Chronic traumatic thoracic aortic aneurysms-results of endovascular treatment. Fourteen-year single-center experience.

AIM: Chronic traumatic thoracic aneurysms are results of blunt trauma of the chest during motorcar accident. Treatment of choice is the endovascular procedure with stent-graft. METHODS: Between 2000-2012 in General and Thoracic Surgery Department 30 patients with post-traumatic aneurysms were operated. In all cases aneurysm was located below left subclavian artery and in 63% developed during road traffic accident. RESULTS: All patients were operated on with 100% technical success and no device failure was noticed. None of patients died during the endovascular procedure and no serious complications like spinal cord ischemia was observed. In one (3%) case, where left subclavian artery was covered, stroke was diagnosed treated conservatively. CONCLUSION: At long-term follow-up, one endoleak type IA was found, solved with balloon-plasty. Two patients died due to cardiac diseases.

Can arteriography serve a diagnostic purpose in plaque type VI by AHA identification in patients with internal carotid artery stenosis?

Subtraction angiography is an invasive diagnostic method, which for a long time was a gold standard in carotid artery and intra-cranial vessel imaging. The aim of this research is to evaluate angiographic imaging in predicting atherosclerotic plaque type VI by AHA morphology and to assess its significance in establishing patients' suitability for a particular operative method. Secondarily, we assessed atherosclerotic lesions in common carotid artery bifurcation. In the paper we analyzed 158 bilateral angiograms of common and internal carotid arteries in extra- and intra-cranial locations. The material consisted of patients hospitalized in the Vascular Surgery Ward of Memorial Copernicus Hospital in Lodz during 2002-2004 who underwent angiography. We concluded that: 1. In symptomatic patients irregular plaque images in subtraction angiography is correlated with plaque type VI by AHA morphology. 2. Angiography is not a sufficient method for selection of the appropriate operative treatment due to its low sensitivity and specificity in plaque morphology imaging. 3. Plaque type VI by AHA is characteristic even for the second group of carotid bifurcation stenosis (by NASCET) and it definitely dominates in group III (by NASCET).

Arteriovenous fistula of the kidney: a case report of 47-year-old female patient treated by embolisation.

Arteriovenous fistulas of the kidney are rare. They may be acquired, idiopathic or arise in congenital arteriovenous malformations. There are only few reports in the current literature describing the successful embolisation of idiopathic arteriovenous fistulas. We report a 47-year-old hypertensive female patient with a successfully embolised arteriovenous fistula. Diagnosis was made on the basis of colour duplex Doppler examination and this method enabled further successful embolisation of the fistula.

[The lateral extraperitoneal access in surgery of the adrenal glands]. / Ocena dostepu bocznego zaotrzewnowego w chirurgii guzów nadnerczy.

This study aimed at evaluating lateral extraperitoneal access to adrenals in 233 patients (103 patients with pheochromocytoma, 101 with Conn syndrome, 11 with Cushing syndrome and 18 patients with hormonally inactive tumours) who underwent surgery in our department within 1981-1998. The age of patients ranged from 10 to 84 years. Biochemical tests have been performed and hormones assayed in all of them prior to surgery, and the localization of tumours has been established by means of the abdominal cavity ultrasound examination and CT scans. Two hundred thirty five tumours have been excised. The mean duration of surgery was 91 minutes and the mean time of postoperative hospital stay--5 days. Postoperative complications have been noted in 4.7% of the operated patients but in the group with pheochromocytoma their incidence increased to 8.7%. In 13.7% of cases an accidental opening of pleural cavity was noted. The majority of cases has had drain left in pleural cavity whereas the remaining patients have had pleurae sewn. There were two hospital deaths in the group of pheochromocytoma, i.e. in 0.85% of all patients. These results and complications were analysed in a discussion. It seems that this kind of surgical access to adrenals can be successfully used in most unilateral adrenal pathologies and in cases of extra-adrenal tumours localized along abdominal aorta. Patients with pheochromocytoma are still in increased surgical risk.

[Characteristics of the hemopoietic stem cell and its biological marker--the CD34 molecule]. / Charakterystyka macierzystej komórki hemopoezy i jej biologicznego markera--molekuly CD34.

The article presents the available data considering the functioning of the basic level of hematopoiesis: stem cell population. The modern concepts refer to the achievements in the field of stem cell research with particular focus on the milestones in the experimental haematology. The analysis of the structure and function of the CD 34 molecule--the main marker of the hematopoietic stem cell population--underline the close relationship between molecular biology and clinical practice. Presentation of the advantages and disadvantages of peripheral blood stem cell transplantation--opens the way to the detailed clinical discussions and presentation of our own experience gained during last year.

[Methods of mobilizing hematopoietic cells, their collection using cell separation, purging--processing of pathologic cells and enrichment with CD 34+ cells--negative and positive selection]. / Metody mobilizacji komórek hemopoetycznych, kolekcji przy pomocy separatorów komórkowych, purgingu--oczyszczania z komórek patologicznych i wzbogacania w komórki CD 34+--negatywna i pozytywna selekcja.

Autological transplantation of bone marrow as well as hematopoietic and precursor cells obtained from peripheral blood with the use of cell apheresis is a therapy applied in the treatment of hematological diseases and solid tumours. The mobilization of hematopoietic cells is performed by applying cytostatic drugs and/or recombinant growth factors (G-CSF, GM-CSF). The collection of CD 34+ cells is performed by using cell separators. An important role in the transplantation procedure is played by purging techniques of transplantation material from residual neoplastic cells (negative selection) or isolation of hematopoietic cells (positive selection). The considerable progress in this field is connected with the implementation of Immunoadsorbtive or magnetic methods as well as those of molecular biology. The improvement of the procedure of hematopoietic cells transplantation and its efficacy is caused by the stimulation of the hematopoiesis by using the combination of cytokines (G-CSF, GM-CSF, IL-3, SCF) and purging of the hematopoietic cells obtained from the cellular apheresis.

[Evaluation of transplantation material based on immunophenotype and in vitro clonogenic assays of hematopoietic stem and progenitor cells]. / Ocena materialu przeszczepowego w oparciu o immunofenotyp hemopoetycznych komórek macierzystych i progenitorowych oraz ich zdolnosci klonogenne w hodowli in vitro.

The qualitative and quantitative methods of transplant material (hematopoietic stem and progenitor cells) evaluation in the Hematology Department of Jagiellonian University in Cracow are performed. Our experience in the first 26 patients suffered from hematological malignancies and solid tumors subjected to high-dose chemotherapy supported with autologous hematopoietic cells transplantation are presented.

[Methods for freezing, thawing and viability estimation of hemopoietic stem cells]. / Metody zamrazania, rozmrazania oraz ocena zywotnosci komórek hemopoetycznych.

Freezing and thawing of hemopoietic stem cells (CD34+) are indispensable stages between their collection from peripheral blood or bone marrow and transfusion to the patient who has previously undergone myeloablative chemotherapy. At present there are two methods of the cells freezing: non-controlled--placing CD34+ cells directly in the final temperature and rate-controlled--gradual cooling them at programmed speed. Non-controlled freezing leads to the considerable loss of cells viability (up to 50%), but it doesn't require the expensive equipment used for rate-controlled freezing (viability loss up to 10%). In order to reduce the loss resulting from intra-cellular crystallization of water the haemopoietic cells are mixed with one of the cryopreservative substances: dimethylsulphoxide-DMSO, hydro-xyethylstarch-HES, polyvinylpyrrolidone-PVP or glycerol. The most important moment of freezing procedure is the phase transition of water. The adequate shape of the cooling curve leads to a considerable reduction of the loss of the cells viability. Further cooling is the most effective when it takes place at max. speed of 5 degrees C/min. The storage of the frozen cells is the best in very low temperatures (-170-180 degrees C-vapour phase of liquid nitrogen), but mechanical freezers (-80 degrees C) are used, too. The thawing procedure should be very fast (up to 90 degrees C/min.) and the defrosted cells must be immediately transfused to the patient because of very high toxicity of cryopreservative agents to non-frozen cells. The cells viability estimation is carried out with trypan blue or cytofluorometrically after incubation with propidine iodide.

[Simple vs bifurcated graft operations in patients with abdominal aortic aneurysm]. / Proteza prosta vs proteza rozwidlona w operacjach tetniaków aorty brzusznej.

We analysed 148 patients treated surgically from 1992-1997 because of abdominal aortic aneurysm (AAA). All patients were divided into two groups: group I--118 (79.7%) patients operated with the implantation of the straight graft and group II--30(20.3%) with the bifurcated graft. The aim of the study was to analyse early (30 days after operation) complications in both groups. The mortality rate was 8.5% for group I and 26.7% for group II. The mortality was also analysed according to AAA symptoms (asymptomatic, symptomatic and ruptured). The death rate in asymptomatic patients from group I was 1.1% versus 13.3% in group II. In symptomatic patients the difference was not statistically significant--20% in group I versus 22.2% in group II. The mortality rate in patients with ruptured AAA was 50% for group I and 66.7% for group II. The early morbidity rate was significantly higher in the second group(p < 0.05) although coexisting diseases were similar for both groups. According to our material we conclude, that operation of AAA should be finished in abdomen if there is only technical possibility. It is especially important for patients with ruptured AAA.

[Complication risk after abdominal aortic aneurysm operations]. / Ryzyko powiklan pooperacyjnych tetniaków aorty brzusznej.

Between 1992-1997 185 patients were treated in our Department because of abdominal aortic aneurysm (AAA). The aim of the study was the evaluation of frequency of hospital mortality (30 days) in patients treated because of AAA. One hundred forty eight (80%) patients were operated on and 37 (20%) were treated classically. The surgical group of 148 patients were divided into three parts: group I: 106 patients with asymptomatic AAA, group II: 24 patients with symptomatic AAA and group III: 18 patients with ruptured AAA. Straight graft was performed in 118 patients (79.7%) with hospital mortality rate 8.5% and bifurcated graft implanted in 30 patients with mortality rate 26.7%. Analysis of our material allowed to find that hospital mortality was in group I: 2.8%, group II: 20.8% and in group III: 55.6%. The main cause of deaths in patients from groups I and II was myocardial infarction and hypovolemic shock in group III. The most common postoperative general complications were cardiac and pulmonary and were significantly more often in group III (p < .05). Other not significantly registered postoperative complications as renal insufficiency were also more common in patients from group III. Analysis of our material revealed that patients with abdominal aortic aneurysm should be operated selectively, when aneurysm diameter reaches 50 mm, and optimal method is straight graft which allows to reduce to minimum postoperative complications.

Alterations in plasma neuropeptide Y immunoreactivity and catecholamine levels during surgical removal of pheochromocytoma.

BACKGROUND: Neuropeptide Y, an abundant neurohormone present with catecholamines in the adrenal medulla, is a potent non-adrenergic vasoconstrictor and a vascular growth factor. OBJECTIVE: To determine the mechanism of the release from, and possible role of neuropeptide Y in, pheochromocytomas, compared with those of catecholamines. METHODS: Plasma and tumour levels of neuropeptide Y-immunoreactivity (by, radioimmunoassay) and of noradrenaline and adrenaline (by a radioenzymatic method) in 29 patients (19 women and 10 men, aged 22-68 years) were measured during surgical removal of the tumour, during alpha-adrenergic and beta-adrenergic blockade. Arterial systemic blood samples were withdrawn before the ligation of the vessels supplying the tumour, during its surgical manipulations and after its removal, while haemodynamics was monitored. RESULTS: Plasma neuropeptide Y levels in 17 patients (58.6%, group I) significantly increased during manipulations of the pheochromocytoma and returned completely to normal after its removal. This response was independent of the plasma neuropeptide Y immunoreactivity manipulation and was correlated to increases in plasma noradrenaline (r = 0.638, P < 0.02) but not adrenaline levels. Manipulation-induced increases in plasma neuropeptide Y-immunoreactivity were associated with greater neuropeptide Y content in tumours (r = 0.508, P < 0.05) but neither plasma nor tumour levels of neuropeptide Y immunoreactivity were correlated to tumour mass. Plasma levels of neuropeptide Y immunoreactivity in the remaining 12 patients (41.4%, group II) remained unchanged throughout the experimental period, while levels of circulating catecholamine rose. In all, in spite of our attempt at complete adrenergic blockade, tumour manipulation elevated arterial blood pressure and these changes were significantly correlated to increases in levels of catecholamines in patients in both groups but also to plasma neuropeptide Y immunoreactivity in patients in group I. CONCLUSION: Pheochromocytomas exhibit different patterns of secretion. For about half of the patients either the secretion of neuropeptide Y is uncoupled from that of catecholamines or its secretion could be obscured by an increase in degradation of neuropeptide Y to inactive fragments undetectable by radioimmunoassay.

[Internal carotid artery endarterectomy--prospective evaluation]. / Endarterektomia tetnicy szyjnej wewnetrznej--ocena prospektywna.

The aim of this study was to present early and late results of carotid endarterectomy (CEA). We evaluated prospectively 270 CEA performed from 1990 to 1996. More of our patients were men (62%), their age ranged from 28 to 82 years (mean 62.4). Preoperative high grade stenosis (> 70%) of internal carotid artery stenosis was recognized in over 91% of patients according to duplex examination. All operations were performed by the same surgical team with the use of standard CEA without patching. General anaesthesia was used to the middle of 1993. Then all the patients were operated on under regional anaesthesia. Our follow-up consisted of clinical and duplex-scan examination performed regularly from 3 to 72 months after CEA. In the immediate postoperative period (30 days) four patients died (mortality rate 1.5%), mostly due to MI. The long term (72 months) follow-up revealed 12 deaths mostly due to heart attacks or cancer. We observed 11 high grade (> 70%) late recurrent stenoses. There were no deaths due to stroke from the operated artery. Duplex-scan of carotid arteries is a very effective and safe method of preoperative and postoperative evaluation. Regional anaesthesia allows direct estimation of neurological statement during operation. CEA is the only one method of stroke prevention in patients with symptomatic high-grade stenoses.

[Pheochromocytoma with hemorrhagic necrosis and rupture with symptoms of acute abdomen and shock]. / Pheochromocytoma--martwica krwotoczna i przerwanie guza z objawami ostrego brzucha i wstrzasem.

A case of a pheochromocytoma with haemorrhagic necrosis resulting in signs of acute abdomen with shock is reported. Diagnosis of a ruptured adrenal tumor was made by CT scanning. Elevated urine and plasma catecholamines as well as histological examination of the removed tumor confirmed the clinical suspicion of pheochromocytoma. The patient made uneventful recovery and is asymptomatic 2 years after surgery. Ruptured pheochromocytoma as a cause of abdominal emergency is discussed in view of the existing literature.