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Background: Abdominal obesity, together with atherogenic dyslipidemia, increased blood pressure and impaired glucose tolerance, was included in the components of metabolic syndrome identifying patients at high risk of cardiovascular diseases. Subcutaneous adipose tissue is a buffer for dietary fatty acids (FAs). It was reported that the fatty acid composition of adipose tissue reflects the dietary intake of FAs in the previous 6 to 9 months. Therefore, we decided to evaluate the early and long-term metabolic effects of lipocavitation and/or thermolipolysis on abdominal fat reduction. Material and Methods: The study population comprised 60 women. Subjects were randomly allocated into one of three subgroups, 20 women per subgroup, and each subgroup received 10 treatments with ultrasound (U group), radiofrequency (RF group), or combined radiofrequency and ultrasound (RF/U group) for the abdominal region. Treatments were provided three times a week using the multifunctional device (Professional Beauty Equipment, HEBE, Warsaw, Poland). Each treatment to reduce adipose tissue, regardless of the method used, involved 20 min of massage with the dedicated applicator head on a rectangular 20 cm × 10 cm area of the abdominal region. Fatty acid composition and biochemical and anthropometric parameters were measured before the first, after 10 treatments and 6 months after the last treatment. Results and discussion: The series of 10 treatments to reduce abdominal adipose tissue using ultrasound, radiofrequency or both methods resulted in a cosmetic effect which was reflected in weight loss and BMI reduction. Reduced waist circumference was also found in patients who received radiofrequency or two types of intervention (RF + U) but not ultrasound treatments. The long-term cosmetic effect (lasting for at least 6 months) was achieved only with RF treatment and was reflected in reduced body weight, BMI and waist circumference. None of the treatments had a direct, short or long-term effect on the lipid profile, insulin resistance markers, inflammation markers, or blood pressure. Consequently, did not modify the risk of cardiovascular diseases.

Evaluation of the prevalence of POT1, ACD, and TERF2IP mutations among Polish melanoma patients. A cohort of 60 patients from melanoma-prone families, 1500 unselected cases and 1500 controls were genotyped. Methodology included Sanger sequencing, in-silico software predilection, and TaqMan assays. We identified three nonsynonymous variants: POT1 c.903 G>T; TERF2IP c.970 A>G; and ACD c.1544 T>C and a splice site variant ACD c.645 G>A. The c.903 G>T was predicted to be pathogenic according to PolyPhen-2, benign according to Mutation Taster, PROVEAN, AGVGD, and SIFT. The c.645 G>A was defined as disease caused by Mutation Taster and Human Splicing Finder and as variant of unknown significance by ClinVar. The other detected variants were described as benign. The c.903 G>T variant was present in two unselected cases and one control [P = 0.57, odds ratio (OR) = 2.00]; the c.645 G>A variant was not detected among the unselected cases and the controls; the c.970 A>G variant was present in 110 cases and 133 controls (P = 0.14, OR = 0.81); the c.1544 T>C variant was present in 687 cases and 642 controls (P = 0.11, OR = 1.07). We found no loss of heterozygosity of the c.903 G>T, c.970 A>G, and c.645 G>A variants. C.645 G>A variant had no effect on splicing or expression. The changes in POT1 c.903 G>T and ACD c.645 G>A can be classified as rare variants of unknown significance, the other variants appear to be polymorphisms. Germline mutations in POT1, ACD, and TERF2IP are infrequent among Polish melanoma patients.

Antiplatelet response to clopidogrel and its influence upon the risk of cardiovascular adverse events among patients with stable coronary artery disease undergoing percutaneous coronary intervention (PCI) has not been investigated fully. Two hundred eleven patients treated with aspirin and clopidogrel were included in the study. Immediately before PCI, residual platelet reactivity testing with impedance aggregometry assay and a single-nucleotide polymorphism genotyping analysis targeting variants of CYP2C19, ABCB1, and PON1 genes was performed. After the index PCI, the patients were screened for cardiovascular events 6 months following bare-metal stent implantation or 12 months following drug-eluting stent implantation. High on-treatment platelet reactivity (HTPR) was observed in 19.43% individuals and low-TPR (LTPR) in 26.54%. In multivariate analysis, HTPR was significantly (p

Background : Left atrial (LA) arrhythmogenic substrate beyond the pulmonary veins (PV) seems to play a crucial role in the maintenance of atrial fibrillation (AF). The aim of this study was to evaluate the association of selected parameters with the presence and extent of voltage-defined LA fibrosis in patients with long-standing persistent AF (LSPAF) undergoing catheter ablation. Methods: One hundred and sixteen consecutive patients underwent high density-high resolution voltage mapping of the LA with a multielectrode catheter following PV isolation and restoration of sinus rhythm with cardioversion. A non-invasive dataset, such as clinical variables, two-and three-dimensional echocardiography determined LA size and function and fibrillatory-wave amplitude on a standard surface electrocardiogram were obtained during AF before ablation. Results: Low-voltage areas (LVA; 15 cm 2 [IQR 8–31]) were detected in 56% of patients. Twenty nine percent of them presented mild, 43% moderate and 28% severe global LVA burden. In univariate analysis, age ≥ 57 years old, female sex, body surface area ≤ 1.76 m 2 , valvular heart disease, moderate mitral regurgitation, chronic coronary syndrome, hypothyroidism, CHA 2 DS 2 -VASc score ≥ 3 and ≥ 4 predicted the presence of LVA. In multivariate analysis only female sex, valvular heart disease and CHA 2 DS 2 -VASc ≥ 4 remained statistically significant. AF duration, LA size and function and fibrillatory-waves amplitude were neither associated with the prediction of the LVA, nor severe LVA burden. Conclusions: A LSPAF diagnosis does not indicate the presence of voltage defined fibrosis in many cases. Simple non-invasive screening of the LSPAF population could predict LVA prevalence.

Introduction: The VisiTag module (CARTO3) provides an objective assessment of radiofrequency (RF) ablation parameters. This study aimed to determine the predictive value and optimal VisiTag threshold settings for prediction of gaps in mature atrial scar, as assessed non-invasively using cardiac magnetic resonance (CMR) imaging. Methods: Twenty-four subjects (11 paroxysmal atrial fibrillation) underwent first-time RF ablation with operators blinded to VisiTag data. Three-dimensional late gadolinium enhancement (LGE) CMR scans were performed at 3 months (1.3 × 1.3 × 4 mm3). A survey of UK operators defined the standard VisiTag settings (“Force,” 8 g; “Time,” 10 seconds; “Percentage Time,” 50%; “Range,” 3 mm; “Impedance” and “Temperature” “off”). Each ablation procedure was exported 27 times, varying single VisiTag parameters from default values. The presence of gaps in VisiTag markers (18 sectors) was assessed for each export and compared with gaps in CMR enhancement. Results: At default settings, VisiTag gaps were specific (97.5%) but less sensitive (50.4%) for CMR gaps. Sensitivity improved at higher thresholds (89.2% at 20 g, 85.6% at 30 seconds, 88.5% impedance 10 Ω, 92.8% temperature 42°C), but with a lower positive predictive value (PPV) (42.3%, 42.7%, 41.1%, and 37.7%, respectively, vs 90.9% at baseline). “Force” thresholds demonstrated stable PPV from 2 to 8 g (P = 0.24), but a rapid fall at forces more than 10 g. The binomial logistic regression model explained 41.7% of gaps; χ 2(4), 148; P < 0.0001, correctly classifying 82% of cases (specificity 94.9%, sensitivity 56.8%). Conclusion: Gaps in VisiTags predict gaps in CMR LGE enhancement with high specificity at default settings. Sensitivity may be improved using more stringent thresholds but at the potential cost of unnecessary ablation, particularly when a force more than 10 g is stipulated.

Adrenal tumors, discovered incidentally in approximately 4.5% of imaging procedures, are known as adrenal incidentalomas. Nonclassic congenital adrenal hyperplasia, mild form of 21-hydroxylase deficiency, may lead to the development of adrenocortical tumors. The aim of the study was to evaluate prevalence of the most common nonclassic mutations of CYP21A2 gene in patients with adrenal incidentalomas and investigate possible relationship with clinical outcome. One hundred adult patients with such lesions were enrolled. Clinical, imaging and biochemical evaluation were performed to rule out hormonal overproduction or potential malignancy. All subjects and a control group of 100 neonates were genotyped for P30L, P453S, and V281L mutations of CYP21A2 gene using direct sequencing. Clinical and imaging features as well as hormone levels were analyzed. Heterozygous CYP21A2 gene mutations were detected in 8 subjects but not in the neonates. Thus, the risk of carrying mutant allele was significantly higher in subjects with adrenal tumors (OR=8.7; 95% CI=2.23–389.56; p=0.003). Mean concentrations of renin, basal, and stimulated 17-hydroxyprogesterone were higher and ACTH was lower in the carriers than in the remaining subjects. Furthermore, the carriers had higher incidence of hypertension (100 vs. 52.1%, p=0.008) and diabetes (50 vs. 11.9%, p=0.003). ACTH-stimulated 17-hydroxyprogesterone levels varied widely among the carriers. In summary, prevalence of P30L, P453S, and V281L mutations of CYP21A2 gene is increased in patients with adrenocortical tumors. In these subjects, carrying the analyzed mutant alleles may increase the risk of diabetes and hypertension. ACTH-stimulation test does not satisfactorily predict presence of heterozygous CYP21A2 mutations in patients with adrenal tumors.

The aim of this study was to compare the periodontal status in patients with type 2 diabetes based on glycated haemoglobin levels and other risk factors.75 patients with DM2 were grouped according to glycemic control: 40 subjects with HbA1c7.0% and 35 subjects with HbA1c≥7.0%. We performed measurements of HbA1c, C-reactive protein (CRP), Approximal Plaque Index (API), Gingival Severity Index (GSI), tooth mobility (TM) as well as periodontal parameters such as probing depth (PD) and clinical attachment level (CAL). Age, gender and duration of the disease were analyzed too.No significant differences in PD, CAL, API, GSI and TM were found between the analyzed groups. HbA1c positively correlated with CRP (p=0.046) and the duration of DM2 (p=0.012) but not with the periodontal parameters. Patients' age was positively correlated with both the duration of DM2 (p=0.002) and CAL (p=0.034). Regardless of HbA1c, men had significantly worse periodontal parameters compared to women (respectively: PD 2.73mm vs. 2.18mm, p=0.01; CAL 3.84mm vs. 2.54mm, p=0.005; proportion of deep pockets 9.06% vs. 2.97%, p=0.01; proportion of teeth with grade 2 mobility 9.14% vs. 2.8%, p=0.02).The selected group of patients attending the Diabetes Outpatient Clinic showed a similar periodontal status with regard to glycated haemoglobin levels and other risk factors except gender. Male gender turned out to be a significant risk factor for periodontal disease in patients with type 2 diabetes mellitus.

The association of BRCA1/2 mutations with melanoma is not completely determined; the interpretation of variants of unknown significance is also problematic. To evaluate these issues we explored the molecular basis of melanoma risk by performing whole-exome sequencing on a cohort of 96 unrelated Polish early-onset melanoma patients and targeted sequencing of BRCA1/2 genes on additional 30 melanoma patients with familial aggregation of breast and other cancers. Sequencing was performed on peripheral blood. We evaluated MutationTaster, Polyphen2, SIFT, PROVEAN algorithms, analyzed segregation with cancer disease (in both families with identified BRCA2 variants) and in one family performed LOH (based on 2 primary tumors). We found neither pathogenic mutations nor variants of unknown significance within BRCA1. We identified two BRCA2 variants of unknown significance: c.9334G>A and c.4534 C>T. Disease allele frequency was evaluated by genotyping of 1230 consecutive melanoma cases, 5000 breast cancer patients, 3500 prostate cancers and 9900 controls. Both variants were found to be absent among unselected cancer patients and healthy controls. The MutationTaster, Polyphen2 and SIFT algorithms indicate that c.9334G>A is a damaging variant. Due to lack of tumour tissue LOH analysis could not be performed for this variant. The variant segregated with the disease. The c.4534 C>T variant did not segregate with disease, there was no LOH of the variant. The c.9334G>A variant, classified as a rare variant of unknown significance, on current evidence may predisposes to cancers of the breast, prostate and melanoma. Functional studies to describe how the DNA change affects the protein function and a large multi-center study to evaluate its penetrance are required.

Wstep: Stymulacja resynchronizująca (CRT) korzystnie wplywa na funkcje lewej komory, zmniejsza objawy kliniczne niewydolności serca (HF), poprawia wydolnośc fizyczną, a takze zmniejsza śmiertelnośc. Redukcja przeplywu wiencowego i jego rezerwy (CFR), ktora wystepuje u pacjentow z HF w przebiegu kardiomiopatii rozstrzeniowej, wiąze sie z gorszym rokowaniem. U osob z kardiomiopatią rozstrzeniową niewiencową (DCM) czesto stwierdza sie obecnośc bloku lewej odnogi peczka Hisa (LBBB). Juz sam LBBB niekorzystnie wplywa na funkcje lewej komory, perfuzje wiencową, szczegolnie w zakresie przegrody miedzykomorowej. Cel: Celem badania byla ocena wplywu stymulacji resynchronizującej na wiencowy przeplyw krwi i rezerwe przeplywu oraz ich znaczenie dla poprawy wydolności serca u pacjentow z DCM. Metody: Zbadano 21 pacjentow (5 kobiet, średni wiek 57,8 ± 8,1 roku) z HF (średnia frakcja wyrzutowa = 26 ± 7%) na tle DCM z LBBB zakwalifikowanych do CRT. Wszyscy mieli angiograficznie prawidlowe naczynia wiencowe. Pomiary przeplywu krwi i CFR wykonano techniką wewnątrzwiencowego doplera w 3 tetnicach wiencowych wyjściowo i średnio 6,7 miesiąca po zastosowaniu CRT. Wyniki: U pacjentow, u ktorych zaobserwowano poprawe kliniczną po zastosowaniu resynchronizacji, CFR wzrosla istotnie w zakresie galezi przedniej zstepującej lewej tetnicy wiencowej (LAD). CFR dla galezi okalającej lewej tetnicy wiencowej (LCX) i prawej tetnicy wiencowej (RCA) nie poprawila sie ani w calej grupie, ani w grupie pacjentow z poprawą kliniczną. Poprawa w zakresie CRF dla LAD koreluje jedynie ze zwezeniem zespolu QRS. Ponadto wyjściowo nie stwierdzono zalezności miedzy parametrami przeplywu krwi i CFR w duzych tetnicach nasierdziowych a stanem wydolności serca oraz parametrami dyssynchronii (szerokością zespolu QRS, parametrami echokardiograficznymi). Wnioski: W DCM rezerwa przeplywu wiencowego w LAD byla znamiennie mniejsza niz w LCX i RCA. Istotna poprawa CFRw LAD w wyniku zastosowania CRT koreluje jedynie ze zwezeniem zespolu QRS.

Background: Clinical studies in humans have shown the site of atrial stimulation to influence atrioventricular (AV) conduction times and refractory periods, the demonstration of dual AV nodal (AVN) pathways, and induction of AVN reentry. These studies often found conflicting results. Moreover, among enrolled patients a minority of them were found to have AVN reentrant tachycardia (AVNRT). Aim: The purpose of this study was to investigate the effect of right and left atrial pacing on the electrophysiological properties of the AV junction in the typical AVNRT population. Methods: Ninety-two consecutive patients with typical AVNRT were included. Atrial pacing was performed from the high right atrium (HRA) and the left atrium via the proximal coronary sinus (CS). Results: Stimulation from either the HRA or the CS could result in dual AVN physiology and AVNRT. No site-dependent differences in the ease of induction of dual AVN pathways with variability of initiation from either site were found. However, AVNRT was easier to induce from the HRA. With CS pacing the leftward but not the rightward AVN approaches were the entry point to the AV node because of significantly shorter AH conduction times compared to HRA pacing. Conduction over the leftward AVN extensions could initiate the tachycardia with significantly shorter critical AH interval compared to conduction over the rightward AVN extensions; however, the AH interval during AVNRT and its cycle length were not significantly different. Conclusions: Rightward and leftward AVN extensions are regular features of the AV node. Their different electrophysiological properties lead to variation in the demonstration of discontinuous AVN conduction and AVNRT during right and left atrial pacing. Despite the observation that the left AVN extensions could compose the entry point to the reentrant circuit, there is no evidence that they constitute the critical component of sustained typical AVNRT.

The wheat curl mite (WCM), Aceria tosichella Keifer, is a major pest of cereals worldwide. It is also a complex of well-defined genetic lineages with divergent physiological traits, which has not been accounted for in applied contexts. The aims of the study were to model the thermal niches of the two most pestiferous WCM lineages, designated MT-1 and MT-8, and to assess the extent to which temperature determines the distribution of these lineages. WCM population dynamics were modeled based on thermal niche data from March to November on the area of Poland (>311,000 km2). The most suitable regions for population development were predicted and compared to empirical field abundance data. Congruence between modeled parameters and field data for mite presence were observed for both WCM lineages although congruence between modeled thermal suitability and mite field abundance was observed only for MT-8. Thermal niche data for MT-1 and MT-8 provide biological insights and aid monitoring and management of WCM and the plant viruses it vectors. The presented models accurately estimate distributions of WCM and can be incorporated into management strategies for both current and predicted climate scenarios.

Five new eriophyoid mite species (Eriophyidae) from Turkey are described and illustrated in this paper: Aceria vanensis n. sp., Aceria onosmae n. sp., Aculus lydii n. sp., Aculus gebeliae n. sp. and Aculus spectabilis n. sp.. The descriptions are based on the morphology of females collected from weedy plants, respectively: Amaranthus retroflexus L. (Amaranthaceae), Onosma isauricum Boiss. et Heldr. (Boraginaceae), Hypericum lydium Boiss. (Hypericaceae), Lotus gebelia Vent. (Fabaceae) and Stachys spectabilis Choisy ex DC. (Lamiaceae). The new species were found to be vagrant on their host plants with no visible damage symptoms observed.

A 75-year-old woman without structural heart disease presented with incessant regular monomorphic atrial tachycardia (AT). Spontaneous arrhythmia termination was repeatedly followed by a single sinus beat before reinitiation. Variations in tachycardia cycle length (CL) between 200 and 400 ms were frequently observed. The P-wave morphology was consistent with a focal origin from the crista terminalis; however, electroanatomic mapping (CARTO 3 system, Biosense Webster Inc., Diamond Bar, CA) demonstrated centrifugal activation of the right atrium originating from the atrial septal wall near the fossa ovalis. Further mapping at the site of the earliest atrial activation during AT revealed a rapid, regularly discharging focus (Figure 1, blue dot) at fixed 100-ms CL represented by the low-amplitude (0.17 mV) spike electrograms (↓) with an isoelectric interval between successive spikes. The accompanying local atrial potential (▼) during firing was clearly sharper, higher (0.75 mV), and well separated from the preceding spike at fixed 30-ms conduction delay but of lower amplitude (0.95 mV) than that during sinus beats (*). The recorded abnormal activity could not be detected when the catheter tip was moved a few millimeters. The initiation and termination of firing at the site of interest were recorded during catheter manipulation. The onset of AT on the surface electrocardiogram did not always coincide with the initiation of local, high-frequency activity but did terminate immediately with cessation of local firing. The first tachycardia P wave and subsequent discernible P waves were identical. Alterations in the degree of atrial capture by the focal activity (from 2:1 to

Standard pre-operative diagnosis of nodular goitre is not always conclusive. The decision about nodular goitre surgery is increasingly based on molecular methods. The aim of the study was to determine BRAF T1799A mutation and KRas proto-oncogene mutation, and the analysis of RASSF1A promoter methylation level in cytological material obtained from FNAB specimens of thyroid nodules.The study population consisted of 85 women and 12 men. The study material was genomic DNA isolated from peripheral blood and thyroid bioptates. Pyrosequencing was used for the evaluation of RASSF1 methylation level. KRas mutation was investigated with Sanger sequencing. BRAF mutation was analysed by standard methods of real-time amplification detection (real-time PCR) with the use of specific starters surrounding the mutated site.A significant positive correlation was demonstrated between mean methylation of four CpG islands of RASSF1A gene and thyroid tumour volume and its largest diameter (p0.05). KRas mutation was not detected in any of the 97 patients. In 7/85 subjects (8.2%) BRAF mutation was observed. In 6/7 patients with BRAF mutation, FNAB of thyroid nodules confirmed a benign nature of the lesions; the material was non-diagnostic in one patient, and papillary thyroid cancer was diagnosed on the basis of postoperative histopathology assessment.The results of genetic tests reported in our study indicate that the presence of BRAF mutation or higher RASSF1A methylation levels in FNAB cytology specimens of benign lesions may be useful in the assessment of oncological risk, while the evaluation of KRas proto-oncogene mutation is not a valuable test in pre-operative diagnosis of nodular goitre.

The aim of this study was to analyze treatment and outcomes in children with glaucoma secondary to diode laser photocoagulation in retinopathy of prematurity.The group of 1507 newborns, examined as outpatients between 2008 and 2013, were retrospectively analyzed. Five patients (0.3%) (nine eyes) with glaucoma following laser treatment for retinopathy of prematurity were identified. Demographic and clinical data was obtained from medical records and compared with corresponding results in the group of glaucoma-free children subjected to diode laser photocoagulation for retinopathy of prematurity. The statistical analysis included Shapiro-Wilk test and U-Mann-Whitney test with statistical significance level p0.05.The following data was collected - mean post-menstrual age at the moment of photocoagulationwas 42 Hbd (38-42) and it was 49.9 (43-54) weeks at the moment of diagnosis of angle-closure glaucoma. The intraocular pressure was significantly elevated in nine in ten eyes which was confirmed objectively and the mean intraocular pressure was 32.0 mmHg (21.6-42.4). The mean corneal diameter was 11.25 mm (10-13) and it was associated with the decreased corneal thickness in pachymetry (p0.05). Six eyes (66.6%) required surgical intervention and intraocular pressure normalization was achieved in all patients. Additionally, the affected eyes tended to be myopic (mean spherical equivalent -1.625 diopter) and have a greater axial length (p0.05).Secondary glaucoma can develop following laser treatment for severe retinopathy of prematurity. Topical treatment and surgical intervention provide effective management.

Psoriasis is a chronic inflammatory dermatosis leading to the development of systemic inflammatory reaction. Previous data indicated the coexistence of psoriasis and the occurrence of metabolic disorders, with the common background of both processes determined by a chronic inflammation. The coexisting disorders, including type 2 diabetes, hypertension, heart ischemic disease, dislipidemia and obesity may have an important impact on intensity of psoriasis activity.The analysis comprised of 82 randomly matched patients with various clinical forms of psoriasis, aged 17 to 81 years. In patients PASI and BSA indexes, BMI value and laboratory parameters of metabolic status (glucose and ureic acid levels, lipid fractions and CRP level in the serum) were evaluated.An average age in examined group was 54,3 years, an average time of presence of psoriasis symptoms was approximately 20 years. An average PASI value was 21,4; an average BSA value was 39.7%. The coexistence of type 2 diabetes was found in 14.6% of patients, hypertension in 42.7% and heart ischemic disease in 17%. Particularly large group of examined patients comprised persons with overweight (34.1%) and obesity (30.5%). Positive correlation between BSA and body weight, BSA and BMI value, BSA and abdominal circumference as well as positive correlation between PASI and body weight, PASI and BMI value, PASI and abdominal circumference were observed. Abnormal serum glucose levels were observed in 19.5% persons, ureic acid level in 2.9%, total cholesterol in 37.8% LDL cholesterol in 48.8%, and HDL cholesterol in 46.3%. CRP level was elevated in 43.9% patients. Positive correlation between BSA and ureic acid level, as well as PASI and ureic acid level was estimated. No correlation between PASI and the other laboratory parameters was found.The occurrence of metabolic syndrome is more common in patients with psoriasis in comparison to the general population. The extent and severity of psoriatic lesions correlate with high body weight, BMI and the level of ureic acid.

The case of a 62-year-old female patient diagnosed with an extremely rare clinical variant of pemphigoid--nodular pemphigoid, imitating prurigo nodularis, is presented in the paper. In connection with the existence of the typical prurigo nodularis-like appearance in the patient, the diagnosis was maintained for several months. However, because of no response to the treatment and the remarkably chronic course of the disease, the patient was admitted to the Department in order to extend the diagnostics and verify the previous diagnosis. The direct and indirect immunofluorescence examinations performed on the patient enabled the final diagnosis of a rare variant of pemphigoid without typical blisters, and effective treatment was carried out.

A 69-year-old woman (case 1) and a 36-year-old man (case 2) without comorbidities, normal pulmonary veins (PV) anatomy and atrial, mitral, PV dimensions were referred for cryoballoon ablation of paroxysmal atrial fibrillation (AF). Although atrial tachycardia (AT) and a frequent atrial ectopy (AE) had never been documented, ongoing AT or AE mimicking sinus rhythm (SR) were noticed at admission. An electrophysiological study, in a drug free state, with catheters placed into the coronary sinus, in the right atrium (RA) and His bundle was performed. The positive P wave in lead V1, superimposed on the negative T wave and the negative P wave in lead aVL in case 1 (Figs. 1A, B), and similarities in the P wave morphology during AE and SR and negative P waves in lead aVL in case 2 (Figs. 2A–C), suggested PV AT/AE. Activation mapping with a circular catheter within each PV was performed. Right inferior PV (RIPV) depolarisation preceded the onset of the ectopic P wave by 60 ms (Fig. 1A) and 50 ms (Fig. 2B), respectively. During cryoapplication with a 28 mm cryoballoon catheter (Fig. 3), SR was restored (Figs. 1B, 2C). We did not notice PV electrical activity within other PVs during AT/AE and SR. Although a single culprit PV was found, isolation of the remaining PVs was performed. Post-ablation, there was a bidirectional block within all PVs and no AT/AF was induced. No recurrences of any atrial arrhythmias were seen during the 18 month drug free post ablation follow-up. Focal AT/AE is a rare arrhythmia mainly arising from the RA (83%). The most frequent foci within the left atrium (LA) are superior PV ostia. Their origin from RIPV and coexisting AF with a trigger limited to the same PV, while it is commonly associated with multiple triggers from multiple veins (94%), is uncommon. Although AT and AF may be initiated by PV triggers, it is unclear whether in the presented cases there were two independent arrhythmogenic foci within one PV or a single AT/AE focus that resulted in a long-term AF. Many authors have suggested that PV AT and PV AF represent distinct entities. PV foci initiating AF have been identified to be located deep within the PV, in contrast to a more ostial location for AT. PV AT patients have a discrete, in contrast to diffuse, process involving PVs and the LA seen in AF. In PV AT patients without a history of AF following a focal ablation, AF episodes have not been documented during long-term follow-up. A single documented episode of a PV AT/AE indicates that the supposed previous episodes were short lasting and self-terminating, or just initiated AF.

The purpose of this study was a retrospective analysis of outcomes following laparoscopic adrenalectomy (LA) performed for benign adrenal tumours responsible for various endocrinological disorders. The patients were diagnosed with non-functioning (NFT) and functioning adrenal tumours (FT) including pheochromocytoma (PH), Conn's syndrome (CO) and Cushing's (CS) syndrome.A total of 165 LAs were carried out between August 1995 and September 2009 via either the transperitoneal (n = 38) or retroperitoneal (n = 127) approach. The analysed factors included demographic data of patients, the American Association of Anaesthesiology score (ASA), indication for surgery, tumour size and side, intraoperative and postoperative outcome of LA including duration of surgery, blood loss, time until ambulation, length of hospital stay, time until return to normal activity, the complication rate, as well as the conversion rate to open adrenalectomy.There were 111 patients with NFT and 54 with FT. Patients with NFT were significantly older than those with CO (p0.05). The mean size of the lesion differed between CO and other adrenal tumours (p0.05) as well as between NFT and PH (p0.05). All the lesions except aldosteronomas were detected predominantly in the right adrenal gland (p0.05). However, despite the different characteristic and clinical disorders related to laparoscopically removed adrenal tumours, the intraoperative and postoperative outcomes did not significantly differ in most cases between the analysed groups of patients.This study shows that LA is a safe, effective, and well-tolerated procedure despite the hormonal activity of the removed lesions. Minimal invasive surgery may be recommended as the 'gold standard' in the treatment of both functioning and non-functioning benign tumours of the adrenal gland.

We report a case of tako-tsubo cardiomyopathy after an unintentional atrioventricular (AV) block during an ablation procedure in a 77 year-old woman. This intriguing case explores three possible reasons that could have triggered the disease: (1) slow pathway destruction; (2) AV nodal complete heart block; (3) the overall stress the patient had experienced.

Laparoscopic adrenalectomy (LA) has become the standardized treatment of benign adrenal lesions over the last two decades, making the indications to open adrenalectomy (OA) limited. The purpose of this study was to show the thirty years of experience in open (OA) and laparoscopic adrenalectomy (LA) gained in one medical centre as well as to compare the results of OA and LA performed for benign adrenal lesions.Three hundred patients underwent 127 open and 173 laparoscopic adrenalectomies between 1979 and 2009 at M. Curie Hospital in Szczecin, Poland. Analyzed factors included patients demographic data, ASA score, indication for surgery, tumour size and side, characteristics of the removed tumours, intraoperative and postoperative outcome of LA and OA, postoperative pain sensation, intraoperative and postoperative complications, and conversion rate from LA to OA. Tumours with diameter exceeding 8 cm were excluded.There were no significant differences regarding the analyzed preoperative data in both groups of patients. The mean operative time was longer in the LA group (137 v. 82 min., p0.0001) and the blood loss was lower in LA group (110 v. 254 mL, p0.0001). The mean time until resumption of normal diet was shorter after LA (22 v. 44 h), as was the mean time until ambulation (17 v. 36 h), mean length of the hospital stay (4.6 v. 6.8 days), and mean time until return to normal activities (14 v. 23 days, p0.0001 for each difference). The analgesic requirement on the first and the second day postoperatively was lower in the LA group (p0.0001). The incidence of intraoperative and postoperative complications did not differ significantly between both analyzed groups. The rate of the conversion from LA to OA was 16%. The histopathological diagnosis was adenoma of the adrenal gland in the majority of cases.This study shows that LA is a safe, effective, and well-tolerated procedure. It may be recommended as a "gold standard" surgery in a case of benign functioning or non-functioning adrenal tumours with diameter less than 8 cm. (Pol J Endocrinol 2010; 61 (1): 94-101).

Rowell's syndrome (RS) is a rare type of coexistence of one of the lupus erythematosus (LE) types (systemic, subacute cutaneous or discoid) and erythema multiforme (EM) (including toxic epidermal necrolysis). We present the case of a 51-year-old patient with a diagnosis of RS, most probably caused by drugs given as psychiatric treatment. After cessation of sodium valproate and initiation of treatment with prednisolone, a spectacular clinical remission was achieved. The likely role of psychiatric drugs, namely sodium valproate and sertraline, as triggering factors, is discussed.