Is routine performance of the uterine cervix canal curettage prior to the curettage of the uterine cavity justified?

Objectives: Endocervical curettage (ECC) together with the dilatation and curettage of the uterine cavity (D & C) is routinely performed in everyday clinical practice. The aim of this study is to assess the rationale of the performance of ECC prior to D & C in indications other than abnormal uterine bleeding (AUB). Material and methods: Case histories of 736 patients after ECC performed in the 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, were analyzed retrospectively, the indications for the procedure — age, menopausal status, parity, procedure operator’s experience — as well as the result of the histopathology examination were taken into account. Three groups of patients were distinguished based on the indications for the procedure. Results: In 645 (87.6%) of cases normal histopathology results were obtained. 40 (5.4%) cases were abnormal. 31 cases of uterine cervix dysplasia were disclosed (CIN 1–20; CIN 2–5; CIN 3–6), 8 cases of endometrial cancer and 1 case of cancer of the uterine cervix were disclosed. In 51 (7%) of cases tissue material for histopathology examination was not obtained. In patients where ECC and D & C were performed due to indications other than abnormal bleeding from uterine cavity, no abnormal results were revealed. In addition, in this group the highest number of non-diagnostic ECCs was reported (11.59%; p < 0.05). Conclusions: In the case of endometrial biopsy for indications other than AUB routine ECC prior to D & C need not be performed

Huntington Disease – Principles and practice of nutritional management

Huntington disease (HD) is a degenerative brain disease clinically manifested by the characteristic triad: physical symptoms including involuntary movements and poor coordination, cognitive changes with less ability to organize routine tasks, and some emotional and behavioral disturbances. For patients with HD, feeding is one of the problems they have to face. People with HD often have lower than average body weight and struggle with malnutrition. As a part of therapy, good nutrition is an intervention maintaining health and functional ability for maximally prolonged time. In the early stages of HD, small amounts of blenderized foods given orally are recommended. In more advanced stages, enteral nutrition is essential using gastric, or jejunal tubes for short term. Most severe cases require gastrostomy or gastrojejunostomy. Although enteral feeding is well tolerated by most of the patients, a number of complications may occur, including damage to the nose, pharynx, or esophagus, aspiration pneumonia, sinusitis, metabolic imbalances due to improper nutrient and fluid supply, adverse effects affecting gastrointestinal system, and refeeding syndrome

Leczenie pozaustrojowe hipercholesterolemii — aspekt opieki pielęgniarskiej

Wiedząc o tym, że choroby układu krążenia związane bezpośrednio z zaburzeniami gospodarki lipidowej są główną przyczyną zgonów w Polsce, bardzo istotne staje się poznanie wszystkich alternatywnych sposobów leczenia tych zaburzeń, w tym leczenia aferezą. Szacuje się, że co najmniej do 2020 roku choroby sercowo-naczyniowe będą główną przyczyną zgonów w społeczeństwach rozwiniętych. Codziennie z powodów sercowo-naczyniowych umiera w Polsce około 500 osób, w tym więcej kobiet niż mężczyzn. Bardzo niepokojący jest fakt, że co trzeci zgon z przyczyn sercowo-naczyniowych wśród mężczyzn i prawie co dziesiąty zgon wśród kobiet dotyczy osób w wieku młodym i średnim (poniżej 65. rż.). Częstość występowania dyslipidemii w Polsce jest szacowana na 60–70% w populacji powyżej 18. roku życia. Najważniejszym celem leczenia zaburzeń lipidowych jest redukcja stężenia cholesterolu lipoproteiny niskiej gęstości (LDL). Cele terapeutyczne zależą od ryzyka epizodu sercowo-naczyniowego. Im większe ryzyko, tym mniejsze powinno być stężenie LDL. Afereza LDL służy do oczyszczenia krwi chorego z LDL cholesterolu oraz lipoproteiny (a). Zabieg ten poprawia również warunki przepływu krwi na poziomie mikrokrążenia. Powodzenie terapii aferezą wymaga zaangażowania wykwalifikowanego personelu medycznego. Jego zadania to: edukacja pacjentów z grupy wysokiego ryzyka, dokładne wyjaśnienie, na czym polega afereza, odpowiednie jej przygotowanie i bezbłędne przeprowadzenie

Impact of routine invasive strategy on outcomes in patients with non-ST-segment elevation myocardial infarction during 2005–2014: A report from the Polish Registry of Acute Coronary Syndromes (PL-ACS)

Background: Non-ST-segment elevation myocardial infarction (NSTEMI) has become the most frequently encountered type of myocardial infarction. The patient clinical profile and management has evolved over the past decade. As there is still a scarcity of data on the latest trends in NSTEMI, changes herein were observed and assessed in the treatment and outcomes in Poland between 2005 and 2014.Methods: A total of 197,192 patients with NSTEMI who enrolled in the Polish Registry of Acute Coronary Syndromes (PL-ACS) between 2005 and 2014 were analyzed. In-hospital and 12-month mortality were assessed.Results: Coronary angiography use increased from 35.8% in 2005–2007 to 90.7% in 2012–2014 (p < 0.05), whereas percutaneous coronary intervention increased from 25.7% in 2005–2007 to 63.6% in 2012–2014 (p < 0.05). There was a 50% reduction in in-hospital mortality (from 5.6% in 2005–2007 to 2.8% in 2012–2014; p < 0.05) and a 30% reduction in 1-year mortality (from 19.4% in 2005–2007 to 13.7% in 2012–2014; p < 0.05). A multivariate analysis confirmed an immense impact of invasive strategy on patient prognosis during in-hospital observation with an odds ratio (OR) of 0.31 (95% confidence interval [CI] 0.29–0.33; p < 0.05) as well as during the 12-month observation with an OR of 0.51 (95% CI 0.49–0.52; p < 0.05).Conclusions: Over the past 10 years, an important advance in the management of NSTEMI has taken place in Poland. Routine invasive strategy resulted in a significant decrease in mortality rates in all groups of NSTEMI patients

Zadania i funkcje pielęgniarki w opiece nad pacjentem w trakcie zabiegu aferezy lipoprotein niskiej gęstości (LDL) — opis przypadku

W pracy został przedstawiony opis 56-letniego pacjenta z udokumentowaną stabilną chorobą wieńcową, po dwukrotnym zawale serca bez uniesienia odcinka ST, leczonego angioplastyką w 2015 i 2016 roku. U chorego zdiagnozowano hipercholesterolemię z wartościami cholesterolu całkowitego w granicach 250–430 mg/dl, cholesterolu lipoprotein niskiej gęstości (LDL) — 200–350 mg/dl. Pacjent był leczony statynami ze złą tolerancją leków hipolipemizujących (miopatia); wystąpiły podwyższone wartości transaminaz w badaniach laboratoryjnych. Został zakwalifikowany do leczenia zewnątrzustrojowego aferezą LDL. Co 14 dni chory ma wykonywane zabiegi techniką filtracji kaskadowej z dostępu obwodowego, przy przepływie krwi 100–130 ml/min, zgodnie z wyliczaną objętością oczyszczania osocza. Sprawowana przez pielęgniarki opieka nad pacjentem w trakcie zabiegów aferezy LDL ma istotne znaczenie dla powodzenia i efektywności terapii

Mid-term follow-up after suture-less aortic heart valve implantation

Background: Aortic stenosis (AS) is the most common valve disease in the adult population and its prevalence increases with age. Unfortunately, older age and comorbidities significantly increase mortality, operative risk and worsen prognosis. In recent years, sutureless bioprosthesis [sutureless-aortic valve replacement (SU-AVR)] has become an alternative to standard AVR or TAVI in high-risk patients. Compared to standard AVR, the advantages of SU-AVR include shorter valve implantation, shorter aortic cross clamp (ACC) and cardiopulmonary bypass (CPB) times and higher valve EOA with more favorable hemodynamic parameters. Good early clinical and hemodynamic outcomes have been reported in several studies. However, although early SU-AVR results reported in the literature are encouraging, there are few results of long term follow-up. The aim of this study is to present long term echocardiographic hemodynamic outcomes of the Enable sutureless bioprosthesis. Methods: The first human implantation of the Enable sutureless bioprosthesis was performed on the 13th January, 2005 by the authors of this manuscript. From that time until July 2008, 25 patients underwent isolated SU-AVR implantation. The median preoperative logistic EuroSCORE was 1.92±0.17 [standard deviation (SD)] and the STS score was 2.96±2.73. Preoperatively, 65.4% of patients were in NYHA class III or IV, the peak/mean gradient transaortic gradient was 84.6/52.1 mmHg. Results: After the SU-AVR procedure, the average peak/mean aortic gradients were respectively: 12.9/7.1 mmHg at the intraoperative time; 18.1/9.5 mmHg at 3–6 months; 18.3/9.6 mmHg at 11–14 months; 16.9/9.3 mmHg at 2 years; 15.3/8 mmHg at 3 years; 13.4/7.1 mmHg at 4 years; 16.7/8.9 mmHg at 5 years follow-up. Other hemodynamic echocardiographic parameters such as LVOT diameter, LVOT peak velocity, LVOT TVI, valve peak velocity and valve TVI were stable during the follow-up period. Conclusions: In summary, sutureless bioprostheses are safe and effective treatments for valve stenosis with excellent outcomes and hemodynamic profile which remained stable during the follow-up period. The peak and mean gradients were 16.7 and 8.9 mmHg, respectively, over a 5-year follow-up period

The chain of survival in hypothermic circulatory arrest : encouraging preliminary results when using early identification, risk stratification and extracorporeal rewarming

BACKGROUND: The prognosis in hypothermic cardiac arrest is frequently good despite prolonged period of hypoperfusion and cardiopulmonary resuscitation. Apart from protective effect of hypothermia itself established protocols of treatment and novel rewarming techniques may influence on outcome. The purpose of the study was to assess the outcome of patients with hypothermic circulatory arrest treated by means of arterio-venous extracorporeal membrane oxygenation (ECMO) according to locally elaborated protocol in Severe Accidental Hypothermia Center in Cracow, Poland. METHODS: Prospective observational case-series study – all patients with confirmed hypothermic cardiac arrest consulted with hypothermia coordinator were accepted for extracorporeal rewarming, unless contraindications for ECMO were observed (active bleeding). RESULTS: The study population consisted of 10 patients (7 male, median age 48.5 years). The core temperature measured esophageally was 16.9–28.4 °C, median 22 °C. On admission 5 patients presented with asystole and 5 with ventricular fibrillation. Duration of circulatory arrest before ECMO implantation was 107 to 345 min (median 156 min). The duration of ECMO support was 1.5 to 91 h (median 22 h). Cardiorespiratory stability and full neurologic recovery was achieved in 7 patients. The duration of mechanical ventilation was 88–437 h (median 177 h) and the length of stay in the ICU was 8–26 days (median 15 days). All survivors had mildly impaired (1 patient, LVEF 40 %) or preserved (6 patients, LVEF 55–65 %) left ventricular systolic function at the time of discharge from ICU. The cause of death of non-survivors (three patients) was acute myocarditis, massive retroperitoneal bleeding, and massive gastrointestinal bleeding. DISCUSSION AND CONCLUSIONS: Our data confirm the high survival rate (70 %) and excellent neurologic outcome in hypothermic cardiac arrest. The following key elements seem to impact the final prognosis: the appropriate coordination of the rescue operation, immediate high-quality CPR (preferably using mechanical chest compression system) and application of ECMO for rewarming and cardiorespiratory support