Comparative investigation of different telemetric methods for measuring intracranial pressure: a prospective pilot study.

OBJECTIVES: Measurement of intracranial pressure (ICP) plays an important role in long-term monitoring and neuro-intensive treatment of patients with a cerebral shunt. Currently, only two complete telemetric implants with different technical features are available worldwide. This prospective pilot study aims to examine patients who had both probes implanted at overlapping times for clinical reasons and represents the first in vivo comparison of both measurement methods. MATERIALS AND METHODS: Patients with a primary subarachnoid hemorrhage or a spontaneous intracerebral hemorrhage with ventricular hemorrhage who had received a telemetric ICP probe (Raumedic® NEUROVENT®-P-tel) were included in the study. Conventional external ventricular drainages (EVD) and ventriculoperitoneal shunts with a telemetric ICP probe (Miethke Sensor Reservoir) were implanted in patients with hydrocephalus who required CSF (cerebrospinal fluid) drainage. Absolute ICP values from all systems were obtained. Due to the overlapping implantation time, parallel ICP measurements were performed via two devices simultaneously. ICP measurements via the sensor reservoir were repeated after 3 and 9 months. Differences between the absolute ICP values measured via the NEUROVENT®-P-tel probe, the Miethke sensor reservoir®, and the EVD were analyzed. RESULTS: Seventeen patients were included in the present study between 2016 and 2018. 63% of all patients were male. In 11 patients the ICP measurements were followed up with both devices for 3 months. ICP measurements of the sensor reservoir showed corresponding trends in 9 cases compared to ICP measurement via the telemetry probe or EVD. Difference in absolute ICP values ranged between 14.5 mmHg and 0.0 mmHg. The average difference of the absolute ICP values in 8 cases was ≤ 3.5 mmHg. CONCLUSION: ICP measurements with both systems continuously showed synchronous absolute ICP values, however absolute values of ICP measurement with the different systems did not match.

Electrical potentials between stent-grafts made from different metals induce negligible corrosion.

OBJECTIVE: Evaluation of the risk of galvanic corrosion in various stent-grafts in current practice, when devices with unmatched alloy compositions are deployed together. METHOD: Five nitinol (NT) and two steel (SS) stent-grafts produced by different companies were used in different combinations to create 21 samples (NT:NT, n = 10; NT:SS, n = 10; SS:SS, n = 1). Electric potential was measured between the metal couplings after immersion in 0.9% NaCl at a temperature of 37 °C. Subsequently, the same samples were incubated for 24 months in 0.9% NaCl at 37-39 °C under hermetic conditions and examined under a scanning electron microscope in order to search for any evidence of corrosion. RESULTS: Electric potentials between different metals alloys were found (means: NT:SS, 181 µV; NT:NT, 101 µV; SS:SS, 160 µV). The mean electrical potential between stainless steel and nitinol samples was significantly higher than between NT:NT couplings (p < .001). During the final scanning electron microscope examination, only one spot of pitting corrosion (>10 µm) on a nitinol surface was found (associated with previous mechanical damage) in an NT:SS sample after 24 months of incubation in vitro and no sign of mechanical failure of the wires was found. CONCLUSION: Direct contact between the stainless steel and the nitinol alloys does indeed create electrical potential but with a minimal risk of galvanic corrosion. No evidence was found for significant galvanic corrosion when two endovascular implants (stent-grafts) made from different metal composition were used in the same procedure.

The effect of PGE administration on the activity of oxidative system in erythrocytes and platelets during ischemia reperfusion injury and on postoperative renal function in patients undergoing open abdominal aortic aneurysm reconstruction.

Postoperative decline of renal function remains a common and unpredictable complication after abdominal aortic aneurysm (AAA) reconstruction. The oxidative stress that occurs during perioperative ischemia/reperfusion injury (I/R) may contribute to the development of this complication. In this study, the influence of intraoperative prostaglandin E (alprostadil) administration on erythrocyte and platelet antioxidants as well as postoperative kidney function modulation were verified. AAA patients were randomly divided into control and study/alprostadil groups. Blood samples were collected directly before aortic clamping and 5 min after aortic declamping. Superoxide dismutase, catalase, glutathione, glutathione peroxidase (GPx), and glutathione transferase (GST) were measured using spectrophotometry. During I/R, the activity of catalase (57.14+/-30.65 vs 128.35+/-91.94 U/mg protein; P < 0.009), GPx (0.21+/-0.18 vs 0.35+/-0.21 mU/g protein; P = 0.028), and GST (217.49+/-101.39 vs 310.66+/-88.86 mU/g protein; P = 0.0006) significantly increased in the control group. GST activity before the aortic clamping was significantly lower in the study/alprostadil group (2.84+/-2.28 vs 3.48+/-2.30 U/g Hb; P = 0.05). The activity of the selected antioxidants proved to be of a diagnostic value for predicting postoperative decline in renal function. In conclusion, during I/R after AAA reconstruction, activation of various erythrocyte and platelet antioxidants occurs. Perioperative administration of alprostadil is associated with disruption of this activation.

Elastin degradation within the abdominal aortic aneurysm wall--relationship between intramural pH and adjacent thrombus formation.

BACKGROUND: The natural history of abdominal aortic aneurysm (AAA) is wall remodelling potentially leading to a final rupture. The pathogenesis of AAA appears to be multifactorial. The aim of this pilot prospective study was to assess the relationship between the thickness of the thrombus within the abdominal aortic aneurysm, intramural pH and local elastin degradation. MATERIALS AND METHODS: The AAA size, intraluminal thrombus (ILT) morphology and location were evaluated in 206 consecutive patients. Thirty patients with large AAA (aortic diameter > or = 50 mm) and adjacent ILT with the thinnest part < or = 10 mm and thickest > or = 25 mm, measured in the region of the maximum diameter of AAA, were included for further study. During AAA surgery intramural pH measurements were performed and specimens taken from both thin thrombus-covered and thick thrombus-covered wall for computerized morphometric analysis. RESULTS: Mean intramural pH value was 7.21 +/- 0.18 for the wall covered by thick ILT and 7.64 +/- 0.10 for the thin one (P < 0.001). Computerized morphometric analysis demonstrated that elastin fibres in the thin thrombus-covered wall were decreased in size (for width--P < 0.0001, for length--P < 0.13), irregularly orientated (P < 0.000001) and the amount of fibres was reduced when compared to the wall covered by thick ILT (P < 0.0004). CONCLUSION: A strong relationship between intramural pH and elastin net destruction suggests that the local alkaline status within the thin thrombus-covered part of the aneurysm wall is contributing to the elastinolytic process.

Metabolism of eicosanoids and their action on renal function during ischaemia and reperfusion: the effect of alprostadil.

Eicosanoids, active metabolites of arachidonic acid (AA), play an important role in the regulation of renal haemodynamics and glomerular filtration. Our study verified the hypothesis on the positive action of exogenously administered PGE(1) on renal function during an operation with temporary ischaemia of the lower half of the body. Also the effect of alprostadil (prostaglandin E(1) analogue) administered during the operation of an abdominal aorta aneurysm on the postoperative systemic metabolism of AA and the glomerular filtration rate (GFR) was investigated. The study included 42 patients with a diagnosed abdominal aorta aneurysm who have been qualified for the operation of implantation of the aortic prosthesis. The patients were randomly assigned to two groups: the study group (I) receiving alprostadil and the control group (II) without alprostadil. The levels of hydroxyeicosatetraenoic acids (15-HETE, 12-HETE, 5-HETE) were determined by RP-HPLC and the level of thromboxane B(2) (TxB(2)) was determined by ELISA in the plasma of the blood drawn from vena cava superior immediately before aortic clamping (A) and 5 min after aortic declamping (B). The administration of PGE(1) affects the metabolism of 15-HETE in a manner dependent on the baseline value of GFR but does not significantly change the postoperative renal function. The metabolism of 15-HETE is affected by the baseline value of GFR1 and a longer period of ischaemia is correlated with lower concentrations of 5-HETE during reperfusion. The results of our studies indicate that TxB(2) influences the postoperative function of kidneys.

Exchange of unsaturated fatty acids between adipose tissue and atherosclerotic plaque studied with artificial neural networks.

The linoleic C18:2 (n-6) and linolenic C18:3 (n-3) are recognized as essential components of the diet. Free radical peroxidation of essential fatty acids (EFAs) present in lipoproteins produces oxidized low-density lipoproteins which play a critical role in the development of atherosclerosis. The accumulation of EFAs in the vascular wall and correlations between their content in the adipose tissue and atherosclerotic plaque have been confirmed. The present study was undertaken to determine the usefulness of a neural network for studying the exchange between tissues of linoleic, alpha-linolenic, and arachidonic acids-three fatty acids with a well-understood metabolism. Atheromatous plaques, adipose tissue, and serum were obtained from 31 patients who underwent surgery due to atherosclerotic stenosis of the abdominal aorta, iliac or femoral arteries. Fatty acids were extracted and separated as methyl esters using gas chromatography. Statistical analysis was done with STATISTICA neural networks package. Several correlations reported previously were corroborated and factors modifying the content of individual EFAs in adipose tissue and atherosclerotic plaque were revealed. Artificial neural networks (ANNs) were used to determine factors modifying the content of linoleic, alpha-linolenic, and arachidonic acids in human atheromatous plaques. The mechanism of exchange of some fatty acids between the adipose tissue, atheromatous plaque, and plasma is discussed. The results provide evidence for an effective mechanism of tissue uptake and turnover of linoleic acid. Reduced plasma levels of this acid are compensated by release from adipose tissue and atheromatous plaque. While alpha-linolenic acid is continuously taken up by the plaque, adipose tissue absorbs this acid to a certain level only. The dynamics of exchange of arachidonic acid between adipose tissue and atheromatous plaque reflects a minor role for adipose tissue in determining plaque content of this acid, suggesting that "de novo" synthesis is the chief source of arachidonic acid in plaques.

[Verification of the diagnosis of Buerger's disease in outpatients]. / Weryfikacja rozpoznan ambulatoryjnych choroby Buergera.

The aim of the paper was to estimate the correctness of thromboangiitis obliterans (TAO) diagnosis in ambulatory patients. 99 patients with initial diagnosis of TAO selected from 3137 outpatients, have been examined in consulting unit for vascular diseases, from 1996 to 1998. Burger's disease has been diagnosed in 26 patients in accordance with Shionoya's criteria. Applying the point scoring system suggested by Papa et al., certain diagnosis could be made in 21 patients and probable on in 3 patients. Of the remaining patients, it is interesting to note that manual examination revealed absence of pulsation at femoral and popliteal arteries in 60% of patients and 42% of patients demonstrated atherosclerosis risk factors. On the other hand superficial thrombophlebitis and Raynaud's phenomenon have been rarely diagnosed in 5 and 18% respectively.

Abdominal aortic aneurysm: association between haptoglobin phenotypes, elastase activity, and neutrophil count in the peripheral blood.

To investigate the role of genetic factors on susceptibility to atherosclerotic arterial disease, the influence of haptoglobin phenotypes (Hp) on serum elastase activity, neutrophil count, and elastin concentration in the aorta was measured in patients with abdominal aortic aneurysm (AAA; n=52) and aortoiliac atherosclerotic occlusive disease (AOD; n=37). Findings (serum elastase activity, peripheral blood neutrophil count) were compared to a control group (CG) of 37 subjects without atherosclerosis. Hp phenotyping performed by starch-gel electrophoresis produced a haptoglobin-hemoglobin complex of three phenotypes: Hp1-1, Hp2-2, and Hp2-1. Distribution of Hp phenotypes was similar in the three study groups (AAA, AOD, CG). Significant increases in serum elastase activity and neutrophil count was measured in Hp2-1 phenotype of AAA patients. Although the aorta wall of aneurysm patients contained less (p<0.001) elastin than that of AOD patients, no significant difference of aorta elastin concentration between the three Hp phenotypes, including Hp2-1, was measured. The postulated association of AAA susceptibility with Hp2-1 phenotype was supported by the study data that demonstrated an increase in serum elastase activity in patients undergoing AAA repair.

[Factors influencing the length of hospital stay of patients qualified for elective carotid endarterectomy]. / Czynniki wplywajace na dlugosc okresu hospitalizacji chorych kwalifikowanych do operacji udroznienia tetnic szyjnych.

The aim of this retrospective study was to identify the factors affecting long hospital stay of patients who underwent carotid endarterectomy. The analysis was based on 233 records of all patients operated on between 1995 and 1998. We have found that the main reasons of lengthened preoperative hospitalization were: insulin dependent diabetes and admission on the day excluding the chance of operation in a short time. Postoperatively, monitoring in intensive care unit and unfounded delay of discharge were the leading reasons of prolonged hospital stay.

[Anticardiolipin antibodies in patients with Buerger's disease]. / Przeciwciala antykardiolipinowe w chorobie Buergera.

The aim of this study was to estimate the incidence of occurrence of anticardiolipin autoantibodies in patients with thromboangitis obliterans (TAO). Patients with Buerger's disease had statisticaverified significant higher frequency of anticardiolipin IgM antibodies than control group. This antibody may play a role in pathogenesis of TAO, although this results should be verified because of the small number of patients and diagnostic criteria.

[The treatment of acute lower limb ischemia]. / Leczenie ostrego niedokrwienia konczyny.

In 1988-1997 297 patients were operated on acute limb ischemia. In 131 patients ischemia was caused by arterial embolism, in 144 patients by acute arterial thrombosis, in 20 patients by arterial trauma and in 2 patients acute aortic dissection. Acute limb ischemia causes 12.8% risk of death especially in elderly and when the reason for ischemia is acute occlusion of aortic bifurcation. The majority of patients with acute arterial thrombosis requires arterial reconstruction.

[The pathogenesis of abdominal aortic aneurysm and polymorphism of haptoglobin and inflammatory factor]. / Patogeneza tetniaka aorty brzusznej a polimorfizm haptoglobiny i czynnik zapalny.

52 patients were operated on for abdominal aortic aneurysm and 38 for aortic occlusion disease. Haptoglobin (Hp) phenotypes were determined in all these patients. Hp and C-reactive protein (CRP) concentrations were determined in each phenotype. On the basis of the statistical analysis the highest percentage of elevated CRP concentrations was found in patients with abdominal aortic aneurysm and phenotype Hp 2-1.

[Aortoiliac graft infection as a diagnostic and treatment problem]. / Zakazenie aortalno-biodrowej protezy naczyniowej jako problem diagnostyczny i leczniczy.

UNLABELLED: Aortoiliac graft infection occurs in 2-6% of patients with such prosthesis. This condition is seldom properly diagnosed by conventional radiographic methods, leading to high morbidity and mortality. Clinically, the diagnosis of aortic graft infection is difficult because patients may have a variety of nondescript clinical complaints. The diagnosis of graft infection when associated with minimal or absent clinical signs of low-grade infection is uncertain, but is critically important to avoid frequently catastrophic complications such as sepsis, gastrointestinal hemorrhage, and suture line disruption. AIM OF THE STUDY: identification of bacterial flora present in aortoiliac graft infection; the presentation of my own experience in the detection of aortoiliac graft infection with special description of isotopic study with WBC labeled 99mTc HM-PAO and estimation of the usefulness of this test in comparison with computed tomography, ultrasonography, fistulography and angiography; evaluation of the usefulness of various treatment methods; establishing principles (algorithm) of diagnostic and therapeutic procedures in the case of the suspicion of aortoiliac graft infection. As many as 1190 patients with implanted aortoiliac graft in 1986-1996 at the General and Vascular Surgery Clinic in Szczecin were studied (Tab. 2). Thirty-one patients in the study had deep aortoiliac graft infection (Tab. 3), while 9 patients had, in addition, prosthetic-enteric fistulae and 1 had arterio-enteric secondary fistulae. The group of 31 patients with deep graft infection, that is 2.6% of all patients (1190), had aortoiliac graft implanted at the mentioned time period (Tab. 4, 5). Test results for detection of graft infection have been analysed (Tab. 17). The results of isotopic investigation (Tab. 16), computed tomography (Tab. 11), ultrasonography (Tab. 13), fistulography (Tab. 14) and angiography (Tab. 15) were compared with intraoperative state or in a case of exclusion of infection, with results of follow up. Results of various paths of treatment were estimated (Tab. 18). Based on performed cultures most common bacterial flora from infected grafts, was identified (Tab. 9, 10). The sensitivity of the isotopic study with labeled white blood cells in detection of graft infection was 88%, specificity was 97%, accuracy 93%, positive predictive value 96%. Other useful diagnostic procedures in detection of aortic graft infection are: computed tomography with an accuracy of 75%, endoscopic investigation useful in detection of arterio-enteric fistulae with an accuracy of 50% and ultrasonography with an accuracy of 35.5% (Tab. 17). The choice of the best treatment is still controversial. In my material total excision of infected graft and extraanatomic revascularization were burdened with 50% mortality rate. Among patients treated less radically the mortality rate was considerably lower. In a group of patients with the excision of the infected graft only, the mortality rate was 9% but the amputation rate was 36.4% and in a group of patients with excision of infected graft and reconstruction in situ, the mortality rate was 25% (Tab. 18). Taking into consideration our results, less aggressive methods of aortic graft infection treatment such as the excision of the infected part of the prosthesis with or without in situ revascularization if only possible should be recommended. Most common in bacterial cultures from infected aortoiliac grafts with prosthetic-enteric fistulae were Escherichia coli found (Tab. 10). In infections without fistula various types of Staphylococcus aureus were identified (Tab. 9). CONCLUSIONS: 1. In cases of aortoiliac graft infection the most common cultured bacteria are found to be Staphylococcus aureus. If there is additional prosthetic-enteric fistula Escherichia coli is the most common cultured bacteria. 2. In a case there was suspicion of aortoiliac graft infection, proper diagnostic procedures are most important for effective ma

[How does carotid artery stenosis increase?]. / Jak powieksza sie zwezenie tetnicy szyjnej?

In 25 patients with carotid artery stenosis equal or higher than 40% colour doppler examinations were performed 105 times. The aim of this study was estimate the dynamics of progress of carotid artery stenosis. The mean time of observation was 22.5 months. In 11 (44%) patients there was no progress of stenosis, in 6 (24%) a leap progress over 30% of arterial lumen, and in 8 (32%) patients the progress of carotid artery stenosis were gradual and slow. The leap progress of carotid artery stenosis was usually caused by eruption or dissection of atherosclerotic plaque located in carotid bifurcation and this situation poses especially high risk of stroke.

[Time and conditions of cerebral ischemic symptoms appearing during carotid endarterectomy under local anesthesia]. / Czas i okolicznosci wystapienia objawów niedokrwienia mózgu podczas operacji tetnic szyjnych w znieczuleniu miejscowym.

In the 1994-1997 238 carotid endarterectomies (CEA) were performed under regional anaesthesia (cervical block) for carotid artery stenosis. In 30 CEA indwelling shunt was necessary. Among 30 patients with shunt 19 (63%) had a stroke before surgery, then 9 (30%) had contralateral internal carotid artery occlusion. Among entire group of 238 patients with CEA 56 (23.5%) had a stroke before surgery and 27 (11.4%) contralateral internal carotid artery occlusion. In our opinion the strongest factor influencing neurological deficiency after clamping trial, is a history of stroke before surgery and in a less degree contralateral internal carotid artery occlusion. The mean time of the neurological deficit during clamping trial was 27 seconds and varied from 5 to 100 sec. and never appeared after 2 minutes of mentioned trial. For that reason we consider 2 minutes clamping trial as sufficient for detection of neurological deficit during CEA under local anaesthesia.

Successful treatment of recurrent reflex sympathetic dystrophy with bilateral lumbar sympathectomies.

The authors report a case of reflex sympathetic dystrophy of the lower right extremity in a 51-year-old white man. The disorder developed 3 months after an ankle fracture, and bilateral lumbar surgical sympathectomies were necessary for successful treatment. Unique to this case is the patient's history of having undergone the same treatment 10 years earlier for the same disorder, which developed after a myocardial infarction and cardiac catheterization of the right femoral artery. Incomplete sympathectomy or regeneration of sympathetic ganglions after the first surgery may explain why the second surgery was necessary in this patient.

[Operation for ruptured abdominal aortic aneurysm without consent for blood transfusion--case report]. / Operacja peknietego tetniaka aorty brzusznej przy braku zgody na transfuzje krwi--opis przypadku.

Successful operation for ruptured abdominal aortic aneurysm (AAA) in a Jehovah's Witness 66-year-old man was presented. The patient was urgently operated for symptomatic AAA. We found during surgery that that aneurysm was ruptured. Bifurcated PTFE aorto-bi-iliac prosthesis was implanted. The patient did not receive any blood or blood-origin products while staying in our Hospital.

[Prolonged abdominal aortic aneurysm rupture penetrating the lumbar spine]. / Przewlekle pekanie aorty brzusznej z drazeniem do kregoslupa ledzwiowego.

The prevalence of prolonged rupture of aortic aneurysm was estimated in a group of 65 patients operated for ruptured abdominal aortic aneurysm (AAA). Patients with chronically contained rupture AAA were hemodynamically stable. Contained rupture of an AAA should be considered in patients presenting unexplained back pain and when radiograms suggest the degenerative changes within spine.

[How quickly does an abdominal aortic aneurysm grow?]. / Jak szybko powieksza sie tetniak aorty brzusznej?

86 patients with Abdominal Aortic Aneurysm was assessed by abdominal ultrasound with respect to growth rate. For aneurysms with diameter 3-4 cm, mean growth rate was 0.215 mm per month, for aneurysms 4-5 cm was 0.33 mm per month and for aneurysms with AP diameter bigger than 50 mm the mean growth rate was 0.78 mm per month.