Treatment of iatrogenic iliac artery rupture during endovascular surgery

Recently a growing number of endovascular operations are associated with an increased number of iatrogenic vascular injuries. The aim of the study is to analyse the treatment of iliac artery damage during angioplasty. Method. In the period 2002–2009, 328 patients underwent endovascular surgery of iliac artery stenosis, 219 men and 109 women aged from 47 to 85 years. Qualified patients displayed IIB, III, and IV stage of ischaemia by Fontaine. The collected information concerned details of the performed procedures, possible complications and ways of solving problems. Results. In 132 cases, endovascular surgery consisted of extension of the iliac artery using a stent, while in 196 no stent was applied. Iatrogenic injury to the iliac artery during the angioplasty occurred in six patients. In four cases, there was damage to the common iliac artery, and in the next two patients to the external iliac artery. In four cases, there was damage to the artery during endovascular expansion, and in two cases after stent implantation. In four cases, the damage to the artery was treated by an endovascular method, in two patients a stent was implanted, in one patient a stent-graft was introduced, and in one case a spillage was sealed using a balloon. Two patients underwent classic surgery due to symptoms of hypovolaemic shock caused by bleeding into the retroperitoneal space; in one case arterial damage was sutured, and in the second patient an aortal-femoral bypass graft was implanted. Of the patients supplied by an intravascular method, in one case, because of the very large retroperitoneal haematoma and the compression symptoms associated with it, surgical drainage was necessary. In the remaining cases, the postoperative course passed without complications. Among the patients who underwent classic surgery there was one case of deep vein thrombosis. All patients achieved satisfactory haemodynamic and clinical effects. There were no deaths. Conclusions. 1. Each instance of iatrogenic iliac artery injury during endovascular surgery requires an individual approach. 2. An attempt to repair damage by an intravascular method is the treatment of choice in haemodynamically stable patients. 3. In cases of large retroperitoneal bleeding, patients require immediate conversion to classical surgery. Acta Angiol 2011; 17, 2: 150–157Wstęp. Rosnąca ostatnio liczba operacji wewnątrznaczyniowych wiąże się również ze zwiększoną liczbą jatrogennych uszkodzeń naczyń. Celem pracy jest analiza sposobu postępowania przy uszkodzeniach tętnic biodrowych w czasie angioplastyki. Materiał i metoda. W latach 2002–2009 operowano wewnątrznaczyniowo 328 chorych ze zwężeniami tętnic biodrowych, w tym 219 mężczyzn i 109 kobiet w wieku 47–85 lat. Do operacji kwalifikowano chorych w IIB, III i IV stadium niedokrwienia według klasyfikacji Fontaine’a. Zbierano informacje na temat szczegółów przeprowadzonych zabiegów, ewentualnych powikłań i sposobów rozwiązywania problemów. Wyniki. W 132 przypadkach wykonano poszerzenie wewnątrznaczyniowe tętnicy biodrowej ze stentem, zaś w 196 bez stentu. Do jatrogennego urazu tętnic biodrowych w miejscu przeprowadzanej angioplastyki doszło u 6 chorych. W 4 przypadkach stwierdzono uszkodzenie tętnicy biodrowej wspólnej, w kolejnych 2 — tętnicy biodrowej zewnętrznej. U 4 chorych do uszkodzenia tętnicy doszło podczas wewnątrznaczyniowego poszerzenia, zaś w 2 przypadkach po wszczepieniu stentu. U 4 chorych uszkodzenie tętnicy leczono metodą wewnątrznaczyniową, u 2 osób implantowano stent, u 1 pacjenta — stentgraft, zaś w 1 przypadku uszczelniono wyciek za pomocą balonu. Dwóch chorych ze względu na objawy wstrząsu hipowolemicznego spowodowanego krwawieniem do przestrzeni zaotrzewnowej operowano klasycznie, w jednym przypadku zszyto uszkodzenie tętnicy, zaś u drugiego chorego wszczepiono pomost aortalno-udowy. Spośród chorych zaopatrzonych metodą wewnątrznaczyniową w jednym przypadku ze względu na bardzo dużego krwiaka zaotrzewnowego i objawy uciskowe z nim związane konieczne było przeprowadzenie jego chirurgicznego drenażu. U pozostałych przebieg pooperacyjny upłynął bez powikłań. Wśród operowanych klasycznie u 1 chorego stwierdzono zakrzepicę żył głębokich. U wszystkich pacjentów uzyskano zadowalający efekt hemodynamiczny i kliniczny. Nie zanotowano zgonów. Wnioski. 1. Każdy przypadek jatrogennego urazu tętnicy biodrowej podczas operacji wewnątrznaczyniowej wymaga indywidualnego podejścia. 2. Próba wewnątrznaczyniowej naprawy uszkodzenia jest postępowaniem z wyboru u chorych w stanie stabilnym hemodynamicznie. 3. W przypadku dużych krwawień do przestrzeni zaotrzewnowej konieczne jest natychmiastowe przeprowadzenie operacji klasycznej. Acta Angiol 2011; 17, 2: 150–15

Implementation of sugar-sweetened beverages tax and its perception among public health stakeholders. A study from Poland

BackgroundOne of tools to tackle growing problem of overweight and obesity are the taxation mechanisms applied to sugar-sweetened beverages, which are expected to influence the common eating behaviors, but also they have impact on the market and public finances. The solution is therefore highly entangled in the complex of social and intersectoral interests generating a number of opportunities and threats affecting its feasibility.AimsThe study aims to depict the views of Polish stakeholders on the implementation of the sugar tax in Poland, particularly the perception of success determinants, barriers, as well as views on the features of the implemented solutions and possible alternatives.MethodsWe used semi-structured interviews with 18 individuals representing key public health stakeholders in Poland. The interview consisted of four parts, where first concentrated on the advantages and disadvantages of the SSB tax, the second part explored stakeholder involvement and stances, third concerned the feasibility of the project, and in the fourth part respondents were asked for suggestions for decision-makers regarding the content of the project and its implementation process. To reconstruct position of 4 main political parties we applied desk research. We used MAXQDA v2020 to analyse the collected data.ResultsStakeholders tend to expressed conflicting views on the effectiveness, relevance and socio-economic impact of the SSB tax. All of them agreed that the tax may appear severe for the poorest groups, children and adolescents, while disagreeing about the economic impact of the levy. The allocation of additional tax revenues was raising doubts, with stakeholders believing that the fiscal aim is the basic reason for implementing the tax, while these resources should be primarily dedicated to health promotion intervention and prevention of diet-related diseases. On the other hand, the political debate on the tax was highly superficial with strong populism arising of the presented positions.ConclusionsThere is a need to conduct a thorough public debate and improvements in terms of public communication to increase social awareness, sealing and refining the implemented solutions. Close cooperation with market players and non-governmental organizations is highly recommended

Vitamin D status including 3-epi-25(OH)D3 among adult patients with thyroid disorders during summer months

Introduction: In the context of pleiotropic vitamin D effects, its role has also been investigated in thyroid pathology, in particular autoimmune thyroid diseases (AITD). However, available data concerning vitamin D status in Polish patients with thyroid disorders are inconclusive. In the study we investigated vitamin D status and adequacy of supplementation, as well as sunlight exposure during summer months among adult patients with thyroid diseases.Material and methods: Adults with diagnosed or suspected thyroid disease were recruited almost entirely in an ambulatory setting between June and September in Northern Poland. Questionnaire examinations were performed, and serum concentrations of 25(OH)D2, 25(OH)D3, 3-epi-25(OH)D3, and 24,25(OH)2D3 were determined by LC-MS/MS.Results: Thirty men and 194 women participated in the study, mean age ± standard deviation (SD): 42 ± 15 years, mean ± SD body mass index (BMI) 26 ± 6 kg/m2. Among the participants, 133 declared L-thyroxine treatment, 44 — Hashimoto’s thyroiditis, 40 — nodular goitre, and 20 — hyperthyroidism and/or Graves’ disease. Mean ± SD 25(OH)D level was 26.9 ± 8.2 ng/ml, and deficiency (< 20 ng/ml) was stated in 12%, insufficiency (20 ≤ 25(OH)D < 30 ng/ml) in 50.4% of study participants. Calcidiol was significantly higher in subjects who declared supplementation, mean ± SD: 29.4 ± 7.5 vs. 25.2 ± 8 ng/ml. Among participants without vitamin D supplementation sunlight exposure correlated with 25(OH)D. The C3 epimer of 25(OH)D3 was detected in all subjects; its concentration correlated strongly with that of 25(OH)D3. 24,25(OH)2D3 levels also strongly correlated with those of 25(OH)D3.Conclusions: To our knowledge, the current study is the first in Poland to analyse vitamin D status in summer months among patients with thyroid diseases, as well as serum 3-epi-25(OH)D3 and 24,25(OH)2D3 concentrations. The data presented here indicate that vitamin D sufficiency is not attained even in summer months in patients with thyroid diseases

Influence of percutaneous pulmonary valve implantation on exercise capacity: Which group of patients benefits most from the intervention?

Background: The aim of the study was to evaluate the role of cardiopulmonary exercise testing (CPET) parameters in assessing exercise capacity improvement after percutaneous pulmonary valve implantation (PPVI). Additionally, it aimed to determine if there are any baseline characteristics influencing that change. Methods and results: The study comprised 32 patients (mean age 26 ± 9); 53% males; diagnosis: tetralogy of Fallot (n = 18), pulmonary atresia (n = 6), Ross procedure (n = 4), other (transposition of great arteries, pulmonary stenosis, double outlet right ventricle, common arterial trunk type II — n = 4) who underwent successful PPVI due to right ventricular out­flow tract dysfunction (predominant pulmonary regurgitation — n = 17, predominant pulmo­nary stenosis — n = 15). Treadmill CPET was performed before and a year after PPVI along with clinical evaluation, cardiac magnetic resonance and transthoracic echocardiography. Twelve months post successful PPVI (pulmonary valve competence restoration and pulmonary gradient reduction from 58.8 ± 47.1 to 26.6 ± 10.8 mm Hg) there was a significant decrease in the ventilatory equivalent for CO2 at peak exercise (EQCO2) (25.3 ± 3.3 to 24.3 ± 3.0, p = 0.04) and oxygen consumption at peak exercise (pVO2) (20.4 ± 5.0 to 22.6 ± 5.3 mL/kg/min, p = 0.04). Improved EQCO2 correlated with an increase in right and left ventricular ejection fraction (respectively R = –0.57, p = 0.002; R = –0.56, p = 0.002). In this study, no baseline factors that might affect improvement in exercise function were found. Conclusions: Successful PPVI leads to an improvement in exercise capacity and hemodynamic response to exercise. The correlation between the improvement in EQCO2 or peak VO2 and baseline characteristics was too weak to reliably identify the group of patients that will benefit from the procedur

Drobnokomórkowy rak płuca - zalecenia diagnostyczno-terapeutyczne Polskiej Grupy Raka Płuca

Drobnokomórkowy rak płuca charakteryzuje się dynamicznym przebiegiem ze skłonnością do wczesnego uogólnienia. W chwili rozpoznania u większości chorych występują objawy kliniczne, a najbardziej typowym obrazem radiograficznym są zmiany w okolicy wnęki płuca lub śródpiersia. Celem badań oceniających zaawansowanie nowotworu powinno być w pierwszym rzędzie wykluczenie obecności przerzutów do odległych narządów. Podstawową metodą leczenia wszystkich chorych jest wielolekowa chemioterapia, a preferowanym schematem - skojarzenie cisplatyny i etopozydu. W ograniczonej postaci choroby chemioterapię należy kojarzyć z jednoczesnym napromienianiem klatki piersiowej. U wszystkich chorych uzyskujących całkowitą odpowiedź wskazane jest elektywne napromienianie mózgu. Chirurgiczne leczenie jest możliwe u niewielkiej części chorych z nowotworem w I stopniu zaawansowania według klasyfikacji TNM, a resekcja powinna być zawsze skojarzona z chemioterapią. W postaci uogólnionej stosuje się wyłącznie chemioterapię. Chorzy z długim czasem przeżycia po leczeniu powinni być starannie obserwowani w kierunku wtórnych nowotworów. Forum Medycyny Rodzinnej 2008, tom 2, nr 1, 56-6