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Guardianship courts seem to issue decisions in case of the need to obtain consent for surgery, amongst other things, when the patient is unable to consciously express written consent, and at the same time does not have a legal representative or a statutory representative does exist, but settlement with him is impossible. The presented study case demonstrated the abnormalities of applying court procedures, as well as the responsibilities and dilemmas posed in front of a surgeon. A specialist surgeon wanted to help the patient and he was able to accomplish his mission.

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INTRODUCTION: Physicians are charged with exceptional responsibility as they take care of the life and health of their patients. The aim of the present doctoral dissertation was to determine the extent and circumstances of malpractice by physicians in West Pomerania reported to Circuit Medical Tribunals of the Circuit Chamber of Physicians and Dentists in Stettin and in Koszalin in 1996-2006, including the dynamics of malpractice, profiles of accused doctors and dentists, and analysis of culpabilities and punishments validly adjudicated. MATERIAL AND METHODS: The research material was compiled basing on the documents of the Circuit Medical Tribunal of the Circuit Chamber of Physicians and Dentists in Stettin and the Circuit Medical Tribunal of the Circuit Chamber of Physicians and Dentists in Koszalin. The material consisted of records of proceedings in which a legally valid verdict was passed by the Circuit Medical Tribunal in 1996-2006. Dynamics were analyzed basing on fixed base indices and chain indices. RESULTS AND CONCLUSIONS: 1. The number of cases and verdicts passed in Stettin and Koszalin increased substantially in 2002-2003 compared with 1996. 2. Surgical specialties dominated over non-surgical ones as regards accusations of malpractice. 3. The majority of malpractice deeds occurred between Monday and Friday 4. The majority of physicians in West Pomerania (Koszalin and Stettin) accused of malpractice were found guilty. 5. The majority of accusations in West Pomerania concerned art. 8 of the Medical Ethics Code and art. 4 of the Physician and Dentist Profession Act. In valid verdicts, the most frequent punishment was admonishment, whereas the most severe punishment was reprimand. 6. Physicians from Koszalin found guilty were significantly younger than those acquitted by the Tribunal. Deeds of malpractice punished by the Tribunal were committed on weekends more often than on other days. 7. None of the cases in Stettin demonstrated a relationship between malpractice and sociodemographic or professional factors.

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67-year-old woman with thrombocytopenia (treated with prednisolon and azathiopryn) was admitted because of acute myocardial infarction without ST segment elevation (NSTEMI). From the 2nd day we observed increasing QTc interval from 461 ms with normal potassium level. Suddenly on the 6th day of the so far uncomplicated AMI ventricular fibrillation developed and was successfully treated with DC shock, and amiodarone (150 mg i.v.) was administered because of recurrent NSVT. Potassium level was 2.9 mmol/l. Within the next 2 days in the morning hours we observed episodes of recurrent polymorphic ventricular tachycardia (PMVT), always progressing into ventricular fibrillation (VF). The ECG showed QT interval--520 ms, QTc--602 ms. The patient was given an increasing dose of beta-blocker and lidokaine in i.v. infusion. After this regimen PMVT/VF did not recur and QT was normalized. Additionally successful PCI of LAD with 80% stenosis was performed. The paper discusses the problem of PMVT in the settings of AMI.

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A case of a 59-year-old man with recurrent angina associated with ST-segment elevation in leads II, III, aVF and V4R-V6R, cardiogenic shock and complete atrio-ventricular block, is presented. Coronary angiography was normal. Therapy with calcium channel blockers was effective. Difficulties in the treatment of patients with variant angina are discussed.

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We describe a case of a 59-year-old female with paroxysmal atrial fibrillation and arterial hypertension who had syncopal attacks due to polymorphic ventricular tachycardia (PMVT) with a short coupling interval of an initiating beat (280 msec). We excluded structural heart disease. In the resting ECG the QTc interval was 420 msec. During Holter monitoring a slight changes of the ST-T segment in V1 were observed (from positive T wave with ST elevation of 1 mm to flat or negative T wave without ST elevation). Additionally, after PMVT a large U-wave (4 mm of amplitude) with the QTU interval of 600 msec and QTUc interval of 662 msec were observed. The U wave disappeared 9 minutes afterwards. The ajmaline test was positive for the Brugada syndrome. The patient received ICD and sotalol, and during 6-month follow-up she remains asymptomatic.

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BACKGROUND: Clinical value of electrocardiographic features of torsade de pointes (TdP) has not yet been well established. AIM: To compare the mode of onset and ECG characteristics of slow (s-TdP) and fast (f-TdP) episodes of TdP. METHODS: 54 episodes of TdP recorded in 6 patients (5 females, one male, mean age 64.4 years) with acquired long QT syndrome were analysed. Baseline rate of TdP (V-V), ventricular rate variability (VRV), coupling interval (CI) at the onset of TdP, prematurity index (PI) and the first cycle length (FCL) were compared between 31 s-TdP (<200 beats/min) and 23 f-TdP (> or =220) episodes of TdP. RESULTS: Episodes of f-TdP were preceded by a significantly faster basal rhythm than s-TdP (R-R interval: 922 ms vs 1062 ms, p=0.03). QT interval was almost identical in both groups (517 ms vs 515 ms, NS, respectively). No significant differences were noted in the CI of the initiating beat (488 ms vs 472 ms, NS) nor in the PI (0.53 vs 0.47, NS). TdP was most frequently spontaneously terminated by a gradual slowing of the tachycardia rate; 58% of s-TdP and 39% of f-TdP episodes stopped in this way. An acceleration of ventricular rate before termination of TdP was noted in 32% of s-TdP and in 26% of f-TdP episodes. Episodes of f-TdP were longer than s-TdP episodes (mean of 19.7 vs 6.7 ventricular complexes per one episode, p=0.0003). There were significant differences in the VRV parameter (p=0.0005) and FCL (p=0.004) between both types of TdP. Faster TdP were characterised by lower ventricular rate variability (VRV - 19.5 msec) than s-TdP (VRV - 39.4 msec). Of 54 episodes of TdP, 9 (16.6%) degenerated into VF and required DC shock. Of 31 s-TdP episodes, one (3.2%) degenerated into VF compared with 8 (34.7%) episodes of f-TdP (p<0.04). CONCLUSIONS: Episodes of fast TdP were characterised by a longer duration, shorter first cycle of the arrhythmia and lower ventricular rate variability than episodes of slow TdP. Fast episodes of TdP were preceded by faster baseline rhythm before TdP. Faster TdP more frequently degenerated into VF than slower episodes.

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Five patients with amiodarone-induced QT prolongation and torsade de pointes are described. Hypokalemia was present in three patients, marked bradycardia - in two, and T-wave alternans - also in two patients. Patients with negative T waves in precordial leads were at higher risk of ventricular fibrillation than the patients with positive T waves. Beta-blocker, lidocaine and, in two patients, tosylate bretylate were effective. All patients survived to hospital discharge, however, one patient died four months later.

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We present a case of a 65-year-old female admitted to the hospital due to severe intracranial hemorrhagia complicated by recurrences of polymorphic ventricular tachycardia of torsade de pointes type. ECG showed a marked prolongation of QT interval and giant U waves. The potassium level was 2.9 mmol/l and magnesium level - 0.6 mmol/l. Intravenous lidocaine and magnesium caused a complete supression of arrhythmia. Unfortunately, the patient died three days later due to cerebral damage and respiratory failure.

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A case of 78 year-old woman with primary hypothyroidism and atrial fibrillation treated with sotalol, complicated with cardiac arrest due to ventricular fibrillation (VF) and torsade de pointes (TdP) is presented. The QT interval was prolonged to 660 msec. Episodes of polymorphic ventricular tachycardia and VF recurred. Lidocaine, tosylate bretylate and betabloker successfully eliminated VF but short-lasting episodes of TdP were still present. Increased doses of hormonal substitution with thyroid hormones successfully eliminated malignant ventricular arrhythmias and normalised QT interval to 430 msec.

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