Percutaneous angioplasty of chronically occluded coronary arteries: long-term clinical follow-up.

BACKGROUND: Percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) is one of the most demanding procedures in interventional cardiology. In spite of growing experience and technological progress, efficacy of PCI of CTO remains lower than that of standard PCI. AIM: To evaluate long-term clinical results of PCI in patients with stable angina and CTO. METHODS: The study involved 459 consecutive patients who underwent the procedure of CTO recanalisation between 1996 and 2003. All procedures were performed using the standard technique. Follow-up examination was carried out based on a written questionnaire, and the mean follow-up period was 30+/-18 months. RESULTS: The average success rate of intervention was 64.9% and 63.8% of patients underwent successful and uneventful procedures. Clinically significant in-hospital complications were noted in 8 (1.6%) patients including 1 (0.2%) death, 2 (0.4%) cases of myocardial infarction and 4 (1.0%) repeated revascularisations. Long-term survival following either successful or failed recanalisation was similar (97.5% vs 97.3%, NS) as was incidence of acute coronary syndromes (12.5% vs 12.1%, respectively; NS). Patients after successful recanalisation less frequently underwent surgical revascularisation (3.6% vs 8.1%, respectively; p <0.05) and also suffered less frequently from angina (CCS 0/CCS I: 20.4% vs 12.1%, p <0.00005). Otherwise, they were at higher risk of repeated PCI due to restenosis (13.2% vs 6.7%, respectively; p <0.05). CONCLUSIONS: Success rate of PCI in patients with chronically occluded coronary arteries and stable angina is moderately high with relatively low incidence of complications. Late benefits from successful recanalisation of coronary artery depend predominantly on improved coronary reserve and decreased need for surgical myocardial revascularisation. Successful recanalisation does not reduce the risk of death or myocardial infarction but is associated with higher frequency of repeated PCI due to restenosis.

Percutaneous transluminal coronary angioplasty for chronic total coronary occlusion in patients with stable angina. Relationship between lesion anatomy, procedure technique and efficacy.

BACKGROUND: In spite of continuing progress in percutaneous coronary interventions (PCI), recanalisation of chronic total coronary occlusion (CTO) still remains a challenge for invasive cardiologists. AIM: To analyse the results of PCI of CTO and to assess the relationship between lesion anatomy, procedural technique and efficacy of PCI in patients with stable angina. METHODS: The study group consisted of 460 consecutive patients (81% males, age 25-80 years, 68% with a history of myocardial infarction [MI]), who underwent CTO recanalisation in our institution between 1996 and 2003. Duration of CTO ranged between 1 and 3 months in 5.9% of patients, 3-6 months -- in 12.4%, more than 6 months -- in 51.7% and was undefined in 30% of patients. RESULTS: The overall average success rate was 65%; it increased from 60% in 1996 to 75% in 2003. The most frequent (92%) cause of failure was the inability to pass a guide wire through the occlusion. The use of soft or standard guide wire was associated with a 68.7% success rate. In those in whom standard methods failed, the use of special guide wire was associated with the efficacy of 61.2%, and the Magnum system -- of 28.6%. Stents were implanted in 34.5% of patients (from none in 1996 to 55% in 2003). Serious peri-procedural complications included one death (0.2%), MI in one (0.2%) patient, repeated urgent PCI in 5 (1.1%) patients, urgent CABG in one (0.2%) patient, perforation of coronary artery requiring pericardiocentesis in one (0.2%) patient, and complications at the site of artery puncture in 14 (3%) patients. Univariate analysis showed that longer duration of occlusion, TIMI flow grade 0, lengthy occlusion, abrupt vessel stump, small vessel diameter, presence of bridge collaterals, branching off at the site of occlusion, and massive calcifications were the factors adversely affecting the outcome. Multivariate analysis revealed that tapered end of the stump, lack of calcifications and TIMI flow grade 1 were the factors independently associated with a favourable outcome. CONCLUSIONS: The overall average efficacy of PCI of CTO is 75% and the risk of peri-procedural complications is low (1.7%). Clinical factors and the anatomy of lesion should be taken into account when planning the procedure. Special guide wires designed for recanalisation of CTO are effective in more than half of patients in whom standard guide wires failed.

Increasing level of prostate-specific antigen and prostate cancer risk factors among 193 men examined in screening procedure.

Prostate cancer is one of the most common cancers in men, therefore has become recently an essential problem of public health. The factors influencing cancer include: androgens metabolism disorders, diabetes mellitus, overweight and obesity, smoking, alcohol and black coffee intake, diet rich in saturated fats and poor in unsaturated, lack of physical activity, geographical zone, race, such carcinogenic substances as: cadmium, materials used in rubber, painting, printing, ship industry etc., contagious factors and also older age and a positive family history of the disease. To diagnose prostate cancer in its early stage such screening procedures as physical examination--digital rectal exam (DRE) and determination of prostate-specific antigen (PSA) level in blood serum are used. The aim of the study was to assess prostate cancer risk factors occurrence in the examined 193 men, aged 50-70 years, who reported to urology outpatient department at Clinical Hospital in Lublin, measure the PSA level in blood serum and examine the correlation between them. Respondents filled in a questionnaire about the presence of prostate cancer risk factors and urogenital symptoms. The questionnaire was completed with DRE and PSA measurement. The results led us to the following conclusions: 1/ in the studied population elevated PSA level is determined in 3.1% of 193 examined men, 2/ increased PSA occurs mainly in men from rural areas, with elementary education, divorced, older (>60 years), using fat-rich diet, smokers, black coffee drinkers, with overweight or obesity and non diabetic, 3/ a combination of PSA test with DRE seems to be useful and rather cheap for the detection of prostate cancer in the early stage of its development.

Health behavior among patients with type 1 and 2 diabetes mellitus as reported from a regional diabetic outpatient department.

The cost of management of diabetes mellitus in Poland, which has become a very common disease recently, is estimated at over 1 milliard zloty a year. Therefore, it is necessary to increase the effectiveness of prevention and treatment of DM and its complications both by using improved methods and the promotion of positive health behaviours such as physical activity, rational diet, and reduction of harmful ones such as smoking, in diabetic patients. The aim of the study was to assess positive and negative health behaviours and the presence of diabetes mellitus complications in type 1 and 2 DM patients of provincial diabetic outpatient department. The study included 53 DM patients who reported to diabetic outpatient department in Biala Podlaska. The participants filled in a questionnaire consisting of some questions applying to the type of DM and a way of treatment, frequency of plasma glucose measurement, medical check-ups, DM complications, coexistent diseases, family history of DM and health behaviours (physical activity, appropriate diet, smoking etc.). The results allowed to draw the following conclusions: 1. the majority of diabetic patients of the studied population lead a fairly healthy life-style: they are physically active, use a suitable diabetic diet, do not smoke, regularly control weight, plasma glucose concentration and blood pressure, declare systematical ophthalmologist control and they take special care about their feet; 2. type 1 diabetic patients are more careful about DM management than type 2 diabetic subjects.

Benign prostatic hyperplasia, prostate cancer and other prostate diseases diagnosed as a result of screening procedure among 1,004 men in the Lublin district.

Urological problems especially connected with prostate diseases appear in older men: prostatitis, benign prostatic hyperplasia, prostate cancer and others. Prostate cancer is the most common cancer in men and the second leading cause of deaths in male population. Therefore, it seems important to early detect prostate cancer in general practice setting due to screening procedures such as digital rectal exam and prostate-specific-antigen test. The aim of the study was to examine the character of diagnoses of a prostate disease among 1,004 men of the Lublin district who reported to a doctor during screening procedure carried out in urology outpatient clinic at Clinical Hospital in Lublin in the year 2000. After physical examination urologists initially diagnosed a prostate disease and sent men suspected to have a prostate cancer to further investigations. There was studied age and place of living. Benign prostate hyperplasia was the most common diagnosis made in 77.1% of subjects. It occurred most often in men aged 51-70 years. Prostate cancer was suspected in 3.5% of subjects. Frequency of benign prostate hyperplasia and prostate cancer suspicion increased with age. On the basis of studies screening procedures seem beneficial in the early detection of prostate cancer in men over 50.