Coronary artery fistulas morphology in coronary computed tomography angiography.

BACKGROUND: The aim of the study was to evaluate coronary artery fistulas (CAFs) in coronary computed tomography angiography (coronary CTA) and verify whether there is correlation between the fistula's morphology and other cardiac functional findings and clinical data. MATERIALS AND METHODS: A group of 14,308 patients who were diagnosed in coronary CTA was retrospectively analysed. Achieved data were related to referrals. RESULTS: Coronary artery fistula frequency was 0.43% in the examined population. The assessment of coronary artery disease was the most frequent indication for the examination. In 2 out of 3 cases the diagnosis of CAFs was incidental. Fistulas to cardiac chambers were significantly shorter than those to other vascular structures (19.9 vs. 61.8 mm, respectively, p = 0.001). Pulmonary trunk was most often the drainage site. Fistulas with singular supply and drainage constituted the majority. The new morphologic classification of CAFs was introduced with linear, spiral, aneurysmal, grid-like and mixed types. Most numerous was the spiral type group. Patients with aneurysmal fistulas had a tendency for wider diameter of aorta and pulmonary trunk. Smallest left ventricle fraction was observed in gridlike fistulas (48.0%, comparing to 59.2% for all patients with fistulas, p = 0.001). Concomitant abnormalities were found in 13.1% of CAFs patients. CONCLUSIONS: Computed tomography angiography has proven to be a useful tool in CAFs detection and morphological assessment. Proposed classification may simplify the predictions whether fistula has a significant influence on cardiac function; however, further studies are needed.

Volumetric reconstruction of the right ventricle improves reproducibility of interventricular septum bowing in patients with pulmonary embolism.

Bowing of the interventricular septum (IVS) is a sign of severe pulmonary embolism(PE); however, it is affected by high interobserver variability. The aim of the study was to evaluate the application of volumetric reconstructions of the right ventricle for assessment of IVS position regarding its accuracy in identifying right ventricular dysfunction, as well as interobserver agreement in evaluating this sign.IVS bowing was evaluated with multiplanar reformations (MPR) and volumetric reconstruction (VR, volume rendering) by 2 observers. The accuracy of IVS bowing sign was better for VR-based assessment; however, it was not significantly better than the MPR-based evaluation. Interobserver agreement was found to be fair (kappa = 0.381) for the MPR-based grading of IVS position as normal orabnormal, while it was significantly better for the VR method (kappa = 0.629,p < 0.001). The VR-based method may improve utilisation of IVS bowing sign inpatients with PE.

[Malignant epibulbar tumours: new strategies in diagnostics and therapy]. / Maligne epibulbäre Tumoren: Neue Strategien in Diagnostik und Therapie.

In this article we discuss the complex diagnostic approaches and therapeutic options for the most important conjunctival malignancies. Conjunctival melanoma can be a diagnostic challenge as it can be difficult to distinguish from benign melanocytic conjunctival tumours. Complete surgical excision accompanied by a coherent adjuvant concept is the key for a curative therapy. Moderate and severe conjunctival intraepithelial neoplasias (CIN) are precancerous lesions and can progress to invasive squamous cell carcinoma. The involvement of large parts of the ocular surface can prevent an R 0-resection. Adjuvant therapeutic concepts are therefore especially important to gain tumour control and preserve the function of the affected eye. Lymphomas are the most common malignant primary tumours of the orbit and ocular adnexa. They can present as primary or secondary tumours of the conjunctiva, the lacrimal gland, the orbital fat, the eye lid or the lacrimal sac. The most common manifestation site of ocular MALT lymphoma is the conjunctiva with 20 - 33 % of all epibulbar lymphomas. More than 75 % of ocular lymphoma patients develop only one lymphomatous lesion. Immunophenotyping allows the exact differentiation between the lymphoma entities. Infectious agents (e.g., Chlamydia psittaci) seem to play a role in the pathogenesis. An overview over radiotherapeutic approaches that are conclusively applicable at the conjunctiva completes the article.

Early post-stroke physical conditioning in hemiplegic patients: A preliminary study.

OBJECTIVE: To establish the value of an early post-stroke evaluation of cardiorespiratory fitness in hemiparetic patients using a one-leg cycling exercise test and to analyze the impact of an adapted physical activity programme 12 weeks after the stroke. PROTOCOL: Eighteen hemiparetic stroke patients participated in the study. The subjects were randomly assigned to one of two groups: the control group (CG) underwent 4 weeks of conventional rehabilitation, whereas the training group (TG) performed additional physical exercises. The initial evaluation (T1) was carried out after 1 week of exercise and the final evaluation (T2) was performed after 28 days. Both evaluations consisted of maximal graded tests performed with the valid leg, followed by completion of a questionnaire on personal autonomy in activities of daily living (ADL). RESULTS: In the CG group, we recorded a 4 to 8% increase in peak oxygen uptake (VO2 peak). There was no significant increase in peak power output (Wpeak). However, the TG displayed significantly (P<0.05) greater peak values than those recorded on study entry (Wpeak: +30%, VO2 peak: +20%). The TG showed a statistically significant improvement in the Barthel and Katz ADL scale scores, whereas the pre- and post-rehabilitation values did not differ significantly in the CG. However, there was no correlation between the Barthel/Katz scale scores and Wpeak. CONCLUSION: Evaluation of cardiorespiratory fitness by using the valid leg seems to be feasible in hemiplegic patients 1 month post-stroke. Early post-stroke physical training appears to be needed to limit the negative effects of functional hypoactivity.

ECG-gated multi-slice computed tomography in the detection of atrial septal aneurysms.

An atrial septal aneurysm (ASA) is an uncommon cardiac abnormality. Clinical manifestation of this abnormality remains unclear: some authors have suggested an association between ASA and arrhythmias or between ASA and cerebral ischaemia. A major role in the diagnosis of ASA to date has been played by transoesophageal echocardiography and transthoracic echocardiography. The purpose of this paper is to present the role of multi-slice computed tomography with ECG gating in the detection and analysis of ASA.

[Deep vein thrombosis following total arthroplasty hip replacement. Ultrasonographic screening in the rehabilitation phase]. / Tiefe Beinvenenthrombose nach alloarthroplastischem Hüftgelenkersatz. Ultraschall-Screening in der Rehabilitationsphase.

UNLABELLED: Deep vein thrombosis requires intensive therapy--either the patients require hospitalisation or their rehabilitation scheme must be adjusted and medical treatment applied. The total number of patients with deep vein thrombosis undetected before admission to rehabilitation facilities is unknown. AIM: Study parameters: 1. The occurrence of undetected deep vein thrombosis upon admittance to a rehabilitation facility. 2. The value of sonography in diagnosing, localising and determining the extent of deep vein thrombosis and 3. the influence of prophylactic antithrombotic treatment applied in the surgical hospital, as well as during the intermittent outpatient phase before admittance to the rehabilitation centre, on the occurrence of deep vein thrombosis. METHODS: 305 patients were examined between Nov. 95 and Dec. 96. The first check was carried out on the day of admission (on the 26th postoperative day, on average). The second check was done on the day of discharge from the rehabilitation centre. RESULTS: Deep vein thrombosis was found in 30 patients (10%). In 27 cases the thrombosis was located in the thigh, in one case it was found in the contralateral leg. 18 of these patients had been discharged from the surgical hospital on the 22nd postoperative day, for an average time of 7 days of outpatient care, before being admitted to the rehabilitation centre. 11 of these patients had not received any prophylactic antithrombotic treatment. One patient developed deep vein thrombosis of the thigh during the rehabilitation phase despite of prophylactic treatment. CONCLUSION: Postoperative sonographic screening of all patients undergoing hip surgery is a useful method to detect deep vein thrombosis. Prophylactic postoperative antithrombotic treatment in the rehabilitation phase is mandatory.

[Arrhythmia in patients after 80 years of age]. / Zaburzenia rytmu serca u chorych po 80. roku zycia.

The purpose of the work is detection and assessment of heart rhythm disturbances in elderly patients treated in the Department of Cardiology in Lublin for various circulatory system diseases. The study includes 66 patients aged 80-98 years, mean age 83.7 years (46 women and 23 men). During 24-hour ECG monitoring by Holter method the occurrence was evaluated of heart rhythm disturbances due to hyperexcitability and conduction disorders as well as the frequency of their treatment either pharmacological or by constant electrostimulation. Arrhythmias due to hyperexcitability were found in 96% of the patients and they were mostly supraventricular (89%). Atrioventricular conduction disturbances occurred in 35% of the patients. Ventricular arrhythmia requiring treatment (group 4 and 5 according to Lown) occurred in 19% of the patients. Electrostimulation therapy was used in 31.8% of the patients.

[Return of sinus rhythm in patients with paroxysmal heart rhythm disturbances]. / Powrót rytmu zatokowego u chorych z napadowymi zaburzeniami rytmu serca.

The purpose of the work was an assessment of the time and mechanism of the return of sinus rhythm in patients with paroxysmal supraventricular heart rhythm disturbances, treated pharmacologically. The Holter method enabled a precise determination of the mechanism of sinus rhythm return. A group of patients could be isolated with bradycardia-tachycardia syndrome, in whom attacks of MAS syndrome occurred only after regression of arrhythmia. At the time of the return of sinus rhythm and immediately after it transient conduction disturbances and hyperexcitability may occur.

The influence of strychnine and glycine on the metabolism of acetylcholine in the rat striatum and hippocampus.

Intracerebroventricular injection of glycine elevated the level and synthesis rate of acetylcholine and the activity of choline acetyltransferase in the striatum. Administration of strychnine alone did not change these parameters, but pretreatment with strychnine abolished the stimulatory effect of glycine on the cholinergic system of the rat striatum. Separate or combined administration of strychnine and glycine did not affect the striatal acetylcholinesterase activity. The drugs did not produce any changes in the cholinergic system indices in the hippocampus.

The effect of glycine on acetylcholine metabolism in rat brain.

Glycine, 0.5 mg icvtr, elevated the striatal acetylcholine (ACh) level 30 and 45 min after the injection, and accelerated ACh synthesis 15-45 min after the administration. Only doses of 0.25 and 0.5 mg produced these effects. Glycine elevated the choline acetyltransferase activity in the striatum, but did not affect acetylcholine esterase. Studies in vitro did not demonstrate an effect of glycine on ACh synthesis in the rat cortex, striatum, and hippocampus.

The effects of intracerebroventricularly applied kainic acid on acetylcholine content and release in rat brain cortex and striatum.

Kainic acid applied intracerebroventricularly at a dose of 0.1 micrograms/rat decreased the ACh level inthe cortex and increased it in the striatum 3 h after the injection. ACh release 3 h from the moment of injection was depressed in both examined structure. 1, 5 and 20 days after injection, ACh level and release were depressed in the striatum.

The influence of taurine on acetylcholine content and synthesis in rat brain.

Taurine applied to rats intracerebroventricularly in doses 0.1--3.0 mg increased ACh level and decreased ACh synthesis in the cerebral cortex. In the striatum ACh level was increased after doses of 0.1--3.0 mg and ACh synthesis was decreased after 0.01--3.0 mg. In the hippocampus taurine appeared to decrease both ACh level (0.5--3.0 mg) and synthesis (0.1--3.0 mg). Maximum effects of taurine were observed 30--60 min following the injection. A possible role of taurine as a neurotransmitter or neuromodulator is discussed.

Investigations on the effects of certain hormones on acetylcholine metabolism in the central nervous system.

The investigations were carried out on white rats determining the level and synthesis of acetylcholine (ACh) in the cerebral cortex, striatum, and in some experiments also in the brain stem. Thyroxine administered subcutaneously increased ACh synthesis in the cerbral cortex and reduced it in the striatum without changing the level of ACh in these structures. After thyroxine administration in vitro these changes were not observed. Intraperitoneal insulin caused no changes in the level and synthesis of ACh while in vitro ACh synthesis was increased in the cortex as well as striatum after insulin. Glucagon, hydrocortisone, adiuretin and oxytocin had no effect on ACh level and synthesis in the tested structures.