Search results

1

Surgical Procedures Not Connected with Transplantation in Patients After Kidney or Kidney and Pancreas Transplant with Stable Function of Graft

100%

Kałuża B., Ziobrowski I., Durlik M.

Polish Journal of Surgery

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2012

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vol. 84

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issue 4

196-201

EN

The aim of the study was to evaluate complication during and after surgical procedure without connection with transplantation among patients after kidney, kidney and pancreas transplantation with stable function of graft.Material and methods. 54 patients underwent 62 surgical procedures without connection with transplantation procedure. Main characteristic: standard immunosuppressive treatment, main age 51.1±13.95 years, men 77.4%, hospitalization time 5.27±3.31 day, group 1 - 55 procedures among patients after kidney transplantation, group 2 - 7 procedure among patients after kidney and pancreas transplantation.Results. Procedures from general surgery comprised 60% [cholecystectomy 19 (51%), left hemicolectomy 1 (3%), esophagus removal 1 (3%), hernia repair 8 (22%), nefrectomy 3 (8%), pancreas transplantation in patients with functional renal graft 1 (3%), laparotomy 4 (11%), vascular surgery 27% (correction of arteriovenosus fistula 13 (76%), by-pass surgery 1 (6%), embolectomy 1 (6%), implantation of aortal - iliac stentgraft 1 (6%), surgery of iliac artery 1 (6%)]. There has been no difference between parameters measured before and after procedure: creatinine (p=0.93), GFR (p=0.07), urea (p=0.25), glycaemia (p=0.322), glycated hemoglobin (p=0.3), C-peptide (p=0.3). In both groups were no differences in levels of creatinine (p=0.78) and urea (p=0.23), measured in the next years after surgical procedure. Mortality 0%, lost of graft 0%, in - hospital morbidity 10 (16.2%) (hematoma 1.6%, endocavitary electrode 1.6%, wound healing defect 16.2%). Morbidity in group 1 - 12.7%, group 2 - 48.8%, p=0.04.Conclusions. Surgical procedures performed in a specialist center do not impaire prognosis of patients with stable function of graft, after kidney, kidney and pancreas transplantation.

2

Risk factors in reoperations in colorectal surgery

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Zawadzki M., Krzystek-Korpacka M., Rząca M., Czarnecki R., Obuszko Z., Sitarska M., Witkiewicz W.

Polish Journal of Surgery

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2019

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vol. 91(4)

13-18

EN

Background: Reoperations in colorectal surgery are usually a consequence of major surgical complications. Recently, the rate of reoperation has been proposed as a marker of surgical performance. Yet, the incidence of re-intervention varies significantly in literature, ranging from 5.2% to 13%. Therefore, in this study we investigated 30-day reoperation rates and made an attempt to identify risk factors of re-intervention following colorectal resection at our institution. Methods: This is a retrospective study of patients who had undergone colorectal resection at a single institution from 2013 to 2017. Univariate and multivariate analysis of predicting factors were performed. Results: Out of 464 patients included, 51 required reoperations (11%). The most common causes of reoperations were anastomotic leakage, postoperative bleeding, and wound dehiscence. In univariate analysis the age of the patient and location of the tumor were related to an increased rate of reoperation. In multivariate analysis patients older than 75 (OR = 2.1; 95%CI = 1.1–3.9) and tumors sited in the rectum (OR = 2.66; 95%CI = 1.4–5) were associated with an increased risk of re-intervention. Patients who required postoperative re-intervention stayed in hospital longer (14 vs. 6 days, P < 0.0001) and had higher mortality (9.8% vs. 1.2%, P = 0.002). Conclusions: Our study shows that reoperation rates that follow colorectal surgery are frequently undervalued. In our series, 11% of patients required an unplanned return to the operative room. Patient’s age and rectal tumors were the two independent factors that affect the rate of reoperation. Novel aspect: Data concerning reoperation rates in colorectal surgery is varying and most reports have shown the incidence of re-intervention to be as low as 5–7%. Our study demonstrates that reoperations after curative surgery for colorectal cancer are more frequent and may occur in over a tenth of total patients operated on.

3

Selected Methods of the Chest Wall Reconstruction for Sternal Dehiscence after Median Sternotomy

100%

Lewandowicz E., Iljin A., Kasielska-Trojan A., Fijałkowska M., Antoszewski B.

Polish Journal of Surgery

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2015

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vol. 86

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issue 5

230-234

EN

Dehiscence of a median sternotomy wound is a potentially devastating and life-threatening complication of cardiac procedures.Depending on the localization, extensiveness, and profoundness of the defect a variety of muscle flaps may be used to cover the frontal mediastinum, in particular: pectoralis major, rectus abdominisor latissimus dorsi. In spite of several options for restoration of sternal integrity we cannot avoid following serious local complications increasing patients morbidity. The aim of this paper is to report a method of sternal dehiscence management. Surgical technique and its results are presented on the example of two patients treated in Plastic, Reconstructive and Aesthetic Surgery Clinic, Medical University in Łódź because of sternal dehiscence after cardiovascular procedure with sternotomy. Our experience indicates that modified bilateral pectoralis major flap seems to be effective surgical method of sternal dehiscence treatment. Also it is worth to remember that surgical procedure in this complication should be performed as soon as possible to decrease patient’s disability and to avoid following complications

4

Is the Age of Patients with Iatrogenic Bile Duct Injuries Increasing?

100%

Stankiewicz R., Najnigier B., Krawczyk M.

Polish Journal of Surgery

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2015

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vol. 87

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issue 3

129-133

EN

Resection of the gall-bladder is still the most common surgical procedure performed at general surgery departments. The laparoscopic method used in the majority of cases offers considerable benefits but at the same time is associated with an increased rate of bile duct complications. So far, a slim female aged 25-50 years was a typical patient with a iatrogenic bile duct injury. The aim of the study was to identify the age of patients with iatrogenic bile duct injuries as well as the clinical course observed in recent years. Material and methods. Gender and age structure of patients admitted to the Department of General, Transplant and Liver Surgery between the beginning of 2011 and June 2014 and treated for iatrogenic bile duct injuries, complications of laparoscopic cholecystectomy, were analysed. The patients were referred to the department as a reference centre. Results. In the group of 186 patients, females predominated (69.4%) and the mean age was 52 years. A considerable increase in the mean age of patients treated in 2014 as compared with previous years was seen. This was related to an increased rate of bile duct injuries in patients aged over 70 years, who accounted for about 25% of the group. In previous years, bile duct injuries in patients of such an advanced age happened considerably less frequently. Conclusions. A iatrogenic bile duct injury in an elderly person may prove a fatal complication. A repair surgery, i.e. the biliary-enteric anastomosis, is a major and burdensome procedure, particularly in the case of patients aged over 70 years. Special caution during laparoscopic cholecystectomy is advised in this population, and the slightest doubts should lead to conversion.

5

Subperiosteal abscess of the temporal area - rare complication of malignant external otitis

100%

Amernik K., Paradowska-Opałka B., Kawczyński M., Jaworowska E.

Polski Przegląd Otorynolaryngologiczny

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2016

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vol. 5(4)

45-49

EN

The aim of this study was to present a case study of 59 years old men with external otitis complicated by subperiostal abscess with destruction of squamosus part of temporal bone. 61 years old men was admitted to the Clinic of Otolaryngology PUM because of severe pain of temporal region on the left side and for few days he was treated for external otitis. The patient complained of severe ear pain, hearing loss and fever 38°C. For a week he was receiving ciprofloxacin orally and as ear drops but symptoms worsened. On the day of addmition edema and pain in temporal region on the left side, trismus and severe edema in left external ear were stated, tympanic membrane was red, thick and there was no perforation in it. Pure tone audiometry showed air bone gap 50-60dB. In computer tomography an abscess in soft tissue of temporal region was stated with destruction of the squamosus part of temporal bone 18x10mm. Surgery was performed – incision of abscess and mastoidectomy. During surgery the place of destruction in the postero – superior part of external auditory canal was identified and it communicated with abscess. The bony destruction and dura were covered with cartilage. In the postoperative period fast general and local recovery appeared. The bacteriological specimen was negative. The patient was diagnosed for diabetes or others immunological impairment but results were negative. In the control pure tone audiometry there was complete closure of air bone gap. The patient was discharged in good general and local condition. In the follow up there was no other ear infections.

6

Risk factors of pancreatitis after endoscopic retrograde cholangiopancreatography – a retrospective cohort study

100%

Głuszek S., Matykiewicz J., Kozieł D., Klimer D., Wawrzycka I., Ogonowska A.

Polish Journal of Surgery

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2015

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vol. 87(10)

499-505

EN

Endoscopic retrograde cholangiopancreatography (ERCP) is the most important non-surgical procedure in serious pancreatic and biliary diseases, still burdened with the risk of severe complications. The objective of the study was to distinguish factors which could increase the risk of occurrence of ERCP complication in the form of pancreatitis. Material and methods. The study included 452 patients who had undergone ERCP. Patients’ records were retrospectively analyzed from the aspect of demographic data, indications for the procedure, type and course of the procedure, type and severity of complications, width of the common bile duct (CBD), concomitant diseases and administered medicines which might increase the risk of complications. Results. In 35 patients (7.7%) a complication occurred in the form of pancreatitis (AP). A severe course was confirmed in 11 patients (31%). Cholelithiasis constituted approximately 2/3 of indications for ERCP. AP after ERCP was significantly more often observed in the group of patients aged under 40 (22.9% vs 8.6%; p<0.05). Narrow biliary ducts (3-8 mm) were the factor increasing the frequency of development of AP (25.9% vs 45%; p<0.05). Death occurred in 5 patients (1.1%), including 4 patients (0.96%) in the group without complications, and in 1 patient (2.85%) with complicated AP. Conclusions. ERCP is a very valuable procedure in clinical treatment; however, it is burdened with the risk of complications, such as AP, bleeding, or duodenal perforation. A group especially exposed to the risk of complications in the form of AP are young patients aged under 40 with a narrow CBD.

7

Supraclavicular Approach to the Subclavian Vein – One Well Forgotten Technique with Impressive Results

88%

Borisov B., Iliev S.

Polish Journal of Surgery

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2019

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vol. 91(4)

19-23

EN

Purpose: Insertion of temporary and tunneled catheters for hemodialysis in the internal jugular vein is a “gold standard”. On the other hand, the supraclavicular approach to the subclavian vein was described by Yoffa in 1965. Despite its old invention, the latter technique has been well forgotten for unknown reasons. The aim of this study is to present our experience with the usage of the supraclavicular approach for insertion of temporary and tunneled catheters as vascular access for hemodialysis treatment. Material and Methods: We provide our experience on the insertion of 506 temporary and 501 tunneled catheters within a fiveyear period (from 1st January 2010 to 31st December 2014). We use 8 (eight) different places for catheters’ insertion, including the subclavian vein via supraclavicular approach following the techniques of D. Yoffa and J. Gorchynski. The collected data include age, sex, reasons for hemodialysis, number of attempts for successful cannulation, number of acute (AC) and chronic (CC) complications, and dependence on the catheter insertion location. Results: The gender distribution shows 463 (46%) women and 544 (54%) men with a median age of 60.0 (+/- 13.2) years. In the cases of temporary catheters: 104 (20.5%) are inserted in the subclavian vein via supraclavicular approach (SCVSC), 70 (13.8%) – in the internal jugular vein (IJV); in the cases of tunneled ones – SCVSC – 281 (56%), and IJV – 207 (41%) catheters, respectively. We found a significant statistical correlation (p < 0.05 and r = 0.23) between acute complications and the insertion position – AC are more for IJV insertion, than in SCVSC. We did not find a significant correlation between the insertion place and the chronic complications. Even central vein stenosis is more frequent in the IJV than in the SCVSC, but this is not significant (p > 0.05). Primary catheter patency of temporary and tunneled catheters is higher when they are inserted in the left veins. Conclusion: We conclude that the supraclavicular approach to the subclavian vein is an easier, safer and practically more convenient method than cannulation of the IJV. The revisit of this approach demonstrates that it should be used more widely.

8

Transient bilateral palsy of vocal cord after tonsillectomy in local anesthesia – case report

88%

Wendt R., Dalke K. J., Glamowski P. T.

Polski Przegląd Otorynolaryngologiczny

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2017

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vol. 6(3)

25-28

EN

Vocal cord palsy as a result of tonsillectomy in local anesthesia is a very rare complication. In literature, there is only few publication describing this side effect of tonsillectomy. We present a case of 26 years old men who was classified for surgical removing of tonsils in local anesthesia using 1% lignocaine with 1:100 000 epinephrine. During the procedure respiratory failure with stridor was developed, examination using indirect laryngoscopy show bilateral vocal chord palsy. The authors present probably pathomechanism of this complication.

9

Risk factors for futile tracheostomy: an analysis of the NIS database.

88%

Ahmed A. M., Arishi A. A., Loss L., Parsikia A., Ortiz J.

Critical Care Innovations

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2020

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vol. 3

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issue 3

1-12

EN

INTRODUCTION: Respiratory insufficiency and failure are leading causes of ICU admissions. Advances in medical technology allow prolonging of survival in critical illnesses. Hence, more tracheostomies are being performed. However, we are limited in predicting who may actually benefit. Our goal was to determine prognostic indicators of early mortality after tracheostomy in order to avoid futile procedures. MATERIAL AND METHODS: We performed a retrospective cohort study utilizing the National Inpatient Sample (NIS) database on all adults who underwent tracheostomy between 2005 and 2015. We defined futile tracheostomy as death within 30 days post tracheostomy during the same hospital admission. Univariate and multivariate testing were performed on the weighted dataset. Odds ratios (OR) were calculated with multivariate logistic regression testing. RESULTS: 851,020 cases met the inclusion criteria. Rate of futility was 12.4% (n=105,658). Total hospitalization cost was greater in the futile group as compared to non-futile group. On Multivariate testing, male gender, age greater than 65, 3 Elixhauser mortality index categories, Asian/Pacific Islander and other race, self-pay and no charge insurance, septicemia and mechanical ventilation greater than 96 hours were independent risk factors to predict futility. Among these, septicemia was the greatest risk for futility (OR 2.32), followed by Elixhauser mortality index >10 (OR 1.954), and Elixhauser mortality index between 3 and 10 (OR 1.468). CONCLUSIONS: Between 2005 and 2015, 12.4% of tracheostomies could be considered futile. Targeted efforts are needed to decrease the number of unnecessary procedures in the critically ill. We should consider the identified risk factors to share more informed discussions with patients and families to set better long-term expectations and realistic goals for care.

PL

WSTĘP: Zapaść krążeniowa i niewydolność oddechowa są głównymi przyczynami przyjęć na OIT. Postęp technolgii w medycynie pozwala na przedłużenie życia w stanach krytycznych. W związki z tym wykonuje się więcej zabiegów tracheostomii. Jednak istnieją ograniczenia w określeniu kto powinien być faktycznie poddany zabiegowi. Celem autorów było określenie prognostycznych wskaźników wczesnej śmiertelności po tracheostomii, aby uniknąć daremnych zabiegów. MATERIAŁ I METODY: Przeprowadzono retrospektywne badanie kohortowe z wykorzystaniem National Inpatient Sample (NIS) - bazy danych osób dorosłych, którzy przeszli tracheostomię w latach 2005–2015. Daremną tracheostomię określilono jako śmierć w ciągu 30 dni po tracheostomii podczas tego samego przyjęcia do szpitala. Testy jednowymiarowe i wielowymiarowe były przeprowadzane na ważonym zbiorze danych. Ilorazy szans (OR) obliczono za pomocą wieloczynnikowych testów regresji logistycznej. WYNIKI: 851,020 przypadków spełniło kryteria włączenia. Wskaźnik daremności wyniósł 12.4% (n = 105,658). Całkowity koszt hospitalizacji był większy w grupie daremnej w porównaniu z grupą nie-daremną. W testach wielowymiarowych, płeć męska, wiek powyżej 65, trzy kategorie wskaźnika śmiertelności Elixhausera, rasy azjatyckie / wyspiarskie i inne rasy, samodzielne i bezpłatne ubezpieczenie, posocznica i wentylacja mechaniczna dłuższa niż 96 godzin były niezależnymi czynnikami ryzyka, które wskazywały na daremność. Pośród tych przypadków posocznica była największym ryzykiem daremności (OR 2.32), a następnie wskaźnik śmiertelności Elixhausera > 10 (OR 1.954), oraz Wskaźnik śmiertelności Elixhausera między 3 a 10 (OR 1.468). WNIOSKI: W latach 2005-2015 12.4% tracheostomii można uznać za daremne. Ukierunkowane wysiłki są potrzebne do zmniejszenia liczby niepotrzebnych zabiegów u osób w stanie krytycznym. Powinniśmy wziąć pod uwagę zidentyfikowane czynniki ryzyka, aby dzielić się bardziej świadomymi dyskusjami z pacjentami i rodzinami w celu ustalenia lepszych i realistycznych długoterminowych oczekiwań opieki.

10

Cervical Chyloma After Thyroidectomy - Two Case Reports and Review of the Literature

88%

Kobiela J., Proczko-Markuszewska M., Stefaniak T., Dijkstrak B.

Polish Journal of Surgery

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2009

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vol. 81

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issue 5

251-255

EN

Thoracic duct injuries are a rare complication of thyroid surgery. This report documents two cases of thoracic duct injury complicated by formation of chyloma following thyroid surgery. The injury was identified post-operatively and treated successfully. We review the diagnostic and therapeutic options and discuss their applicability to our patients.

11

Czy noworodki urodzone blisko terminu porodu mają więcej problemów od noworodków donoszonych?

75%

Ćwik M., Siedlarz M.

Annales Academiae Medicae Silesiensis

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2011

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vol. 65

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issue 4

19-23

EN

INTRODUCTION Late pre term infants, is defi ned by birth at 34 0/7 through 36 6/7 weeks’ of gestation. Those infants are always less physiologically and metabolically mature than term infants. They express unique features which are challenges to physicians and nurses involved in their care. The purpose of this study was to determine whether newborn babies, who were born before the expected date of delivery have more problems than those, who were born at term. MATERIAL AND METHODS We have conducted a retrospective cohort study of pre-term and on term newborns admitted to Neonatology Department of Medical University of Silesia from the 1st January 2007 to 31st December 2007. The study included 935 infants. 212 of them were born as late-preterm, and 723 at term. We investigated: Apgar score, length of hospital stay, birth weight, frequency of cesarean section, infancy complications such as: hyperbilirubinemia, respiratory distress syndrome and intraventricular haemorrhage, temperature instability, and infections. RESULTS Pre-term newborns had a lower Apgar score at 1-minute than the full-term ones. Average length of hospital stay was signifi cantly longer for pre-term infants. After birth pre-term newborns were also more likely than term newborns to develop hyperbilirubinemia (p < 0.001), respiratory distress syndrome (p < 0.001), temperature instability (p < 0.001), infections (p < 0.001). Intraventricular haemorrhage occurred more commonly among pre-term newborns than term newborns (p < 0.001). In the pre-term group there were more frequent cesarean sections than in the term – group (p < 0.001). CONCLUSIONS Pre-term infants had signifi cantly more medical problems compared with full-term infants. Those newborns are rather minimally pre-term infants than near – term infants.

PL

WSTĘP Noworodki urodzone blisko terminu porodu defi niowane są jako urodzone między 34 tygodniem 0/7 dni a 36 tygodniem 6/7 dni wieku ciążowego. W praktyce położniczej i pediatrycznej prawie donoszone noworodki są często uważane za czynnościowo w pełni dojrzałe, jednak mimo relatywnie dużych rozmiarów wykazują one często objawy kliniczne związane z niedojrzałością. Celem niniejszej pracy było przeanalizowanie, czy zaburzenia występujące u noworodków urodzonych blisko terminu porodu stanowią istotny problem kliniczny w porównaniu ze stanem noworodków urodzonych o czasie. MATERIAŁ I METODY Dokonano analizy retrospektywnej 1187 historii rozwoju noworodków. Do badań wybrano historie 212 noworodków urodzonych blisko terminu porodu oraz 723 noworodki donoszone. Oceniono: czas pobytu w szpitalu, stan ogólny noworodków w skali Apgar oraz występowanie zaburzeń w okresie adaptacyjnym. WYNIKI Noworodki urodzone blisko terminu porodu miały niższe wartości w skali Apgar w pierwszej minucie życia niż noworodki donoszone. Udokumentowano istotne różnice długości pobytu w szpitalu w obu badanych grupach. U prawie donoszonych noworodków istotnie częściej rozpoznawano zaburzenia w okresie wczesnonoworodkowym, takie jak hiperbilirubinemia (p < 0,001), zespół zaburzeń oddychania (ZZO; p < 0,001), zaburzenia termoregulacji (p < 0,001), infekcje (p < 0,001) oraz krwawienia do- i okołokomorowe (p < 0,001). Noworodki prawie donoszone istotnie częściej rodziły się drogą cięcia cesarskiego (p < 0,001). WNIOSEK Prawie donoszone noworodki mają istotnie więcej problemów medycznych w porównaniu z noworodkami donoszonymi.

12

Wrośnięty PEG – powikłanie żywienia dojelitowego

63%

Adamiec C., Dryla P., Gil J., Saracyn M., Nowak T., Wołyńska-Szkudlarek A., Bobula M.

Pediatria i Medycyna Rodzinna

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2015

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vol. 11

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issue 3

315-320

EN

Good nutritional status of the patient is very often key to successful medical intervention. For patients capable of safe and efficient swallowing, the modification of diet or introduction of oral nutritional supplements is sufficient. In patients with swallowing disorders, regardless of their aetiology, artificial nutrition access is required. In the case of long-term nutritional therapy, percutaneous endoscopic gastrostomy (PEG) insertion is considered the gold standard. The procedure of inserting a PEG feeding tube is not difficult to perform and is widely used. As any invasive medical procedure, PEG tube insertion involves the risk of complications. Typical complications that may follow this common procedure include dislodgement, dysfunction, skin infection in the area of PEG catheter placement and aspiration of gastric contents. A rare or rather rarely diagnosed complication that may result from PEG tube placement is the migration of the internal bumper under the gastric mucosa, or even deeper. This can result in the covering of the internal bumper with granulation tissue and gradual loss of its functionality. Correct prevention and treatment allows to keep the catheter functionality and protect against other serious, often life-threatening, complications such as extensive phlegmon infection of the anterior abdominal wall. The best prophylaxis is the education of caregivers providing long-term care of the PEG outside of hospital. Early recognition of the complication allows for preservative treatment and maintenance of a fully functional nutrition access. In the case of extensive and deep migration and the site being fully covered with mucosa, PEG removal and insertion of a new one is often necessary. In some cases, it is possible to use the existing, mature PEG canal with well-defined edges; however, in the case of severe infection a new PEG tube is inserted at another site.

PL

Właściwy stan odżywienia pacjenta bardzo często decyduje o sukcesie całego procesu leczniczego. W przypadku chorych, którzy samodzielnie połykają, wsparcie żywieniowe może być realizowane przez zmianę diety lub dołączenie doustnych suplementów pokarmowych. Pacjenci z zaburzeniami połykania (niezależnie od ich etiologii) muszą mieć wytworzony sztuczny dostęp do przewodu pokarmowego. W razie konieczności żywienia długoterminowego złotym standardem jest wytworzenie przezskórnej gastrostomii metodą endoskopową (percutaneous endoscopic gastrostomy, PEG). Założenie sondy żywieniowej tego typu nie jest technicznie trudne, jednak – jak każda procedura inwazyjna – wiąże się z ryzykiem powikłań. Typowe powikłania związane z obecnością PEG to wypadnięcie, zatkanie, aspiracja treści pokarmowej oraz infekcja skóry w miejscu założenia cewnika. Rzadziej występującym (albo raczej rzadziej rozpoznawanym) powikłaniem jest jego stopniowe zagłębianie się w błonie śluzowej, z następowym obrośnięciem tkanką ziarninową i stopniową utratą funkcji. Właściwe postępowanie zapobiegawcze i odpowiednie leczenie pozwalają zachować funkcjonalność cewnika i chronią przed wystąpieniem innych – często groźnych dla życia – powikłań, m.in. rozległej ropowicy przedniej ściany jamy brzusznej. Najlepszą profilaktykę powikłań stanowi edukacja osób zajmujących się PEG w warunkach pozaszpitalnych. Wczesne rozpoznanie problemu pozwala na wdrożenie postępowania zachowawczego i utrzymanie dojścia żywieniowego. Rozpoznanie w stadium zaawansowanym wymaga często usunięcia cewnika i założenia nowego. Istnieje możliwość wykorzystania już wysztancowanego kanału przetoki, ale w przypadku dużego odczynu zapalnego wprowadza się nowy cewnik w sąsiedztwie.

13

Przemijający deficyt neurologiczny spowodowany neurotoksycznym działaniem środka kontrastowego użytego do zabiegu koronarografii

63%

Wilczewska R., Kułakowska A., Korneluk-Sadzyńska A., Borowik H., Drozdowski W.

Aktualności Neurologiczne

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2010

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vol. 10

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issue 3

172 - 175

EN

Coronary angiography is an invasive procedure and may lead to complications. The most common of them are: myocardial infarction, embolism (e.g. cerebral embolism), dysrhythmia and acute circulatory insufficiency. Damage to the artery and subsequent major bleeding or thrombosis, vasovagal reaction and allergic reactions may also occur. Neurological deficits caused by contrast medium neurotoxicity are very rare complications of percutaneous coronary interventions. Contrast medium infiltrates blood-brain barrier and produces transient disturbances of neural membranes function. The neurotoxicity depends on its ionic properties, osmolality and solubility. Contrast medium neurotoxicity usually concerns occipital lobes and transient cortical blindness is its most common clinical manifestation. Transient pyramidal deficits due to contrast medium neurotoxicity are very rarely observed. The authors present a case of 70-yearold woman who developed left-sided hemiparesis and conjugate deviation of the eyes to the right after coronary angiography with subsequent right coronary artery angioplasty and stenting. Computed tomography (CT) of the brain performed just after occurrence of the neurological deficit revealed hyperintensive areas in sulci of the cerebral convexities and in the right frontal lobe. Control brain CT done after 24 hours did not show hyperintensive areas mentioned above. All symptoms of neurological deficit withdrew during 72 hours. Neurotoxicity of contrast medium seems to be responsible for occurrence of neurological deficit symptoms in a presented case.

PL

Koronarografia jest badaniem inwazyjnym i niesie ze sobą ryzyko wystąpienia powikłań. Najczęstszymi z nich są: zawały serca, incydenty zatorowe (w tym zatory tętnic mózgowych), zaburzenia rytmu serca i ostra niewydolność krążenia. Zdarzają się także uszkodzenia tętnicy i miejscowe krwawienia, reakcje naczyniowo-błędne i odczyny alergiczne. Deficyty neurologiczne spowodowane neurotoksycznym działaniem środka kontrastowego są bardzo rzadkim powikłaniem przezskórnych interwencji wieńcowych. Kontrast przenika przez barierę krew-mózg i powoduje przejściowe zaburzenia funkcji błon neuronalnych. Neurotoksyczne działanie środka kontrastowego zależy od jego właściwości jonowych, osmolalności i rozpuszczalności. Neurotoksyczność kontrastu dotyczy zazwyczaj płatów potylicznych, a jej najczęstszą manifestacją kliniczną jest przemijająca ślepota korowa. Przejściowe deficyty piramidowe wywołane działaniem środka kontrastowego są bardzo rzadko obserwowane. Autorzy przedstawiają przypadek 70-letniej kobiety, u której po zabiegu koronarografii oraz angioplastyki i stentowania prawej tętnicy wieńcowej wystąpił deficyt neurologiczny pod postacią niedowładu połowiczego lewostronnego oraz przymusowego skierowania gałek ocznych w stronę prawą. Wykonana bezpośrednio po wystąpieniu objawów klinicznych tomografia komputerowa (TK) mózgu ujawniła obecność hiperintensywnych ognisk w bruzdach mózgowych na sklepistości półkul mózgu oraz w prawym płacie czołowym. Kontrolna TK wykonana po upływie 24 godzin nie uwidoczniła wspomnianych ognisk. Objawy neurologiczne całkowicie wycofały się w ciągu 72 godzin od zachorowania. Wydaje się, iż działanie neurotoksyczne środka kontrastowego jest odpowiedzialne za objawy deficytu neurologicznego, które wystąpiły w prezentowanym przypadku.

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