Some considerations about the procedure of informed consent in patients prepared for electroconvulsive treatment

Electroconvulsive therapy (ECT) as a medical procedure of higher risk as well as a therapy evoking certain controversies requires strict obedience to the conditions of acquiring the patient's informed consent to the offered method of treatment. To acquire the patient's consent it is necessary to inform him/her about the different aspects of electroconvulsive therapy. The paper stresses that in the case of ECT therapy, the spoken information given to the patient seems insufficient. It is necessary to work out a Polish questionnaire for acquiring the patient's consent to electroconvulsive therapy and to apply it in all psychiatric institutions that carry out ECT procedures.     

Clinical analysis of pregnancy complicated by hypertension in the material of the Department of Obstetrics and Perinatology of the Pomeranian Academy of Medicine

OBJECTIVES: The aim of this study was retrospective analysis of arterial hypertension during pregnancy in the Department of Obstetrics and Perinatology of Pomeranian Academy of Medicine in Szczecin, and severe PIH intensive obstetrical care optimization. DESIGN: The retrospective analysis of 81 pregnancies complicated by arterial hypertension in the years 1995-2000 was performed. MATERIAL AND METHODS: The retrospective analysis of 81 pregnancies was performed. Patients were divided into two groups. In the first pregnancy was ended by caesarean section (n = 43), in the second by vaginal delivery. The mean gestational age, the way of delivery, accompanying diseases, uric acid levels, short term variability, Dawes - Reedman's criteria, presence of decelerations in CTG, Doppler PI, S/D, RI parameters in umbilical artery and cerebral arteries, presence of AEDVF and REDVF in umbilical artery were analyzed. RESULTS: Caesarean section was performed in 53.1% of all cases, in 46.9% vaginal delivery took place. Absolute range of short-term variability was more often less than 6 ms in caesarean section group (41.9%). Uric acid level was also higher in caesarean section group (p = 0.000194) CONCLUSIONS: 1. The caesarean rate in pregnancies complicated by arterial hypertension is over 50% and during severe PIH is approximately 100%. 2. Caesarean section takes place before estimated delivery date and indications to it are in most cases connected with a main disease 3. Short-term variability is lower among patients from caesarean section group. 4. Uric acid level is a relevant parameter of a degree of arterial hypertension, and the level is higher in first group. 5. Doppler velocimetry of umbilical artery and middle cerebral artery are valid part of obstetrical care among patients with PIH.     

Primary cardiac paraganglioma

We report a case of a 29-year-old male, who during workup of hypertension was found to have a malignant primary paraganglioma of the heart. The tumor arose from the site of the aortopulmonary window and right ventricular outflow tract (RVOT) and was removed with the aid of cardiopulmonary bypass. Reconstruction of the RVOT and pulmonary valve was necessary because of involvement by the tumor. The surgical course was uncomplicated, with normalization of catecholamine secretion and blood pressure.     

Disturbances of purine nucleotide metabolism in uremia

The increased concentration of adenosine triphosphate (ATP) in erythrocytes from patients with chronic renal failure (CRF) has been observed in many studies but the mechanism leading to these abnormalities still is controversial. It is believed that hyperphosphatemia and metabolic acidosis triggering enhanced reutilization of purine bases are the factors responsible for changes in erythrocyte nucleotide concentration. During the past decade we have performed several studies. A summary of the obtained results is presented. A high-performance liquid chromatography technique was used for the determination of plasma and intraerythrocyte nucleotide concentrations. Labeled adenine and adenosine were used for measuring adenine incorporation. In CRF patients treated conservatively increased concentrations of ATP levels and other nucleotides such as adenosine diphosphate were found. Adenosine monophosphate and hypoxanthine levels were lower than in controls. In hemodialyzed patients both ATP and adenosine monophosphate intraerythrocyte concentrations were higher than in controls. At the same time, adenosine monophosphate and hypoxantine level were comparable with levels in healthy people. The main pattern of nucleotides during hemodialysis remained unchanged, independent from the mode of therapy. The only exception was a decreased level of hypoxantine. Results of a consecutive study have suggested that the increased rate of adenine incorporation into the adenine nucleotide pool could be partially responsible for the increased ATP concentration in uremic erythrocytes. Last but not least, trying to elucidate the pathomechanism of adenine nucleotide disturbances in uremia, we have found that the concentration of N-methyl-2-pyridone-5-carboxamide (2PY), one of the end products of nicotinamide-adenine dinucleotide degradation, were enhanced in CRF patients to values that are potentially toxic. Our findings suggest that 2PY could be a novel uremic toxin. Disturbances of nucleotide metabolism are one of the important components of uremic syndrome.     

Surgical strategies in the removal of malignant tumors and benign lesions of the anterior skull base

The choice of surgical approaches to the tumors of the anterior skull base is determined by the location, dimensions of such lesions and their relations to the surrounding structures. Furthermore, the need for the reconstruction of the dura and skull base structures has an important influence on the decision about the surgical procedure. Transfacial approaches provide limited exposure, especially when tumors damage the floor of the anterior cranial fossa and involve the frontobasal dura and brain. Transcranial, craniofacial and subcranial approaches in particular may aid a surgeon in the removal of such lesions, and often these surgical procedures are the only beneficial methods. Our study comprised 15 patients. Transcranial approaches were used in ten cases. In five further cases, we adopted craniofacial or subcranial approaches. Total removal of these lesions was possible in 13 cases. Neither important complications nor death after surgery was observed except for two cases (craniofacial/subcranial approach) where the CSF leak and CNS infection were reported. We deem that the transcranial approach creates a good possibility for total removal of anterior skull base tumors, particularly of the benign lesions, and permits reconstruction of the skull base damaged by the tumor. However, in patients with large malignant tumors, the en bloc resection via the combined craniofacial/subcranial approach achieved better outcome.Parts of the materials of this research were presented at the 12th European Congress of Neurosurgery—EANS 2003, 7–12 September, Lisboa, Portugal     

Survival of cervical cancer patients in selected regions of Poland in 1990-1996, in relation to some prognostic factors

To evaluate whether cervical cancer patients in selected regions of Poland show similar 5-year survival rates and if they are different from European average and, also, to evaluate the effect of selected prognostic factors. The analysis based on a cohort of 1386 cervical cancer cases identified by population-based Cancer Registries collecting data from Kieleckie and Opolskie voivodships and from the City of Warsaw in 1990-96. These data become complete by adding information from medical records. The 5-year relative survival rates were calculated using the life tables method, and, a multivariant regression analysis was applied for evaluation of prognostic factors. The regions differed significantly in stage distribution (p<0.001), however, they were similar in age groups and histological diagnosis. The age-standardized relative 5-year overall survival rate was 52.2%, and was among lowest rates in Europe. The rate in Kieleckie was 60.7%; in Opolskie--43.3%, and in Warsaw--51.9%. The rates for Stage I in those regions were comparable at over 80%, but were different for Stage II and higher stages. The multivariant analysis showed a significant risk increase related to stage advancement (p<0.0001) as well as to the place of living in Opolskie (p=0.02) and to the adenocarcinoma diagnosis (p=0.05). However, the analysis did not confirm the effect of age of diagnosis as a prognostic factor. The overall, age-standardised 5-year relative survival rates of cervical cancer patients are one of the lowest in Europe, though diversified in the regions. They are almost satisfactory and close to European average in Kieleckie where prevention was effective, but poor in the other regions. The low survivals overall are basically due to the unsatisfactory proportion of the early stage of disease. The uneven survivals of patients with Stage II and higher stages of cancer in the selected regions of Poland suggest different standards of treatment.     

Estimated risk for altered fetal growth resulting from exposure to fine particles during pregnancy: an epidemiologic prospective cohort study in Poland

The purpose of this study was to estimate exposure of pregnant women in Poland to fine particulate matter [less than or equal to 2.5 microm in diameter (PM 2.5)] and to assess its effect on the birth outcomes. The cohort consisted of 362 pregnant women who gave birth between 34 and 43 weeks of gestation. The enrollment included only nonsmoking women with singleton pregnancies, 18-35 years of age, who were free from chronic diseases such as diabetes and hypertension. PM 2.5 was measured by personal air monitoring over 48 hr during the second trimester of pregnancy. All assessed birth effects were adjusted in multiple linear regression models for potential confounding factors such as the size of mother (maternal height, prepregnancy weight), parity, sex of child, gestational age, season of birth, and self-reported environmental tobacco smoke (ETS). The regression model explained 35% of the variability in birth weight (beta = -200.8, p = 0.03), and both regression coefficients for PM 2.5 and birth length (beta = -1.44, p = 0.01) and head circumference (HC; beta = -0.73, p = 0.02) were significant as well. In all regression models, the effect of ETS was insignificant. Predicted reduction in birth weight at an increase of exposure from 10 to 50 microg/m3 was 140.3 g. The corresponding predicted reduction of birth length would be 1.0 cm, and of HC, 0.5 cm. The study provides new and convincing epidemiologic evidence that high personal exposure to fine particles is associated with adverse effects on the developing fetus. These results indicate the need to reduce ambient fine particulate concentrations. However, further research should establish possible biologic mechanisms explaining the observed relationship.