Morphological characteristics of potentially malignant pulmonary nodules in high-risk male smokers detected in lung cancer screening trial in Cracow, Poland.

The purpose of this paper was to present morphological characteristics of potentially malignant nodules revealed in a group of male smokers aged 50-74 with a very high risk for developing lung cancer estimated in the study for lung cancer screening in Cracow (Poland). Nine hundred male smokers aged 50 to 74 years were invited to the study and were asked in questionnaires about e.g. smoking exposure history. Exclusion criteria included e.g. positive cancer history and chest computed tomography (CT) examination in the previous year. Based on CT results and characteristics of pulmonary nodules subjects were classified to group A (low risk), group B (indeterminate) and group C (high-risk individuals - required work-up). Final diagnosis was based on pathological results of postoperative material. Thirty-nine males of mean age 63.4 (standard deviation (SD): 6.69 years) revealed 41 potentially malignant pulmonary nodules in baseline screening. In 14 subjects 16 type C pulmonary nodules were histologically proved. Nine nodules were found to be benign lesions, while 7 nodules revealed malignant lung cancer: 5 cases of adenocarcinoma and 2 cases of adenosquamous carcinoma. We determined morphological characteristics of potentially malignant pulmonary nodules in 39 high-risk male smokers and proved lung cancer in 7 subjects.

Does higher gadolinium concentration play a role in the morphologic assessment of brain tumors? Results of a multicenter intraindividual crossover comparison of gadobutrol versus gadobenate dimeglumine (the MERIT Study).

BACKGROUND AND PURPOSE: Gadobenate dimeglumine has proved advantageous compared with other gadolinium-based contrast agents for contrast-enhanced brain MR imaging. Gadobutrol is a more highly concentrated agent (1.0 mol/L). This study intraindividually compared 0.1-mmol/kg doses of these agents for qualitative and quantitative evaluation of brain tumors. MATERIALS AND METHODS: Adult patients with suspected or known brain tumors underwent 2 identical MR imaging examinations at 1.5T, 1 with gadobenate dimeglumine and the other with gadobutrol, both at a dose of 0.1-mmol/kg body weight. The agents were injected in randomized order separated by 3-14 days. Imaging sequences and acquisition timing were identical for the 2 examinations. Three blinded readers evaluated images qualitatively for diagnostic information (lesion extent, delineation, morphology, enhancement, global preference) and quantitatively for CNR and LBR. RESULTS: One hundred fourteen of 123 enrolled patients successfully underwent both examinations. Final diagnoses were intra-axial tumors, metastases, extra-axial tumors, "other" tumors, and "nontumor" (49, 46, 8, 7, and 4 subjects, respectively). Readers 1, 2, and 3 demonstrated preference for gadobenate dimeglumine in 46 (40.7%), 54 (47.4%), and 49 (43.0%) patients, respectively, compared with 6, 7, and 7 patients for gadobutrol (P < .0001, all readers). Highly significant (P < .0001, all readers) preference for gadobenate dimeglumine was demonstrated for all other qualitative end points. Inter-reader agreement was good for all evaluations (κ = 0.414-0.629). Significantly superior CNR and LBR were determined for gadobenate dimeglumine (P < .019, all readers). CONCLUSIONS: Significantly greater morphologic information and lesion enhancement are achieved on brain MR imaging with 0.1-mmol/kg gadobenate dimeglumine compared with gadobutrol at an equivalent dose.

Coronary artery calcification, common carotid artery intima-media thickness and aortic pulse wave velocity in patients on peritoneal dialysis.

An increasing body of evidence suggests that atherosclerosis in patients with uremia differs from that found in general population in terms of advancement and localization of vascular lesions. It has also been suggested that different non-invasive techniques of vascular system evaluation are designed to show different types of lesions (i.e. vascular calcification, stiffness or 'classical' atherosclerosis). The aim of the study was to search for possible associations between results obtained with three different non-invasive methods of vascular system assessment in three different vascular sites in patients treated with peritoneal dialysis (PD). 61 patients (28 F, 33 M), mean age of 50.4+/-13.6 years, on maintenance PD for a median period of 10 months (range 1-96 months) were included. Coronary artery disease (CAD) was present in 21 subjects. In all subjects coronary artery calcification score (CaSc) using multi-row spiral computed tomography (MSCT), aortic pulse wave velocity (AoPWV) and ultrasound-based common carotid artery intima-media thickness (CCA-IMT) were performed as methods for assessing coronary calcium burden, arterial stiffness and atherosclerosis, respectively. Median value of CaSc equaled 11.5 Agatston units (range 0-5502.8 units). Median AoPWV was 10.4 m/s (range 7.56-18.1 m/s), and median CCA-IMT-0.6 mm (range 0.3-1.0 mm). In 16 patients (26.2%) at least one plaque in at least one common carotid artery was found on ultrasound. CaSc correlated with AoPWV (R=0.32, p<0.01) and with CCA-IMT (R=0.35, p<0.005), whereas no association was found between AoPWV and CCA-IMT. AoPWV, but not CaSc nor IMT correlated with blood pressure. The values of CCA-IMT and AoPWV increased together with consecutive Agatston categories (with p<0.001 for differences in AoPWV and p<0.05 for CCA-IMT). Patients with at least one plaque found in at least one CCA and patients with CAD were characterized with significantly higher values of CaSc, IMT and PWV, when compared to plaque-free and CAD- negative subjects, respectively. Association between CaSc and both IMT and PWV may suggest that the mechanism of three assessed vascular pathologies may be based, to some extent, on the process of pathologic calcium-phosphate deposition. Lack of correlation found between PWV and IMT may suggest that aortic stiffness and carotid atherosclerosis may partially differ in their pathologic background and/or are dissociated in time.

Osteoma of the sphenoid sinus.

OBJECTIVE: Only twenty cases of osteomas of the sphenoid sinus have been reported. This tumour causes progressively worsening headaches and visual disturbance and should be resected when symptomatic or fast-growing. In selected cases, endoscopic sinus surgery offers an effective alternative to open procedures. CASE REPORT: The authors report a case of sphenoid osteoma in a 19-year old woman. Computed tomography performed because of complaints of progressively worsening headaches identified a large osteoma of the sphenoid sinus. The clinical features and radiological assessment of the disease are presented together with a review of the literature. RESULTS: The endoscopic technique used for resection of the tumour gave a very good result. CONCLUSION: Sphenoid osteoma is an extremely rare lesion which can be approached endoscopically in selected cases.

Optimizing the assessment of age-related changes in trabecular bone.

The goal of this study was to develop an optimal procedure to determine age-related changes in trabecular bone. The investigations were based on two-dimensional images of the human vertebral trabecular bone specimens. The following indices of trabecular structure were considered: bone volume/total volume, star volume of the marrow cavity, Euler number and the probability of disconnection (straightforwardly connected with the number of separated parts of the network). To follow precisely the changes in the trabecular structure with age, a computer simulation model was used. Up to 35 years of physiological remodelling were simulated. The validation of the model calculations was based on a quantitative comparison with the data measured for older individuals. The simulations confirmed that the description of the age-related changes in the trabecular bone by means of the architectural parameter (star volume) constitutes a promising tool for subjects older than approximately 50 years. For individuals younger than approximately 50 years bone mineral density (bone volume/total volume) seems to be the best suited descriptor. The results suggest that the optimal diagnostic procedure is age-dependent and should not be limited to the bone mineral density measurement. The clinical usefulness of the procedure has been validated by examination of the CT images.

[QT dispersion in DDD and VVI paced patients after myocardial infarction or with left ventricular hypertrophy]. / Dyspersja odstepu QT w dlugotrwalej stymulacji dwujamowej typu DDD i komorowej VVI u chorych po zawale miesnia serca lub z jego przerostem.

The aim of this study was to assess the alterations of stroke volume (SV) on the QT dispersion (QTD) as a result of different pacing modes and programmed AV delays in patients (pts) after myocardial infarction (MI) or with left ventricular hypertrophy (LVH). We studied 14 MI pts (9 M, 5 F) in mean age 72.3 +/- 3.7 yrs (Group I) and 12 pts with LVH (7 M, 5 F) in mean age 67.3 +/- 5.9 yrs (Group II), in whom DDD pacemakers were implanted due to complete atrioventricular block. The control group (Group III) consisted of 9 pts without MI or LVH. In all cases basic rate of the pacemaker was programmed at 70/min. Resting ECG showed all atrial and ventricular complexes captured. AV delay optimization was based on the measurements of SV by Doppler echocardiography. QT intervals (QTi) were measured from 12-lead ECG at 50 mm/s speed. QTD was calculated as the difference between maximal and minimal QTi. It was measured at optimal (opt. DDD, with highest SV) and "unoptimal" (unopt. DDD) programmed AV intervals and then in VVI mode (with lowest SV) after following reprogramming of the pacemaker. In Group I and II, a strong correlation between SV and QTD was found (R = 0.816 and -0.897, respectively). In control group, it was insignificant (R = -0.339). In VVI mode SV was significantly lower than in unopt. DDD (in Mi pts: 56.1 ml vs 71.1 ml, respectively, p < 0.01; in LVH pts: 64.1 ml vs 96.7 ml, respectively, p < 0.005) and QTD was significantly greater (74.8 ms vs 66.8 ms, respectively, p < 0.005 and 70.0 ms vs 53.5 ms, respectively, p < 0.005). In LVH pts or MI pts programming of different AV intervals and pacing modes significantly influences QTD.

[Successful RF ablation in a patient with paroxysmal atrial fibrillation induces by atrioventricular nodal reentrant tachycardia]. / Skuteczne leczenie metoda przezskórnej ablacji RF u pacjentki z napadowym migotaniem przedsionków wyzwalanym przez nawrotny czestoskurcz z wezla przedsionkowo-komorowego.

We describe a case of 47-year old patient with frequent episodes of paroxysmal atrial fibrillation (PAF) with fast ventricular rate. During electrophysiological study an atrioventricular nodal reentrant tachycardia (AVNRT) was diagnosed with rapid degeneration into atrial fibrillation. Successful RF ablation of slow pathway was performed. There were no PAF recurrences during six months follow-up.

[Qualification of patients for procedures to resect lung parenchyma during general anesthesia]. / Kwalifikacja chorych do zabiegów resekcji miazszu pluca w znieczuleniu ogólnym.

Authors described the methods and techniques of pulmonary and circulatory assessment of patients undergoing pulmonary resection. The most emphasis has been put on the perioperative management specially in patients with compromised pulmonary and circulatory system.

[The influence of anesthesia methods on appearance of perioperative complications in patients after lung parenchyma resection]. / Wplyw metody znieczulenia na wystepowanie powiklan okolooperacyjnych u chorych poddanych resekcji miazszu pluca.

We analyzed the influence of different methods of anaesthesia on perioperative complications in 184 patients (ASA 1 and 2) anaesthetized with intermittent one lung ventilation for pulmonary resection. Depends on the method of anaesthesia patients were divided into 3 groups: Group 1--patients under inhalation anaesthesia, Group 2--patients under mixed inhalation and intravenous anaesthesia and Group 3 patients anaesthetized intravenously. The analysis of intra- and postoperative data showed no correlation between perioperative complications and methods of anaesthesia, when the appropriate technique of anaesthesia has been used.

[Long-term results of coronary balloon angioplasty in various age groups]. / Wyniki angioplastyki wiencowej u chorych w róznych grupach wiekowych.

UNLABELLED: Some data indicate that natural history of coronary artery disease in younger patients is characterised by high dynamics and therefore the long-term results of revascularisation procedures have generally poorer outcome. To verify this we compared the early and the long-term results of balloon angioplasty in 630 consecutive patients divided into four age groups: < 40 years (77 patients), 41-50 years (247 patients), 51-60 years (160 patients) and > 60 years (146 patients). Groups differed significantly in many clinical factors: higher proportion of women and unstable angina were encountered in older groups, while higher frequency of hypertension, hypertriglycerydaemia, current smoking, familial history of angina, prior myocardial infarction, were more often observed in younger patients. Groups did not differ in such angiographic factors as: global ejection fraction (EF), presence of multivessel disease, type of dilated lesions and vessels, multilesion PTCA, except higher frequency of EF < 50% in patients < 40 years of age. Immediate results of angioplasty did not differ significantly between the respective age groups: success rate was 87-94%, complications rate between 4.5% and 6.5%, complete revascularisation was achieved in 46-61% patients (NS). In the mean 5-year follow-up period repeated angiography was carried out with comparable frequency in about half of the studied patients (NS). Restenosis rate equalled 21-42% and significantly increased with the patients' age (p = 0.02 in chi 2, 0.009 in log-rank test), the related reinterventions rate likewise (p = 0.05 in chi 2, 0.009 in log-rank test). We did not observe any differences among the respective groups with regard to significant atherosclerosis progression, which was encountered in 15-19% of patients (NS). Survival rate did not differ significantly either, being in fact quite high (96-99%). Myocardial infarction in follow-up significantly more frequently (p = 0.01) occurred in patients < 40 years of age, in comparison with patients > 60 years of age, although it did not differ significantly in terms of overall test for independence (p = 0.3) and log-rank test (p = 0.07). The frequency of major coronary events significantly increased according to patients' age as opposed to the event-free survival (p = 0.02 in both tests). Uni and multivariate analysis confirmed that age over 50 years is an independent factor of restenosis, reintervention, and major coronary event in follow-up. Patients functional status at the end of observation period, according to CCS criteria, proved that in the older age groups the percentage of patients with none, or minor anginal complaints decreased, whereas the proportion of patients exhibiting the symptoms of severe angina (Class III and IV) significantly increased (p = 0.006). CONCLUSIONS: Balloon angioplasty offered similar short-term outcome in all age groups, as well as the survival rate during the 5-year follow-up period. Frequency of restenosis significantly increased in older patients especially the ones over 50 years of age; this in turn resulting in a higher reinterventions rate among them. On the other hand, patients below 40 years of age suffered more frequently from myocardial infarction during the follow-up period. Major coronary events were more frequent in patients over 50 years of age. Better functional status was observed in younger patients at the end of observation period.

[Quality of life in diabetic patients with coronary artery disease treated with percutaneous coronary angioplasty]. / Jakosc zycia chorych z choroba wiencowa i cukrzyca leczonych za pomoca przezskórnej angioplastyki naczyn wiencowych.

UNLABELLED: Increased restenosis rate, higher incidence of coronary events, and, in some studies also increased mortality are observed during long-term follow-up in patients (pts) with diabetes mellitus treated with percutaneous coronary angioplasty. This is why some authors suggest that indications for PTCA in the group of diabetic pts should be significantly limited. The aim of our study was the estimation of clinical condition and quality of life in diabetic patients who underwent PTCA procedure in order to establish indications for percutaneous revascularisation in this group of pts. The study group consisted of 54 diabetic patients who were successfully treated with percutaneous coronary angioplasty in the period of 1987-1996. All pts were assessed clinically and quality of life was estimated on the basis of specially designed questionnaire. During mean 5-year follow-up 1(1.9%) patient died, 2 (3.7%) pts had acute myocardial infarction, restenosis was diagnosed in 25 (46.3%) pts. Repeated revascularisation was necessary in 27 (50%) pts. Significant clinical improvement was observed in the pts from the study group as compared to their clinical condition before the procedure (CCS 0 or I--61% vs 0%, p < 0.0001, III--9% vs. 39%, p < 0.0003, IV--1.9% vs. 22%, p < 0.001). The rate of pts who were employed did not change in consequence of successful PTCA procedure. The number of pts returning to work was equal to the number of patients receiving social benefits. Subjective improvement was declared by 87% of pts. Lack of angina pectoris episodes was reported by 52% of pts and in 35% of pts the number of angina pectoris episodes was significantly reduced. Better tolerance of physical activity was declared by 59% of pts, and 65% of the studied pts fully came back to their non-professional activities. Partial return to non-professional activities was possible for 24% of pts. Normal sexual activity was declared by 65% of pts. Only 9% of the studied pts experienced significant limitation in their sexual activity. PTCA met the expectations of 89% of pts while the number of negative opinions, i.e. the lack of subjective improvement, impaired quality of life, or disappointment with the results of the PTCA procedure did not exceed 13%. Significantly worse results of the selected parameters describing the quality of life were observed in the group of diabetic pts treated with insulin. CONCLUSIONS: PTCA improved quality of life in 60-90% of pts with diabetes mellitus, nevertheless, did not affect the employment status of successfully treated pts. Patients who needed insulin therapy had worse indicators of life quality, however thorough analysis suggest that PTCA can be advised as a method of treatment in the group of diabetic patients with coronary artery disease.

[Quality of life in patients after implantation of pacemaker type DDD]. / Samoocena jakosci zycia chorych po wszczepieniu rozrusznika serca typu DDD.

The aim of this study was to evaluate quality of life in pts with DDD pacemakers. The study group consisted of 343 pts (181 F, 162 M), mean age 66.7 +/- 2.5 y (19-92) in whom DDD pacemakers were implanted in the years 1992-1998 due to sick sinus syndrome (213 pts) or AV block (130 pts). Follow-up period was 111-2574 days, mean 924.58 +/- 550 days. The QOL assessment was based on the questionnaire prepared at our Center. The questionnaires were mailed to the pts. The significant improvement in overall well-being (p < 0.001), physical capacity (p < 0.005) and concentration (p < 0.025) was found as compared to the time before implantation. The incidence of syncopy decreased after implantation (p < 0.001). The pts complained of: limitation of arm moving (50.1%), anxiety for disturbances of PM function (41.4%), resignation from job (17.2%), restriction of sport activity (15.7%), necessity for follow-up visits (15.7%) and limitation of sex activity (10.2%). There were not significant differences in QOL between pts paced due to SSS or AV block. We found significant improvement in QOL after implantation of DDD pacemakers. The questionnaire-based assessment of QOL may be useful in management of DDD-paced pts.

Association of Helicobacter pylori infection with coronary heart disease.

The role of Helicobacter pylori (HP) as the main etiological factor in gastritis and peptic ulcer disease is undisputable. Gastric mucosal damage caused by HP involves various bacterial and host-dependent toxic substances that have been recently associated with an increased risk of coronary artery disease (CAD), possibly through the activation acute phase response and of procoagulant hemostatic factors. Recent studies showed a close and strong correlation between plasma increments of some cytokines such as IL-6 or TNFalpha and cardiovascular diseases. HP infection induces platelet activation and aggregation that could be the pathogenic explanation of the association between HP infection and CAD. The aim of this study was to determine the seroprevalence of HP infection and antibodies to CagA, an antigen that is expressed by the most virulent HP strains inducing an enhanced gastric inflammatory response, in patients undergoing routine coronary artery examination. We studied 76 patients with CAD and 81 healthy controls patients without significant change in coronary circulation. Angiograms were read by two independent experienced cardiologists blinded to the results of HP status. The presence of serum IgG antibodies to HP and to CagA and plasma interleukin-8 (IL-8) levels was measured by ELISA. In addition plasma C-reactive protein fibrinogen, total cholesterol and lipids levels were measured in all studied patients. Seropositivity to HP was found in 81.5 % of cases and in 51% of controls and the difference in prevalence was statistically significant, the odds ratio being 4.3 for Hp patients. Antibody to CagA protein was detected in 47.3% of CAD but only in 28% of healthy controls (OR = 2.3 vs OR = 10). C-reactive protein, plasma fibrinogen and total cholesterol were, respectively higher in patients with CAD than in controls. Present data show that there is significant link between CAD and HP infection. The HP infection significantly increases the risk of CAD, especially when both the anti-HP IgG and anti-CagA IgG are considered. Higher prevalence of cytotoxic HP strains might enhance the atherosclerotic process by inducing a persistent, low grade inflammatory response in arterial wall with enhanced synthesis of acute phase reactants.