Electrocardiology

The acuteness score (based on the modified Anderson-Wilkins score) estimates the acuteness of ischemia based on ST-segment, Q-wave and T-wave measurements obtained from the electrocardiogram (ECG) in patients with ST Elevation Myocardial Infarction (STEMI). The score (range 1 (least acute) to 4 (most acute)) identifies patients with substantial myocardial salvage potential regardless of patient reported symptom duration. However, due to the complexity of the score, it is not used in clinical practice. Therefore, we aimed to develop a reliable algorithm that automatically computes the acuteness score. We scored 50 pre-hospital ECGs from STEMI patients, manually and by the automated algorithm. We assessed the reliability test between the manual and automated algorithm by interclass correlation coefficient (ICC) and Bland-Altman plot. The ICC was 0.84 (95% CI 0.72-0.91), P<0.0001. The mean difference between manual and automated acuteness score was 0.17±0.66. In only two cases, there was a major disagreement between the two scores. There was an excellent agreement between the scores for the remaining 48 ECGs, all within the upper (1.46) and lower (-1.12) limits of agreement. In conclusion, we have developed an automated algorithm for measurement of the modified Anderson-Wilkins ECG acuteness score from the pre-hospital ECG in STEMI patients. This automated algorithm is highly reliable, can be applied in daily practice for research purposes and may be implemented in commercial automated ECG analysis programs to achieve practical use for decision support in the acute phase of STEMI.

Paragangliomas are rare neoplasms of neurological origin and account for 0.012% of all tumors. Only 10% of them have extraadrenal localization. Head and neck paragangliomas account for 0.33% neoplasms of that localization. Typically paragangliomas are benign tumors, but even 19% cases may have malignant potential. On the neck they are located typically closely to carotid artery bifurcation, jugular bulb and along the course of vagus nerve. Laryngeal localization is very rare. Nonspecific manifestation and wide spectrum of symptoms cause difficulty in diagnosis of paragangliomas. Presentation of the diagnostic process, performed treatment and obtained results of neck paragangliomas in the material of the Department of Otolaryngology of Warsaw Medical University in years 2001-2010. There was performed retrospective analysis, based on the medical documentation of 14 patients with neck paragangliomas (9 women and 5 men), age range 25-62 years, hospitalized in the Department of Otolaryngology of Warsaw Medical University during the last 10 years. The date from the history, physical examination, radiological evaluation and the method of performed treatment and post-treatment complications were studied. Out of 14 patients with neck paragangliomas, there were 9 cases of isolated tumors and 5 cases of synchronic, multicentric neoplasms. The most common and single symptom was nonspecific neck mass. Doppler ultrasonography was adequate diagnostic tool in carotid artery paragangliomas. To diagnose mulicentric paraganglioma, vagal or laryngeal paraganglioma more thorough radiological examination was necessary, including computed tomography, magnetic resonance and angiography. All patients had performed surgical treatment. There were observed very good results in patients with isolated paragangiomas of carotid artery or larynx. Surgical management of multicentric and vagal paragangliomas was exposed to higher risk of cranial nerve paresis. (1) Paragangliomas are rare tumors of nonspecific clinical manifestation, making the early diagnosis very difficult. (2) Precise radiological evaluation is necessary taking into consideration quite high incidence of multicentric paragangliomas. (3) There is higher risk of cranial nerve paresis after surgical treatment of multicentric paragangliomas, neoplasms larger then 5 centimeters in diameter and vagal paragangliomas then in isolated carotid artery paragangliomas.

Results The most frequently reported symptoms included: discomfort and a sensation of a foreign body in the throat. Some patients complained about having difficulty swallowing, hearing problems, and hoarseness. In most cases, the tumor remained symptomless and ...

Inverted papilloma is benign epidermal neoplasm of not recognized etiology. The lesion is estimated to represent 0.5-4% of sinonasal tumors. Generally inverted papilloma is unilateral, arises from the lateral nasal wall and characterizes with local destruction and rapid growth. The tumor can possibly undergo malignant transformation. The treatment of choice is surgery, recently endoscopic approach is considered to be superior to the open approach. was evaluation of recurrent inverted papilloma treatment results in the experience of Otolaryngology Department, Medical University of Warsaw, from 1982 to 2009. The group of 124 patient (66 men and 58 women) aged from 26 to 79 with inverted papilloma operated between 1982 and 2009 were enrolled in the study. Follow up was from 6 months to 27 years. Most common primary localization of the tumor was combined lateral nasal wall and maxillary sinus (42%). In 37% the lesion involved unilaterally the lateral nasal wall, maxillary sinus and ethmoid sinuses, rarely it was localized only in the lateral nasal wall (16.1%) and exclusively in the nasal septum (4.8%). All the patients were treated surgically, 46% of patients underwent endoscopic procedure, 37.1% lateral rhinotomy, 15% Denker rhinotomy and 1.6% midfacial degloving. Recurrence was observed in 15.3% including 57.9% after endoscopic surgery, 26% after Denker operation and 15.8% after lateral rhinotomy. Malignant transformation was observed in 5 patient (4%). All the patients with recurrent inverted papilloma were treated surgically, 5.3% of patient underwent midfacial degloving, 5.3% Caldwell-Luc operation, 10.5% endoscopic procedure, 26.3% Denker operation and 52.6% lateral rhinotomy. 1. Endonasal and open approach should be considered in the surgical treatment of recurrent inverted papilloma. 2. Endoscopic approach is preferred in the recent years but qualification for each method should depend on lesion localization, extent and volume. 3. Regular follow-up enables early recurrence diagnosis and treatment.

Long QT syndrome is a disease of delayed ventricular repolarization. It manifests clinically as recurrent syncope and sudden cardiac death caused by an atypical form of polymorphic ventricular tachycardia known as torsades de pointes (TdP). Evidence obtained from the studies using the rabbit left and right ventricular wedge preparations indicates that the development of TdP is relying not only on the genesis of an R-on-T trigger, but also on the formation of a functional reentrant substrate. When ventricular endocardial or subendocardial repolarization is prolonged either because of gene mutations or by drugs that reduce the net repolarization current, cell membrane potential fluctuates during phase 2 of the action potential phase 2 because of reactivation of L-type calcium current, that is, the appearance of phase 2 early afterdepolarization (EAD). In the rabbit left ventricular wedge, QT prolongation and EAD due to pure IKr inhibition are accompanied by a disproportional increase in transmural dispersion of repolarization (TDR). Early afterdepolarization in endocardium or subendocardium is able to produce new action potentials in cells with a relatively short action potential duration (eg, ventricular epicardium) probably via an electrotonic effect when TDR is large enough. This, in turn, results in an R-on-T extrasystole that is capable of initiating TdP. Enhanced TDR is essential not only for the genesis of the first initiating beat of TdP by facilitating the propagation of EAD, but also for the maintenance of TdP by serving as a functional reentrant substrate.

ABSTRACT Transfacial surgery with the use of microscopic end endoscopic techniques has been used for resection malignant tumors of the paranasal sinuses and anterior skull base. After tumor resection the dura mater injuries should be carefully closed to avoid the most common postoperative complications (encephalocele, meningocele, meningitis, intracranial abscess and pneumoencephalus). Authors analyzed cases of tumors of nasal cavity and paranasal sinuses with extension to anterior scull base treated in ENT Department of Medical University of Warsaw. In case of small injuries to 10 mm in diameter the reconstruction was usually performed with multi-layer technique. In cases of bigger defects the dural plane was rebuild with fascia lata flap by suturing it to the dura mater. Authors conclude that malignant tumors of the paranasal sinuses and anterior skull base can be resected entirely, together with dura mater by the extracranial approach through a lateral rhinotomy incision. The dura mater defect can be reconstructed by the same approach avoiding intracranial manipulation and tension on frontal lobes. The diameter of dural defect determinates materials and technique of closure.

Continuing uncertainty exists about standardized procedures for the placement of electrocardiographic (ECG) chest electrodes, technical variability being the largest error source for short-term variations in amplitudes and waveforms of the chest lead ECGs. To avoid presumed attenuation of ECG amplitudes by abundant breast tissue, anterolateral chest electrodes in women are often placed under the breasts and too low. There is

Pre-hospital 12-lead ECG interpretation is important because pre-hospital activation of the coronary catheterization laboratory reduces ST-segment elevation myocardial infarction (STEMI) discovery-to-treatment time. In addition, some ECG features indicate higher risk in STEMI such as proximal left anterior descending (LAD) culprit lesion location. The challenging nature of the pre-hospital environment can lead to noisier ECGs which make automated STEMI detection difficult. We describe an automated system to classify lesion location as proximal LAD, LAD, right coronary artery (RCA) and left circumflex (LCx) and test the performance on pre-hospital 12-lead ECG. The overall classifier was designed from three linked classifiers to separate LAD from non-LAD (RCA or LCx) in the first step, RCA from LCx in a second classifier and proximal from non-proximal LAD in the third classifier. The proximal LAD classifier was designed for high specificity because the output may be used in the decisi...