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The duplex Doppler examination of extremities arteries is the primary diagnostic method in detecting disorders leading to lower and upper extremities blood supply disturbances. In many cases the Doppler ultrasound plays a major role in the process of qualification to the reconstructive procedures or conservative treatment, especially to the endovascular procedures. Regardless of the widespread availability and high sensitivity and specificity of this method it's burdened with serious drawbacks. The most important of them are evaluation subjectivity and variety of methods determining the haemodynamic stenosis consequences. They often cause difficulties in comparing the test results carried out in different centres and to find correlations with other imaging methods results. In order to overcome these drawbacks, Polish Society for Vascular Surgery has attempted to develop recommendations for uniform methodology of extremities arteries Doppler examination. Legal terms, the manner of examination and its interpretation were presented. Proposing the way of highlights results and messages conclusion to enable the recommendations implementation of endovascular and surgical qualifications relating to surgical treatment. We hope that these recommendations will help to standardise examination techniques.

Vascular endothelium is the layer of cells that line blood vessels and serve as the primary barrier between the blood and the tissues. These cells play many important functions such as regulation of the vascular tone, blood flow and pressure control, maintaining the balance between thrombosis and fibrinolysis, participation in immune system reactions and new blood vessels formation. Disturbance in any of these functions may contribute to the development of different diseases such as for e.g. hypertension, atherosclerosis and deep vein thrombosis, as well as cancer.

Derangements within autonomic nervous system take part in the natural history of cardiovascular disease. Current paper presents three categories of methods measuring autonomic status: direct methods (e.g. laboratory tests measuring circulating catecholamine levels or based on isotopes, microneurography), indirect methods applied at rest (e.g. analysis of heart rate variability, spectral and sequence methods of arterial baroreflex sensitivity assessment) and indirect methods, associated with the exposure to physiological stimuli (e.g. Ewing's battery, central and peripheral chemoreceptor sensitivity assessment, invasive methods of arterial baroreflex sensitivity assessment). This review provides an insight into the physiology of reflex regulatory mechanisms within cardiorespiratory system, including their complex and unstable nature.

Unlabelled: Cerebral ischemic stroke which basic exponent is an sudden occurrence of neurological deficits is also characterized by deep disturbances of human organism homeostasis. It is known that many functions of a healthy human organism is subjected to the rhythmical changes during the twenty-four hours, and the state of illness can disturb them in a crucial way. The aim of the study was to examine the dynamics of changes of glucose concentration in blood of patients with acute phase of cerebral ischemic stroke in chosen times of day., Material and Methods: The examinations were carried out on 16 non-diabetic patients (11 men, 5 women), aged between 57 and 76 where the cerebral ischemic stroke was confirmed by the Computer Tomography of the head. The patients were on high protein diet with total energy value of 2283 +/- 130.0 kcal per twenty-four hours in three meal times: at 09AM, 02PM, 06PM. The venous blood for examinations was drawn 6 times during the day: at 01AM, 05AM, 09AM, 01PM, 05PM, 09PM on the 1st, 3rd, 5th and 10th day after the stroke occurred. The following concentrations in blood were denoted glucose., Results: In patients with the acute phase of cerebral ischemic stroke the significant disorders of carbohydrate metabolism can be observed in times between 09AM and 01PM on both the 1st, 3rd and the 5th day of the duration of the disease., Conclusions: The received results may take effect in the proofreading of pharmacological treatment with the consideration of the times of day.

Unlabelled: Severe aortic regurgitation and stenosis are urgent indication for aortic valve replacement in patients with left ventricular dysfunction, however the effect of cardiac surgery may differ in both groups. The aim of the study was to evaluate the early changes of haemodynamic parameters of heart: ejection fraction, endsystolic and enddiastolic left ventricle diameters, endsystolic and enddiastolic left ventricular wall thickness and left atrium diameter, depending on ejection fraction value (EF), in patients undergoing aortic valve replacement due to isolated aortic stenosis or regurgitation., Materials and Methods: 250 patients engaged to the study were subjected to the mechanical aortic valve replacement in Cardiac Surgery Department in Lodz. All patients were divided into two groups--patients operated due to aortic regurgitation and aortic stenosis. Then each group, depending on EF volume before operation, was divided into two subgroups (A - EF between 35 and 50%; B - EF below 35%)., Results: Comparing the pre- and early postoperative period, ejection fraction rose markedly in both subgroups of patients with aortic stenosis and the highest increase was ascertained in subgroups A. Analyzing endsystolic and enddiastolic left ventricle diameters we observed the reduction of left ventricle diameters in all groups. Evaluating endsystolic left ventricular wall thickness we observed the increase of wall thickness in both subgroups B. Analogically enddiastolic left ventricular wall thickness increased in all analyzing groups, whereas in groups with lowest fraction the rise was essential., Conclusions: Aortic valve replacement both due to aortic stenosis and regurgitation is associated with improved haemodynamic status in early postoperative period.

Unlabelled: Bleeding after biopsy of the liver (LB) is a rare event, hard to prognose and occurs frequently in those cases, when we do not expect it. Bleeding is the main reason of complications and deaths subsequent to LB. The aim of the study was to prognose the bleeding on the basis of hemodynamic disturbances and clinical symptoms occurring just after LB., Material and Methods: The study was performed on 145 patients with LB. The blood pressure and heart rate were examined before and after procedure of biopsy. In the group of 142 patients without bleeding complications, circulating disturbances and clinical symptoms were compared with three patients of bleeding subsequent to LB. The patients with bleeding were analyzed retrospectively., Results: In the group of patients without bleeding complications after LB there was observed statistically significant reduction of blood pressure. In 29 cases (46%) bradycardia occurred, in 15 cases (23.8%) clinical symptoms of vasovagal syndrome were noticed. Pain at the needle insertion site and shoulder pain happened in 15 (10.6%) patients. In one patient with low hypotension the pain was intense and localized in the whole abdominal cavity. In two cases with bleeding the hypotension occurred in 6th and 7th hour with the heart rate 60-70/min and in the third case the massive bleeding led to the shock., Conclusion: Hemodynamic disturbances including hypotension and bradycardia are frequent and difficult to diagnose. Bradycardia does not differentiate vasovagal reaction after LB with hypotension caused by bleeding. Coincidence of hypotension with abdominal pain indicates the high probability of bleeding subsequent to LB. Ultrasound examination of the abdomen is highly useful in the confirmation of bleeding complications.

CT perfusion is a new diagnostic method which enables imaging of the hemodynamics of tissues and organs. Until now most of the publications have been focused on the use of this technique to assess acute stroke. The aim of the presented work is to show the role of CT perfusion in the diagnosis of cerebral gliomas. These tumors are characterized by intensive vascularity which results in an increased blood volume (CBV), blood flow (CBF) and permeability surface (PS) values in perfusion CT examination. A correlation has been reported between perfusion parameters and the histopathological tumor grade. CT perfusion provides morphological and functional information which is useful in the diagnosis, planning treatment strategies and monitoring of the therapeutic effect in cerebral gliomas.

Cannabinoids, the active ingredients of Cannabis sativa, have been used by humans as hallucinogens and therapeutic agents for thousands of years. These agents are now known to act through the cannabinoid CB1 and CB2 receptors. The recent discovery of endogenous cannabinoids and the fact that they are involved in the pathology of hypotension associated with hemorrhage, sepsis, cirrhosis, and myocardial infarction indicate that cannabinoids play a greater role in human and animal pathophysiology than initially anticipated. Anandamide is the first of the endogenous cannabinoid ligands discovered. Its intravenous administration produces a characteristic three-phase response in the circulatory systems of experimental animals: In phase 1--a short-lasting decrease in heart rate and systemic blood pressure is related to activation of vanilloid TRPV1 receptors. In phase 2 an increase in blood pressure involves multiple mechanisms, both central (probably through the rostral ventrolateral medulla) and peripheral (vascular, Ca2+-dependent). In phase 3 there is a prolonged decrease in blood pressure and sometimes bradycardia, related to the activation of cannabinoid CB1 and vanilloid TRPV1 receptors. On the basis of this three-phase mechanism, the present paper intends to describe the participation of anandamide in the circulatory system under physiological and pathophysiological conditions. It also discusses the possibility of applying cannabinoid ligands as new therapeutic agents for the treatment of some pathologies.

Unlabelled: Head-up tilting causes many changes in cardiovascular system (CVS), and stimulates sympathetic nervous system, which leads to increase of total peripheral resistance (TPR) and acceleration of heart rate (HR). The hemodynamic changes influence pulse wave shape and mechanical properties of the arterial system. Arterial compliance (C) and elastance (Ea) are parameters used to describe mechanical properties of the arterial system. The study aim was to evaluate arterial stiffness by evaluation of arterial elastance and compliance during graded head-up tilting and assessment of the relationship between the change of the tilt angle and those parameters in healthy young subjects., Material and Methods: The study was conducted in 32 healthy volunteers (21-30 years old, 17 female). After 20 minutes of supine rest, the head-up tilting was performed with the use of a tilt-table with electrical engine. The tilt-table was stopped for 1 minute after reaching the angle of 15 degrees and its multiples (i.e. 30, 45, 60, 75 and 90 degrees). Hemodynamic parameters were measured by means of chest bioelectrical impedance method (BioZcom monitor, CardioDynamics, USA). The association of the sine of the tilt angle with Ea and C was calculated with the use of Pearson correlation., Results: A strong positive correlation between the sine of the tilt angle and Ea was noted (r = 0. 5084; p < 0.0001). A negative correlation between the change of the tilt angle during head-up tilting and C was found (r = -0.4608; p < 0.0001)., Conclusion: During graded head-up tilting, arterial stiffness increases in young healthy people.

Unlabelled: Adrenomedullin (ADM) is a potent vasodilator playing role in regulation of central hemodynamic. The concentration of plasma ADM in healthy people increases under the influence of orthostatic stress. In patients with vasovagal syncope (VS) the changes in ADM concentration could be responsible either for syncope provocation or prevention. The aim of the study was to assess the influence of phase of the head-up tilt test (HUTT) in which the syncope occurred on the plasma concentration of ADM., Material and Methods: The study was performed in 25 patients (pts) (18 women and 7 men), mean age 45.0+/-16.1 years with cardiodepressive reactions during HUTT according to the Italian protocol with nitroglycerine (NTG) provocation if necessary: Syncope was caused in 23 pts due to vasovagal reaction: in 17 pts syncope occurred after NTG provocation (group 1), and in 6 pts occurred in the passive phase of tilt (group 2a), in 2 pts due to dysautonomic reactions (group 2b). The head-up tilt test was performed according to ESC guidelines. The blood for ADM concentration was drawn after 30 min supine rest (ADM 1) and immediately after syncope (ADM 2). ADM level was measured using radioimmunological method. The results. In group 1 plasma level of ADM significantly decreased after the HUTT (3.2+/-3.4 vs 1.7+/-1,4 pg/0.1 ml; p<0.05) and in group 2a increased significantly (1.3+/-0.8 vs 2.7+/-1.3 pg/0.1 ml; p<0.05) comparing to baseline values. The ADM concentration did not differ between the groups in baseline conditions and was significantly higher after the syncope in group 2a (p<0.05). Conclusions. The excessive increase of ADM concentration during the passive phase of HUTT could play the causative role in pathogenesis of VS occurring early during the HUTT. In patients with VS after NTG provocation the decrease of ADM concentration can be the result of hemodynamic changes in the presence of vasodilating drug and may be the mechanism that could prevent the syncope.

EC-SOD catalyzes the dismutation of superoxide radical to hydrogen peroxide and oxygen in the interstitial spaces of tissues and in extracellular fluids (plasma, lymph, and synovial fluid). It eliminates superoxide radicals from the cell environment and prevents the formation of reactive oxygen species and their derivatives. EC-SOD is a secretory, tetrameric glycoprotein containing copper and zinc, with a high affinity to certain glycosaminoglycans, such as heparin and heparan sulfate. It plays an important role in maintaining vascular tone, lung function, and the metabolism of NO, and in the pathology of such diseases as atherosclerosis, diabetes, and arthritis. This paper describes EC-SOD structure, function in tissues, and possibilities of therapy with application of this enzyme.

Headache is one of the most common medical complaints of civilized humans; migraine, according to the IHS classification, is most often a primary episodic headache disorder. The pathophysiology of migraine is still unclear. The authors reviewed the literature and discussed mechanisms of pain, aura and other migraine symptoms. The last century has brought the shift from the vascular theory (that cranial vessels are the prime movers of the disorder) to a more integrated neurovascular theory, which takes the view that vascular change is secondary to neural activation. The most current concept of migraine pathophysiology describes migraine as a manifestation of the hereditary or predisposed sensitivity of neurovascular reaction to certain stimuli or to cyclic changes in the central nervous system. The initiation of migraine attack involves primary CNS dysfunction with subsequent activation of the trigeminovascular system. In this complex reaction a variety of biochemical factors take place. Detailed studies of this pathological pathway enable proper treatment methods to be applied.

Heme oxygenase (HO) degrades heme to carbon monoxide (CO), ferrous ions, and the bile pigment biliverdin, which is subsequently reduced to the other important bile pigment, bilirubin, by biliverdin reductase. Fe2+ liberated from the heme molecule upregulates ferritin production, and bile pigments are potent endogenous antioxidants. The HO enzyme exists in three isophorms: HO-1 is expressed at low levels under physiological conditions, but is induced by numerous factors, including oxidative stress, inflammation, nitric oxide, an elevated level of substrate, and hypoxia. HO-2 is a constitutive enzyme involved in the baseline production of CO in the cardiovascular and nervous systems, whereas HO-3 is also ubiquitously expressed, but possesses low catalytic activity. Like nitric oxide, CO activates soluble guanylate cyclase and elevates cGMP in target tissues, which dilates blood vessels. It also does this by directly activating potassium channels in vascular smooth muscle cells. In addition, CO inhibits platelet aggregation and proliferation of vascular smooth muscle cells, inhibits apoptosis, and stimulates angiogenesis. Both deficiency, and excess of HO-1 may be involved in the pathogenesis of arterial hypertension. Induction of HO-1 attenuates atherosclerosis and myocardial ischemia-reperfusion injury. Pharmacological and genetic induction of HO-1 as well as the delivery of exogenous CO are promising therapeutic strategies for the treatment of cardiovascular diseases.

Liver transplantation is becoming more and more common treatment method of liver diseases. The occurring complications may result from ischemia and reperfusion. However, the precise mechanism of these changes is not fully known. Microcirculation disturbances leading to ischemic damage of cells or their death are among those factors which cause liver damage under the influence of ischemia and reperfusion. These disturbances are intensified by increase of liver ischemia time and correlate with the number of wasted away hepatocytes. Endothelial cells, Browicz-Kupffer cells, neutrophils and thrombocytes are thought to play an essential role in liver microcirculation disturbances. Disturbed balance between local vasodilators and vasoconstrictors is also an important factor as it increases the lesions caused by reperfusion due to improper blood circulation. Nitrogen oxide (NO) is the most important local vasodilator. Inhibition of its synthesis in the period of early liver damage due to reperfusion causes a decrease of blood flow and increase of the occurring changes. Such strong vasoconstrictors as endothelin-1 and thromboxane play an important role. Reperfusion by damaging endothelial cells of sinusoid vessels affects the loss of endothelial barrier by the liver sinusoid vessels.

Purpose: To assess temperature on the eye surface after local anesthesia due to phacoemulsyfication., Material and Methods: 15 patients treated with local anesthesia: peribulbar - 5, retrobulbar - 5 and sub Tenon anesthesia. Mean temperature on both eye surface was assessed with termovision camera (Inframetrics 760) before surgery, 20 minutes and 1 hour after anesthesia., Results: In all examined groups changes in temperature values in anesthetized and contralateral eye were observed. Significant decrease of temperature was observed after sub Tenon anesthesia., Conclusions: Eye surface temperature and its changes can be considered as indirect indicator of blood supply and blood supply disturbances after local anesthesia.

A case of severe organic affective disorder after head trauma with loss of consciousness is presented. While CT in this case was normal, SPECT brain perfusion imaging showed hipoperfusion in the right frontal lobe and the left temporal-parietal region. The psychologic tests: Benton, Bender, MMPI confirmed changes in CNS as well. These findings help to explain the severity and chronicity of disorders and medical certification.

The aim of the work was evaluation of influence of infectious process before and in first few days of cerebral infarction on concentrations of acute phase proteins (APP). We evaluated also dynamics of changes of APP and correlation between infection and clinical status and size of ischemia. We examined 47 sick: 30 without infections and 17 with infectious process. Concentrations of C-reactive protein (CRP) and fibrinogen in serum were estimated on 1, 3 and 7 day of infarction. Fisher's scale was used to evaluate patients' clinical status. Comparing to patients without infection, in patients with infection, concentrations of CRP and fibrinogen were higher in all days of investigation but dynamic of changes was different. The highest concentrations of APP in patients without infection were observed on 3 day of infarction (CRP 3.55 +/- 6.76 mg/dl, fibrinogen 425.7 +/- 117.9 mg/dl). In group with infection APP gradually increased and was highest on 7 day (CRP 7.91 +/- 9.28 mg/dl, fibrinogen 422 +/- 119.5 mg/dl). Clinical status of patients with infection compare to patients without infection was heavier and the ischemic focus was larger. Infectious process coexisting witch infectious process influences on deterioration of clinical status and intensifies neurological disorders.

A case of refractory hemodynamic instability following metoprolol and diltiazem overdose is reported. Management included intra-aortic balloon counterpulsation as an adjunct to pharmacologic therapy in cardiogenic shock from overdose of myocardial depressant drugs.

Unlabelled: The aim of our study was to investigate prevalence, characteristics and extensiveness of CA plaques in acute stroke using high-resolution B-mode USG., Methods: USG of CA was performed with a 7.0-MHz Duplex-type scanner Acuson 128 XP/10 C. We examined 149 patients aged 26-95 years, with acute ischemic stroke, consecutively admitted to our Department. Atheromatous plaques morphology was determined using the HSP Classification (H--Hemodynamic characteristics, S--Surface plaque, P--Plaque echogenics)., Results: An extracranial carotid disease (CCA, ICA, ECA) was found in 85 (57%) patients, while 67 (45%) patients had atheromatous changes in ICA. Bilateral ICA plaques were found in 22 (15%) patients, and unilateral--in 45 (30%) patients. In 17 (11%) patients plaques were associated with artery occlusion (in 16 cases ipsilateral to the stroke site, and in 1 case--contralateral). No bilateral occlusion of ICA was observed. In 6 (4%) patients stenosis (ranging from 60 to 99%) was found in only one ICA, while in 4 (2.7%) cases there was also contralateral stenosis < 60%. In 4 patients a contralateral occlusion was present. Ulcerated plaques were noted in 22 (15%) patients--in 18 cases ipsilateral to the stroke, and in the remaining 4--contralaterally. None of the patients had a bilateral ulceration., Conclusion: Atheromatous ICA changes were found in 45% of the patients under study. However, these plaques may be the cause of cerebral ischemia associated with a high-grade stenosis, occlusion or ulceration ipsilateral to the stroke site in 15.45% of the patients only.

Most recent studies on transcranial Doppler (TCD) in the acute phase of ischemic stroke are reviewed in this paper. TCD is a highly sensitive and specific method of quick, bedside assessment of cerebrovascular circulation hemodynamics in the acute phase of ischemic stroke. The following issues are discussed in the paper: a new classification of ultrasound pathological changes associated with intracranial arteries occlusion or stenosis, the frequency of spontaneous re-canalisation by TCD, a comparison of TCD results with findings obtained by means of other vascular imaging techniques (e.g. DSA, CTA and MRA), relationship between TCD baseline assessment of primary blood flow changes and thrombolysis efficacy (the so-called TIBI classification, Thrombolysis in Brain Ischemia), and prognostic significance of TCD in the acute ischemic stroke. Moreover, first clinical reports on an additive effect of TCD on thrombolytic therapy are presented. The main limitations of TCD include the lack of sufficient bone window in 5-15% of patients and the lack of sufficiently trained staff capable of performing the examination a 24 h duty, since results of the examination to a large degree depend on the examiner's skills.

Mild head injury constitutes about 75% of all head injury cases. The post-concussion syndrome usually following a mild head injury is connected with numerous symptoms and not very severe signs. Research findings indicate that the symptoms related to mild head injuries persist for over 6 months in most patients. Accumulating evidence provided by neuropathological, physiological, psychological and neuroimaging studies pointing to an organic substrate of the postconcussion syndrome invalidates the "Hollywood head injury myth". No information is available on Doppler evaluation in patients with mild head injury. The aim of the study was to evaluate blood flow in selected precranial and intracranial vessels using Doppler ultrasonography in patients at various stages after mild head injuries. The dynamic assessment of blood flow velocity and pulsatility index was carried out in 51 patients on the day of the injury, on the third day, and the sixth day. Moreover, 22 patients were assessed at a follow-up six months to five years the injury. The control group consisted of 61 healthy volunteers. Obtained results show an increase in the blood flow velocity in the middle cerebral artery on the day of the injury and a decrease within the following days in younger patients (aged < 30 yrs). In older persons (aged > 30 yrs) and patients with injuries sustained in a distant past, the indices of blood flow velocity in precranial and intracranial arteries did not significantly differ from these in the control group of comparable age. In our opinion mild head injury affects the blood flow velocity in cerebral arteries. The haemodynamic disturbances noted in younger patients with mild head injuries seem to be connected with changes in the autonomous nervous system activity.

Morphological changes found during post-mortem examination of victim dying from accidental hypothermia were collected and disputed in this paper. The practical usefulness of these changes in the diagnosis of sudden death was estimated.

Unlabelled: The aim of this study was to evaluate the alterations of stroke volume (SV) on the QT dispersion (QTD) as a result of different pacing modes (DDD, VVI) and programmed AV delays (AVD)., Material and Methods: We studied 60 patients (pts) (22 F, 38 M) in mean age 67.5 +/- 7.5 yrs in whom DDD pacemakers were implanted due to complete atrioventricular block (AVB III degree). 10 pts had coronary artery disease (CAD)--"CAD" subgroup, 14 pts arterial hypertension (AH)--"AH" subgroup, 27 pts CAD and AH--"AH + CAD" subgroup. The control group consisted of 9 pts without structural heart disease, but with AVB III degree, paced in DDD mode. Previous myocardial infarction was recognised in 7 patients in "CAD" subgroup and in 7 patients in "AH + CAD" subgroup. Left ventricular hypertrophy was detected in 4 men in "AH" subgroup and in 8 patients in "AH + CAD" subgroup. In all cases basic rate of the pacemaker was programmed at 70/min. Resting ECG showed all atrial and ventricular complexes captured. AVD optimization was based on the measurements of SV by Doppler echocardiography. QT intervals (QT) were measured from 12-lead ECG at 50 mm/sec. speed. QTD was calculated as the difference between maximal and minimal QT. It was measured at optimal AVD (with highest SV--opt. DDD) and "unoptimal" AVD (unopt. DDD) programmed AV intervals and then in VVI mode (with lowest SV) after 24 hrs following reprogramming of the pacemaker., Results: In the whole population, in DDD mode, we found a strong correlation between SV and QTD (r = -0.655; p < 0.01). In VVI mode SV was significantly lower than in unopt. DDD (78.7 ml vs 90.0 ml, p < 0.001) and QTD was significantly greater (74.3 ms vs 69.2 ms, p < 0.05). The modifications in AVD and conversion of pacing mode (VVI to DDD) leading to maximal SV resulted in decreased QT dispersion. The highest SV (128.9 ml at opt. DDD) and the lowest QTD (48.3 ms at opt. DDD) were seen in the controls, but changes in dispersion were the least and insignificant during different pacing modes. In CAD; AH + CAD pts, we observed the lowest SV (61.7 ml; 74.9 ml at VVI respectively) and the highest QTD (77.8 ms; 80.9 ms at VVI respectively). In these pts, the modifications of AVD and conversion of pacing mode (VVI to opt. DDD) leading to maximal SV (106.8 ml; 115.9 ml in CAD and AH + CAD pts, respectively) resulted in decreased QTD (53.9 ms; 56.6 ms, respectively). During DDD pacing there was significant correlation of QTD to SV (r = -0.680; r = -0.656, respectively). In CAD pts with myocardial infarction or in AH pts with LV hypertrophy the correlation of SV to QTD was stronger (r = -0.937, r = -0.886, p < 0.025, respectively). We didn't find the correlation in the control group (r = -0.318)., Conclusions: Programming of different AVD and pacing modes significantly influences QTD in CAD and/or AH pts. QTD reflects hemodynamic status of these paced pts.

Aim: In our study we utilised transcranial Doppler sonography (TCD) and the test with intravenously administered acetazolamide (reversible inhibitor of carbonic anhydrase) which causes vasodilatation of the brain resistance vessels to assess cerebrovascular reserve capacity (CVRC) in patients with symptomatic and asymptomatic carotid stenosis., Material: 25 patients (22 male, 3 female; aged 46-82; mean 62 years) with carotid artery disease were examined. They were qualified for the operation because of that., Method: Blood flow wave spectrum in the right and left middle cerebral artery (MCA) was analysed. 2 MHz pulsed-wave transducer was placed over the appropriate temporal acoustic window. We measured mean blood flow velocity (Vmean) in both MCAs. The records were taken: a) at rest, b) 15 minutes after 1.0 g of acetazolamide was administered intravenously. Cerebrovascular reserve (CVRC) was calculated as the maximal percentage increase in the appropriate MCA after the administration of acetazolamide in comparison with its value at rest. The values of CVRC were analysed statistically., Results: 15 minutes after acetazolamide was injected CVRC was 44 +/- 15% (mean +/- SD) (range 0-74) in asymptomatic hemispheres. In 30 patients (97%) CVRC was 46 +/- 12% (23-74) and in 1 patient (3%) 0% (case nr 7). In the group of symptomatic hemispheres CVRC was 12 +/- 15% (-16-36) after acetazolamide administration. In 12 patients (63%) from this group CVRC was positive: 20 +/- 11% (3-33), in 4 patients (21%) CVRC was 0% (cases nr 8, 9, 22, 23) and in other 3 patients (16%) CVRC was negative: -7 +/- 8 (-16(-)-3) (cases nr 4, 12, 19)., Conclusion: 1. The group of patients with symptomatic hemispheres have statistically lower CVRC in comparison with the group of asymptomatic hemispheres. 2. There was no statistical difference between the mean values of CVRC in patients with bilateral, severe carotid stenosis and the ones with unilateral changes. 3. We believe that such a test performed by means of TCD and intravenously injected acetazolamide can indicate a subgroup of patients with carotid stenosis for whom carotid endarterectomy is necessary at the earliest time because of possible early neurological complications appearance which are related to the lack or serious impairment of CVRC.

The aim of this study was to estimate the results of tilt table testing in two groups of healthy adolescents--swimmers and control. Cardio-vascular reactions on tilting were determined by the measurements of heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP). The study was carried out in accordance with the Polish Cardiac Society procedure. The positive tilt table testing results were observed in most young swimmers and in about thirty per cent of controls. The differences in the cardiovascular reactions were observed, too. The clinical interpretation and usefulness of these results must be established by future investigations.

The study was carried out in 17 randomly chosen patients who were subjected to cholecystectomy under general anesthesia with the use of laparolift method. Heart rate, systolic and diastolic blood pressure, wedge pressure, mean pulmonary artery pressure, central venous pressure and stroke volume were analyzed in the five following stages of the procedure. The performed examinations showed the transient increase of the pressures in peripheral and pulmonary vascular system as well as heart rate acceleration--during the operation and the increase of cardiac output in postoperative period. The observed changes did not need therapeutic interventions in any case. The obtained results prove that applied operative technique caused no dangerous side effects.

The Near Infrared Spectroscopy (NIRS) has been established as a non-invasive method for monitoring the oxygenation state of human brain at the bedside. This possible by observing spectral changes in the tissue caused by presence of oxygenated hemoglobin, deoxygenated hemoglobin and cytochrome aa3. In this paper the technical data of the NIRS instrument and its clinical application particularly in investigation of cerebral oxygenation and hemodynamic has been described.

Left ventricular function was compared in 27 patients who had conventional mitral valve replacement--cMVR (group I) and 24 patients who had modified mitral valve replacement with preservation of chordae tendineae and papillary muscles--mMVR (group II) (Tab. 1). In group I 12 patients were operated on because of isolated mitral stenosis (group Ia) and 15 patients due to mitral insufficiency (group Ib). In group II mitral stenosis was indication for operation in 5 patients (group IIa) and mitral insufficiency in 19 patients (group IIb) (Tab. 2). In each group pre- and postoperative values of stroke volume, stroke volume index, right ventricular stroke work index, left ventricular stroke work index and the need for inotropic support were compared (Tab. 5). Patients after cMVR (group I) showed decreased values of all compared indices. 59.3% of patients in this group needed inotropic support in early postoperative period. This tendency was more prominent in group Ib (mitral insufficiency) than in group Ia (mitral stenosis). Patients in group II did not show significant differences between pre- and postoperative hemodynamic data except significantly increased stroke volume and right ventricular stroke work index in group IIb. 41.7% of patients in group II needed inotropic support. Summing up, left ventricular function deteriorated after operation in the group with subvalvular apparatus excised. The deterioration was especially significant in the patients operated on because of mitral insufficiency.

Classification, mechanism of action, hemodynamic and electrophysiological effects of calcium antagonists also structure of L-type calcium channel (cell receptor for this group of drugs) have been presented. Current views about the role of calcium channel antagonists in treatment of vasospastic angina pectoris, in particular Prinzmetal's angina, have been discussed. The use of calcium antagonists for the prevention of coronary restenosis after successful percutaneous transluminal coronary angioplasty have been analysed. Beneficial effects of calcium channel blockers (diltiazem 180 mg per day and verapamil 480 mg per day) for the prevention of restenosis after coronary angioplasty in a group of patients with stable angina pectoris have been demonstrated. Future directions in the trials on the calcium antagonists were been also presented.

The aim of the work was to check if cerebrospinal fluid drainage performed under general anaesthesia altered in time the permeability of the blood/cerebrospinal fluid barrier (BCSFB), the part of blood-brain barrier. Twelve adult Chinchilla rabbits were included into the study. The animals were divided into 2 groups: control and investigated. The cerebrospinal fluid drainage was performed in animals from the studied group. Gentamycin was applied as the marker of tightness of BCSFB; under normal circumstances BCSFB prevented or limited the passage of gentamycin to the cerebrospinal fluid after intravenous administration. Heart rate (HR), arterial blood pressure (SAP, DAP, MAP), central venous pressure (CVP), blood-gas analysis (BGA), end-expiratory CO2 pressure (et CO2), hemoglobin, hematocrit, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were recorded. General anaesthesia was performed under circumstances that excluded the influence of any additional factor on the permeability of the BCSFB and haemodynamic, haematologic and gasometric parameters were stable in all animals. The influence of the cerebrospinal fluid drainage on the permeability of the BCSFB was evaluated using gentamycin concentration levels in blood and cerebrospinal fluid. Mean haemodynamic, haematologic and gasometric parameter values showed no within-group and between-group differences. In the investigated group the cerebrospinal fluid drainage was followed by a decrease in intracranial pressure (Tab. 1, Fig 1.) without changes in cerebral perfusion pressure (Tab. 2, Fig. 2). No significant changes in gentamycin permeability indexes were stated (Tab. 3, Fig. 3). Cerebrospinal fluid drainage performed under general anaesthesia caused no increase of the permeability of the BCSFB. A decrease of the intracranial pressure without changes of the cerebral perfusion pressure followed the cerebrospinal fluid drainage.

Arterial hypertension is a hemodynamic changeable process. The haemodynamic parameters also change when the disease develops. The changes of main haemodynamic parameters according to the intensity of hypertensive disease at rest and during exercise have been presented. The haemodynamic changes observed during short-term physical exercise, may be the indication for evaluation and foreseeing the changes in patients with essential arterial hypertension. Simultaneously the authors draw the attention to a permanent and slow increase in total peripheral resistance (TPR) form the earliest stages of the disease.

The contemporary literature has widely described the role of insufficiency of blood flow in glaucomatous damage. The paper presents the blood supply of the optic nerve head and the role of systemic and nocturnal hypotension, vasospasmus syndrome, carotide artery disease, location of the wathershed zone in relation to the optic disc and the effects of defective autoregulation of blood flow in glaucoma. The implications of vascular risk factors in glaucoma for its prognostics and management are discussed.

The authors emphasize the complex and multifactorial mechanism by which retinal vein occlusion occurs. A special attention is paid to arterial insufficiency which impacts formation of clinical picture as well as the development of occlusion and the complications.

Purpose: This prospective study was designed to compare intraocular pressure changes and haemodynamic response to insertion of either a laryngeal mask or an orotracheal tube during general anaesthesia for cataract surgery., Material and Methods: The effect of techniques (tracheal tube-TT, laryngeal mask airway-LMA) securing a clear upper airway on the heart rate changes (HR), arterial pressure (SAP, DAP), oxygen saturation (SpO2), end-tidal carbon-dioxide pressure (Et-CO2), intraocular pressure (IOP) and the incidence of coughing, stridor and sore throat was analysed in 60 patients undergoing cataract surgery during general anaesthesia., Results: The mean values for HR, SAP, DAP and IOP measured before and after induction of anaesthesia were not different in both groups. After securing a clear airway, mean HR increased in TT group to 95.5/min and decreased to 75.7/min in LMA group. SAP increased in TT group to 131 mmHg, DAP to 82.6 mmHg, whilst in LMA group both values decreased to 98.6 mmHG and 66.3 mmHg, respectively. The significant difference in IOP values was observed after intubation or using laryngeal mask. In TT group, intraocular pressure increased to 15 mmHg in healthy eye and to 13.6 mmHg in ill eye whilst there was a decrease in LMA group to 5.5 and 7.43 mmHg, respectively. Furthermore, a greater incidence of such complications as coughing, stridor and sore throat in TT group was observed., Conclusion: The results show that using LMA in microsurgery during general anaesthesia is more advantageous and safer for patients in comparison with tracheal intubation.

The aim of this study was to test if the lung compliance and other indices of pulmonary function correlated with hemodynamic parameters in patients with secondary pulmonary hypertension due to mitral stenosis. 36 patients (mean age 50 years) with mitral stenosis (mean mitral valve area-1.2 cm2), without history of lung diseases were analyzed in the study. 16 patients (group A) were in the II-nd and 20 patients (group B) were in the III-rd and IV-th NYHA class. All patients underwent Swan-Ganz catheterization with evaluation of pulmonary pressures, resistances and pulmonary veins compliance. Pulmonary function tests (spirometry, plethysomography, lung compliance) were also performed. In both analyzed groups the pulmonary artery pressure and pulmonary vein compliance correlated significantly with pulmonary compliance.

The aim of the study was the estimation of the right ventricular function in patients with hypertrophic cardiomyopathy (HC). 20 patients, 14 men and 6 women of age 23-50 with echocardiography diagnosed hypertrophic cardiomyopathy were examined. Equilibrium gated radionuclide angiography was performed in all patients. Right and left ventricle ejection fraction (EF), 1/3 first ejection fraction (1/3EF), maximal and average rate of emptying (MER, AER), time to peak emptying (TTPE), 1/3 first filling fraction (1/3FF), maximal and average rate of filling (MFR, AFR), time to peak filling (TTPF) and MFR/MER ratio were calculated. Analysing function of right ventricle in patients with HC impaired diastolic function was observed. MFR was 1.44 +/- 0.54EDV/s,AFR-0.95 +/- 0.24EDV/s, 1/3 FF-0.49 +/- 0.09. Positive correlation between right and left ventricle MFR was found (r = 0.62; p < 0.01). Mean value of RVEF was 40.8 +/- 7%, 1/3EF-17.5 +/- 5%, MER-1.88 +/- 0.4EDV/s, AER-1.59 +/- 0.4EDV/s. Decreased ejection fractions of the right ventricle in patients with the thickest interventricular septum were observed. Mean value of the time to peak emptying was short (x = 68.6 ms). Regional ejection fractions from septum region of RV were decreased. It was the result of the abnormal function of the interventricular septum in patients with hypertrophic cardiomyopathy. Indexes of RV function in the two groups of patients were also analysed: with and without left ventricular outflow tract obstruction. Mean value of RV systolic and diastolic function indexes were similar in two groups of patients. In conclusion, impairment of the right ventricle diastolic function in patients with hypertrophic cardiomyopathy is predominated. The more diastolic function of the RV deteriorates the worse diastolic function of the left ventricle remains in patients with HC.

CPAP breathing increases alveolar and intrathoracic pressures. We aimed to investigate the effects of CPAP and BiPAP breathing on pulmonary haemodynamics in patients with OSA. Ten male patients with OSA (AHI = 48 +/- 22) were studied. In each patient intravascular and esophageal pressures were measured and mean transmural pulmonary artery and transmural wedge (Pwtm) pressures were calculated. After baseline recordings patients were submitted to 25 min. of CPAP and BiPAP breathing in random order. The pressure of 10 cm H20 for CPAP and 10/4 cm H20 for BiPAP was used. At baseline pulmonary arterial pressures and flow were normal. CPAP breathing resulted in an increase in mean pulmonary intravascular pressure from 15.5 +/- 1.8 mmHg to 17.1 +/- 2.3 mmHg (p < 0.05). Transmural pressure did not change. There was also no change in the cardiac output (CO) and pulmonary vascular resistance (PVR). At some time points pulmonary arterial pressures were higher during CPAP breathing than during BiPAP breathing (p < 0.01). BiPAP breathing had no effect on intravascular and transmural pressures, CO and PVR. We conclude that CPAP breathing increase pulmonary intravascular but not transmural, true, pressure. BiPAP breathing does not change pulmonary haemodynamics what may be of importance as pulmonary circulation is concerned.

The aim of the study was to assess the efficacy of low dose subcutaneous (sc) recombinant human erythropoietin (rHuEpo) therapy in hemodialysis (hd) patients, with particular emphasis on their quality of life. 25 anemic (Ht < 25%) hd patients with end-stage renal disease were given small sc doses of rHuEpo once or twice weekly for 12 months. During first 4 months of the therapy there was a significant increase of Ht (21.1 +/- 0.5 vs 28.5 +/- 0.6%; p < 0.0001) and serum hb (6.68 +/- 0.12 vs 8.51 +/- 0.18 g/dl; p < 0.0001) at mean induction dose of 52.5 +/- 2.5 IU/kg/week and this was maintained with a mean dose 67.0 +/- 10.5 IU/kg/week. RHuEpo was effective in 24 patients; all of them required no blood transfusions after starting the therapy. In majority of patients an substantial (p < 0.01) improvements in exercise tolerance, well-being, cold tolerance, sexual satisfaction and libido were observed, although sexual hormones profile revealed no significant changes during the treatment. Within first 6 months of the study cardiac index decreased substantially (p < 0.01), mainly because of stroke volume reduction, but after one year this hemodynamic improvement was noted only in patients who maintained a stable blood pressure. Hypertension worsened in 31% of patients. Low-dose s.c. rHuEpo: (1) is effective and safe treatment for anemia in hds patients, sufficient to abolish blood transfusion requirements; (2) produces significant improvements in quality of life; and (3) allows for 50% costs reduction.

The study was carried out in 42 healthy men--control group and in 21 patients with borderline essential hypertension. It was found that the patients differ in hemodynamics from the control group. The group patients as a whole show significantly higher blood pressure, lower plasma volume and shorter total transit time compared with normotensive men. Division the patients on the renin subgroups revealed significant difference. High renin patients had hyperkinetic circulation. Patients with normal renin had significantly elevated total peripheral resistance. These results suggest that renin-angiotensin system no played an essential role in pathogenesis of borderline hypertension.

The aim of the study was to assess effects of long-term oxygen therapy (LTOT) on pulmonary haemodynamics in patients with chronic obstructive pulmonary disease (COPD). 93 pts (73M, 20F) mean age 58 years, entered the study. Their functional characteristics at entry for LTOT revealed: VC 2.33L, FEV1, 0.85L, FEV1/VC 37%, PaO2 55.5 mmHg, PaO2 46.7 mmHg, Hct 50%. Pulmonary haemodynamics showed: mild pulmonary hypertension (mean pulmonary arterial pressure PPA 25.9 mmHg), normal pulmonary wedge pressure (Pw) and increased driving pressure (PPA-Pw) 17.8 mmHg. Cardiac output (CO) was normal and pulmonary vascular resistance (PVR) averaged 313 dyne.s.cm-5. All enrolled patients were treated with oxygen at home and followed-up for at least 2 years. After 2 years of LTOT PPA and Pw fell by 2.4. and 2.6 mmHg, respectively, and (PPA-Pw) remained stable. An increase in CO by 0.31.min-1 was found while PVR was stable. After 4 years of treatment PPA, (PPA-Pw) and CO increased by 1.5, 1.7 mmHg and 0.9 l.min-1 respectively, while Pw and PVR remained stable. In 12 six years survivors PPA decreased after 2 years by 4.4 mmHg and cardiac output increased by 2 l.min-1 both returning to baseline after 6 years of LTOT. No significant changes in PVR were observed. Comparison of lung function tests before and after 6 years of LTOT showed deterioration of airways obstruction and of respiratory failure. LTOT for 14 h/d results in long-term stabilization of the hypoxic pulmonary hypertension despite of the progression of the natural course of COPD.

The aim of the work was an attempt at answering the question whether there is any correlation between the haemodynamic indices describing arterial elasticity assessed by physical analysis of the circulatory system and lipid risk factors for arterial atherosclerosis in boys aged 15 to 18 years. The studies included 45 boys with lipid risk factors for atherosclerosis. The control group included 53 boys without lipid risk factors. In boys aged 17-18 years with lipid risk factors for atherosclerosis as compared with their peers with normal serum lipid level, a statistically significant change of arterial elasticity was found. A positive correlation was also found between the increased serum cholesterol level and the values of air-chamber elasticity index and peripheral vascular resistance, and a negative correlation was demonstrated between the decreased serum HDL-cholesterol concentration and the increase of pulse wave velocity in the aorta, air-chamber elasticity index and peripheral vascular resistance.