Morphometrical features of left atrial appendage in the atrial fibrillation patients subjected to left atrial appendage closure

BACKGROUND

This study aimed to evaluate the morphometrical features of left atrial appendage (LAA) in patients with atrial fibrillation, subjected to LAA percutaneous closure (LARIAT) for stroke prevention.

MATERIALS AND METHODS

Computed tomography (CT) scans of 51 patients with atrial fibrillation subjected to LARIAT procedure were comparatively evaluated with 50 patients with sinus rhythm (control group). Three-dimensional reconstructions were created using volume-rendering for evaluation.

RESULTS

No differences were found in LAA types of distribution (cauliflower: 25.5 vs. 34.0%, chicken wing: 45.1 vs. 46.0%, arrowhead: 29.4 vs. 20.0%, all p > 0.05) between groups. However, the study group was characterized by LAAs with a lower number of lobes. The LAA orifice anteroposterior and transverse diameters (19.3 ± 4.12 vs. 17.2 ± 4.0 mm, p = 0.01 and 25.1 ± 5.1 vs. 20.5 ± ± 4.4 mm, p = 0.001), orifice area (387.2 ± 133.9 vs. 327.1 ± 128.3 mm2, p = 0.02) and orifice perimeter (70.2 ± 12.5 vs. 61.2 ± 11.6 mm, p = 0.04) was significantly larger in atrial fibrillation patients. More oval LAA orifices was found in atrial fibrillation group (94.0 vs. 70.4%, p = 0.001). No statistically significant differences were found in LAA body length (47.4 ± 15.4 vs. 43.7 ± 10.9 mm, p = 0.17), body width (24.7 ± 5.6 vs. 24.4 ± 5.8 mm, p = 0.81), and chamber depth (17.7 ± 3.5 vs. 16.5 ± 3.8 mm, p = 0.11). Calculated LAA ejection fraction was significantly lower in study group compared to healthy patients (16.4 ± 14.9 vs. 48.2 ± 12.9%, p = 0.001).

CONCLUSIONS

Important morphometrical differences in LAA orifice have been found, which was significantly larger and more oval in patients with atrial fibrillation compared to healthy controls. Although no difference in LAA body type and size was observed; the LAA ejection fraction was significantly lower in atrial fibrillation rhythm patients.

Quality of life in women with urinary stress incontinence and evaluation of tension-free vaginal tape treatment

OBJECTIVES

Assessment of quality of life in women stress urinary incontinence (USI) and evaluation of tension-free vaginal tape (TVT) treatment.

MATERIAL AND METHODS

The research included a group of 112 women aged 33-78 years. Before as well as 3 and 6 months after the TVT operation, patients were asked to fill in quality of life questionnaires.

RESULTS

After 3 months 87.25% of the women reported full regression of USI symptoms, 7.8% an insignificant improvement, and 4.9% did not observe any change. After 6 months 85.71% reported full regression, 9.18% an insignificant improvement, and 5.1% did not observe any change. USI is responsible for a decrease in physical activity. The most uncomfortable symptom is involuntary urine leakage occurring mainly during an effort or sleep. After the TVT procedure, the majority of women confirmed a significant improvement in quality of life.

CONCLUSIONS

The TVT procedure is an effective method of treating USI in women: it significantly improves quality of life, with a recovery rate of 85-87%, and a low rate of complications.

[Venosus thromboembolism in pregnancy--case report]

Venosus thromboembolic disease is an important problem in pregnant women. The overall risk of venosus thromboembolism in pregnancy is 6-times greater then in non pregnant women. In the article we present a case of a pregnant woman with venosus thromboembolism. The analysis of the pregnancy and mode of delivery, development of disease, diagnostic and therapeutic method.

[Effect of the body weight of pregnant women on delivery and the birth state of the newborn]

Systematic and lately even rapid growth of the number of overweight people has been recently observed. In the economically well-developed countries fatness is the real problem of the contemporary man. The evaluation of the body weight of the pregnant women and its influence on the delivery and the birth state of the infants has been the aim of the study. 139 cases of pregnant women with physiological pregnancy have been analyzed. The pregnant women were divided into 4 groups according to the body weight at the early pregnancy which according to WHO criteria was expressed by the body mass index (BMI). The body mass of the delivering woman, date of delivery, way of delivering and probable delivering complications, performed obstetrical procedures, estimated blood loss of the delivering woman, sex, weight and length and the birth state of the infant according to the Apgar scale were evaluated prospectively. Analyzing the body mass of the women at the early pregnancy, underweight was stated at 55 women (39.57%), the proper body weight at 66 cases (47.48%), overweight at 12 cases (8.63%) and the fatness at 6 cases (4.32%). The average body mass index (BMI) at the early pregnancy was 21.63 kg/m2 and its increase during pregnancy was 5.95 kg/m2. It has been found out that the increase of body mass during pregnancy corresponds to the body weight before pregnancy and amounts to 16.22 kg on average. The study has shown more cases of surgical deliveries, greater intrapartum blood loss in the group of overweight and fat women, and greater harm to the vulva/vagina during delivery in the group of underweight women. The best delivery state of the babies has been found out in the group of women with the proper body weight.

[The influence of the sounds of music on chosen cardiotocographic parameters in mature pregnancies]

The influence of the sounds of music on adults' organisms is well investigated. It is widely known that low rhythm music can diminish psychophysical tension acting as a relaxing and anxiolytic agent, while fast rhythm of the music may have just opposite action-excitement. Despite the big number of publications about the influence of the sounds on human organism only very few papers about fetal reactions on music have been reported. A prospective study of 38 patients with mature pregnancies was made to evaluate the changes in the chosen cardiotocographic (CTG) parameters while listening to the different kinds of the music. Only physiological pregnancies were qualified. In the procedure all the patients were performed a Non Stress Test, than continuing CTG observation were exposed to three kinds of music: low (relaxation), medium (activation), fast rhythm (excitation). Uterine contractility, fetal heart rate (FHR), fetal movements (FM), incidence of accelerations and decelerations, oscillation mid-value were noted. A proportional positive correlation between the uterine contractility, fetal movements and the increase of the rhythm of the music was observed. No influence of the music on fetal heart rate and oscillation mid value was observed. An increased incidence of accelerations while playing the music was reported comparing to the control (i.e. pregnant patients not exposed to the music). No decelerations were observed.

CONCLUSIONS

1. Music has a significant impact on fetal behaviour. 2. Various sounds of music have influence on distinct behaviour of fetus. 3. Increasing rhythm of music intensifies uterine contractility and fetal movements.

[Analysis of fear structure and intensity at women in prolonged pregnancy]

41 women in prolonged pregnancy were involved into anonymous researches. By the use of survey created in IVth Obstetrics and Gynaecological Department of Silesian Medical School and STAI Spielberger questionnaire and AS Cattell questionnaire and K test MPI Eyseneck Scale--the structure, level of intensity and crystallisation fear was examined. The expectation and wishes of women were known. The general psychological characteristic was done and dominant strategies of coping with difficult situations were isolated. Higher fear levels, mostly of reactive genesis and crystallised mainly on the pregnancy, higher level of ergic tension and suspicion and high level of psychic integration and strong ego were observed.

[Delivery with husband]

On the basis of the own questionnaire, the research concerning 60 married couples, experiencing family delivery, was made. It was stated that there is strong emotional bound between parents and strong need for experiencing the delivery together.

[Vaginal delivery after previous cesarean: comparison between own method and Weinstein's predictive score]

121 women after previous caesarean section were examined. The amount of successful labours were compared (according to the own diagnostic card) with the foreseeing probability of vaginal labours according to Weinstein's score. 63% pregnant woman was classified to the natural labour on the base of the own diagnostic card, probability of natural labour according to Weinstein's score were more or equal than 67%. There were no agreement between prognostic Weinstein's scale and our own method in the cases of failed attempt of labour followed by caesarean section.