Przegla̧d lekarski
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The aim of the study was to evaluate cardiopulmonary exercise capacity (WTS) in adult patients with atrial septal defect (ASD). After excluding 10 patients with additional cardiac, pulmonary or muscle diseases, 53 patients with ASD (Gr-ASD; mean age 37.8 +/- 14.9 years; 35 women, 19 men) were enrolled in our study. In addition, we evaluated 22 healthy age and gender matched control subjects (Gr-K; mean age 36.6 +/- 14.9 years; 13 women, 9 men). First, all subjects underwent resting spirometry and forced vital capacity--(FVC; % of predicted value), one-second forced expiratory volume--(FEV1; % of predicted value) and FEV1/FVC (%) were determined. Then each subject performed a symptom-limited, incremental exercise test (modo Bruce). We evaluated the following parameters of resting metabolism: respiratory rate--(RR; L/min), minute ventilation--(VE; L/min), tidal volume--(Vt; L), oxygen uptake--(VO2; ml/kg/min), end-tidal carbon dioxide pressure--(PET CO2; mmHg), end tidal oxygen pressure--(PET O2; mmHg), ventilatory equivalent for carbon dioxide--(VE/VCO2) and ventilatory equivalent for oxygen--(VE/VO2). The following exercise parameters were analysed: peak oxygen uptake--(VO2 peak; ml/kg/min), VO2 peak expressed as % of predicted value--(VO2 %N), anaerobic threshold--(AT; % VO2 max), ventilatory equivalent for carbon dioxide--(VE/VCO2), end-tidal carbon dioxide pressure--(PET CO2; mmHg), O2 pulse, time of exercise--(T; min) and time to AT--(TAT; min). In addition, we performed a subgroup analysis for ASD patients below and > or = 40 years of age. All values were expressed as mean +/- SD. ⋯ WTS allows appropriate evaluation of cardiopulmonary capacity in ASD patients, though the mechanisms underlying ventilatory and hemodynamic abnormalities are still not fully understood. Adult patients with ASD reveal ventilatory abnormalities with an age-related trend towards deterioration. Cardiopulmonary exercise capacity in adults with ASD is markedly reduced in comparison with healthy population and deteriorates with age. WTS complements echocardiographic and hemodynamic evaluation of patients with ASD, and is helpful in indicating patients for ASD closure and their follow up.
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Cerebral vasospasm is a complication diagnosed in angiography among about 2/3 of patients after subarachnoid haemorrhage with ruptured cerebral aneurysm. In half of the cases it appears in disturbances of consciousness, neurological deficits and vegetative disturbances. It's final result can be ischemic stroke. ⋯ Undertaking hemodynamic treatment; 4. Aminosteroid administration; 5. Performance of angioplasty in the case of lack of reaction to previous types of treatment of cerebral vasospasm.
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Repolarization disorders leading to ventricular tachyarrhythmias are common causes of sudden cardiac death. Two of the disorders have been recently described at the molecular level revealing gene mutations: long QT syndrome, characterized by a prolonged QT interval corrected for heart rate and high incidence of malignant ventricular tachycardia, mainly torsade de pointes, and Brugada syndrome characterized by a ST segment elevation in the right precordial leads (V1-V3), right bundle branch block and idiopathic ventricular fibrillation. ⋯ On the basis of these repolarization disorders lay ion channel dysfunctions. The new discoveries may in the future allow a better diagnosis by genetic testing and raise the possibility of effective treatment by means of the gene-specific therapy.
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Early epicardial vessel patency and tissue perfusion limit infarct size, improve survival and are crucial for optimum functional recovery of the ischaemic myocardium in patients with acute myocardial infarction (AMI). Coronary angiography has been considered the "gold standard" in assessment of reperfusion. Restoration of coronary patency is not a guarantee of myocardial cellular perfusion. ST-segment elevation resolution observed in electrocardiogram (ECG) early after initiation of primary PTCA could be potentially correlated with reperfusion. ⋯ 1. Presence of early ST segment elevation resolution after angiographically successful primary PTCA identifies patients who are more likely to benefit from the early restoration of flow in the infarct related artery. 2. TIMI measures greatly overestimate the success of primary PTCA; they only assess vessel patency, not myocardial cellular perfusion. 3. "Electrocardiographic reperfusion" provides a real-time physiologic marker of cellular perfusion and is a significant predictor of LV contractility recovery--more useful than angiographic reperfusion. 4. ST-segment monitoring is a reliable, non-invasive and inexpensive method to evaluate myocardial perfusion.
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Comparative Study
[Evaluation of selected parameters of blood coagulation and the fibrinolysis system in patients undergoing total hip replacement].
Patients undergoing orthopedic surgery, particularly total hip replacement procedure belong to a group of patients with a high risk of thromboembolic complications. Postoperative deep vein thrombosis may occur in 40-80% of these patients. 4-19% of patients develop clinically evident pulmonary embolism and approximately 7% of cases in this group result in death. A thorough evaluation of coagulation disorders in the perioperative period could lead to detecting risk factors of thromboembolic complications development and could facilitate more effective prophylaxis management. ⋯ After 24 hours marked decrease of coagulation parameters was noted. In group A significantly less thromboembolic complications was observed. On the basis of the performed examinations the following conclusions were drawn. (1) during total hip replacement surgery and particularly during the period of the first 12 hours after procedure, marked activation of coagulation and fibrinolysis occurred. (2) the application of the hemodilution procedure does not influence significantly the degree of coagulation and fibrinolysis disorders in the perioperative period.