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Chorostowska-Wynimko J, Domagała-Kulawik J, Fijałkowska A, Koseła MK, Kuca P, Radzikowska E, Szturmowicz M. Nowości z Kongresu ERS w Barcelonie, 18–22 Września 2010 (Część I). Adv Respir Med 2011. [DOI: 10.5603/arm.27676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Podczas Kongresu Europejskiego Towarzystwa Płucnego (ERS, European Respiratory Society) zostałam wybrana Delegatem Narodowym Polski na 3-letnią kadencję [...]
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Chorostowska-Wynimko J, Domagała-Kulawik J, Fijałkowska A, Koseła MK, Kuca P, Radzikowska E, Szturmowicz M. [Highlights from the ERS Congress in Barcelona, 18-22 September, 2010 (Part 1)]. PNEUMONOLOGIA I ALERGOLOGIA POLSKA 2011; 79:151-164. [PMID: 21351068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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Bilska A, Wilińska E, Szturmowicz M, Wawrzyńska L, Fijałkowska A, Oniszh K, Swiatowiec A, Wsół A, Torbicki A. [Recurrent effusive pericarditis in the course of adult-onset Still's disease--case reports of two patients]. PNEUMONOLOGIA I ALERGOLOGIA POLSKA 2011; 79:215-221. [PMID: 21509734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Pericardial effusion is caused by various pathological agents. In differential diagnosis infectious as well as non-infectious factors have to be considered. Adult-onset Still disease (AOSD)--relatively uncommon systemic inflammatory disorder of unknown etiology--is among possible diagnosis. The disease typically affects patients in the age between 16-35 years and is characterized by spiking fever, arthralgia, evanescent salmon rash with other abnormalities including pharingitis, serositis (especially pleuritis and pericarditis) and leucocytosis as well as increased serum levels of inflammatory indicators. We present two patients with recurrent pericardial effusion in the course of AOSD.
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Szturmowicz M, Kacprzak A, Burakowska B, Kurzyna M, Fijałkowska A, Bestry I, Torbicki A. In search of markers of treatment failure and poor prognosis in IPAH – the value of mosaic lung attenuation pattern on thin-section CT scans. Multidiscip Respir Med 2010. [DOI: 10.4081/mrm.2010.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Despite the development of specific therapies for pulmonary arterial hypertension (PAH) some patients fail to respond to such treatment. One of the potential reasons for the unresponsiveness to targeted therapies may be the presence of fibrous occlusion of small pulmonary veins that accompanies pre-capillary arteriopathy. This type of pathologic change is called pulmonary veno-occlusive disease (PVOD). Underdiagnosed PVOD occurs probably in 5-10% of idiopathic pulmonary hypertension (IPAH) and in a substantial proportion of PAH related to connective tissue diseases (mainly in scleroderma). A definite diagnosis of PVOD requires histologi- cal examination of lung sample, but surgical lung biopsy in pulmonary hypertension is combined with high risk of bleeding. Thus major interest is focused on a non-invasive diagnostic approach enabling early recognition of PVOD and referral for lung transplantation. The present review is focused on the radiological features suggestive of PVOD-like vasculopathy in PAH.
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Fijałkowska A, Kowalczyk M. [Peripheral blood perfusion during desflurane anaesthesia]. ANESTEZJOLOGIA INTENSYWNA TERAPIA 2010; 42:11-14. [PMID: 20608208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Peripheral perfusion may be compromised during anaesthesia and surgery, however its direct assessment is difficult, and sometimes may lead to false conclusions. Recently, a new generation of pulse oximeters has been introduced, which allows for the differentiation between pulsatile and non-pulsatile flow. The difference is expressed as the perfusion index (PI). METHODS ASA I and II class women, scheduled for elective gynaecologic surgery, received fentanyl/ desflurane anaesthesia were studied. PI was noted before anaesthesia, after fentanyl injection, after endotracheal intubation, at the beginning of surgery, during the procedure at 10 minute intervals, at the end of procedure, after eye opening, after extubation, and before discharge to the ward. The depth of anaesthesia was assessed by spectral entropy and expressed as the A-line Autoregressive Index (AAI); the latter was compared to PI. RESULTS Forty-five patients aged 37 +/- 13.8 years were enrolled in the study. PI increased after induction of anaesthesia and remained increased during surgery. There was a significant negative correlation between PI and AAI (r = -0.908; p = 0.00000), and between AAI and end-tidal desflurane concentration ((r = -0.788; p = 0.0008). PI correlated positively with end-tidal desflurane concentration (r = +0.757; p = 0.002). CONCLUSION The new generation of pulse oximeters allows not only the more accurate assessment of haemoglobin saturation, but also the detection of pathologic forms of haemoglobin and the assessment of peripheral blood flow. Peripheral perfusion is increased during desflurane anaesthesia, and is also closely related to the depth of anaesthesia.
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Walczak B, Demkow U, Fijałkowska A. Methods of Estimating Concentration of the D-Dimers Used in Venous Thromboembolism Diagnosis. Adv Respir Med 2009. [DOI: 10.5603/arm.27807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
D-dimers (DD) are final products of stabilized fibrin degradation process. Elevated level of DD indicates parallel activation of both coagulation and fibrinolysis. D-dimers play important role in the diagnosis of deep vein thrombosis and pulmonary embolism. All diagnostic methods detecting DD are based on monoclonal antibodies. There are three basic techniques used to measure DD: latex agglutination, full blood agglutination and immunoenzymatic methods. Nowadays new methods based on in vivo detection of DD using antibodies labeled with technetium are under clinical evaluation.
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Fijałkowska A. D-dimer in Diagnosis and Treatment of Pulmonary Embolism. Adv Respir Med 2009. [DOI: 10.5603/arm.27808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
D-dimer level estimation, specific fibrin degradation product, is a permanent part of diagnostic strategies of pulmonary embolism (PE). Approximetly 30% of a suspected non-high risk PE can be ruled out with high sensitive D-dimer test when pre-test clinical probability is non-high. Recent guidelines underline that only very sensitive DD assays can be used. The main limitation of DD tests is relatively low specificity especially in hospitalized population, in elder patients, with cancer and in pregnancy. New indication for DD test mentioned in current guidelines is estimation of risk of recurrence after withdrawal of anticoagulant. Negative DD test identify patients with low risk of recurrence.
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Kacprzak A, Szturmowicz M, Burakowska B, Fijałkowska A, Kurzyna M, Wieteska M, Florczyk M, Zyłkowska J, Franczuk M, Wesołowski S, Torbicki A. [Abnormalities in high-resolution computed tomography of the lungs in patients with idiopathic pulmonary arterial hypertension -- correlation with hemodynamic parameters and prognostic significance]. PNEUMONOLOGIA I ALERGOLOGIA POLSKA 2009; 77:23-30. [PMID: 19308906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION The risk stratification in idiopathic pulmonary arterial hypertension (IPAH) patients is currently based on haemodynamic and functional parameters as well as serum biomarker concentrations. Until now the importance of changes appearing in high-resolution computed tomography (HRCT) of the lungs of patients with IPAH has not been investigated. MATERIAL AND METHODS Lung HRCT scans were analysed retrospectively in 48 IPAH patients (patients): 37 women, 11 men, mean age 41 +/- 15 years. RESULTS Focal ground-glass opacifications (FGG) were found in 12 patients (25%), and centrilobular nodules (CN) were found in 8 patients (17%). In the remaining 58% of patients HRCT revealed no changes (N). Significantly lower stroke volume was found in the CN group (41.0 +/- 8.5 ml) compared to 60.8 +/- 15.1 ml in the FGG group and 58.1 +/- 18.0 ml in the N group (p = 0.03). Right atrial pressure was significantly higher in the CN group (12.2 +/- 4.86 mm Hg) than in the FGG group (6.9 +/- 3.9 mm Hg) and the N group (7.6 +/- 5.3 mm Hg), p = 0.047. The presence of nodules was combined with considerably increased risk of death, both in univariate analysis (HR 5.35, 95% CI: 1.16-24.7, p = 0.03) and in multivariate analysis (HR 6.98, 95% CI: 1.41-34.59, p = 0.02). Ground-glass opacifications correlated neither with haemodynamic nor functional indexes, and were of no prognostic significance. CONCLUSIONS The presence of centrilobular nodules in lung HRCT scans of IPAH patients was combined with more severe haemodynamic compromise and was an independent negative prognostic indicator.
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Fijałkowska A. [D-dimer in diagnosis and treatment of pulmonary embolism]. PNEUMONOLOGIA I ALERGOLOGIA POLSKA 2009; 77:271-275. [PMID: 19591098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
D-dimer level estimation, specific fibrin degradation product, is a permanent part of diagnostic strategies of pulmonary embolism (PE). Approximately 30% of a suspected non-high risk PE can be ruled out with high sensitive D-dimer test when pre-test clinical probability is non-high. Recent guidelines underline that only very sensitive DD assays can be used. The main limitation of DD tests is relatively low specificity especially in hospitalized population, in elder patients, with cancer and in pregnancy. New indication for DD test mentioned in current guidelines is estimation of risk of recurrence after withdrawal of anticoagulant. Negative DD test identify patients with low risk of recurrence.
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Walczak B, Demkow U, Fijałkowska A. [Methods of estimating concentration of the D-dimers used in venous thromboembolism diagnosis]. PNEUMONOLOGIA I ALERGOLOGIA POLSKA 2009; 77:264-270. [PMID: 19591097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
D-dimers (DD) are final products of stabilized fibrin degradation process. Elevated level of DD indicates parallel activation of both coagulation and fibrinolysis. D-dimers play important role in the diagnosis of deep vein thrombosis and pulmonary embolism. All diagnostic methods detecting DD are based on monoclonal antibodies. There are three basic techniques used to measure DD: latex agglutination, full blood agglutination and immunoenzymatic methods. Nowadays new methods based on in vivo detection of DD using antibodies labeled with technetium are under clinical evaluation.
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Kacprzak A, Szturmowicz M, Burakowska B, Fijałkowska A, Kurzyna M, Wieteska M, Florczyk M, Żyłkowska J, Franczuk M, Wesołowski S, Torbicki A. Abnormalities in High-Resolution Computed Tomography of the Lungs in Patients with Idiopathic Pulmonary Arterial Hypertension—Correlation with Haemodynamic Parameters and Prognostic Significance. Adv Respir Med 2008. [DOI: 10.5603/arm.27849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction: The risk stratification in idiopathic pulmonary arterial hypertension (IPAH) patients is currently based on haemodynamic and functional parameters as well as serum biomarker concentrations. Until now the importance of changes appearing in high-resolution computed tomography (HRCT) of the lungs of patients with IPAH has not been investigated. Material and methods: Lung HRCT scans were analysed retrospectively in 48 IPAH patients (patients): 37 women, 11 men, mean age 41 ± 15 years. Results: Focal ground-glass opacifications (FGG) were found in 12 patients (25%), and centrilobular nodules (CN) were found in 8 patients (17%). In the remaining 58% of patients HRCT revealed no changes (N). Significantly lower stroke volume was found in the CN group (41.0 ± 8.5 ml) compared to 60.8 ± 15.1 ml in the FGG group and 58.1 ± 18.0 ml in the N group (p = 0.03). Right atrial pressure was significantly higher in the CN group (12.2 ± 4.86 mm Hg) than in the FGG group (6.9 ± 3.9 mm Hg) and the N group (7.6 ± 5.3 mm Hg), p = 0.047. The presence of nodules was combined with considerably increased risk of death, both in univariate analysis (HR 5.35, 95% CI: 1.16–24.7, p = 0.03) and in multivariate analysis (HR 6.98, 95% CI: 1.41–34.59, p = 0.02). Ground-glass opacifications correlated neither with haemodynamic nor functional indexes, and were of no prognostic significance. Conclusions: The presence of centrilobular nodules in lung HRCT scans of IPAH patients was combined with more severe haemodynamic compromise and was an independent negative prognostic indicator.
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Kurzyna M, Zyłkowska J, Fijałkowska A, Florczyk M, Wieteska M, Kacprzak A, Burakowski J, Szturmowicz M, Wawrzyńska L, Torbicki A. Characteristics and prognosis of patients with decompensated right ventricular failure during the course of pulmonary hypertension. Kardiol Pol 2008; 66:1033-1041. [PMID: 19006024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND New therapies for pulmonary arterial hypertension have prolonged survival but simultaneously increased the number of hospital admissions because of decompensated right heart failure (DRHF). The optimal approach in DRHF has not been established yet. AIM Analysis of clinical course of DRHF in a group of patients with pulmonary hypertension treated in a single referral centre. METHODS We retrospectively analysed 60 episodes of DRHF in 37 patients (29 females, mean age 44+/-17 years) with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension admitted to our hospital between 2005 and 2007. We assessed the cause of decompensation, vital signs at admission, functional class and laboratory values. We classified all episodes into four haemodynamic profiles using the value of systolic blood pressure together with presence of peripheral perfusion abnormalities (profile cold vs. warm) and symptoms of venous congestion (profile wet vs. dry). Primary end-point was in-hospital mortality. RESULTS The most common causes of DRHF were infection (27%), drug noncompliance (20%), and pulmonary embolism (3%). In 48% no causative factor was indentified. There were 19 (32%) in-hospital deaths. The highest mortality was observed among patients with connective tissue disease (61%). The haemodynamic profile 'warm-wet' was the most common (48%) and the profile 'cold-dry' was the rarest but was associated with a 100% mortality. Patients who died had higher value of functional class (3.84+/-0.38 vs. 3.51+/-0.55, p=0.01) and higher activity of aspartate transaminase (61+/-61 vs. 42+/-78 U/l, p=0.02) compared with those who survived. In multivariate analysis higher dopamine dose (RR 2.0/1 microg/kg/min, 95% CI 1.00-5.00, p <0.001) was an independent factor of in-hospital death. In contrast 'rescue therapy' with iloprost or treprostinil decreased mortality (RR 0.09, 95% CI 0.01-0.99, p=0.04). Mortality in patients receiving dopamine was higher (60 vs. 18%, p=0.001) than in patients treated without dopamine. CONCLUSION Mortality in patients with pulmonary hypertension and DRHF remains very high and seems to be related to haemodynamic profile on admission. The newly introduced therapy with parenteral prostanoids may be more beneficial than dopamine infusion.
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Lewandowski K, Szturmowicz M, Fijałkowska A, Kurzyna M, Hajduk B, Burakowska B, Chmielecki D, Torbicki A. Zator tętnicy płucnej w przebiegu zakrzepicy żył głebokich kończyn dolnych u choregoz obustronnym złamaniem kości udowej. PNEUMONOLOGIA I ALERGOLOGIA POLSKA 2008. [DOI: 10.5603/arm.28252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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64
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Fijołek J, Wiatr E, Tomkowski W, Fijałkowska A, Wiechecka A, Jabłoński W. Zespół antyfosfolipidowy - pierwotny czy wtórny? problem leczniczy. PNEUMONOLOGIA I ALERGOLOGIA POLSKA 2008. [DOI: 10.5603/arm.28266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Paczek A, Szturmowicz M, Wiatr E, Burakowska B, Fijałkowska A, Torbicki A. Interstitial Pneumonitis in a Patient Treated with Amiodarone—Case Report. Adv Respir Med 2008. [DOI: 10.5603/arm.27917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Amiodarone, antiarrhythmic drug of III class is used in patients with supraventricular and ventricular arrhythmias, often with coexisting congestive heart failure. Side effects of amiodarone treatment are observed in approximately 75% of patients. Most dangerous are the symptoms of amiodarone pulmonary toxicity occuring in 2–17% of patients. We present a patient with COPD, in whom interstitial pneumonitis with radiologic features of organizing pneumonia developed after one year of amiodaron treatment due to supraventricular and ventricular arrhythmias. The drug was stopped and steroids were introduced due to marked respiratory insufficiency. Regression of pulmonary symptoms and improvement of ventilatory parameters were observed after 3 months of treatment. Pathogenesis, diagnostic procedures and current methods of treatment of this jatrogenic disease are discussed.
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Szturmowicz M, Fijałkowska A, Rowińska-Zakrzewska E, Khalil LY, Piwek A, Kuca P, Opoka L, Augustynowicz-Kopeć E, Zwolska Z, Torbicki A. Mycobacterium kansasii infection in chronic thromboembolic pulmonary hypertension (CTEPH), report of two cases. PNEUMONOLOGIA I ALERGOLOGIA POLSKA 2008. [DOI: 10.5603/arm.28180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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67
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Wawrzyńska L, Kurzyna M, Kuca P, Fijałkowska A, Kober J, Florczyk M, Torbicki A. Autoimmune thyroid diseases in patients with primary pulmonary hypertension. PNEUMONOLOGIA I ALERGOLOGIA POLSKA 2008. [DOI: 10.5603/arm.28201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Paczek A, Szturmowicz M, Wiatr E, Burakowska B, Fijałkowska A, Torbicki A. [Interstitial pneumonitis in a patient treated with amiodarone -- case report]. PNEUMONOLOGIA I ALERGOLOGIA POLSKA 2008; 76:118-124. [PMID: 18464227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Amiodarone, antiarrhythmic drug of III class is used in patients with supraventricular and ventricular arrhythmias, often with coexisting congestive heart failure. Side effects of amiodarone treatment are observed in approximately 75% of patients. Most dangerous are the symptoms of amiodarone pulmonary toxicity occuring in 2-17% of patients. We present a patient with COPD, in whom interstitial pneumonitis with radiologic features of organizing pneumonia developed after one year of amiodaron treatment due to supraventricular and ventricular arrhythmias. The drug was stopped and steroids were introduced due to marked respiratory insufficiency. Regression of pulmonary symptoms and improvement of ventilatory parameters were observed after 3 months of treatment. Pathogenesis, diagnostic procedures and current methods of treatment of this jatrogenic disease are discussed.
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Florczyk M, Stawecka-Pawełczyk A, Kurzyna M, Fijałkowska A, Burakowska J, Żyłkowska J, Szturmowicz M, Wawrzyńska L, Tomkowski W, Torbicki A. Unusual Cause of Right Heart Failure Decompensation in 21-Years Old Patient with Idiopathic Pulmonary Arterial Hypertension—A Case Report. Adv Respir Med 2007. [DOI: 10.5603/arm.28009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors describe a case of 21-years old woman with idiopathic pulmonary arterial hypertension with atypical clinical consequences of massive internal bleeding. Despite significant hypovolemia clinical and laboratory presentation was one of RV failure with dilatation of right heart ventricle and increased plasma level of markers of myocardial stretch and injury (NT-proBNP and troponin, respectively). This is attributed to impaired right ventricular coronary perfusion and hypoxia. Intensive treatment restored baseline RV conditions and at 15 months follow-up no persistent right heart impairment was observed. This case demonstrates that bleeding should be also considered in differential diagnosis of exacerbation of right ventricular failure in patients with pulmonary arterial hypertension.
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Florczyk M, Stawecka-Pawełczyk A, Kurzyna M, Fijałkowska A, Burakowska J, Zyłkowska J, Szturmowicz M, Wawrzyńska L, Tomkowski W, Torbicki A. [Unusual cause of right heart failure decompensation in 21-years old patient with idiopathic pulmonary arterial hypertension -- a case report]. PNEUMONOLOGIA I ALERGOLOGIA POLSKA 2007; 75:95-9. [PMID: 17541918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
The authors describe a case of 21-years old woman with idiopathic pulmonary arterial hypertension with atypical clinical consequences of massive internal bleeding. Despite significant hypovolemia clinical and laboratory presentation was one of RV failure with dilatation of right heart ventricle and increased plasma level of markers of myocardial stretch and injury (NT-proBNP and troponin, respectively). This is attributed to impaired right ventricular coronary perfusion and hypoxia. Intensive treatment restored baseline RV conditions and at 15 months follow-up no persistent right heart impairment was observed. This case demonstrates that bleeding should be also considered in differential diagnosis of exacerbation of right ventricular failure in patients with pulmonary arterial hypertension.
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Dawidowicz AL, Fijałkowska A. Possibilities of Propofol Analysis in Various Blood Components by Means of HPLC. J LIQ CHROMATOGR R T 2006. [DOI: 10.1080/10826079608007192] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wawrzyńska L, Remiszewski P, Kurzyna M, Fijałkowska A, Burakowski J, Dabrowski M, Orłowski T, Roszkowski K, Dłutek P, Klepetko W, Torbicki A. [A case of a patient with idiopathic pulmonary arterial hypertension treated with lung transplantation: a "bumpy road" to success]. POLSKIE ARCHIWUM MEDYCYNY WEWNETRZNEJ 2006; 115:565-71. [PMID: 17263229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We describe a case of 29 year old man, a first Polish patient with idiopathic arterial hypertension (IPAH) listed from Poland and successfully treated with lung transplantation in Vienna. Time from diagnosis to lung transplant was merely 11 months. Rapid clinical deterioration required treatment with most of currently approved or emerging methods, including oral and parenteral prostacyclin analogues administration by inhalation and chronic subcutaneous infusion. Atrial balloon septostomy was used to bridge the patient to transplant. We describe multiple problems in providing pharmacotherapy and in arranging logistics for lung transplantation. Peri- and multiple post-transplantation complications including dehiscence of right main bronchial anastomosis and its successful therapy are also presented. We consider good long term outcome as assessed 26 months post transplantation as an encouragement for other attempts at lung transplantation in patients with IPAH and for development of this method of therapy in Poland.
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Pawlak-Cieślik A, Szturmowicz M, Fijałkowska A, Tomkowski W, Kupis W, Langfort R, Demkow U, Wiechecka A, Orłowski T, Torbicki A. [Neoplastic pericarditis--the role of different diagnostic procedures]. POLSKIE ARCHIWUM MEDYCYNY WEWNETRZNEJ 2006; 115:37-44. [PMID: 17278783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The aim of the study was to assess the role of different diagnostic procedures in the recognition of malignant pericarditis. Consecutive medical records of the patients with pericardial effusion treated with pericardiocentesis or pericardioscopy in the period of 1982-2002 were analyzed retrospectively. Criteria of neoplastic pericarditis were: positive result of pericardial fluid cytology and/or neoplastic infiltration found in pericardial biopsy specimen. Criteria of non-neoplastic pericarditis were: negative result of pericardial fluid cytology and pericardial biopsy specimen, no neoplastic disease diagnosed at presentation and during 3-years of follow up. Malignant pericarditis was diagnosed in 47 patients (pts), nonmalignant in 51. Echocardiographic signs of cardiac tamponade were found in 80% of pts with neoplastic pericarditis and 40% of pts with non-malignant disease (p = 0.0001). Chest CT scan revealed the presence of enlarged mediastinal lymph nodes in 94% of pts with malignant pericarditis and only 11% of pts with non-malignant disease (p = 0.00001). Pericardial thickness on CT scan exceeded 8 mm in 75% of the pts with malignant pericarditis and 8% of pts with nonmalignant disease (p = 0.0003). Pericardial fluid (pf) CEA concentration was significantly higher in the patients with neoplastic pericarditis than in the pts with non-malignant process. CEA > 5 ng/ml and Cyfra 21-1>50 ng/ml were found in 43% of the pts with malignant pericarditis and none of the pts with benign pericarditis. Thus we recommend chest CT scan and pericardial fluid tumor markers (CEA and Cyfra 21-1) assessment as the procedures helpful in the recognition of malignant pericarditis.
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Kober J, Tomkowski W, Pływaczewski R, Fijałkowska A, Kurzyna M, Torbicki A, Zieliński J. [Right ventricle structure and function in patients with obstructive sleep apnea (OSA)]. POLSKIE ARCHIWUM MEDYCYNY WEWNETRZNEJ 2004; 111:455-65. [PMID: 15517760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
UNLABELLED The structure and function of right ventricle was echocardiographically assessed in patients (pts) with OSA and analyzed taking into account the presence of obesity and/or systemic hypertension (SH). Therefore, 118 pts (98 M, 20 F, aged 48,5 8,4 yr) were divided into OH = obese with z OSA and SH (n = 22), ON = obese with OSA, and no SH (n = 20), OC = OSA without either obesity and SH (n = 21), GH = obese without OSA but with SH (n = 18), GN = obese without either OSA or SH (n =17). Control group (ZZ) comprised 20 healthy subjects (14M,6F). Right ventricular diameter (RVD), diastolic (DRVW), and systolic right ventricle free wall thickness (SRVW) were measured and its systolic thickening (ST-RVW) was calculated. Acceleration time of ejection into pulmonary artery (AcT) was measured with Doppler echocardiography. RESULTS St. sign. p < 0.05 between: 1: all groups except OH and ON, GH and GN, GH and OC, GN and OC; 2--like 1 except ZZ and OC; 3--OH and all subgroup except ON, ON and GH, ON and ZZ, OC and GN; 4-- ON and all subgroups except OH, OH and OC, OH and GH, OH and GN. CONCLUSIONS Enlargement and functionally compromised RV is found in OBS mostly with concomitant obesity. Pulmonary hypertension at rest in patients with isolated OSA is rare and also requires additional contributing factors.
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Kuca P, Kurzyna M, Sikora J, Fijałkowska A, Kober J, Hajduk B, Torbicki A. [Effect of localization of pulmonary arterial changes on echocardiographic indices of right heart function and their correlation with exercise capacity: comparison of arterial and thromboembolic pulmonary hypertension]. POLSKIE ARCHIWUM MEDYCYNY WEWNETRZNEJ 2004; 111:467-75. [PMID: 15517761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
AIM To assess correlation between exercise tolerance and Doppler-derived indices of right ventricular (RV)--pulmonary arterial coupling in patients with different location of vascular lesions causing pulmonary hypertension (PH). MATERIAL 45 patients: 21 with thromboembolic (TE-PH) and 24 with arterial PH defined as systolic pulmonary arterial pressure (SPAP) > 40 mm Hg. The two groups were similar as far as SPAP (74,8 +/- 15,2 vs 76.5 +/- 14,1 mm Hg, p = ns) and distance covered during 6 minute walk test (339 +/- 116 vs 320 +/- 127, p = ns) are concerned. RESULTS Flow velocity curve in the RV outflow tract were different in the two groups. Time from onset to peak velocity of ejection (acceleration time, AcT) as well as to midsystolic deceleration were shorter in TE-PH then in arterial PH (59.0 +/- 6.3 vs 68.1 +/- 15.4 msec, p = 0.015 and 123.8 +/- 17.9 vs 137.9 +/- 29.7 msec, p = 0.071, respectively). In the whole studied group as well as in arterial PH significant correlation between exercise tolerance and Doppler-derived indices of RV--pulmonary arterial coupling were found (r = 0.51, p < 0.001 and r = 0.72, p = < 0.001, respectively). Interestingly, no such relationship was found in TE-PH, (r = 0.16, p = ns). CONCLUSION In contrast to arterial PH, pressure wave prematurely reflected from the intraluminal thrombi seem to disturb the RV ejection pattern and its correlation with exercise tolerance in TE-PH. Whether progression or effects of treatment on arterial PH can be assessed by monitoring changes in Doppler-derived indices of RV--pulmonary arterial coupling requires further studies.
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