Neurological symptoms associated with cerebral hyperperfusion syndrome after CEA and CAS--one centre study.

BACKGROUND: There are two equivalent in efficacy methods of the treatment of carotid artery stenosis: endarterectomy (CEA) and stenting (CAS), in which the blood flow increases in most patients by 20-40% over baseline, in some exceeding 100% and being symptomatic and leading to cerebral hyperperfusion syndrome (CHS). AIM: The aim of this study is to analyze the structure of neurological symptoms associated with CHS in patients with carotid artery revascularization. PATIENTS AND METHODS: Retrospective analysis included 1386 consecutive patients treated in the Department of General and Vascular Surgery between 2005 and 2011, with 625 of them were subjected to CEA and 761 to CAS. If neurological symptoms occurred, patients were consulted by a neurologist and ultrasonography (USG) examination and CT were performed. Neurological symptoms in patients with new onset of headache ipsilateral to the carotid revascularization were extracted from medical records and nursing documentation. RESULTS: Neurological symptoms attributed to CHS were observed in 66 (10.6%) of CEA and 61 (8.0 %) of CAS group. The frequency was similar in both groups (p = 0.43). The occurrence of epileptic attacks was similar in both study groups. The only difference was the less frequent falling of the lip in CAS group. Transient bradycardia and/or hypotension were observed in CAS (8.8% vs. 10.4% and 1.3% vs. 1.3%, respectively). No difference in stroke appearance between groups were found. CONCLUSIONS: The occurrence of neurological symptoms attributable to cerebral hyperperfusion syndrome after carotid artery revascularization in short term observation is similar regardless of the method used.

The influence of Body Mass Index on chronic venous disorders therapy.

AIM: Obesity is of importance among the risk factors predisposing for chronic venous disorders (CVD). Little is known how obesity affects the management of CVD. As the data concerning the treatments of CVD in the obese are incomplete, we performed an analysis of the different CVD therapies managements with respect to body mass index and the obesity. METHODS: We analyzed 9797 CVD patients from of a previous large national CVD survey, in regard to their Body Mass Index (BMI), CVD class and CVD therapies. Among them 2213 patients presented class I, 516 class II or morbid obesity. RESULTS: BMI was significantly associated with the method of CVD therapy. Logistic regression showed that venoactive drugs are preferentially used except in class I obesity patients but also when therapy is managed by general practitioner. Logistic regression analysis showed that class II and morbid obesity is associated with more frequent prevalence of previous surgical procedures related to CVD (OR=2.62 with 95% confidence interval of [2.16-3.17]) and topical agent use, (OR=1.77, [1.38-2.25]) but with a significant decreased compliance with compression therapy (OR=0.74, [0.61 - 0.89]), regardless of the clinical course of the disease, and socio-demographic factors. While class I obesity increased the adherence with VADs. CONCLUSION: The therapy of CVD is affected by body mass index. Class II and morbid obese CVD patients are less frequently compliant with compression therapy but are willing to accept surgical procedures and the use of topical agents.

Compliance in pharmacotherapy in patients with chronic venous disorders.

AIM: The aim of this study was to evaluate the factors that limit the use of venoactive drugs (VADs), especially in patient with chronic venous disorders (CVD) noncompliant with compression therapy in a nationwide survey. METHODS: Analysis included 5134 CVD patients compliant with compression therapy and 4663 of those not accepting such method of therapy, participating in a large survey. RESULTS: Venoactive drugs (VADs) and topical agents were used significantly less frequently by patients noncompliant with compression therapy compared to the compliant population (95.2% vs. 97.7%, P<0.001 and 70.1% vs. 79.9%, P<0.001, respectively). There were also less patients on two VADs concurrently in these subgroups (14.6% vs. 24.6%, P<0.001 respectively). Logistic regression analysis confirmed that noncompliant also have decreased adherence to Ruscus aculeatus extracts (OR=0.870), micronized purified flavonoid fraction (MPFF) preparations (OR=0.886), and topical agents (OR=0.877), but not horse chestnuts seed extracts. Coexisting obesity and other chronic illnesses were among the factors that decreased the use of Ruscus aculeatus extracts and micronized purified flavonoid fraction (MPFF) preparations. The use of topical agents was reduced with age, male sex, patients with coexisting chronic illnesses, obesity and adverse to accepting compression therapy. Additionally diuretics, antiplatelet agents and low-molecular weight heparins were less frequently used in the noncompliant population. CONCLUSIONS: Patients who are not compliant with compression therapy are more frequently not adherent to pharmacological therapy. Coexisting obesity and other chronic illnesses demonstrate decrease in adherence to CVD pharmacotherapy.

Compliance with compression stockings in patients with chronic venous disorders.

OBJECTIVE: The aim of this large survey was to evaluate non-compliance with compression stockings in chronic venous disorder (CVD) patients. METHOD: A total of 16,770 CVD patients participated in this study. RESULTS: Compression stockings were used by 25.6% of CVD patients and 46.6% of the patients were never prescribed compression therapy. Compression stocking use was found to increase with the clinical stage of CVD. The percentage of patients using compression stockings during control visits increased to 37.4%. Furthermore, 5.3% of the patients coming to control visits discontinued the use of compression stockings owing to high cost, sweating, itching, cosmetic reason, oedema exacerbation, exudation lesions of lower legs and application difficulty. Past episodes of vein thrombosis (OR = 0.80), of stroke (OR = 0.28) and of varicose veins surgery (OR = 0.28) were decreasing, while the management by a general practitioner was increasing the risk (OR = 1.36) of compression therapy cessation. CONCLUSION: (1) Compression stockings are too rarely prescribed and often unaccepted at early stages of CVD; (2) The common reason for discontinuation of compression therapy is its high cost.

Indole compounds in fruiting bodies of some selected Macromycetes species and in their mycelia cultured in vitro.

Methanol extracts of fruiting bodies of two purportedly edible species of higher fungi (Macromycetes)- Tricholoma equestre (L.: Fr.) Kumm. and Xerocomus badius (Fr.) Kühn.ex Gilb., collected from a natural environment and of biomass obtained from in vitro cultures were assayed for contents of nine indole compounds. Common indole compounds in extracts from fruiting bodies of both species were: tryptophan, tryptamine and serotonin, in mycelial extracts from in vitro cultures: tryptophan and tryptamine. Contents of the compounds investigated varied widely, from 0.182 to 2.851 mg/100g d.w. in fruiting bodies and from 0.322 to 2.096 mg/100g d.w. in biomass from in vitro cultures, respectively.

Toll-like receptors and the tendency of normal mucous membrane to transform to polyp or colorectal cancer.

The aim of this study was to identify differences in Toll-like receptor (TLR) expression patterns in normal and diseased tissues of patients with polyps and colorectal cancer. Eight patients were included in the study group (aged 38 to 72 years). Sixteen HG-U133A oligonucleotide microarrays were analysed including four of colonic polyps, four of adenocarcinoma with different degree of histological differentiation (2 poorly and 2 highly differentiated), and eight of macroscopically normal tissue. The levels of selected TLR mRNA transcripts were analysed. An analysis of all per cent variability values with regard to malignancy stage increasing from polyp to stages I to III adenocarcinoma, and normal colon mucosa shows a statistically significant relationship for TLR2 (increasing) and TLR3 (decreasing). In polyps, copy numbers of TLR3, TLR4 and TLR5 mRNA were the highest and TLR7 mRNA the lowest. In normal colon mucosa of polyposis patients the highest mRNA copy numbers were observed for TLR3, and the lowest for TLR7. TLR3 may serve as a marker of colon tissue metaplasia and may indicate the tendency of normal tissue to form polyps transforming to colorectal cancer.

Self-expandable metallic stents in the treatment of post-esophagogastrostomy/post-esophagoenterostomy fistula.

Esophageus or gaster resection in patients with malignant disease is still a treatment of choice. It is obvious that each surgical procedure in these patients carries some possibility of complications. Esophageo-gastric or esophageo-jejuno anastomosis has a 4-27% frequency of fistula occurrence. All these result in 65% mortality in cases of poorer prognosis. The aim of this paper is not to present all types of complications but to objectively analyse the usefulness of the covered stent placement in the treatment of anastomotic fistulas. We present six patients who were treated for postoperative fistula of esophageo-gastric anastomosis (1 case) or esophageo-jejuno anastomosis (5 cases). All patients were treated with stapler suture for digestive tract reconstruction after malignancy removal during the primary surgical procedure. Signs and symptoms of suture leak between 5-8 days post-surgery were observed. Conservative therapy was not effective. Thus a new method of treatment was employed - covered stent placement. The procedure was performed under X-ray control. In all treated patients there was change for the better and quick reduction of secretion from the fistulas was observed. All patients were discharged from the department after several days and all had survived at 30 days follow-up. Covered esophageal stent placement seems to be a safe and promising method of treatment for patients with anastomotic fistula which significantly reduces mortality and improves quality of live. Our experiences confirms that of other investigators.

Smooth muscle cell apoptosis in primary varicose veins.

OBJECTIVES: One of the important factors responsible for vessel wall remodelling is programmed cell death. In the paper the role of smooth muscle cell (SMC) apoptosis in primary varicose veins (PVV) is investigated. MATERIAL AND METHODS: Vein specimens were obtained from 40 patients with PVV. In each case proximal and distal (upper crural) great saphenous veins (GSV) were harvested. Morphometric computer assessed quantitative evaluation of SMCs, collagen and elastin content was carried out. Apoptotic cells were detected by TUNEL assay. The levels of p53, BAX, BCLl-2 and p21 mRNA expression were assessed by real time RT-QPCR and the presence of respective proteins in the vessel wall was confirmed by immunohistochemistry. RESULTS: In the proximal GSV segments a significant increase of p53, p21 and BCL-2 mRNA levels was found in PVV patients. In the distal segments BAX and BCL-2 expression levels were higher. Taking into account the patient age, elevated p53 mRNA expression level was noticed in the distal incompetent GSVs of young PVV patients. In this group a statistically significant increase in the apoptotic index (APIx) within the vein media was found which correlated positively with p53 mRNA expression level. There was no increase of the apoptotic activity in elderly patients that led to the structural changes increase. In proximal GSV segments, despite SMC amount reduction or presence of structural changes in perivalvular wall region, no increase of the APIx with was noticed. CONCLUSIONS: P53-related apoptosis is one of the regulatory mechanisms of vein wall homeostasis maintenance. During varicose vein development its activation is related to the early stages of the disease. In the further course, the down-regulation of the SMC apoptosis within the vein media leads to the structural changes increase. The reduction of the SMC population corresponding to an increase of p21 expression in proximal saphenous vein segments suggests that the cell cycle disturbances may lead to the 'weakness' of the proximal GSV wall. Valve injury is not the only factor leading to the varicose veins occurrence.

The effect of prolonged ischaemia and cryopreservation on the cell viability of human aortic and femoral artery allografts.

The viability of the human arterial allograft cells depends on the time and method of vessel procurement and storage. In this study, an evaluation of the effect of the duration of 4 degrees C ischaemia and cryopreservation on human aortic and femoral artery allograft viability was performed. After the isolation of arterial wall cells, the identification of cultured cells was performed using mRNA analysis for estimation of smooth-muscle markers of differentiation: desmin and heavy-caldesmon. The viability of cells from the medial layer of the aortic wall ranged from 74 to 90% (61-79% for femoral arteries). Cold ischaemia time (from harvesting until the beginning of the preparation) is a statistically significant factor influencing smooth muscle cell viability. Smooth muscle cells represented the majority of live cell population.

[Inflammatory abdominal aortic aneurysm]. / Zapalny tetniak aorty brzusznej.

The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

Neoplastic lesions of the human liver in relation to the activity of the cytochrome P-450 dependent monooxygenase system.

We studied the activity of Mixed function oxidase (MFO) in human livers affected by cancer. We determined the content of cytochrome P-450 and b5, as well as the activity of their corresponding reductases, according to generally accepted methods. Liver fragments corresponding with a) healthy tissue, b) tissue at the cancer border and, c) cancerous tissue were collected during surgery from patients with liver cancer. We noted that the developing liver cancer decreased the level of cytochrome P-450, even by a magnitude order. The activity of its corresponding reductase was higher in cancerous than in healthy tissues. Cytochrome b5 behaved in an analogous manner, although the decrease in its content was less significant. NADH-cytochrome b5 reductase activity changes were insignificant.

[Repeated excision of abdominal aortic aneurysm--case report]. / Ponowne wyciecie tetniaka aorty brzusznej--opis przypadku.

A case of 69-year-old male patient with recurrent abdominal aortic aneurysm is described. The patient had been successfully operated on for infrarenal abdominal aortic aneurysm 4 years before, and 2 months postoperatively dilatation of juxtarenal part of abdominal aorta was diagnosed in ultrasonic examination. Due to progressive enlargement of juxtarenal aneurysm the patient was admitted to hospital again and operated on. Excision of aneurysm with implantation of both renal arteries to the prosthesis was done. The perioperative course was uneventful. Authors emphasize the importance of evaluation of abdominal aorta after operative treatment of aneurysm (ultrasonic, CT, MRI) to diagnose recurrent aneurysms.

Thrombocytosis after prophylactic administration of enoxaparin: unexpected findings in a Polish prospective multicenter trial on the efficacy and safety of enoxaparin in the prevention of postoperative thromboembolism.

BACKGROUND: Heparin-related thrombocytopenia is a common complication of heparin administration and therefore platelet count was monitored in our study. EXPERIMENTAL DESIGN: Prospective multicentre study. SETTING: 14 Departments of General, Thoracic or OrthopaedicSurgery, Poland. PATIENTS: 290 patients--150 general or thoracic surgery patients aged above 40 years, and 140 orthopaedic surgery patients aged between 18 and 60 years. INTERVENTIONS: All patients received 20 mg (general and thoracic surgery) or 40 mg of enoxaparin (orthopaedic surgery) once daily subcutaneously both before surgery and during postoperative immobilisation. MEASURES: Platelet count was evaluated prior to surgery and on the 5th, 7th, 11th and 15th day following the operation. RESULTS: There was neither thrombocytopenia nor heparin-induced thrombosis. Paradoxically, postoperative platelet count in most cases increased slightly but statistically significantly, but in some however, even above 600 G/l, nevertheless in these patients no thrombotic complications occurred. Postoperative thrombocytosis was greater in patients with neoplasms as well as those with excessive perioperative blood loss and transfusions. CONCLUSIONS: As platelet count was not the main topic of our study, the presented data should be regarded only as preliminary. Further investigations to resolve the cause of the observed phenomenon of thrombocytosis are therefore necessary.

[Is a post-cholecystectomy syndrome the result of inappropriate preoperative diagnosis?]. / Czy tzw. zespól po cholecystektomii moze byc wynikiem niedokladnej diagnostyki przedoperacyjnej?

The occurrence of the postcholecystectomy syndrome is very often connected with inappropriate preoperative diagnostics. One of the reasons might be the presence of gastric or duodenal ulcer, what can be connected with peri- and late postoperative complications. The prospective analysis of 250 patients admitted to the Department because of cholelithiasis was performed. In 28.8% of cases endoscopical changes in the upper alimentary tract were recognized. That is why, in patients qualified for cholecystectomy the upper alimentary tract endoscopy should be performed.

[The infection of the vascular prosthesis treated by the human cryopreserved allograft implantation: a case report]. / Infekcja protezy naczyniowej leczona wszczepieniem ludzkiego mrozonego allograftu--opis przypadku.

75 years old patient was admitted to the Department with infection of the previously implanted bifurcated aorto-bifemoral by-pass. Periprosthetic retroperitoneal abdominal abscess in the US--colour doppler examination was recognized. Unilateral femoral pulse was present--the patient after femoral amputation of the right leg. In the first step of the treatment, the drainage of the periprosthetic abscess was performed. Because of poor results of the local and pharmacological treatment and bleeding from the prosthesis, in the next step, human cryopreserved aorto--femoral allograft was implanted "in situ". Simultaneously, bifurcated prosthesis was evacuated. In the postoperative period, healing of the inquinal wounds was excellent. There were no problems connected with peripheral circulation. The patient was discharged from the hospital on the 24th post-operative day in the good local and general condition. Homograft is an efficient and promising alternative for the treatment of severe vascular prosthesis infections.

[Missed abdominal neoplasms during laparoscopic cholecystectomy and herniorrhaphy--analysis of material]. / Przeoczone nowotwory jamy brzusznej w czasie cholecystektomii i herniorrhaphii laparoskopowej--analiza materialu.

UNLABELLED: The authors present 9 cases of overlooking abdomen cavity neoplasma during laparoscopic cholecystectomy (L. Ch.) 8 patients had L. Ch. in other laparoscopic centers. Localisation of the tumors concerned: head of pancreas in 3 cases, posterior wall of stomach in 3 patients and splecic flexurae of colon in 2 cases. Patient was reoperated because of: painless jaundice in 3 cases, bleeding from upper part of digestive tract in 3 cases, acute or subacute intestinal obstruction in 2 cases. The period of time between the L. Ch. and a reoperation was: 2 weeks up to 2 months in patients with tumor of large or small bowel, 1 month up to 1 year in patients with head of pancreas carcinoma and 2 months up to 14 months in patients with stomach neoplasma. None of the patients complained about symptoms of neoplastic illness before the L. Ch. Small, deeply located or unapproachable for the examination tumors of an abdominal cavity might be easily overlooked during L. Ch. CONCLUSIONS: 1. Perhaps better anamnesis and more extensive diagnostic procedures (G. endoscopy, ERCP, CT) might have caused earlier discovery of the malignancies in some of these patients. 2. During laparoscopic control of abdomen cavity overlooking of neoplastic illness, particularly in patients aged over 40 is possible.

[Analysis of mortality risk factors in patients with ruptured abdominal aortic aneurysm]. / Analiza czynników ryzyka zgonu u chorych z peknietym tetniakiem aorty brzusznej.

The purpose of the study was to estimate which factors could have effect on successful outcome of surgery in patients operated on for ruptured abdominal aortic aneurysm (RAAA). The analysis referred to 66 patients operated upon from 1992 to 1995. The specification of all factors which could bring the influence on the successful result of the surgical treatment, was done. The statistical analysis was taken using the Yule-Kendall test and according to it for each factor the risk coefficient Q (from 0.8 to 1.0) was suggested. The group of factors conditioning in each case the failure of surgical procedure was noticed. There were differences in mortality after surgical treatment of RAAA -from 41.2% to 83.3%, mean 63.6%. The mortality of 100% was ascertained in patients with Q above 3.5. The correlation between number of patients with expected risk factors and increasing mortality rate was done. This method is useful for explaining divergences in results of surgical treatment in patients with RAAA and may be helpful for qualification of patients for surgical procedure.

[Second look in abdominal surgery]. / Second Look w chirurgii jamy brzusznej.

The paper presents authors experience and indications for an elective relaparotomy performed as the second-look laparotomy after primary operation. 12 patients with vascular or surgical diseases were operated on for: abdominal neoplastic tumors (2 patients), elective abdominal aneurysm (2 patients), ruptured abdominal aneurysm (2), abdominal aneurysm ruptured into the inferior caval vein (1), ruptured aneurysm of the iliac artery (1), abdominal aortic coarctation with visceral arteries abnormality (1), thrombosis of the superior mesenteric artery (1) and peritonitis because of intestinal ischaemia and necrosis (2 patients). In all cases an elective relaparotomy was done on the 1st or 2nd postoperative day. 5 patients died, in 4 cases complications found during second look relaparotomy required surgical treatment (2 of this patients died, two other were successfully treated). The authors discuss indications and advantages of elective second-look laparotomy in abdominal surgery according to the anticipated risk factors and patients condition.

A comparison of the clinical usefulness of CA 19-9 and CA 50 in the diagnosis and monitoring of gastrointestinal cancers.

We compared serum levels of CA 19-9 and CA 50 in 108 patients with malignant neoplasms of the stomach, pancreas, liver, and colon with the serum levels in 60 patients with benign gastrointestinal diseases, and 10 healthy subjects. Increased serum levels of CA 19-9 and CA 50 were found in 51.8 and 62% of the cancer patients, respectively. The results of CA 19-9 and CA 50 assays in the nonneoplastic group showed less specificity. False positive results were noted in 11.7% of CA 19-9 tests and in 31.6% of CA 50 tests. We concluded that in gastrointestinal cancer, the CA 19-9 test should be performed initially. CA 50 determination can be useful, but the lower specificity of the test should be taken into consideration. CA 50 should be recommended only for postoperative monitoring, especially in patients with normal CA 19-9 serum levels.