The PA of GC, CC, and RC extracts was assayed by the recalcification of human normal or F VII-DP, and the PA of normal tissue was also determined. The PA of normal tissue was higher than that of the cancer tissues in all groups of specimens. Substitution of normal plasma by F VII-DP resulted in significant depression of the PA and the differences in the PA between the normal and cancer tissue samples disappeared. Preincubation of normal and cancer tissue extracts with the cysteine proteinase inhibitors, mercuric chloride and iodoacetamide, did not affect the PA of these extracts. We conclude that the PA of the investigated cancer extracts is factor VII-dependent and can be related to the presence of tissue factor within cancer tissue.

Procoagulant activity (PA) and fibrinolytic activity (FA) were investigated in 14 specimens of gastric cancer (GC) and in 26 specimens of colorectal cancer (CC) and simultaneously, in samples of the normal mucosa obtained from the same organs. Histochemical localization of plasminogen activator was performed at the tumor borderline. The PA of the tumor extracts was in most cases lower than in the corresponding normal mucosa from GC as well as CC patients. The FA of the extracts of CC was also lower than that of normal mucosa. On the other hand, 11 of 14 cases with GC showed a significantly higher FA in the tumor extracts than that in the corresponding normal mucosa. The histochemical localization of plasminogen activator revealed that its activity is connected with small and medium-sized blood vessels, but not with the cells of the two kinds of cancer investigated. Morphological and histochemical findings from both kinds of cancer demonstrate that the FA of their extracts depends on the vascularity of specimens of the respective tumors.

Case report -An 86-year old patient developed pneumothorax a few hours after pacemaker implantation. Surprisingly, the pneumothorax localized contralaterally to the site of subclavian vein puncture. It was treated with chest tube puncture, under the care of a pneumonologist, resulting in full recovery. Although pneumothorax localized contralaterally to the site of subclavian vein puncture during pacemaker implantation is very rare, it has been reported in the literature. CaseAn 86-year-old male patient underwent dual chamber pacemaker implantation due to symptomatic second degree atrioventricular block 2:1. His medical history was also positive for paroxysmal atrial fibrillation, hypertension, and chronic obstructive pulmonary disease. No significant deviations were reported in laboratory tests.The device (Medtronic Sensia DR) was implanted in the left prepectoral region via a subclavian approach. An active fixation ventricular lead (Medtronic 5076-58 MRI) was implanted into the right ventricular outflow tract through left cephalic vein venesection, while another active fixation atrial lead (Medtronic 4076-52) was located within the right atrial appendage using left subclavian vein puncture. The procedure went without perioperative complications. Post-procedure chest radiographs taken directly after the intervention were satisfactory.Five hours later, the patient suddenly reported shortness of breath and a stabbing pain in the chest intensified by inspiration. A chest X-ray (posteroanterior view) revealed a right-sided (contralateral) pneumothorax (Figure 1), while the lateral view appeared normal (Figure 2). A chest tube

A 56-year-old man was referred to the clinic for implantation of a pacemaker due to symptomatic junctional bradycardia. His medical history was positive for Starr-Edwards ball tricuspid valve implantation, excision of a right ventricular myxoma and reoperation of this area for thrombosis. Due to previous surgery, we implanted a dual-chamber pacing system with the ventricular lead introduced CaseA 56-year-old man was referred for implantation of a pacemaker due to exacerbation of symptomatic junctional bradycardia, which was also observed in the electrocardiogram and confirmed in the intracardiac electrogram (Figure 1). His medical history was positive for Starr-Edwards ball valve implantation in the tricuspid position, excision of a right ventricular myxoma, both in 1979, and reoperation of this area for prosthetic valve thrombosis 37 years prior to the current admission, while being negative for features of heart failure.Intraoperative ECG revealed a prolonged PR interval, which, in combination with symptomatic bradycardia in sick sinus disease, was an indication for dual chamber pacemaker Figure 1. Electrocardiography on admission at the standard chart speed of 25 mm/s. Junctional rhythm with mean heart rate of 39 bpm.

Excessive daytime sleepiness or an increased need for sleep are an increasingly common reason of medical appointments. For years, the literature on sleep disorders has reported a complex two-way relationship between excessive sleepiness and mental disorders – especially mood disorders, which include winter depression in seasonal affective disorder. Assessment and effective treatment of excessive sleepiness in patients with seasonal affective disorder is an important component of the therapy. Hypersomnia is often a residual symptom of affective disorders, compromising the quality of life and daily functioning. Modafinil is an agent used in adults to treat excessive sleepiness associated with narcolepsy, with or without cataplexy. In addition to the registered indications, previous studies have shown efficacy and good tolerance of modafinil as augmentation treatment of depressive episodes in patients with residual symptoms in the form of fatigue and excessive daytime sleepiness, who received drugs from the group of serotonin reuptake inhibitors. The aim of this paper is to present the problem of excessive daytime sleepiness in the course of seasonal affective disorder and to propose modafinil therapy.