THE DIFFICULTIES IN THE DIAGNOSIS OF PULMONARY HYPERTENSION ASSOCIATED WITH CHRONIC LUNG DISEASE.

OBJECTIVE: Introduction: Chronic lung disease (WHO group 3) is the second leading cause of pulmonary hypertension (PH). In turn, the development of PH influences the course of lung disease, worsening the clinical symptoms and prognosis. The aim: To analyse the difficulties in the diagnosis of pulmonary hypertension due to chronic lung disease. PATIENTS AND METHODS: Review and Discussion: According to recent literature, PH in the course of lung diseases develops as a result of both "parenchymal" and vascular pathology in patients with a genetic predisposition. Prolonged infection (especially viral) may be an additional promoting factor. Elevation of pulmonary arterial pressure (PAP) is usually moderate and correlates with severity of lung disease. In a small minority, PAP may reach that seen in WHO group 1 pulmonary arterial hypertension (PAH). CONCLUSION: Conclusions: Echocardiography and right heart catheterization are the principal tools for the diagnosis of PH in chronic lung diseases. Unfortunately, current medications for treating PAH have not shown benefit in controlled trials of group 3 PH, hence their routine use is not recommended. Patients with severe group 3 PH should be considered for referral to expert centres or entry into clinical trials.

IMAGING TECHNIQUES IN THE DIAGNOSIS OF PULMONARY HYPERTENSION.

OBJECTIVE: Introduction: Pulmonary hypertension is defined as being a haemodynamic state, wherein the mean pulmonary artery pressure measured during right heart catheterization is equal or greater than 25 mmHg. As a result, right ventricular heart failure develops and clinical symptoms such as dyspnea, fatigue, weakness, angina and fainting occur. The aim: To highlight the role of imaging techniques in diagnostic process for pulmonary hypertension. PATIENTS AND METHODS: Review and Disscusion: The diagnosis of pulmonary hypertension is multistage and often requires a number of studies. Currently, imaging techniques play a significant role in the diagnostic algorithm for pulmonary hypertension due to the fact that they are non-invasive and readily available, and many of their parameters are closely related to pulmonary hemodynamics. CONCLUSION: Conclusions: The diagnosis of pulmonary hypertension requires a multistep approach and a number of imaging studies. The suspicion of the disease is based on medical history, clinical symptoms and chest radiogram. Echocardiography plays a crucial role in pulmonary hypertension detection. A computed tomography and cardiac magnetic resonance are valuable methods in determining the cause of suspected or confirmed pulmonary hypertension.

ECHOCARDIOGRAPHIC EVALUATION OF THE RIGHT HEART IN THE PULMONARY HYPERTENSION.

OBJECTIVE: Introduction: A comprehensive assessment of right ventricular size and function, as well as evaluation of pulmonary artery pressures is an integral part of every echocardiographic examination. It is important to know the relevant guidelines but also the pitfalls of echocardiography. The aim: To determine the significance of echocardiography in the diagnostic process, prognosis and evaluation of treatment effectiveness in pulmonary hypertension. PATIENTS AND METHODS: Review and Discussion: The gold standard for evaluation of size, ejection fraction, and stroke volume of the right ventricle is cardiac magnetic resonance. Whereas, the gold standard for the assessments of pulmonary artery pressures is right heart catheterization. However, echocardiography is the first diagnostic modality in the assessment of size and function of the right heart. CONCLUSION: Conclusions: Echocardiographic evaluation of the right heart plays a fundamental role in the diagnostic process of pulmonary hypertension. Echocardiography is essential to predict the course of the disease and assess the treatment efficiency.

Does gender influence the outcome of ischemic heart disease?

Diseases of the cardiovascular system (myocardial infarction, stroke, heart failure, hypertensive heart disease, cardiomyopathy) account for 40% of all deaths in men and up to 49% of all deaths in women. For a long time it was thought that the clinical picture of ischemic heart disease in men and women was similar. Now, however, there are more reports suggesting that diverse manifestations of the symptoms of ischemic disease may be related to differences between sexes. The disparity between women and men is also evident in the diagnostic process, and various pathological mechanisms of cardiovascular diseases, in particular myocardial ischemia in men and women, affect the differences in the results of diagnostic tests. Vasomotor dysfunction is particularly frequent in women, as their coronary vessels are more sensitive to the catecholamines released during mental stress, resulting in spasm and ischemic myocardium. Moreover, a much lower dose of acetylcholine induced vasoconstriction, which indicates that women are more sensitive to this neurotransmitter. Therefore, coronary vasomotor disorders in the form of epicardial and microvascular dysfunction are more often seen in women. All these mentioned factors resulted in higher mortality and poorer quality of life of women suffering from ischemic heart disease.

[Breasts self examination - everything we want you to know about it - survey study].

OBJECTIVE: Introduction: Breasts self examination is first line prevention in case of breast cancer. It is cheap, it is easy and it can save your life. That is why it is so important that every woman and even man know how to do it. The aim: To estimate the level of knowledge about breasts self examination among women and also among people connected with medicine. PATIENTS AND METHODS: Materials and methods: The data were gathered through the internet questionnaire, which contained of 14 questions. There were 204 respondents : 53% women and 47% men. Among them there were 93% people related with medicine. Average age was 23,5 years. The participation was voluntary and annonymous. RESULTS: Results: Among female respondents 57% admit doing breasts self examination, however only 23% of them do that regularly every month. Also only 36% of the respondents know how to do proper examination. When asked if they ever had their breasts examined by the doctor, only 20% replied positively. We also prepared questions for people connected with medical field: we asked them if doing breasts examination for the patient they would feel confident (61% replied negatively.) and also if they had a chance to do breasts examination during studies most of them replied negatively. CONCLUSION: Conclusions: To conclude, even among women connected with medical field the knowledge is not enough, which is the most concerning since they should educate others and diagnose concerning symptoms. We should put more afford to break the tabu and pay more attention to breast examination.

[testicles self examination - knowledge and abilities - survey study].

OBJECTIVE: Introduction: Testicle cancer is a common malignant cancer among young men (20 to 44 years). In 90% of cases we can feel nodule or change of consistency, which means during testicles self examination we can quickly discover cancer. The aim: To estimate the level of knowledge about testicles self examination among men and also medical stuff and students. PATIENTS AND METHODS: Materials and methods: We gathered the data through the internet questionnaire, which contained of 13 questions. There were 204 respondents (53% women and 47% men). 93% were related with medicine. Average age was 23,5 years old. The participation in the study was voluntary and annonymous. RESULTS: Results: Only 41% of our respondents perform self examination. When asked if They every had Their testicles checked by a doctor only 33% responded positively. Most of the respondents almost correctly point out symtpoms and risk factors of testicles cancer. Only 22% of medical related respondents feel confident while performing testicles examination with the patient and just 12% of them had a chance to do it during studies. We also asked our respondents if They have ever seen a social campaign about priopriate testicles self exmiantion and 80% of them respondet negatively. CONCLUSION: Conclusions: The level of education about testicles examination is on low level. Men are usually aware of the risk, but They neglect it. In most cases doctors do not examine testicles and are not confident about it. We have to put more concern to that case.