Risk factors and frequency of postprocedural hemodynamic instability after carotid artery stent placement

The frequency, risk factors and long term consequences of reflexive postprocedural hypotension (PH) following carotid artery stenting (CAS) are not well known. Prospective analysis of 30 patients with 6-month follow-up undergoing CAS with an emboli-protection device was performed. A validated 24-hour ABPM was taken 24 hours before and after CAS. PH was defined as systolic blood pressure (SBP) <90mm Hg, or decrease in mean arterial BP (MAP) of ≥20% or systolic BP (SBP) of ≥30 mm Hg of baseline BP reading. Neurological assessments were performed 24 hours after CAS and at 6 month follow-up visit. Median age was 69 years, 70% were male, 86% of patients had symptomatic carotid stenosis. Twenty patients (67%) experienced PH, 43% had transient bradycardia, 30% had both PH and bradycardia. The cumulated postprocedural mean SBP and DBP decreased from baseline 128/67 mm Hg to 108/54 mm Hg (p <0.01), mean day (69/min) and night HR (58/min) decreased to respectively 58/min and 49/min (p <0.01). We found no association of PH with age, ischemic heart disease, bifurcation involvement, balloon size, inflation pressure, longer lesion length. Patients with PH significantly (p <0.05) less often were treated with Ca-antagonist (25% vs 70%), more often had ipsilateral ulcerated plaque (85% vs 50%) and had hemodynamically significant stenosis of contralateral ICA (60% vs 30%). During 6 month follow-up only 1 case of neurological deterioration was noticed. PH was a common phenomenon after CAS, however it did not result in neurological complications. Patients at risk can be possibly identified through clinical and angiographic variables.

Nieopiewani bohaterowie tragicznego pokolenia

This is an expanded version of text presented during II International Conference of Association of Polish Physicians in Chicago on 9.30.2019 as a celebration of the 80th anniversary of the beginning of WWII and the 75th anniversary of the Warsaw Uprising [1]. The author, a son of Polish physicians, professor emeritus of Columbia College Chicago, shows – using his parents’ biographies as examples – the fight for humanity itself and for the humanistic values of the medical profession under both Nazi and communist totalitarian rule. He described the way of life of his father – a Polish commissioned military officer, a psychiatrist, prisoner of Soviet labor camps, participant of the Battle of Monte Cassino, organizer of programs of psychiatric care for Polish soldiers and veterans in Italy, England, and the United States. Likewise, he described the life of his mother, a pediatrician working for The Baudouin House in Warsaw, who was rescuing Jewish children from the Holocaust risking her own life. Forced to leave Warsaw, she and her 6‑year‑old daughter illegally crossed the borders of several countries to unite in Verona, Italy with her husband. Sharing a soldier’s life with him, she placed care for their expanding family above her own job as a physician. The publication contains copies of documents e.g. discovered by the author in Russia at the time of making his documentary film “Children in Exile” about the fate of Polish children sent to Soviet labor camps

Wstępna diagnostyka chorób krwi

Final result of treatment of majority of neoplastic and non‑neoplastic blood disorders depends on their early diagnosis and immediate referral to hematologist. This determines that initial hematological diagnosis has to be carried out on the level of family physician or other doctor, who in the process of diagnosis of other disorder will detect abnormalities that may suggest a blood disorder. Current article concerns the use of a triad of laboratory tests: complete blood count, erythrocyte sedimentation rate, and urine analysis. Borderline values are provided that should prompt referral to a hematologist, and it is explained why these particular values were accepted. Common use of such information should shorten time from initial symptoms of blood disorders to the beginning of therapy.

Terapia zorientowana na traumę w placówkach ochrony zdrowia

The recognition of traumatic experiences across all aspects of human life has spurred the development of research on the impacts of trauma in various segments of society. The Adverse Childhood Experiences Study (ACES) first documented the correlation between childhood trauma exposure and physical and mental health disorders in adulthood. Further studies provided additional evidence of the long lasting impacts of trauma and led to practices to decrease re-traumatizing policies and practices. Trauma informed care (TIC) offers concepts and approaches for successful engagement and effective treatment for trauma survivors. This paper presents six basic principles of TIC and the methods for their application. This study also presents the results of research on the importance of understanding an individual’s conceptualization of the trauma event. It has been suggested that the individual’s unique perceptions of the trauma experience should influence the selection of an appropriate therapeutic approach.

Podpułkownik doktor medycyny Konstanty Świder (1908–1965), zasłużony psychiatra Polskich Sił Zbrojnych na Zachodzie

This is the first of three papers published in this issue of the Lekarz Wojskowy (Military Physician) magazine dedicated to an outstanding military physician, Lt. Col. Konstanty Świder MD, PhD, forgotten in Poland. The paper presents his lineage, school years and studies, at the Physician Department of the Warsaw University and at the Medical Cadets School in Warsaw. The beginning of Świder’s career as a professional military physician in Poland, his fate after the outbreak of the WWII in September 1939 – time he spent in Soviet captivity, his military service in the Anders’ Army in the Soviet Union, in the Middle East, and during the Italian Campaign, and his contribution to building a psychiatric support system for soldiers of the Polish Armed Forces in the West are described. The last part of the paper describes the course of Dr. Konstanty Świder’s professional stabilization as an immigrant in the USA and his activity in the Polish diaspora in Chicago up to his premature death in 1965. Moreover, examples of Dr. Świder’s literary work and information on the status and professional activity of his children in the USA are presented.

Nurkowania rekreacyjne kobiet i dzieci

Amateur diving, done for recreation or as a sport, is one of the activities which has recently been gaining in popularity both in Poland and abroad. Until only a few decades ago, scuba diving was primarily the domain of healthy men at the working age for whom underwater work was part of their job. Currently, scuba diving has become popular with individuals of all ages and both sexes. There is an increasing number of diving enthusiasts among women and children. Underwater sports and activities require good physical health and therefore defining clear contraindications to scuba diving, both diseases and physiological conditions (e.g. pregnancy). The paper presents issues related to recreational diving for women and children taking into account physiological and psychological aspects, health assessment and contraindications to diving.

Zapobieganie chorobom psychicznym na szczeblu Korpusu

Paper delivered on December 19, 1945 at the Conference of Polish Military Physicians in Bologna [1,2]. The subject of the paper is prophylaxis of mental disorders in the 2nd Polish Corps in Italy, from the end of the war (May 1945) till the evacuation of the Corps to the United Kingdom (autumn 1946). Both organisation of the psychiatric support and preventive procedure rules for the most frequent forms of psychiatric and behaviour disorders are presented in the unique environment of the post‑war disarray, unclear political situation and uncertainty of the soldiers’ personal future. The role of the Centre for the Exhausted, forms of therapy, as well as non‑medical preventive strategies designed to reduce referrals to the psychiatric hospitals, evacuations to the rear and discharges from the armed forces are described. The paper, published in 1946 in the “Conference Proceedings” that was not widely available, fills the gap in knowledge on psychiatric prophylaxis in the Polish Armed Forces in the West and evokes doctor Konstanty Świder (1908–1965), a meritorious military psychiatrist, forgotten in the post‑war Poland. Both the original terminology and spelling were maintained in the reprint of the paper.

Płk dr med. Adolf Malinowski (1891–1962), zasłużony polski psychiatra wojskowy i sądowy

Tematem pracy są życie i dokonania płk. dr. med. Adolfa Malinowskiego (1891–1962) w dziedzinie psychiatrii wojskowej i sądowej. Omówiono jego rodowód, przebieg nauki szkolnej i studiów w Cesarskiej Wojskowo-Medycznej Akademii (VMA) w Petersburgu (2010–2014), służbę lekarza pułkowego w armii rosyjskiej podczas I wojny światowej (1914–1918) i w I Korpusie Polskim (1918) oraz pracę cywilną po demobilizacji (1918–1920). Przedstawiono przebieg służby w Wojsku Polskim: w wojnie polsko-bolszewickiej 1920 r., w Szpitalu Obszaru Warownego Wilno (1922–1934), Szpitalu Szkolnym CWSan. w Warszawie (1934–1939) oraz w wojnie obronnej 1939 r. Scharakteryzowano jego pracę w Szpitalu Ujazdowskim w okresie okupacji niemieckiej i podczas powstania warszawskiego (1939–1944). Opisano również przebieg służby wojskowej płk. A. Malinowskiego po II wojnie światowej oraz pracę naukowo-dydaktyczną w Klinice Psychiatrycznej Akademii Medycznej w Gdańsku (1947–1954), po zwolnieniu z wojska. Przedstawiono spis jego publikacji naukowych i wybrane z nich cytaty. Przytoczono opinie przełożonych, współpracowników i kolegów, charakteryzujące osobę dr. med. A. Malinowskiego oraz jego etos jako lekarza i oficera WP.