[Prevalence of dangerous arrhythmia during pharmacological stress echocardiography]. / Czestosc wystepowania groznych zaburzen rytmu podczas farmakologicznej echokardiografii obciazeniowej.

UNLABELLED: Pharmacological stress echocardiography (SE) has become a routine diagnostic and prognostic method in patients with ischemic heart disease. However, all stress tests can provoke undesirable adverse effects including dangerous arrhythmia. The aim of the study was to access the prevalence and types of arrhythmia that can appear during SE. MATERIALS AND METHODS: A retrospective study included the cohort of patients studied using SE in our Department of Cardiology between 1995 and 2002. We followed the data of 836 patients (pts) (615 men, aged 52 +/- 5 yrs). Dobutamine SE was performed in 695 pts (83.2%) and dipyridamole SE in a group of 141 pts (16.8%). Additionally, atropine was administrated to achieve submaximal heart rate in a group of 694 pts (83%). 519 pts (62%) underwent SE was performed according to high dose protocol and in 317 pts (35%)--low dose protocol. RESULTS: During SE the following arrhythmia events were observed: one persistent ventricular tachycardia (0.12%) and two paroxysmal atrial fibrillation (0.24%) in dobutamine test. The set of unsustained ventricular tachycardia in six patients (0.72%) 5 patients from dobutamine group and 1 from dipyridamole group). Complex forms of ventricular extrasystoles (as bigeminy and trigeminy) in 46 pts (5.5%) 43 in dobutamine SE and 3 in dipyridamole SE. All arrhythmias were mild and withdrew spontaneously or after beta-blockers administration. CONCLUSIONS: The risk of dangerous arrhythmia during either dobutamine SE or dipyridamole SE is small and similar in both groups. Dobutamine SE tends to provoke of mild arrhythmia (p = 0.075) more often.

Symptomatic atrial pacemaker lead thrombosis: detection by echocardiography and successful surgical treatment.

Formation of thrombi on a permanent pacemaker lead is a rare complication of pacing. However, because of its serious outcome it should be suspected in a patient who reveals right-sided heart failure, dyspnea, or syncope. An early decision to perform an echocardiographic examination, followed by surgical or thrombolytic treatment can solve this clinical problem. In a 69-year-old woman with increasing signs of congestive heart failure, echocardiography revealed a mobile mass in the right atrium attached to the pacemaker lead. Because of threatened symptoms and large dimensions of the mass, urgent surgical removal of the endocardial lead was successfully performed.

[Infection of red deer with lung nematodes in Polish and Belorussian parts of Bialowieza Forest]. / Zarazenie jeleni nicieniami plucnymi w Polskiej i bialoruskiej czesci Puszczy bialowieskiej.

Fecal samples from red deer from polish and belorussian parts of Bialowieza Forest were examined by Baermann method. First stage larvae of three species of lung nematodes were found. In polish part in 100% of samples were larvae of E. cervi, in 50% V. sagittatus and in 21% D. noerneri, and in belorussian the level of infection was lower and larvae were in 92%, 36% and 12% of samples respectively. In significant part of samples were met mixtured invasion of two or three species. Finding of larvae of E. cervi is the first registration of this species in belorussian part of Bialowieza Forest, and V. sagittatus is a new species for the fauna of Byelorussia. Nematodes E. cervi are dangerous for domestic ruminants.

[Taking history in diagnosing coronary artery disease in the 21st century--wasting time or a valuable diagnostic tool?]. / Badanie podmiotowe w rozpoznawaniu choroby wiencowej w XXI wieku--strata czasu czy tez moze wartosciowa metoda diagnostyczna?

UNLABELLED: The relation of chest pain characteristics and other features of the history of disease to coronary angiograms was assessed in 551 patients with chest pain regarded as definite or probable stable angina pectoris. A standardised questionnaire was used to record demographic details and chest pain characteristics of interviewed patients. The differentiation between typical, atypical or nonanginal pain was based on classification proposed by Diamond. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > 50 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery). CONCLUSION: Chest pain characteristics remains an effective tool for estimating probability of coronary artery disease.

Definition of flow parameters in proximal nonstenotic coronary arteries using transesophageal Doppler echocardiography.

Transesophageal echocardiography (TEE) enables the visualization of proximal coronary arteries. We investigated the feasibility of coronary flow evaluation using TEE, as well as to define flow parameters found in normal proximal coronary arteries. The subgroups of patients with normal proximal segments of coronary arteries were selected from the cohort of 210 patients undergoing routine coronary angiography. The left main coronary artery (LMCA), proximal segment of left anterior descending coronary artery (LAD), left circumflex artery (LCx), and right coronary artery (RCA) were analyzed separately in 147, 64, 53, and 70 patients, respectively. Proximal coronary arteries were evaluated in the transverse plane using a 5-MHz TEE probe, and the flow in normal arteries was registered using pulsed-wave Doppler. The registration of flow with pulsed-wave Doppler was feasible in 88% of studies for the LMCA, 85% for the LAD, 58% for the LCx, and 65% for the RCA. Normal flow was laminar with distinct phasic character (diastolic predominance). Mean +/- SD values of peak coronary flow velocity were (systole/diastole) for the LMCA, 36 +/- 11/71 +/- 19 cm/sec; the LAD, 31 +/- 9/67 +/- 19 cm/sec; the LCx, 36 +/- 13/75 +/- 24 cm/sec; and the RCA, 25 +/- 8/39 +/- 12 cm/sec. Peak diastolic coronary flow velocity was most significantly correlated with heart rate. Doppler evaluation of proximal coronary flow is feasible using TEE in the majority of patients. The knowledge of normal flow values, which is different for the left and the right coronary artery, provides the background for proper interpretation of flow in diseased coronary arteries.

[Use of harmonic echocardiographic contrast imaging and intravenous bolus of Levovist for evaluation of the left ventricle]. / Zastosowanie harmonicznej echokardiografii kontrastowej z dozylnym podaniem Levovistu do oceny lewej komory serca.

Harmonic imaging is a new imaging modality using nonlinear acoustic response, which is particularly sensitive for the particles of contrast agents. Our study was designed to compare the potential of harmonic echocardiographic imaging of the left ventricle using a contrast agent, Levovist to improve the detection of endocardium in patients with suboptimal image quality. 40 patients were studied using standard transthoracic apical views of the left ventricle patients using fundamental frequency and second harmonic frequency after and intravenous injection of 2.5 g Levovist. The quality of endocardial delineation in 16 standard segments was scored from 0 to 2. Endocardial visualization index was calculated as a mean of the scores to express overall diagnostic quality. Harmonic imaging with contrast significantly improved left ventricular endocardial border detection (endocardial visualization index at baseline 1.24 +/- 0.41, with contrast 1.63 +/- 0.38; p < 0.001). The improvement was qualitatively observed in all parts of the left ventricle: in apex (2.4 +/- 0.8), in the middle part (2.5 +/- 0.9) and slightly less in the basal part (2.1 +/- 1.1) as scored on a 0-3 scale. The number of invisible segments decreased from 124 (fundamental) to 50 in contrast harmonic mode. The persistence of the contrast enhancement, prolonged in harmonic as compared to fundamental imaging (284 +/- 136s vs 117 +/- 87s; p < 0.001) enabled convenient recording of all necessary views. Harmonic imaging after an intravenous injection of Levovist significantly improves the visualization of left ventricular endocardial border. Prolonged contrast effect after a single bolus enhances the pertinence of the method in clinical practice.

[Travassosius rufus (Trichostrongylidae)--new for Poland nematode of beavers and comments about helminthfauna of these animals]. / Travassosius rufus (Trichostrongylidae)--nowy dla Polski nicien bobrów i uwagi o helmintofaunie tych zwierzat.

Two females of beaver from north-east Poland were necropsied. Moreover, 15 samples of feaces were examinated. Both necropsied beavers were infected with 46 and 362 specimens of trematode Stichorchis subtriquetrus (RUDOLPHI 1814). In stomach of one beaver were found 2800 specimens of nematode Travassosius rufus Khalil, 1922. It was the first registration of this species in Poland. Coproscopical examination showed eggs of S. subtriquetrus in all 15 fecal samples and eggs T. rufus in 5 samples.

[Helminth fauna of free living European bison Bison bonasus (L.) in Bieszczady Mountains (Karpatian Mountains, Poland)]. / Helmintofauna zubrów Bison bonasus (L.) zyjacych na swobodzie w Bieszczadach (Karpaty, Polska).

Four free living European bison from Bialowieza/Caucasus line shot in February 1997 within Lutowiska Forestry District in the Bieszczady Mountains were used in investigations. All examined animals were infected with helminths. There were found 10 species of parasites. Five species of them Ostertagia leptospicularis, O. kolchida, Spiculopteragia boehmi, Cooperia pectinata and Ashworthius sidemi are thypical parasites of Cervides, and from them were infected bison in Bieszczady. In all necropsied animals was found invasion of nematode A. sidemi, with mean intensity 1542 specimens. It is the first registration of A. sidemi in Poland and European bison is a new host for this parasite. It seems that the source of infection A. sidemi in European bison in Bieszczady is the local population of deer, which during their migrations could bring this parasite from neighbouring Ukraine and Slovakia, where this nematode have been introduced together with deer Cervus nippon. There are also presented results of coproscopic examinations of 17 fecal samples from free living European bison in Bieszczady.

[Which medical treatment can minimize late complications after pharmacologic treatment of unstable angina?]. / Jakie leczenie farmakologiczne minimalizuje odlegle powiklania po zachowawczym leczeniu niestabilnej choroby wiencowej?

UNLABELLED: Current pharmacological treatment of unstable coronary diseases has significantly reduced the rate of early and late complications. Aim of this study was to investigate the impact of in-hospital and ambulatory treatment on the occurrence of late complications in patients with unstable angina treated conservatively. The study group consisted of consecutive 79 patients hospitalized in our Department on the turn of years 1998-1999 (48 men--age 62 +/- 11 years), followed up by at least 1 year. We analyzed the administered agents on the first day of hospitalization: acetylsalicylic acid, heparin, nitroglycerin, beta-adrenergic agents, calcium channels blockers, statins and ACE inhibitors, as well these drugs prescribed for ambulatory management. At least one complication (recurrent hospitalization due to coronary artery disease, unstable angina pectoris, myocardial infarction, need for revascularization or death) occurred in 57 patients (72%) in a follow-up of 16 +/- 3 months. The following drugs significantly reduced rate of late complications (OR--odds ratio, CI--confidence interval, p--significance level):--intravenous heparin during hospitalization: OR = 0.22; CI = 0.12-0.42; p = 0.007;--acetylsalicylic acid administration during hospitalization: OR = 0.42; CI = 0.22-0.77; p = 0.03;--acetylsalicylic acid prescribed for ambulatory treatment: OR = 0.24; CI = 0.13-0.46; p = 0.05. CONCLUSIONS: Heparin and acetylsalicylic acid treatment seems to reduce the number of late complications in patients treated conservatively for the episode of unstable angina.

[Side effects during dobutamine stress echocardiography: analysis of 582 studies]. / Objawy niepozadane echokardiograficznej próby dobutaminowej--analiza 582 badan.

The purpose of the study was to assess the safety, adverse effects and complications of the dobutamine stress echocardiography (ED). 582 patients without previous infarction were prospectively studied with ED. There were 196 female and 368 male, age varied from 27 to 74 years, mean 52. Dobutamine was given in stepwise increasing doses from 5 to 40 mcg/kg/min. Mean maximal dose achieved was 33 mcg/kg/min. Atropine was added in 253 (43%) cases. Significant coronary artery disease was present in 323 patients (53%). There were no death, no myocardial infarction or episodes of sustained ventricular tachycardia as a result of ED. The test was terminated when following conditions were revealed: target heart rate (28.9%), maximal established dose achieved (25.3%), left ventricular asynergy (19.6%), angina pectoris (10.8%), increase of systolic blood pressure above 220 mm Hg (2.6%), hypotension (7.6%), nonsustained ventricular tachycardia (1.7%). The most common non-cardiac side effects were skin tingling (19.8%), atypical chest pain(16.3%), palpitations (13.9%) and headache (7.9%). The most side effects were usually well tolerated, without the need for test cessation. The ED was terminated only in 4 (0.6%) patients because of non-cardiac side effects including nausea (0.3%) and headache (0.3%). We conclude that ED may be safely performed in routine clinical practice. Side effects were rare and usually minor. Most severe ischemic pain was relieved by test interruption and sublingual nitro-glycerine or short acting beta-blocker administration.

Coronary anomalies diagnosed with transesophageal echocardiography: complementary clinical value in adults.

INTRODUCTION: Coronary arteriography remains a gold standard for the evaluation of coronary anatomy. In the case of anatomical anomalies, understanding of vessel course based upon a coronary angiogram may be difficult. Transesophageal echocardiography is a noninvasive method allowing tomographic visualization of proximal coronary arteries. Experience concerning its usefulness for the assessment of anomalous coronary arteries is limited. MATERIAL: Eleven patients with confirmed coronary anomalies studied between 1993-96 were identified in the cohort of those undergoing transesophageal echocardiography. RESULTS: Transesophageal echocardiography revealed potentially serious anomalies (origin of left or right coronary artery from contralateral aortic sinus) in 3 patients and benign in 8. Coronary ostia and proximal course could be delineated in all patients. Anatomical information was consistent between methods, except for a separate origin of the left anterior descending and circumflex artery, where the angiogram missed a very short common left main coronary artery in 2 patients. The relationship between the coronary arteries, aorta and pulmonary trunk was better defined by the echocardiogram. Doppler flow analysis allowed us to exclude anomaly-related flow disturbances. CONCLUSIONS: Transesophageal echocardiography can be considered as a noninvasive technique with the potential for anatomical and functional evaluation of anomalous proximal coronary arteries and deserves a routine use whenever such a condition is suspected. This approach may simplify invasive procedures in this patient group.

[A focus of Dermacentor reticulatus kept by red and fallow deer in animal husbandry (Kosewo, Poland)]. / Ognisko Dermacentor reticulatus podtrzymywane przez jelenie i daniele w hodowli fermowej (Kosewo, Polska).

Focus of Dermacentor reticulatus has been found on the area of fenced Cervides Farm. Very frequent occurrence of D. reticulatus on plants of red and fallow deer pens indicates that these animals in farm conditions are good hosts of adult forms of this tick. On pens of red deer the number of ticks caught on plants was considerable greater than on pens of fallow deer. However, proportion of males in spring and autumn populations of ticks caught on fallow deer pens was considerable greater than on red deer pens. Finding of adult forms of D. reticulatus in many sites in Masuria allows to ascertain that Cervides Farm in Kosewo has been established on the area of natural occurrence of this tick.

Regression of left ventricular dilatation and hypertrophy after aortic valve replacement.

The aim of the study was to assess the influence of aortic valve replacement on left ventricular size and muscle hypertrophy according to the type of preexisting valve disease (aortic stenosis, insufficiency or combined disease). The study group consisted of 143 consecutive patients (pts) after aortic valve replacement (109 men, 34 women, mean age 48.1 +/- 10.9 years). Reason for the operation was aortic stenosis in 35 pts, aortic insufficiency in 64 pts and combined disease in 44 pts. Echocardiography was performed before surgery, 1 month and 1 year after operation, and yearly during 5-year follow-up. Transvalvular aortic pressure gradients decreased significantly after valve replacement in all subsets without further changes during follow-up (Pmax (mmHg): from 54.2 +/- 20.7 to 17.9 +/- 9.6 in combined disease pts, from 72.3 +/- 19.9 to 21.6 +/- 14.6 in aortic stenosis and from 34.5 +/- 24.2 to 15.6 +/- 11.3 in aortic insufficiency pts, respectively, P < 0.0005). One year after surgery the diastolic dimension of the left ventricle decreased significantly in all subjects, whereas the systolic dimension only in aortic insufficiency and combined disease pts (from 44 +/- 11.8 to 31.6 +/- 5.4 mm, P < 0.001 and from 41.9 +/- 11.5 to 33 +/- 6.7 mm, P < 0.05, respectively). Further decrease of both diastolic and systolic dimensions was observed only in the aortic insufficiency group. Ejection fraction of left ventricle increased only in combined disease pts (from 51.6 +/- 10% to 56.8 +/- 8.2%, P < 0.05). Wall thickness of the left ventricle decreased 1 year after valve replacement only in the aortic stenosis group and in further follow-up in the aortic stenosis and combined disease group. Normalization of left ventricular size is observed in more than 90% of patients during 5-year follow-up as opposed to left ventricular muscle hypertrophy, regressed only in less than a half of the study population. In patients with aortic valve disease the greatest hemodynamic improvement is observed 1 year after valve replacement. This is expressed by marked reduction of the left ventricular dimensions and wall thickness, without significant improvement of the ejection fraction. Further regression of left ventricle dimensions occurs in patients operated on due to predominant valve insufficiency, whereas regression of left ventricular hypertrophy is observed in patients with preexisting valvular stenosis.

[Large-intestinal nematoda in bison]. / Nicienie jelita grubego zubrów.

In the Bialowieza Forest the parasitological autopsy of large intestine of 6 bisons was made at the beginning of winter of 1987-1988, and 9 dissections were made in the latter part of both seasons. Four species of nematodes were found to occur together: Chabertia ovina, Oesophagostomum radiatum, Oe. venulosum and Trichocephalus ovis. At the end of wintering in bisons the invasion of Ch. ovina appeared in high percent of animals, but the intensity of it was low. However, the extensity and intensity of invasion of three remaining species of nematodes distinctly arose. In comparison with bisons in closed reserves, free living bisons assimilated Oe. venulosum and Ch. ovina. It is likely that the winter quarters are the source of invasion. It can be explained by the permanent accumulation of feaces with invasive forms of nematodes, and by feeding bisons on the great amount of hay, in which the invasive forms of nematodes may also occur.

[Usefulness of reduction and fusion in the management of spondylolisthesis]. / Przydatnosc nastawienia i usztywnienia w leczeniu kregozmyku.

The results of treatment of spondylolisthesis in 72 patients by reduction with the use of Harrington rods and circumferential fusion were reported. In dysplastic spondylolisthesis 75% satisfactory results and 83.4% spinal fusions were achieved, in stenotic spondylolistheses 80% and 85% respectively. The influence of operation on sacral bone position against lumbar spine could not be accurately traced with the aid of Wiltse radiological criteria. The authors consider arthrodesis "in situ" as insufficient procedure, especially in dysplastic type of spondylolisthesis. They recommend addition of anterior fusion that retains and stabilizes reduction being limited to single motoric unit of the spine.