Effectivity-ecosphere-economics in nZEB retrofit procedures.

Sustainable development has by now become an element deeply integrated in the everyday design. It has many shades and may be found under many names. We speak about resiliency in design and procurement of passive, ecologic, plus energy, or nZEB buildings. Nevertheless, if we look closely, we may distinguish certain characteristic ideas. First, sustainable development of societies and urbanization processes should be consistent on a deeper level than presently, and be included within design processes, organization, and planning, as well as modernization and redevelopment procedures of existing urban tissue. Secondly, urbanization should be perceived holistically, as an interaction and harmonious development of both natural and manmade environments, with solutions based on the best technical and technological standards available. Lastly, described ideas are achievable only, if we include continuous cooperation between urban planners, architects, specialist consultants, as well as energy-efficient interdisciplinary solutions to achieve high standard energy measures. One of the thresholds is economic feasibility; the other is health and well-being of the users which should always be discussed as a priority. This paper-outside a brief theoretical approach to initial procedures in design management-will dwell on transformation and modernization of an existing building belonging to the Warsaw University of Technology, one of the oldest universities in Poland, its founding dating back to the beginning of the twentieth century. In 2015, a Nordic Finance Mechanism grant dedicated to the nZEB technology transfer from Norway to Poland was awarded to a group of researchers from Warsaw University of Technology and NTNU Trondheim. The main aim of the project is implementation of nZEB knowledge in Poland, as well as preparation of two integrated concept designs for public (University) buildings as exemplary case studies which could act as the benchmarks for other public buildings.

Zenker diverticulum: Experience in surgical treatment of large diverticula.

The purpose of this retrospective study is to show that transcervical diverticulectomy (TD) in treatment of Zenker diverticulum (ZD) can still be a first choice procedure in selected patients and in experienced hands its safety might be compared to the minimally invasive endoscopic diverticulostomy.The study cohort consisted of 44 patients (18 male, 26 female) operated for (ZD). All the patients underwent open diverticulectomy. The decision to choose open surgical repair depended on surgical risk, age of the patient, size of the diverticular septum (the distance between the top of the diverticulum and its bottom on barium study), and patient's preference.Mean age of patients was 64.6 ±â€Š11.9 years; range: 26 to 88 years. A total of 36.4% out of them finished 70 years. Postoperative mortality was nil. Two major complications (4.5%) requiring surgical intervention occurred: leak and hematoma.Data were analyzed by t test for independent samples using Statistica 12.5 software. P value <0.05 was considered statistically significant.Surgical treatment of patients with ZD should be individualized. Large Zenker diverticula with the septum longer than 6 cm should preferably be resected through an open approach because it is not possible to remove the septum completely during one-step endoscopic procedure and diverticulostomy creates a weak and large common cavity in the esophagus. Surgical repair is effective for all sizes of diverticula, but its most serious complications such as leakage or laryngeal nerve injury should be considered, especially in elderly patients with comorbidities. However, age alone should not be the main criterion if choosing the treatment option.

Personal experiences in direct ultrasound-guided injection of thrombin into the lumen of pseudoaneurysm as a method of treatment in case of iatrogenic femoral artery damage.

BACKGROUND: Pseudoaneurysms constitute a quite common complication of procedures requiring puncture of the common femoral artery. The risk factors of the condition include: obesity, arterial hypertension, sex (more prevalent in males) as well as antithrombotic therapy. MATERIAL/METHODS: The US-guided injection of thrombin into the pseudoaneurysm lumen was performed in patients referred from the Department of Invasive Cardiology who had undergone coronarography or coronary angioplasty. Pseudoaneurysms constituted the complication of common femoral artery canulation. After setting the diagnosis of pseudoaneurysm by means of Doppler ultrasound, patients with large pseudoaneurysms of volume exceeding 10 mm were qualified for thrombin injection. Generally, 33 patients underwent the treatment. In 3 cases - due to the presence of multiocular pseudoaneurysm - thrombin was administered twice. RESULTS: Taking into account the safety of the procedure, ultimately 33 patients were qualified for thrombin administration, in whom aneurism of diameter exceeding 10 mm was diagnosed. In 3 patients with aneurysm of less than 10mm, only a compression band was used prophylactically. In one case, because of a considerable oedema surrounding the tissue, as well as deep location of the aneurysm in the groin, thrombin treatment was not given due to technical reasons. In 30 cases, single administration of thrombin was effective and resulted in a complete thrombosis of the pseudoaneurism lumen within a couple of seconds following thrombin injection. In 3 patients with multicellular aneurysm, thrombin was given twice, resulting in a total obliteration of the pseudoaneurysm in two cases only. No complications were observed after the performed procedures. No recanalisation of pseudoaneurysms was demonstrated in follow-up examinations. CONCLUSIONS: 1. Direct thrombin injection into the pseudoaneurysm lumen can constitute an alternative method of treatment for open surgical techniques. 2. The procedure is highly effective, cheap and minimally invasive.