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EN
Introduction: Echocardiographic assessment of the interior vena cava (IVC) is part of the estimation of right atrial pressure. In young women values exceeding norm are observed. The aim of our study was an echocardiographic assessment of the IVC dimension depending on the phase of menstrual cycle among young, healthy women. Materials and methods: Female students of the Medical University of Gdańsk were enrolled into the study. Each patient underwent echocardiographic examination of the IVC diameter (d-IVC) and respiratory decrease in dimension in two time points, depending on the menstrual cycle phase: in the first days of menstruation (Phase M) or in the second part of menstrual cycle (Phase L). Results: 31 patients completed the study. There was a significant difference between the d-IVC in Phase M and Phase L (1.98±0.25cm vs 1.86±0.3cm; p <0.05). We did not observe correlation in terms of the inspiratory collapsibility. In the Phase M 77% patients achieved at least 50% decrease in dimension during inspiration comparing to 87% in Phase L (p=0.89). 35% patients had d-IVC exceeding reference values. Conclusion: In population of young women, the diameter of IVC exceeding reference values can be observed. IVC dimension depends on the menstrual cycle.
EN
Introduction: Tumors which most frequently metastasize to the heart include: malignant melanoma, lung cancer, breast cancer, ovarian cancer, kidney cancer, leukemia, lymphomas and esophageal cancer. Purpose: The purpose of this paper was clinical analysis of a group of patients operated in deep hypothermic circulatory arrest due to tumors of the right atrium and the inferior vena cava. Material and method: The study covered 7 patients operated at the Cardiac Surgery Clinic with a cardiac tumor diagnosed on the basis of an echocardiographic assessment in the years 2012–2019. Before qualifying for surgical treatment, each patient underwent: thorough interview and physical examination, 12-lead ECG, laboratory tests and echocardiography. Patients additionally underwent: computed tomography of the chest or abdomen, magnetic resonance imaging and coronary angiography on the basis of which patients with significant coronary artery changes underwent simultaneous coronary artery bypass graft. After preparation, the tumor was excised from the vena cava and right atrium with simultaneous removal of the primary tumor, most often kidney cancer. Early and distant results of treatment were analyzed in the examined group of patients to determine the following endpoints: hospital mortality and survival after surgery: after 3 months and 12 months. Results: Of all operated patients: 2 individuals died in the early postoperative period due to hemorrhagic complications (hospital mortality – 28.6%), and 5 patients (71.4%) were discharged from the Clinic in a good general condition. In total, 3-month survival was 71.4%, and 12-month survival amounted to 28.6%. Conclusions: Surgeries are very complex and challenging, and usually take on average 8–10 hours. It can improve the outcomes of palliative oncological treatment, better physical function (cardiovascular fitness) and extend life from several months to several years in more than ²/3 patients.
EN
INTRODUCTION: Echocardiographic assessment of the interior vena cava (IVC) is part of the estimation of right atrial pressure. In young women values exceeding norm are observed. The aim of our study was an echocardiographic assessment of the IVC dimension depending on the phase of menstrual cycle among young, healthy women. MATERIALS AND METHODS: Female students of the Medical University of Gdańsk were enrolled into the study. Each patient underwent echocardiographic examination of the IVC diameter (d-IVC) and respiratory decrease in dimension in two time points, depending on the menstrual cycle phase: in the first days of menstruation (Phase M) or in the second part of menstrual cycle (Phase L). RESULTS: 31 patients completed the study. There was a significant difference between the d-IVC in Phase M and Phase L (1.98±0.25cm vs 1.86±0.3cm; p <0.05). We did not observe correlation in terms of the inspiratory collapsibility. In the Phase M 77% patients achieved at least 50% decrease in dimension during inspiration comparing to 87% in Phase L (p=0.89). 35% patients had d-IVC exceeding reference values. CONCLUSION: In population of young women, the diameter of IVC exceeding reference values can be observed. IVC dimension depends on the menstrual cycle.
EN
Inferior vena cava leiomyosarcoma is a malignant neoplasm rarely diagnosed. The study presented two cases of inferior vena cava leiomyosarcomas subject to treatment at the Department of Oncology, Center of Oncology in Warsaw. The first patient underwent surgery after a two-year thorough gastroenterological diagnostic process, being suspected of pancreatic cancer. Proper diagnosis was established intraoperatively, the tumor was completely excised. After ten months the patient was subject to chemotherapy, due to the presence of distant metastatic lesions. Chemotherapy was stopped after 24 months, due to disease progression. The patient died six months, thereafter. The second patient underwent surgery after a short diagnostic process, being suspected of an adrenal gland tumor. Proper diagnosis was established intraoperatively, and the tumor was completely excised. The patient remained under close oncological control. Three years after the procedure disease recurrence was not observed. Retroperitoneal space tumors pose a significant clinical problem. Rapid diagnosis and proper therapeutic decisions often determine the future of such patients. The five-year survival rate of patients subject to radical surgical treatment, due to inferior vena cava leiomyosarcomasa ranges between 33 and 55%.
EN
The aim of the study was to compare the values of the sonographic inferior vena cava/ aorta index obtained with the transducer placed in the median line and right anterior axillary line. Material and methods: The study enrolled 45 volunteers, including 33 women, aged 22.5 ± 1.26 with a negative history of circulatory and renal diseases. The study consisted in a sonographic assessment and measurement of the inferior vena cava and aorta by placing the transducer in the anterior median line and right anterior axillary line. The value of the inferior vena cava/aorta index was obtained by calculating the ratio of the diameters of the inferior vena cava and aorta. The diameter measurements were taken by placing the ultrasound transducer in the anterior median line and right anterior axillary line. Two examiners performed the measurement three times and used convex probes of 3.5–5 MHz. Additionally, the subjects’ weight, height and arterial blood pressure were taken. Results: Following a statistical analysis with the use of STATISTICA software, the following values of the inferior vena cava/aorta index were obtained: in the anterior median line – 1.43 ± 0.21, and in the right anterior axillary line – 1.285 ± 0.19. There was no statistically significant difference between the measurements obtained by the two examiners (p = 0.17). A strong correlation was noted between the inferior vena cava/ aorta indices calculated in both sites of transducer placement, which was irrespective of the examiners (the correlation coefficient: r = 0.61 and r = 0.71). The study indicate that the inferior vena cava/aorta index measured in the right anterior axillary line is a simple and reproducible method for determining the body fluid status; the examinations conducted in both sites may be used interchangeably. Further studies are needed to determine reference values for the inferior vena cava/aorta index measured in the right anterior axillary line.
PL
Celem pracy była ocena porównawcza wartości ultrasonograficznego współczynnika żyła główna dolna/aorta z przyłożenia głowicy w linii środkowej i pachowej przedniej prawej. Materiał i metoda: W badaniu udział wzięło 45 ochotników, w tym 33 kobiety, w wieku 22,5 ± 1,26 roku, z ujemnym wywiadem w kierunku chorób układu krążenia i nerek. Badanie polegało na ultrasonograficznej ocenie i pomiarach żyły głównej dolnej i aorty z przyłożenia głowicy w linii środkowej przedniej oraz w pachowej przedniej prawej. Wartość współczynnika żyła główna dolna/aorta uzyskiwano, wyliczając iloraz średnicy żyły głównej dolnej i aorty. Pomiary średnicy naczyń były wykonywane z przyłożenia głowicy ultrasonograficznej w linii środkowej przedniej oraz linii pachowej przedniej prawej. Dwóch badających wykonywało wszystkie pomiary trzykrotnie, stosując głowicę convex 3,5–5 MHz. Zmierzono także masę ciała, wzrost i ciśnienie tętnicze. Wyniki: Po opracowaniu statystycznym za pomocą programu STATISTICA uzyskano następujące wartości współczynnika żyła główna dolna/aorta: w linii środkowej przedniej 1,43 ± 0,21, w linii pachowej przedniej po stronie prawej 1,285 ± 0,19. Nie wykazano istotnej statystycznie różnicy w pomiarach tego współczynnika pomiędzy badaczami (p = 0,17). Zaobserwowano silną korelację pomiędzy współczynnikami żyła główna dolna/aorta w obu przyłożeniach niezależnie od badającego (współczynnik korelacji r = 0,61 i r = 0,71). Na postawie przeprowadzonych badań wysunięto następujące wnioski: współczynnik żyła główna dolna/aorta mierzony w linii pachowej przedniej po stronie prawej jest prostą i powtarzalną metodą oceny nawodnienia pacjentów; badania w obu punktach przyłożenia mogą być stosowane zamiennie. Konieczne są dalsze badania w celu wyznaczenia norm współczynnika żyła główna dolna/aorta w linii pachowej przedniej po stronie prawej.
EN
Appropriate hydration is a very important prognostic factor for the patient’s health. Ultrasonographic assessment of hydration status is rarely used in pediatric medicine and it is not used at all in neonates due to the fact that no reference values have been established for this age group. The aim of the paper was to establish reference values for neonates. Material and methods: The study included 50 neonates from two hospitals in the Lower Silesia region of Poland; 25 of them were healthy patients (full-term newborns with no perinatal complications) and 25 were sick patients (newborns with heart defects such as ostium secundum atrial septal defect, ventricular septal defect, permanent foramen ovale and patent ductus arteriosus as well as newborns with neonatal jaundice or pneumonia that occurred during the first days of life). The ultrasound scans were conducted during the first days of the children’s life. For every child inferior vena cava diameter was measured in the substernal area, longitudinal plane, M-mode in two respiratory phases: inhalation and exhalation. In addition, abdominal aorta diameter was determined (substernal area, transverse plane). Results: The study demonstrated a statistically significant difference in the calculated inferior vena cava collapsibility index between both groups. Two other indices included the ratio of the inferior vena cava diameter during the expiratory phase to the diameter of the aorta and the ratio of the inferior vena cava diameter during the inspiratory phase to the diameter of the aorta; a statistically significant difference between both groups was found only for the measurements in the inspiratory phase. Conclusions: Based on the study results normal ranges for hydration indices in neonates were established. The need for the measurement of the abovementioned parameters in the inspiratory phase was determined. In addition, the usefulness of the ultrasound examination for the evaluation of body fluid status in this pediatric age group, particularly in preterm newborns, was noted due to its painless and non-invasive nature as well as easy access to equipment at neonatology wards.
PL
Prawidłowe nawodnienie jest bardzo istotnym czynnikiem rokowniczym stanu zdrowia pacjenta. Ultrasonograficzna ocena nawodnienia w pediatrii jest używana bardzo rzadko, a u noworodków nie jest stosowana ze względu na brak wyznaczonych wartości referencyjnych dla tej grupy wiekowej. Celem pracy było wyznaczenie wartości referencyjnych dla noworodków. Materiał i metody: W badaniu uczestniczyło 50 noworodków z dwóch dolnośląskich szpitali: 25 pacjentów zdrowych (noworodki urodzone o czasie, bez powikłań okresu okołoporodowego) oraz 25 pacjentów chorych (noworodki z wadami serca, takimi jak ubytek przegrody międzyprzedsionkowej typu otworu drugiego, ubytek przegrody międzykomorowej, przetrwały otwór owalny, przetrwały przewód tętniczy, oraz noworodki, u których w pierwszych dniach życia wystąpiła żółtaczka noworodkowa lub zapalenie płuc). Badania wykonywano w pierwszych dobach życia. U każdego dziecka dokonywano pomiaru średnicy żyły głównej dolnej w okolicy podmostkowej, w projekcji podłużnej, w prezentacji M-mode w dwóch fazach oddechowych: wdech i wydech. Dodatkowo wyznaczano średnicę aorty brzusznej (okolica podmostkowa, projekcja poprzeczna). Wyniki: W pracy wykazano istotną statystycznie różnicę między wyliczonymi współczynnikami zapadalności żyły głównej dolnej w obu grupach. Natomiast w ocenie dwóch kolejnych współczynników (stosunek średnicy żyły głównej dolnej w fazie wydechu do średnicy aorty i stosunek średnicy żyły głównej dolnej w fazie wdechu do średnicy aorty) istotną statystycznie różnię stwierdzono tylko w przypadku pomiarów w fazie wdechowej. Wnioski: Na podstawie przeprowadzonego badania wyznaczono wartości referencyjne współczynników oceniających nawodnienie w grupie noworodków. Stwierdzono konieczność pomiarów wyżej wymienionych parametrów w fazie wdechowej. Dodatkowo zwrócono uwagę na przydatność metody ultrasonograficznej do oceny nawodnienia w tej grupie wiekowej, a w szczególności wcześniaków, ze względu na bezbolesność, bezinwazyjność i dostęp do sprzętu na oddziałach neonatologicznych.
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