Meningoencephalitis caused by Lactobacillus plantarum - case report.

Specific strains of Lactobacillus spp. are widely used as probiotic agents but it has been repeatedly reported that may have a pathogenic potential. We present the report on a case of meningoencephalitis caused by Lactobacillus plantarum in a 63-year-old man with newly diagnosed metastatic planoepitheliale lung cancer. The patient was hospitalised due to newly diagnosed cancer and during the course of hospitalisation developed symptoms of neuroinfection. On the basis of the symptoms and results of the conducted tests the patient was diagnosed with bacterial meningoencephalitis. In microbiological tests of the blood and cerebrospinal fluid L. plantarum was cultured. During the course of antibiotic therapy the patient's condition improved. Lactobacilli are now recognised as a causative agent of infection, most notably bacteraemia. To our knowledge, this is the fourth documented case of Lactobacillus-associated neuroinfection, and only the second in an adult. Lactobacilli cause mostly opportunistic infections in immunocompromised individuals.

Brachiocephalic Vein Stenting and Body-Floss Technique as a Treatment of CVD in Dialysis-Dependent Patient - Case Report and Literature Review.

BACKGROUND: Given the increasing number of elderly hemodialysis-dependent patients with concomitant chronic diseases the successful creation and maintenance of reliable vascular access become a real challenge. In current literature central vein disease (CVD) is defined as at least 50% narrowing up to total occlusion of central veins of the thorax including superior vena cava (SVC), brachiocephalic (BCV), subclavian (SCV) and internal jugular vein (IJV). The incidence of CVD has been reported to be as high as 23% in the total dialysis population and 41% in those with access related complains. CASE REPORT: 61-year-old man has been admitted to the local radiology department with symptoms of the superior vena cava syndrome. The venography revealed occlusion of the right brachiocephalic vein. Due to Tortuosity and lack of stamp of right subclavian vein contributed to the decision to perform recanalization by "body floss" technique. In a further step we have performed PTA of obstructed vein segment using 7×40 mm balloon. Due to the presence of residual stenosis it was decided to implant two self - expanding stents 10×40 mm. After the procedure the patient was discharged in good condition and transferred to dialysis center. CONCLUSIONS: Main objective was the salvage of a functioning arteriovenous fistula. Performed endovascular intervention is a safe and effective approach to correct CVD for a short term. To ensure long lasting effects the patient will require enhanced follow-up and inevitable reinterventions. For that matter, prevention of CVD remains critical.

Knowledge and prevalence of risk factors for coronary artery disease in patients after the first and repeated percutaneous coronary intervention.

BACKGROUND: Percutaneous coronary intervention (PCI) is an effective method for the treatment ofcoronary artery disease (CAD) that allows for a short hospital stay and fast recovery. It has been shown that PCI is a predictor of nonattendance at cardiac rehabilitation and correlates with poor adherence to lifestyle changes. AIMS: The study was conducted to evaluate the influence of education offered during PCI­related hospitalization on knowledge, awareness, and prevalence of self­reported risk factors for CAD. METHODS: We collected data using a self­designed 56­item questionnaire. Questions assessed the knowledge of CAD risk factors and the level of their control. The maximal knowledge score was 31 points and the maximal control score, 15 points. RESULTS: The study group consisted of 200 consecutive patients undergoing PCI. Patients with a history of PCI performed at least 8 weeks prior to their current hospitalization were included in the prior­PCI group (64%), whereas the pre­PCI group comprised patients with no history of revascularization (36%). The median (interquartile range [IQR]) knowledge score was 19 (12.5-23) points in the pre­PCI and 21 (12.5-24) points in the prior­PCI group (P = 0.35). The median (IQR) risk control score was 5 (4.5-7) points in the pre­PCI and 6 (4-8) points in the prior­PCI group (P = 0.4). There was no correlation between the level of knowledge and the actual prevalence of CAD risk factors. We found that 50% of the prior­PCI patients did not attend any rehabilitation, which correlated with poor control of CAD risk factors (P = 0.001). CONCLUSIONS: Currently used models of postprocedural education do not have an adequate effect on patient knowledge and do not bring recommended lifestyle changes.

Clinical outcomes in nonagenarians undergoing a percutaneous coronary intervention: data from the ORPKI Polish National Registry 2014-2016.

BACKGROUND: Despite an increase in the proportion of nonagenarians in demographic structure, there is still a paucity of data on the utilization and outcome of percutaneous coronary interventions (PCIs) in this population. Also, very old patients are under-represented in randomized clinical trials and their treatment is still an emerging challenge. Thus, we sought to compare patient profiles and periprocedural outcomes of PCI in nonagenarians and patients younger than 90 years. PATIENTS AND METHODS: Data were based on the Polish National Registry of PCI (ORPKI). A total of 651 080 consecutive patients with stable angina (SA) (n=260 920) or acute coronary syndrome (ACS) (n=390 160) undergoing PCI with at least one stent implanted were included. Patients were stratified according to age (<90 and ≥90 years). RESULTS: Of all included patients, 4413 (0.7%) were older than or equal to 90 years. A similar rate of periprocedural complications was observed in both groups. However, cardiac arrest during both angiography and PCI occurred more often in nonagenarians (0.21 vs. 0.83%; 0.42 vs. 1.07%, respectively, for both P=0.001). Similarly, periprocedural mortality was higher in patients older than or equal to 90 years (0.27 vs. 1.88%; P=0.001). There were no differences in periprocedural outcomes between groups in the SA setting. However, a higher rate of periprocedural cardiac arrest [1971 (0.51%) vs. 43 (1.15%); P=0.001] and mortality [1622 (0.42%) vs. 83 (2.2%); P=0.001] were observed in nonagenarians compared with younger counterparts admitted with ACS. CONCLUSION: Nonagenarians undergoing PCI because of SA may have similar outcomes as patients younger than 90 years. In ACS presentation, they may have worse outcomes than younger counterparts.

An evaluation of dual source computed tomography used with the de Weert classification to detect vulnerable plaque, using IVUS virtual histology as a standard of reference.

BACKGROUND: One of the main risk factors for cerebral ischemic events is atherosclerotic disease of the internal carotid artery (ICA). Nowadays, increasing attention is being paid to the relationship between the morphological features of atherosclerotic plaque and the occurrence of stroke. Several studies have demonstrated that the presence of specific vulnerable plaque types, with a large lipid core and thin fibrous cap, can be used as an independent risk predictor of cerebral ischemic events. OBJECTIVES: The present study is an attempt to develop the method of plaque surface morphology assessment presented by de Weert et al. by correlating the results of Dual Source Computed Tomography (DSCT) with those from intravascular ultrasound virtual histology (IVUS-VH). MATERIAL AND METHODS: A group of 30 symptomatic patients (13 men and 17 women; 72 ± 9 years) with ICA stenosis suspected on the basis of ultrasound imaging (US) and confirmed to be above 70% in DSCT underwent intravascular ultrasound (IVUS) imaging. RESULTS: The results of DSCT were categorized according to the de Weert classification. There were 13 cases (43%) with smooth wall surfaces, 10 cases (33%) with discreet wall irregularities, and seven cases (23%) with incursions of contrast, indicating the presence of ulceration. In the IVUS-VH examinations, 4 out of 30 cases (13%) were identified as having adaptive intimal thickening (AIT), 4 (13%) as showing pathological intimal thickening (PIT), 6 (20%) with fibroatheromas (FA), six (20%) with fibrocalcific plaque (FCa), and 10 (33%) as having thin-cap fibroatheroma (TCFA), which is high-risk plaque. Comparing the above results showed that all the patients with confirmed wall ulceration in DSCT were characterized as having high-risk plaque in IVUS-VH. CONCLUSIONS: Using DSCT with the de Weert classification of plaque surface morphology makes reliable detection of ulcerations possible; therefore, this could become a significant new technique to improve current imaging protocols for patients with a high risk of ischemic cerebrovascular events.