[Acute thrombosis during carotid artery stenting treated with percutaneous embolectomy in a patient resistant to heparin]. / Przezskórna angioplastyka tetnicy szyjnej wewnetrznej powiklana ostra zakrzepica leczona przezskóna embolektomia u chorego z opornoscia na heparyne.

A case of a 61-year-old man with previous stroke, treated with stent implantation due to carotid artery stenosis, is presented. During the elective procedure we observed acute thrombosis in the carotid artery due to heparin resistance unknown before. Embolectomy with open filter of the distal neuroprotection system was successfully performed. The second procedure, after a few months with a direct thrombin inhibitor, was fully successful.

Atrial septostomy in treatment of end-stage right heart failure in patients with pulmonary hypertension.

BACKGROUND: Right ventricular (RV) failure is the main cause of death in patients with pulmonary hypertension (PH). Balloon atrial septostomy (BAS) is believed to relieve symptoms of PH by increasing systemic flow and reducing RV preload. METHODS: Fourteen BAS procedures were performed in 11 patients (5 men and 6 women; mean [+/- SD] age, 33 +/- 12 years) with RV failure in the course of PH that was refractory to conventional treatment. BAS consisted of a puncture of the interatrial septum and subsequent dilatations with balloons of increasing diameter in a step-by-step manner. RESULTS: After BAS, the mean oxygen saturation of aortic blood decreased (before, 93 +/- 4%; after, 84 +/- 4%; p = 0.001), while mean cardiac index increased (before, 1.54 +/- 0.34 L/min/m(2); after, 1.78 +/- 0.35 L/min/m(2); p = 0.001), resulting in a positive trend for mean systemic oxygen transport (before, 270 +/- 64 mL/min; after, 286 +/- 81 mL/min; p = 0.08). Pulmonary vascular resistance (PVR) slightly increased immediately after the procedure, and this rise inversely correlated with mixed venous blood partial oxygen pressure both before BAS (r = -0.69; p = 0.009) and after BAS (r = -0.64; p = 0.018). Mean functional class improved from 3.2 +/- 0.4 to 2.6 +/- 0.7 (p = 0.03) after 1 month. At follow-up (mean time to follow-up, 8.1 +/- 6.2 months; range, 0.8 to 20.2 months), seven patients died and two underwent lung transplantation. There was no difference in the survival rate compared to that obtained from National Institutes of Health equation. A significant size reduction in the created defect was observed in six patients, requiring repeat BAS procedures in three cases. CONCLUSIONS: The current BAS technique improves cardiac index and functional class without significant periprocedural complications, except for a transient increase in PVR related to acute desaturation of mixed venous blood. At long-term follow-up, a high incidence of spontaneous decrease in orifice size has been observed.

Systemic inflammatory response syndrome in the course of status epilepticus: 7-year, two-center observational study.

OBJECTIVES: This study was aimed at identifying patients with systemic inflammatory response syndrome (SIRS) and determining whether the presence of SIRS on admission was associated with drug resistance and poor outcome in status epilepticus (SE) patients. METHODS: We conducted a prospective review of patients consecutively admitted to two territory centers over a 7-year period. SIRS was considered present if the necessary criteria persisted for 12h. Other potential outcome predictors in a cohort of patients with SE were also collected. The primary outcome was defined as mortality during 30 days of observation, and the secondary outcome was defined as refractory SE. Logistic regression was used to determine independent predictors. RESULTS: Of 127 subjects, 85 patients met the inclusion criteria. In the entire population, 43% developed SIRS at SE onset and, among them, 16% had SIRS attributed to SE alone. Subjects with refractory SE accounted for 39%, and the mortality rate for the entire population was 35%. SIRS was independently associated with drug resistance (OR 3.93, 95% CI: 1.57-9.9) and death (OR 6.76, 95% CI: 1.33-34.32). CONCLUSIONS: We observed that approximately half of the patients with SE developed SIRS, and that SIRS is the independent risk factor for drug resistance and death. We also observed that SIRS was a secondary event for SE itself.

[Left main coronary artery stenting in a ninety year old female with recurrent acute coronary syndrome -- a case report]. / Stentowanie pnia lewej tetnicy wiencowej u 90-letniej chorej wracajacej do szpitala z powodu ostrego zespolu wiencowego. Opis przypadku.

A case of a ninety year old female with recurrent acute coronary syndrome is presented. Coronary angiography revealed critical left main coronary artery stenosis which was successfully treated with angioplasty and stent implantation. Data from literature on the left main stenting in the elderly are discussed.

Prognostic Significance of NT-proBNP Levels in Patients over 65 Presenting Acute Myocardial Infarction Treated Invasively or Conservatively.

OBJECTIVES: Assessment of prognostic significance of NT-proBNP level and the effects of invasive (I) and conservative (C) treatment of acute myocardial infarction (AMI) in patients over 65. MATERIALS AND METHODS: One-year survival was assessed in 286 consecutive patients with AMI aged 65-100 (79 ± 8) subjected to I or C treatment (136 and 150 individuals), respectively. RESULTS: 245 (85%) patients survived in-hospital stay: 124 (91.1%) received I treatment and 121 (80.6%) received C treatment. Heart failure (HF) was diagnosed in 30 patients receiving I treatment (22.6%) and in 71 subjected to C treatment (47.3%), p < 0,0001. NT-proBNP levels in the latter group were significantly higher than in the 185 patients without HF (12311 ± 13560 pg/mL versus 4773 ± 8807 pg/mL, p < 0.0001). NT-proBNP levels after coronary angioplasty were lower than in patients receiving C treatment (5922 ± 10250 pg/mL versus 8718 ± 12024 pg/mL, p = 0.0002). Left ventricular ejection fraction was significantly higher in I patients than in C patients (47 ± 13% versus 42 ± 11.6%, p = 0.004). During the one-year follow-up, 82.3% of I patients and 61.2% of the C patients survived (p < 0.0003). There was a significantly lower probability of death at NT-proBNP below 8548.5 pg/mL. CONCLUSIONS: The NT-proBNP level in the first day of AMI is a good prognosticator. One-year follow-up prognosis for patients who received I treatment in the AMI is better than that for C patients. I patients exhibit superior left ventricular function after angioplasty and in the follow-up.

Percutaneous internal carotid artery angioplasty with stenting: early and long-term results.

BACKGROUND: Cerebro-vascular accidents are the third most common cause of death. The most frequent localisation of lesions responsible for stroke are bifurcation of the common carotid artery or the proximal internal carotid artery (ICA). Surgical carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the non-pharmacological methods used to treat carotid artery stenosis. AIM: To assess the efficacy and safety of CAS of ICA. METHODS: CAS was performed in 75 patients (49 males, 26 females) with a mean age of 65.2+/-9.1 years. Twenty (26.7%) patients underwent CAS with the use of the central nervous system (CNS) protective devices. The immediate, mid-term, and long-term results were analysed. RESULTS: In total, 84 stents were implanted to 80 ICA in 73 patients. In two patients stent implantation was not possible. In 7 (9%) patients with a stenosis of both ICA, a bilateral procedure was performed. In two patients concomitant dilatations of the vertebral artery, and in the other two - of subclavian artery, were performed. In 38 patients coronary angiography was performed directly before CAS; one patient underwent coronary angioplasty. In 20 patients protective CNS devices were used. During the procedure four patients developed ischaemic stroke on the side of CAS. In one patient neurological symptoms completely disappeared within 48 hours. The type of technique used during CAS did not influence the frequency of ischaemic complications. Four patients developed hyperperfusion syndrome which disappeared after a few days. There were fire deaths during follow-up: three due to myocardial infarction (MI), one - after urgent CABG, and one due to pulmonary embolism. There were no deaths due to stroke. No new ischaemic changes in CNS nor significant changes in the neurological status, using the UNSS or Barthel scales, were observed. Asymptomatic restenosis was documented in six patients whereas one patient developed symptomatic restenosis due to stent deformation. CONCLUSIONS: Percutaneous angioplasty of an internal carotid artery carries a risk not exceeding that of surgical endarterectomy. In our study, a one-year follow-up revealed a minor risk of ischaemic stroke. Percutaneous angioplasty with the use of protective devices should be tested in larger groups of patients in order to establish the real clinical usefulness and improved safety of this technique.

[Morphologic parameters of blood platelets and activity NA+/H+ (NHE-1) exchanger in normal pregnancy and pregnancy complicated with preeclampsia]. / Parametry morfologiczne plytek krwi i aktywnosc wymieniacza Na+/H+ (NHE-1) u ciezarnych zdrowych i z preeklampsja.

UNLABELLED: The aim of the study was the evaluation of number and morphologic parameters of blood platelets and sodium-proton platelet exchangers in pregnant women in the 3rd trimester of pregnancy, healthy (155) and with preeclampsia (40). RESULTS: Blood platelet number was significantly lower in patients with preeclampsia than in healthy subjects (195,000 vs 222,000). Mean platelet volume was significantly higher in patients with preeclampsia (9.5 fl vs 8.6 fl). The activity of Na+/H+ was slightly higher in pregnants with preeclampsia.

[Lamellar body count and interleukin-6 levels in women with preterm labor]. / Ciala lamelarne i interleukina-6 w diagnostyce porodu przedwczesnego.

Our purpose was to investigate the amniotic fluid lamellar body count and interleukin-6 levels in women with preterm labor. The study was carried out on 50 amniotic fluid collections obtained by amniocentesis or during cesarean delivery. Concentration of lamellar body (CL) and interleukin-6 (IL-6) were performed. We found significantly lower lamellar body count values in women at risk of preterm delivery before 34 weeks' gestation and elevated amniotic fluid IL-6 concentration (CL--20.81 +/- 6.73 x 103/ul, IL-6--318.3 +/- 18.7 pg/ml) when compared with pregnancies at term (CL--77.1 +/- 28 x 103/ul, IL-6--142 +/- 15.3 pg/ml).

[Growth factors in pregnancy complications with preeclampsia]. / Niektóre czynniki wzrostu w ciazy powiklanej preeklampsja.

The aim of the study was to determine the concentrations of TGF-beta, PDGF and VEGF growth factors in peripheral blood. The examinations were carried out in the group of pregnant women with preeclampsia. The results were compared to those obtained in a control group of healthy pregnant women. The statistically significant increase in all examined growth factors was observed in women with preeclampsia in comparison to healthy women. The results suggest that growth factors may play an important role in etiology and pathophysiology of preeclampsia.

[Nitric oxide in preterm labor]. / Tlenek azotu w porodzie przedwczesnym.

Synthesis of nitric oxide proceeds in the human myometrium. Decrease of its concentrations can play an essential part in the initiation of uterine contractions in term. Authors suppose, that inhibition of the synthesis of nitric oxide plays a role in premature labour. Concentrations of nitric oxide in women with threatening premature labour were marked. Group I consisted of women with premature departure of amniotic fluid, group II--woman with retained amniotic fluid and with idiopathic contractile activity, group III--woman with departure of amniotic fluid and with idiopathic contractile activity. Concentration of nitric oxide was lower in the group of women with a premature contractile activity in comparison with healthy pregnant women in the same period of pregnancy. Higher concentrations of nitric oxide were observed in the group of patients without contractile activity after departure of amniotic fluid.

Selected local and peripheral intereactions of some cytokines in etiopathogenesis of preeclampsia.

In accordance with presented results and clinical observation it should be assumed that basic phenomena resulting in clinical sign of preeclampsia take place already in implantation and embryogenesis. Abnormal trophoblastic infiltrations and changes in vascular endothelium functioning occur due to disturbed interaction of cytokines and growth factors. Pathologies present in endothelial cells (EC) become the cause of blood overcoagulation and hypertension and promote other clinical symptoms of preeclampsia.