Can Echocardiography, Especially Tricuspid Annular Plane Systolic Excursion Measurement, Predict Pulmonary Hypertension and Improve Prognosis in Patients on Long-Term Dialysis?

In recent years, increasing attention has been paid to pulmonary hypertension (PH) as a strong and independent risk factor for adverse outcome in the population of patients on long-term dialysis. Published results of observational studies indicate that the problem of PH refers mostly to patients on long-term hemodialysis and is less common in peritoneal dialysis patients. The main cause of this complication is proximal location of the arteriovenous fistula, causing chronically increased cardiac output. This paper presents the usefulness of transthoracic echocardiography (TTE) for measurement of the Tricuspid Annular Plane Systolic Excursion (TAPSE) in the early diagnosis of PH in dialysis patients. Echocardiographic diagnosis of pulmonary hypertension with TTE, especially in the case of HD patients, ensures the selection of the proper location for the first arteriovenous fistula and facilitates the decision to switch to peritoneal dialysis or to accelerate the process of qualification for kidney transplantation.

Echocardiographic markers of left ventricular dysfunction among men with uncontrolled hypertension and stage 3 chronic kidney disease.

BACKGROUND: Current guidelines for the management of arterial hypertension (AH) emphasize the importance of diagnosing subclinical organ damage, which determines cardiovascular prognosis. The aim of our study was to evaluate the prevalence of left ventricular hypertrophy (LVH), LV geometry patterns, and LV systolic/diastolic dysfunction among men with uncontrolled AH and chronic kidney disease (CKD) stages 3A and 3B. MATERIAL/METHODS: The study group included 256 men with essential AH. Glomerular filtration rate (eGFR) was calculated by the simplified MDRD equation. Left ventricular structure and function were assessed using echocardiography. RESULTS: Target blood pressure values were observed in 44 (17.2%) patients. In the studied group, eGFR <60 ml/min/1.73 m2 was found in 67 (26.2%) subjects. Forty-nine (19.14%) patients were in stage 3A and 18 patients (7.03%) in stage 3B of CKD. We demonstrated that LVEDD, LA, RWT, and LVMI ECHO parameters were distinctly higher (p<0.05) in poorly controlled hypertensive patients in CKD stage 3B when compared with patients in CKD stage 3A. A significantly higher prevalence of LVH, including LV eccentric hypertrophy, was observed in stage 3B when compared to stage 3A of CKD (p<0.05). LVEF and E/A ratio decreased along with the decline of renal function (p<0.05). CONCLUSIONS: Relationships between eGFR values and echocardiographic abnormalities of LV structure and function observed by us support the division of CKD stage 3 into 2 substages, 3A and 3B, as proposed by recently published guidelines. Intensification of therapeutic regimen in the CKD 3B substage is therefore crucial from both cardiological and nephrological perspectives.

Single incision laparoscopic surgery transabdominal pre-peritoneal hernia repair - case report.

Single incision laparoscopic surgery (SILS) minimizes perioperative trauma and allows surgical procedures without a visible scar. Here we present a case in which the transabdominal pre-peritoneal method was used in inguinal hernioplasty using a SILS port. The presented case is part of a new trend in surgery to minimize operative trauma. In 2009, when the operation was conducted, it was an innovative procedure.

The place of subfascial endoscopic perforator vein surgery (SEPS) in advanced chronic venous insufficiency treatment.

In spite of medical science development and initiation of new technologies in minimally invasive surgery, treatment of advanced chronic venous insufficiency at the 5(th) and 6(th) degree of CEAP classification is still a great clinical challenge. In case of no satisfactory results of non-surgical treatment of recurrent venous ulcers, scientists search for alternative therapeutic methods which could be more effective and lasting. Subfascial endoscopic perforator vein surgery (SEPS) as a method of reducing venous pressure in the superficial venous system could provide healing of the recurrent venous ulcer. In this study we present a review of contemporary opinions about the place and significance of subfascial endoscopic perforator vein surgery as a treatment of advanced chronic venous insufficiency.

[Thrombus or tumour of the mitral valve--a case of 75-year-old woman with acute coronary syndrome and aortic insufficiency]. / Skrzeplina czy guz zastawki mitralnej--przypadek 75-letniej chorej z ostrym zespolem wiencowym i niedomykalnoscia aortalna.

Papillary fibroelastomas are rare, primary, benign cardiac tumors most frequently located in the heart valves. They are a potential cause of systemic embolization and may be associated with myocardial ischaemia, transient ischaemic attacks, strokes, or sudden death. We describe the case of 75-year-old woman with diagnosed aortic insufficiency who was admitted to hospital with acute coronary syndrome. The fibroelastoma of the anterior mitral leaflet was diagnosed using transthoracic and transoesophageal echocardiography. We provide a differential diagnosis and review of the literature concerning the pathologic intracardiac masses affecting cardiac valves.

[Cardiovascular diseases risk factors knowledge among soldiers of the Polish army]. / Znajomosc czynników ryzyka chorób ukladu sercowo-naczyniowego wsród zolnierzy polskiej armii.

UNLABELLED: Cardiovascular diseases (CVDs) are the main cause of death and disability in Poland. There are many risk factors of CVD which are modifiable due to preventive strategies. Knowledge about these factors among population at risk of CVD is the most important condition for success of them. THE AIM OF THE STUDY: To evaluate the knowledge of CVD risk factors among soldiers of the Polish Army and try to identify a demographic factors influenced on them. MATERIAL AND METHODS: Authors investigated the level of knowledge about CVD risk factors among 644 soldiers (aged between 18 to 62 years) using the special questionnaire. Whole group was analyzed according to a place of origin: city, town and village and according to a function: professionals and conscripts. RESULTS: Soldiers achieved a total score of 58.4% correct answers. Commonly known risk factors of CVD (average 82% of correct answers) in studied group were: obesity, tobacco smoking, high level of cholesterol and hypertension. Knowledge about above risk factors was significantly higher (p < 0.01) than about other. Lesser known risk factors (average 54% of correct answers) were: male gender, abnormal diet, sedentary lifestyle, family history of CVDs, diabetes, family history of heart infarction below 55 yrs and peripheral atherosclerosis. residents achieved 64.5% correct answers, town--61.5%, and village--58%. Professionals achieved 65.1% vs. 58.8% for conscripts. The level of knowledge about CVD risk factors are significantly higher among professionals than in urban population. CONCLUSIONS: Our data confirm the need of continuation and developing new CVDs preventive strategies in Poland, especially among poor educated and village populations. There is a need to emphasize the role of lesser known, modifiable CVD risk factors (e.g., obesity, sedentary lifestyle) in existing and future health programs.

[Predictors of chronic kidney disease in hypertensive patients]. / Czynniki predysponujace do przewleklej choroby nerek u chorych na nadcisnienie tenicze.

UNLABELLED: Actual European guidelines for the management of arterial hypertension (AH) have recognized the importance of renal function impairment on long-term prognosis in patients with this condition. Chronic kidney disease (CKD) is defined as glomerular filtration rate (GFR) below 60 ml/min/1.73 m2 and is associated with increased risk of cardiovascular events particularly among patients with AH. The aim of the study was to evaluate the predictors for CKD in patients with AH. MATERIAL AND METHODS: The study was performed in 748 consecutive hospitalized patients with diagnosed and treated essential AH. We estimated GFR using abbreviated Modification of Diet in Renal Disease (MDRD) equation and assessed relationship between clinical and laboratory parameters with GFR below 60 ml/min/1.73 m2 (analysis of variance and logistic regression analysis). RESULTS: According to estimated GFR using the MDRD formula, CKD (GFR below 60 ml/min/ 1.73 m2) was found in 314 patients (42%). Patients with CKD were significantly more likely to be older, to have atherogenic dyslipidemia and clinical manifestations of atherosclerosis (coronary heart disease, prior myocardial infarction and cerebral atherosclerosis). Women more likely (71%) fulfilled criteria for CKD. Independent predictors of GFR value below 60 ml/min/1.73 m2 (CKD) were: age > 65 years, woman gender and atherogenic dyslipidaemia, there was a trend for clinical manifestations of atherosclerosis (p = 0.079). CONCLUSIONS: CKD is present in about 40% of patients with AH. Simple clinical parameters (age > 65 years, female gender, atherogenic dyslipidemia, clinical manifestations of atherosclerosis) are predictors of the prevalence of this serious complication of AH which is characterized by high cardiovascular risk. More frequent estimation of GFR in clinical practice will allow to identify this population of patients earlier.

[Diminished glomerular filtration rate as a marker of chronic kidney disease in hypertensive patients]. / Uposledzona filtracja klebuszkowa jako marker przewleklej choroby nerek u chorych na nadcisnienie tetnicze.

UNLABELLED: Recent guidelines of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) for the management of arterial hypertension (AH) have recognized the importance of renal function impairment on cardiovascular (CV) prognosis in patients with this condition. Chronic kidney disease (CKD) is associated with increased risk of CV risk and end-stage renal disease (ESRD) particularly among patients with AH. AIM OF THE STUDY: Our aims were to assess the frequency of CKD according to assessed values of glomerular filtration rate (GFR) in patients with essential AH and distribution of traditional risk factors of cardiovascular diseases in this population. MATERIAL AND METHODS: The study was performed in 749 consecutive hospitalized patients with diagnosed and treated essential AH. All patients were subjected to complete history, physical examination and laboratory studies including lipid profile, fasting glucose and creatinine concentration. We estimated GFR using abbreviated MDRD (Modification of Diet in Renal Disease) formula. According to K/DOQI (Dialysis Outcome Quality Initiative), CKD was defined as GFR below 60 ml/min/1.73m2. RESULTS: Mean age in studied group was 68.8 years (57.8% female). CKD diagnosed according to estimated GFR was found in 314 patients (42%). Women more likely (71%) fulfilled criteria for CKD in studied group. Patients with CKD were significantly more likely to be older, to have atherogenic dyslipidemia and a history of cardiovascular diseases (coronary heart disease, prior myocardial infarction, heart failure) (p < 0.01). CONCLUSIONS: According to the ESH/ESC guidelines, CKD among AH patients is associated with high risk of CV complications and ESRD. This group of AH patients requires a integrative therapeutic strategy including optimal blood pressure control together with modification of traditional cardiovascular risk factors and treatment of established CV diseases. To identify this high risk population the systematic assessment of GFR and other CV factors should be done in every case of AH, especially in older and female patients.

Spinal epidural abscess penetrating into retroperitoneal space in patient with diabetes mellitus type 2: early diagnosis and treatment requirement.

Spinal epidural abscess (SEA) is a rare condition with very serious prognosis. Predisposing factors for SEA include bacterial infections, immunocompromised states such as diabetes mellitus, intravenous drug abuse, alcoholism, AIDS, as well as spinal surgery and modern techniques of epidural anesthesia. The most common causative agent for SEA is Staphylococcus aureus. The typical clinical signs of SEA are back pain, fever and neurologic dysficit. Magnetic resonance (MR) of the spine and vertebral column is the best imaging diagnostic method in suspected cases. Emergency surgical decompression combined with intravenous antibiotics is the therapeutic method of choice. Conservative treatment may be appropriate in selected patients. Unless the typical presentation of SEA correct diagnosis of this illness is often overlooked and not considered initially. It delays suitable management and leads to poor outcome. We report a classic case of SEA in a woman with a history of diabetes mellitus.

[Apical hypertrophic cardiomyopathy as a cause of cardiac insufficiency in an 84-year-old woman--a case report]. / Koniuszkowa kardiomiopatia przerostowa jako przyczyna objawowej niewydolnosci serca u 84-letniej chorej.

Apical hypertrophic cardiomyopathy (ApHCM) is a unique form of hypertrophic cardiomyopathy first described in Japan in 1976. The typical features of ApHCM consist of 'giant' negative T waves in the ECG and a 'spade-like' configuration of the left ventricular cavity detected by imaging techniques. We describe a case of an 84-year-old female in whom heart failure was the first symptom of the disease.

[Left ventricular hypertrophy among hypertensive patients with diminished glomerular filtration rate]. / Przerost lewej komory u chorych na nadcisnienie tetnicze z uposledzona filtracja klebuszkowa.

UNLABELLED: Current guidelines of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) for the management of arterial hypertension (AH) have recognized the importance of subclinical organ damages such as renal function impairment and left ventricular hypertrophy (LVH) on cardiovascular prognosis in patients with this condition. AIM: To assess the prevalence of LVH among hypertensive patients with diminished renal function. We evaluated the relationship between reduced estimated glomerular filtration rate (eGFR) and LVH diagnosed with echocardiography (ECHO) (odds ratio, OR). MATERIAL AND METHODS: The study was performed in 749 consecutive hospitalized patients with diagnosed and treated essential AH. Chronic kidney disease (CKD) was defined as eGFR < 60 ml/min/1.73 m2. LVH was definied by the presence of the voltage criteria of Sokolow-Lyon (sum of the Sv1 i Rv5/6 > 38 mm) in electrocardiography (ECG) and by echocardiographically assessed left ventricle mass (LVM) and left ventricle mass index (LVMI) (LVMI > or = 125 g/m2 among men and > or = 110 g/m2 among women). RESULTS: Mean value of eGFR in the studied group was 65.2 +/- 17.9 ml/min/1.73 m2. CKD diagnosed according to eGFR was found in 314 patients (42%). An ECG LVH was present in 68 patients (9.1%). Mean value of LVM in the studied group was 65.2 +/- 17.9 ml/min/1.73m2 and LVMI 118.78 +/- 28.1 g/m2, respectively. LVH diagnosed according to LVMI value occurred in 226 patients (48.8% of patients who underwent ECHO examination). There was no difference in the prevalence of ECG LVH between patients with CKD and without these condition (about 9%). Mean value of LVMI was statistically higher in CKD group (p<0.05). The risk of abnormal LVMI values in echocardiogram increased in age over 65 (OR 3.64), in the presence of atherogenic dyslipidaemia (OR 1.73), diabetes (OR 1.68), clinical signs of atherosclerosis (OR 4.36), eGFR < 60 ml/min/1.73 m2 (OR 1.90) and ECG LVH (OR 1.53). CONCLUSIONS: CKD was present in about one-half of AH patients. CKD patients had worse global cardiovascular profile as compared with those with normal renal function. The prevalence of LVH diagnosed with ECHO is more common in this group, eGFR < 60 ml/ min/1.73 m2 increases the odds for LVH diagnosis based upon ECHO. This simple parameter can be helpful for more accurate qualification for ECHO examinations in AH patients.

[C-reactive protein as a new risk factor of coronary heart disease in the population of young Polish males]. / Bialko C-reaktywne jako nowy czynnik zagrozenia choroba niedokrwienna serca w populacji mlodych zdrowych Polaków.

UNLABELLED: The aim of this study was to measure the levels of C-reactive protein (CRP) and examine their relationship with traditional risk factors of the coronary heart disease. Methods and participants. We examined a group of 150 males aged between 18 and 24. Each participant underwent physical examination and gave his previous medical history which included the place of residence, family background and current medication. In each case blood pressure was measured and body mass index (BMI) as well as waist/hip (W/H) ratio were established. The following biochemical parameters were measured in the serum of each participant: glucose, total cholesterol, HDL-cholesterol, triglycerides, apolipoproteins A-I and B (Apo A, Apo B), uric acid and C-reactive protein. LDL-cholesterol level was obtained from Friedewald's formula. High sensitivity C-reactive protein (hs-CRP) was measured by automatic DADE-Behring nefelometer. RESULTS: The results underwent variation, correlation and regression analyses. The mean age of participants was 20.5 +/- 1.2 years. The mean BMI, W/H ratio, systolic and diastolic blood pressure as well as traditional coronary heart disease risk factors (total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, uric acid, Apo A, Apo B) were within reference range. The mean CRP level was 0.135 +/- 0.24 mg/dl. There was statistically significant positive correlation between CRP level and W/H ratio. There was statistically significant negative correlation between CRP level and HDL-cholesterol and Apo-A levels. There was no statistically significant correlation between CRP level and smoking. CONCLUSIONS: Our study confirmed findings by other authors that there is a relationship between CRP level and other coronary heart disease factors such as W/H ratio and HDL-cholesterol. The lack of relationship between CRP level and smoking remains consistent with previous findings of Onat and Mendall. The mean CRP level in our study group was similar to CRP levels observed in large European populations.

[Risk factors of cardiovascular disease among newborns with intrauterine growth retardation]. / Czynniki zagrozenia chorobami ukladu krazenia wsród noworodków z zespolem dystrofii wewnatrzmacicznej.

It has been suggested that individuals with low birth weight have higher risk of cardiovascular diseases. Aim of the study was to determine serum lipids and glucose concentrations in newborns with intrauterine growth retardation (IUGR). Results were compared with the same parameters in regular birth weight (RBW) children. We analysed relations of birth weight with history of smoking and positive familial history of cardiovascular diseases among mothers, too. We observed statistically significant higher (p < 0.01) mean concentrations od triglycerides in newborns with IUGR. These children had statistically significant lower (p < 0.01) mean concentrations of HDL-cholesterol. Mothers of IUGR newborns had much frequent (p < 0.01) positive family history of cardiovascular diseases and history of smoking.