Przeglad lekarski最新文献

Retrognathia is a common featureof many fetal anomalies that may bediagnosed during ultrasound examination.The most common methodused for the diagnosis of this conditionis the inferior facial angle (IFA). Theexisting reference ranges for IFA havebeen established for the fetuses at 18-28 weeks gestation and may be not applicablein the first trimester. The aimof the study was to document changesof IFA from 11+0 to 13+6 weeks gestation,to verify the reproducibility of IFAcalculations obtained by the same examinerand to investigate the possibleassociation between IFA values at thefirst and second trimester scans.

Material and methods: A prospectivestudy was performed in 512 singletonpregnancies during the firsttrimester ultrasound exam. IFA wascalculated by measuring the anglemade by the cross-section of a lineorthogonal to the forehead at the levelof nasofrontal suture and the line fromthe tip of the mentum to the anteriorborder of the more protrusive lip. In100 cases, stored images were usedto calculate IFA twice by the sameexaminer. In a second trimester scan,IFA was measured again in 215 fetuses.

Results: The median IFA value atthe time of the first trimester (IFA-1)was 880 (IQR: 8.0) and decreased withcrown-rump length (CRL) and biparietaldiameter (BPD). A moderate negativecorrelation was shown betweenIFA-1 and CRL (r= 0.3; p<0.001) as wellas between IFA-1 and BPD-1 (r= 0.176;p=0.010). An intraclass correlationcoefficient (ICC) of 0.87 (95% CI: 0.81– 0.91) confirmed strong intraobserveragreement between two IFA measurements.In 215 fetuses that underwenta second trimester screening, themedian IFA-2 was significantly lowercompared to IFA-1(215) (750; IQR: 10.0vs.870; IQR: 8.0; p<0.001), and therewas no correlation between IFA1215 andIFA-2 (r= -0.024; p=0.731).

Conclusions: In the first trimester,IFA decreases with CRL and BPD.When performed by the same operator,measurement of IFA is reproducible. There is no correlationbetween the IFA values in the first and second trimesters.

Small cerebral vessel disease is arelatively new group of angiopathiesdiagnosed more frequently thanks tocommon availability of neuroimaging.The most frequent and the mostknown disease which belongs to thisgroup is CADASIL (cerebral autosomaldominant arteriopathy with subcorticalinfarcts and leukoencephalopathy).Despite the name, it is a generalizedsmall vessel disease, in whichsymptoms of brain damage dominate.The disease manifests as recurrentischemic strokes, progressing dementia,migraine and mental disorders –symptoms which usually appear in 4-5decade of life in patients without typicalrisk factors for vascular disease. Inneuroimaging hyperintense changesand small ischemic foci disseminatedin the cerebral white matter are seen.CADASIL is caused by mutations inthe NOTCH 3 gene, which lead to thedegeneration and loss of smooth musclecells in small arteries. The diseaseis diagnosed on the basis of the resultof the genetic test and microscopicexamination of blood vessels in thematerial derived from a skin or skinmusclebiopsy. Since more and morefrequently new techniques of neuroimagingreveal changes in the cerebralwhite matter - often asymptomatic or/and mistakenly diagnosed as demyelinatinglesions - only knowledge aboutCADASIL and other microangiopathiesallows to avoid diagnostic errors.

Instruction: To answer the questionif minimally invasive aortic valvereplacement surgery through a rightanterior minithoracotomy (RT-AVR)may result in increased incidence ofpostoperative pulmonary complicationscompared to conventional aorticvalve replacement through a mediansternotomy (AVR).

Material and methods: It was retrospectiveanalysis of 212 patientsscheduled for RT-AVR and 212 forAVR between January 2011 and December2014 selected with propensityscore matching. Respiratory systemcomplications are analysed.

Results: Postoperative blooddrainage was 353±249 and 524±325ml in RT-AVR and AVR groups respectively(p<0.001). Hospital stay was5.7±1.6 and 8.5±4.3 days (p<0.001),ICU stay was 1.3±1.2 and 2.6±2.8 days(p<0.001) in RT-AVR and AVR patientsrespectively. Respiratory systemcomplications occurred in 13.7% ofRT-AVR patients and 17.0% of AVRpatients (p=0.364). Pneumonia was diagnosedin 2.4% and 0.5% of patients(p=0.129), pneumothorax in 2.0% and1.3% of patients (p=0.515), pleural effusionin 8.5% and 7.5% of patients(p =0.732) and thoracentesis wasperformed in 7.1% and 7.5% of patientsfrom RT-AVR and AVR groupsrespectively. Mediastinitis was diagnosedin 0.0% of RT-AVR and 2.8% ofAVR patients (p=0.020). Phrenic nervedysfunction was present in 3.8% ofRT-AVR and in 0.0% of AVR patients(p=0.006). COPD (OR=5.5; p<0.001)and increased postoperative bloodloss (OR=3.5; p<0.001) were risk factorsof postoperative pulmonary complications.

Conclusion: Minimally invasiveRT-AVR surgery did not result in increasedrate of postoperative pulmonarycomplications compared toconventional AVR surgery througha median sternotomy.