[Chronic lower limb ischemia--clinical symptom element of atherosclerosis--actual guideline]. / Przewlekle niedokrwienie konczyn dolnych--element obrazu klinicznego miazdzycy tetnic--aktualne zalecenia.

Peripheral atherosclerosis is the leading cause of chronic lower limb ischemia (PAD). In European populations the disease occurs frequently. In the early stages often does not cause obvious symptoms. Since the PAD coexists with other areas of vascular activity is associated with high cardiovascular risk (myocardial infarction, cerebral stroke, sudden death). The article discusses the symptoms, diagnosis and treatment of the main aspects of the PAD, useful in medical practice primary care. Diagnostic strategy of patients with claudication punctuation depends on the clinical situation, the size of claudication distance and the impact this symptom on quality of life of the patient. The treatment should include modification of risk factors for atherosclerosis. Important are: smoking cessation, control of blood pressure and lipid disorders and the desire for normalization of body weight. The conservative treatment is a key consideration in antiplatelet therapy and rehabilitation.

Thromboangiitis obliterans in the 21st century--a new face of disease.

Thromboangiitis obliterans (TAO) is a relatively rare disease of peripheral blood vessels, affecting small and medium sized arteries and veins. Although the first description of the disease was given by Winiwarter almost 130 years ago, etiology of TAO remains not elucidated. Smoking is considered as a precipitating factor of the disease. We emphasised some particular features of the new face of TAO - significant decrease in incidences, increased disease prevalence among women and coexistence of other than smoking atherosclerotic risk factors (especially disturbances of glucose metabolism). Contemporary methods of treatment were also discussed.

[Evaluation of proinflammatory cytokines in chronic lower limb ischaemia diabetic macroangiopathy and arteriosclerosis obliterans]. / Ocena wybranych cytokin prozapalnych w przewleklym niedokrwieniu konczyn w przebiegu makroangiopatii cukrzycowej i miazdzycy zarostowej.

UNLABELLED: Proinflammatory cytokines play the crucial role in the arising and progression of atherosclerotic changes. Between them are: tumor necrosis factor alpha (TNF-alpha) and interleukin 6 (IL-6). The significant role in the atherosclerotic changes play adhesive molecules produced by endothelium as the answer to the cytokines stimulation. THE AIM OF THE STUDY was the evaluation of the serum concentration of TNF-alpha, IL-6 and selectin E in the patients with chronic lower limb ischaemia with and without diabetes type 2. All patients had antropometric measurements (BMI) as well as the standard biochemic evaluations and the angiologic diagnosis were performed. MATERIAL AND METHODS: The 17 patients with chronic peripheral arterial disease (the mean age 55.9+/-7.8 years) and 23 with chronic arterial ischaemia and diabetes (the mean age 61.8+/-7.6 years) were included into the final evaluation. The control group consist of 14 healthy volunteers; mean age 43.9+/-11.5 years. RESULTS: The concentration of TNF-alpha in both groups was statistically significant higher in comparison to control group. High concentration of IL-6 was in patients with arteriosclerosis, and selectin E in the group with diabetes and chronic arterial ischaemia in course of macroangiopathy. CONCLUSIONS: At the satisfactory metabolic glicemic compensation and without obesity the statistically significant differences at level of analyzed cytokines in the both groups were not shown. The high level of selectin E in the diabetes group shows for the more activation of endothelium cells.

[Lipoprotein(a) and plasminogen patients with diabetes mellitus complicated with peripheral angiopathy and hypertension]. / Lipoproteina(a) i plazminogen u chorych na cukrzyce powiklana angiopatia obwodowa i nadcisnieniem tetniczym.

UNLABELLED: High serum level of lipoprotein(a) [Lp(a)] is one of the risk factors of atherosclerosis and so do high total cholesterol (TC) or LDL-cholesterol (LDL-ch) serum levels or diabetes mellitus. Structure of the protein part of Lp(a) is similar to plasminogen (PL). The aim of the study was estimation serum concentrations of: Lp(a), TC, LDL-ch, HDL-cholesterol (HDL-ch), triglycerides (TG) and PL in diabetic patients macroangiopathy hypertension. 63 patients (35 females and 28 males) with diabetes mellitus were included into the study. 36 of them suffered from chronic limb ischaemia caused by diabetic macroangiopathy 44 persons of the group were hypertensive. Control group consisted of 15 healthy people in the similar age. PL was estimated by turbidimetric method, Lp(a)--by ELISA, other lipids--by routine methods. RESULTS: In diabetic patients in comparison to healthy persons were significantly higher: Lp(a) serum (p<0.003), PL (p<0.001), TC, LDL-ch, and significantly lower: HDL-ch. There were no statistically significant differences in Lp(a), other lipids and PL levels in patients with chronic leg ischaemia vs without that complication and in hypertensive vs normotensive diabetics.

[Contemporary treatment of diabetic foot]. / Wspólczesne zasady terapii stopy cukrzycowej.

The management of patients with diabetic foot presents an important challenge for health services research. Since today there is no algorithm describingkind of diagnostic tests and treatment is the best for patients with different extremity ulcers. This article could be helpful for future decisions regarding the management of patients with lower extremity ulceration.

[Review of current etiopathogenic data of Buerger disease]. / Przeglad danych etiopatogenetycznych o chorobie Buergera.

Although 75 years have passed since Buerger's disease was described as a separate nosological, its etiology and pathogenesis are not sufficiently elucidated. According to many authors the disease origin is significantly connected to genetic and environmental factors. Exposure of some patients with special genotype, mainly HLA-A9 and HLA-B5, to environmental factors, mainly nicotine, may be the base of etiology and pathogenesis of Buerger's disease. Discovery of antielastin, anticollagen I and III antibodies, antinicotine and antivascular antigen antibodies in blood of patients, allowed to put forward a theory of immunological character of TO. In Buerger's disease, defined in recent years as an inactive collagenosis, immunological complexes, cell toxins developing during phagocytosis, found in smokers, constitute the main agents responsible for vascular wall damage. Disturbance of prostacyclin I2/thromboxane A2 balance and accelerated platelet aggregation cause spasm of arterioles and in effect lead to higher procoagulant readiness. Some adhesive molecules, for example P and L selectins, play an important role in vascular endothelium damage. Prostaglandin treatment induces an improvement of vascular wall (endothelium) status, and simultaneously improvement of tissue perfusion, expressed by a decrease of selectin and vWF concentrations and of the number of desquamated endothelial cells.

[New aspects of prostaglandin E1 therapeutic influence in thrombo-angiitis obliterans]. / Nowe aspekty leczniczego wplywu prostaglandyny E1 w zarostowo-zakrzepowym zapaleniu naczyn.

Prostaglandin E1 because of its unique protective and repaired endothelial action is used in the treatment of many diseases. The aim of the study was the investigation of prostaglandin E1 influence on some adhesive molecules profile in the patients with thrombangitis obliterans. 21 patients, aged 31-49 years (mean 40.3 +/- 5.3), with thrombangitis obliterans were observed. The control group consisted of 22 healthy patients, aged 18-50 years (mean 34.6 +/- 12.25 years). In both groups as well the number of circulated endothelial cells and selectin L, P, E and vWF factor concentration were measured. In patients suffered from thrombangitis obliterans these parameters were measured before and after 21 days intraarterial 10 mg PGE1 (Alprostadil) infusion. No PGE1 influence on selectin E concentration was observed, the mean values as well before as after the treatment were equal to 66.56 +/- 8.92 ng/ml. The decrease in selectin P concentration was observed but the difference was not statistically significant. The statistically significant reduction was observed in selectin L (decrease from 799.88 +/- 104.79 ng/ml to 764.83 +/- 116.04 ng/ml) and vWF concentration (decrease from 195.04% +/- 26.2% to 187.69% +/- 22.83%). The final PGE1 therapeutic result was the circulating endothelial cells decrease (from 2.47 +/- 1.01 before to 2.36 +/- 0.97 cells/ml after treatment). Intraarterial PGE1 infusion in patients with thrombangitis obliterans results in significant selectin L, vWF factor concentration decrease less; this decrease is less marked in selectin P concentration. As the inhibition of the adhesive molecules activation effect the number of exfoliated circulated endothelial cells decrease is observed.