[Effectiveness of heart tumor therapy in the cardiology department during 7 year follow-up]. / Skutecznosc leczenia guzów serca rozpoznanych w klinice kardiologii w siedmioletniej obserwacji.

UNLABELLED: Neoplasms of the heart are rare. Usually asymptomatic on the early stage are diagnosed incidentally. Among primary heart neoplasms the most often benign tumors are diagnosed--mostly myxomas, whereas the majority of malignant heart tumors are sarcomas. The aim of this paper was to present heart tumors diagnosed in the cardiology department, their symptoms, used diagnostic tests and therapy and to show after therapy quality of life changes. MATERIAL AND METHODS: There were 18 patients included to the study, whom during hospitalization in the cardiology department heart tumors were diagnosed. There were 11 women and 7 men, aged from 33- to 76-years-old (mean 60,5 years). To all of the patients medical interview, physical examination, EKG, UCG and laboratory test were performed. Additionally in some cases computed tomography or magnetic resonance imaging of the chest and coronary angiograms were done. Based on the diagnostic tests results the patients were qualified to conservative or surgical treatment. RESULTS: Among 18 heart tumor patients in 12 cases primary benign tumors were diagnosed (66,6%), 1 patient had primary malignant tumor (5,5%), there were 3 cases of metastatic tumors (16,6%) and 2 patients with non-neoplasmic tumors--clots (11,1%). From 18 subjects with heart tumor 3 patients died because of advanced stage of neoplasmic disease and presence of metastatic tumors in the heart. CONCLUSIONS: Results of the study show, that heart tumors, regardless of development of diagnostic tests, are still diagnosed too late. The study group follow-up proved, that early diagnosis and proper heart tumor treatment prevented complications and improved the quality of life. It is worth to emphasize, that coronary angiogram in some cases allowed to diagnose coronary artery disease, to treat heart tumor and to perform coronary artery by-pass grafting simultaneously.

[Clinical significance of transesophageal and epiaortal echocardiography of ascending aorta in risk estimation of neurological complications in coronary artery by-pass patients]. / Znaczenie badania echokardiograficznego przezprzelykowego i epiaortalnego aorty wstepujacej w prognozowaniu ryzyka powiklan neurologicznych u chorych poddanych zabiegowi pomostowania tetnic wiencowych.

UNLABELLED: Advanced atherosclerotic changes in aortal wall are an important factor in taking decision to use minimal-invasive method of coronary artery by-pass grafting. There are some methods for diagnosing atherosclerotic changes in ascending aorta, i.e.: roentgenogram, computer tomography, magnetic resonance imaging, transthoracic echocardiography and especially transesophageal echocardiography and epiaortal echocardiography. THE AIM OF THE STUDY: To define usefulness of transesophageal and epiaortal echocardiography as a method of prognosing neurological complications in patients during coronary artery by-pass grafting. MATERIAL AND METHODS: Study group consisted of 32 consecutive patients who had coronary surgery in II Chair and Department of Cardiosurgery, Silesian Medical University in Katowice due to ischemic heart disease in whom before the surgery ascending aorta wall was evaluated with transesophageal and epiaortal echocardiography and then monitoring of microembolism was performed. Transesophageal examination was performed with Philips Sonos 7500 device with 5 MHz transducer in anesthetized patient. Ascending aorta from level of aortic valve to the aortic arch in long and short axis was evaluated. Epiaortal echocardiography was performer with 7.5 MHz vesseltransducer and Hewlett-Packard Sonos 100 CF H-P device immediately after chest opening. Transesophageal echocardiography of ascending aorta evaluated: intima-media complex thickness and presence of atherosclerotic plaques and calcifications. Microembolism monitoring was performed in 18 patients before and during surgery. Using 2 MHz transducer placed in left and right temporal region number of microembolic incidents were evaluated. RESULTS: Analysis of relationship between aortic wall thickness and microembolic signals during cardiopulmonary by-pass was performed. During cardiopulmonary by-pass microembolic signals (from 7 to 698 signals) were detected in 7 patients. During analysis number of microembolic signals was normalized to cardiopulmonary by-pass duration time. CONCLUSIONS: There was found correlation between number of microembolic signals during cardiopulmonary by-pass and thickness of aortic posterior wall in all of it's levels, using epiaortal method in short axis. This same was found using lateral wall measurements. There was no correlation between aortic wall thickness evaluated with transesophageal echocardiography and numbers of microembolic signals.

[Standard electrocardiography and Holter monitoring changes in acromegalic patients]. / Ocena standardowego i 24-godzinnego zapisu elektrokardiograficznego u chorych na akromegalie.

UNLABELLED: Aberrations in circulation related to improper thyroid, parathyroid, adrenal and gonadal function were well researched and recognized. Our knowledge of relation between growth hormone and cardiovascular system is somewhat limited. AIM OF THE STUDY: Our attention was describe occurring in acromegaly complications of cardiovascular function detectable by standard 12-lead ECG and 24-hour Hotter monitoring. MATERIAL AND METHODS: Our research compared 28 patients (15 with hypertension among them) with acromegaly with mean 10-years duration of disease, 20 patients with hypertension and 20 normal subjects. All subjects underwent physical examination followed by standard resting ecg and 24-hour Holter monitoring. Several different ECG parameters were compared: heart reate, arrhythmia (in Holter), times of QRS, QT and QTc intervals and features of atrial and ventricle hypertrophy. RESULTS: Result of this comparison indicates presence of substantial electric cardiac disturbances in acromegaly patients. Patients with acromegaly have substantial QT and QTc prolongation. ECG analysis showed QRS complex prolongation in this group. Much often they had supraventricular and ventricular arrhythmias. Those are complex aberrances which may have important implications for patient's well-being. CONCLUSION: In acromegaly patients significant electrical heart function disturbances were shown. These could be threatening for their life. This group should be early monitored by cardiologist.

Gene expression of kinin receptors B1 and B2 in PBMC from patients with cardiac syndrome X.

INTRODUCTION: Cardiac syndrome X (CSX) is defined by typical chest pain, ST segment depression on ECG and normal coronary angiography. Pathology of CSX may involve microvascular dysfunction related to inflammation and abnormal pain sensitivity. Kinins are labile peptides participating in vasodilation, inflammation and pain. Their effects are mediated by two receptors: B1 and B2. The aim of the study was to assess gene expression of kinin receptors in peripheral blood mononuclear cells (PBMC) from patients with CSX. METHODS: The study was carried out in 34 patients with cardiac syndrome X, 13 with unstable angina and ten healthy subjects. Total mRNA was extracted from PBMC and the number of mRNA copies was assessed by quantitive reverse transcriptase polymerase chain reaction. RESULTS AND CONCLUSION: The study showed 7-fold higher transcriptional activity of B1R in CSX vs. control and 3.5 higher vs. UA. B2R expression was 2.5-fold higher in CSX group vs. control and UA, while in the letter two groups it was similar. Such disturbance in kinin signaling may participate in local vasoconstriction and may reflect disturbances in kinin signaling leading to nociceptive disturbances in these patients.

Left internal mammary artery improves 5-year survival in patients under 40 subjected to surgical revascularization.

BACKGROUND: The population of young patients under 40 requiring coronary bypass surgery is characterized by an extremely and unusually rapid progression of coronary heart disease. The aim of the present study was to assess the clinical status and quality of life in these patients after surgery in relation to the type of conduit used to revascularize the left anterior descending artery (LAD). METHODS: One hundred seventeen patients under 40 (range, 30-40 years) underwent coronary artery bypass grafting (CABG) at our institution between 1991 and 1999. Ninety-one patients received LIMA to LAD graft (group A), and in 26 patients the saphenous vein was used to graft this vessel (group B). Seventy-eight patients (63 in group A and 15 in group B) were assessed after a mean time of 71 +/- 26 months. They were asked to fill out a questionnaire aimed at their subjective assessment of their quality of life as compared with their preoperative status. RESULTS: Five-year actuarial survival was higher in patients with LIMA to LAD graft (log rank test: P < .004). The functional status of patients in group B was significantly worse in comparison to group A: respectively, CCS 2.2 +/- 1.1 versus 1.5 +/- 0.7; (P = .02), NYHA 2.2 +/- 1.1 versus 1.3 +/- 0.5; (P = .002). Patients in group B more frequently required reinstitution of nitroglycerine treatment (93% versus 56%; P = .025). We failed to show differences between the 2 groups as far as subjective quality of life is concerned. In summary, 63% of patients perceived it to be worse, 29% to be better, and 8% felt it had not changed. CONCLUSION: The use of LIMA is crucial in patients undergoing CABG under the age of 40 in order to achieve the best possible surgical results. Quicker recurrence of coronary disease symptoms is observed when a vein is used to graft the LAD. It may reflect an earlier progress of atherosclerosis in venous grafts.

[QT dispersion and characteristics of left ventricular hypertrophy in primary hypertension]. / Dyspersja odstepu QT a charakter przerostu lewej komory w pierwotnym nadcisnieniu tetniczym.

UNLABELLED: The aim of the study was to evaluate the QT dispersion and the severity of arrhythmias in hypertensive patients according to the asymmetry of the left ventricular hypertrophy. The study group consisted of 47 hypertensive patients. In 24 of them the left ventricular hypertrophy was symmetrical (group I) and in 23--asymmetrical (group II). For the evaluation of the left ventricular hypertrophy its thickness was analyzed in 13 segments. The ratio between the maximum and minimum thickness from any location was determined as the asymmetry index (AI). The value of this index 1,3 distinguished between patients with the symmetrical and asymmetrical left ventricular hypertrophy. 20 healthy subjects were examined as a control group (group III). All subjects underwent physical examination, the standard 12-lead electrocardiogram (ECG), twenty-four hour Holter recording and echocardiography. All the results for the QT dispersion (QTd, QTdc, QTdR) were highest in group II, lower in patients from group I and the lowest were observed in the control group. The differences in all parameters between group I and II were statistically significant: for QTd--V p < 0.01, QTdc--p < 0.05, QTdR--p < 0.05. The differences between groups II and III as well as I and III were statistically significant for all QT dispersion parameters: for QTd--p < 0.001 and p < 0.01 respectively, QTdc--p < 0.001, QTdR--p < 0.001 for both groups. We have observed a very distinct positive correlation between the asymmetry index and QTd, QTdc, QTdR (p < 0.001). These values correlated also, but less distinctly with the left ventricular mass index--LVMI (p < 0.05). The frequency and severity of ventricular ectopic beats did not differ significantly between group I and II. The results obtained indicate the lack of connection between the frequency of ventricular premature complexes and (1) all QT dispersion parameters, (2) LVMI, (3) AI. Supraventricular premature complexes occurred significantly more frequently in patients with the asymmetrical left ventricular hypertrophy compared to the group with the regular left ventricular hypertrophy (p < 0.05) and control group (p < 0.01). CONCLUSIONS: The left ventricular hypertrophy in primary hypertension may increase the QT dispersion. It seems that asymmetry of the left ventricular hypertrophy reinforces this increase. The increased QT dispersion in primary hypertension does not influence significantly the occurrence of ventricular arrhythmias.