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Aim of the study: To analyze the influence of sociodemografic and some risk factors as well as patients knowledge, social relations and religions practices on survival time of patients in terminal phase of neoplastic diseases, as well as the influence of sex and place of residence on frequency of use of palliative care. Material and methods: Questionnaire examination of 1028 patients, inhabitants of Hrubieszów district (mean age 66.5 ±12.5; 418 female) under ambulatory palliative care in years 1993-2009 was performed. Results: Mean survival time was 81 days. Everyday visits friends, radiotherapy and lack in of neoplastic diseases histories in family (22 days, OR = 1.60, p = 0.0076, 95% CI: 1.13-2.25; 18 days, OR = 1.91, p = 0.002, 95% CI: 1.26-2.88 and 10 days OR = 1.56, p = 0.0105, 95% CI: 1.11-2.21 respectively) were the independent factors prolonging the survival time. The frequency of use of palliative care is greater for city than rural residents (35.1% vs. 64.9%; p = 0.0003 respectively). Conclusions: Independent factors prolonging the survival time are everyday visits friends, radiotherapy and lack of neoplastic diseases histories in family. The frequency of use of the palliative care is greater for city inhabitants. [ABSTRACT FROM AUTHOR]

Aim of the Study: Assessment of safety and diagnostic value of stress echocardiography protocol based on rapid pacing in patients with implanted permanent pacemakers operating in AAI/DDD and VVI modes., Material and Methods: 88 rapid pacing stress echo tests were performed in 60 patients (39M, 21F, aged 47-79, mean 64 +/- 9 years), utilizing permanent pacemakers. Left ventricular segmental contractility was assessed at rest and during 100/min and 85% of predicted maximal heart rate. Each pacing stage lasted for 3minutes. The test was performed with the use of AAI/DDD or VVI pacing mode and then repeated with WV mode in pts with DDD pacemaker. Coronary stenosis of at least 50% was considered significant. Mean duration of the test was 9.9 +/- 1.7 min, including 6.7 +/- 1.4 min of pacing., Results: No severe adverse effects were observed. Among 88 tests performed, AAI/DDD modes were used in 41 and VVI mode in 47 were as significant increase of the heart rate comparing to baseline was achieved - 68 vs 129/min; p<0.0001, including patients treated with beta-blockers - 69 vs 128/min; p < 0.0001. No significant differences in systolic blood pressure were found between rest and stress (126 vs 126 mm Hg). In 58 patients (66%) the test was considered positive for ischemia, in 29 (33%), negative and in 1 (1%) nondiagnostic. Sensitivity, specificity, accuracy, positive and negative predictive values were respectively: 92%, 66%, 79%, 78% i 86%. For AAI/ DDD modes the above values calculated for the entire group were: 95%, 75%, 85%, 79%, 94%, while for VVI mode they were: 90%, 56%, 73%, 76%, 77% (NS). In the presence of left ventricular hypertrophy the accuracy was 79% for AAI/DDD and 71% for VVI mode, and in patients without hypertrophy 92% and 74% respectively., Conclusions: A stress echo protocol using permanent pacemaker for rapid pacing is a brief and safe diagnostic technique. Accuracy of the test is similar regardless of the pacing mode used. The test can be utilized as a technique of choice for noninvasive diagnostics of coronary disease in patients with permanent pacemakers.

A case of a 50-year-old female with hypertension and diabetes, admitted to the hospital due to echocardiographically detected left atrial tumour, is presented. Differential diagnosis included thrombus, myxoma and infectious tumour. The patient underwent surgery. Histopathological examination revealed the presence of an abscess in the left atrium. This report underlines the difficulties in the diagnosis of cardiac tumours.

Contrast induced nephrotoxity [CIN] is a common form of hospital-acquire renal failure. Prevention can decrease the need for dialysis, morbility, and reduce health care costs. All patiens receiving iodine-contrast medium should be assessed for risk of developing CIN. Prophylaxis can reduce CIN. Patients at risk requiring injection of contrast medium [CM] with important clinical indications should receive a small dose of non-ionic iso-osmolar dimeric or non-ionic low osmolar monomeric CM and hydratation with normal saline before and after exposure. This brings the best protection with the fewest adverse effects.

Unstable angina in chronically haemodialysed patients has poor clinical outcome. Surgical treatment of these patients is a procedure of high risk. According to guidelines left main coronary artery stenosis is the indication for by-pass grafting. In some cases the alternative to surgical treatment could become percutaneous coronary intervention. We present the case of the patient in which we have perform multivessel percutaneous coronary angioplasties including left main coronary artery.

Unlabelled: The relation of stress dobutamine echocardiography test results to angiographic features was assessed in 551 patients with chest pain regarded as definite or probable stable angina pectoris. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > 50 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery) and stress dobutamine echocardiography (DSE): Ischemia was defined as new or worsening wall motion abnormalities using a 16-segment model. Sensitivity and specificity of DSE was calculated: 85% and 69% respectively for the entire group, 79% and 71% in women, 87% and 66% in men and compared with diagnostic value of the electrocardiographic exercise test (EE) in the same population. Sensitivity and specificity of the EE was respectively: 93% and 21% for the entire group, 91% and 16% in women, 94% and 27% in men., Conclusions: 1. DSE has comparable sensitivity but significantly higher specificity than EE. 2. Variables determining false positive result of DSE are as follows: mean maximal heart rate, reached % of the target heart rate and wall motion abnormalities present in single segment. 3. Variables determining false negative results are: sex (male) and one vessel disease. 4. Treatment with beta-adrenolytic agents increases incidence of nondiagnostic results of DSE.