The influence of the call with a mobile phone on heart rate variability parameters in healthy volunteers

It is possible that electromagnetic field (EMF) generated by mobile phones (MP) may have an influence on the autonomic nervous system (ANS) and modulates the function of circulatory system. The aim of the study was to estimate the influence of the call with a mobile phone on heart rate variability (HRV) in young healthy people. The time and frequency domain HRV analyses were performed to assess the changes in sympathovagal balance in a group of 32 healthy students with normal electrocardiogram (ECG) and echocardiogram at rest. The frequency domain variables were computed: ultra low frequency (ULF) power, very low frequency (VLF) power, low frequency (LF) power, high frequency (HF) power and LF/HF ratio was determined. ECG Holter monitoring was recorded in standardized conditions: from 08:00 to 09:00 in the morning in a sitting position, within 20 min periods: before the telephone call (period I), during the call with use of mobile phone (period II), and after the telephone call (period III). During 20 min call with a mobile phone time domain parameters such as standard deviation of all normal sinus RR intervals (SDNN [ms]--period I: 73.94+/-25.02, period II: 91.63+/-35.99, period III: 75.06+/-27.62; I-II: p<0.05, II-III: p<0.05) and standard deviation of the averaged normal sinus RR intervals for all 5-mm segments (SDANN [ms]--period I: 47.78+/-22.69, period II: 60.72+/-27.55, period III: 47.12+/-23.21; I-II: p<0.05, II-III: p<0.05) were significantly increased. As well as very low frequency (VLF [ms2]--period I: 456.62+/-214.13, period II: 566.84+/-216.99, period III: 477.43+/-203.94; I-II: p<0.05), low frequency (LF [ms(2)]--period I: 607.97+/-201.33, period II: 758.28+/-307.90, period III: 627.09+/-220.33; I-II: p<0.01, II-III: p<0.05) and high frequency (HF [ms(2)]--period I: 538.44+/-290.63, period II: 730.31+/-445.78, period III: 590.94+/-301.64; I-II: p<0.05) components were the highest and the LF/HF ratio (period I: 1.48+/-0.38, period II: 1.16+/-0.35, period III: 1.46+/-0.40; I-II: p<0.05, II-III: p<0.05) was the lowest during a call with a mobile phone. The tone of the parasympathetic system measured indirectly by analysis of heart rate variability was increased while sympathetic tone was lowered during the call with use of a mobile phone. It was shown that the call with a mobile phone may change the autonomic balance in healthy subjects. Changes in heart rate variability during the call with a mobile phone could be affected by electromagnetic field but the influence of speaking cannot be excluded.

Batwing Mastopexy as Oncoplastic Surgical Approach to Periareolar Tumors in Upper Quadrants

Aims and background

Batwing mastopexy (BWM) is an oncoplastic technique most commonly used in the treatment of 12 o'clock periareolar tumors. The aim of this study was to assess the early cosmetic results of BWM performed for periareolar lesions located in the upper quadrants, i.e. from 10 to 2 o'clock position.

Methods and study design

A prospective analysis of a preliminary group of 35 women with periareolar intraductal or invasive breast cancer in the upper quadrants was done. All patients underwent wide lumpectomy with clear margins followed by BWM in order to obtain favorable cosmesis. For invasive cancers axillary biopsy or dissection was performed by separate incision. Cosmetic outcome was assessed 4 weeks after surgery by the patient with reference to breast shape, nipple-areola complex (NAC) position and scar arrangement. The result was rated as poor, medium or good for each parameter.

Results

There were no poor ratings of cosmetic outcome. The result was rated as medium by 5 women (14%) regarding breast shape and by 3 regarding NAC position (9%). The remaining women evaluated these parameters as good (86% and 91%, respectively). In contrast, scar arrangement was assessed as good by 26 patients (74%), medium by 8 (23%), and poor by 1 (3%). All women rating scar arrangement as other than good had a lesion located in the upper lateral quadrant. Considering the reasons for the relatively low scar acceptance by these women, the only important cause of disappointment was the placement of one of the radial parts of the scar in the area of decolletage in the upper medial quadrant.

Conclusions

BWM allows to achieve favorable breast shape and NAC position for lesions located in the upper quadrants regardless of the medial or lateral side. However, when performed in the lateral quadrant it produces a scar that can be hard to accept for some women.

The role of surgery in the treatment of colorectal metastases from primary skin melanoma

AIM

The study assessed the role of colorectal surgery in the treatment of metastatic melanoma and identified patients who can most benefit from surgical resection.

METHOD

A retrospective analysis was made of 34 consecutive patients with skin melanoma who underwent surgical resection of large bowel metastasis.

RESULTS

The median disease-free interval between diagnosis of the primary and metastatic melanoma was 24 (7-98) months. Nine (27%) patients underwent emergency surgery for obstruction and 25 (73%) had an elective procedure. Resection with curative intent was performed in 14 (41%) and palliative resection in 20 (59%) patients. There was no postoperative mortality and morbidity occurred in 9%. The median survival following surgery was 11.5 (4-68) months. The 1-, 2- and 5-year survival rates were 50%, 32% and 17% respectively. Median survival was significantly increased in patients without extra-abdominal metastases, with no evidence of non-large-bowel metastases, if the disease-free interval was longer than 24 months and when curative resection was performed. In multivariate analysis, an apparently complete or palliative resection and the absence or presence of extra-abdominal metastases were the most important prognostic factors.

CONCLUSION

An aggressive surgical approach to large bowel metastatic melanoma results in good palliation and effective relief of symptoms with acceptable morbidity and mortality.

Batwing mastopexy as oncoplastic surgical approach to periareolar tumors in upper quadrants

AIMS AND BACKGROUND

Batwing mastopexy (BWM) is an oncoplastic technique most commonly used in the treatment of 12 o'clock periareolar tumors. The aim of this study was to assess the early cosmetic results of BWM performed for periareolar lesions located in the upper quadrants, i.e. from 10 to 2 o'clock position.

METHODS AND STUDY DESIGN

A prospective analysis of a preliminary group of 35 women with periareolar intraductal or invasive breast cancer in the upper quadrants was done. All patients underwent wide lumpectomy with clear margins followed by BWM in order to obtain favorable cosmesis. For invasive cancers axillary biopsy or dissection was performed by separate incision. Cosmetic outcome was assessed 4 weeks after surgery by the patient with reference to breast shape, nipple-areola complex (NAC) position and scar arrangement. The result was rated as poor, medium or good for each parameter.

RESULTS

There were no poor ratings of cosmetic outcome. The result was rated as medium by 5 women (14%) regarding breast shape and by 3 regarding NAC position (9%). The remaining women evaluated these parameters as good (86% and 91%, respectively). In contrast, scar arrangement was assessed as good by 26 patients (74%), medium by 8 (23%), and poor by 1 (3%). All women rating scar arrangement as other than good had a lesion located in the upper lateral quadrant. Considering the reasons for the relatively low scar acceptance by these women, the only important cause of disappointment was the placement of one of the radial parts of the scar in the area of decolletage in the upper medial quadrant.

CONCLUSIONS

BWM allows to achieve favorable breast shape and NAC position for lesions located in the upper quadrants regardless of the medial or lateral side. However, when performed in the lateral quadrant it produces a scar that can be hard to accept for some women.

Screening of athletes: An electrocardiogram is not enough

Professional and amateur athletic training can cause tremendous overload of the cardiovascular system and thus become a trigger of serious and often fatal cardiac events in athletes with a previously undetected underlying cardiovascular disease. Therefore, every athlete should undergo a specialized diagnostic and qualification screening before a training program is prescribed or continued. However, it is still an unresolved issue which of the accessible diagnostic tools should be routinely applied in order to increase the safety of extreme physical training and reduce the risk of sudden cardiac death. Pre-participation athlete evaluation including a standard electrocardiogram (ECG), physical examination, and familial history of cardiovascular diseases is important, but does not always guarantee high diagnostic accuracy. Hence, the aim of this review article is to discuss the controversy over the usefulness of ECG for the detection of cardiovascular diseases in athletes as well as the views on athlete screening methods in Europe and the USA. Differential diagnostic options and screening schemes are also described in particular groups of athletes in reference to their age, cardiovascular risk factors, as well as intensity and type of sport discipline.

Apoptotic changes in the myocardium in the course of experimentally-induced pleurisy

The secreted proinflammatory interleukins IL-1, IL-6 and TNF in the course of experimentally-induced pleurisy can be the cause of pathological changes in the ultrastructure of cardiac muscle and of apoptosis. The pleurisy was induced in rats by means of carrageenin. The scraps of cardiac muscle obtained during the inflammatory reaction in the pleura were analysed by means of an electron microscope. The scraps were also stained with the TUNEL method in order to find the apoptotic foci. It was proved by the experiment that the inflammatory process affected mitochondria in the cardiomyocytes, enhanced collagen fibre synthesis and contributed to the formation of apoptotic foci in the cardiac muscle.

Assessment of body surface potential mapping in diabetic patients with recognized depression

OBJECTIVES

Parameters of body surface potential mapping (BSPM) in DM II patients are significantly different comparing with healthy non-diabetic subjects. Hypothesis that these changes are more pronounced in DM II patients with depression was tested in the present study. For this purpose, analysis of the relationship between the Int-QRST (isointegral) maps distribution and the depressive symptoms intensification, as well interrelation between depressive and diabetic symptoms were performed.

MATERIAL AND METHODS

BSPM registrations were obtained from the three study groups (aged 37-52 years), namely 40 diabetic patients with clinically documented depression, 30 depressive patient without DM and 90 normal subjects. BSPM recordings were displayed in a form of the Int-QRST maps. Examination with BDI and HbA1c test were also performed in all investigated subjects.

RESULTS

Isointegral QRST maps turned out to display abnormal, i.e. non-dipolar distribution. Moreover, extent of Int-QRST maps multipolarity increased in the examined diabetic patients along with DM II duration, BDI scores and HbA1c level.

CONCLUSIONS

Non-dipolar distribution of Int-QRST maps, more pronounced in diabetic patients with depression, can be a specific indicator of the increased risk of severe ventricular arrhythmias occurring prior to abnormalities detectable on the standard 12-lead ECG recordings, which is of great importance especially in prevention of life-threatening arrhythmias.

COVID - 19 - a New Challenging Disease for Intensivists and Cardiologists. From Basic Science to the Clinical Setting

A novel coronavirus causing Acute Respiratory Distress Syndrome (SARS-CoV-2) has been considered the cause of a large number of lower respiratory tract infections leading to severe respiratory failure in many cases. However, the evidence-based hospital reports show that the COVID -19 infestation may range from an asymptomatic or minimally symptomatic course with an almost bizarre deterioration of life parameters (“silent hypoxia”) through to critically ill patients with multiple organ failure including that of the lungs, kidneys, nervous system and other organs. Moreover, this coronavirus disease may cause significant lung damage in asymptomatic COVID-19 positive patients who recover at home.The virus enters through the angiotensin-converting enzyme 2 receptor (ACE2) widely expressed in the cardiovascular system and other organs and tissues, which can result in myocardial injury, myocarditis, acute myocardial infarction, heart failure, arrhythmias, brain stroke, acute pleuritis, pneumonia and venous thromboembolic events. COVID -19 - induced failure of some central mechanisms controlling breathing and the circulation may explain the mismatch between the clinical symptoms and the objective physiologic life parameters in many patients treated by intensivists or cardiologists. The severity of coronavirus disease is dependent on numerous factors including the magnitude of the host immune response, the impairment of central and peripheral nervous system, age, co-morbidities (e.g. diabetes, arterial hypertension, obesity, chronic heart failure) and presumably genetic proclivity. A brand-new treatment approach with use of alternative or experimental therapies such us Extracorporeal Membrane Oxygenation (ECMO), plasmapheresis, proinflammatory interleukins - targeted drugs, covalescent plasma transfusion, virus replication inhibitors is obviously needed in some COVID-19 patients.

[Haemolytic anaemia following implantation of the mitral annuloplasty ring: a case report]

Haemolytic anaemia following mitral annuloplasty is uncommon as compared with mitral valve replacement procedures. A 67-year-old woman, who underwent mitral annuloplasty and CABG, developed haemolytic anaemia. Echocardiographic examination revealed mitral regurgitation jet colliding with mitral ring. The management of these cases usually demands redo surgery. In the presented case, the direction of mild mitral regurgitant jet with respectfully high velocity contributed significantly to the early postoperative haemolysis. Redo surgery with implantation of bioprosthesis caused withdrawal of intravascular haemolysis.

The Therapeutic Potential of Different Surgical Approaches in the Management of Cardiac Myxoma: A Systematic Review

Background: Cardiac myxomas are benign tumors of the heart. They occur mostly in the left atrium. The preferred treatment is surgical resection, which can be performed via conventional median sternotomy, minimally invasive, or robotic-assisted approaches. This study aimed to evaluate the outcomes, advantages, and limitations of these surgical methods, with a focus on their safety, efficacy, and impact on patient recovery. Methods: This systemic review was conducted according to PRISMA guidelines. The chosen databases were systematically searched using the keywords "cardiac myxoma", "resection", "approach", "minimally invasive", and "robotic surgery". The comparison between the surgical strategies was based on thirteen articles, which met the inclusion criteria. Results: Median sternotomy remains the standard technique, providing excellent surgical access but is associated with longer hospital stays, higher blood loss, and increased risk of complications such as stroke. Minimally invasive approaches demonstrated comparable safety with shorter ICU stays, reduced blood loss, and lower postoperative pain but presented challenges, including limited exposure and longer procedure times. Robotic-assisted surgery showed potential as a safe alternative but was limited by high costs and technical demands. However, the data on minimally invasive and robotic methods are limited due to the rarity of cardiac myxomas. Conclusions: The choice of surgical technique should be individualised by considering the tumour size, location, patient condition, and surgeon expertise. Routine postoperative echocardiographic monitoring is essential to detect residual or recurrent tumours. Further studies are needed to validate the long-term efficacy of minimally invasive and robotic approaches.

[Pericarditis as a consequence and first symptom of microcellular lung carcinoma--case report]

A case of a patient suffering from Streptococcal suppurative pericarditis with cardiac tamponade and acute renal failure as a first symptom of disseminated lung cancer is presented. The examination of pericardial fluid only confirmed Streptococcal infection as a cause of exudative pericarditis. The neoplasmatic cells were not found in the examined fluid. Next, chest CT and bronchoscopy were performed due to the lack of clinical improvement, recurrence of severe pericardial effusion and enlargement of the upper mediastinum found on chest radiogram. CT and bronchoscopy allowed to establish the final diagnosis - disseminated lung cancer.

[Effect of psychotherapy on autonomic balance in VDT-operators with somatoform disorders]

BACKGROUND

The omnipresence of stress-inducing factors that stems from the permanent development of our civilization results in a constantly growing number of people with neurotic disorders. Computer technology, a very new labor technique, has become a stressful factor. Stressful factors initially affect the central nervous system, which modifies vegetative functions. The autonomic balance can be a measurable indicator of disease severity.

MATERIALS AND METHODS

The study group consisted of 50 VDT-operators with neurotic disorders. Twenty five healthy VDT-operators formed the control group. The autonomic balance was investigated with Holter monitoring. Each of the 50 neurotic VDT-operators were qualified for a 3-month psychotherapy.

RESULTS

The analysis of Holter recordings proved that the applied model of psychotherapy significantly reduced the number of sympathicotonics in favor of normotonics in the study group (p < 0.01).

CONCLUSIONS

The Holter analysis can be considered as a reliable indicator of the effect of psychotherapy.

Impact of nebivolol on levels of serum nitric oxide, plasma von Willebrand factor and exercise stress testing parameters in hypertensive and ischemic heart disease patients

BACKGROUND

The dysfunction of vascular endothelium precedes the development of atherosclerosis in patients with arterial hypertension. Nebivolol is a very specific beta-blocker, which can be characterized by a strong endothelial vasodilatative effect. The aim of the study was the assessment of changes in concentrations of serum nitric oxide (NO), plasma von Willebrand factor (vWf) and selected parameters of electrocardiographic exercise tests after 4-week nebivolol treatment.

METHODS

Twenty-one patients were included in the study, aged from 34 to 82 years with primary arterial hypertension or primary arterial hypertension and ischemic heart disease. Blood samples were taken for measurements of serum NO and plasma vWf. Electrocardiographic stress tests were also performed. Subsequently, nebivolol was administered for four weeks and the aforementioned measurements were repeated.

RESULTS

A significant increase in serum NO concentration was found in all the investigated patients after nebivolol treatment. A prolongation of exercise time, increase in metabolic equivalent and decrease in double product were also noted in patients after nebivolol treatment.

CONCLUSIONS

Nebivolol treatment improves parameters of electrocardiographic exercise test in patients with arterial hypertension. The improvement of the parameters of the exercise test was not observed in those patients who showed no significant increase in serum NO concentration following nebivolol treatment.

Cognitive disorders in type 2 diabetic patients with recognized depression

OBJECTIVES

The most important factors in the pathogenesis of cognitive disorders in diabetes mellitus (DM) are metabolic changes directly caused by hyperglycemia. Impairment of cognitive function is accompanied by a decrease in cerebral insulin. Insulin improves cognitive processes, including somatosensoric cognitive functions. Cognitive disorders are especially pronounced if diabetic patients suffer also from depression.

MATERIAL AND METHODS

The evaluation of cognitive functions, especially sensomotoric skills were obtained from three study groups (aged 37-52 years): 30 healthy subjects, 40 diabetic patients with clinically documented depression and 30 depressive patients without DM. The sensomotoric skills were carried out using a SPS-2001E apparatus - a computer working stress simulator. The examination with Beck Depression Inventory (BDI) were also performed in all the investigated persons.

RESULTS

Sensomotoric skills investigation revealed slight cognitive disorders in the early stages DM (subgroup IA) and its intensification according to increasing BDI scores and HbA1c blood concentration (from subgroup IA to IC). Intensification of sensomotoric cognitive disorders was significantly higher (p<0.001) in the depressive patients with DM (group I), than in these without DM (group III).

CONCLUSIONS

The obtained results suggest that coincidence of aggravating factors, such as depression and metabolic disorders in DM, may cause mutual interactions leading to premature and more intense cognitive impairment. The method proposed by the authors may serve as a screening examination in early diagnosis of CNS disorders reflected by somatosensoric cognitive disorders. The presented work indicates importance of sensomotoric skills investigation for the early diagnosis of the nervous system damage related to DM.

Cardiovascular screening of elderly athletes

The permanently growing interest in amateur and professional sports activities among young, middle-aged and elderly athletes raises serious concerns about athletes' health, the safety of physical training, and the sports-related risk of sudden cardiac death and other cardiovascular complications during exercise. In recent years there has been an increasing number of cases of sudden cardiac death during physical effort. At present, life expectancy in the most developed countries grows rapidly and the number of people >65 years dramatically increases. Moreover, biological age of the population is lower. Subsequently, relevant increase in the number of elderly athletes involved in various types of sports activities has been reported in many countries. It was also demonstrated that physical activity has strong beneficial effect on cognitive functions, psychomotor performance and thus exercise capacity, which is very important for the elderly people in their everyday routine activities. Nonetheless, it should be remembered that participation in amateur and professional sports activities may be associated with risk of serious cardiovascular events in the elderly athletes often suffering from various civilization diseases. It is also reported that the number of elderly people after interventional cardiology procedures, open heart surgery and cancer treatment (chemotherapy, radiotherapy), who wish to participate in various sports activities, systematically grows. The authors of the paper conduct a literature review on cardiovascular risk assessment in the elderly athletes including the contemporary cardiology diagnostic methods and diagnostic schemes to prevent sudden cardiac death and other cardiovascular events during exercise. The controversies over efficacy of particular diagnostic tools to detect cardiovascular diseases in the elderly athletes and worldwide epidemiologic data concerning risk of sudden cardiac death during physical exercise have been also presented. Here, the authors have derived suggestions for establishment of comprehensive diagnostic schemes to prevent sudden cardiac death during sports activities. Med Pr Work Health Saf. 2024;75(3):233-241.

Resting heart rate and its change induced by physical training in patients with ischemic heart disease at various ages treated with beta-blockers

BACKGROUND

The present study was aimed at possible modifications of resting HR induced by systematic physical training in patients of different age populations with ischemic heart disease (IHD) subjected to chronic therapeutic beta-blockade.

METHODS

The goal was the assessment of initial resting heart rate (HR) and its change after 6 months of physical training in two groups of patients with IHD at various ages (A: 55.5 +/- +/- 4.6 years; B: 72.5 +/- 4.37 years) treated with beta-blockers, the dosage of which was not modified during the observation.

RESULTS

Comparison between the groups A and B concerned the initial rHR (min-1): 79.3 +/- +/- 8.3 vs. 73.6 +/- 8.3 (p < 0.01), the after-training rHR: 70.9 +/- 7.9 vs. 67.7 +/- 8.4 (NS), and the delta of rHR: -8.4 +/- 4.8 vs. -5.9 +/- 2.8 (p < 0.01). Statistically significant correlation coefficients both between the patients' ages and the initial rHR (r = -0.377) and the delta of rHR (r = 0.347) were noted.

CONCLUSIONS

The reduction of rHR after 6-months of training was less in the older IHD patients because of their lower initial rHR compared with the younger patients, which was probably determined more by physiological vagotonia than therapeutic beta-blockade. (Cardiol J 2007; 14: 493-496).

[Pseudoaneurysm of the left ventricle in a 42-year-old patient with chronic viral hepatitis and history of infective endocarditis]

A case of a 42-year-old male patient with symptoms of chronic heart failure, history of infective endocarditis and drug abuse is presented. Echocardiography revealed the presence of pseudoaneurysm of the left ventricle, probably of post-inflammatory origin. Further course of the disease was complicated by multiorgan dysfunction, inflammatory and intravascular coagulation process, which led finally to acute circulatory and respiratory failure and death soon before planned cardiac surgery. Autopsy confirmed the diagnosis of left ventricular pseudoaneurysm.

Assessment of the Psychometric Properties of the Tampa Scale of Kinesiophobia (TSK) Questionnaire in Poland Based on Patients with Type 2 Diabetes Complicated by Stroke

Background/Objectives: Kinesiophobia, or the fear of movement, is a significant problem in the rehabilitation of patients after a stroke, especially in individuals with diabetes, who have an increased risk of health complications. The aim of the study was to validate the Tampa Scale for Kinesiophobia (TSK) for assessing kinesiophobia in the context of patients with diabetes complicated by stroke to ensure its adequacy and reliability in this specific group of patients. Methods: After considering exclusion criteria, 166 patients with type 2 diabetes after ischemic stroke, hospitalized in the neurological rehabilitation ward, were included in the analysis. A survey using the TSK was conducted in the study group. A reliability analysis of the questionnaire was conducted, and then exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to disclose the number of factors that characterize the study group. Results: The Cronbach's alpha value for the entire scale is 0.875. The value for all the questions on the scale was also above 0.86, so they are considered reliable. Removing any question does not increase the value of Cronbach's alpha or Guttman index. Based on the scree plot, two factors were identified. The first factor includes 12 items and forms a physical factor, while the second factor includes 5 items and forms a psychological factor. The fit of the two-factor model was checked using confirmatory factor analysis. The final two-factor model has an acceptable fit. All the factor loadings are statistically significant. The factor loadings range from 0.262 to 0.729 for the physical factor and from 0.543 to 0.822 for the psychological factor. Conclusions: The TSK is a reliable and valid tool for assessing the level of kinesiophobia in a group of patients with type 2 diabetes complicated by stroke. The results of the study using this tool may contribute to the development of more effective therapeutic strategies that take into account the specific physical and psychological needs of this group of patients.