Effect of a 3-Week Low-Calorie Diet and Balneological Treatment on Selected Coagulation Parameters in Morbidly Obese Patients.

BACKGROUND: The most common cause of death among people with obesity are cardiovascular complications as a result of a hypercoagulability state. OBJECTIVES: The purpose of the study was to assess the potential of coagulation system activation depending on the tissue factor and to analyze of the influence of a 3-week low-calorie diet and balneological treatment on selected coagulation parameters in morbidly obese patients. MATERIAL AND METHODS: The study included 36 patients (28 females and 8 males; mean age 46) with the value of BMI > 40 kg/m2. The study was designed in two stages: baseline and after 21-days. The evaluation of tissue factor (TF), tissue factor pathway inhibitor (TFPI), von Willebrand factor (vWF), fibrinogen, D-dimer, thrombin-antithrombin complexes (TAT), and the activity of antithrombin (AT) was performed in patients before and after the treatment. The control group consisted of 24 healthy volunteers (16 females and 8 males) at a mean age of 39 with BMI . 24.9 kg/m2. RESULTS: There were significantly higher levels of TF, TFPI, fibrinogen, TAT complexes and D-dimer in the study group as compared to the controls. Moreover, there were no significant changes in the parameters studied before and after the treatment. In the group of obese patients, there were significant positive correlations between the concentrations of vWF and BMI and BMI changes and a significant negative correlation between the WHR changes and TFPI concentration. CONCLUSIONS: The study confirmed that morbidly obese patients represent a high risk of hypercoagulability state, despite no clinical evidence, which could be due to the great inhibitory potential of TFPI in suppressing the extrinsic pathway of the coagulation system. However, the lack of effect of the 3-week exposure to the LCD and balneological treatment in morbidly obese subjects indicates that substantial fat mass must be reduced before adequate hemostasis is re-established.

Useful Points of Geometry and Topography of the Lumbar Triangle for Transversus Abdominis Plane Block.

BACKGROUND: A new look at the topography of the lumbar triangle becomes a challenge for modern anesthesia. The aim of this study was to redefine the topography of the lumbar triangle for transverse abdominis plane block. MATERIAL AND METHODS: We explored 74 lumbar regions in 37 preserved cadavers (17 F and 20 M). RESULTS: The lumbar triangle was identified in 66 (89%) out of all explored cadavers' lumbar regions. The predominant triangle was the acute-angled shaped. It was identified in 39 (59%) out of all explored lumbar regions. The second type of dissected triangles had the obtuse-angled shaped. Most triangles of acute-angled shaped and obtuse-angled shaped (36) had medium surface (range from 3 cm2 to 6 cm2), which accounted for 55% of all dissected lumbar triangles. The mean surface of the lumbar triangle was 3.6±2.2 cm2. Based on other measurements, we demonstrated that the majority of the lumbar triangles (62 triangles) were beyond the posterior axillary line. CONCLUSIONS: According to the obtained results, the randomized searching for lumbar triangle should be limited to the area situated beyond of the posterior axillary line. The region situated anteriorly to the midaxillary line was defined in the study as the critical area for finding the lumbar triangle. Outcomes from the study revealed that the size and the location of the lumbar triangle as the gate for the transverse abdominal plane block may be responsible for difficulties encountered by anesthetists. Thus, establishing the area with the highest probability of localization of the lumbar triangle can improve both safety and efficiency of transversus abdominis plane block.

Impact of kidney donor hemostasis on risk of complications after transplantation--preliminary outcomes.

BACKGROUND: This study analyzes the influence the of kidney donor hemostasis on the risk of complications in the kidney recipient after transplantation. MATERIAL AND METHODS: We enrolled 38 deceased kidney donors, of whom 14 donors died from a physical injury and the others died from ischemic or bleeding central nervous system stroke. The donors were categorized into 2 subgroups. If the recipient's postoperative period proceeded smoothly, the kidney donor was assigned to the uncomplicated donors (UD) group. If the recipient's postoperative period was complicated, the donor was assigned to the complicated (CD) Group. The CD group of consisted of 9 donors who died from strokes or bleedings and 2 who died from physical injury. We examined the antithrombin (AT) protein C (PC), complexes of thrombin/antithrombin (TAT), fragments F1+2 of prothrombin (F1+2), plasminogen (Pl), complexes of plasmin/antiplasmin (PAP), and D-dimers (D-d). RESULTS: In the CD group had decreased activity of AT, PC, and Pl and increased activity of F1+2, TAT, and D-d. The UD group had a higher level of PAP. The CD group had evidence of intensive blood coagulation, but the UD group had evidence of fibrinolysis. Fisher's exact test revealed an increased risk in recipients who received a kidney from the CD group. CONCLUSIONS: The hemostasis of the kidney donors had a correlation with the occurrence of some complications in the kidney recipients, especially complications connected with activation of blood coagulation. It seems that the activation of fibrinolysis could be positive prognostic factor, but this requires further investigations.

PAI-1 and α2-AP in patients with morbid obesity.

BACKGROUND: Obesity is a multifactorial, progressing and life-long illness that consists in an exaggerated collection of fatty tissue. In 1997 WHO acknowledged that overweight and obesity had the character of an epidemic in developed countries. Studies show that in Poland morbid obesity was diagnosed in 2.2% of women and in 0.6% of men. Thromboembolic incidents occur very often in people with obesity, especially with morbid obesity. In hypercoagulability, fibrinolysis process decides about the scale of clinical symptoms of disorders of the hemostasis. OBJECTIVES: The aim of this study was to assess the chosen parameters of the fibrinolysis process in patients with BMI crossing 40, classified for surgical treatment of obesity. MATERIAL AND METHODS: The study was conducted in 50 patients with BMI > 40, including 30 women and 20 men. The mean age of the patients was 38.5 years. The control group was made up of 20 healthy volunteers, with a mean age of 38 years. In the blood of both groups the following examinations were performed: concentration of tissue plasminogen activator antigen (t-PA:Ag), antigen of the plasminogen activator inhibitor type-1 (PAI-1:Ag), D-dimers, fibrinogen and plasminogen, activity of the α2-antiplasmin (α2-AP). RESULTS: The conducted study showed that in patients with morbid obesity there was a higher concentration of tPA:Ag, PAI-1:Ag, D-dimers and a higher activity of α2-AP. CONCLUSIONS: The conducted study demonstrates that the activation of the fibrinolysis process appeared after the coagulation process, indicated by an increase in the t-PA:Ag concentration and D-dimers concentration in patients with morbid obesity. The essential growth of PAI-1:Ag level and α2-AP level shows strong inhibition of fibrinolysis in patients.

[Blood coagulation parameters in patients with lichen planus]. / Wybrane parametry ukladu krzepniecia krwi u chorych na liszaj plaski.

The aim of this study was to evaluate some blood parameters of coagulation process in blood plasma of patients suffering from lichen planus. The study group consisted of 23 patients--14 women and 9 men, aged 33-75 years. Control group contained 30-age matched healthy persons. In blood of plasma the following parameters were determined: activity of antithrombin III (AT III) and concentration of prothrombin fragments 1+2 (F1+2), complexes thrombin-antithrombin III (TAT). In blood plasma of patients with lichen planus the concentration of F1+2 was significantly higher than in healthy persons. Increased concentration of F1+2 indicated intensive thrombinogenesis in vivo in patients with lichen planus.

[Plasmin-alpha 2-antiplasmin complexes in blood of patient with lichen planus against the background of other fibrinolysis parameters]. / Kompleksy plazmina-alpha 2-antyplazmina na tle wybranych parametrów fibrynolizy we krwi chorych na liszaj plaski.

The aim of the present study was to evaluate fibrinolysis in patients with lichen planus. In blood of 20 patients (12 women, 8 men) the levels of tissue type plasminogen activator (t-PA), plasmin-antiplasmin complexes (PAP) and D-dimer were examined. The control group consisted of 37 healthy volunteers. The concentrations of t-PA, PAP and D-dimer were higher in patients with lichen planus in comparison with the control group. It seems that increased level of t-PA antigen in the blood of the patients with lichen planus was the effect of t-PA releasing from endothelial cells. The results of the present study suggest that increased concentrations of t-PA antigen, PAP and D-dimer were the evidence of higher activity of fibrinolysis system in subjects with lichen planus.

Levels of F(1+2) prothrombin fragments and thrombin - antithrombin III (TAT) complexes in patients with dermatitis herpetiformis.

BACKGROUND: Dermatitis herpetiformis (DH) is a rare bullous disease of autoimmune etiology. It is an intestinocutaneous syndrome, in which vesicopapular cutaneous lesions are accompanied by gluten-dependent enteropathy. The diagnosis of DH is based on immunopathological investigation of unaffected skin fragment (granular IgA deposits present at the tops of dermal papillae and IgA - EmA present in the serum). MATERIAL/METHODS: The studied group consisted of 33 patients with dermatitis herpetiformis - 23 males and 10 females aged 22-78 (mean age 44.7). In all the patients, the following parameters of blood coagulation systems were determined in the plasma Levels of prothrombin fragments 1+2 (F(1+2)), levels of thrombin - antithrombin III (TAT) complexes, antithrombin III activity (AT III). RESULTS: In patients with dermatitis herpetiformis, the main level of F(1+2) fragments amounted to 9.08 nmol/l, as compared with 1.14 nmol/l in the control group (the difference statistically significant, p<0.0001). In DH patients, the levels of TAT complexes were over twice higher than among the controls and that difference also reached statistical significance (p<0.0001). Mean antithrombin III activity (AT III) in patients with DH reached 102.60% and was similar to that observed in the control group (104.68%). CONCLUSIONS: In patients with dermatitis herpetiformis, increased levels of F(1+2) prothrombin fragments and TAT complexes indicate enhanced in vivo thrombinogenesis. No statistically significant differences of F(1+2), TAT and AT III levels in DH patients related to their sex, age and duration of the disease were observed.