Tissue post-classification using the measured acoustic signals during 355 nm laser atherectomy procedures.

The current laser atherectomy technologies to treat patients with challenging (to-cross) total chronic occlusions with a step-by-step (SBS) approach (without leading guide wire), are lacking real-time signal monitoring of the ablated tissues, and carry the risk for vessel perforation. We present first time post-classification of ablated tissues using acoustic signals recorded by a microphone placed nearby during five atherectomy procedures using 355 nm solid-state Auryon laser device performed with an SBS approach, some with highly severe calcification. Using our machine-learning algorithm, the classification results of these ablation signals recordings from five patients showed 93.7% classification accuracy with arterial vs nonarterial wall material. While still very preliminary and requiring a larger study and thereafter as commercial device, the results of these first acoustic post-classification in SBS cases are very promising. This study implies, as a general statement, that online recording of the acoustic signals using a noncontact microphone, may potentially serve for an online classification of the ablated tissue in SBS cases. This technology could be used to confirm correct positioning in the vasculature, and by this, to potentially further reduce the risk of perforation using 355 nm laser atherectomy in such procedures.

The risk of renal function deterioration in abdominal aortic stent graft patients with and without previous kidney function failure - an analysis of risk factors.

PURPOSE: Kidney failure influences the treatment outcomes of abdominal aortic aneurysm (AAA). A prospective study of renal function before and after aortic stent-graft treatment was performed. Special attention was paid to the influence of preoperative kidney function as well as the impact of the radiological follow-up. MATERIAL AND METHODS: A total of 214 endovascularly treated AAA patients were included. In all cases, pre- and postope-rative estimated glomerular filtration rate (eGFR) and serum creatinine were noted. Patients were prospectively followed up for a minimum of two years. RESULTS: The baseline eGFR was 69.38 ± 16.29 ml/min/1.73 m2. Chronic kidney disease at baseline was noted in 29% of patients. In the direct postoperative period, acute kidney injury was identified in 8.4% of cases. Additional endo-vascular procedures within two years of observation were performed in 5.6% of cases, and over the two years of follow-up, in the study group from one to six angio-computed tomographic scans (angio-CT) per patient were performed. The mean eGFR value after the 24-month follow-up was significantly lower than the preoperative value. Among the factors influencing kidney function, an angio-CT during the same hospital stay of the primary stent-graft procedures was identified. The type of stent-graft, contrast volume during the primary procedure, need for reintervention, concomitant disease presence, and statin use did not show statistical significance. CONCLUSIONS: Angio-CT followed by stent-graft implantation over a short time interval (within the same hospitalisation) significantly worsened renal function in the late follow-up and should be avoided in elective AAA cases.

[A role of kallikrein-kinin system in gut diseases]. / Rola ukladu kalikreina-kininy w chorobach przewodu pokarmowego.

Kallikreins are serine proteases, which are divided into plasma kallikrein and tissue kallikrein. Kallikreins cleave kininogen, theirs main substrate to release bradykinin, a potent inflammatory mediator. Kinins act directly by B2 and B1 receptors, or indirectly stimulating synthesis of nitric oxide, prostanoids and cytokinines by epithelial cells, smooth muscle cells, endothelial cells and fibroblasts. Recent experimental studies and clinical data indicate a pathogenic role of the kallikrein-kinin system in gastrointestinal disorders including inflammatory bowel disease, acute pancreatitis, colorectal and gastric cancer and pathogenesis of ascites. New molecular biology techniques and development of specific antibodies permit to evaluate the expression of genes and localization of proteins of the kallikrein-kinin components. Experimental studies indicate a modulatory effect of a specific kallikrein inhibition and kinin receptor antagonist suggesting its therapeutic potential in human gut diseases.

[Instillagel in prevention of postoperative urinary tract infection--randomized trial]. / Instillagel w profilaktyce pooperacyjnych zakazen ukladu moczowego. Badanie randomizowane.

UNLABELLED: The progress of operative technique, introduction of new drugs, modernizing of medical equipment are the cause of long and complicated operations. For that reason, the number of patients, who need the catheterization of the urinary bladder is increasing. The use of the vesical catheter over 5 days is the cause of the urinary tract infection (bacterial and mycotic), the bacteraemia and the extension of the time of recovery. The aim of the study was the estimation of the usefulness of the preparation Instillagel used at the time of the urinary bladder catheterization in the patients before an operation, in aspect of frequency of urinary tract infection. Between January and December 2000, 59 patients were selected for the study. The patients were divided into two groups. In the first group, the preparation Instillagel was used at the time of the catheterization. In the control group 2% Lignocainum hydrochloricum was used at the time of the catheterization. The study was prospective and randomized. The usefulness of the preparation Insillagel was estimated through the comparison of frequency of the urinary tract infection in both groups. The catheterization of the urinary bladder was performed according to aseptic principle. The difference between number and age of the patients in both groups was not statistically significant (p = 0.8538). The time of the keeping of the vesical catheter was similar in both groups (p = 0.576635). The urinary tract infection estimated on the basis of clinical symptoms and laboratory findings was diagnosed in 13 patients (5 patients in the first group, and 8 patients in the control group). The frequency of urinary tract infection was not statistically significant in both groups. CONCLUSIONS: The urinary tract infection is frequent complication in patients with catheter in the urinary bladder, before operation. The frequency of urinary tract infection was not statistically significant in both groups. The discomfort and pain occurred with the same frequency in both groups.