Prognostic value of exercise tests performed 3 months after coronary artery grafting in evaluation cardiac events. 6 years follow-up

Prognostic value of exercise test in evaluation of cardiac events were examined in 326 pts after coronary artery bypass grafting (CABG). During 6 years follow up 18 (5.5%) cardiac deaths and 23 (7.1%) myocardial infarctions were observed. Chest pains persisted in 116 pts (35.6%) and 37 (11.3%) pts needed hospital treatment. Coronary and bypass angiography were performed in 25 pts (7.7%) followed by PTCA in 8 pts (2.5%) and CABG in 5 (1.5%) pts. Exercise duration and maximal work capacity in exercise tests were significantly lower in pts with cardiac events. Reasons of exercise termination: ST segment depression, heart rate and blood pressure values were not different in pts with and without cardiac events and didn't have prognostic value. Patients with cardiac events had significantly reduced left ventricle function. The value of ejection fraction influenced significantly relative risk of cardiac death (p < 0.05).     

Acute myocardial infarction during pregnancy complicated with pulmonary oedema

Acute myocardial infarction, a rare peripartum event, is accompanied by significant maternal and fetal mortality. We report a 41-year-old woman who developed an acute myocardial infarction during the third trimester of pregnancy. The case of infarction was complicated with pulmonary oedema on the 3 day after delivery. Coronary angiography was performed 7 weeks post partum and no coronary lesions were detected. Therapeutic options in such condition are discussed and review of relevant literature is presented.     

The renin-angiotensin system as a risk factor and therapeutic target for cardiovascular and renal disease

The renin-angiotensin system (RAS) plays an important homeostatic role in BP regulation, water and salt balance, and tissue growth control under physiologic conditions. On the other hand, a pivotal involvement of the RAS in the pathophysiology of cardiovascular and renal disease is extensively supported by both basic and clinical evidence. In particular, it is today recognized that angiotensin II (AngII), the biologic effector of the RAS, may prompt a number of relevant structural and functional abnormalities through the activation of a complex of cellular effects mostly mediated via its binding with the AT(1) subtype receptors. The key role of these AngII-linked mechanisms of disease is strongly corroborated by large interventional studies. In fact, pharmacologic interference with RAS activity, by both preventing AngII formation with angiotensin-converting enzyme inhibitors or antagonizing its binding to cell membrane receptors by selective antagonists, is associated with highly beneficial outcomes in major disease conditions (hypertension, diabetes, renal failure, heart failure, myocardial infarction, stroke, and others). This article briefly reviews the current views on the biologic organization of RAS evidence supporting a pathogenic role of the RAS activity in promoting cardiac, vascular, and renal disease, and finally provides the basis for considering inhibition of RAS activity a major target for therapeutic interventions in these conditions.     

Relationship of serum interleukin-7 concentration and the coagulation state in children with nephrotic syndrome

BACKGROUND: Enhanced platelet reactivity may play a significant role in the hypercoagulable state of nephrotic syndrome (NS). Thrombocytosis with platelet aggregation cause the release of some cytokines, among them interleukin-7 (IL-7). The aim of the study was to evaluate serum IL-7 levels in children with the symptoms of NS and to determine a correlation between its concentration and platelet count, other hemostatic factors, and NS intensity. METHODS: The study was performed in two groups. I--the examined group of 26 children with NS (12 boys, 14 girls) aged 6.8 +/- 2.1 years, subjected to two examinations: A--before treatment, B--during treatment with prednisone (60 mg/kg 24 h after albuminuria regression); and II--the control group (C) of 20 healthy children. Serum IL-7 level was assayed by enzyme-linked immunosorbent assay method using a R & D Quantikine set. RESULTS: In group I, IL-7 level in examination A (33.33 +/- 33.24 pg/mL) was higher than in the control subjects (P < 0.01). In examination B, IL-7 concentration was reduced to the level of 10.86 +/- 5.22 pg/mL and did not differ from the controls (P > 0.05). A positive correlation was observed between IL-7 and platelet count and serum fibrinogen level. A negative correlation was noted with antithrombin III concentration. No correlation was found with serum levels of albumin and cholesterol or urine protein. CONCLUSION: In children with NS, serum IL-7 level increases proportionally to the elevated platelet count and other hemostatic components, but shows no correlation with serum albumin or urine protein.     

Non-Hodgkin's lymphoma presenting as a breast mass in patients with HIV infection: a report of three cases

Breast involvement with non-Hodgkin's lymphoma (NHL) is rare. Patients with AIDS have an increased incidence of NHL, often with high-grade histology, extranodal presentation and aggressive clinical course. Lymphoma of the breast in patients with HIV-1 infection has not been reported. We reviewed our tumor registry database of all AIDS-associated NHL and report on the clinical presentation and long-term outcome of 3 patients with AIDS who presented with lymphomatous involvement of the breast.     

Vibro-pressure massage and vibro-aerosols in the treatment of middle ear diseases in children and youth

Otitis media with effusion and eustachitis occur very often in childhood. In dependence on advanced of otitis media with effusion and eustachitis, we use surgical and nonsurgical treatment. In short-term otitis media with effusion and eustachitis performs tympanotomy, insufflation of the Eustachian tube by Politzer and Valsava's methods and vibro-pressure massage AMSA. The aim of this study is estimation of efficacy vibro-pressure massage AMSA in otitis media with effusion and eustachitis in children. The study population consisted of 34 children and youth aged between 3-17 years with otitis media with effusion or eustachitis. In all people we performed 10 procedures of vibro-pressure massage AMSA administered 4 mg dexamethasone in vibro-aerosol. Efficiency of treatment was estimated by comparison otolaryngology examination, pure tone audiometry and tympanometry. In 76.7% ears with eustachitis we observed correct results of examinations of hearing acuity after treatment. It was more two times better then in children with otitis media with effusion. Vibro-pressure massage AMSA 10 times with 4 mg dexamethasone in vibro-aerosol is good method in treatment of eustachitis. In otitis media with effusion isn't efficacious enough. In this case we recommended tympanostomy tube.     

Analysis of postoperative hemorrhage after adenoidectomy and tonsillectomy in children in own material

Hypertophy of pharyngeal tonsil and palatine tonsils is the most common cause of nasal obstruction in children. When the obstruction of the nasopharynx causes recurrent infections of upper respiratory tract, chronic otitis media secretoria or sleep apnoea, then adenoidectomy with or without tonsillectomy is indicated. The purpose of the study was analysis of postoperative hemorrhage after adenoidectomy with or without tonsillectomy. The influent of frequent infections of upper respiratory tract, disorders of blood clotting, chronic diseases, seasons of the year, operation time and general anesthesia on postoperative hemorrhage was estimated. A group of 1184 children after adenoidectomy with or without tonsillectomy was studied. Postoperative hemorrhage occurred in 59 children (4.98%). Early bleeding was frequently occurred after adenotonsillectomy and late bleeding after adenoidectomy. There was relationship between the time of general anesthesia and incidences of postoperative bleeding. Food or inhalation allergy, recurrent infections of upper respiratory tract and male sex are risk factors of postoperative hemorrhage after adenoidectomy with or without tonsillectomy.     

The results of newborn hearing screening by means of transient evoked otoacoustic emissions

OBJECTIVE: The incidence of sensorineural hearing loss is between 1 and 3 per 1000 in healthy neonates and 2-4 per 100 in high-risk children. Transient evoked otoacoustic emissions (TEOAEs) represent a method which can be applied to all newborns prior to hospital discharge, enabling early identification of hearing loss. The aim of the study was to evaluate the results of newborn hearing screening by means of TEOAEs. METHODS: Between 01.10.2002 and 30.09.2003, 5601 newborns born in the University Hospital in Poznan, Poland were screened with ERO SCAN (MAICO). Healthy neonates were screened in the second or third day of life and children treated in pathology unit--when their general condition was stable. The risk factors of hearing loss were recorded in a questionnaire. Children who failed the screening test or had risk factors of hearing impairment were referred to the outpatient clinic for further evaluation. RESULTS: Risk factors were identified in 739 newborns. The most often risk factors were: use of ototoxic drugs, low Apgar score and prematurity. Positive test result was obtained in 219 (3.91%) children unilaterally and in 137 (2.45%) bilaterally. In healthy children the prevalence of positive results was 3.56% and in high-risk infants 24.9%. The relative risk of positive test results was the highest in infants with positive family history (RR=7.5), congenital malformations (RR=6.7) and low Apgar score (RR=5). Of the group of 912 children, who were referred to the specialist, only 218 turned up to be assessed during the observation period and had the additional otoacoustic emission test performed. There was not any significant difference in the percentage of children with and without risk factors who turned up for the second test and in whom the result was positive (39.7% versus 40.3%). In 41.9% children with risk factors whose screening test was negative, the second exam gave positive result. CONCLUSIONS: The incidence of positive results in newborn hearing screening is much higher than the prevalence of hearing loss in general population and these results need verification by more precise methods. However, TEOAEs enable to select children who should be referred for audiological evaluation.     

Sleep disturbances in patients treated for panic disorder

BACKGROUND AND PURPOSE: Disturbed night sleep is a common complaint of patients with panic disorder. The aim of the present study was to demonstrate whether the sleep disturbances can be successively influenced by the standard therapy for treating panic disorder. PATIENTS AND METHODS: Psychiatric examinations of 20 outpatients with panic disorder were supplemented with a study of sleep quality using standardised interviews, sleep logs and polysomnographic recordings. RESULTS: A statistical comparison of data showed that reduced anxiety after successful treatment of panic disorder was not necessarily followed by improved sleep parameters. CONCLUSION: The results suggest that the conventional therapy applied to these patients is not sufficient to treat the co-existing insomnia. Consequently, it seems to be of importance to supplement the treatment of panic disorders with specific treatment of the sleep disturbance.