Exceptional life-threatening complication 19 years after Ravitch correction of pectus excavatum.

BACKGROUND: Ravitch technique of chest correction has been considered, although invasive, as a safe and efficacious surgical method. CASE: We describe a case of a 35-year-old woman with cardiac tamponade and in cardiogenic shock due to exceptional late complication after pectus excavatum reconstruction by means of classic Ravitch technique 19 years earlier. This very late adverse event was caused by a broken metal sternal wire that injured the wall of the ascending aorta. The patient underwent salvage repair of this segment of the aorta in cardiopulmonary bypass. Postoperative course and postdischarge 3-year follow-up have been uneventful. CONCLUSION: Therefore, life-threatening cardiovascular complications may occur even many years after reconstructive surgery for chest deformity.

[Progressive cardiac tamponade and right ventricular free wall perforation as complications after dual-chamber pacemaker implantation - a case report]. / Perforacja wolnej sciany prawej komory i postepujaca tamponada serca jako powiklanie po implantacji dwujamowego ukladu stymulujacego - opis przypadku.

In recent years the number of complications related to implantation of cardiac stimulating systems is increasing. Life-threatening myocardial perforation leading to cardiac tamponade is one of the rarest complications. In that case it is necessary to take the immediate lifesaving procedures. A CASE REPORT: 61-year-old woman ended up in the cardiac surgery department with progressive cardiac tamponade and cardiogenic shock symptoms. Three weeks earlier due to the tachycardia-bradycardia syndrome with second-degree atrioventricular block diagnosis, the cardiac stimulating system was implanted into the heart at the cardiology department. Two days after the discharge from hospital the patient appeared in the emergency department with non-specific chest symptoms, which disappeared after analgesic drugs. After another two weeks the patient returned to the emergency department in general poor condition. Echocardiographic examination showed fluid in both pleural cavities, a dense layer around heart and fluid out wards from the layer in the pericardial space. Furthermore, CT scan showed unobvious shape crossing the heart muscle. Firstly, the patient was admitted to the cardiology department and next transferred to the cardio surgery where on account of deteriorating condition was made a decision urgent sternotomy and revision pericardial sac. Intraoperatively were found perforation of right ventricular free wall caused by stimulation electrode and hole communicating pericardial space with left pleural cavity. The operation went well, without any complications. The patient was discharged from hospital 12 days after surgery. CONCLUSIONS: In the case of suspected complications related to the implantation of electrostimulation equipment, it is necessary to perform appropriate diagnostics and implement urgent procedures, including surgery.

Fighting Left Handers Promotes Different Visual Perceptual Strategies than Right Handers: The Study of Eye Movements of Foil Fencers in Attack and Defence.

Left handers have long held the edge over right handers in one-on-one interactive combat sports. Particularly in fencing, top rankings show a relatively strong overrepresentation of left handers over right handers. Whether this can be attributed to perceptual strategies used by fencers in their bouts remains to be established. This study aims to verify whether right-handed fencers assess their opponents' behaviour based on different perceptual strategies when fencing a left vs. right hander. Twelve top-level (i.e., Olympic fencers, Junior World Team Fencing Champions, and top Polish senior foil fencers) right-handed female foil fencers (aged 16-30 years) took part in the study. They performed a total of 40 actions: 10 repetitions of offensive actions (attack) and 10 repetitions of defensive actions (defence), each type of action performed under 2 conditions (right- vs. left-handed opponent). While the participants were fencing, their eye movements were being recorded with a remote eye-tracker (SMI ETG 2.0). Both in their offensive and defensive actions, the fencers produced more fixations to the armed hand and spent more time observing the armed hand in duels with a left-handed (vs. right-handed) opponent. In defence, it was also the guard that attracted more fixations and gained a longer observation time in bouts with a left hander. In duels with a right-handed opponent, a higher number of fixations in attack and in defence, and longer observation times in defence were found for the upper torso. The results may point to different perceptual strategies employed in bouts with left- vs. right-handed individuals. The findings from this study may help to promote the implementation of specialized perceptual training programmes in foil fencing.

[Lyell's syndrome complicated with multi-organ failure and patient's death after complex cardiac surgery - a case report]. / Zespól Lyella powiklany niewydolnoscia wielonarzadowa i zgonem chorego po zlozonej operacji kardiochirurgicznej ­ opis przypadku.

A complex cardiac surgery may be associated with a number of complications. The occurrence of toxic epidermal necrolysis (TEN) in the postoperative period in a patient who has already experienced other complications contributes to the worsening of his prognosis. Despite the regression of necrotic skin lesions TEN can lead to tragic complications. A CASE REPORT: A 48-year-old patient was admitted as scheduled to a cardiac surgery ward for a complex cardiac surgery. During the procedure, a mechanical aortic valve prosthesis, an ascending aorta prosthesis were implanted, and the left internal thoracic artery (LIMA) was grafted to the left anterior descending coronary artery (LAD). The intraoperative course was not complicated. In the postoperative period, some fluid was found in the left pleural cavity, which was decompressed. In the following days of the postoperative period an instability of the sternum and a serous-bloody discharge from the wound ocurred, these resulted in the reoperation and use of vacuum-assisted closure (VAC) therapy. Later, there were also haemorrhagic complications requiring surgical intervention and numerous transfusions of blood components. The patient was diagnosed with a very rare complication in the form of toxic epidermal necrolysis. Despite the therapy and regression of skin lesions an irreversible multi-organ failure developed in the patient which resulted in his death. CONCLUSIONS: Toxic epidermal necrolysis turned out to be a complication significantly contributing to the patient's death.

Prof. Eugeniusz Piasecki's Contribution to the Development of Polish Physiotherapy.

Based on source materials, this article presents the activity of Prof. Eugeniusz Piasecki towards the development of physiotherapy in Poland. After completing his studies at the Faculty of Medicine of Jagiellonian University and a pedagogical course in physical education for gymnastics teachers at secondary schools and teacher training centres, he went to Vienna to deepen his knowledge of medical gymnastics and hydrotherapy. During a scientific trip to Sweden, he became acquainted with Pehr Henrique Ling's method. In the years 1900-1916, E. Piasecki ran a healing gymnastics, orthopaedics and massage facility in Lviv. He was also active in the "Sokol" Gymnastic Society and worked in the gymnasiums owned by his father Wenanty Piasecki in Cracow and Zakopane. At the University of Lviv he taught school hygiene, theory of physical education as well as conducting research and teaching in the physiology of exercise. There he also obtained his habilitation in 1909. His overarching objective was to eliminate German gymnastics, which he considered harmful, from schools in Galicia. Instead, he advocated Swedish gymnastics, based on scientific evidence and anatomo-physiological analysis of each movement. His research focused, among others, on the effect of various physical exercises on the cardio-respiratory and osteo-articular systems in children. The results of E. Piasecki's studies were the basis for a critical evalu-ation of the irrational strength exercises of German gymnastics. He endeavoured to promote physical education as much as possible, adapting it to the specific needs of schools, hospitals and spas. As head of the Department of Theory of Physical Education and School Hygiene (since 1919) and then the Institute of Physical Education (since 1924) at Poznan University, together with Prof. Ireneusz Wierzejewski, Dr Wiktor Dega,Ph.D., and Dr Franciszek Raszej, Ph.D., he laid the foundations of rehabilitation in Poland. Thanks to him, the Poznan centre carried out research in medical gymnastics and massage, preparing specialists in the area of corrective exercises and, later, physiotherapy in Poland.

Professional Activities of Professor Kazimiera Milanowska in the Field of Rehabilitation.

Professor Kazimiera Milanowska is a rehabilitation physician and academic scholar of international renown. She has extensive expert knowledge and scientific achievements in the fields of medical rehabilitation and physical culture sciences. The aim of the present biographical study was to present the development of Prof. Kazimiera Milanowska's career. As Head of the Rehabilitation Department at the Medical Academy in Poznan, she delivered lectures on the clinical foundations of rehabilitation and theory and philosophy of modern rehabilitation as well as numerous courses on methods of musculoskeletal compensation and adaptation, muscle reeducation, and rehabilitation following peripheral neuron injury. Kazimiera Milanowska has published numerous papers and books (221). She was the pioneer of combined electromyographic and ergometric diagnostics in Poland.