[New methods of interventional treatment of varicose veins]. / Nowe metody w leczeniu interwencyjnym zylaków konczyn dolnych.

Lower limb veins diseases belong to frequently occurring disease syndromes. It covers 62% of adult Poles. They are not only an aesthetic problem. They can cause a lot of subjective and objective ailments significantly reducing the quality of life - from asymptomatic spider veins to permanent pain in lower limbs, especially in standing, fixed edema, skin lesions and ulceration. Superficial chronic venous insufficiency is due to incompetence of the saphenofemoral junction and great or small saphenous vein. Conventional surgery involves high ligation, stripping and phlebectomy. Recently, at the beginning of XXI century, minimally invasive endovenous techniques which became as alternatives to conventional surgery. Currently, the number of possible methods of treatment of venous disease available for use exceeds ten.

Computerized System for Quantitative Assessment of Atherosclerotic Plaques in the Femoral and Iliac Arteries Visualized by Multislice Computed Tomography.

OBJECTIVE: The investigation is aimed at the development of a semiautomatic method of examining the femoral and iliac arteries, and quantifying atherosclerotic plaques visible in the multislice computed tomography images. METHODS: We have utilized the advanced morphology and segmentation methods for processing of a series of the images. In particular, a novel sorted pixel intensity approach to segment the artery into the lumen/plaque regions has been used, and effectively combined with the Gaussian mixture modeling to increase the accuracy of the segmentation. RESULTS: Our numerical results are compared with those obtained manually by two experts. Statistics relevant to the progression of atherosclerosis have also been suggested. Results of the semiautomatic tracking of the femoral and iliac arteries and of the quantitative evaluation of atherosclerotic alterations therein have been shown to correspond well with the expert's results. CONCLUSION: The developed system is likely to be valuable tool for supporting the quantitative evaluation of atherosclerotic changes in arteries. SIGNIFICANCE: In its present form the system can be used for planning surgical treatment and/or predicting the course of the atherosclerotic alterations.

Lymphatic complications after vascular interventions.

INTRODUCTION: Lymphorrhea due to classical and mini-invasive surgical interventions on femoral and popliteal arteries is a serious hindrance to patient treatment. Depending on the experience of a particular center, the incidence and frequency of this type of complication may constitute a serious clinical problem. While the level of lymphorrhea intensity and its duration result in certain foreseeable consequences, their treatment can be a time-consuming and multistep procedure. AIM: To compare different types of vascular interventions with lymphorrhea occurrence. MATERIAL AND METHODS: The authors conducted a retrospective analysis of lymphatic complications based on the material collected between 2005 and 2012 at the Department of Vascular and Endovascular Surgery of the Military Institute of Medicine in Warsaw and in the Department of Interventional Cardiology and Angiology of the Institute of Cardiology in Anin, Warsaw, in 2009-2012. RESULTS: Maintaining due thoroughness when dissecting tissues and treating the cutting line in this area with ligatures and tissue puncture are the most reliable methods of minimizing the risk of lymphatic leakage after surgical procedures performed in a classical way. The lymphatic complication under analysis is far less likely to occur when procedures are performed as planned and an endovascular technique is used - statistical significance p < 0.05. Minimally invasive and fully percutaneous procedures performed via needle puncture, including the use of the fascial closure technique to close the femoral artery, eliminate the likelihood of the occurrence of this vascular complication - statistical significance was found with p value less than 0.05. CONCLUSIONS: We concluded that in every case by minimizing the vascular approach we protected the patient against lymphatic complications.

New surgical modification of fascial closure following endovascular aortic pathology repair.

INTRODUCTION: There are clear benefits of percutaneous versus open femoral access for endovascular aortic pathology repair. All closing devices commercially available are expensive. Surgical closure of the femoral artery risks potential prolonged wound healing and as a consequence longer hospital stay. Fascial closure is a technique that remains an interesting option. AIM: To evaluate the efficacy of the surgical modification of hemostasis control after endovascular repair of aortic pathology. MATERIAL AND METHODS: One hundred sixteen common femoral arteries in a group of 58 patients underwent a minimally invasive procedure. Patients suffering from abdominal, thoracic aorta aneurysms, acute thoracic aorta type B dissections and traumatic aortic injury were treated. RESULTS: A 1-year period of experience in fascial closure of 116 common femoral arteries was presented in the group of 58 patients undergoing endovascular interventions. Five intraoperative complications were observed and one late. Three primary failures were due to hemorrhage in three arteries, one required open repair and two additional compression after the procedure. Two cases of limb ischemia required surgical correction of artery closure. One limb ischemia was detected 4 weeks later, and was treated conservatively. At 1 year, 92 fascial closures (80%) were in the follow-up and 24 (20%) were lost to follow-up. CONCLUSIONS: This new modification of fascial closure is a safe and cheap method of arterial closure following endovascular repair of selected aortic pathologies. The usage of two suture lines makes this procedure easy and quick. Fascial closure technique is comparable to other techniques in terms of success and complication rates.

Morphological evaluation of the iliac and femoral arteries; possibilities and perspectives.

UNLABELLED: The study presented an approach to the morphometric image of atherosclerotic lesions of the final segment of the abdominal aorta, femoral and iliac arteries, considering possible endovascular intervention. The evaluation of these arteries is very important, because they are often used as a point of access for endovascular procedures performed on the peripheral arteries, or within the thoracic and abdominal aorta and its branches, as well as coronary arteries. The aim of the study was to determine morphometric measurements describing the atherosclerotic lesions, including the methodology of their surgical interpretation. MATERIAL AND METHODS: The study group comprised 128 tomograms of patients qualified for surgery. An algorithm based on the mathematical morphology was designed to track the vessels, starting from the division of the common femoral artery, and ending at the bifurcation of the abdominal aorta. We proposed a set of numerical measurements of the observed arterial changes. RESULTS AND CONCLUSIONS: We analysed 128 tomograms with a 94.5% efficiency, and with the assessment accuracy of the degree of lumen reduction (MAE--1.5%). We observed much higher measurement values of local tortuosity of the atherosclerotic arteries (0.3-1 radians), as compared to their anatomical course in a healthy subject (0-0.2 radians). The presented method can be a very accurate and useful tool in the numerical analysis of the lumen distribution of the arteries and atherosclerosis, dedicated to surgeons elaborating management strategies.

Cancer seeding contributes to intestinal anastomotic dehiscence.

BACKGROUND: Surgical wounds in cancer patients have a relatively high dehiscence rate. Although colon cancer resections are performed so as to include macroscopically non-involved tissues, some cancer cells can be present in the line of transection. The local healing process may facilitate proliferation of these localized cancer cells and the high cytokine concentration within the healing wound may also attract cancer cells from distant sites to migrate into the wound area. The growing tumor cells may then stretch the wound, hampering its contraction process. METHODS: The aim of the study was to monitor and compare, using immunohistochemical methods, the healing process of intestinal anastomosis in both normal rats and in rats with disseminated cancer (the CC531 colon cancer model). RESULTS: There was a significantly higher rate of anastomotic dehiscence in the group of rats with disseminated cancer, than in the group of normal rats. There were no significant differences between the two groups in the levels of mononuclear wound infiltration or of formation of connective tissue or new vessels. All anastomotic wounds in animals with disseminated cancer had abundant infiltrates of both migrating and proliferating cancer cells. CONCLUSIONS: We confirmed that the environment of a healing wound attracts cancer cells. Migration of cancer cells to the wound and centrifugal cancer proliferation may adversely affect the healing process and cause wound disruption.

[Heart failure as an independent prognostic factor for endovascular method of abdominal aortic aneurysm treatment]. / Niewydolnosc serca jako niezalezny czynnik prognostyczny w leczeniu tetniaka aorty brzusznej sposobem wewnatrznaczyniowym.

Endovascular aneurysm repair (EVAR) has been accepted as an alternative to traditional open surgery in selected patients. Now it is a widely accepted standard. In case of contraindications for open repair, after accomplishing including criteria for EVAR, the patient can be treated by this method. Despite the minimally invasiveness of this treatment, several complications may occur during or after EVAR. Complications arise from the limitations of the method and improper patient selection. We report a case of patient with heart failure and complications after EVAR.

[The case of an acute thoracic aorta dissection in the patient with Marphan syndrome]. / Przypadek ostrego rozwarstwienia aorty u chorego z zespolem Marfana.

Acute thoracic aorta dissection is one the most dangerous pathology of aorta. If left untreated, is associated with high mortality. Early diagnosis and proper treatment improves outcomes. Miniinvasive procedures give the opportunity to plan the hybrid approach. In this way, all the advantages and opportunities of chosen methods can be used, minimising their complications. Multidisciplinary cooperation during the whole process of treatment, including out-patient care is crutial. Doing so creates the optimal conditions for the treatment by reducing operative trauma and improving the quality of life.

Stewart-Treves syndrome angiosarcoma expresses phenotypes of both blood and lymphatic capillaries.

BACKGROUND: The development of angiosarcoma in oedematous tissue is referred to as Stewart-Treves syndrome (STS). This rare and fatal complication is associated with chronic post mastectomy lymphoedema and radiotherapy for breast cancer. Angiosarcoma spread is facilitated by the formation of blood vessels (angiogenesis) and lymph vessels (lymphangiogenesis). In the future antiangiogenic therapy may improve the poor outcome of current treatments. There was evidence that blocking the angiogenenesis would inhibit progression of angiosarcoma. It seems reasonable to hypothesize that blocking the lymphangiogenesis may yield similar results. Although angiosarcomas commonly derive from blood vessels, in case of STS angiosarcomas chronic lymphoedema may suggest its lymphatic origin. The goal of this study was to visualize interstitial space and lymphatics in the central and peripheral regions of STS angiosarcoma. METHODS: On tissue samples obtained from STS angiosarcoma we have performed: first colour stereoscopic lymphography to visualise the morphology of lymphatic vessels and extracellular spaces, second immunohistochemical staining specific for lymphatic vessels endothelium (LYVE-1) and blood endothelial cells (CD31, factor VIII) and prolymphangiogenic vascular endothelial growth factor (VEGF-C) for precise identification of lymphatic endothelia. STS angiosarcoma morphology was assessed by comparison of pictures obtained on lymphography, microscopy and confocal microscopy. RESULTS: STS angiosarcomas present heterogenous morphology with areas dominated by hemangiosarcoma and lymphangiosarcoma structures. STS angiosarcoma expressed phenotypes of both blood and lymphatic endothelia. LYVE-1 and VEGF-C is expressed by STS angiosarcoma and may be used to discriminate tumour differentiation. Morphology of lymphatic vessels and spaces in the tumour suggest absence of their normal lymphatic function. CONCLUSIONS: Our results confirmed both hemangio- and lymphangiogenic origin of STS angiosarcoma. Expression of VEGF-C makes STS angiosarcoma a good candidate for targeted antilymphangiogenic therapy. However, morphology of intratumoral lymphatics on colour lymphography suggested their impaired function, which can hamper drug distribution.

[Abdominal angina syndrome--case report]. / Zespól anginy brzusznej--opis przypadku.

Bowel atherosclerotic ischemia is one of the type of clinical presentation of this general inflammatory arterial disease. In this article was depicted a case of 58-year-old female with clinical presentation of chronic bowel ischemia, e.g., chronic stomach pain, defecation disturbance and cachexia. Diagnostic process, difficulties during diagnostic and therapy were presented. The patient was referred to the surgery The diagnostic process and surgical treatment performed in our hospital were compared with actual recommendations of specialists and standards.

[Combined management of pancreatic injury after airgunshot--case report]. / Skojarzone leczenie obrazenia trzustki po postrzale z broni pneumatycznej--opis przypadku.

Pancreatic trauma is a big diagnostic and therapeutic challenge for physicians. Because of retroperitoneal localization pancreas is protected from damages. Isolated pancreatic injury is rare. Usually it is connected with a multiple trauma. Damages of the other organs mask the symptoms of pancreas disorders and delay the diagnosis. On the other hand the prognosis is strictly connected with the state of the other organs. Early diagnosis and precise evaluation of the trauma extensiveness determines the appropriate method of the treatment. Surgery is a main therapy but the combined method of management is often necessary, including endoscopy. Computed tomography (CT) is the first diagnostic method showing the pancreatic parenchymas damage and its complications. Endoscopic Retrograde Cholangiopancreatography (ERCP) is the best tool to show the major ductal injury. The status of the major pancreas duct determines surgery management. Often the placement of stents is required. This therapy can save the patient from pancreatectomy. In this article was depicted a case of 19th patient with pancreatic injury who sustained airgun shot. Despite laparotomy and surgery external drainage the pancreatocutaneous fistula appeared. It was successfully treated by endoscopic placement of stent during ERCP.

[Microwave ablation of liver tumors as a new instrument for minimally invasive liver surgery]. / Mikrofalowa ablacja guzów watroby jako nowe narzedzie w malo inwazyjnej chirurgii watroby.

Incidence of primary and secondary liver tumors is increasing. Hepatic resection remains the treatment of choice for hepatic tumors. For various reasons the vast majority of patients with liver tumors are not suitable for resection. These patients are candidates for several image-guided focal thermal ablative therapies as alternatives to resection. Currently available ablative techniques include cryotherapy, radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation, high-intensity focused ultrasound ablation (HIFU), and ethanol injection. Presently RFA is most widely heat-based technology used for treatment of liver malignancies due to its availability, efficacy and low complication rates. However, RFA can be time-consuming and associated with higher recurrence rates in larger lesions. MWA is a new thermal ablative technique that uses electromagnetic energy to produce coagulation necrosis. MWA has several advantages over RFA such as an improved convection profile, consistently higher intratumoral temperatures, larger ablation volumes, faster ablation times, and the option of using multiple antennae simultaneously. We report our first experience using MWA and a Coviden Valleyab 915 MHz generator for ablation of liver tumor with respect to our previous experience with RFA. Further this study reviews current literature on the RFA and MWA for the treatment of the liver malignances. In our opinion although experience is limited MWA appears to be a safe and effective technology for hepatic tumor ablation and in some cases may be superior alternative to RFA.

[Vascular access for hemodialysis--own experiences]. / Dostep naczyniowy do hemodializ--doswiadczenia wlasne.

AIM OF THE STUDY: We present own experiences in creation and/or reconstruction of vascular access for hemodialysis. MATERIAL AND METHODS: 91 pts (63 men, 28 female) aged 18 to 89 years, with irreversible renal failure qualified for renal replacement therapy, 47% of them with diabetic nephropathy. In years 1996-2006, 167 surgical procedures of creation or reconstruction of vascular access for hemodialysis were performed. In the qualification for surgical procedure we used clinical assessment as well as Doppler ultrasound or computed tomography angiography. RESULTS: In 3 cases from all 167 patients we performed fistula ligation due to transfer to peritoneal dialysis. In the 164 others cases we performed 18 types of different procedures among other thing: 95 first or second degree arteriovenous fistulas creation, 35 procedures of revascularisation and 34 procedures of fistula reconstruction. In our material own modification of Cimino-Brescia arteriovenous anastomosis was introduced with positive hemodynamic effects in all cases. In the discussion we stressed the necessity of selection of creation/reconstruction methods individually for every patient especially in ageing and diabetic population of patients with chronic kidney disease with many cardiovascular complications both in predialysis stage of kidney failure as well as in the course of long term dialysotheraphy. CONCLUSION: The assurance in optimal vascular access for hemodialysis is still big challenge especially in patients of advanced age. Individual approach to every case gives the chance of choice the best surgical procedures for optimal vascular access for hemodialysis.

[Asymptomatic intraperitoneal adhesions disease as the potential cause of unfeasibility of creation dialysis access to peritoneal cavity--case reports]. / Bezobjawowa choroba zrostowa otrzewnej jako potencjalna przyczyna niemozliwosci wytworzenia dostepu dializacyjnego do jamy otrzewnowej--opis przypadków.

Peritoneal dialysis is one of three, complementary methods of renal replacement therapy, including also hemodialysis and kidney transplantation. After qualification for peritoneal dialysis program special attention should be paid for creation proper dialysis access through correct implantation of peritoneal catheter. On the basis of three cases we present difficulties of Tenckhoff peritoneal catheter implantation in patients with massive peritoneal adhesions without previous surgical interventions and other risk factors for peritoneal adhesions.

Surgical resection for persistent seroma, following modified radical mastectomy.

BACKGROUND: Seroma formation following modified radical mastectomy with axillary lymph node dissection for breast cancer is a most common wound complication. In our experience seroma occurs in approximately 50% of patients undergoing mastectomy. Postmastectomy seromas usually vanishes within a few weeks after operation. CASE PRESENTATION: In this report we present the case of a 73 year old woman who had undergone mastectomy with axillary lymph node dissection for breast cancer, complicated by lymphorrhea and formation fibrous encapsulated seroma resistant to conservative treatment which required surgical resection. CONCLUSION: We stand in opinion that in some cases of prolonged seromatous effusion with confirmed formation of thick walled reservoir the operation with resection and closure of supplying regional lymph vessels may be the best treatment, if possible preceded by arm lymphoscyntygraphy.

[The role of immune system in colon metastasis. Lymphangiogenesis or lymphedema in cancer tissue]. / Rola ukladu chlonnego w tworzeniu przerzutów raka jelita grubego. Limfangiogeneza czy limfedema w tkance nowotworowej.

The extent of lymph node metastasis is a major determinant for the staging and the prognosis of most human malignancies. Although the clinical significance of lymph node involvement is well documented, molecular mechanisms that promote tumor spread into the lymphatic or blood vascular systems and widespread dissemination are not well understood. Although there is a large body of evidence that newly visualized lymphatics facilitate formation of metastases, it remains unclear whether these are "new" or simply pre-existing dilated vessels. High level of permeability of tumor blood capillaries brings about high tissue fluid and lymph formation. The physical forces but not the putative cancer-produced VEGF C may be responsible for more lymphatics seen around cancer than in normal tissue. The main question to be answered is: are there morphologic and functional differences between newly formed and pre-existing intra- or peri-tumoral lymphatics? In our experience specimens of gastric and colon cancer revealed presence of peri-tumoral but not intra-tumoral lymphatics. Tumor tissue contained numerous tissue fluid "lakes" communicating with lymphatics. We speculate that increased production of lymph in the tumor tissue caused by high blood capillary permeability brings about dilatation of the interstitial space and peri-tumoral lymphatics. Excessive lymph flow may drag tumor cells. This article is reviews current literature on the role of angiogenesis and lymphangiogenesis in cancer metastasis with respect to own research.

[Influence of operative treatment on quality of life of patients with primary varicose veins of bottom limbs]. / Wplyw leczenia operacyjnego na jakosc zycia chorych z pierwotnymi zylakami konczyn dolnych.

UNLABELLED: Apparently, the most successful method of treating primary varicose veins of bottom limbs is performing the surgery. THE AIM: The evaluation of the influence of operative treatment on quality of life (QL). MATERIAL AND METHODS: The research was done on the group of 114 patients in age 16-76 year (middling 46,9), in clinical stage C2-C4 according to CEAP Using a CIVIQ questionnaire (Chronic Venous Insuffitienty Quality of life Questionnaire) two indexes were reckoned: the first concerned the quality of life and the second the quality of improvement. The research was done prospectively and comparatively on patients operated according to classic method of stripping and cryostripping. RESULTS: The improvement of QL was 61.43% for all examined group of patients during three-year observation. CONCLUSIONS: The surgery improved the QL of patients with varicose veins of bottom limbs whether either of the methods was applied. The research of QL may be useful to evaluate the methods of treatment.

Efficacy and tolerability of liposomal heparin spraygel as an add-on treatment in the management of superficial venous thrombosis.

Superficial venous thrombosis usually resolves spontaneously in a few weeks. In most cases, treatment includes peroral analgesics or nonsteroidal anti-inflammatory drugs accompanied by the recommendation to wear elastic stockings and perform regular mild ambulation. In contrast to this "standard treatment," a recent ACCP guideline has recommended that patients affected by spontaneous superficial thrombophlebitis be treated with intermediate doses of unfractionated or low-molecular-weight heparin. This study was designed to assess the efficacy of topically applied heparin spraygel in terms of reduction of local symptoms and signs of superficial venous thrombosis.