Correlation of patient maximum skin doses in cardiac procedures with various dose indicators.

In most countries of European Union, legislation requires the determination of the total skin dose received by patients during interventional procedures in order to prevent deterministic damages. Various dose indicators like dose-area product (DAP), cumulative dose (CD) and entrance dose at the patient plane (EFD) are used for patient dosimetry purposes in clinical practice. This study aimed at relating those dose indicators with doses ascribed to the most irradiated areas of the patient skin usually expressed in terms of local maximal skin dose (MSD). The study was performed in two different facilities for two most common cardiac procedures coronary angiography (CA) and percutaneous coronary interventions (PCI). For CA procedures, the registered values of fluoroscopy time, total DAP and MSD were in the range (0.7-27.3) min, (16-317) Gy cm(2) and (43-1507) mGy, respectively, and for interventions, accordingly (2.1-43.6) min, (17-425) Gy cm(2), (71-1555) mGy. Moreover, for CA procedures, CD and EFD were in the ranges (295-4689) mGy and (121-1768) mGy and for PCI (267-6524) mGy and (68-2279) mGy, respectively. No general and satisfactory correlation was found for safe estimation of MSD. However, results show that the best dose indicator which might serve for rough, preliminary estimation is DAP value. In the study, the appropriate trigger levels were proposed for both facilities.

Right ventricular outflow tract obstruction by cardiac metastasis as the first manifestation of follicular thyroid carcinoma.

A 40-year-old man was sent to the echocardiographic laboratory because of a heart murmur. An intracardiac mass, causing obstruction of flow within right ventricle, was diagnosed and the patient was referred to surgery. Histologic examination classified the mass as a metastasis of highly differentiated follicular carcinoma of the thyroid gland. Thyroidectomy was performed and radioiodine treatment instituted. Thus echocardiographic identification of right ventricular outflow obstructing mass was the initial presentation of follicular carcinoma of the thyroid gland. Early detection of this moderately disseminated malignancy allowed for surgical excision and systemic radioactive iodine treatment.

[Hypoglycemic coma in chronic alcoholism]. / Spiaczka hipoglikemiczna w przebiegu przewleklego alkoholizmu.

The authors present two cases of chronic alcoholism in two female patients aged 41 and 52 years without diabetes mellitus, in whom hypoglycaemic coma occurred during the abstinence period. Hypoglycaemia in one patient occurred suddenly as a result of fasting within 24 hours following the last alcohol intake, whereas a severe hypoglycaemia in the second patient was developing progressively during 72 hours; patient did not eat much and the last meal took 24 hours before the onset of hypoglycaemic coma. Diagnosis of hypoglycaemic coma was suspected because as no alcohol or acetic acid smell were felt, no alcohol or methanol was detected in blood (tested only in one patient). Adrenergic reactions were not distinct (no excessive sweating, convulsions, tachycardia). The authors suggest, that a severe hypoglycaemia should be considered in patients suspected of alcoholism, and the treatment should start earlier with intravenous glucose administration.

[Hydrothorax as a major symptom of decompensated liver cirrhosis]. / Plyn przesiekowy w oplucnej jako dominujacy objaw niewyrównanej marskosci watroby.

A case of a 54-year patient with decompensated liver cirrhosis is presented. As a major symptom rapidly increasing hydrothorax on the right side without marked ascites was observed. Diagnosing and simultaneously establishing etiology of hydrothorax on the base of clinical and laboratory findings was a difficult process. Imaging tests did not show any signs of splenomegaly.

[Analysis of risk factors for coronary disease in women with their first acute myocardial infarction]. / Analiza czynników zagrozenia choroba niedokrwienna serca u kobiet z pierwszym zawalem miesnia sercowego.

Based on the analysis of the results of the investigation performed in 92 women hospitalized between 1989 and 1992 with the first acute myocardial infarction (AMI), frequency of coronary artery disease (CAD) risk factors was assessed with attention to the patient's age. It was proved that in women under 44 yrs the most common factors are: cigarette smoking, family history of CAD or myocardial infarction (MI), decreased levels of HDL-cholesterol and hypertriglyceridemia. In older age there are: hypercholesterolemia, decreased levels of HDL-cholesterol, hypertriglyceridemia, arterial hypertension, obesity and diabetes mellitus. Furthermore, some differences in the frequency of CAD risk factors between the both sexes were noted. In women under 44 yrs cigarette smoking, significant family history, decreased levels of HDL-cholesterol and hypertriglyceridemia occurred more often than in men. In women above 56 yrs we found significantly higher levels of total cholesterol and triglycerides, lower levels of HDL-cholesterol, higher frequency of hypertension, diabetes and obesity, compared to men.

Coronary anomalies diagnosed with transesophageal echocardiography: complementary clinical value in adults.

INTRODUCTION: Coronary arteriography remains a gold standard for the evaluation of coronary anatomy. In the case of anatomical anomalies, understanding of vessel course based upon a coronary angiogram may be difficult. Transesophageal echocardiography is a noninvasive method allowing tomographic visualization of proximal coronary arteries. Experience concerning its usefulness for the assessment of anomalous coronary arteries is limited. MATERIAL: Eleven patients with confirmed coronary anomalies studied between 1993-96 were identified in the cohort of those undergoing transesophageal echocardiography. RESULTS: Transesophageal echocardiography revealed potentially serious anomalies (origin of left or right coronary artery from contralateral aortic sinus) in 3 patients and benign in 8. Coronary ostia and proximal course could be delineated in all patients. Anatomical information was consistent between methods, except for a separate origin of the left anterior descending and circumflex artery, where the angiogram missed a very short common left main coronary artery in 2 patients. The relationship between the coronary arteries, aorta and pulmonary trunk was better defined by the echocardiogram. Doppler flow analysis allowed us to exclude anomaly-related flow disturbances. CONCLUSIONS: Transesophageal echocardiography can be considered as a noninvasive technique with the potential for anatomical and functional evaluation of anomalous proximal coronary arteries and deserves a routine use whenever such a condition is suspected. This approach may simplify invasive procedures in this patient group.