Should information about sexual health be included in education directed toward men with cardiovascular diseases?

BACKGROUND: Modifiable risk factors contribute to the pathogenesis of cardiovascular disease (CVD) and erectile dysfunction (ED). We aimed to compare the knowledge about the contribution of modifiable risk factors to the pathogenesis of CVD and ED. The impact of patients' having modifiable risk factors on the awareness of their negative influence on the development of CVD and ED was examined. METHODS: To this multicenter cohort study, we included 417 patients with CHD who had been hospitalized in the cardiology or cardiac surgery department during the previous six weeks and underwent cardiac rehabilitation in one of the five centers. Knowledge about modifiable risk factors was collected. ED was assessed by an abridged IIEF-5 questionnaire. Comparisons between groups were conducted using the Student's t-test, Mann-Whitney U test, and Kruskal-Wallis test. Relationships were analyzed with Spearman's rank correlation coefficient. RESULTS: The mean number of correctly identified risk factors for CVD was significantly higher than those for ED (3.71 ± 1.87 vs. 2.00 ± 1.94; p < .0001). Smoking was the most recognized risk factor both for CVD and ED. Dyslipidemia was least frequently identified as a risk factor for CVD. Sedentary lifestyle was the only risk factor whose incidence did not affect the level of patient knowledge. CONCLUSIONS: Cardiac patients with ED know more about risk factors for CVD than ED. It is necessary to include information about the negative impact of modifiable risk factors on sexual health into education programs promoting healthy lifestyles in men with cardiovascular diseases.

Heart ventricular activation in VAT difference maps from children with chronic kidney disease.

Children with chronic kidney disease (CKD) are affected by cardiovascular complications, including disturbances in the intraventricular conduction system. Body surface potential mapping (BSPM) is a non-invasive method of assessing the cardioelectrical field. Our aim was to investigate conduction disturbances in young CKD patients using ventricular activation time (VAT) maps. Our study comprised 22 CKD children (mean age: 13.1 ± 2.5 years) treated conservatively and 29 control patients. For each child 12-lead electrocardiogram (ECG) readings were taken, and blood pressure and serum concentrations of iPTH, Pi, t-Ca, creatinine, Fe(+3), ferritin, and Hb, as well as eGFR were measured. All children underwent registration in the 87-lead BSPM system, and group-mean VAT maps and a difference map, which presents statistically significant differences between the groups, were created. The VAT map distribution in CKD patients revealed abnormalities specific to left anterior fascicle block. The difference map displays the areas of intergroup VAT changes, which are of discriminative value in detecting intraventricular conduction disturbances. Intraventricular conduction impairments in the left bundle branch may occur in children with CKD. BSPM enables conduction disturbances in CKD children to be detected earlier than using 12-lead ECG. The difference map derived from the group-mean isochrone maps precisely localizes the sites of disturbed conduction in the heart intraventricular conduction system.

Effect of kidney transplantation on heart conduction disturbances in children treated with chronic hemodialysis--a pilot study.

Aim of the study was to assess the effect of KT on heart conduction in HD children. Non-invasive electrocardiographic method of BSPM was used. Isochrone maps, presenting a VAT distribution, were taken from eight HD patients and 26 normal subjects. Patients were divided into two groups: I--three children were HD <12 months prior to KT; II--five children were HD >12 months prior to KT. After KT, the groups were marked as IP and IIP. Serum iPTH and phosphate levels were significantly higher in both HD groups than in controls, with a considerable normalization after transplantation. HD patients demonstrated neither conduction abnormalities on ECG nor left ventricular hypertrophy. Group-mean VAT maps revealed: I and II--similar patterns of complete LBBB; IP--partial normalization to a pattern of anterior fascicle block; IIP--preserved pattern of LBBB. Intraventricular conduction disturbances found in HD children using BSPM were alleviated by KT. Short HD therapy increases a chance of conduction disturbances regression after KT, contrary to the longer HD treatment. BSPM is more sensitive than standard ECG in detecting heart conduction impairments in the HD patients.

Brain-stem auditory evoked potentials in children and adolescents with anorexia nervosa.

OBJECTIVE: In the course of anorexia nervosa (AN), the central nervous system (CNS) undergoes both anatomic and functional changes that may cause disturbances of stimulation transmission in the sensory areas of CNS. Method of brain-stem auditory evoked potentials (BAEPs) was used in the children with AN to test the auditory pathway transmission. MATERIALS AND METHODS: The study included 37 children and adolescents, aged 10-18 years, with clinically diagnosed AN. BAEPs were recorded after a click stimulation of 75 dB intensity. Then, wave I latency (response from the auditory nerve) and inter-peak latency I-V (IPL I-V; response from the brain-stem) were analyzed. RESULTS: Abnormalities of the BAEPs recordings were noted total in 32.4% of the study patients. Predominantly (in 24.3%), a decreased transmission within the brain-stem, expressed as the IPL I-V prolongation, was observed. It was also found that the percentage of the abnormal BAEPs results and the degree of IPL I-V prolongation were increasing together with enhancing AN severity. CONCLUSIONS: IPL I-V prolongation observed in the AN children reflects a disturbed neural transmission in the brain-stem section of the auditory pathway and can be ascribed to impairments in the nerves myelin sheath.

Diagnosis of hypogonadism in patients treated with low energy shock wave therapy for erectile dysfunction: a narrative review.

Several methods of treatment of erectile dysfunction (ED) are offered with low energy shock-wave therapy (LESWT) gaining increasing attention. Reports have documented that LESWT stimulates tissue neovascularization, proliferation and differentiation of endothelial cells, and production of nitric oxide - all can improve the condition of erectile tissue. However, the overall and sexual condition of men deteriorates with age which is linked with a constant decrease in testosterone concentration. A higher risk of sexual health disorders and reduced physical fitness correlates with a testosterone concentration of <12 nmol/L. Such patients may require testosterone replacement therapy. We conducted a target literature review to investigate whether testosterone concentration is taken into account in studies on the use of LESWT in the treatment of ED. We found that most studies did not provide any information on testosterone status. Only 8 of 25 studies examined showed values of testosterone concentrations. Only one of these analyses checked the relationship between the efficacy of LESWT and testosterone concentration. As a result, meta-analyses published to date may not show the full value of LESWT in the treatment of ED. We conclude that in the light of the significant role testosterone plays in the process of an erection and the mechanism of LESWT action, it can be recommended to examine testosterone concentration and to diagnose hypogonadism during the qualification of patients to studies on LESWT efficacy. Moreover, the effectiveness of LESWT in relation to the current testosterone concentration should also be further investigated.

Sexual health in Polish elderly men with coronary artery disease: importance, expectations, and reality.

Deterioration in overall health, hormonal disturbances, and erectile dysfunction (ED) contributes to limitations in sexual activity in the elderly, which is further limited by incorrect beliefs about the hazards of sexual activity in cardiac patients. We aimed to analyze the occurrence of ED in elderly men, their perception of the relevance of good sexual function, and their expectations of physicians. A cross-sectional study encompassed 731 patients with coronary artery disease (CAD) subjected to cardiac rehabilitation. Demographic data and data on modifiable risk factors and patient expectations were collected. ED was assessed using the IIEF-5 questionnaire. Relationships among the risk factors for ED, occurrence of ED, and patient expectations, as well as the changes in the indicators between 2012 and 2016, were analyzed. The mean age of men was 70.7 ± 5.1 years. The prevalence of ED was 93.0%. The IIEF-5 score was significantly associated with age, tobacco smoking, exercise tolerance, time to diagnosis of CAD, and treatment with calcium channel blockers and diuretics. Patients declared that sexual activity was overall important (47.9%) or very important (25.6%). Three hundred and sixty (49.3%) patients expected their physician to show interest in their sexual health, but the topic was addressed in only 12.5%. Over the past few years, we have observed an increase in the awareness and importance of sexual health as well as a significant increase in patients' expectations of physicians to show interest in their sexual health. Patients' expectations of discussing and receiving treatment for ED remain an unmet medical need.

Electrocardiographic evaluation in patients with systemic scleroderma and without clinically evident heart disease.

BACKGROUND: In patients with systemic scleroderma (SSc), clinically evident cardiac involvement is recognized to be a poor prognostic factor. The aim of the study was to evaluate electrocardiographic changes, parameters of heart rate variability (HRV), and heart rate turbulence (HRT) in patients with SSc without evident symptoms of heart disease. METHODS: A group of 27 patients with SSc were subjected to standard electrocardiography (ECG) examination and 24-hour Holter monitoring. Analysis of HRV in time and frequency domains, HRT, and echocardiography were also performed. RESULTS: Holter monitoring revealed a larger number of premature supraventricular contractions (PSVCs), as well as premature ventricular contractions (PVCs) in the patients with systemic scleroderma, as compared with the control group. Moreover, the SSc patients showed decreased parameters of time and frequency domains, as referred to the controls, especially during night hours. In four patients, abnormal HRT values were present. On echocardiography, only slight changes were found, however in five patients left ventricle diastolic dysfunction was diagnosed. CONCLUSIONS: The noninvasive electrocardiographic methods seems to be useful for detecting early heart involvement in course of SSc and could be recommended for routine used in clinical practice. Significance of HRT analysis in patients with SSc needs further elucidation.

Usefulness of body surface potential mapping for early identification of the intraventricular conduction disorders in young patients with chronic kidney disease.

BACKGROUND: Cardiovascular complications are considered a significant problem in patients with chronic kidney disease (CKD). Body surface potential mapping (BSPM) is a noninvasive method that is useful in detecting early changes involving the heart. The aim of the study was to evaluate possible abnormalities within the cardiac intraventricular conduction system in young patients with CKD using the BSPM method. METHODS: Based on the BSPM registrations, the QRS-T isointegral maps were created in 42 young patients with CKD (on hemodialysis, subgroup Ia; on peritoneal dialysis, subgroup Ib; on conservative treatment, group II) and in 26 healthy subjects. Serum levels of electrolytes, urea, and creatinine were also assessed in the entire study population. RESULTS: In the healthy subjects, the maximums of the group mean QRS-T isointegral map were located in the left lower anterior part of the thorax, whereas in the Ia patients, the maximums were focused at the medial sternum line. The QRS-T maps, both for Ib and II groups, showed the positive integrals covering the left part of the anterior thorax. In all the patients with CKD, standard 12-lead electrocardiogram (ECG) and echocardiography findings were within the reference range. CONCLUSIONS: In the hemodialyzed patients with CKD, the group-mean QRS-T isointegral map distribution suggested a significant delay of excitation propagation in the left bundle branch, although no abnormalities were found with standard ECG. In the patients with CKD treated with peritoneal dialysis or conservatively, the group-mean QRS-T isointegral maps were characteristic for the early phase of conduction disturbances within the left bundle branch, which again was not observed on the standard ECG recordings.

[The influence of hemodialysis on heart's intraventricular conduction system--pilot study]. / Wplyw zabiegu hemodializy na uklad bodzco-przewodzacy serca u dzieci i mlodziezy--badanie pilotazowe.

UNLABELLED: The highest percent of cardiac muscle damages is written down in children which are exposed to hemodialysis. In this group the heart examinations using body surface heart potential mapping (BSPM) method have been carried out. The aim of the study was to assess the influence of hemodialysis on heart's electrodynamics in children and adolescent during replacement therapy. MATERIAL AND METHODS: Multielectrode recording have been done in every kid before and after hemodialysis. For every record it was created isopotential map. By the comparing our maps with model maps for healthy children it was affirmed that in greater part of studied examples of hemodialysed children there are present early changes indicating conducting disturbances in left bundle of fasciculus atrioventricularis (His) and initial stage of left ventricular hypertrophy (LVH). That changes haven't been confirmed in classic ECG, which suggests that the disturbances in excitation conductance observed on isointegral maps are far beyond the area detected by 12-electrode classic ECG recording. RESULTS: The maps made before dialysis are characterised by large, unsymmetrical isopotential lines changes over the left and right ventricle. After carried out of hemodialysis the image of ECG records was improving. In all of cases the isoline distribution in sternal and anterior lower left part of chest comes back to norm. Changes are visible merely over the left ventricle and in anterior upper right part of chest what is connected with just stabilised conducting disturbances in the left branch of His bundle, left bundle of fasciculus atrioventricularis (His bundle). CONCLUSIONS: 1. In children who are treated by repeated hemodialysis approach to disturbances in the cardiac intraventricular conduction system. 2. Those disturbances are improved by a singular hemodialysis. 3. BSPM method detects earlier changes in the cardiac intraventricular conduction system than the classical ECG.

Relation of Postexercise Reduction of Arterial Blood Pressure and Erectile Dysfunction in Patients with Coronary Heart Disease.

Penile erection is a hemodynamic process consisting of 2 synchronized components in which the first (active) requires proper vascular endothelium functioning, whereas the second one (passive) is based on a veno-occlusive mechanism. Antihypertensive treatment reduces the passive component, often leading to the development of erectile dysfunction (ED), but lifestyle modifications can improve the sexual functioning. The study aimed to evaluate the association between blood pressure (BP) reduction caused by cardiovascular training and the intensity of ED in men with coronary heart disease. A total of 101 men (mean age 59.50 ± 7.93) with ED treated invasively for coronary heart disease and subjected to cardiac rehabilitation were enrolled. Patient characteristics, the International Index of Erectile Function 5 (IIEF-5) questionnaire (IIEF-5), and BP values were collected at baseline and after 6 months of cardiac rehabilitation and were analyzed. Cardiac rehabilitation led to a significant reduction of 5.08 mm Hg in systolic BP (p <0.001) and of 1.60 mm Hg in diastolic BP (p <0.001). The IIEF-5 score (EQ) significantly increased (median 15, interquartile range 11 to 19 vs median 18, interquartile range 12 to 21, p <0.001). Greater improvement in sexual performance was significantly negatively correlated with age, concentration of triglycerides, and high-density lipoprotein, whereas it was positively correlated with the presence of diabetes and baseline IIEF-5 score. After excluding patients with diabetes, a greater decrease in systolic BP was found to be significantly associated with greater improvement in erectile performance. In conclusion, a reduction of arterial BP caused by cardiac training is accompanied by improvement in erectile performance. This effect is the strongest in patients with hypertension and those with dyslipidemia.

[The value of the cytocins and the solubility of theirs receptors in the serum of the patients with the cervical cancer]. / Wartosc oznaczania wybranych cytokin i ich rozpuszczalnych receptorów w surowicy chorych na raka szyjki macicy.

The study encompassed 146 women with recognized invasive cervical cancer in 4 clinical stages. Patients underwent therapy in Oncologic Gynaecology Department of Wroclaw Medical University in 2001 and 2002 years. The correlation between pretreatment serum level of proangiogenic and inflammation factors--VEGF, sTNF-R1, IL-6 and clinical stage or early effects of therapy were observed. The strong and statistically significant relationship between pretreatment serum level of IL-6 and sTNF-R1 and clinical stage with early effect of treatment were found. The statistically significant correlation between serum level of all investigated parameters and clinical stage of cervix cancer was noticed. VEGF wasn't an independent prognostic factor in the study, but the prognostic value of IL-6 was demonstrated.

[Age and effects of long-term cardiac training in patients with ischemic heart disease]. / Wiek a efekty dlugoterminowego treningu kardiologicznego u pacjentów z choroba niedokrwienna serca.

UNLABELLED: Ongoing with age decline of physical capacity reflects permanent processes of aging occurring in organism. It leads to a successive reduction of physical activity level, resulting with time in restrictions of independent life ability, which then causes anxiety and progressing social isolation. THE AIM: Evaluation of relation between age and effort tolerance in patients with chronic ischemic heart disease and comparison of cardiac rehabilitation effects in two patient groups at significantly various age. MATERIAL AND METHOD: The study comprised 103 patients (69 males and 34 females) at the mean age of 61.2 +/- 0,8 years. The patients were referred to rehabilitation because of undergone invasive treatment of IHD, using CABG (44 pts) and PTCA (48 pts), or acute coronary syndromes (11 pts). The study group was divided to the two subgroups, "A" and "B", differing significantly (p < 0.01) from each other by age. "A" group was constituted by 30 the youngest patients, with the mean age of 51.6 +/- 0.5 yrs, whereas "B" group comprised 30 the oldest patients, with the mean age of 70.9 +/- 0.6 yrs. The examined groups were comparable as to the drug treatment, clinical status, echocardiographic parameters and BMI values. During the observation period no changes in treatment and diet were made. The all patients were subjected to six-month cardiac rehabilitation, consisting of cycle ergometer training (3 times/week) and generally improving exercises (2 times/week). The parameters analyzed were the values of metabolic equivalent (MET) obtained at the initial and the final exercise treadmill test, likewise the delta of MET. RESULTS: For a population of 103 patients with IHD, the negative, statistically significant correlation Pearson's coefficient between age and MET values of initial and final exercise tests and insignificant Pearson's coefficient between age and values of MET delta were obtained. Comparison analysis of the mean MET of initial and final exercise test and the mean MET delta did not show any significant differences between the both examined "A" (young) and "B" (old) groups. CONCLUSIONS: In the examined patients with IHD, there were observed a negative, significant correlation between age and effort tolerance before and after the cardiac rehabilitation cycle, and a lack of significant correlation between age and delta of effort tolerance. There was found no considerable difference concerning a delta of effort tolerance between the patients with IHD falling into the young and the old groups.

Low-energy Shock Wave Therapy-A Novel Treatment Option for Erectile Dysfunction in Men With Cardiovascular Disease.

Patients with cardiovascular disease (CVD) are prone to developing erectile dysfunction (ED) owing to the common risk factors and pathogenesis underlying ED and CVD. As a result, ED affects nearly 80% of male patients with CVD. The efficacy of phosphodiesterase type 5 inhibitors, vacuum erection devices, or intracavernosal injection of vasodilating agents is well established in the treatment of ED; however, their use is limited. Low-energy shock wave therapy is a novel modality that may become a causative treatment for ED. This review aims to assess the efficacy and safety of low-energy shock wave therapy in the treatment of ED in men with CVD.

Sexual health of male cardiac patients - present status and expectations of patients with coronary heart disease.

INTRODUCTION: Due to the pathogenetic association between erectile disorders and cardiovascular diseases, cardiologists consult many patients with erectile dysfunction (ED). The aim of the study was to evaluate sexual function in patients with coronary heart disease (CHD) and the use of sexual knowledge in cardiology practice, both current use and that expected by patients. MATERIAL AND METHODS: One thousand one hundred and thirty-six patients (average age: 60.73 ±9.20) underwent a dedicated survey which encompassed demographic data and the presence of modifiable ED risk factors. The presence of ED was assessed using the International Index of Erectile Function (IIEF-5) Questionnaire. RESULTS: Sexual problems were discussed by cardiologists with 45 (3.96%) patients. The frequency of initiating the topic was significantly associated with the respondents' education level (p = 0.0031); however, it was not associated with the patients' age, duration of CHD, presence of ED, or modifiable risk factors. Four hundred and sixteen (36.62%) respondents indicated that they expect their cardiologist to take an interest in their ED. Nine hundred and twenty-six (81.51%) patients claimed good sexual function to be important or very important to them. Attitude to sexual function was significantly associated with age (p < 0.0001), duration of CHD (p = 0.0018), education (p = 0.0011), presence of ED (p = 0.0041), diabetes (p = 0.0283) and hyperlipidaemia (p = 0.0014). CONCLUSIONS: The low frequency with which cardiologists initiate the topic of ED is in contrast to the expectations of patients with CHD. The majority of these patients regard good sexual maintenance as an important part of their life.

Heart rate recovery, cardiac rehabilitation and erectile dysfunction in males with ischaemic heart disease.

OBJECTIVE: Heart rate recovery (HRR) is a recognised marker used in clinical practice for assessing the risk of sudden cardiac death. Physical exercise leads to an improvement in HRR and has a proven beneficial effect on erection quality (EQ) related to the activity of the autonomic nervous system in men with ischaemic heart disease (IHD). This paper evaluates the relationship between HRR and EQ in patients with IHD and erectile dysfunction (ED) who underwent cardiac rehabilitation. METHODS: The main analysis was based on the Mann-Whitney U test, Wilcoxon signed-rank test, Spearman correlation coefficient, Pearson's chi-square test, chi-square test, with the Yates correction and (if possible) parametric tests were used. This prospective, non-randomised intervention study included 124 men with IHD and ED [International Index of Erectile Function (IIEF-5) scores of ≤21]. Of these, 89 patients underwent a 6-month cardiac rehabilitation phase III programme, whereas 35 did not. The results of the participants' total IIEF-5 scores and their HRR, demographic and clinical data were analysed. RESULTS: The results of the 89 rehabilitated patients (mean age: 60.44±9.29 years) and 35 controls (mean age: 61.43±8.81 years) were analysed. In the rehabilitated patients, the mean baseline IIEF-5 score was 13.15±5.76 (95% CI: 11.93-14.36) and HRR was 16.49±7.68/min (95% CI: 14.88-18.11). After cardiac rehabilitation, the parameters of ED and HRR improved significantly and were significantly higher than those of the controls; the mean IIEF-5 score of the rehabilitated group increased to 15.36±6.51 (95% CI: 13.99-16.73), while HRR increased to 21.40±7.25/min (95% CI: 19.88-22.93). A significant correlation was found between ∆HRR and ∆EQ (r=0.409791) as a result of the 6-month cardiac training programme. CONCLUSION: Cardiac rehabilitation assessed by HRR has a sizable effect on autonomic balance in patients with IHD and ED, which plays a significant role in the mechanism of erection improvement.

Cardiovascular Risk Factors Among Lower Silesian Students of the Faculty of Medicine: Knowledge and Distribution.

BACKGROUND: Cardiovascular disease is a major contributor to the global burden of disease. Further reduction of cardiovascular mortality will require multidirectional prevention. Popularizing prevention measures requires the involvement of qualified and well-educated personnel. Before any modifications of educational programs it is necessary to assess the level of knowledge of future physicians. OBJECTIVES: The aim of the study was to evaluate medical students' knowledge of cardiovascular (CV) risk factors. The paper presents the outcomes of a study investigating the knowledge of CV risk factors and the prevalence of those risk factors in the study population. MATERIAL AND METHODS: The study was conducted between 2007 and 2012 and the study population was comprised of 1406 students (497 men and 909 women) from South and South Western Poland. A survey designed by the authors, based on the Framingham survey, was used for the interviews. RESULTS: The students correctly identified 4.38 ± 0.91 CV risk factors. The most frequently listed risk factors for cardiovascular diseases were a lack of physical activity and a fat-rich diet. The study participants who identified CV risk factors more or less accurately do not follow the recommendations aimed at prevention. Awareness, even relatively high awareness, does not correlate with a healthy lifestyle. Extreme examples of this are people who are aware of the negative effects of cigarette smoking but continue to smoke. CONCLUSIONS: The study revealed an insufficient level of awareness of CV risk factors among medical students.

Laparoscopic pyeloplasty with cephalad translocation of the crossing vessel - a new approach to the Hellström technique.

INTRODUCTION: It is believed that lower pole crossing vessels may play an important role in the etiology of ureteropelvic junction obstruction (UPJO). A conventional operative technique, which seems to be widely used in patients with UPJO, is Anderson-Hynes (A-H) plasty with dorsal transposition of the vessel. An attractive alternative to dorsal transposition of the vessel might be its cephalad translocation. AIM: To assess the effectiveness of cephalad translocation of the crossing vessel in patients who underwent laparoscopic A-H or Y-V pyeloplasty. MATERIAL AND METHODS: Eighty-five patients were included in the study. To assess the effectiveness of cephalad translocation of the crossing vessel in patients who underwent laparoscopic pyeloplasty, the results of the procedure were compared to the results of laparoscopic pyeloplasties performed in patients without crossing vessels (control group). Success was defined as the following factors taken collectively: 80% or greater pain relief according to VAS, no sign of obstruction on intravenous urography (patent UPJ), decreasing excretion curve with T1/2 < 12 min, and improved or stable differential renal function on diuretic renography. RESULTS: The mean follow-up was 53.7 months. There was no statistically significant difference in the success rate between the compared groups (group 1 - cases with cephalad translocation of the crossing artery, and group 2 - cases without crossing vessels) in patients who underwent A-H plasty or Y-V plasty. CONCLUSIONS: The analysis of our data seems to indicate that cephalad translocation of the anterior crossing vessel gives good therapeutic results in patients who undergo laparoscopic pyeloplasty.

Comparison of Endovascular Aneurysm Repair with Open Repair in Patients with Abdominal Aortic Aneurysm in Our Own Material in Years 2002-2011.

BACKGROUND: Endovascular abdominal aortic aneurysm repair has become an alternative to open surgical repair of abdominal aortic aneurysm since the early 1990s. The conventional method remains the gold standard in the treatment of Abdominal Aortic Aneurysm (AAA); however, a large percentage of patients do not qualify for this treatment due to the high risk of perioperational death and complications. OBJECTIVES: The objective of this work was to compare AAA surgeries performed by both classical and endovascular methods in years 2002-2011. MATERIAL AND METHODS: Medical documentation of elective AAA patients undergoing surgical treatment was retrospectively analyzed on the basis of archive- and computer database data. The analysis included the patients' demographics, internal disease burden, as well as causes of deaths and complications within 30 days after the procedure and 1 year follow-up. RESULTS: Thirty-day and 1-year mortality rates in patients treated in the elective setting were 1.5% and 8.7% for endovascular method and 4.0% and 15.7% for the open method. The comparison of mortality rates in 115 high-risk patients undergoing elective OR treatment with 275 high-risk treatment patients undergoing EVAR surgery (7.8% vs. 1.5%, 8.7% vs. 15.7%, p<.01) showed that the endovascular method significantly reduced the mortality in the latter group. CONCLUSIONS: Endovascular treatment is an attractive option in AAA; especially in heavily burdened patients, because it definitely reduces mortality. EVAR was found to be advantageous over OR in case of high-risk patients.

Effect of Endurance Cardiovascular Training Intensity on Erectile Dysfunction Severity in Men With Ischemic Heart Disease.

The protective effect of physical activity on arteries is not limited to coronary vessels, but extends to the whole arterial system, including arteries, in which endothelial dysfunction and atherosclerotic changes are one of the key factors affecting erectile dysfunction development. The objective of this study was to report whether the endurance training intensity and training-induced chronotropic response are linked with a change in erectile dysfunction intensity in men with ischemic heart disease. A total of 150 men treated for ischemic heart disease, who suffered from erectile dysfunction, were analyzed. The study group consisted of 115 patients who were subjected to a cardiac rehabilitation program. The control group consisted of 35 patients who were not subjected to any cardiac rehabilitation. An IIEF-5 (International Index of Erectile Function) questionnaire was used for determining erectile dysfunction before and after cardiac rehabilitation. Cardiac training intensity was objectified by parameters describing work of endurance training. The mean initial intensity of erectile dysfunction in the study group was 12.46 ± 6.01 (95% confidence interval [CI] = 11.35-13.57). Final erectile dysfunction intensity (EDI) assessed after the cardiac rehabilitation program in the study group was 14.35 ± 6.88 (95% CI = 13.08-15.62), and it was statistically significantly greater from initial EDI. Mean final training work was statistically significantly greater than mean initial training work. From among the parameters describing training work, none were related significantly to reduction of EDI. In conclusion, cardiac rehabilitation program-induced improvement in erection severity is not correlated with endurance training intensity. Chronotropic response during exercise may be used for initial assessment of change in cardiac rehabilitation program-induced erection severity.

The distribution of interstitial cells of Cajal in congenital ureteropelvic junction obstruction.

PURPOSE: The authors analysed the distribution of c-kit-positive interstitial cells of Cajal (ICCs) in obstructed ureteropelvic junction (UPJ) and its age-related changes. METHODS: Twenty specimens were obtained from children with intrinsic ureteropelvic junction obstruction (UPJO), at the average age of 8.1 years (8 months-16.8 years), fixed in formalin and embedded in paraffin. Five control samples were taken from children at the average age of 2.3 years (2.4 months-7.4 years). All specimens were analysed by the immunohistochemistry test with light microscopy with respect to c-kit expression. The distribution of c-kit-positive ICCs in the two groups was compared and the correlation between the distribution of c-kit-positive ICCs and the patients' age in UPJO cases was analysed. The results were examined by Yates' χ(2) test, Mann-Whitney U test, and t test for Pearson's correlation coefficient. A P value < 0.05 was considered as statistically significant. RESULTS: No statistically significant differences were found in the distribution of c-kit-positive ICCs between UPJO and the control group. No correlation was established between the age of patients with UPJO and the distribution of c-kit-positive ICCs. CONCLUSION: No distributional difference found in obstructed and unobstructed UPJ seems to indicate that UPJO is not associated with anomalous distribution of c-kit-positive ICCs. Age-related changes in the expression of c-kit-positive ICCs are equally distributed in obstructed UPJ.