Biomedical subjects

J Legutko

Publications and source records attributed to J Legutko.

At least 19 recordsLinked to original sources

PubMed2004

Comparison of dual-chamber pacing with nonsurgical septal reduction effect in patients with hypertrophic obstructive cardiomyopathy.

OBJECTIVES: The aim of the study was to compare the influence of dual-chamber pacing vs. nonsurgical septal reduction on hemodynamic and morphological parameters in patients with obstructive form of hypertrophic cardiomyopathy. METHODS: Nineteen patients with dual-chamber pacing (group I) and 9 patients who underwent nonsurgical septal reduction (group II) were studied at baseline and after a 6-month follow-up. The changes of left ventricular outflow tract gradient and posterior wall thickness (as an index of left ventricular hypertrophy regression) were compared. RESULTS: The baseline left ventricular outflow tract gradient was comparable between group I and group II (77+/-25 vs. 82+/-25 mm Hg, p>0.05). At 6-month follow-up, the left ventricular outflow tract gradient was reduced to a similar level in both groups (28+/-19 vs. 25+/-12 mm Hg, p>0.05). At baseline, posterior wall hypertrophy was comparable between groups (12.9+/-1.7 vs. 13.6+/-2.2 mm, p>0.05). During follow-up, the posterior wall thickness was unchanged in the pacing group (12.9+/-1.7 vs. 12.6+/-1.6 mm, p>0.05), whereas nonsurgical septal reduction induced regression of left ventricular hypertrophy in myocardial region remote from the infarcted septal segment (13.6+/-2.2 vs. 10.5+/-2.3 mm, p<0.003). CONCLUSION: Despite comparable reduction of instantaneous left ventricular outflow tract gradient, the nonsurgical septal reduction decreased posterior wall thickness, whereas pacing did not reduce left ventricular hypertrophy. Thus, regression of left ventricular hypertrophy that appeared solely after nonsurgical septal reduction may reflect the more permanent reduction of left ventricular pressure overload. Thus, not only hemodynamic but also morphological benefit from nonsurgical septal reduction seems to indicate the superiority of this method over dual-chamber pacing.

Cardiac Pacing, Artificial↗

PubMed2003

History of Polish gastrointestinal surgery.

Surgery is the oldest discipline of medicine. The first Poland's University Chair of Surgery was established in the 18(th) century. Surgery that had been until then the domain of barbers became a clinical discipline. In the 19(th) century Polish surgeons were actively involved in the development of gastrointestinal surgery. Most famous among them, J. Mikulicz Radecki and L. Rydygier. They invented novel surgical techniques used for the treatment of many diseases. Their achievements contributed to creating Polish school of surgery, that was further developed throughout the 20(th) century. The progress in gastrointestinal surgery has been continued in the 21(st) century in spite of existing economic barriers.

Digestive System Surgical Procedures↗

PubMed2001

[Direct stent implantation under control of intracoronary ultrasonography. Immediate and late results].

UNLABELLED: Stents of a new generation have been developed, permitting immediate implantation without predilatation of the lesion site. Intracoronary ultrasound (ICUS) has been found useful in precise evaluation of stent expansion and in improvement of long-term therapeutic outcomes. The purpose of the study was to evaluate the safety and efficacy of direct stent implantation using intracoronary ultrasound. The study comprised 30 patients (8 women and 22 men) aged below 70 years with stable and unstable angina pectoris. ICUS was performed at baseline before making a decision about direct stent implantation and during the procedure to evaluate stent expansion. Direct stenting was performed in 26 patients achieving an angiographically and clinically optimal result (100% efficacy). In four patients direct stenting was abandoned because of massive calcifications in the affected artery detected by ICUS at baseline. During the 9-month follow-up recurrence of anginal pain requiring repeated intervention was observed in 3 patients (11.5%). CONCLUSIONS: The use of ICUS prior to direct stenting considerably improves the efficacy of the procedure and long-term therapeutic outcomes. Before wide popularisation of direct stenting under ICUS guidance it is necessary to carry out multicentre randomised clinical studies to verify the expected improvement of long-term results as compared with conventional stent implantation with pre-dilatation.

Adult↗

PubMed2001

[Pathogenesis and significance of gastroduodenal reflux].

For over a century duodenogastric reflux (DGR) has been considered the main cause of the primary or secondary alkaline gastritis. In the first case it occurred in patients who had not been operated earlier, in the latter one in those after surgery of stomach, duodenum, gallbladder and bile ducts. Since first time many reports of clinical and experimental studies have demonstrated destructive effect of pancreatic enzymes, bile acids and their by-products on stomach mucose producing in consequence non-specific histologic lesions. It has been also observed that duodenogastric reflux plays the basic role in the patho-genesis of gastritis and other GI tract diseases (gastric ulcer, reflux oesophagitis, progressing metaplasia or oesophageal and gastric cancer). As far as diagnosing of alkaline gastritis requires histologic confirmation, duodenogastric reflux brings many more problems. However, the progress in medicine and technology allow direct measurement of quality and quantity of this reflux.

Disease Progression↗

PubMed2001

[Current diagnosis of gastroduodenal reflux and biliary gastritis].

Though primary and secondary duodenogastric reflux (DGR) have been accepted in the medical literature as separate clinical units, reliable and standardised methods of detection have not been known since long. Therefore, the role of DGR in the pathogenesis of upper GI tract diseases makes a problem. So far applied measurement techniques allow only indirect diagnosis of DGR, which is often unphysiological and not objective. These methods do not allow also quantitative evaluation. Unsatisfying results obtained with the use of these methods and further search for the effective system of 24-hour monitoring of bilirubin concentration, which is indirect marker of alkaline reflux Bilitec 2000 is the most physiologic technique of ambulatory recording of the retrograde duodenogastric reflux. It makes possible objective diagnosing of alkaline gastritis as a result of excessive exposure of gastric mucose to destructive effect of bile and pancreatic juice.

Bile Reflux↗

PubMed2001

[Restenosis after coronary balloon angioplasty. Prevention and treatment].

The paper describes the mechanisms as well as clinical and angiographic risk factors for the development of restenosis after balloon coronary angioplasty. Based on literature findings and personal experience the ways of preventing restenosis were reviewed taking into account the optimisation of immediate angioplasty results based upon intracoronary ultrasound and physiological measurements of the coronary flow reserve. The paper also reviews the available techniques in the management of restenosis after balloon coronary angioplasty.

Cardiac Surgical Procedures↗

PubMed2001

[Intracoronary ultrasound assessment of balloon angioplasty with "stent-like' angiographic result].

The aim of the study was to evaluate by intracoronary ultrasound (ICUS) the efficacy of optimal coronary balloon angioplasty (POBA) guided by quantitative coronary angiography (QCA). The study population included 40 patients who underwent conventional coronary balloon angioplasty, in whom a stent-like result was achieved (percent diameter stenosis (%DS) < 35% in QCA). In all patients diagnostic ICUS assessment was performed after the procedure. The site of stenosis and the proximal and distal reference segments were analysed with respect to residual plaque burden (RPB), true vessel dimension (the media-to-media diameter) and type of vascular remodelling. Despite an optimal angiographic result residual plaque burden was 70 +/- 6% at the site of stenosis, whereas in the reference segments it was around 45% indicating the severity of atherosclerosis in angiographically normal vascular segments. No significant differences were seen between averaged reference vessel diameter in QCA (Ref.D) and averaged luminal reference diameter in ICUS. In contrast, true vessel diameter in ICUS was significantly larger than Ref.D in QCA (p < 0.001). Positive vascular remodelling at the site of stenosis was observed in most patients. Optimal angiographic result of QCA-guided POBA does not indicate optimal dilatation of the lesion. In most patients ICUS reveals marked residual plaque burden, which is an independent predictor of restenosis after percutaneous coronary interventions.

Adult↗

PubMed2000

Balloon positioning difficulties during nonsurgical septal reduction therapy in a patient with hypertrophic obstructive cardiomyopathy.

Dual chamber (DDD) pacing and catheter-based nonsurgical septal reduction therapy (NSRT) with ethanol are evaluated for treatment of patients with hypertrophic cardiomyopathy. This report describes a patient with hypertrophic cardiomyopathy and left ventricular outflow tract obstruction who had failed to respond to DDD pacing but showed benefit from subsequent NSRT. Procedural difficulties during NSRT due to massive septal hypertrophy are presented.

Adult↗

PubMed2000

The importance of ventricular septal morphology in the effectiveness of dual chamber pacing in hypertrophic obstructive cardiomyopathy.

It has been reported that older patients with hypertrophic obstructive cardiomyopathy (HOCM) benefited the most from dual chamber (DDD) pacing. Since in older patients the distribution of septal hypertrophy and left ventricular (LV) cavity shape differs from that in younger patients, we decided to study the efficacy of DDD pacing on the reduction of LV outflow tract (LVOT) gradient in different patterns of septal hypertrophy. We compared HOCM patients with nonreversed septal curvature, thus preserving the elliptical LV cavity contour (common in the elderly), (group I) versus patients with reversed septal curvature, deforming the LV cavity to a crescent shape (common in the young), (group II). Eighteen HOCM patients were studied (11 patients in group I and 7 patients in group II). After implantation of a DDD pacemaker, the LVOT gradient was measured using Doppler echocardiography at various programmed AV delay intervals to determine the maximal percentage decrease of LVOT gradient from baseline. The measurement was repeated after at least a 6-month follow-up (chronic DDD pacing). The baseline LVOT gradient was comparable between groups (79 +/- 28 vs 81 +/- 25 mmHg, P = 0.92). The LVOT gradient reduction at acute DDD pacing was significantly greater in group I than group II (61 +/- 18% vs 23 +/- 10%, P = 0.0001). This difference in favor of the patients from group I was maintained at midterm follow-up (69 +/- 17% vs 40 +/- 17% P = 0.0076). In conclusion, patients with normal septal curvature and preserved elliptical LV cavity shape had a greater reduction of LVOT gradient after DDD pacing than patients with reversed septal curvature deforming LV cavity. The proposed criterion assessing the septal curvature may be useful to predict the efficacy of DDD pacing in the reduction of LVOT gradient.

Adult↗

PubMed2000

[Propolis: its properties and administration to patients treated for some surgical diseases].

The authors tested a bee-hive product propolis as a drug to treat patients operated for goitre, patients with wounds and ulcerations difficult to heal and patients with non-specific rectal inflammation. They also tested the effectiveness of propolis as supplementary means in eradicating treatment of Helicobacter pylori. It was found that the drug was tolerated very well, practically had no side-effects and was highly effective. Preparations of propolis can be successfully used in surgery.

Anti-Infective Agents↗

PubMed1999

[Intraoperative manometry in laparoscopic antireflux procedures --indications, methods and clinical results].

UNLABELLED: The aim of the study is evaluating the efficiency of intraoperative manometry during laparoscopic Nissen fundoplication and its ability to prevent postoperative complications. METHOD: Sixteen patients with Gastroesophageal Reflux Disease were included in the study. Clinical examinations, x-ray, endoscopy, pH-metry, and manometric studies were performed before, and 3-6 m.o. after surgery. Fourteen patients were undergoing Nissen fundoplication, and two "floppy Nissen" fundoplications due to the specific preoperative manometric indications. RESULTS: Postoperatively the mean proportion of time at pH < 4.0 on pH-metry decreased from 188 min. (range 96-263) to 8.5 min. (range 2-25). Mean number of reflux episodes significantly lowered after fundoplication from 18.9 (range 2-36) to 0.5 (range 0-3). Gastroesophageal junction mean pressure measured postoperatively reached 24.7 mmHg, and was significantly higher than preoperatively (8.9 mmHg). Mean length of LES increased from 1.2 cm (range 0.8-2.5) to 3.6 cm (range 2.4-4.6) postoperatively. CONCLUSIONS: Laparoscopic Nissen fundoplication assisted by the simultaneous continuous intraoperative manometry is feasible and effective procedure. Continuous LES pressure monitoring during laparoscopic fundoplication with simultaneous computer-video assisted display can be advised as an objective method of intraoperative evaluation of antireflux mechanism.

Adult↗

PubMed1998

[Hormonal islet cell tumors. Proposition of a diagnostic-therapeutic model].

Islet cell tumors make a serious therapeutic problem due to their specific clinical presentation and the necessity of applying a variety of multidisciplinary diagnostic and therapeutic methods. The authors present their own algorithm for diagnosing and treatment of islet-cell tumors worked out basing on many-year experience.

Adenoma, Islet Cell↗

PubMed1997

Multicenter evaluation of dual-therapy (omeprazol and amoxycillin) for Helicobacter pylori-associated duodenal and gastric ulcer (two years of the observation).

Treatment with the proton pump inhibitor (omeprazole) and single antibiotic (amoxycillin), two synergistic compounds, can cure Helicobacter pylori (H. pylori) infection, but this therapy is not as effective as had been expected. However, some studies show promising results. The aim of our study was to evaluate the effect of two weeks dual-therapy with omeprazole (O) and amoxycillin (A) on gastric (GU) and duodenal ulcer (DU) patients: ulcer healing, eradication of the H. pylori and recurrence rate of the ulcer. We studied 216 patients (aged 18-70) endoscopically proven GU (58 patients) and DU (158 patients). Rapid urease test from the two antrum biopses and two antral and two corporeal biopses using Giemsa stain method for confirmation of the H. pylori infection were used. The patients were treated with omeprazole 20 mg BID and amoxycillin 1.0 g BID for 2 weeks and investigated every 4 months during 2 years. Clearance effect of Hp infection was achieved in 65.1% GU and 66.4% DU patients. Eradication ("check point" after 4 months) in 43% DU and 56.6% GU patients was confirmed. Reinfection rate was found in 16% during 2 years. We conclude--dual-therapy (O and A) is not sufficiently effective to be recommended as an anti-H. pylori treatment. H. pylori eradication prevents recurrence of peptic ulcer and is an important issue in attempts to achieve permanent ulcer healing.

Adolescent↗

PubMed1996

[Diabetic foot syndrome in clinical practice. I. A model of a Diabetic Foot Consulting Unit].

Complex pathogenesis of the foot syndrome involving a number of body system and tissues provided us with grounds for making multispecialistic assessment of its severity. Also a decision about the type and intensity of procedure should be multispecialistic. An interdisciplinary team consists of a diabetologist, diabetic educator, podiatrist, kinesitherapist, orthopedist, general and vascular surgeon and a consultant from manufacturing corrective shoes. The make-up of the team implies that the procedure includes education, metabolic normalization of diabetes mellitus, orthopedic correction, possible surgical intervention and rehabilitation. Results discussed in part II of the study indicate the effectiveness of such approach.

Diabetes Mellitus↗

PubMed1996

[Diabetic foot syndrome in clinical practice. II. Results after one year at the Diabetic Foot Consulting Unit].

The study included 46 patients with the diabetic foot syndrome and ulcerations, and 40 patients with high-risk foot. Mean duration of hospitalization of the patients with ulcerations was 54 days, mean daily glycemia decreased from 162.5 mg% to 114.9 mg%. Ulcerations were completely healed in 93.5% of patients, whereas high and partial foot amputation was high and 3.2% of patients, respectively. The annual amputation rate was 2.3% in the entire group of diabetic foot patients (86). The present results indicate the necessity for adoption of a multidisciplinary approach to the problem of diabetic foot. It may be added that cooperation in glycemia normalization and patients education may decrease the number of amputations, and hence the degree of physical disability in diabetic foot patients.

Adult↗

PubMed1996

Determinants of depressed left ventricular ejection fraction in pure mitral stenosis with preserved sinus rhythm.

BACKGROUND AND AIM OF THE STUDY: Although depressed left ventricular ejection fraction is present in a considerable proportion of subjects with pure mitral stenosis (MS), its mechanisms are not clearly identified. The purpose of this study was to identify determinants of depressed ejection fraction in young patients with isolated mitral stenosis in sinus rhythm. METHODS: We retrospectively analyzed 320 records of patients with MS (mitral valve area < or = 2.0 cm2) who underwent invasive diagnostic procedure in our center. Of these 39 subjects aged 20-40 years with isolated MS in sinus rhythm were selected for the final analysis. RESULTS: An ejection fraction not exceeding 50% was found in 12 patients (group A). When comparing group A to the remainder (group B), group A patients had lower left ventricular end-diastolic volume indices (60.5 +/- 21.6 ml/m2 vs. 76.1 +/- 16.1 ml/m2, p = 0.02) and stroke volume indices (28.0 +/- 10.4 vs. 47.9 +/- 12.0, p < 0.001). No significant differences between the groups in patients' age, end-systolic volume index, mitral valve area, mean transmitral gradient, left-sided cardiac pressures, pulmonary wedge pressure, systemic vascular resistance, and cardiac output were found. Indices of left ventricular isovolumic contraction and relaxation as well as end-systolic indices of left ventricular function were also comparable. Group A had significantly higher pulmonary vascular resistance, pulmonary artery pressures, and higher heart rate. An approximate index of left ventricular compliance was significantly lower in group A with similar left ventricular minimal and end-diastolic pressures. CONCLUSIONS: Depressed ejection fraction in pure mitral stenosis with preserved sinus rhythm seems attributable to left ventricular underfilling that appears to be precipitated by other factors in addition to a narrowed mitral orifice, e.g. decreased passive left ventricular compliance and/or altered interventricular interactions.

Adult↗

PubMed1993

Long-term results of highly selective vagotomy in the treatment of duodenal ulcer patients using the intra-operative endoscopic congo red test to identify the parietal cell antrum-corpus borderline.

A total of 151 patients with uncomplicated duodenal ulcers were treated with highly selective vagotomy. The patients were subsequently observed prospectively for a period of 3-17 years. The recurrence rate for the whole group reached 4.6%. The parietal cell antrum-corpus borderline for denervation was marked using the intra-operative endoscopic Congo Red Test. The test was useful for the classification of patients into the group (own method) and for the identification of patients with "acid antrum". Between 1974-1980, Highly selective vagotomy was performed in 93 patients in some of whom single clusters of parietal cells were diagnosed in the prepyloric region (acid antrum, type A). The recurrence rate in this group reached 7.5%. In a group of 58 patients operated on after 1980 from which "acid antrum" cases were eliminated, no recurrences have so far been observed. Additionally, the results of early and late complications and the results of patient self-estimation using to Visick's scale are discussed.

Adolescent↗

PubMed1992

The magnitude of left ventricular myocardial hypertrophy related to the degree of its dysfunction in patients with dilated cardiomyopathy (DCM).

The aim of the study was to analyze the relationship between the magnitude of left ventricular (LV) hypertrophy and selected haemodynamic parameters reflecting LV systolic and diastolic function. The "hypertrophy-function" relationship was evaluated in 22 patients with dilated cardiomyopathy (DCM) and in patients with left ventricular dilatation resulting from volume overload due to valve disease (DVOL). The parametres of systolic and diastolic left ventricular function were obtained from right- and left-heart catheterization and quantitative angiocardiography, DCM patients were divided into subgroups depending on the magnitude of hypertrophy and degree of dilatation: Ia- moderate hypertrophy (100 g/m2 < LVMI < 175 g/m2). Ib- massive hypertrophy (LVMI > 175 g/m2); IIa- mass/volume ratio (M/V) < 1.1, and IIb - M/V > 1.1. It was found that the magnitude of myocardial hypertrophy and the M/V ratio do not affect the degree of systolic and diastolic dysfunction in patients with DCM. Myocardial hypertrophy accompanying dilatation due to DCM and DVOL showed very similar progression of impairment of isovolumetric systole and relaxation. Significant differences in EF, LVMDP and LVEDP may result from a different degree of total LV volume stiffness as a consequence of various mechanisms of hypertrophy in DCM and DVOL.

Adolescent↗