Clinical usefulness of color Doppler imaging in the management of the neck region vessels in patients with intraocular tumors : preliminary report

Background: The purpose of the study was to assess the clinical usefulness of color Doppler ultrasonography (CDU) examinations of the neck vessels in patients with intraocular tumors as well as to establish whether the changes in these vessels had an influence on further ophthalmologic procedures. Material/Methods: Clinical ophthalmological examinations such as visual acuity, anterior segment and ocular fundus, as well as color Doppler ultrasonography of the bulbar and neck region vessels were performed on 38 patients, aged 44-70 years with eyeball tumors. Localization, size, vascularization of the intrabulbar tumors and big vessels of the neck region were analyzed. Results: In 28 patients, choroidal melanoma was identified, and the vascularity of tumor mass was monitored in 10 patients after brachytherapy. Compression or infiltration of jugular veins or carotid artery were not observed. Severe internal carotid artery stenosis due to arteriosclerosis was detected in 5 patients, but no one was suggested to be operated on first in Vascular Surgery Department. Conclusions: Color Doppler ultrasonography should be the first choice technique in the neck vessels and intrabulbar tumors imaging. Visualization of the mass lesions vascularity and the evaluation of amplitude of blood flow velocity allows to monitor the effectiveness of their therapy. It was found that this technique is useful in deciding upon the method of treatment in patients with coexisting arteriosclerosis

Zastosowanie przezskórnej wewnątrznaczyniowej angioplastyki w leczeniu zwężeń i niedrożności tętnic podudzia

Background: The method of percutaneous transluminal angioplasty in the treatment of stenoses and obstruction of crural arteries was introduced. Material/Methods: In 51 patients aged 51-86 years (mean: 69 years), including 32 men and 19 women, 56 procedures of crural PTA were carried out. The patients were classified as Fontaine's clinical stages IIb-IV. The procedures involved stenoses in 40 cases and 16 artery occlusions. The average length of the lesion was 2.7±1.6 cm. In 22 cases, crural PTA was performed in combination with PTA of the femoropopliteal segment and in 34 cases only crural PTA was carried out. The angioplasty was performed with antegrade puncture through the ipsilateral common femoral artery in 48 patients and in 3 from retrograde puncture with the cross-over method. For the procedures of the crural arteries, guide wires and coronary balloons were used. The following risk factors were present in the patients: 49% diabetes, 48% cigarette smoking, 42% hypertension, and 23% hyperlipidemia. The comorbidity with the highest incidence was ischemic heart disease (51%). Results: Good primary arteriographic and clinical results were achieved in 50 cases (89.2%). The ankle-brachial index (ABI) increased on average by 0.26 (0.20-0.52). In one case, occlusion of an artery occurred as a complication, and in 5 the procedure failed without any serious clinical consequences. Conclusions: Percutaneous balloon angioplasty is an effective method of treatment of patients with stenoses and short obstructions of crural arteries

Przezskórne leczenie krytycznego niedokrwienia kończyn dolnych u pacjentów z niedrożnością tętnic podudzi

Background: This article describes the application of percutaneous transluminal angioplasty (PTA) in the treatment of crural artery obstruction in patients with critical lower limb ischemia. Material/Methods: In 17 patients, 24 PTAs of crural artery obstructions were performed. The clinical material consisted of 9 men and 8 women, whose mean age was 72 years (range 54-85 years). 11 patients were classified in clinical stage Fontaine IV, and 6 in stage III. The obstructions were from 3 to 21 cm (mean 6 cm). In 8 cases, PTA of the femoropopliteal segment was also carried out. The risk factors and comorbidities included diabetes 10 cases (58.8%), hypertension 9 cases (56%), ischemic heart disease 8 cases (50%), hyperlipidemia 7 cases (43.8%), cerebrovascular diseases 3 cases (18.8%), and cigarette smoking 6 cases (37.5%). Technical success was defined as restoration of the artery along its whole length to the foot. Pain relief at rest and healing of trophic lesions at 30-day follow-up were recognized as a good outcome. Results: Technical success was achieved in 12 patients (70.6%). In 2 cases the patency was only restored in the proximal part of the artery (12.5%). In 3 cases (17.6%) the procedure failed. In one case acute occlusion of the artery occurred. In 2 cases the obstruction was not successfully passed with a guidewire. In 4 cases hematoma was found at the puncture site, without clinical consequences. In 13 patients (76.4%) clinical success was achieved. Conclusions: Percutaneous transluminal angioplasty is an effective and relatively safe method of treatment of patients with critical limb ischemia caused by obstruction of the crural arteries

Duplex sonography in erectile dysfunction diagnosis

Badanie doplerowskie prącia wprowadzili do praktyki medycznej Lue i wsp. w 1985 roku, dzięki odkryciu, że iniekcja dojamista papaweryny powoduje wzwód [1]. Za pomocą techniki doplerowskiej można zmierzyć przepływ krwi w tętnicach głębokich prącia po farmakologicznie wywołanym wzwodzie. Badanie powinno się przeprowadzać w komfortowych warunkach, zapewniających prywatność. Preparaty o działaniu wazodylatacyjnym stosuje się w iniekcji do ciał jamistych. Odpowiedź na środki farmakologiczne obserwuje się po podaniu 20–40 mg papaweryny lub 5–20 mg prostaglandyny E1 (PGE1). Papaweryna i PGE1 działają na tętnice głębokie prącia, rozkurczając mięśniówkę gładką naczyń. Aby uwidocznić tętnice głębokie penisa, ciała jamiste należy obrazować w przekrojach podłużnym i poprzecznym od podstawy po żołądź prącia. Analiza widma doplerowskiego w tych tętnicach umożliwia pomiar prędkości szczytowo-skurczowej (PSV, peak systolic velocity) oraz końcowo-rozkurczowej (EDV, end-diastolic velocity) oraz współczynnika oporności (RI, resistive index) określanego na podstawie wzoru RI = (PSV – EDV)/EDV. Prędkość szczytowo-skurczowa mierzona po iniekcji dojamistej preparatu o działaniu wazodylatacyjnym to najważniejszy parametr pozwalający rozpoznać impotencję o podłożu naczyniowym. Prędkość szczytowo-skurczowa o wartości niższej niż 25 cm/s wskazuje na utrudnienie w dopływie krwi do prącia. Wykluczenie patologii dopływu krwi do penisa sugeruje możliwość nadmiernego przecieku żylnego jako przyczyny zaburzeń wzwodu. Prędkość końcowo-rozkurczowa wyższa niż 7 cm/s jest typowa dla mężczyzn z zaburzeniami odpływu krwi z prącia. Istnieje również grupa pacjentów z mieszanym typem dysfunkcji wzwodu, charakteryzujących się współistnieniem utrudnień w dopływie krwi oraz nadmiernym przeciekiem żylnym.Duplex sonography of the penis was introduced to the medical practice by Lue et al. in 1985. It was possible after discovery that intracavernosal injection (ICI) of papaverine resulted in complete erection. The doppler technique measures velocity of blood flow in the cavernosal arteries during artificially inducted erection. The examination should be performed in comfortable conditions. The vasomotor agents are injected into the corpus cavernoosum. Adequate response is being observed after injecting 20-40 mg papaverine or 5-20 mg prostaglandin E1 (PGE1). Papaverine and PGE1 are potent smooth muscle relaxants that act directly on the deep penile arteries. To demonstrate deep penile arteries the corporal bodies should be scanned in the transverse and sagittal planes from base to the tip of the penis. Spectral analysis of doppler waveform in the cavernosal arteries enables measurement of peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI) calculated from the formula RI = (PSV - EDV)/EDV. PSV after ICI of vasodilatating agent is the most helpful parameter to evaluate arteriogenic impotence. The level of PSV in deep penile artery less than 25 cm/s is a strong evidence of arterial inflow disease. If arterial insufficientie is excluded, excessive venous leakage is the most probable source of erectile dysfunction. EDV exceeding 7 cm/s is characteristic for men with veno-occlusive disorders. There is also a group of patients with mixed type of ED with coegsisting arterial inflow insufficiency and excessive venous leakage

Badania ultrasonograficzne tarczycy u pacjentek obciążonych występowaniem nowotworów rodzinnych

Background: Detection of new gene mutations, which increase the risk of neoplasm (e.g. breast and thyroid gland) improves the examinations that can help in early diagnosis and quick treatment. The aim of this study was to assess the frequency of asymptomatic focal lesions in ultrasonographic examinations of women at confirmed risk of family neoplasm aggregation. Material/Methods: A total of 445 women aged 25-60 years were examined in 2004-2005. 278 patients descended from families with higher frequency of confirmed risk of familial neoplasm (I group), 167 belonged to the control group. Ultrasonographic examinations of the breast and thyroid gland were performed in all women. Patients were divided into selected groups depending on the kind of changes. Results: In the analyzed material asymptomatic focal changes in the thyroid gland were found in 46, 5% of the first group and 61,6% of the control group. The solid-cystic lesions in this material were ascertained in 36% of the first group and 51% of the second group. Conclusions: A large frequency (almost 50%) of the asymptomatic focal changes in thyroid glands were found. Detections of lesions were similar in both groups: the confirmed risk of familial neoplasm group and the control group. On the basis of these findings we can conclude, that it is reasonable to perform screening examinations of thyroid glands in connection with breast's diagnostics

Obrazy mammograficzne i sonomammograficzne raka sutka u pacjentek obciążonych genetycznie, w tym z wykrytą mutacją BRCA1

Background: Carriers o f the BRCA1 mutation have 50-80% increased risk o f breast cancer. Therefore it is necessary to perform screening examinations regularly, more frequently than in the normal population. We suggest beginning mammography at 35 years of age, which significantly increases the chance of early detection of the cancer. Material/Methods: A total of 293 women aged 20-60 years were analyzed. All the women were examined at the Hereditary Cancer Center. Mammography and sonomammography were performed on all patients. Mammograms of women who had undergone mastectomy were evaluated retrospectively. Results: Benign-like changes, such as dense cysts or fibroadenomas, in the carrier group of the BRCA1 gene mutation were found in 40.5% of the women. Dynamic growth of the tumor was symptomatic. In the remaining group of women, morphology o f the detected cancers revealed large, stagingdependent variability. Conclusion: On the basis of these findings we can conclude that cancer in women with the BRCA1 gene mutation can have a benign-like morphology, but with rapid tumor growth. Therefore all suspicious or atypical changes should be verified histopathologically

The analysis of “more electric engine” technology to improve the environmental performance of aircraft jet engine

In aviation, there is now a dynamic development of aircraft equipment related to the implementation of “more electric aircraft” technology. This concept offers the ability to improve the use of on-board systems, e.g. environmental operating conditions of aircraft jet engine. This technology is named “more electric engine”. It allows the use of magnetic levitation technology at engine turbine shaft bearing. The development of this technology relates to the dynamic change of electronic power systems for civilian transport aircraft, the use of adaptive control methods and new materials in aviation technology. All technologies are improved the environmental operating conditions of the on-board system, e.g. operational flexibility, technological potential growth. [1] In the paper will be presented the TS-21 aircraft jet engine. This engine is modernized in the Jet Engine Laboratory of the Military University of Technology. The paper is presented a digital engine control system, the operating parameters acquisition system and magnetic bearing system. It is described the concept of active magnetic suspension of the turbine engine shaft support. The magnetic suspension technology allows eliminate mechanical bearing arrangements with an oil installation, friction forces and classical, mechanical bearings. The paper contains the simulation and experimental results of a modernized jet engine TS-21

The analysis of “more electric engine” technology to improve the environmental performance of aircraft jet engine

In aviation, there is now a dynamic development of aircraft equipment related to the implementation of “more electric aircraft” technology. This concept offers the ability to improve the use of on-board systems, e.g. environmental operating conditions of aircraft jet engine. This technology is named “more electric engine”. It allows the use of magnetic levitation technology at engine turbine shaft bearing. The development of this technology relates to the dynamic change of electronic power systems for civilian transport aircraft, the use of adaptive control methods and new materials in aviation technology. All technologies are improved the environmental operating conditions of the on-board system, e.g. operational flexibility, technological potential growth. [1] In the paper will be presented the TS-21 aircraft jet engine. This engine is modernized in the Jet Engine Laboratory of the Military University of Technology. The paper is presented a digital engine control system, the operating parameters acquisition system and magnetic bearing system. It is described the concept of active magnetic suspension of the turbine engine shaft support. The magnetic suspension technology allows eliminate mechanical bearing arrangements with an oil installation, friction forces and classical, mechanical bearings. The paper contains the simulation and experimental results of a modernized jet engine TS-21

Evaluation of CRC-Metastatic Hepatic Lesion Chemoembolization with Irinotecan-Loaded Microspheres, According to the Site of Embolization

With the chemembolization of colorectal-cancer (CRC)-metastatic hepatic lesions by irinotecan-loaded microspheres, most researchers recommend slow embolizate delivery at the lobar-artery level to the entire liver parenchyma without obtaining visible stasis. An association has been reported between postoperatively visible embolizate stasis and lesion response to treatment. Possibly, in some cases, more selective administration might give greater benefit, particularly with previous systemic chemotherapy failure. Objective: Treatment response evaluation after chemoembolization of CRC-metastatic liver lesions with irinotecan-loaded microspheres, according to a hepatic-artery branch level of administration. Patients and methods: The analysis included 54 patients (24 females, 30 males) with large (median diameter > 5 cm) CRC-metastatic liver lesions, who underwent 196 chemoembolization procedures (mean 3.63 per patient) with irinotecan (100 mg)-loaded microspheres. Patients were divided into two groups according to initial embolizate-administration branch level: Group A (n = 26): at the segmental or subsegmental-vessel level; Group B (n = 28): at the lobar-branch level. Treatment response was assessed by computed-tomography (mRECIST criteria); overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan–Meier method and adverse effects were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE; version 5.0). Results: There were statistically significant differences in the occurrence of partial response (PR): higher in Group A (42.3%) than Group B (17.9%) (p = 0.039) and occurrence of stable disease (SD): lower (p = 0.025) in Group A (11.5%) than Group B (39.4%). However, occurrence of disease progression (PD) was similar: Group A: 42.3%; Group B: 42.9% (p = 0.93). Patients in Group A presented with more favorable PFS (p = 0.029) and OS (p = 0.039) than Group B. Median survival times: Group A: 15.2 months; Group B: 13.1 months. There was no significant difference in complication incidence between groups (Group A: seven complications; Group B: six complications; p = 0.863). Conclusion: Superselective chemoembolizate administration to vessels supplying large CRC-metastatic liver lesions gave better response to treatment and extended patient survival time, without significantly increasing complication risk