Giant postnephrectomy arteriovenous fistula in a patient with tuberous sclerosis and anomalous inferior vena cava: treatment with amplatzer vascular plug embolization.

A case of 61-year-old woman with tuberous sclerosis complex, who developed a fistula between renal artery and renal vein after left-side nephrectomy, was presented. In addition, an abnormal course of inferior vena cava was detected (type 3 Morito). High-flow fistula was causing volume high output heart failure and pulmonary circulation overload with pulmonary hypertension. Because of large size of the fistula, it had to be treated with implantation of Amplatzer II to the renal artery. The procedure was successfully performed using the brachial artery access.

[Evaluation of clinical usefulness of selected laboratory markers in the prediction of myocardial infarction in patients under secondary prevention]. / Ocena uzytecznosci klinicznej wybranych wskazników laboratoryjnych w predykcji zawalu miesnia sercowego u chorych objetych prewencja wtórna.

UNLABELLED: The aim of the study was to evaluate the range of chronic inflammation in patients after second or subsequent myocardial infarction, and to compare it with its range in patients after first MI. MATERIAL AND METHODS: C-reactive protein measurement clinical value was examined by high sensitivity CRP method (hsCRP) and compared to clinical value of other heart attack risk factors: total cholesterol (TC) and cholesterol in HDL fraction (HDL-C), triglycerides (TG) and fibrinogen (FBG). The research included 120 patients in two investigated groups: Z2--30 patients undergoing secondary prevention after second (subsequent) heart attack, and Z1--30 patients with first myocardial infarction. There were two reference groups: KOR--30 people undergoing planned coronarography and K--30 healthy individuals. Groups Z2, Z1 and KOR patients were treated with PCI (percutaneous coronary intervention). RESULTS: HsCRP medians for group Z2 (2.65 mg/I) and groups Z, (2.25 mg/) and KOR (2.35 mg/l) were significantly higher than in group K (1.10 mg/dl). CONCLUSIONS: Highest clinical value of hsCRP in coronary attack prediction was confirmed. Relative area under ROC curve (AUC) was highest in group 2, higher than in group Z1 (0.778 and 0.711, respectively). In patients undergoing secondary prevention, group Z2, hsCRP measurement showed higher clinical value in subsequ ent myocardial infarction prediction than in first one. In groups Z2 and Z1, HDL-C measurement also shows high diagnostic value for coronary risk assessment. AUC are 0.875 and 0.782, respectively. However, in treatment with statins, high AUC values do not necessarily reflect myocardial infarction risk.

Elderly and patients with sick sinus syndrome have lower chances for appropriate pacemaker mode selection, according to the Polish Cardiac Society recommendations -- a single-centre retrospective analysis.

BACKGROUND: The Polish Cardiac Society recommendations for permanent heart pacing have been valid since 1999. The clinical use of these guidelines is, however, still limited. AIM: To analyse whether the chosen pacing strategy is consistent with the Polish Cardiac Society recommendations and to estimate the effects of analysed factors on selecting optimal or suboptimal pacing modes. METHOD: Retrospective analysis of medical records and procedure protocols of 1052 patients who underwent pacemaker implantation between 1 January 2000 and 31 December 2004 was performed. In each case, the applied pacing mode was compared against the optimal one defined according to the guidelines of the Polish Cardiac Society. A number of demographic and clinical factors associated with the procedure were analysed and correlated with the optimal pacing mode selection. RESULTS: During the analysed period, 59.3% of patients received optimal pacing. The percentage of patients with optimal pacing increased in the consecutive years from 40.2% in 2000 to 68.5% in 2005. In a univariate regression analysis, patients above the age of 70 years, with sick sinus syndrome as an indication for pacing, as well as cardiac heart failure and obesity, received optimal pacing significantly less frequently. In a multivariate analysis, advanced age and sick sinus syndrome were found to be independent predictors of suboptimal pacing. CONCLUSIONS: About 60% of patients had their pacemakers implanted with the optimal pacing mode selection according to the valid recommendations. Patients over the age of 70 years, as well as patients with sick sinus syndrome, had significantly lower chances of receiving optimal pacing.

[Persistent left superior vena cava]. / Przetrwala zyla glówna górna lewa.

Persistent left superior vena cava -- a case report. A case of a 72-year-old female admitted for pacemaker implantation is presented. During the procedure, persistent left superior vena cava was found. Pacemaker was inserted via right subclavicular vein.

Doxorubicin-induced ventricular arrhythmia treated by implantation of an automatic cardioverter-defibrillator.

Anthracyclines are a group of potent antitumour agents and cardiotoxicity is an important factor limiting their therapeutic effectiveness. Although cardiomyopathy is the most widely recognized type of cardiotoxic reaction, early arrhythmia following anthracycline administration may be of clinical significance as well. We report a case of ventricular tachycardia causing cardiac arrest in a female treated with doxorubicin as adjuvant therapy of breast cancer. Due to recurrence of the arrhythmia and a desire to continue chemotherapy, an automatic cardioverter-defibrillator was implanted with excellent effect.