Robin Heart 2003--present state of the Polish telemanipulator project for cardiac surgery assistance.

The Polish telemanipulator (Robin Heart), for use in cardiac surgery, has been realized by the Foundation of Cardiac Surgery Development in Zabrze, Poland, in cooperation with specialists from the Technical University of Lodz and Warsaw University of Technology. The brief history of robotic surgery and fundamental advantages of employing robots in this field--safe, reliable and repeatable operative results with less patient pain, trauma and recovery time--follow the assumptions of the Polish Cardio-Robot project. The cardiac surgery robot, Robin Heart, is an original construction with a segment type structure which allows the various combination of its parts for different types of surgery. The telemanipulator for cardiac surgery will consist of two arms equipped with tools and one arm holding the camera. Several models suitable for surgeon contact systems, using the experience of centers designing the artificial hand and haptic systems have been worked out. The detailed mechanical analysis and original construction of main parts of the robot and development of the surgical planning system are presented in further sections.

Heart retrieval for cardiac homograft.

BACKGROUND: The use of homograft tissue instead of various artificial materials in contemporary cardiovascular surgery, although limited by the constant shortage of donor organs, has become the clinically preferable procedure. The proper technique of heart retrieval, with strict donor qualification criteria and sterility procedures, is one of the key points in the successful preparation of allografts to be used later in a selected group of patients undergoing cardiac surgery, especially in the repair of pediatric congenital heart defects. MATERIAL AND METHODS: The article presents the most popular surgical technique to use for retrieving a heart for cardiac homograft in multiorgan procurement and routine autopsy, including the immediate preliminary preparation and transport, as recommended by the majority of tissue bank institutions. The qualification criteria for tissue donation, delicate preparation techniques, and sterility protocols are also important issues for successful cardiac homograft retrieval. Recently a tendency towards a growing number of pediatric donors can be observed. The techniques presented in this article should also be applied in cases of homograft retrieval from pediatric donors. RESULTS: This article analyzes our seven-year-long experience, involving a total number of 608 hearts retrieved for cardiac homografts, with special attention to the main reasons for disqualification of the organs delivered to the tissue bank. CONCLUSIONS: 1. The procedures for the sterility of tissue retrieval, especially in autopsies with heart retrieval, although they may sometimes be difficult for the surgeon or pathologist, are necessary to provide maximum benefit from harvested tissues. 2. The proper technique for pediatric homograft retrieval is twice as important in tissue delivery protocols.

Biological heart valve--an alternative to mechanical valve.

Bioprosthetic heart valve, derived from human or animal tissues is a commercial, implantable valve characterised by good haemodynamic parameters, low haemolysis ratio and satisfactory durability. Until now, its wide-spread therapeutic use has been limited by the progressing leaflet calcification. The aim of the paper is to present the benefits, adverse reactions as well as problems associated with the improvement of this bioprosthesis.

A congenital defect of the pericardium.

Ten patients with congenital defects of the pericardium were treated in Departments of Cardiac Surgery, Silesian School of Medicine in Zabrze and Katowice between 1989 and 1998. There were eight children and two adults, eight males and two females. In each case the pericardial defect was discovered intraoperatively during surgery for congenital heart defect. There were no cases with clinical symptoms that could be clearly related to the defect of the pericardial sac. In the case of a child with a complete absence of the left pericardial wall the heart was significantly rotated contrary to the defect. The final outcome of the congenital heart defect surgery was satisfactory in each case. An abbreviated historical review of the diagnosis and treatment of the pericardial defects is presented with special attention placed on therapeutic management. Surgical correction of pericardial defects is concluded to be justified in patients with clinical symptoms. In most cases pericardial defects are discovered intraoperatively, but when they are large the said defects do not require any treatment.

Inhaled corticosteroid improves bronchial reactivity and decreases symptoms in patients with mitral stenosis.

STUDY OBJECTIVE: To determine if treatment with inhaled budesonide forte can diminish increased bronchial hyperreactivity and improve symptoms in patients with mitral valve stenosis. DESIGN: The study was randomized, double blind, and placebo controlled. SETTING: Outpatient/university hospital. PATIENTS: Twelve subjects, 8 female and 4 male, who qualified for mitral valve replacement. All subjects presented with increased bronchial reactivity to histamine at the time of the study. INTERVENTIONS: Patients received placebo or budesonide forte twice a day (1,200 mg/d) for 6 weeks. During the study, patients were treated with the same doses of diuretics and other medications that could affect bronchial reactivity. MEASUREMENTS: Spirometry, provocative concentration of histamine causing a 20% fall in the FEV1 (PC20H), symptom scores. RESULTS: In the treated group, the initial PC20H was 0.82+/-0.72 mg/mL; in the placebo group 1.39+/-1.3 mg/mL. After 6 weeks of treatment, PC20H was significantly higher (3.07+/-2.28 mg/mL; p > 0.01) in the budesonide-treated group and remained unchanged in the placebo group (1.49+/-0.91). Symptom scores were significantly lower after administration of budesonide forte (mean change, 4.0+/-2.6). CONCLUSIONS: Six weeks of treatment with budesonide forte significantly decreased bronchial reactivity to histamine and improved symptoms in patients with mitral valve stenosis.

Coarctation of the aorta with right aortic arch. A rare case and atypical clinical picture.

We report the case of a 13-year-old girl with a diffusely hypoplastic right aortic arch, anomalous origin of the left subclavian artery, and a small, insignificant ventricular septal defect. The patient's pulse was forceful at the carotid arteries, but it was markedly weaker at all extremities. Catheterization revealed that both common carotid arteries arose from the dilated ascending aorta; the right subclavian and vertebral arteries arose from the hypoplastic posterior segment of the aortic arch, and the left subclavian artery arose from the normally developed descending aorta. The pressure gradient between the ascending and descending aorta was 80 mmHg. A bypass grafting procedure was performed to connect the ascending and the upper abdominal aorta. No pressure gradient remained after the operation, nor was a gradient detected during 2 years of follow-up. The origin of both subclavian arteries distal to the area of coarctation resulted in an atypical clinical picture and delayed diagnosis. Ten previously reported cases of coarctation of the aorta with right aortic arch are reviewed.

[Natural killer cell count in hemodialysis patients]. / Liczba naturalnych komórek cytotoksycznych u hemodializowanych chorych.

UNLABELLED: The patients with chronic renal failure present an immunodeficiency state manifested by prolonged tolerance to allografts, increased incidence of infections and abnormally high incidence of neoplasia. The present study aimed to assess the effect of chronic uraemia and haemodialysis treatment on the natural killer cells (NK cells) count. Peripheral blood NK cells (CD3-, CD16+), total lymphocytes, leukocytes, monocytes and granulocytes of 24 hemodialyzed patients with chronic renal failure and 32 healthy subjects were studied using flow cytometry. In the investigated group of patients with chronic renal failure treated with haemodialysis the count of NK cells (CD3-, CD16+) in the peripheral blood was significantly decreased in comparison to healthy subjects (137 +/- 11 versus 229 +/- 13, p < 0.001) and a significant negative correlation (r = -0.391, p < 0.05) was observed between the duration of haemodialysis treatment and the count of NK cells (CD3-, CD16+). CONCLUSIONS: 1) Chronic uraemia and haemodialysis treatment exerts a negative effect on NK cells (CD3-, CD16+) count in the peripheral blood. 2) The count of NK cells (CD3-, CD16+) in the peripheral blood in patients with chronic renal failure treated with haemodialysis could be a prognostic marker of susceptibility to infections and malignancy.

[The effect of repeated use of cuprophane and polysulfone dialyzers during hemodialysis on the count of natural killer cells in blood]. / Wplyw wielokrotnego uzycia dializatorów kuprofanowych i polisulfonowych w czasie hemodializy na liczbe naturalnych komórek cytotoksycznych we krwi.

UNLABELLED: The aim of the study was to compare the effect of hemodialysis with the reused cuprophane and polysulfone dialyzers and bicarbonate dialysis on the count of natural killer cells in the peripheral blood in patients with chronic renal failure during the hour of haemodialysis. The study was performed in 16 patients with chronic renal failure just before haemodialysis (0') as well as 15 and 60 minutes after the beginning of haemodialysis with the first and the fourth use of membranes. The count of natural killer cells (CD3-, CD16+) in the peripheral blood was assessed using the flow cytometry. CONCLUSIONS: 1) The count of natural killer cells (CD3-, CD16+) decreased transiently in the peripheral blood in observed patients during haemodialysis. 2) The use of new cuprophane membrane decreased the count of natural killer cells in peripheral blood during haemodialysis significantly more than the haemodialysis with the use of polysulfone membranes and reused cuprophane membrane. 3) The count of the natural killer cells (CD3-, CD16+) in the peripheral blood in patients with chronic renal failure assessed 15 minutes after the start of haemodialysis could be a marker of dialysis membrane hemocompatibility.

Serum beta-2-microglobulin (beta-2-M) levels in heart transplant patients (HTP).

UNLABELLED: The present paper aim to answer following questions: 1. What is serum beta-2-M levels in HTP? 2. Does significant correlations between serum beta-2-M levels and serum creatinine levels or creatinine clearance (inulin clearance) exit? 3. Does any significant correlation between serum beta-2-M levels and blood cyclosporine A concentration exit? Three groups of subjects were studied. The first group consisted of 33 heart transplant patients (HTP), the second group consisted of 12 patients with small decline kidney function, and the third one consisted of 36 healthy subjects. In all examined subjects serum beta-2-M (RIA) creatinine, creatinine and inulin (steady state dosis method) clearance were assessed. CONCLUSION: 1. In observed HTP serum beta-2-M level is significantly higher then in controls and patients with small decline kidney function; 2. A significant correlation between kidney function and -2-M level in HTP as well as in other examined groups subjects exit; 3. Presence a significant positive correlation between serum beta-2-M level and blood cyclosporine A concentration suggest that beta-2-M level can be a good parametr to define cyclosporine A tubular toxicity.

Follow-up of infants after systemic-pulmonary shunts, performed with fresh frozen vein homografts. Postoperative angiographic assessment.

Ten of twenty-six modified Blalock-Taussig shunts performed with fresh frozen vein homograft were studied angiographically. In two of them the shunt was stenosed. The remaining eight shunts were satisfactory. Among them in four irregularities of the inner surface and in four spindle shape of the shunt were observed. The diameter ratio between subclavian artery and homograft at the time of operation and later as seen on the angiograms did not change. This suggests that spindle shape of homograft is caused by growth rather than by aneurysm formation.

[Effect of hemodialysis with cuprophane and polysulfone membranes on counts of leukocytes, granulocytes, monocytes, lymphocytes and lymphocyte subsets]. / Wplyw hemodializy dializatorami kuprofanowymi i polisulfonowymi na liczbe leukocytów, granulocytów, monocytów, limfocytów i podklas limfocytów.

In patients with chronic renal failure treated with haemodialysis many disorders of specific and unspecific immunity were observed. Several different parameters such as direct interaction with dialyzer membrane, hypersensitivity to components within the membrane, complement activation, or presence of endotoxins in the dialysis fluid or water supply can activate the immune system during haemodialysis and cause immunity disorders. This study aimed to compare the biocompatibility of two different dialysis membranes on the ground of the influence on the counts of immunity cells in the first hour of haemodialysis when the interaction between blood and membrane were the greatest. In 18 patients with CRF granulocytes, monocytes, lymphocytes B and T, T4 and T8 cells were counted just before haemodialysis, 15 minutes and 60 minutes after the start of haemodialysis. In all patients the investigation was done first using the cuprophane dialysis membrane and then using polysulfone dialysis membrane. The cell populations were differentiated by flow cytometry on Fascan using the conjugated monoclonal antibodies. During the first 15 minutes of haemodialysis with cuprophane membrane the amount of all investigated cells populations decreased significantly. With polysulfone membrane only monocytes decreased significantly in the first 15 minutes of haemodialysis. These results indicate that the polysulfone membrane is more biocompatible than the cuprophane one and suggest that using the biocompatible membranes some disorders of immunity system in this patients can be prevented.