The value of ventricular gradient for predicting pulmonary hypertension and mortality in hemodialysis patients.

Pulmonary hypertension (PHT) is associated with increased mortality in hemodialysis (HD) patients. The ventricular gradient optimized for right ventricular pressure overload (VG-RVPO) is sensitive to early changes in right ventricular overload. The study aimed to assess the ability of the VG-RVPO to detect PHT and predict all-cause and cardiac mortality in HD patients. 265 selected HD patients were enrolled. Clinical, biochemical, electrocardiographic, and echocardiographic parameters were evaluated. Patients were divided into normal and abnormal VG-RVPO groups, and were followed-up for 3 years. Abnormal VG-RVPO patients were more likely to be at high or intermediate risk for PHT, were older, had longer HD vintage, higher prevalence of myocardial infarction, higher parathormone levels, shorter pulmonary flow acceleration time, lower left ventricular ejection fraction, higher values of left atrial volume index, left ventricular mass index, and peak tricuspid regurgitant velocity. Both all-cause and CV mortality were higher in abnormal VG-RVPO group. In multivariate Cox analysis, VG-RVPO remained an independent and strong predictor of all-cause and CV mortality. In HD patients, abnormal VG-RVPO not only predicts PHT, but also all-cause and CV mortality.

Low-T3 syndrome and signal-averaged ECG in haemodialysed patients.

The study was designed to evaluate the potential link between low-T3 syndrome and signal-averaged ECG parameters (SAECG) in a group of hemodialyzed patients (HD-pts). 52 selected HD-pts (without relevant thyroid and cardiac diseases) were included. SAECGs were performed postdialysis together with evaluating free triiodothyronine (fT3), free thyroxine (fT4), reverse triiodothyronine (rT3), thyroid stimulating hormone levels and echocardiography. For each SAECG, QRS duration (QRSd), root-mean-square voltage of the terminal 40 ms of the QRS (RMS40), and low-amplitude signal duration (LAS40) were measured. Abnormal SAECGs were found in 30.8 % of HD-pt. HD-pts with decreased fT3 and increased rT3 values (low-T3 positive) revealed higher QRSd and LAS40 values in comparison with low-T3 negative HD-pts (p = 0.019, p < 0.001 respectively). Low-T3 positive HD-pts had lower RMS40 values than low-T3 negative patients (p < 0.001). The Pearson test showed significant correlations between QRSd and fT3 (r = -0.592, p < 0.001); QRSd and rT3 (r = 0.562, p < 0.001); RMS40 and fT3 (r = 0.432, p = 0.009); RMS40 and rT3 (r = -0.325, p = 0.025). On multivariate analysis, both fT3 and rT3 levels were found to be independent predictors of QRSd and RMS40 values. Our study showed that decreased fT3 and increased rT3 concentrations due to low-T3 syndrome influence SAECG parameters in HD-pt.

[Measurement of fluid compartments using electrical bioimpedance for assessment of target weight in hemodialysis patients]. / Pomiar przestrzeni wodnych za pomoca techniki bioimpedancji elektrycznej w celu oszacowania wagi oczekiwanej u pacjentów hemodializowanych.

The prescription of optimal hydration status in hemodialysis patients remains a much disputed topic in dialysis treatment. In particular, assessment of the patients optimal weight ("target weight") poses considerable difficulties. Multifrequency bioimpedance spectroscopy analysis (BIS) has been recommended as a non invasive, practical, and relatively non expensive method to determine hydration and nutritional status in patients on maintenance hemodialysis (HD). In the current study we used whole body BIS analysis for determination of body water (BW) compartments; total body water (TBW), extracellular water (ECW), and intracellular water (ICW) in 133 healthy adults, and in 227 hemodialysis patients with end-stage renal disease. BIS results were compared to anthropometric measurements. Our results showed strong correlation between TBW measured by BIS in control group in comparison to anthropometric calculation (p = 0.001). In HD patients we observed higher range of TBW, and TBW/ECW ratio (from 15.6 to 56.1 L and from 0.33 to 0.78), as measured by BIS at pre-HD, and also post-HD period (TBW ranged from 13.1 to 56.2 L, ECW/TBW ratio ranged from 0.33 to 1.27). The TBW BIS results did not correlate with anthropometric calculation. We postulate using of multi-frequency bioimpedance technique in precise determination of fluid compartments and in consequence in the assessment of "target weight" in hemodialysis population.

[Complication due to intraperitoneal dialysis catheter insertion]. / Powiklania zwiazane z zakladaniem cewnika do dializ otrzewnowych.

During the last 6 years 300 stylet and Tenckhoff catheters were inserted into the peritoneal cavity. In 5 cases an abdominal viscus has been perforated or injured. The complications were twice a perforation of bowel, twice a perforation of bladder and once an injury of aorta. The authors discussed the therapeutic procedure (conservative or operative) and the late consequences of those complications.

[Injuries to the knee extensor system in patients with longterm hemodialysis]. / Uszkodzenia aparatu wyprostnego kolana u osób przewlekle dializowanych.

Types and causes of renal osteodystrophy in chronic (3-12 years, hemodialysed patients are presented. Tissue weakening due to osteodystrophy resulted in 6 extensor mechanism lesions in 4 patients. Two quadriceps tendon avulsions, 1 patellar fracture, 2 patellar tendon avulsions involving the tip of patella and 1 patellar tendon rupture occurred. Pathomorphology and course of surgical treatment has been discussed. Good functional results have been achieved.

Erythropoietin treatment in patients on maintenance haemodialysis in dialysis centers of South-East region of Poland--present state.

South-East region of Poland includes six voivodeships, with about 3.6 mln of inhabitants. Nine dialysis centers work in this region with 273 places to perform maintenance haemodialysis outside Lublin, and 53 places in Lublin Clinic Center. The aim of this paper was to analyse the state of r-Hu EPO treatment in chronic dialysis patients. We would like to compare the treatment possibilities in the clinic unit with other haemodialysis units of our region and with data from Western Europe that we know from EDTA report. Simultaneously we decided to estimate real possibilities of iron treatment monitoring. As it is well known correct management of iron supplementation treatment, allows for the significant reduction of r-Hu EPO administration.

[Histological classification of uveal melanoma]. / Histologiczna klasyfikacja czerniaków naczyniówki.

Cytological classification of choroidal malignant melanomas recommended by WHO and based on the Callender classification (spindle A and B, mixed and epithelioid) is presented. Prognosis according to the histological types is discussed.

[Use of neodymium-YAG laser in cataract extraction]. / Zastosowanie lasera neodymowego YAG w chirurgii zacmy.

Observations of 45 procedures in 35 patients before and after cataract surgery suggest, that the application of Nd-YAG laser is an effective and safe method of treatment. The most frequent procedures were posterior capsulotomy, iridotomy, vitreotomy, membranotomy, anterior and posterior synechotomy and decission of secondary cataract. Possible complications include intraocular pressure elevations, damage of artificial lenses and hemorrhages from iris vessels.

[Acute bilateral ischemia of the optic nerve in gastrointestinal hemorrhage]. / Ostre obustronne niedokrwienie nerwów wzrokowych w przebiegu krwawienia z przewodu pokarmowego.

Presented is a case of a permanent, total, bilateral loss of vision occurring in the course of treatment by blood transfusions of a severe anaemia caused by a duodenal ulcer haemorrhage. The mechanism of ischaemia of the optic nerve in similar cases and possibilities of its treatment are discussed.

[Possibilities of the treatment of senile retinoschisis]. / Mozliwosci leczenia starczego rozwarstwienia siatkówki.

Photocoagulation and cryopexy were applied in 5 patients with retinoschisis; in 3 they were connected with a temporary invagination of the sclera by means of a Lincoff-Kreissig balloon. After the photocoagulation the authors attained the control of the increase of schisis in 3 patients; in 1 woman-patient a progress of pathological changes was seen. Cryopexy connected with a temporary invagination lead to a good result in a case not formerly treated. The same method in patients treated before by the photocoagulation of the detachment area was definitely less effective. It was suggested that the use of invagination and pressure upon the eye after the break of the choroi-retinal barrier may speed-up the absorption of the fluid from schisis cavity.

[Our observations concerning the use of low temperature in the treatment of glaucoma]. / Obserwacje wlasne zastosowania niskiej temperatury w leczeniu jaskry.

Cyclocryoapplication in glaucomatous patients is performed since 1983 by the method settled on the basis of results of experimental investigations. Observations concern 174 persons with various forms of glaucoma. Best results were obtained in patients with glaucoma in the course of uveitis, with secondary glaucoma after perforating injuries and after intracapsular cataract extraction. Fewest favourable results were observed in patients with closed angle glaucoma.