs. 1.69 in the control group; p = 0.04). Therewere more unnecessary loops of lead in LDTD patients than in the control group (41.7% vs.5.24%; p = 0.001). There were no signifi cant differences in average time from implantationto extraction and the number of preceding procedures. Signifi cant tricuspid regurgitation(TR-grade III–IV) was found in 96% of LDTD patients, whereas stenosis with regurgitationin 4%. The 10% frequency of severe TR (not lead dependent) in the control group patients wasobserved. The main mechanism of LDTD was abnormal leafl et coaptation caused by: loop ofthe lead (42%), septal leafl et pulled toward the interventricular septum (37%) or too intensivelead impingement of the leafl ets (21%). LDTD patients were treated with TLE and reimplantationof the lead to the right ventricle (87.5%) or to the cardiac vein (4.2%), or surgery procedure with epicardial lead placement following ineffective TLE (8.3%). The radiological and clinicaleffi cacy of TLE procedure was very high and comparable between the groups I and II (91.7%vs. 94.2%; p = 0.6 and 100% vs. 98.4%; p = 0.46, respectively). Repeated echocardiographyshowed reduced severity of tricuspid valve dysfunction in 62.5% of LDTD patients. The follow--up interview confi rmed clinical improvement in 75% of patients (further improvement aftercardiosurgery in 2 patients was observed).Conclusions: LDTD is a diagnostic and therapeutic challenge. The main reason for LDTDwas abnormal leafl et coaptation caused by lead loop presence, or propping, or impingementthe leafl ets by the lead. Probably, TLE with lead reimplantation is a safe and effective optionin LDTD management. An alternative option is TLE with omitted tricuspid valve reimplantation.Cardiac surgery with epicardial lead placement should be reserved for patients withineffective previous procedures

Probe spectroscopy in an operating magneto-optical trap: the role of Raman transitions between discrete and continuum atomic states

We report on cw measurements of probe beam absorption and four-wave-mixing spectra in a $^{85}$Rb magneto-optical trap taken while the trap is in operation. The trapping beams are used as pump light. We concentrate on the central feature of the spectra at small pump-probe detuning and attribute its narrow resonant structures to the superposition of Raman transitions between light-shifted sublevels of the ground atomic state and to atomic recoil processes. These two contributions have different dependencies on trap parameters and we show that the former is inhomogeneously broadened. The strong dependence of the spectra on the probe-beam polarization indicates the existence of large optical anisotropy of the cold-atom sample, which is attributed to the recoil effects. We point out that the recoil-induced resonances can be isolated from other contributions, making pump-probe spectroscopy a highly sensitive diagnostic tool for atoms in a working MOT.Comment: 9 pages, 8 figure

Reasons for delay in treatment of breast cancer detected due to breast self-examination in women from the Lubelskie Region

Objectives: A delay in diagnosis and treatment of breast cancer patients is observed despite access to modern diagnostic methods. The aim of the study was to evaluate time between the first symptoms of breast cancer and treatment commencement, as well as to analyze reasons for the delay. Materials and methods: The research was conducted on 260 breast cancer patients treated at the Oncology Center in Lublin between 2008 and 2011. ‘Patient delay’ was defined as the time gap of >3 months between first symptoms of cancer and the doctor’s appointment and ‘system delay’ as the time gap of >1 month between the first medical consultation and commencement of treatment. Results: Mean patient delay was 32.2 ± 63.8 weeks. The main reasons were: disregard of symptoms (51%) and fear of being diagnosed with cancer (48%). Factors which significantly influenced the length of patient delay included: age >65 years, non-regular gynecologic care, lack of prior cancer screening and lack of family history of breast cancer. Mean system delay was 3.1 ± 2.9 weeks. Tumors < 5cm in diameter and clinical presentation other than a tumor, significantly influenced the system delay. Conclusions: A significant delay in diagnosis and treatment of breast cancer remains to be noted. Delay in seeking medical help was observed in 20% of the patients, whereas the referral was delayed due to system fault in 38% of the cases. Contrary to popular belief, patient delay (mean 32.2 ± 63.8 weeks) is 10 times longer than system delay (3.1 ± 2.9 weeks), suggesting an urgent need for further education of the general public and creating more accessible medical care