Takotsubo cardiomyopathy (TCM) represents an acute systolic left ventricular dysfunction typically triggered by severe psychological or physical stress. Oncological patients due to emotional distress of the diagnosis, proinflammatory and prothrombotic nature of cancer and also physical stress often following complex anticancer therapies are at high-risk of TCM. Moreover, there are also few reports of TCM associated with oncological treatment, mostly chemotherapy. Recent data from large registries indicate a surprisingly high incidence of malignancy in TCM, significant differences in clinical characteristics and unfavorable short- and long-term clinical outcomes in this specific group of patients. Therefore, we present two case reports of TCM that occurred during active anticancer therapy. Both women were admitted with suspicion of acute coronary syndrome. The first patient underwent mastectomy two years before due to hormone receptor-positive breast cancer and on admission she was during adjuvant hormonotherapy with tamoxifen. The admission of the second patient was preceded by fifteen fractions of adjuvant external beam radiotherapy due to intermediate-risk endometrial cancer after radical hysterectomy. Based on coronary angiography type I of acute coronary syndrome was excluded. Both patients negated stressful situations in the period immediately before the symptoms onset. Within hospital course baseline apical ballooning observed in both cases fully recovered and enabled subsequent completion of oncological treatment in accordance with adopted treatment protocols without recurrence of TCM. To our knowledge, presented cases are the first reports showing direct relationship between TCM and adjuvant hormonotherapy with tamoxifen or pelvic radiotherapy.
B a c k g r o u n d: Near Infrared Spectroscopy (NIRS) is considered a reliable assessment method of a balance between cerebral oxygen demand and supply. One of forms of anaesthesia applied during extensive abdominal surgical procedures is the epidural anaesthesia. Its application in addition to the general anaesthesia is a commonly accepted form of anaesthesia in patients undergoing abdominal surgery. The aim of this study was to verify the hypothesis that epidural blocks may have eff ects on cerebral saturation in patients undergoing abdominal surgery under general anaesthesia.
M e t h o d s: Cerebral saturation was monitored intrasurgically. Reduction of cerebral oxymetry by over 25% in relation to the baseline, or cerebral oxymetry value below 50% was considered clinically significant.
R e s u l t s: One hundred and one (101) subsequent and non-randomised patients, age between 35 and 84 years (mean 64 ± 10) qualifi ed for major abdominal surgeries were enrolled. In 14 (13.9%) patients of 101 enrolled a clinically signifi cant reduction of cerebral saturation was observed. In 50 (49.5%) of the enrolled patients, the epidural anaesthesia was applied along the general anaesthesia. A clinically signifi cant reduction of cerebral saturation was observed in 9 of them. No statistically significant association was found between the application of epidural anaesthesia and development of cerebral desaturation.
C o n c l u s i o n: The application of epidural anaesthesia caused no clinically significant reduction of cerebral saturation during the general anaesthesia in course of major abdominal surgical procedures.
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