Association of the bitter taste genes TAS2R38 and CA6 and breast cancer risk; a case-control study of Polish women in Poland and Polish immigrants in USA.

It is known that the perception of bitterness is mediated by type 2 bitter taste receptors (TAS2Rs). However, recent reports have suggested that the carbonic anhydrase 6 (CA6) gene may also influence bitterness sensing. Genetic variants in these genes could influence dietary intake of brassica vegetables, whose increased consumption has been observed in the literature, though inconsistently, to decrease breast cancer (BC) risk. We hypothesized that the estimated odds ratios (ORs) for the association between BC and taster diplotype (PAV/PAV) and/or genotype A/A, will be in the direction of increased BC risk, potentially due to reduced consumption of brassica vegetables. Using a case-control study of BC in Polish women in Poland (210 cases and 262 controls) and Polish immigrant women to USA (78 cases and 170 controls) we evaluated the association of the taster diplotypes in TAS2R38 gene and genotypes in the CA6 gene and BC risk in these two populations individually and jointly. No significant increase in risk was observed for the TAS2R38 PAV/PAV diplotype (tasters) in each population individually or in the joint population. For the CA6 gene, in the joint population, we observed an increased BC risk for the combined G/A and G/G genotypes (non-tasters) vs A/A (tasters), OR = 1.41 (95% CI 1.04-1.90, p = 0.026) which after adjustment for False Discovery Rate (FDR), was not significant at p≤0.05 level. However, for the joint population and for the combined genotype of the two genes AVI/AVI+G* (non-tasters) vs. PAV/*+A/A (tasters), we observed a significant increase in BC risk, OR = 1.77 (95%CI 1.47-2.74, p = 0.01), for the non-tasters, which remained significant after FDR adjustment. In conclusion for the joint population and the joint effect for the two bitter sensing genes, we observed an increase in BC risk for the bitterness non-tasters, association which is in the opposite direction to our original hypothesis.

Implementation of the Patient Counselling Service at the Cancer Hospital in Radom, Poland.

Background: Non-adherence occurs in various groups of patients, including those with chronic diseases. One strategy to increase adherence among oncological patients is to individualise treatment and expand pharmaceutical care. Pharmaceutical labels that remind patients how they should take their medications are of great importance in this respect. Objective: The main objective of this study was to evaluate medication adherence in oncological patients, and to gather their opinions on the individual medication labelling system as an element of effective treatment. Methods: The study was conducted in 2021 among 82 patients of the oncological department of the Centre of Oncology in Radom. The research tool was a questionnaire consisting of personal data and two parts relating to the patient's disease and the medication labelling system. Results: Nearly half of the respondents reported that they forget to take medications and how they should take them. These problems increased with the age of the patient and the number of administered medications. Of the respondents, 89% stated that the labels with dosing information are helpful. Over 67% agreed that these labels should be affixed to all medications. Nearly 90% of the respondents believed the labels should be available in all pharmacies. Conclusions: Non-adherence is a common phenomenon among oncological patients. Pharmacists providing a labelling service for medicinal products can play a significant role in reducing this phenomenon.

Determinants of E-Cigarette and Cigarette Use among Youth and Young Adults in Poland-PolNicoYouth Study.

Teen use of tobacco-related products is a significant public health concern. This study evaluated the predictors of e-cigarette use among secondary school students who were never cigarette smokers and ever cigarette smokers in Poland. METHODS: This study examined a sample of Polish youths aged 13-19 (n = 19,241) attending 200 schools, 12 on average in each county. The study was a part of the National Health Program in Poland for 2016-2020. Logistic regression and multivariable logistic regression models were used to calculate crude and adjusted odds ratios. RESULTS: Of all participants, 32.5% were ever cigarette users. Among the never cigarette users, 13.6% were deemed susceptible to e-cigarette use. Among the ever cigarette users, 60.6% were deemed susceptible to e-cigarette use. Of those susceptible to e-cigarette use, 68.2% were among the 32.5% ever cigarette users. The profile of e-cigarette use among never e-cigarette users also included: pocket money available per month (more than 150 PLN) (OR = 1.7; p = 0.001), 16-17 years old (OR = 1.9; p = 0.001), parental tobacco smoking and e-cigarette usage (OR = 2.0; p = 0.01 and OR = 1.7; p = 0.001 respectively), maternal secondary education (OR = 1.1; p = 0.04), and living in big cities >500,000 inhabitants (OR = 1.4; p = 0.04). E-cigarette users among ever cigarette users were similar to never cigarette users in their opinion that e-cigarette use is less harmful than traditional smoking (OR = 1.6; p = 0.0012) and living with both parents smoking cigarettes (OR = 1.3; p = 0.02). Additionally, the determinants were: female gender (OR = 1.5; p = 0.009) in the age group less than 15 years of age (OR = 1.3; p = 0.007). CONCLUSIONS: The major determinant of e-cigarette use in this population was prior smoking. Additionally, the results revealed that fairly obvious predictors such as parental smoking and a belief in the less harmfulness of e-cigarette use are important determinants for smoking among never or ever e-cigarette users.

Metastatic and non-metastatic sentinel inguinofemoral lymph nodes in vulvar cancer show an increased lymphangiogenesis.

INTRODUCTION AND OBJECTIVE: Lymph node involvement is a strong predictor of disease recurrence and patient survival in vulvar cancer. The aim of the study was to evaluate the feasibility of sentinel lymph node (SLN) screening, the incidence of skip metastases, and lymph node lymphangiogenesis. MATERIAL AND METHODS: Fifty-five patients participated in this prospective, single centre study. A double SLN screening method was employed using radiocolloid (technetium-99 sulfur colloid) and 1.0% Isosulfan Blue. Immunohistochemistry, using a mouse monoclonal antibody against D2-40, was used to evaluate lymphatic vessel density (LVD). All calculations were performed using STATISTICA software v. 10 (StatSoft, USA, 2011); p < 0.05 was considered significant. RESULTS: Using both methods of SLN detection, 100% accuracy was achieved, and skip metastases were diagnosed in only one woman (1.82%). Peri-tumour median LVD was significantly increased compared with matched intra-tumour samples (p < 0.001), while median LVD was significantly lower in negative, compared with positive SLN, regardless of whether matched non-SLN were negative (p < 0.001) or positive (p = 0.005). Metastatic SLN exhibited significantly higher median LVD compared with matched negative non-SLN (p = 0.015), while no significant difference in median LVD was detected between positive SLN and matched positive non-SLN. However, negative SLN had a significantly higher median LVD compared with matched negative non-SLN (p = 0.012). CONCLUSIONS: SLN detection is a safe and feasible procedure in vulvar cancer. In patients without nodular involvement, SLN, compared with non-SLN, exhibited significantly higher median LVD, which may be an indication of its preparation to host metastases, and thus requires further investigation.

Awareness and attitudes towards clinical trials among Polish oncological patients who had never participated in a clinical trial.

BACKGROUND: Participation in a clinical trial significantly shortens waiting time associated with receiving specialist care. Furthermore, it may be the case that, through clinical trials, subjects can access medicines that are not typically available in Poland. OBJECTIVES: The aim of this study was to determine the opinions of oncological patients about clinical trials. MATERIAL AND METHODS: The research has been carried out during the years 2014-2016. A proprietary questionnaire consisting of 10 closed, single and multiple choice questions about awareness and perceptions of clinical trials, and 5 questions concerning demographic information was used. A group of 256 patients with cancer (54% women, 46% men), aged 21-77 years, was surveyed. RESULTS: Respondents were statistically more likely to decide to participate in a clinical trial as oncological patients than the healthy volunteers (Pearson's χ2 test p = 0.00006). The desire to qualify for clinical trials in no way depends on the knowledge of side effects (Pearson's χ2 test p = 0.16796). CONCLUSIONS: Our study found that the patients' awareness about clinical trials varied. However, a positive attitude towards research was visible. The main identified barriers to clinical trial participation were fear of possible side effects. Most patients regarded clinical trials as useful, and considered that they are conducted to introduce new treatment/new drug.

[Patient safety in poland according to analysis of medical adverse events].

The paper presents the analysis of rulings from regional commisions on health care malpractice in Poland wiith special attention to patient safety issues. The analysis entails causes, types and consequensence of 469 malpractice claims. In 23,7% of cases the claim was confirmed by commission. The most frequent types of malpractice was body injury. General surgery and othopedis were the major medical specialities when confirmed malpractices took place.

Analysis of Quality of Life Subjective Perception by Patients Treated for Prostate Cancer with the EORTC QLQ-C30 Questionnaire and QLQ-PR25 Module.

Prostate cancer in men is the second most occurring cancer in Poland and represents approximately 13.2 % of all cancers. At the same time, it is the third largest cause of death in men, being responsible for approximately 8 % of deaths. The study was conducted among patients of Oncological Hospital in Wieliszew. The study included 83 men diagnosed with prostate cancer at the age of 51-84 years. The patients gave their written consent to participate in the study, to which the overall standardized questionnaires EORTC QLQ-C30 and QLQ-PR25 for patients with prostate cancer was applied. Significant deterioration of the state of health due to cancer was indicated by a total of 10.84 % of patients. At the same time, it was found that although there are differences between quality of life in various age groups of respondents, they are statistically insignificant (Chi2 = 59.96; p = 0.00734; R = 0.09; p > 0.05). Subjective QoL did not depend on the stage of cancer treatment, type of therapy, or significant deterioration in the patient's state of health in the last stage of disease. Both disease and therapy have impact on quality of life in all its dimensions, in particular as regards the patient's physical functioning and his frequent fatigue. There is a strong relationship between a patient's subjective assessment of quality of life and pain that significantly hampers everyday activities. This demonstrates the need for continuous monitoring and relieving pain directly associated with cancer and methods of its treatment.

Incidence and mortality rates in breast, corpus uteri, and ovarian cancers in Poland (1980-2013): an analysis of population-based data in relation to socioeconomic changes.

OBJECTIVES: This study aimed to analyze incidence and mortality trends in breast cancer (BC), corpus uteri cancer (CUC), and ovarian cancer (OC) in Poland in the context of sociodemographic changes. MATERIALS AND METHODS: Incidence and mortality data (1980-2013) were retrieved from the Polish National Cancer Registry, while socioeconomic data (1960-2013) were obtained from the World Bank. Age-standardized incidence and mortality rates were calculated by direct standardization, and join-point regression was performed to describe trends using the average annual percentage change (AAPC). RESULTS: A significant decrease in birth and fertility rates and a large increase in gross domestic product were observed together with a decrease in the total mortality rate among women, as well as an increase in life expectancy for women. A large, significant increase in BC incidence was observed (AAPC1980-1990 2.14, AAPC1990-1996 4.71, AAPC1996-2013 2.21), with a small but significant decrease in mortality after a slight increase (AAPC1980-1994 0.52, AAPC1994-2013 -0.66). During the period 1980-2013, a significant increase in CUC incidence (AAPC1980-1994 3.7, AAPC1994-2013 1.93) was observed, with an initial mortality-rate reduction followed by a significant increase (AAPC1980-2006 -1.12, AAPC2006-2013 3.74). After the initial increase of both OC incidence and mortality from 1994, the incidence rate decreased significantly (AAPC1980-1994 2.98, AAPC1994-2013 -0.49), as did the mortality rate (AAPC1980-1994 0.52, AAPC1994-2013 -0.66). CONCLUSION: After 1994, a decrease in OC incidence was found, while the incidence of BC and CUC continued to increase. A reduction in mortality rate was observed for BC and OC predominantly at the end of the study period, while for CUC, after a long decreasing mortality trend, a significant increase was observed.

Diagnosis of hepatitis C virus infection in pregnant women in the healthcare system in Poland: Is it worth the effort?

The hepatitis C virus (HCV) is globally recognized as a serious public health concern. Current statistics indicate that approximately 2% of people worldwide and 1.9% of people in Poland suffer from HCV infection.This study was conducted to assess the anti-HCV seroprevalence in pregnant women in Poland and subsequently provide recommendations on the rationale for obligatory screening.A total of 42,274 women participated in our study, of which 16,130 were pregnant. We were granted access to their health data stored in the form of electronic medical records kept by the network of outpatient clinics throughout Poland.The lowest rate of positive anti-HCV test results was found in women ages 25 to 34 (0.73%); however, younger and older age groups had similar rates (15-24 = 0.86%; 35-44 = 0.84%). Additional analysis of data from the period between 2011 and 2014 revealed a downward trend in the proportion of positive anti-HCV tests among pregnant women (mean positive anti-HCV = -0.001 × year + 1.9451; R = 0.7274). Regardless of the gradual increase in the number of female patients undergoing screening between 2004 and 2015, there has been a constant decrease in the rate of positive cases. The rate of pregnant women potentially infected with HCV was twice as lower than that in a control group of women undergoing tests for other medical circumstances: 0.76% vs 1.67% (P < 0.0001).Analysis of real-world data of female patients in Poland provides evidence that screening based on an individual's medical history and behavioral risk factors in clinical circumstances would be more effective than obligatory testing of all pregnant women.

Age-related trends in anti-Mullerian hormone serum level in women with unilateral and bilateral ovarian endometriomas prior to surgery.

BACKGROUND: Endometriosis is a well-known cause of infertility, and the anti-Mullerian hormone (AMH) is an accepted biomarker of ovarian reserve and response to artificial reproductive technology procedures. The present study was a prospective analysis of age-dependent AMH serum concentration in women with bilateral and unilateral ovarian endometriomas before therapy onset compared with healthy controls. METHODS: This prospective cross-sectional study included 384 women aged 18-48 years. AMH serum concentration was assessed between days 3 and 6 of the menstrual cycle in 78 patients with bilateral and 157 patients with unilateral ovarian endometriomas and compared with 149 healthy controls. Ovarian endometriosis was confirmed histopathologically, and data were presented as medians with interquartile range (IQR). RESULTS: Stage III endometriosis was diagnosed in 53.2 %, stage IV in 18.3 %, stage V in 23.4 % and stage VI in 5.4 % of the patients. Patients with bilateral ovarian endometriomas showed the lowest median AMH levels compared with patients suffering from unilateral ovarian endometriosis (0.55; IQR: 0.59 vs. 2.00; IQR: 2.80; p < 0.001) and the control group (0.55; IQR: 0.59 vs. 2.84; IQR: 3.2; p < 0.001). Median AMH concentration values were not significantly different between patients with unilateral ovarian endometriosis and the healthy controls (2.00; IQR: 2.80 vs. 2.84; IQR: 3.2; p = 0.182). A strongly negative correlation between AMH levels and age was confirmed in healthy individuals (R = -0.834; p < 0.001) and women with unilateral ovarian endometriomas (R = -0.774; p < 0.001). Patients with bilateral ovarian endometriosis showed a significantly negative but only moderate correlation between AMH levels and age (R = -0.633; p < 0.001), which was significantly lower than in the healthy controls (R = -0.633 vs. R = -0.834; p = 0.006) but not in the patients with unilateral ovarian endometriosis (R = -0.663 vs. R-0.774; p = 0.093). Based on a multivariate regression analysis, only bilateral localization of ovarian endometrial cysts (p = 0.003) and patient age (p < 0.001), but not left/right localization of unilateral cyst or cyst volume, were negatively associated with AMH serum concentration. CONCLUSION: According to our data, unilateral ovarian endometriosis had a moderately negative and nonsignificant effect on AMH-based ovarian reserve evaluated prior to surgery, irrespective of age. In contrast, the ovarian reserve was significantly reduced in women with bilateral ovarian endometriomas.

Primary Vulvo-Vaginal Cancers: Trends in Incidence and Mortality in Poland (1999-2012).

BACKGROUND: The aim of this study was to determine the incidence, mortality rates and trends of vulvar and vaginal cancers in Poland. METHODS: Data were retrieved from the Polish National Cancer Registry. Age-standardised rates (ASRs) of cancer incidence and mortality were calculated by direct standardisation, and joinpoint regression was performed to describe the trends using the average annual percent change (AAPC). RESULTS: From 1999 to 2012, the number of diagnosed cases of vulvar cancer was 5,958, and the ASRs of incidence varied from 0.99 to 1.18, with a significant trend towards a decrease (AAPC -0.78; p < 0.05). The ASR of mortality varied from 0.39 to 0.62, with a slight but insignificant increase in trend (AAPC 0.72; p > 0.05). The ASR of vaginal cancer incidence varied from 0.21 to 0.31, while the ASR of mortality ranged from 0.09 to 0.22. This study also proved a significantly falling trend in vaginal cancer mortality (AAPC -4.69; p < 0.05) and a decreasing trend in vaginal cancer incidence (AAPC -1.67; p > 0.05). CONCLUSION: The rarity of vulvar and vaginal cancers as well as the decline in their incidence rates should not discourage further research on the epidemiology and treatment of these conditions.

Thrombocytopenia and perioperative complications after stentless Freedom Solo valve implantation.

BACKGROUND: Freedom Solo (FS) stentless bioprostheses have superior haemodynamic performance compared to stented valves; however, the data of thrombocytopenia after FS implantations is disturbing. AIM: To compare platelet count and perioperative complications between stentless and stented biological valves in patients undergoing aortic valve replacement. METHODS: In 29 patients, FS bovine valves (Sorin Group, Saluggia, Italy) were implanted. Platelet counts were analysed before surgery, on the day of operation, on four consecutive postoperative days (POD) as well as at discharge, and compared to 29 control patients with biological stented porcine valves (Labcor Laboratorios TLBP-A Supra). The analysis of the perioperative variables extracorporeal circulation (ECC), aortic cross clamping (XC) and mechanical ventilation times, as well as blood supply, was performed. RESULTS: Initial platelet counts were comparable in both groups. In the FS group, platelet levels on the four consecutive POD were significantly lower. The lowest platelet value (13 × 10³/µL), related to fatal thrombotic thrombocytopenic purpura, was found in one patient from the FS group. ECC as well as XC and mechanical ventilation times, were significantly longer in the FS group, and more blood transfusions in these patients were required. In multiple regression analysis, ECC and XC times did not correlate with platelet count. CONCLUSIONS: Implantations of FS stentless bioprostheses are related to significantly lower platelet counts. Severe perioperative complications and their relation to thrombocytopenia need further evaluation.

[Study on engagement in health promotion at the workplace of non-public health providers in Poland]. / Badanie zaangazowania firm oferujacych pracownikom opieik medyczna w promowanie zdrowia w miejscu pracy w Polsce.

UNLABELLED: Increasing life expectancy in Europe impose a necessity to extend a work ability span. Appropriate health status of working population requires not merely curative care in case of diagnosed diseases but also comprehensive preventive care. AIM: The article provides results of a study on engagement of the Polish companies that are covered by a private employee health plans in certain workplace health promotion activities. MATERIAL AND METHODS: [corrected] 411 companies out of invited 3512 (11,7% participation rate) took part in the study performed in 2011. The majority of study group were large companies (over 50 employees--74%), and smaller, privately owned (less than 50 employees--77%). Companies were asked questions using ENWHP checklist tool on supporting employees in physical activity, smoking cessation, healthy diet and coping with stress. RESULTS: In general, 44% of the companies declared any engagement in employee health promotion. Results showed that companies support mainly physical activity (27% of a study group) and quitting smoking (19%). Researched employers rarely offered support in healthy diet (8%) or stress reduction (5%). There is also a significant relation between higher engagement rate in health promotion among companies that have implemented a special health policy and detailed action plans. However, small enterprises were less likely to provide any preventive action to employees. Even if small enterprises decide to implement any health promotion they usually were based on a single action without broader planning.

Risk factors of neurological complications in cardiac surgery.

BACKGROUND: Postoperative complications are integral to cardiac surgery. The most serious ones are stroke, which develops in about 7.5% of the patients, and postoperative encephalopathy, which affects 10-30% of the patients. According to bibliographical data, the number of complications is increasing. AIM: To analyse the risk factors and the types of neurological complications in patients undergoing heart surgery. METHODS: We assessed retrospectively 323 consecutive patients undergoing surgery at the Department of Cardiac Surgery, University Teaching Hospital, Medical University of Bialystok, Poland, between July 2007 and June 2008. Group 1 comprised patients without neurological complications (n = 287; 89%) and Group 2 consisted of patients with neurological complications (n = 36; 11%). Our analysis included the following: preoperative status (age, sex, co-morbidities), intraoperative course (surgery type, duration of cardiopulmonary bypass [CPB], duration of aortic cross-clamping, types of medications administered, necessity of reinfusion from the cardiotomy reservoir and the necessity of tranexamic acid infusion) and the postoperative course (time to regaining consciousness, duration of mechanical ventilation, development of complications, types of complications). The results were then analysed statistically: arithmetic means and standard deviations were calculated for quantitative variables and the quantitative and percentage distributions were calculated for qualitative variables. The between- group comparisons of the quantitative variables were carried out using the t-Student test, while the qualitative variables were compared using the χ(2) test. The variables that proved significant in the univariate comparisons were included in the multivariate model. Regression analysis was the final step of the analysis of the risk factors for neurological complications. Based on the analysis of the ROC curve we calculated the cutoff values for the continuous variables. We calculated odds ratios with their 95% confidence intervals. P values of less than 0.05 were considered statistically significant. RESULTS: Among the 36 patients in Group 2, postoperative encephalopathy developed in 22 patients, transient ischaemic attacks in 7 patients, ischaemic stroke in 6 patients (associated with right hemisphere damage in 3 patients and with left hemisphere damage in 3 patients) and haemorrhagic stroke in 1 patient (right hemisphere). Early mortality was 5% with 2 (0.69%) patients dying in Group 1 and 14 (38.9%) in Group 2. Univariate analysis revealed that the preoperative risk factors of neurological complications were: age >68 years (with a cutoff value of 58.5 years), a history of stroke with paresis, atrial fibrillation (AF) and a euroSCORE of >6 (with a cutoff value of 4.5). The peri- and postoperative risk factors included: surgery type (complex coronary and valvular surgeries aortic valve surgeries), duration of CPB of >142 min, duration of aortic crossclamping of >88 min, mean perfusion pressure during CPB of <70 mm Hg, haemodilution manifested by a haematocrit (HCT) of <28%, perfusate supply, time to regaining consciousness of >14.5 h and duration of artificial ventilation of >30.5 h. Multivariate analysis revealed the following factors to increase the risk of neurological complications: long duration of ventilation, a history of stroke with paresis, AF, low HCT values and long duration of aortic cross-clamping. The Nagelkerke R2 coefficient of determination was 0.636, the sensitivity was 74.36%, the specificity was 97.545% and the accuracy was 94.74%. CONCLUSIONS: In patients undergoing heart surgery, the independent risk factors of neurological complications in the first 30 days include: long duration of ventilation, a history of stroke with paresis, AF, haemodilution manifested by an HCT of <28% and long duration of aortic cross-clamping. Neurological complications are associated with high postoperative mortality.

[Apicoaortic valved conduit as an alternative method of surgical treatment of aortic stenosis - a case report]. / Wszczepienie protezy zaopatrzonej w zastawke pomiedzy koniuszkiem lewej komory a aorta zstepujaca jako alternatywna metoda operacji zwezenia zastawki aortalnej - opis przypadku.

A case of a 73-year-old patient with critical aortic stenosis, porcelain aorta and occluded femoral arteries is presented. We performed apico-aortic valved conduit (A-AVC) without cardiopulmonary bypass (CPB). Hegar dilator inserted through the apex into the left ventricle allowed anastomosis of dacron tube to the apex. Valved conduit was anastomosed to the descending aorta. Both tubes were connected. Before the operation, maximal gradient through the valve was 95, after operation dropped to 33 mmHg. This method of apical anastomosis allowed to perform A-AVC without CPB in a patient with extremely high peri-operative risk while using CPB.

[Acute prosthetic valve thrombosis in a patient with neoplastic disease--difficulties with anticoagulation therapy]. / Ostra zakrzepica na sztucznej zastawce mitralnej u kobiety z choroba nowotworowa. Trudnosci leczenia przeciwzakrzepowego.

A case of a 50-year-old woman with prosthetic mitral valve complicated by severe thrombosis as an effect of incorrect anticoagulation treatment during rectal cancer biopsy, is presented. During echocardiographic evaluation a dysfunction prosthetic mitral valve with extremely high maximal mitral gradient (50.2 mmHg) was found. The patient was qualified for surgical intervention and mechanical prosthetic mitral valve was replaced by a biological one. This report underlines the difficulties in the anticoagulation therapy in patients with prosthetic heart valves.

[Emergency hybrid surgery for ruptured aortic arch aneurysm--a case report]. / Leczenie hybrydowe pekniecia luku aorty ekstraanatomicznym przeszczepieniem tetnic doglowowych bez krazenia pozaustrojowego, z równoczesnym wszczepieniem stentgraftu luku.

We describe a case of 67-year-old man suffering from chronic aortic arch aneurysm complicated by rupture and hemorrhage to the left pleural cavity. The patient underwent emergency hybrid operation: extraanatomical transposition of aortic arch branches to ascending aorta and implantation of stentgraft into the arch without the extracorporeal circulation.

[Recurrent thrombosis of a mitral mechanical heart valve prosthesis during puerperium--a case report]. / Nawracajaca zakrzepica na sztucznej zastawce mitralnej.

A case of a 27-year-old female with prosthetic mitral valve is presented. Prolonged anticoagulation therapy was continued during pregnancy without complications. During puerperium, the dose of subcutaneous low molecular weight heparin was reduced due to subcutaneous blood effusions. Subsequently, the patient developed acute left ventricular heart failure due to prosthetic valve thrombosis. She underwent urgent surgery with new prosthetic valve implantation. Two weeks later she suffered another episode of acute mitral prosthetic valve thrombosis which was effectively treated with intravenous heparin. Difficulties concerning prolonged anticoagulation during pregnancy and puerperium in patients with prosthetic valves are discussed.

[Acute normovolemic hemodilution together with aprotinin applied as a scheme of blood saving in cardiac surgery]. / Ostra normowolemiczna hemodylucja w polaczeniu z podawaniem aprotyniny jako schemat oszczedzania krwi w kardiochirurgii.

The risk of blood loss in open heart surgery procedures is related to a high level of homologous blood transfusion. Due to numerous possible complications connected with transfusion, as well as the increase in prices of blood preparations, methods of blood saving are of great interest. The aim of the study was to assess acute normovolemic hemo-dilution (ANH) efficacy and aprotinin administration in homologous blood usage limitations. The study was conducted in the group of 265 patients operated on during the period of 12 months. The control group consisted of patients operated on during the period 6 months. The scheme of ANH with the administration of aprotinin was applied in the second half-year period. A statistically significant reduction in the percentage of patients who required blood transfusions was observed (77.2%/53%). The scheme applied enabled to reduce procedure costs in regard to blood preparation purchase. The results have shown that ANH together with antifibrinolytic drug administration is not only an efficient but also profitable strategy of blood saving.