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Wrocław, Poland

Siewiera J.,4th Military Hospital | Siewiera J.,Wroclaw University | Trnka J.,Wroclaw University | Kubler A.,Wroclaw University
Anaesthesiology Intensive Therapy

In contemporary clinical practice, the issue of requesting patient consent to perform therapeutic treatment plays an important role. The conscious consent of a patient as an expression of one's will greatly strengthens the legality of medical procedures performed by a physician, regardless of the medical fi eld. However, obtaining consent to treatment in the Intensive Care Unit (ICU) often poses enormous diffi culties in daily clinical work, and has in recent decades been the cause of much dispute between doctors and lawyers. The correct interpretation of the provisions under the relevant laws determines the safety and comfort of the medical practice in the ICU. This study compared the current rules of normative acts of Polish common law relating to medical practice in intensive care units and issued on the basis of the judgments of the common court of law over the past ten years. On the basis of those provisions, the authors conclude that the patient should be informed by the anaesthesiologist during the visit as to the possibility of postoperative therapy in the ICU. The extent of such information depends on the likelihood of having treatment in the ICU. The consent of the patient for hospitalisation in the ICU should be mandatory in the case of treatments which are very likely to necessitate such hospitalisation. This concerns especially cardiac surgery, neurosurgery and treatments for patients with a signifi cant burden of disease. The authors of this study propose that an information and consent form to undergo treatment in the intensive care unit should be included within the anaesthesia consent form. Source

Costanzo M.R.,Midwest Heart Foundation | Khayat R.,Ohio State University | Ponikowski P.,4th Military Hospital | Ponikowski P.,Wroclaw Medical University | And 4 more authors.
Journal of the American College of Cardiology

Central sleep apnea (CSA) is a highly prevalent, though often unrecognized, comorbidity in patients with heart failure (HF). Data from HF population studies suggest that it may present in 30% to 50% of HF patients. CSA is recognized as an important contributor to the progression of HF and to HF-related morbidity and mortality. Over the past 2 decades, an expanding body of research has begun to shed light on the pathophysiologic mechanisms of CSA. Armed with this growing knowledge base, the sleep, respiratory, and cardiovascular research communities have been working to identify ways to treat CSA in HF with the ultimate goal of improving patient quality of life and clinical outcomes. In this paper, we examine the current state of knowledge about the mechanisms of CSA in HF and review emerging therapies for this disorder. © 2015 American College of Cardiology Foundation. Source

Ponikowski P.,4th Military Hospital | Ponikowski P.,Wroclaw Medical University | Javaheri S.,Sleepcare Diagnostics | Michalkiewicz D.,Military Medical Institute | And 17 more authors.
European Heart Journal

Aims: Periodic breathing with central sleep apnoea (CSA) is common in heart failure patients and is associated with poor quality of life and increased risk of morbidity and mortality. We conducted a prospective, non-randomized, acute study to determine the feasibility of using unilateral transvenous phrenic nerve stimulation for the treatment of CSA in heart failure patients. Methods and results: Thirty-one patients from six centres underwent attempted transvenous lead placement. Of these, 16 qualified to undergo two successive nights of polysomnography - one night with and one night without phrenic nerve stimulation. Comparisons were made between the two nights using the following indices: apnoea-hypopnoea index (AHI), central apnoea index (CAI), obstructive apnoea index (OAI), hypopnoea index, arousal index, and 4% oxygen desaturation index (ODI4%). Patients underwent phrenic nerve stimulation from either the right brachiocephalic vein (n = 8) or the left brachiocephalic or pericardiophrenic vein (n = 8). Therapy period was (mean ± SD) 251 ± 71 min. Stimulation resulted in significant improvement in the AHI [median (inter-quartile range); 45 (39-59) vs. 23 (12-27) events/h, P = 0.002], CAI [27 (11-38) vs. 1 (0-5) events/h, P≤ 0.001], arousal index [32 (20-42) vs. 12 (9-27) events/h, P = 0.001], and ODI4% [31 (22-36) vs. 14 (7-20) events/h, P = 0.002]. No significant changes occurred in the OAI or hypopnoea index. Two adverse events occurred (lead thrombus and episode of ventricular tachycardia), though neither was directly related to phrenic nerve stimulation therapy. Conclusion: Unilateral transvenous phrenic nerve stimulation significantly reduces episodes of CSA and restores a more natural breathing pattern in patients with heart failure. This approach may represent a novel therapy for CSA and warrants further study. ClinicalTrials.gov identifier: NCT00909259. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2011. Source

Chachaj A.,Wroclaw Medical University | Drozdz K.,Wroclaw Medical University | Chabowski M.,4th Military Hospital | Dziegiel P.,Wroclaw Medical University | And 4 more authors.

Lymphangioleiomyomatosis (LAM) is a rare disease characterized by diffuse thin- walled cysts throughout the lungs on computed tomography and diffuse proliferation of abnormal smooth muscle-like cells (I AM cells) on lung biopsy. LAM affects women almost exclusively, predominantly in their reproductive age. The most typical presenting symptoms include dyspnea, spontaneous pneumothorax, cough and chylothorax. Abdominal findings represent less common initial manifestations of the disease and may pose diagnostic difficulties. The treatment of LAM has not been fully established. Recent studies report effectiveness of sirolimus in LAM patients. We report the case of a 45-year-old woman with sporadic I AM, successfully treated with sirolimus, in whom the first manifestation of the disease was chyloperitoneum and after three and nine years, respectively, lymphedema of the left lower extremity and right sided chylothorax occurred. Source

Zimny A.,Wroclaw Medical University | Bladowska J.,Wroclaw Medical University | Macioszek A.,4th Military Hospital | Szewczyk P.,Wroclaw Medical University | And 6 more authors.
Journal of Alzheimer's Disease

Background: The posterior cingulate region is an area of the earliest pathological changes in amnestic mild cognitive impairment (aMCI). The utility of FDG-PET imaging in dementia is already well established. Objectives: The aim of the study was to compare FDG-PET with advanced MR measurements: MR spectroscopy (MRS), perfusion weighted imaging (PWI), and diffusion tensor imaging (DTI) within the posterior cingulate region in patients with aMCI. Methods: Fifty-five patients diagnosed with aMCI (66.5 y) and 20 age-matched controls (69 y) underwent MR examination including MRS, PWI, and DTI followed by FDG-PET scanning. Values of MRS metabolite ratios (NAA/Cr, Cho/Cr, mI/Cr), PWI cerebral blood volume (rCBV), and DTI fractional anisotropy (FA) were compared to the FDG-PET rates of glucose metabolism. Results: Compared to controls, aMCI patients showed significant (p < 0.05) glucose hypometabolism, and lower rCBV and FA values. FDG-PET results correlated significantly with rCBV values. Compared to FDG-PET, PWI showed similar and DTI greater accuracy in distinguishing aMCI from controls. According to FDG-PET findings, two groups of aMCI patients were established: those with lower (PET-positive) and normal (PET-negative) glucose uptake. PET-positive aMCI subjects showed normal MRS findings, lower rCBV and FA values, while PET-negative patients revealed normal MRS and PWI results but significantly lower FA values. Conclusions: Advanced MR techniques such as PWI and particularly DTI may be regarded as competitive techniques to FDGPET. DTI was the only method to show alterations in aMCI patients with normal FDG-PET, PWI, and MRS findings. DTI seems to be a very sensitive biomarker of early degeneration in aMCI. © 2015 - IOS Press and the authors. All rights reserved. Source

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