Pro-health measures as a creator of new behavior norms and attitudes.

The monograph analyzes health behaviors and main factors on the basis of which it is possible to transform a lifestyle generally focused on the well-being of an individual and society. According to WHO, health is a state of complete physical, mental and social well-being, and not only the absence of a disease. The definition clearly explains its multidimensional and multithreaded character dependent subjectively on every individual and on social and cultural conditions. Health in its general meaning becomes a subjective human feeling. Each individual plays an important role in the process of providing it. Good health condition can be achieved by proper nutrition, regular doctor's check-up visits and active way of life. Health behaviors are still a key element of the daily activity of everyone. Despite the fact that full knowledge of the concept of "healthy lifestyle" prevails, still many people avoid categorical statements. In response to questions about lifestyle, a significant number of respondents often indicate an intention or willingness to change, or to partially comply with the requirements, which results from weakness and lack of determination in action. Knowledge supported by the offer of attractive models that promote the right patterns of behavior can have a positive impact on the global health of the society.

Direct MRI fistulography with hydrogen peroxide in patients with recurrent perianal fistulas: a new proposal of extended diagnostics.

BACKGROUND: Perianal fistulas are malformations of the anorectal area. Accurate preoperative assessment of perianal fistula tract is a main assumption in diagnosis of the disease, affecting the operation efficiency. The aim of the study was to present our experience in application of a new diagnostic protocol based on the magnetic resonance imaging (MRI) examination using a mixture of hydrogen peroxide (HP) and gadolinium as a direct contrast medium in evaluation of recurrent fistulas tract. The method is referred to as HPMRI. MATERIAL AND METHODS: The study group consisted of 12 subjects operated on from 2011. Direct HPMRI fistulography was performed in all subjects before the operation. All types of fistulas were precisely evaluated by HPMRI examination. RESULTS: Intraoperative state confirmed complete course of fistulas in 11 cases. In 1 case, an internal opening was not found. CONCLUSIONS: We suggest that this new method of direct HPMRI fistulography may improve visualization of the tracts of recurrent fistulas and improve efficacy of surgical procedures.

[Familial congenital diaphragmatic hernia with anencephly-exencephaly and spina bifida]. / Rodzinne wystepowanie wrodzonej przepukliny przeponowej z wada dystroficzna i bezczaszkowiem.

Congenital Diaphragmatic Hernia (CDH) occurs with an estimated incidence of 1 to 2500 live births. Even though the exact etiology is still unknown, more and more often current research points out genetic factors as the possible cause of the defect. According to the latest data and the own experience 50-60% of CDH cases are isolated. The rest forms a group of CDH complicated by an additional anatomic defect or a genetic syndrome caused by a mutation of a single gene or the whole chromosome. We have presented a case study of a 32 years-old multigravida para 3, who has been referred to the Reference Centre of Prenatal Cardiology in 30 weeks of gestation due to the diagnosis of acrania with exencephaly, spina bifida and suspicion for CDH in a fetus. Although the patient's first child died due to CDH, the patient neither before nor during the pregnancy was getting a folic acid supplementation. Moreover, she has not agreed on a further cytogenetic testing or an advanced consultation with a clinical geneticist. The child died after delivery in a local hospital. The case was described to indicate the problem that the CDH diagnostic procedure is still missing a molecular genetic analysis especially in the cases of recurrent CDH. By saying that in the cases of CDH we should always strive to complete the molecular testing having in mind that by discovering pathogenesis and genes responsible for the formation of CDH we not only might improve the therapeutic methods but also find a way to prevent its development.

Usefulness of magnetic resonance imaging as a prognostic variable in myelodysplastic syndromes.

BACKGROUND: Myelodysplastic syndromes are clonal disorders of stem cells, characterized by heterogeneous clinical presentation. Hematopoiesis is ineffective, characterized by abnormal differentiation, maturation and survival of hematopoietic cells. MATERIAL AND METHODS: The examinations were conducted in the Hematology Ward and the Internal Medicine Ward of the Specialist Hospital No. 1 in Bytom in the years 2006-2011. The study group included 53 patients with diagnosed myelodysplastic syndrome. The results of magnetic resonance imaging (MRI) of the spine were obtained from the medical documentation of patients. RESULTS: In the group of patients diagnosed with RT (refractory thrombocytopenia) and in the group diagnosed with RA (refractory anemia), 100% of lumbar spine images in T1- and T2- weighted sequences assessed together showed increased signal intensity. In patients diagnosed with RAEB (refractory anemia with excess blasts), MRI showed decreased signal intensity in 76.5% of subjects in the sequences analyzed together. In the group of patients with increased LDH (lactate dehydrogenase), 22 patients (55%) showed decreased signal intensity in the combined analysis of T1- and T2-weighted sequences. Among transfusion-dependent patients, 20 scans (60.6%) showed decreased signal intensity. CONCLUSIONS: As the risk category of MDS increases towards high - bad risk, decreased signal intensity is observed in lumbar spine MRI in T1- and T2-weighted images in all studied stratification scales. There is a positive correlation between decreased signal intensity in lumbar spine MRI examinations and increased LDH level in blood serum, as well as dependence on blood product transfusions, especially packed red blood cells.

Copeptin constitutes a novel biomarker of degenerative aortic stenosis.

Copeptin is a new biomarker of cardiovascular diseases. Its diagnostic value in degenerative aortic valve stenosis (AS) with preserved left ventricle systolic function is unknown. We aimed to assess the association of serum copeptin levels with AS severity and coexistence of coronary artery disease (CAD). Sixty-four patients with AS and preserved left ventricle systolic function including 40 with severe degenerative AS (group sAS, effective orifice area EOA = 0.67 cm(2)) and 24 with moderate degenerative AS (group mAS, EOA = 1.40 cm(2)) were enrolled into the study. Twenty-three patients without AS and heart failure, matched for age, sex, and CAD occurrence served as the control group (group C). Serum levels of copeptin and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured using enzyme-linked immunosorbent assay. The mean serum copeptin concentrations were significantly higher in patients with AS: sAS (405 pg/ml) and mAS (351 pg/ml; sAS vs mAS P < 0.05), compared with group C (302 pg/ml, P < 0.05). Serum copeptin levels correlated inversely with EOA (r = -0.55; P < 0.001) in AS patients. There was no correlation between copeptin and NT-proBNP or association with the coexisting CAD. Receiver-operating characteristics analysis showed that copeptin was a good marker of severe/moderate AS (sensitivity 71 %; specificity 87 %), with the optimized cut-off value of 354 pg/ml. Serum copeptin concentration constitutes a novel biomarker of degenerative AS. Coexisting CAD does not interfere with copeptin level.

Usefulness of spinal magnetic resonance imaging in patients with myelodysplastic syndromes.

BACKGROUND: Myelodysplastic syndrome is a rare, chronic hematological disease characterized by heterogeneous clinical presentations. Subtypes of myelodysplastic syndrome are characterized by different survival times and ability to transform into acute myeloid leukemia. OBJECTIVES: The objective of the study included the assessment of the relationship between the images obtained by magnetic resonance scans of lumbar spine and the clinical symptoms of the disease in patients diagnosed with myelodysplastic syndrome, as well as the assessment of the correlation of the images with the phase of transformation into acute myeloid leukemia. MATERIAL/METHODS: The study-related tests were carried out in Specialist Hospital No. 1 in Bytom between 2006 and 2011 and involved 53 patients aged 55÷77, divided into groups according to the diagnosed subtype of myelodysplastic syndrome. The study also included the prognosis of overall survival and time to transformation into AML on the basis of valid classifications. The spinal magnetic resonance scans were obtained from medical documentation. The analysis included images obtained using T1- and T2-weighted sequences in sagittal, transverse and frontal planes in all patients, images obtained using the STIR sequence from 21 patients as well as 40 images obtained after contrast administration. The statistical analysis of the results was carried out using STATISTICA software. CONCLUSIONS: The obtained results demonstrated that the magnetic resonance scans revealed statistically significant changes in the images of bone marrow in vertebral body scans; with a decrease in the intensity of MRI signals correlated with the RAEB subtype, particularly with transformation into acute myeloid leukemia as well as with the high IPSS risk score with regard to the time of survival and transformation into acute myeloid leukemia. The research-related test results indicate the importance of magnetic resonance imaging in diagnostics and the assessment of the disease dynamics.

Low-flow severe aortic stenosis with preserved ejection fraction, N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiovascular remodeling.

BACKGROUND AND AIM OF THE STUDY: Severe aortic stenosis (AS) with preserved systolic function may coexist with 'low flow' and a lower stroke volume (SV). As the mechanisms of this phenomenon are not fully understood, the study aim was to assess the cardiac and vascular mechanisms of 'low-flow' severe AS with a preserved left ventricular ejection fraction (LVEF). METHODS: Forty-four consecutive patients (mean age 69.7 +/- 7.6 years) with severe degenerative AS [mean effective orifice area (EOA) 0.7 +/- 0.3 cm2] and preserved LVEF (> 50%) were enrolled into the study, and allocated to two groups depending on their stroke volume index (SVI) (< 35 and > or = 35 ml/m2, respectively). The clinical data, N-terminal pro-brain natriuretic peptide (NT-proBNP) serum levels and ultrasound assessment of LV geometry and function [stroke work (SW), relative wall thickness (RWT)], AS severity, indices of systemic arterial hemodynamics [systemic arterial compliance (SAC), systemic vascular resistance (SVR)] and remodeling [flow-mediated dilatation (FMD), pulse wave velocity (PWV)], as well as valvuloarterial impedance (Z(va)) were analyzed for all study patients. RESULTS: Twenty-four patients (56%; 13 females, 11 males) had low-flow LV output, and 20 (44%; four females, 16 males) had a normal LV output. The mean NT-proBNP serum levels were comparable between the study groups. An analysis of LV remodeling and function revealed a lower LV end-diastolic volume (LVEDV; 85.5 +/- 24.1 versus 160.4 +/- 60.9 ml, p = 0.001), LV end-systolic volume (LVESV; 40.3 +/- 18.5 versus 66.8 +/- 44.2 ml, p = 0.03), LV mass index (LVMI; 150.1 +/- 53.4 versus 183.7 +/- 57.5 g/m2, p = 0.07) and SW (95.6 +/- 23.7 versus 183.2 +/- 50.6 mmHg x ml, p < 0.0001) in the group with SVI < 35 ml/m2. The average RWT was higher in the group with SVI < 35 ml/m2 (48.7 +/- 14.8 versus 40.0 +/- 7.5, p = 0.04). The indices of systemic arterial hemodynamics were significantly different between the groups: the SAC was lower, and the SVR and Z(va) were higher, in patients with SVI < 35 ml/m2 while FMD values were significantly greater in patients with SVI < 35 ml/m2 (11.85 +/- 6.4 versus 7.29 +/- 6.3%, p = 0.035). However, the brachial artery diameter (BAd) was smaller in the latter group, and no differences were found in the FMD x BAd index values. The PWV values were comparable in both study groups. CONCLUSION: The low-flow phenomenon in severe AS with preserved LVEF is related to smaller LV dimensions, LV concentric hypertrophy, and an increased systemic arterial afterload without differences in plasma NT-proBNP levels. 'Paradoxically' higher values of FMD observed in this population may be associated with a higher proportion of females and a smaller BAd.

Electrocardiogram teletransmission and teleconsultation: essential elements of the organisation of medical care for patients with ST segment elevation myocardial infarction: a single centre experience.

BACKGROUND: Optimal treatment of ST segment elevation myocardial infarction (STEMI) should be initiated immediately. System delay is considered an important indicator of quality of care in STEMI, and at the same time it is an independent predictor of clinical outcomes. It can be modified largely by introducing organisational changes. Although conditions have been created in Poland for common use of electrocardiogram (ECG) teletransmission and direct transfer of all STEMI patients to cardiac catheterisation laboratories, no uniform management algorithms have been introduced. AIM: To summarize several years of our experience with the use of ECG teletransmission and teleconsultation system in a Polish rural region, present conclusions drawn from practical use of the suggested management algorithm, and compare effectiveness of this system in its early and established phases. METHODS: The reported network consists of a single percutaneous coronary intervention (PCI)-capable hospital, emergency medical services (EMS) system, and several local non-PCI-capable hospitals. We extensively discussed the management algorithm based on prehospital diagnosis with ECG teletransmission and teleconsultation, and direct patient transfer to a PCI-capable hospital. Delays seen immediately after the system was introduced were compared with data obtained after several years of its stable functioning. RESULTS: In 2005-2013, the average time to STEMI reperfusion therapy (total delay) was 282.3 (median 213) min, patient-related delay was 164.1 (median 74) min, and system delay was 116.8 (median 111) min. Primary PCI was performed in 93% of STEMI patients, with 21.1% of patients treated within 90 min after the first medical contact (FMC) and 61.1% of patients treated within 120 min after FMC. In 2006-2010, no significant change in the total delay was seen (340 min in 2006 vs. 311 min in 2010, p = 0.1429). A significant reduction was seen in the system delay both overall (-8.3%, p = 0.0318) and in hospital (-24.0%, p < 0.0001). Primary PCI was performed within 90 min after FMC in 14.0% of patients in 2006 and in 30.6% of patients in 2010 (+118.6%, p = 0.0049), and within 120 min after FMC in 55% and 62.2% of patients, respectively (p = 0.3008). The delay from FMC to the diagnosis decreased (-32.1%, p = 0.0356) but the overall EMS delay did not change (102.7 vs. 103.7 min, p = 0.6725). Patient transfer time to the cardiac catheterisation laboratory remained unchanged (54.8 vs. 60.1 min, p = 0.0828), as was the patient-related delay (161.9 vs. 150.2 min, p = 0.2801). CONCLUSIONS: An ECG teletransmission and teleconsultation system reduces the system delay. ECG teletransmission systems work well in rural areas with low population density and a single large PCI-capable hospital. With increasing experience, a gradual increase in the effectiveness of management protocols involving ECG teletransmission is seen.

Biomarkers of calcification and atherosclerosis in patients with degenerative aortic stenosis in relation to concomitant coronary artery disease.

INTRODUCTION: There is an ongoing debate regarding aortic valve degenerative processes. Some markers of calcification and atherosclerosis may be potentially useful in establishing their etiology. OBJECTIVES: The aim of the study was to assess the biochemical markers of calcification and atherosclerosis in patients with degenerative aortic stenosis (AS) in relation to the aortic valve calcium score (AVCS) and concomitant coronary artery disease (CAD). PATIENTS AND METHODS: The study involved 88 patients: 68 patients with degenerative AS (group A), including 44 patients with severe AS (A1; 25 patients with CAD) and 24 patients with moderate AS (A2; 13 patients with CAD) and 20 matched subjects as controls (18 patients with CAD). In all patients, clinical data were assessed, laboratory tests were done (including the analysis of serum interleukin4 [IL-4], osteoprotegerin [OPG], and fetuin-A levels), coronary angiography was performed, and the AVCS was measured. RESULTS: Study groups and subgroups had comparable serum IL-4, OPG, and fetuin-A levels. There were significant differences in the AVCS between patients with severe AS, moderate AS, and controls (3605 ± 2542 Agatston units [AU], 1390 ± 1143 AU, 100 ± 194 AU, respectively; P <0.001). There were no significant correlations between the AVCS and serum IL-4, OPG, or fetuin-A levels. In moderate AS, serum OPG levels were higher in subjects with concomitant CAD (5.84 ± 1.4 vs. 4.03 ± 1.3 pmol/l, P = 0.036). In severe AS, the mean AVCS was similar in patients with and without CAD. Higher AVCS was observed only in patients with moderate AS and coexisting CAD compared with patients without CAD (1644 ± 1285 vs. 902 ± 789 AU, P = 0.038). CONCLUSIONS: There were no significant differences between patients with and without degenerative AS in selected biochemical markers. The presence of CAD in moderate AS was associated with increased AVCS and serum OPG levels suggesting the effect of atherosclerosis on early valve calcification. In patients with severe AS, there were no correlations between calcification and atherosclerotic markers.

Preoperative quantification of aortic valve stenosis: comparison of 64-slice computed tomography with transesophageal and transthoracic echocardiography and size of implanted prosthesis.

Precise measurements of aortic complex diameters are essential for preoperative examinations of patients with aortic stenosis (AS) scheduled for aortic valve (AV) replacement. We aimed to prospectively compare the accuracy of transthoracic echocardiography (TTE), transoesophageal echocardiography (TEE) and multi-slice computed tomography (MSCT) measurements of the AV complex and to analyze the role of the multi-modality aortic annulus diameter (AAd) assessment in the selection of the optimal prosthesis to be implanted in patients surgically treated for degenerative AS. 20 patients (F/M: 3/17; age: 69 ± 6.5 years) with severe degenerative AS were enrolled into the study. TTE, TEE and MSCT including AV calcium score (AVCS) assessment were performed in all patients. The values of AAd obtained in the long AV complex axis (TTE, TEE, MSCT) and in multiplanar perpendicular imaging (MSCT) were compared to the size of implanted prosthesis. The mean AAd was 24 ± 3.6 mm using TTE, 26 ± 4.2 mm using TEE, and 26.9 ± 3.2 in MSCT (P = 0.04 vs. TTE). The mean diameter of the left ventricle out-flow tract in TTE (19.9 ± 2.7 mm) and TEE (19.5 ± 2.7 mm) were smaller than in MSCT (24.9 ± 3.3 mm, P < 0.001 for both). The mean size of implanted prosthesis (22.2 ± 2.3 mm) was significantly smaller than the mean AAd measured by TTE (P = 0.0039), TEE (P = 0.0004), and MSCT (P < 0.0001). The implanted prosthesis size correlated significantly to the AAd: r = 0.603, P = 0.005 for TTE, r = 0.592, P = 0.006 for TEE, and r = 0.791, P < 0.001 for MSCT. Obesity and extensive valve calcification (AV calcium score ≥ 3177Ag.U.) were identified as potent factors that caused a deterioration of both TTE and MSCT performance. The accuracy of AAd measurements in TEE was only limited by AV calcification. In multivariate regression analysis the mean value of the minimum and maximum AAd obtained in MSCT-multiplanar perpendicular imaging was an independent factor (r = 0.802, P < 0.0001) predicting the size of implanted prosthesis. In patients with AS echocardiography remains the main diagnostics tool in clinical practice. MSCT as a 3-dimentional modality allows for accurate measurement of entire AV complex and facilitates optimal matching of prosthesis size.

Usefulness assessment of preoperative MRI fistulography in patients with perianal fistulas.

BACKGROUND: Accurate preoperative assessment of the perianal fistulous tract is the main purpose of the diagnostics and to a large extend determines surgery effectiveness. One of the useful diagnostic methods in perianal fistulas is magnetic resonance imaging. The authors presented experiences in the application of MRI fistulography for evaluation of cases of perianal fistulas difficult to diagnose and treat. MATERIAL/METHODS: Own examination method was described; MRI fistulography findings were analyzed and compared with intraoperative conditions in 14 patients (11 men and 3 women) diagnosed in the years 2005- 2009. Eight patients had recurrent fistulas and 6 had primary fistulas. Imaging was performed with a GE SIGNA LX HS scanner with a 1.5-Tesla field strength and a dedicated surface coil placed at the level of hip joints. Contrast agent was a gadolinium-based solution. RESULTS: Intraoperative findings were consistent with radiological descriptions of 13 MRI fistulographies. Only in one case, according to surgery findings, it was a transsphincteric fistula with an abscess in the ischioanal fossa, with an orifice in the posterior crypt; the radiologist described it as a transsphincteric, internal blind fistula. CONCLUSIONS: Due to its accuracy in the assessment of the perianal fistulous tracts in soft tissues, MRI fistulography becomes a useful and recommended diagnostic method in this pathology. It shows the location of the fistula regarding the system of anal sphincters, and identifies the internal orifice and branching of the fistula. It enables precise planning of surgical treatment. Authors suggest that this diagnostic method should be improved and applied more commonly.

B-cell lymphoma in a 70 year-old male patient with a cardiac tumour.

We present a case of a 70 year-old male with B-cell lymphoma of which the first clinical presentation was cardiac infiltration. The patient underwent full chemotherapy with complete tumour regression. Kardiol Pol 2011; 69, 10: 1063-1065.

[Adult patient after correction of tetralogy of Fallot--diagnostic and therapeutic issues]. / Dorosly chory po korekcji tetralogii Fallota--problemy diagnostyczne i terapeutyczne.

Over the last 40 years, we have witnessed an impressive revolution in the management of congenital heart disease (CHD). The major factors contributing to this advance include: enhanced diagnostic abilities, improved surgical procedures, sophisticated intensive care and finally better understanding of natural history of CHD. Recent epidemiological studies have documented that although CHD still remains the principal cause o death among infants, a significant increase in the number of patients with heart defects who survive into the adulthood have been observed. Nowadays, for the first time, the number of adults with CHD equals the numbe of children with this defect. Tetralogy of Fallot (TOF) is one of the most frequent congenital cyanotic heart diseases treated with either corrective or palliative surgical techniques. Successful operation followed by specialized care enable patients to have almost normal life expectancy. In the current paper, we have provided the update on the management, diagnostic approach and treatment of adult patients after the TOF correction. Figures present typical problems related to the echocardiographic evaluation.