Successful closure of a large PDA with an Amplazter septal occluder in a child with heart failure and pulmonary hypertension--a case report

Transcatheter methods for closure of patent ductus arteriosus (PDA) have been known as an effective technique for many years. The devices designed for interventional closure of PDA, coexisting with elevated pulmonary artery pressure are still far from ideal and there is a significant risk of embolisation into the aorta. We present a case of a 14-year-old girl with a large PDA, pulmonary hypertension and congestive heart failure. She underwent successful PDA closure with an Amplatzer atrial septal occluder (ASO), a device originally designed to close an atrial septal defect.     

Severe pulmonary hypertension caused by untreated mitral stenosis. It still happens in the XXI century

We present a case of a 58 years old patient with extremely severe mitral stenosis. Several years ago she denied surgical treatment despite qualification by cardiologists. At present hospitalisation mitral valve area was calculated as 0.5 cm(2) with systolic right ventricular systolic pressure of 125 mmHg. Right ventricle was hypertrophied and extremely enlarged as well as both atria. Surprisingly she was still in sinus rhythm and had no thrombi in the left atrium. Patient died before scheduled surgery because of cardiac decompensation and renal insufficiency.     

Coronary vessel trees from 3D imagery: a topological approach

We propose a simple method for reconstructing vascular trees from 3D images. Our algorithm extracts persistent maxima of the intensity on all axis-aligned 2D slices of the input image. The maxima concentrate along 1D intensity ridges, in particular along blood vessels. We build a forest connecting the persistent maxima with short edges. The forest tends to approximate the blood vessels present in the image, but also contains numerous spurious features and often fails to connect segments belonging to one vessel in low contrast areas. We improve the forest by applying simple geometric filters that trim short branches, fill gaps in blood vessels and remove spurious branches from the vascular tree to be extracted. Experiments show that our technique can be applied to extract coronary trees from heart CT scans.     

Osteoporotic fractures - reduction of the risk is possible

Osteoporosis is a widely known but still poorly understood disease. It is one of the most common causes of pain complaints in older persons. The aim of osteoporosis treatment is to prevent fractures, which are often the primary clinical manifestation of osteoporosis. All preventive measures are more effective when they are introduced at an early stage. An important role is assigned to achieving a high peak bone mass and eliminating nutritional risk factors in the early decades of life. It is essential to achieve broad public awareness of osteoporosis and the risk factors for subsequent fractures. The effectiveness of fracture prevention efforts, regardless of the methods applied, is a function of the timing of their introduction. It is highest in the group of patients without fractures, but should be implemented in all patients, even in cases with several broken vertebras and both distal radii. It is never too late for effective treatment. Proper procedures in the initial treatment of fractures are also important. Methods allowing for early mobilization and restoration of physical activity after fracture are of vital importance. This problem, widely discussed in the orthopedic environment, was definitively addressed by the document entitled "Recommendations for Care of the Osteoporotic Fracture Patient to Reduce the Risk of Future Fracture," developed and published in 2004 by the World Orthopedic Osteoporosis Organization (WOOO). Similar initiatives have begun to appear in Poland, initiated by the National Consultant for Orthopedics and the President of the Polish Orthopedics and Traumatology Society. The aim of this work is to prepare diagnostic and therapeutic protocols for all patients with low-energy fractures, to prevent deterioration of disease symptoms, and to minimize the risk of subsequent fractures.     

"The inhibiting casts" used in cerebral palsed children

Inhibiting casts, introduced to rehabilitation practice by NDT-Bobath therapists, are being used with increasing frequency in the physiotherapy of children with cerebral palsy (CP). In the literature these plaster casts are known as tone-reducing plasters, spasticity-reducing plasters, or short leg plaster casts. The casts are installed on the lower leg and foot in the form of plaster shoes to immobilize the foot and ankle joints in the proper position. This creates conditions for constant manipulation of the limb using key points located on the lower leg and foot. According to the NDT-Bobath concept, this enables positive changes in postural and locomotor patterns, as well as the distribution of postural tone. The construction and application of these inhibitive casts are not the same as in the standard plaster casts used to correct foot deformations. The casts are placed on both feet regardless of the type of paresis, for a period from one to three weeks, depending on the child's age. New casts can be applied repeatedly during the child's rehabilitation. Experience shows that inhibitive casts are a very important aid in the treatment of CP children. The decision to use plaster casting requires experience and detailed functional assessment for each individual child, in terms of muscle tone distribution, the necessary compensatory patterns, and disturbances in the coordination of motor patterns.     

The butterfies' vertebra-diagnostic difficulties - case report

The hemivertebras constitute about 33% of all congenital defects of spine and can be detected accidentally during diagnostics of pain syndrome of spine or other neurological disturbances. In the paper is introduced the case of patient with pain syndrome of spine (man, physical worker, 47years old), who was directed to the rehabilitation ward with recognition of pathologic fracture of vertebra Th10. In consideration on lack of correlation between radiological pictures and patient's neurological state the diagnostics was extended for 3D CT. CT revealed the presence of development defect of spine. Conducted diagnostics and rehabilitation permitted for improvement of patient's state as well as settlement of principles for further procedures. The necessary verification of diagnosis and diagnostics of patients during inpatient and ambulatory rehabilitation shouldn't be sensation but should constitute standard in contracts with National Health Fund.     

CD4+CD25+ T regulatory cells inhibit cytotoxic activity of CTL and NK cells in humans-impact of immunosenescence

We hypothesized that advanced age and medical conditions had an impact on the accumulation of CD4+CD25+ T regulatory cells (Treg), which in turn could deteriorate cytotoxic activity of CD8+ T and NK cells. Volunteers were divided according to the Senieur Protocol into healthy young and elderly and non-healthy young and elderly subjects. The numbers of Treg cells in peripheral blood, their influence on CD8+ T and NK cells and production of IL2 as well as apoptosis intensity of Treg cells were measured. The number of Treg cells was higher in both elderly groups than in respective young ones. Compared to healthy subjects, those with medical conditions were revealed to have higher numbers of Treg cells. In addition, the highest accumulation of Treg cells in non-healthy elderly could be a result of their resistance to undergo apoptosis. The frequency of Treg cells correlated inversely with the activity of autologous cytotoxic cells in PBMC and production of IL2 by autologous CD4+CD25- Th cells. Thus, these parameters were the most highly decreased in non-healthy subjects, notably in the elderly. However, these parameters improved in the cultures of pure sorted cells. The only subset capable of decreasing them to the levels noted in PBMC when added back was Treg cells, which proved the link between the number of Treg cells, cytotoxic activity and production of IL2. Concluding, we found that Treg accumulated as a result of ageing and/or medical conditions were capable of decreasing cytotoxic activity of CD8+ T and NK cells and production of IL2.     

Iron sucrose induced morphological and functional changes in the rat kidney

Treatment of anemia in uremic patients requires simultaneous supplementation of erythropoietin and iron. Because of the impaired iron absorption from the gastrointestinal tract in conditions of renal insufficiency, intravenous supplementation is a treatment of choice in such conditions. Iron compounds used for intravenous supplementation induce several systemic side effects, and therefore, we studied the effect of chronic exposure to iron sucrose in rats on renal function. Experiments were performed on male Wistar rats, which were infused intraperitoneally every 4 days, for 28 days with iron sucrose in a dose 1 mg/kg bw or 10 mg/kg bw diluted in 20 mL of the dialysis fluid. Control animals were infused with plain dialysis fluid. Renal function was evaluated at the beginning and at the end of the study. Additionally morphology of the kidneys was evaluated in all animals after 28 days of the study. Chronic exposure of rats to iron sucrose resulted in increased accumulation of PAS-positive material in their glomeruli: + 38% at Fe 1 mg/kg bw P < 0.05 and + 42% at Fe 10 mg/kg/bw P < 0.01 and collagen in the peritubular area: + 40% at Fe 1 mg/kg bw P < 0.005 and + 77% at Fe 10 mg/kg/bw P < 0.001. Only renal clearance of urea was decreased by 53%, P < 0.01 in rats exposed to iron sucrose at a dose of 10 mg/kg bw. Chronic exposure of rats to iron sucrose results in morphologic changes of the kidney; however, mild impairment in renal function was observed only at the highest (10 mg Fe/kg bw) concentration of iron sucrose.