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Złożona angioplastyka wieńcowa ektopowo odchodzącej gałęzi okalającej
No full textThe authors present the case of a 68-year-old man treated for symptomatic multivessel coronary artery disease with ananomalous origin of the circumflex artery (Cx) from the right coronary sinus. The patient was revascularized with coronaryartery bypass grafting, during which only the significantly stenosed left anterior descending artery and diagonal branch were grafted. Unfortunately, a graft to the Cx could not be implanted. Following surgery, the patient continued to experience postprandial and exertional angina, which did not resolve despite intensive pharmacological treatment. Therefore, a follow-up coronary angiography and bypass graft assessment were performed, confirming significant stenosis of the circumflex artery, while the grafts to the left anterior descending and diagonal branch were functioning properly. An attempt was made for percutaneous coronary intervention, encountering significant technical difficulties due to the ectopic origin of the vesseland severe stenoses of the vessel. Finally, three stents were successfully implanted, achieving a good angiographic result.The procedure was associated with exceeding the radiation dose of 5.5 Gy and administration of 300 mL of angiographiccontrast. After the procedure, the patient reported no chest pain and was discharged for further outpatient care in good condition.W pracy przedstawiono przebieg diagnostyki i leczenia 68-letniego mężczyzny z objawową, wielonaczyniową chorobą wieńcową oraz anomalią odejścia gałęzi okalającej (Cx) z prawej zatoki wieńcowej. Pacjent został poddany rewaskularyzacji kardiochirurgicznej, podczas której wykonano pomosty jedynie do istotnie zwężonych: tętnicy przedniej zstępującej oraz gałęzi diagonalnej lewej tętnicy wieńcowej. Ze względu na trudności techniczne nie wszczepiono pomostu do Cx. Po zabiegu utrzymywały się dolegliwości dławicowe o charakterze poposiłkowym i powysiłkowym, niewycofujące się mimo intensywnej terapii farmakologicznej. Z uwagi na brak poprawy klinicznej wykonano kontrolną koronarografię i bypassografię, które potwierdziły istotne przewężenie gałęzi okalającej przy prawidłowo funkcjonujących pomostach do gałęzi międzykomorowej przedniej oraz gałęzi diagonalnej. Podjęto próbę przezskórnej angioplastyki, napotykając znaczne trudności techniczne wynikające z ektopowego odejścia naczynia oraz obecności zwężeń w jego przebiegu. Ostatecznie implantowano trzy stenty, uzyskując dobry wynik angiograficzny. Zabieg wiązał się z przekroczeniem dawki promieniowania (5,5 Gy) oraz podaniem 300 ml kontrastu angiograficznego. Po zabiegu pacjent nie zgłaszał dolegliwości bólowych w klatce piersiowej i został wypisany do dalszego leczenia ambulatoryjnego w stanie ogólnym dobrym
Metallic silhouette technique for performing ultra-low contrast percutaneous coronary intervention in advanced chronic kidney disease patients
No full textWiększość procedur w kardiologii inwazyjnej wiąże się z podaniem pacjentom środka kontrastowego i niestety może prowadzić do zaostrzenia choroby nerek. Odpowiednie przygotowanie pacjenta do zabiegu i zastosowanie nowych technik zabiegowych może zmniejszyć ryzyko wystąpienia nefropatii wywołanej podaniem kontrastu. Podstawową kwestią, która może pomóc w osiągnięciu tego celu, jest wykorzystanie nowoczesnych i pomysłowych rozwiązań oraz obrazowania wewnątrznaczyniowego do wykonania przezskórnej interwencji wieńcowej o minimalnym zużyciu kontrastu lub przezskórnej interwencji wieńcowej bez zastosowania kontrastu. Technika metalowego szkieletu jest jednym z takich rozwiązań, a jej kliniczne zastosowanie przedstawiono na przykładzie dwóch niezależnie wykonanych procedur.Most invasive cardiology procedures involve the administration of a contrast medium to patients, and unfortunately this can lead to exacerbation of kidney disease. Adequate preparation of the patient and the use of novel procedural techniques can reduce the risk of contrast-induced nephropathy. The best way to achieve this goal is the use of modern technologies and intracoronary imaging to perform ultra-low contrast percutaneous coronary intervention and no-contrast percutaneous coronary intervention. One of these techniques, called ‘metallic silhouette’, is presented below by way of two case reports of independently performed procedures
Inclusive reproductive health: ensuring equity for all
No full textIntroduction: Ensuring inclusivity in reproductive healthcare is imperative in addressing disparities affecting marginalised populations. Socioeconomic, cultural, and geographic factors persist in impeding equitable healthcare access. This review explores salient challenges and strategies for fostering inclusivity.
Material and methods: A comprehensive literature review was conducted using major databases, including PubMed, Scopus, Web of Science, and Google Scholar, encompassing studies published between 2008 and mid-2024. Keywords included inclusive reproductive health, health equity, and reproductive justice. The resulting articles were then screened and synthesised.
Results: This review highlight significant disparities linked to factors such as race, gender, socioeconomic status, and geographic location. These disparities are linked to a number of barriers, including discriminatory policies, limited culturally competent care, and provider biases. The review also identifies strategies for improvement, including the integration of intersectionality in health policies, the enhancement of provider training, and the support of community-driven initiatives.
Conclusions: The authors call for policy reforms, interdisciplinary training, and improved access to culturally competent services in order to achieve inclusive reproductive healthcare. A comprehensive, equity-focused approach is recommended to ensure dignified and accessible care for all individuals
Analysis of the relationship between the dissection of avascular spaces and blood loss in various modifications of radical hysterectomy performed for placenta percreta, ovarian cancer or cervical cancer
No full textIntroduction. The treatment of pregnant women with placenta accreta spectrum (PAS) remains both an organizational and therapeutic challenge. In recent years, the number of caesarean sections has increased, and caesarean section, alongside placenta previa, is one of the main risk factors for placental invasion. The PAS is no longer rare, with placenta percreta (invasive placenta) accounting for 5% of cases — these being the most severe in terms of treatment complexity. The currently recommended approach involves an elective classical caesarean section with leaving the placenta in utero and performing simultaneous peripartum hysterectomy. Alternatively, conservative management with leaving the placenta in situ and possible delayed hysterectomy is an option. Hemorrhage and other severe complications can occur in up to half of PAS cases, with an even higher incidence in conservative management. Therefore, the technique of hysterectomy and the surgical expertise of the operator play a crucial role in minimizing the risk of hemorrhage and urinary tract injury. Peripartum hysterectomy for placenta percreta falls into the category of multiorgan resections, incorporating a modified radical hysterectomy. Technically very similar procedures are commonly performed by gynecologic oncologists in the treatment of advanced ovarian malignancies. The preferred technique in such cases is often the Hudson operation, a modification of the classical Wertheim procedure. In order to properly perform such an operation, it is necessary to dissect the avascular spaces within the operative field, which helps prevent hemorrhage and reduces the number of other complications.
Material and methods. A multicenter retrospective comparative study included 166 patients. Clinical and organizational parameters characterizing the course of surgical treatment were analyzed in the following patient groups: those operated on for placenta percreta and ovarian cancer. The reference group consisted of patients who underwent surgery for cervical cancer.
Results. The risk of hemorrhage in modified radical hysterectomy was highest in procedures performed for placenta percreta. In these cases, statistically more units of packed red blood cells (pRBC) and fresh frozen plasma (FFP) were transfused, although the procedure itself did not take significantly longer. Blood loss was lower when more avascular spaces were dissected. The highest number of avascular spaces were prepared in radical hysterectomy for cervical cancer, while the lowest number was associated with surgeries for placenta percreta.
Conclusions. The dissection of avascular spaces is one of the methods to reduce the risk of uncontrolled blood loss during radical hysterectomy.
Health-related quality of life after radical cystectomy with different urinary diversions. What we know so far?
No full textIntroduction. Muscle-invasive bladder cancer (MIBC) is a highly aggressive malignancy, with radical cystectomy (RC) remaining the gold standard of treatment. Following RC, urinary diversion (UD) is required, with various surgical options available, including ureterocutaneostomy (UCS), ileal conduit (IC), and orthotopic neobladder (ONB). Despite advances in surgical techniques, the five-year overall survival rates remain poor, and preserving health-related quality of life (HRQoL) has become a critical goal in patient-centered care.
Objective. This review aims to synthesize the available evidence regarding HRQoL outcomes associated with different types of urinary diversion in patients undergoing RC for MIBC, to identify current knowledge gaps, and to highlight directions for future research.
Methods. A comprehensive review of PubMed literature from the late 1990s to the present was conducted, evaluating studies assessing HRQoL across various UD types. Key findings from both retrospective and prospective analyses, as well as meta-analyses, were summarized and critically appraised, with particular focus on validated HRQoL assessment tools and reported patient outcomes.
Results. Although early studies suggested superior HRQoL outcomes in ONB patients, subsequent research has provided conflicting results, with several studies reporting no significant differences between UD types. Variability in patient selection, surgical expertise, follow-up duration, and the use of diverse HRQoL instruments complicates direct comparisons. Furthermore, while numerous questionnaires (e.g., EORTC BLM30, FACT-Bl-Cys, IONB-PRO) are available, the absence of a universally accepted standard hinders consistent assessment.
Conclusions. Currently, no definitive conclusions can be drawn regarding the optimal UD type based solely on HRQoL outcomes. Further high-quality, prospective studies with standardized methodologies are urgently needed to better understand the long-term impact of different UD approaches and to guide evidence-based, patient-centered surgical decisions in MIBC management
Tebentafusp (IMCgp100) in the treatment of uveal melanoma — from preclinical evidence to clinical practice
No full textTebentafusp (IMCgp100) is a novel bispecific immunotherapy that contains a specifically engineered soluble T-cell receptor (TCR) capable of recognising the gp100 epitope on the surface of tumour cells presented by human leukocyte antigen-A*02:01 (HLA- A*02:01 (HLA-A2) is a specific allele within the HLA-A2 group). The HLA-A2 is then fused to the single-chain variable fragment of anti-CD3, which binds to T-cells and destroys them. Tebentafusp has been shown to cause a significant increase in pro-inflammatory cytokine levels that are detrimental to the tumour. The preliminary results of tebentafusp in solid tumours are encouraging, particularly in advanced/metastatic uveal melanoma (UM). In a randomised phase III study (IMCgp100-202; n = 378), patients with untreated HLA*02:01 positive metastatic UM (mUM), tebentafusp significantly improved overall survival (OS) with a hazard ratio (HR) of 0.51 compared to the investigator’s choice, mainly pembrolizumab (82%). The one-year OS rate for tebentafusp was 73% compared to 59% for pembrolizumab. For comparison, the single-arm GEM1402 study (n = 52) reported a one-year OS rate of 52% for the combination of nivolumab and Ipilimumab in metastatic UM. The most common adverse reactions related to tebentafusp include cytokine release syndrome (CRS) and dermatological reactions such as rash. It is the first drug with OS benefit in advanced/metastatic UM patients. However, further research is needed to optimise its use, improve patient selection, develop combination therapies and identify predictive and prognostic biomarkers.
The relationship between selected macronutrient intake, body composition, and adiponectin levels in male and female students with different levels of physical activity
No full textIntroduction: The study aimed to evaluate the relationship between selected macronutrient intake, bodycomposition, and adiponectin levels in male and female students with different levels of physical activity.
Material and methods: A total of 198 students with different levels of physical activity were accepted forthe study. Circulating adiponectin was assayed. The daily intake of macronutrients was assessed. Bodycomposition was evaluated by the bioelectrical impedance analysis (BIA) method.
Results: Men, regardless of their level of physical activity, had higher height, body weight, lean body mass,and BMI compared to women. In comparison to men, women had a higher percentage of body fat. Menconsumed more protein, fats, carbohydrates, and fatty acids compared to women.
Conclusions: The key determinants of adiponectin levels were the level of physical activity, gender, andpercentage of body fat, rather than the intake of the analyzed nutrients
Is surgical cure possible in butterfly gioblastomas? An unusual case report
No full textAim: Butterfly glioblastoma (bGBM) is a rare type of glioblastoma characterized by a butterfly appearanceon magnetic resonance imaging due to its spread to both hemispheres and invasion of the corpuscallosum (CC). There are different treatment approaches considered as resection-biopsy-inoperative inthe treatment of this highly aggressive brain tumor. The study aimed to share the applied treatment andresults to contribute to the literature.Case report: A 56-year-old female patient was diagnosed with bGBM and operated on in a health centerand received postoperative radiotherapy. Almost total cure was observed in the 6th month follow-up magneticresonance imaging and no neurological deficit was observed in the patient's physical examination.Discussion: The patient had almost complete surgical recovery, which is expected to be extremely rare inbutterfly glioblastomas. Surgical interventions for butterfly glioblastomas cause devastating neurologicaldeficits in some patients. BGBMs are generally considered inoperable, but previous literature studies andthe present case may change the treatment approach to bGBMs.Conclusion: Aggressive surgical resection may be an effective treatment method to be preferred in suitablepatients due to its positive effects on both surveillance and survival. Chemo-radiotherapy applied afterwardsignificantly reduces recurrence by increasing the effect of surgical cure
Terra firma-forme dermatosis: a case report and literature review
No full textTerra firma-forme dermatosis (TFFD) is a benign and infrequently described condition of unknown etiology,presenting as asymptomatic brown-black plaques that mimic unwashed skin. This case presentsa 15-year-old female with chest lesions resistant to soap and water but completely removed with ethylalcohol, confirming TFFD. Terra firma-forme dermatosis typically affects areas like the trunk, neck, and faceand is often misdiagnosed as dermatosis neglecta or acanthosis nigricans. Despite its straightforwarddiagnosis using a simple alcohol rub test, TFFD is rarely reported in the literature, leading to unnecessarytreatments and diagnostic procedures. Raising awareness of TFFD among clinicians can ensure accuratediagnosis, prompt treatment, and avoidance of unnecessary procedures, improving patient outcomesand reducing distress