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Coronavirus disease 2019 (COVID-19) pandemic disorganised healthcare systems and has caused a reduction in the number of hospitalizations and procedures. Cardiac implantable electronic device (CIED) procedure rates and clinical characteristics of their recipients were compared in corresponding weeks of 2019 and 2020 were analyzed.The database of the National Health Fund (NHF) in Poland was retrospectively analyzed. 3206 patients who underwent CIED implantation in the Silesia - a region in Southern Poland comprising an adult population of 3.8 million between 12th and 31st week of 2020. Patients were classified into groups: the recipient of an implantable cardioverter-defibrillator or cardiac resynchronization therapy group (ICD/CRT) or pacemaker group (PM).During the pandemic a reduction of 39.38% of implantations was observed compared to the same period in 2019 (1210 vs. 1996 patients) and had impacted both groups. Two phases lasting 10 weeks each could be distinguished: total lockdown (maximal reduction) and the recovery phase with growing numbers of procedures. Patient baseline characteristics (sex, age, comorbidities) who were implanted during the COVID-19 pandemic did not differ from the 2019 period. The rate of peri-procedural mortality was also similar.During COVID-19 pandemic period a reduction in CIED implantations of all types was observed. Despite the decreased number of performed CIED implants, no differences in baseline patient characteristics were observed.

Background: Implantable cardioverter-defibrillator (ICD) therapy has been proven effective in the prevention of sudden cardiac death, but data on outcomes of ICD therapy in the young and otherwise healthy patients with long QT syndrome (LQTS) are limited. Aim: We sought to collect data on appropriate and inappropriate ICD discharges, risk factors, and ICD-related complications. Methods: All LQTS patients implanted with an ICD in 14 centres were investigated. Demographic, clinical, and ICD therapy data were collected. Results: The study included 67 patients (88% female). Median age at ICD implantation was 31 years (12–77 years). ICD indication was based on resuscitated cardiac arrest in 46 patients, syncope in 18 patients, and malignant family history in three patients. During a median follow-up of 48 months, 39 (58%) patients received one or more ICD therapies. Time to first appropriate discharge was up to 55 months. Inappropriate therapies were triggered by fast sinus rhythm, atrial fibrillation, and T-wave oversensing. No predictors of inappropriate shocks were identified. Risk factors for appropriate ICD therapy were: (1) recurrent syncope despite b-blocker treatment before ICD implantation, (2) pacemaker therapy before ICD implantation, (3) single-chamber ICD, and (4) noncompliance to b-blockers. In 38 (57%) patients, at least one complication occurred. Conclusions: ICD therapy is effective in nearly half the patient population; however, the rates of early and late complica­tions are high. Although the number of unnecessary ICD shocks and reimplantation procedures may be lowered by modern programming and increased longevity of newer ICD generators, other adverse events are less likely to be reduced.

Background: The prevalence of abdominal obesity and type 2 diabetes mellitus (T2DM) is a public health challenge. New solutions need to be developed to help patients implement lifestyle changes. Objective: The objective of the study was to evaluate a fully automated Web-based intervention designed to help users improve their dietary habits and increase their physical activity. Methods: The Accompagnement Nutritionnel de l’Obesite et du Diabete par E-coaching (ANODE) study was a 16-week, 1:1 parallel-arm, open-label randomized clinical trial. Patients with T2DM and abdominal obesity (n=120, aged 18-75 years) were recruited. Patients in the intervention arm (n=60) had access to a fully automated program (ANODE) to improve their lifestyle. Patients were asked to log on at least once per week. Human contact was limited to hotline support in cases of technical issues. The dietetic tool provided personalized menus and a shopping list for the day or the week. Stepwise physical activity was prescribed. The control arm (n=60) received general nutritional advice. The primary outcome was the change of the dietary score (International Diet Quality Index; DQI-I) between baseline and the end of the study. Secondary endpoints included changes in body weight, waist circumference, hemoglobin A1c (HbA1c) and measured maximum oxygen consumption (VO2 max). Results: The mean age of the participants was 57 years (standard deviation [SD] 9), mean body mass index was 33 kg/m² (SD 4), mean HbA1c was 7.2% (SD 1.1), and 66.7% (80/120) of participants were women. Using an intention-to-treat analysis, the DQI-I score (54.0, SD 5.7 in the ANODE arm; 52.8, SD 6.2 in the control arm; P=.28) increased significantly in the ANODE arm compared to the control arm (+4.55, SD 5.91 vs -1.68, SD 5.18; between arms P

WOS: 000418210700016, PubMed ID: 28336205, Background: Andersen-Tawil syndrome (ATS) is rare channelopathy caused by KCNJ2 mutation and probably KCNJ5. It is characterized by arrhythmias, neurological symptoms, and dysmorphic features. The present study retrospectively examined the characteristics of 11 unrelated families with ATS. Methods: This study consisted of 11 probands positive for KCNJ2 variants and 33 family members (mean age 30.0 +/- 17.3 years, female n=31). Additional genetic screening of 3 LQTS genes (KCNQ1, KCNH2, SCN5A) was performed in 9 families. Predictors of arrhythmias [premature ventricular beats>2000/24h, biventricular and polymorphic ventricular tachycardia (VT)], syncope, and/or cardiac arrest (CA) were evaluated. Results: In KCNJ2 mutation carriers vs non-carriers (n=25 vs n=19) significant differences were observed in U-wave manifestations in V2-V4, T-peak-T-end duration, QTUc duration (p2000/24h was higher (p=0.005). Conclusion: A higher risk of arrhythmia, syncope, and/or CA is associated with the presence of micrognathia, periodic paralysis, and prolonged T-peak-T-end time. Our findings suggest that K897T may contribute to the occurrence of syncope. (C) 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved., NHLBI of the NIHUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Heart Lung & Blood Institute (NHLBI) [HL47678], The Turkish part of the research was supported by NHLBI of the NIH (HL47678, CA).

Mutations in sodium channel alpha-subunit gene (SCN5A) result in multiple arrhythmic syndromes, including long QT3 (LQT3), Brugada syndrome (BS), an inherited cardiac conduction defect, sudden unexpected nocturnal death syndrome (SUNDS) and sudden infant death syndrome (SIDS), constituting a spectrum of disease entities termed Na+ channelopathies. These diseases are allelic disorders, if not the same disease with variable penetrance and variable modifiers worldwide. Interestingly, death occurs during sleep in all of these disorders, suggesting a common mechanism. To date, mutational analyses have revealed about 103 distinct mutations in SCN5A, of which at least more than 30 mutations are associated with LQT3, whereas the rest of the mutations are affiliated with the remaining sodium channel disorders. The majority of these mutations are missense. However, other types such as deletions, insertions, frameshifts, nonsense and splice-donor errors have also been reported.

Three hundred and three strains of group A streptococci (GAS) isolated from adults with pharyngitis were tested to evaluate their phenotype of resistance to macrolides-lincosamides and to search for macrolide resistance genes. MICs of clarithromycin were determined. The overall rate of resistance to both erythromycin and clarithromycin was 9.6%. Constitutive, inducible and M phenotypes of resistance were detected in 4.3, 2 and 3.3% of strains, respectively. All constitutive phenotypes harboured ermB genes, whereas inducible phenotypes had the ermTR gene and M phenotypes had the mefA gene. In France, the current resistance rate of GAS to erythromycin and clarithromycin remains low.

Neuron-specific enolase (NSE) is a glycolytic enzyme localized within neuronal and neuroendocrine tissues. Serum NSE is widely used as a marker of neuroendocrine tumors. Moderate serum NSE elevation has been reported in some patients with benign lung diseases. We decided to investigate whether the elevation of serum NSE in non-neoplastic lung diseases is connected with hypoxemia and to what extent the recovery of sufficient ventilation with a respirator may influence NSE concentrations. Serum NSE was estimated by means of radioimmunoassay in 83 patients with various non-neoplastic lung diseases. Serum NSE exceeding 12.5 micrograms/L was significantly more frequent in patients with marked hypoxemia (PaO26.67 kPa; p = 0.03) than in others. The median NSE value in the group of patients without respiratory failure (Ro) was 7.2 micrograms/L (10%12.5 micrograms/L), in the group of patients with respiratory failure not requiring mechanical ventilation (Rf) it was 8.5 micrograms/L (24%12.5 micrograms/L), and in the group of patients with respiratory failure requiring mechanical ventilation (Rfv) 13.1 micrograms/L (60%12.5 micrograms/L). The differences between the Rfv group and the other two groups (Rf and Ro) were significant (P = 0.049 and p = 0.0004, respectively). During successful mechanical ventilation elevated serum NSE decreased to values below the cutoff in 8/10 patients. We conclude that serum NSE elevation is a frequent event in patients with terminal hypoxemia in the course of benign lung diseases. Normalization of serum NSE is observed in the majority of patients during the first week of mechanical ventilation.

This study was designed to assess the value of tumor marker evaluation in pericardial fluid for the recognition of malignant pericarditis. Thirty-six patients with signs and symptoms of large pericardial effusion entered the study. Pericardiocentesis with pericardial fluid drainage was performed in all of them. CEA and NSE levels were evaluated in the pericardial fluid and compared to pericardial fluid cytology. The median CEA value in malignant effusions was 80 ng/ml (range 0-305 ng/ml) and in non-malignant ones 1.26 ng/ml (range 0.2-18.4 ng/ml), p Pericardial fluid cytology was positive in 22 of 26 patients with malignant pericarditis (85%). CEA exceeding 5 ng/ml or positive cytology were seen in 96% of the patients with malignant pericarditis. The median NSE value in malignant pericardial effusions was 41.8 μg/l (range 2-172 μg/l) and in non-malignant ones 5.85 μg/l (range 1-83.9 μg/l), p

Human chorionic gonadotropin (HCG)-like immunoreactivity has been found in many non-trophoblastic tumours, but the biological behaviour of HCG-producing cells has not been clarified yet. The aim of the study was to estimate the frequency of serum HCG beta subunit (s beta HCG) elevation in patients with small-cell lung cancer (SCLC) and to assess its possible prognostic role in this type of tumour. An attempt was also made to reclassify the histology in selected cases to see whether the elevated (s beta HCG) level is connected with any special subtype of small-cell lung cancer. A total of 156 SCLC patients entered the study: 93 men, 63 women, median age 58 years. s beta HCG activity was measured by immunoenzyme assay (Abbott EIA beta HCG 15-15) before treatment. s beta HCG elevation (above 5 mIU/ml) was found in 21 of 156 patients (14%). Response to treatment after chemotherapy (complete and partial response) was obtained in only 48% of those patients in whom elevated s beta HCG was found, in comparison to the 73% response rate observed in the remaining patients. Only 5% of patients with elevated s beta HCG survived 2 years, in comparison to 21% surviving for 2 years among the remaining patients. The prognostic significance of elevated s beta HCG and extent of disease were independent of each other (Cox's proportional-hazard model). Thus s beta HCG elevation in SCLC seems to be a marker of more resistant tumours and of poor prognosis. We have not found any connection between the subtype of small-cell lung cancer and elevated s beta HCG. Elevated s beta HCG was found in 2 out of 11 patients with oat-cell carcinoma, in 3 out of 10 patients with an intermediate cell type and in 5 out of 13 patients with small-cell lung cancer in which the assessment of the subtype was not possible.

Summary Objective To develop and validate a new health related quality of life (HRQOL) questionnaire specific to obesity and its management. Methods This study was in two parts. The first (Study 1) consisted of the creation of a new tool derived from the American "Impact of Weight on Quality of Life Questionnaire" (IWQOL, 74 items) by adding to it a 17 items specific complementary module. This initial questionnaire (91 items) was reduced so as to obtain a questionnaire adapted to socio-cultural factors of obesity and dietary weight management in France. The objective of the second (Study 2) was to validate this final questionnaire by evaluating its psychometric properties: construction validity, internal reliability, concurrent validity in relation to a generic questionnaire, the SF-12, clinical validity by studying the effects of age, gender and body mass index (BMI), and reproducibility. Results The results of Study 1, obtained in 128 obese patients (mean age: 42.5 12.1, BMI: 34.5 2.8 kg/m 2 , women: 83.6%) enabled reduction of the 91 questionnaire items to 36, grouped into 5 dimensions: physical impact, psycho-social impact, sex life, comfort with food and diet experience. Two hundred and twelve patients (mean age: 43.3 12.2, BMI: 35.8 7.4 kg/m 2 , women: 77.7%) were included in Study 2, among whom 75 filled out the questionnaire twice at a one week interval. Analyses enabled verification of the construction validity and internal reliability (Cronbach alpha > 0.7) of the questionnaire as well as its concurrent validity in relation to summarized SF-12 scores and its clinical validity. The "physical impact" dimension was significantly influenced by BMI and age, the dimensions "sex life" and "diet experience" by the factors gender and BMI, while "psycho-social impact" was influenced by the 3 factors cited. Its reproducibility was also deemed satisfactory (intra-class correlation coefficient > 0.8). Conclusion This new questionnaire, called the "Echelle Qualite de Vie, Obesite et Dietetique (EQVOD)"/"Quality of Life, Obesity and Dietetics (QOLOD)" rating scale is sufficiently reliable and reproducible to be used in clinical practice. It is a simple tool adapted to socio-cultural factors of obesity in France, enabling taking into account of the effects of dietary management on the HRQOL of obese people.

Experimental studies documented the relationship between T wave alternans (TWA) and duration of refractoriness. To date, association between TWA and QT interval on standard ECG has not been examined. Aim. To assess the relationship between TWA and QT interval.The study group consisted of 70 patients (57 males, mean age 56+/-16 years) with implantable cardioverterdefibrillator (ICD). TWA was measured using a high-resolution ECG obtained from surface orthogonal bipolar XYZ leads and analysed using a Fast Fourier transform. All recordings were performed during ventricular pacing at 100 betas/min. Correlation between T wave amplitude (T max) and QT interval (measured from R wave to T max) was calculated.TWA was found in 18 patients. In this group of patients, there was a significant positive correlation between Tmax and QT (r = 0.766), whereas in patients with negative TWA no such correlation was detected.(1) Positive correlation between QT and T max probably depicts the relationship between T wave amplitude and duration of repolarisation, which is associated with TWA; (2) methods used for T wave localisation, based on the identification of Q wave (with possible QT-RR correction) overestimate TWA due to periodic changes (with TWA frequency) in location of T wave in the analysed window; and (3) these results provide new insights in the genesis of TWA.

Mutations in SCN5A lead to a broad spectrum of phenotypes, including the Long QT syndrome, Brugada syndrome, Idiopathic ventricular fibrillation (IVF), Sudden infant death syndrome (SIDS) (probably regarded as a form of LQT3), Sudden unexplained nocturnal death syndrome (SUNDS) and isolated progressive cardiac conduction defect (PCCD) (Lev-Lenegre disease). Brugada Syndrome (BS) is a form of idiopathic ventricular fibrillation characterized by the right bundle-branch block pattern and ST elevation (STE) in the right precordial leads of the ECG. Mutations of the cardiac sodium channel SCN5A cause the disorder, and an implantable cardioverter-defibrillator is often recommended for affected individuals. In this study sequences of the coding region of the SCN5A gene were analysed in patients with the LQT3, Brugada Syndrome and other arrythmogenic disorders. Different mSSCP patterns are described with no disease-related SSCP conformers in any sample. Direct sequencing of the SCN5A gene confirmed the absence of mutations. This suggests that the analysed region of the SCN5A gene is not commonly involved in the pathogenesis of the Brugada Syndrome and associated disorders.

The analysis of 49 fatal cases of venous thromboembolism--VTE (15% of total ambulatory patients number during long observation was performed. The advanced age of patients, multiple risk factors, underlying circulatory and respiratory tract diseases, malignancies, previous episodes of VTE especially with secondary pulmonary hypertension were the most important factors determining fatal prognoses in those patients.

The aim of this study was to evaluate the effectiveness and side-effects of intrapericardial administration of cisplatin (IAC), in cases of abundant malignant pericardial effusion (MPE) and/or cardiac tamponade occurring in the course of adenocarcinoma of the lung (AL). Fifteen consecutive patients with abundant MPE and AL (4 females and 11 males; mean age 54 yrs) entered this prospective study. Following pericardiocentesis and insertion of a polyurethane catheter, the pericardial fluid was drained. Malignant aetiology of the pericardial fluid was confirmed by cytological examination. After confirmation of MPE, cisplatin (10 mg in 20 mL normal saline) was instilled directly into the pericardial space, over a period of 5 min for 3-5 consecutive days. Treatment was considered successful (response) if the patient survived 30 days without recurrence of symptoms of abundant MPE, and no other interventions directed to the pericardium were required. Response was achieved in 10 patients (67%). The mean (+/-SEM) dose of cisplatin was 56 (+/-18.9) mg. There were no complications related to the pericardiocentesis. Transient atrial fibrillation was detected in one patient. Mild nausea also occurred in one case. No hypotension or retrosternal pain was observed. Sclerotization of the pericardium and pericarditis constrictiva were detected after IAC in only one case. Cisplatin administered directly into pericardial space is effective and safe. Intraperitoneal administration of cisplatin appears to be the method of choice in the treatment of recurrent malignant pleural effusion in patients with primary adenocarcinoma of the lung. Sclerosis of the pericardial space is a very rare complication observed after intraperitoneal administration of cisplatin therapy.

Patients with cardiac tamponade or large malignant pericardial effusion, who survived longer than 30 days after withdrawal of catheter from the pericardial space, entered the study. Main goal of investigations was: evaluation of the effectiveness and side-effects of intrapericardial administration of cisplatin in cases with malignant pericardial effusion (MPE) and cardiac tamponade or large pericardial effusion in a course of the lung cancer. Sixteen patients (four women and 12 men), mean age 53 years, median age 57 years, range 27-70 years, entered this retrospective study. After pericardiocentesis and insertion of a polyurethane catheter, pericardial fluid was drained. Malignant etiology of pericardial fluid was confirmed by cytological examination and/or by echocardiography. The diagnosis of malignancy was based upon histological examination of samples obtained from primary tumor. After confirmation of MPE cisplatin (10 mg in 20 ml normal saline) was instilled over 5 min during 1-5 consecutive days (maximal total cisplatin dose in single course: 50 mg) directly into pericardial space. If a large pericardial fluid reoccurred the courses with intrapericardial administration of cisplatin were repeated. Treatment was considered successful if the patient with malignant effusion survived 30 days without recurrence of symptoms of large pericardial effusion and no other interventions directed to the pericardium were required. In 14 (87.5%) cases malignant pericardial effusion was confirmed by cytological analysis of pericardial fluid. In two cases echocardiography confirmed metastatic tumors to the pericardium. Positive effect of intrapericardial treatment with cisplatin was achieved in 15 cases (93.75%). Mean survival period in the whole group was 6.59 months (+/-6.2 months), median survival period was 3.7 months, range 2-24.1 months. There were no complications related to the pericardiocentesis. Transient atrial fibrillation was detected in three patients (18.8%). Mild nausea occurred in one case. No hypotension and retrosternal pain were observed. Cisplatin administered directly into pericardial space (CAP) seems to be effective and safe. No sclerosis of the pericardial space was observed after CAP.

The purpose of this study was the evaluation of the effectiveness of intrapericardial administration of tetracycline, 5-fluorouracil and cisplatin in patients with recurrent malignant pericardial effusion. In 33 cases with malignant pericardial effusion 46 pericardiocenteses under two-dimensional echo-cardiography were performed. No complications were observed after this procedure. Pericardiocentesis was followed by catheterization of the pericardial space for a mean period of 15 days (range 1-64). In 4 cases bacterial pericarditis was observed during catheterization. The mean volume of the pericardial fluid was 2.41 (range 0.4-13 l). In cases with bloody pericardial fluid the PO2, PCO2 and pH of the fluid were estimated and the results compared with the values for venous blood obtained from the upper limbs. Highly statistically significant differences were documented. Twenty cases of malignant pericardial effusion were treated with direct pericardial administration of cisplatin, 3 with 5-fluorouracil and 2 with tetracycline. Good results (no fluid reaccumulation) were observed only after cisplatin therapy. We conclude that pericardiocentesis performed under two-dimensional echo cardiography, followed by pericardial catheterization and direct pericardial treatment with cisplatin are the methods of choice in cases with malignant pericardial effusion. In cases with bloody pericardial fluid PO2, PCO2 and pH analysis can be useful to differentiate the source of the bloody fluid (blood or bloody fluid).

A case of systemic form of juvenile chronic arthritis (Still's disease) is presented. Difficulties in confirmation of diagnosis are described. After nonsteroidal-antiinflammatory drugs and cytostatics administration very good therapeutical effect was achieved.

Patients with heart failure secondary to coronary heart disease (CHD) are characterized by an imbalance of the autonomic nervous system, which can be assessed by analysis of the heart rate variability (HRV). However it is still unclear whether all patients with CHD reveal suppression of HRV and if it is related to hemodynamic function and contractile disturbances of the left ventricle. To answer these questions data from 105 consecutive patients were analyzed and compared with 17 healthy subjects. All study participants underwent 24-hour ambulatory ECG recordings with calculation of HRV parameters and angiographic examination after collection of clinical data and other noninvasive evaluations. Time- (SDRR, SDANN, SD, pNN50) and frequency- (LF, HF) domain parameters of HRV were assessed. All ventriculographic and hemodynamic measurements were used in the analysis. Highly significant correlations were found between all HRV parameters, and left ventricular ejection fraction (LVEF) and left ventricular end-diastolic pressure (P < 0.001). Patients with LVEF < 40% were characterized by significantly lower values of HRV and impairment or lack (LVEF < 20%) of diurnal variation of frequency-domain measurements of HRV. Patients with segmental akinesis or dyskinesis also had lower values of HRV. The group with dyskinesis was characterized by significantly lower diurnal rhythms of LF and HF, independent of LVEF.

The diagnosis of tuberculous pericarditis is difficult. The cultures of the pericardial fluid for M.tuberculosis are often negative. The determination of ADA activity in pleural fluid in TB patients /PTS/ is very useful. It seemed reasonable to measure ADA activity in pericardial effusion. ADA activity in pericardial fluid of 40PTS/19 women and 21 men/with large pericardial effusion of different etiologies who were treated in our institute in years 1988-1995 was investigated. The median age was 44 years. In each case the pericardiocentesis was performed. PTS were grouped as follows: group I-4 PTS with strongly suspected TB pericarditis, group II-32 PTS with malignancy and group III-4 PTS with miscellaneous diseases. In group I the mean ADA activity was 24U/I(3-60), in group II 18U/I (3-60) and in group III 18U/I (0-37) (with a cutoff value for ADA activity of 40U/I). It was definitive bacteriologic diagnosis of TB pericarditis in PTS of group I. Our observation does not confirm the earlier data about the high ADA activity in clinically suspected TB pericarditis without bacteriologic diagnosis. The value of ADA determination in pericardial fluid is its high specificity (97%) in excluding of TB etiology of pericardial effusion.

43-year old woman, with considerable overweight had been admitted to Intensive Medical Care Unit with suspicion of pulmonary embolism (PE). The patient had the limb immobilized in gypsum for last several weeks. This episode was tangled with recurrent thrombosis of deep veins in the left limb, treated with heparin and oral anticoagulants irregularly without sufficient control. Taking into consideration the data of anamnesis, clinical picture and the results of ECG, chest X-ray, gasometric and echocardiographic examination we got much closer to the recognition of PE. Our suspicion of PE was confirmed by the result of pulmonary angiography. Indications for thrombolytic treatment (r-tPA) had been established. During the following hours considerable improvement of general state was observed. The therapy was continued with constant drip infusion of heparin. No prolongation of therapeutic PTT was observed. The deficit of AT III was diagnosed. In this situation the patient was given AT III to obtain normalization of its level and therapeutic extension of PTT. Therefore there were settled indications for the operation of uterus with myoma changes. As the rich thrombolytic material in the leg's vein was found the patient was implanted LGM Filter, with excellent prophylactic effect (no PE in perioperative period). The clinical course of our case enabled to present most of diagnostic, therapeutic and preventive methods applied in venous thromboembolism.

The incidence and clinical significance of pulmonary embolism (PE) in pulmonary malignancy were analysed among 111 autopsy cases including: 65 primary and 24 metastatic lung cancer, 8 hematological malignancies and 14-malignant pleural mesothelioma. In 34 (31%) cases PE was found, in 4 (12%) patients cancer tissue emboli was documented. In nonsmall cell lung cancer the frequency of PE was 40%, compared to 24% in small cell, 25% in metastatic lung cancer and 14% in mesothelioma. Deep venous thrombosis of lower extremities was the source of thrombotic material in 35% cases. In remaining cases the sources of thrombotic material were different (caval vein inferior, superior, and their main branches, right heart cavities, pulmonary artery). In 8 patients with PE the acute form of DIC was observed. In 15 (44%) patients the clinical ante mortem diagnosis of PE was done. In 26% of all analysed cases PE was the direct cause of death. We concluded that PE is a frequent and dangerous complication of lung neoplasms. Clinical diagnosis can be extremely difficult.

12 patients (7 male and 5 female) with confirmed pulmonary embolism (PE) with: angiography-5 cases, conventional contrast-enhanced CT-2 cases, echocardiography-2 cases, autopsy-3 cases were diagnosed as clinically acute PE. Criteria of clinically acute PE were: cardiac arrest-1 case-2 cases, shock-1 case, acute cor pulmonale-9 cases and acute cor pulmonale with shock. All patients were treated with heparin, administered with therapeutic prolongation of aPTT. Clinically acute PE (if possible confirmed with angiography, TC and/or echocardiography) was treated with rtPA administered in 10 minutes lasting bolus in doses 0.6-0.8 mg per kg of body weight (50 mg of rtPA during 10 minutes administered into peripheral veins). In 9 patients with pulmonary hypertension, significant decrease of tricuspidal gradient (measured echocardiographically during several hours after administration of rtPA) was documented. Improvement in PaO2, SaO2 and decrease of heart rate and respiratory rate were also achieved. No serious bleeding complications were observed after mentioned treatment. Control investigations (conventional contrast-enhanced CT and spiral CT) performed several days after rtPA administration revealed thrombus in pulmonary artery. We conclude: I rtPA administered in bolus simultaneously with heparin significantly decreased pulmonaryhypertension; rtPA administered simultaneously with heparin is safe method of treatment of PE; hemodynamic improvement after administration of rtPA is not univocal with full fibrynolitic effect.

Dressler-like syndrome has been described in about 3-4% of patients after pulmonary embolism (PE). Out of 207 patients admitted to our hospital in whom the clinical diagnosis of PE was confirmed by scintigraphy, spiral computer tomography and angiography, in 19 patients (9.2%) pericardial fluid was detected and pericardial syndrome (PS) after PE was diagnosed. Other causes of pericarditis were excluded. Mean value of pericardial fluid in echocardiographic examination-behind left ventricular posterior wall was 3.84 mm (range 2-10 mm). No clinical or echocardiographic symptoms of cardiac tamponade were observed. In 6 patients PS complicated clinically massive PE, in 3 patients-non-massive PE, in 10 patients recurrent PE. In 6 patients fibrinolytic and in 13 patients heparin therapy was instituted. In 3 cases corticosteroids were given. No increase of pericardial fluid during fibrinolytic or heparin therapy was observed.1. PS after PE is more frequent, than it was estimated previously 2. During therapy of PE the echocardiographic monitoring of the amount of pericardial fluid is mandatory 3. The clinician considering in similar situations the risk-benefit ratio of fibrinolytics and anticoagulants should not abstain from the use of these drugs in the presence of PS after PE, in cases with high probability of cardiac tamponade-pericardial catheter should be used.

The purpose of this study was to determine usefulness of non invasive echocardiographic measurements in patients with severe obstructive sleep apnea (OSA). Diagnosis of OSA was established by polysomnography. We investigated 18 patients (16M, 2F), mean age 45 +/- 10 years, mean weight 114 +/- 16 kg and mean apnea/hypopnea index 69 +/- 23. Two-dimensional (2D) and Doppler echocardiography (DOP) was used to assess: 1. Systolic function of left ventricle by determination of cardiac output (CO), ejection fraction (EF), 2. Diastolic function of left ventricle by calculation of mitral early diastolic velocity to arterial velocity ratio (Ev/Av) and atrial flow to total mitral flow ratio (AF/Tf), 3. Right ventricle thickness in systole (RVWS) and diastole (RVWD), and its diastolic diameter (RVD), 4. Pulmonary arterial pressure (PAP) by evaluation of acceleration time in the pulmonary artery (ACT) and tricuspid regurgitation jet velocity (TR). Results (mean +/- SD): Co 6.67 +/- 2.0 L/min, EF 44 +/- 5.6%, RVWS 10.9 +/- 1.3 mm, RVWD 6.7 +/- 1.1 mm, RVD 30.3 +/- 2.8 mm, Ev/Av 1.22 +/- 0.39, Af/Tf 0.38 +/- 0.11, AcT 121.4 +/- 20.3 ms. These data confirm that intermittent hypoxia and increased ventricular afterload cause both systolic and diastolic left ventricular dysfunction. Right ventricular hypertrophy found despite normal resting, wake, PAP could be probably attributed to transient pulmonary hypertension during repeatable nocturnal hypoxic episodes.

We studied 14 consecutive patients with severe pulmonary hypertension due to chronic major vessel thromboembolic pulmonary hypertension (CPTEH), clinical entity that may be successfully surgically treated by pulmonary thrombendarterectomy. Resting pulmonary mechanics and gas exchange were investigated. Exercise tolerance was studied by 3 different exercise tests. Pulmonary volumes and flows were normal. Some patients presented with decreased lung compliance and reduced diffusion capacity for carbon monoxide. Majority of patients had hypoxaemia and respiratory alkalosis. Exercise tolerance was very limited. In 6 minute walking test patients covered 346 +/- 95 meters. During Bruce test patients completed from 1 to 4 stages. During incremental maximal symptom limited test on cycloergometer patients achieved 56 +/- 18 watts. We concluded that patients with CPTEH present with resting hypoxaemia deteriorating further on exercise and severely limited exercise tolerance.

30 consecutive patients with large malignant pericardial effusion (MPE) entered this prospective study. After pericardiocentesis and insertion of a polyurethane catheter, pericardial fluid was drained. Malignant etiology of pericardial fluid was confirmed by cytological examination. After confirmation of MPE cisplatin (10 mg in 20 ml normal saline) was instilled over 5 minutes during 5 consecutive days directly into pericardial space. If fluid reaccumulation occurred the courses were repeated every 3 weeks. Treatment was considered successful if the patient with malignant effusion survived 30 days without recurrence of symptoms of large pericardial effusion and other interventions directed to the pericardium were required. Positive effect of intrapericardial treatment with cisplatin was achieved in 18 cases (60%). Mean period of response was 3, 7 months (+/-6). Cisplatin administered directly into pericardial space is effective and safe method of treatment of recurrent MPE. Sclerosis of the pericardial space is rare complication connected with CP. Positive effect of CP can depend on improvement of lymphatic drainage from heart. CP seems to be method of choice in intal intrapericardial treatment in patients with malignant cardiac tamponade and recurrent MPE in course of lung cancer.

In 18 patients with proximal deep venous thrombosis (PDVT) confirmed by phlebography, no symptoms and signs of pulmonary embolism (PE) were observed. All patients were treated with nadroparin. During first 6 days of treatment in all patients perfusion lung scans were performed. 8 patients (44.4%) of all group developed lung scans positive for PE (silent PE). Period of successful treatment of PDVT was 10 days. No evidence of recurrent PE were observed during the period of treatment. We conclude that: 1. Frequency of silent PE in patients with PDVT is very high-lack of symptoms and signs of PE does not exclude the presence of PE in this group of patients. 2. In all patients with PDVT perfusion lung scan should be performed even in cases with no symptoms and signs of PE. 3. Low molecular weight heparins administered subcutaneously are effective in treatment either silent PE or PDVT.

There have been report concerning decrease of thyroid gland hormones concentrations in respiratory diseases. The aim of this study was to estimate the influence of severe respiratory failure (RF) of Intensive Care Unit (ICU) patients on blood serum thyroid hormone concentration. The tests were carried out in 22 ICU- patients with partial or total RF in whom the relationship between PO2, pH, PCO2 and TT3, TT4, FT3, rT3, FT4 was tested. The obtained data indicate that: 1. In patients with RF ESS takes place, 2. ESS seems to be related to the decrease of PO2; statistically significant correlation between TT3, FT3, rT3, and PO2 exist, 3. The increase of TT3 serum concentration directly correlates with the improvement of clinical state of patients. The lowest TT3 concentrations were observed in "ante mortem" patients. This fact suggest the prognostic value of TT3, TT4 concentration measurements in patients with RF.

Three cases of Wegener's granulomatosis are presented. In every case the different clinical picture was observed. In the first case dominated the pulmonary changes and fingers necrosis. In that case the excellent therapeutic effect of etoposide was observed. In the second case the most important clinical sings illustrated severe renal insufficiency. The third case demonstrated pericardial and skin changes. The significance of early diagnosis and early institution of proper therapy was discussed.

Nineteen patients with exacerbation of chronic respiratory insufficiency treated with mechanical ventilation were included in the study. The mean weaning time from the respirator was 15.9 days (+/- 12.1), ranging from 2 to 49 days. Success was met in 9 patients using inspiratory pressure support (IPS), in 2 synchronized intermittent mandatory ventilation (SIMV), in 8 the simplest model (stepwise prolongation of spontaneous ventilation during continuous mechanical ventilation--CMV/SV). All options were used in the same patients throughout the weaning procedure. The use of IPS led to a successful weaning in those patients in whom other options (CMV/SV, SIMV) were not fortunate. The application of IPS was begun at 40 cm H2O, gradually decreasing the support pressure. The duration of spontaneous breathing in all weaning options was not only depended on gasometric values, continuous SaO2 monitoring, but mainly on the patients' subjective sense of fatigue. The impression of exhaustion preceded the changes of gasometric parameters and fall of SaO2. The basis of effective weaning is proper selection of respirator parameters, providing almost identical gasometric values if individual patient's to those prior exacerbation of chronic respiratory insufficiency. The duration of weaning negatively correlated (0.25) with FEV1 values.

In 10 patients with thromboembolic disease 1 Gunther filter and 9 LGM filters were inserted. Indications for filter placement were: pulmonary hypertension caused by recurrent pulmonary embolism in 3 cases; planned surgery in 2 patients with pulmonary embolism and deep venous thrombosis; recurrent pulmonary embolism despite of anticoagulant treatment in 2 cases, previously performed thrombo-endarterectomy in 1 case; contraindications for anticoagulant treatment in 1 case and complications of anticoagulant therapy also in 1 case. No serious complications after filter placement were observed.

Diagnostic difficulties found in a 41 year old female presenting with fever, chills, fainting spells, tachycardia, hypotension, interstitial consolidation in both lungs and enlargement of the cardiac silhouette on a chest radiogram are discussed. Unsuccessful antibacterial and antituberculous therapy led to a supposition of a collagen disease. The diagnosis of a bacterial endocarditis with bacterial pulmonary emboli was made basing on determination of bacterial vegetation on cusps of the tricuspid valve.

Case of recurrent, clinically acute massive pulmonary embolism treated with rtPA (administered 0.6 mg/kg, during 10 minutes simultaneously with heparin) is presented. Minimal clinical improvement was observed after mentioned procedure. Good clinical response was achieved after LGM filter insertion into vena cava inferior. Clinical course was complicated by Dressler-like syndrome successfully treated with steroids. Problems of massive pulmonary embolism, vena cava filter prophylaxis and pericardial complication of pulmonary embolism are discussed.

HCG-like immunoreactivity has been found in many nontrophoblastic tumors, but the biological behaviour of HCG--producing cells has not been clarified yet. The aim of the study was to estimate the frequency of serum bHCG (sbHCG) elevation in SCLC patients and to assess its possible prognostic role in this type of tumor. 156 SCLC patients entered the study: 93 men, 63 women, median age 58 years. SbHCG activity was measured with immunoenzymassay (Abbott EIA bHCG 15-15) before treatment. ScHCG elevation (5 mIU/ml) was found in 21 of 156 patients (14%). Response to treatment after chemotherapy (CR + PR) was obtained in only 48% of those patients in whom elevated sbHCG was found, in comparison to 73% of response rate observed in the remaining patients. Only 5% of patients with elevated sbHCG survived 2 years, in comparison to 21% of 2-years survivors in the remaining patients. Thus sbHCG elevation in SCLC seems to be a marker of more resistant tumors and of poor prognosis.

Acute massive pulmonary embolism (AMPE) is an event that places the recipient at an unusually high risk of sudden death. Among 183 patients with thromboembolic disease, AMPE has been diagnosed clinically in 58 cases (32%). Diagnostic criteria: cardiac arrest (24 cases--41%), shock (12--21%) acute cor pulmonale (ACP 15--26%) and ACP with shock (7 cases--12%). There were 33 women and 25 men aged 22-88 years in this group. In 25 patients heparin (H), in 7 streptokinase (S), in 1 tPA, in 7 S after H have been used, 26 patients (45%) survived, 32 (55%) died: there were 20 sudden deaths. Advanced underlying cardiopulmonary diseases or/and recurrent pulmonary embolism seem to be the most important predictors of fatal outcome of AMPE.

Among the risk factors of venous thromboembolism malignant neoplasms play a very important role. 43-years old man with adenocarcinoma of the lung, neoplasmatic cardiac tamponade and recurrent deep venous thrombosis has been presented. The pitfalls in diagnosis and particularly in treatment of venous thromboembolism in cancer-patients have been discussed.

Nine patients (seven men and two women), median age 57 years (range 40-68 years), with large malignant pericardial effusion confirmed by cytological examination, were treated with direct intrapericardial administration of cisplatin. After insertion of a polyurethane catheter, fluid was drained and cisplatin (10 mg in 20 ml normal saline) was instilled over 5 min during 5 consecutive days (total cisplatin dose: 50 mg). If fluid reaccumulation occurred the courses were repeated every 3 weeks. All of the patients achieved a complete therapeutic response (no more fluid reaccumulation). The median time of response was 2.8 months (range 1-24 months). Mild nausea occurred in two patients, supraventricular arrhythmia in one patient and infectious complications in one patient. Eight patients died because of disease progression without evidence of cardiac tamponade or stricture. Autopsy, performed in 7 cases, revealed neoplastic involvement of the pericardium in all of the patients, but pericardial effusion was seen in one patient only.

Thromboembolic pulmonary hypertension is an uncommon condition with poor prognosis. Vasodilators may be effective in some patients with that disease. The effect of nifedipine on hemodynamics was investigated in two patients with thromboembolic pulmonary hypertension treated with acenocoumarol. Nifedipine was administered in 20 mg doses hourly during right cardiac catheterization and was repeated after 1 hour until a decrease in systemic pressure occurred. Patients received 80 mg and 120 mg of nifedipine. Pulmonary artery pressures decreased in both cases. An increase of cardiac output and decrease of pulmonary vascular resistance were observed after 60-80 mg of nifedipine and continued to the end of the investigation. No effect on heart rate was observed. We suggest that high doses of nifedipine may be--in some patients--effective in reducing thromboembolic pulmonary hypertension.

The rate of both: false-positive and false-negative diagnoses of pulmonary embolism (PE) is high. To determine the accuracy of the ante-mortem diagnosis of PE we reviewed 78 autopsies and compared the clinical and pathological diagnoses in that group. In 64 cases PE was diagnosed clinically: in 43 it was confirmed by autopsy (67%). In 21 cases (33%) the clinical diagnoses were false-positive. There were 57 pathological diagnoses altogether: in 14 cases (25%) the clinical diagnoses were false-negative. Among falsely diagnosed patients, the diagnoses of myocardial infarction, pneumonia and malignancy were most frequent. We tried to find some distinctive features separating the cases in the subgroups. Among them venous diseases were more frequent in PE than in falsely diagnosed patients.

Pulmonary embolism (PE) is a serious complication of the chronic obstructive pulmonary disease (COPD). Retrospective studies on patients with COPD treated intensive care unit (ICU) were performed to determine: 1. frequency of PE, 2. clinical course of PE in ICU-COPD-cases, 3. frequency of PE as a cause of death in the studied group. There was 10.9% of PE in COPD patients. In the analyzed group clinical presentation of PE was characterized by acute, severe, life threatening complications leading to death in 86.7%. PE was the most frequent cause of death (40.6%) in ICU-COPD patients. The results of treatment of PE in COPD are poor and the mortality in that group of patients is very high. We believe, that the improvement of management can be achieved by antithromboembolic prophylaxis, which should be instituted as soon as possible in all ICU-COPD-patients.

Oral anticoagulants are generally accepted as secondary prophylaxis in patients with thromboembolic disease. Long term oral anticoagulant treatment of 24 survivors of clinically acute massive pulmonary embolism (AMPE) was assessed. There were following indications for such a treatment: recurrent PE/DVT in history and/or continuous risk factors. In the group of survivors of AMPE with continuing risk factors or the recurrence of that disaster the long-term oral anticoagulant therapy is effective, relatively safe and therefore justified.

Among 121 patients with pulmonary embolism (PE) five (4%) developed pericardial syndrome, connected with PE. Other known causes of pericarditis were ruled out. In 3 cases corticosteroids were administered with anticoagulants and/or fibrinolytic agents without complications. We believe that the clinician considering in similar situations the risk-benefit ratio of anticoagulant or/and fibrinolytic therapy should certainly use corticosteroids and not abstain from the use of anticoagulants and/or fibrinolytic agents in presence of pericardial syndrome after PE. In cases with huge pericardial effusion catheter should be inserted into pericardial space, because of high probability of cardiac tamponade.

A decreased plasma antithrombin III activity has been noted in 12 out of 20 patients. In 2 patients it was most probably congenital defect, whereas in the remaining 10 patients--acquired. The observed disorders in the activity of antithrombin III with particular reference to anticoagulant therapy have been discussed.

SummaryIn a prospective multicenter trial, 149 consecutive patients with phlebographically proven proximal and/or distal deep vein thrombosis of the leg were randomly allocated to receive subcutaneously for 10 days either low molecular weight heparin CY 216 (Fraxiparine) in a fixed dose or unfractionated heparin (UFH) in doses adjusted according to the activated partial thromboplastin time. Pre- and post-treatment phlebograms were assessed blindly using the Arnesen’s score system in 134 patients available for analysis of the treatment efficacy. The mean phlebographic score after 10 days of treatment was significantly decreased in both groups (p

A case report of lactate acidosis in the course of status asthmaticus in a 34 year old female is presented. The lactate acidosis was due to increased anaerobic glycolysis in respiratory muscles caused by decreased oxygen recruitment and increased oxygen consumption by respiratory muscles. The authors discuss the clinical significance of lactate acidosis and proper treatment of status asthmaticus.

In a 22 year old female with primary pulmonary hypertension Doppler echocardiography revealed a systolic gradient between the right atrium and ventricle of 11.3 kPa (85 mmHg). A trial of high dose nifedipine therapy was started. It's efficacy was assessed by monitoring the tricuspid gradient. During therapy variations of the gradient were seen but without a favorable, steady, decrease trend. Although nifedipine did not produce any improvement during the "acute trial"--nifedipine therapy was continued--initially 60 mg, followed by 80 mg and finally 100 mg per day. Efficacy of this therapy was also controlled by Doppler echocardiography. Nifedipine was discontinued after 8 months due to lack of improvement in the patient's state. The patient died 30 months from the initial symptoms. Pathomorphological examination confirmed the clinical diagnosis. The use of Doppler echocardiography in assessing the vasodilators in primary pulmonary hypertension is discussed.