Jan Paweł Skóra - Academia.edu (original) (raw)
Papers by Jan Paweł Skóra
Acta Angiologica, 2002
Background. The study was performed to examine the healing process of a vascular prosthesis impla... more Background. The study was performed to examine the healing process of a vascular prosthesis implanted into the arterial system and the formation of neointima. Materials and methods. The study was conducted on 16 dogs in which PTFE prostheses of 6 mm diameter had been implanted in the aortofemoral region. The animals underwent autopsy after 6 months. The prosthesis together with the aorta and the femoral artery was explanted in order to perform tests of the proximal and distal anastomosis area under the light and the transmission electron microscopes. Results. It was confirmed that the inner membrane (intima) of the distal anastomosis was thicker. The results were highly statistically significant (p = 0.0000000002824). Contrary to the proximal anastomosis, the area of the distal anastomosis revealed the presence of macrophages and granulocytes, being the markers of the active inflammatory reaction. Additionally, there were more myofibroblasts in this area and collagen deposits were bigger. Conclusions. The differences between the proximal and distal anastomosis are the result of haemodynamic processes. Tangential stress, appearing parallel to the blood flow, is much more prominent in the distal anastomosis area as opposed to the shear stress, appearing perpendicular to the vessel. Therefore, neointimal thickening in the area of distal anastomosis is caused by haemodynamic factors and the biological incompatibility of the prosthesis and the artery (compliance mismatch). Prolonged stimulation of the inflammatory process causes the formation of neointima as well as the increased collagen production, hypertrophy and thickening of the inner membrane. All of these result in haemodynamic disturbances, the increase of the vascular resistance and the turbulent blood flow. They, in turn, may become the cause of clinical complications such as thrombosis of the prosthesis, late prosthesis infection and formation of the aneurysm in the area of anastomosis.
Advances in Clinical and Experimental Medicine, 2008
Background. Gene therapy is a new approach in the treatment of cardiovascular diseases such as at... more Background. Gene therapy is a new approach in the treatment of cardiovascular diseases such as atherosclerosis, restenosis, hypertension, and thrombotic disease. Non−viral delivery systems have low transfection efficiency, especially in primary cells such as vascular endothelial cells. To improve the delivery efficiency of genetic mater− ial into cells by non−viral carriers, further investigations are required. Objectives. The purpose of this study was to evaluate non−viral transfection reagents with respect to transfection efficiency and cytotoxicity in the HUVEC line. The transcriptional activities of the CMV and SV40 promoters in human endothelial cells were also analyzed and compared. Material and Methods. Four commercially available transfection reagents (ExGen 500, jetPEI TM , FuGENE ® HD, and Metafectene TM PRO) and EGFP−encoding plasmid were studied. In vitro transfection efficiency in the HUVEC line was assayed by the number of EGFP−expressing cells using fluorescence micro...
Advances in clinical and experimental medicine : official organ Wroclaw Medical University
Chronic limb ischemia is a serious clinical problem. Patients who do not qualify for standard tre... more Chronic limb ischemia is a serious clinical problem. Patients who do not qualify for standard treatment may benefit from novel gene therapies. This study evaluated angiogenesis following intramuscular injections of angiogenic plasmid Ang-1 in Fisher rats. Twenty rats had plasmids injected intramuscularly in their hind limbs. The study group consisted of 10 animals which received the Ang-1 plasmid, while the control group consisted of 10 rats that received an empty plasmid. All the animals were euthanized after 12 weeks and tissue samples from the hind limb thigh muscles and internal organs were harvested for histological and immunohistochemical examinations. To assess the angiogenesis the number of vessels in the hind limb muscles visualized by the SMA and FVIII markers was counted for each animal in five separate microscopic fields. There were no pathological lesions or any signs of neoplastic angiogenesis in any of the 20 rats. The number of vessels visualized by the FVIII marker ...
Acta Angiologica, 2005
Implantation of a vascular prosthesis is the therapy of choice in patients with abdominal aortic ... more Implantation of a vascular prosthesis is the therapy of choice in patients with abdominal aortic aneurysms and in patients with atheromatous lesions either occluding the lumen of the aorta and iliac arteries or substantially narrowing it. Epidemiologic studies show an increasing number of patients with aneurysms of the abdominal aorta below the renal arteries. This results from more profound diagnostic methods on one hand, and on the other-from the ageing of the population. Patients undergoing routine abdominal aortic surgery often present myocardial ischemic disease, past myocardial infarctions, arterial hypertension, impaired pulmonary gas exchange, diabetes and cerebral vessels insufficiency. Therefore, planned for the heaviest vascular surgery, they belong to the group at greatest operative risk. The aim of this thesis was to show the present stateof-the-art of clamping and releasing the clamp in the abdominal part of the aorta, the impact of the occlusion on life-sustaining organs and procedures aimed at minimization of haemodynamic changes occurring during the most overburdening phases of the surgery. The crucial role of proper preoperative procedures is stressed, including cardiologic diagnostics up to coronarography when reasonable, as well as optimization of the patient's condition before surgery. The authors present general principles of anaesthesia in this kind of surgery considering up to date knowledge about the benefits of combined general and epidural anaesthesia compared to sole general anaesthesia, appropriate pain control, adequate fluids dosing as well as monitoring during the postoperative period. The importance of cooperation within a multidisciplinary team, consisting of a surgeon, anaesthetist, cardiologist and, when necessary, nephrologist or neurologist, is stressed.
Chirurgia Polska, 2002
Streszczenie Infekcja po wszczepieniu protez z materiałów sztucznych stanowi ogromny problem w ch... more Streszczenie Infekcja po wszczepieniu protez z materiałów sztucznych stanowi ogromny problem w chirurgii naczyniowej. W pracy przedstawiono 2 przypadki zakażenia protezy naczyniowej aortalno-dwuudowej, ograniczone do dystalnej części ramienia. Ze względu na brak efektu leczenia przy zastosowaniu metod klasycznych chorych operowano, wymieniając zakażony odcinek na homograft tętniczy. Kontrola pooperacyjna wykazała ustąpienie infekcji.
Acta Angiologica, 2006
Background. Background. Background. Background. Background. In this paper, 50 cases of massive ao... more Background. Background. Background. Background. Background. In this paper, 50 cases of massive aorto-ilio-femoral graft infection treated by the replacement of infected prosthesis with arterial homograft in the
Chirurgia Polska, 2003
Wstęp: Autorzy w pracy przedstawili własną modyfikację dostępu operacyjnego w leczeniu infekcji p... more Wstęp: Autorzy w pracy przedstawili własną modyfikację dostępu operacyjnego w leczeniu infekcji protez naczyniowych. Wymiana zakażonej protezy naczyniowej, często protezy aortalno-dwuudowej jest ciężkim zabiegiem operacyjnym, szczególnie trudnym w przypadku przetoki aortalno-dwunastniczej. Materiał i metody: Badanie objęło 37 chorych leczonych operacyjnie z powodu infekcji protezy naczyniowej aortalno-dwuudowej dakronowej. Pierwsza grupa (7 chorych) z dostępem pośrodkowym i druga grupa (30 chorych) z własną modyfikacją dostępu. W przedstawionej modyfikacji stosuje się cięcie skośne od łuku żebrowego lewego do kolca biodrowego górnego prawego i odsłania przestrzeń zaotrzewnową wypreparowując aortę brzuszną na wysokości odejścia tętnic nerkowych. Wyniki: W drugiej grupie uzyskano skrócenie czasu zabiegu operacyjnego i zmniejszenie utraty krwi. Wnioski: Własny dostęp operacyjny ułatwia wymianę zakażonej protezy i ewentualną operację na przewodzie pokarmowym.
Advances in clinical and experimental medicine : official organ Wroclaw Medical University
There is no data available explaining the correlation between the intensity of exercise training ... more There is no data available explaining the correlation between the intensity of exercise training and kidney transplant recipients' health and fitness condition. A retrospective study was performed using a questionnaire form. The questionnaire was filled out by members of the Polish department of the World Transplant Games Federation and the Polish Association of People on Dialysis and After Kidney Transplantation. 167 patients (Age: 36 ± 11 yrs, Males: 52%) were enrolled in the study. Even two hours of exercise per week after the transplantation statistically significantly ameliorated the recipients' self-reported health (p = 0.007) and fitness condition (p < 0.0001). The amount of time devoted weekly to sports positively correlated with the patient's health and fitness condition (p = 0.00325 and p = 0.00123 respectively). People who did not exercise had higher BMI levels than those who practiced sports (25.8 ± 5.2 and 24 ± 3.99 respectively, p = 0.0003) but the weekl...
Polski przeglad chirurgiczny, 2012
Inflammatory mediators play an important role in thrombosis etiopathology. Diagnostic radioisotop... more Inflammatory mediators play an important role in thrombosis etiopathology. Diagnostic radioisotopic tests can be used to assess the activity of thrombo-inflammatory process. The aim of the study was to assess the suitability of Tc-99m HMPAO labelled leukocyte scintigraphy in the diagnostics of deep vein thrombosis. The study covered 45 patients with lower limb deep vein thrombosis treated in 2009 at the Department of Vascular, General and Transplantological Surgery of the Wrocław Medical University. Scintigraphic test were performed during the first few days after the onset of symptoms and 8 weeks later. All patients with active deep vein thrombosis had higher levels of TC-99m-HMPAO markers in sick limbs. After 8 weeks, 93% of patients still had elevated levels of radioisotope in limbs with an active thrombosis process. However, the levels of markers were clearly lower than in the acute phase of thrombosis. 1. In the chronic phase of thrombosis, 93% of patients still have higher lev...
Polimery w medycynie, 2011
The chronic lower limbs ischaemia is caused mainly by arteriosclerosis. After insufficient conser... more The chronic lower limbs ischaemia is caused mainly by arteriosclerosis. After insufficient conservative treatment only the surgical intervention can salvage the limb. The revascularisation surgery can be performed by open surgery with implantation of the prosthetic bypass or by endovascular angioplasty with stent. This second method seems to be the best alternative for the patients with several concomitant systemic diseases. Nevertheless it is limited by presence of the long-distance arteriosclerotic lesions. The resolve of that problem is use of new generation of long endovascular covered stents. They can be succesfuly used in aorto-femoral and femoro-popliteal segment. Their efficiacy is simmilar to traditional prosthetic grafts.
Polimery w medycynie, 2011
In order to determine the processes arising during the healing in vascular grafts the following e... more In order to determine the processes arising during the healing in vascular grafts the following experiment was desinged in 16 dogs. The animals underwent implantation of unilateral bypass aorto-femoral (straight prosthesis from politetrafluoroethylrne--PTFE). After the 6 months all the animals sacrificed and vascular grafts were dissected and exam in electron microscopy. There were significant differences in the histological findings in structure of neoitima between the proximal and distal anastomoses vascular prostheses. There were evidence of presence of fibroblasts but not macrophages in proximal anastomoses The histological structure of the proximal anastomoses indicates that inflammatory processes was ended during the prosthesis healing. There were presence of macrophages and myofibroblasts, some in the active secretion of collagen in distal anastomoses. Theses images of vascular anastomoses of artery with politerafluoroeth-ylene prosthesis corresponds to the chronic inflammato...
![Research paper thumbnail of [The use of the synthetic silver coated prosthesis and penduculated omentum flap in the treatment of prostheses infection]](https://attachments.academia-assets.com/113090888/thumbnails/1.jpg)
](Polimery w medycynie, 2009
There is a methods of surgical treatment of secondary enteroaortal fistula after infection of vas... more There is a methods of surgical treatment of secondary enteroaortal fistula after infection of vascular prostheses with the use silver prosthesis and great omentum. Secondary enteroaortal fistula is the most serious complication followed infection of vascular prosthesis, with high risk of death rate regardless of different operative methods. Patients is operated and the dracon prosthesis was exchanged to arterial homograft, which is more resistant to infections or subclavio-femoral bypasses. Removing of intestinal fistula included resection of duodenum and gastroenterotomy or duodenorrhaphy. The modification of duodenal fistula provision relies on duodenorraphy and protection of that area and prosthesis with pediculated flap of gastrocolic omentum conducted retrocolicaly in retroperitoneum space. The retrocolical and retroperitoneal omentoplasty seems to be a practical modification of aorto-duodenal fistula treatment with useful protection of duodenal plastic.
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2007
The paper presents the results of our hybrid gene-cell therapy in case of critical lower limb isc... more The paper presents the results of our hybrid gene-cell therapy in case of critical lower limb ischemia. Eighteen patients with critical limb ischemia were enrolled to the study. The bone marrow from each patient was harvested. It had been incubated with VEGF165 gene plasmid for two hours before it was administrated intramuscularly into patient's lower limb. In the study we evaluated: safety, clinical outcomes of the therapy, venous blood VEGF protein concentration before and after (at: 7th, 14th, 28th and 90th day) administration of the stem cells. We obtained samples of muscles from the patients who underwent the limb amputation, which were examined histological and by PCR (Polymerase Chain Reaction) for detection of plasmid genes. We observed very good clinical outcomes of the therapy. In ten of eighteen patients (-55%) critical lower limb ischemia symptoms subsided--they saved their limbs. The serum VEGF concentration was higher than in healthy controls (p < 0.05). We obse...
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2006
In the study we assessed the clinical and histological benefits of gene therapy in no-option pati... more In the study we assessed the clinical and histological benefits of gene therapy in no-option patients with critical lower limb ischemia. We administrated VEGF165 (Vascular Endothelial Growth Factor) plasmid to 10 patients. The plasmid was injected intramuscularly into lower limb. In the study we evaluated: clinical outcomes, venous blood VEGF protein concentration before and after (7th, 14th, 28th and 90th day) administration of plasmid. From patients who required amputation we obtained samples of muscles, which were examined histological and by PCR (Polymerase Chain Reaction) for detection of plasmid genes. Only two patients from the group did not require amputation due to the therapy. In eight patients the operation was essential. Serum VEGF concentration was higher than in healthy controls (p < 0.05). We observed increase of the concentration of the cytokine on the 14th day an decrease on the 90th day after administration of plasmid (p < 0.05). Histological analysis did not...
![Research paper thumbnail of [The use of silver/collagen coated vascular prostheses in infected environment]](https://attachments.academia-assets.com/113090930/thumbnails/1.jpg)
](Polimery w medycynie, 2006
The purpose of this study is to evaluate of the use of and silver-coated medical prosthesis in ca... more The purpose of this study is to evaluate of the use of and silver-coated medical prosthesis in cases of the massive vascular graft infection. In this paper the use of silver-coated medical prosthesis (29 patients) of massive dacron graft infection in Departament of Vascular, General and Transplantation Surgery In Wroclaw University of Medicine In the years 1999-2004 is presented. For lack of tissue material and because of the exclusion of extraanatomic bypass application, in situ replacement was attempted using silver-coated dacron vascular prosthesis more resistant to infection. Before and after the surgery in all patients imaging studies were performed. Duplex-Doppler Ultrasound demonstrated perigraft fluid collections and the scintigraphy with use of Technetium-labeled leukocytes revealed vast migration to the infected prosthesis. The remission of the symptoms of infection was obtained. In the postoperative follow up no perigraft fluid collections were observed. In the most cases...
Polimery w medycynie, 2004
In this paper the treatment of arterial complications of the Thoracic Outlet Syndrome (TOS) is pr... more In this paper the treatment of arterial complications of the Thoracic Outlet Syndrome (TOS) is presented. The investigation of 14 patients treated in the Department of Vascular, General and Transplantological Surgery of the Wroclaw Medical University for arterial complications of the TOS (as upper limb ischemia and/or the subclavian artery aneurysm in 14 patients) was performed. In case of complications associated with compression of the subclavian artery the operation consisted of resection of the first rib and accessory osseous and muscular pathological elements using supraclavicular and/or infraclavicular approach with implantation of externally supported ringed vascular polytetrafluoroethylene bypass (PTFE) were performed. The therapy results were estimated with use of The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire of American Academy of Orthopedic Surgeons. In case of upper limb ischemia the improvement of blood flow was obtained after the subclavian-brachi...
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2004
In order to study pathogenesis of vascular prosthesis healing process the following experiment wa... more In order to study pathogenesis of vascular prosthesis healing process the following experiment was designed. 16 dogs underwent implantation of unilateral straight aorto-femoral teflon (PTFE, polytetrafluoroethylene) by-pass. After 6 months all dogs were killed, dissected and vascular prostheses with margin of adjacent aorta and femoral artery were collected for further study. Areas of proximal and distal anastomosis were examined immunohistochemically. Presence of coagulation factor VII, and C3 complement factor were studied. The obtained results were analyzed statistically by means of t-Student test. Factor VII as well C3 were found in areas of both proximal and distal anastomosis. Concentration of all two substances in proximal and distal anastomosis was compared. No statistically valid differences in factor VII concentration in proximal and distal anastomosis were found, whereas amounts of C3 factor as well as degree of extracellular matrix infiltration were markedly higher in di...
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2004
There is growing experimental evidence that Chlamydia pneumoniae is a risk factor and contribute ... more There is growing experimental evidence that Chlamydia pneumoniae is a risk factor and contribute to the development of atherosclerosis of carotid artery. This process might cause stenosis of carotid artery and TIA or stroke. Aim of this study was to evaluate the frequency of Ch. pneumoniae infection in carotid artery stenosis patients and in control group-healthy artery from multiorgan donors. From each of 84 patients undergoing carotid endarterectomy the samples were analyzed by nested PCR for Ch. pneumoniae DNA. Furthermore we determined DNA Ch. pneumoniae in carotid artery from 20 multiorgan donors. In control group-healthy artery the PCR for Ch. pneumoniae was negative in all samples. Ch. pneumoniae was detected in 57 patients (67.85%) with symptomatic carotid artery stenosis, however in 27 patients (32.15%) the PCR test was negative. We did not observe infection of Ch. pneumoniae in healthy carotid artery-control group. We noted great frequency of infection in patients with ste...
Folia morphologica, 2003
Cases of massive purulent infection of vascular prosthesis are demonstrated in this study. Infect... more Cases of massive purulent infection of vascular prosthesis are demonstrated in this study. Infected prosthesis was substituted by arterial homograft, harvested during multi-organ procurement, and stored by the cold ischaemia method. In the follow-up period, the patients were divided into two groups, those treated with immunosuppression (n = 16) and those treated without immunosuppressive drugs (n = 13). The patients underwent resurgery, during which a fragment of arterial wall was taken for electron microscopic examination. In the group with immunosuppression, the presence of the following structures was observed: endothelial cells, the intima, with a great number of elastic and collagen fibrils with fibrinogen inclusions, and active phagocyting myoblasts and myofibroblasts. In the group without immunosuppression electron microscopic examination showed the total destruction of the wall of the ruptured arterial homograft - absence of endothelium and sparse, damaged fibroblasts of the...
Polish Journal of Surgery, 2012
in Wrocław 3 Kierownik: prof. dr hab. m. sąsiadek the aim of the study was to analyse early resul... more in Wrocław 3 Kierownik: prof. dr hab. m. sąsiadek the aim of the study was to analyse early results of treatment of acute type B aortic dissection. material and methods. 59 patients, treated between 1998 and 2011, were divided into four groups. Group I comprised ten patients in whom hybrid procedures were performed: extra-anatomical bypass graft from the brachio-cephalic trunk to the left carotid artery in six patients, transposition of the left carotid artery to the right one in two patients, and reversed Y prosthesis from the brachio-cephalic trunk to both carotids in the remaining 2 patients, to facilitate stent-grafting. Group II comprised 13 patientsin whom endovascular procedures were performed (stent-grafting). Group III comprised 21 patients in whom conventional surgery was done. Group IV comprised 15 patients who were treated conservatively. Results. In group I, a very good clinical outcome, without complications, was achieved in six patients (60% of cases). The total mortality rate was 40%. One patient died on the operation table, following stent-grafting, due to the rupture of the aortic arch. Two patients died as a result of brain damage (cerebral aneurysm rupture in one, and ischemic stroke in the other). In one patient, an aorto-oesophageal fistula developed. In group II, one patient died during endovascular procedure. Another patient suffered from type 1 endoleak, requiring repeated endovascular surgery.In group III, 15 patients (72%) died. Moreover, four patients required acorrective cardiac surgery (Bentall procedure)which in three patients resulted in death. Thus, the total mortality rate in this group was as high as 85%. In group IV, the mortality rate was13%. Conclusions. We noticed a clear superiority of endovascular procedures over conventional surgeriesfor acute type B aortic dissection. Hybrid procedures for acute, complicated type B aortic dissection evidently reduce mortality and postoperative morbidity. Uncomplicated acute type B aortic dissections should be treated conservatively at intensivecare units.
Acta Angiologica, 2002
Background. The study was performed to examine the healing process of a vascular prosthesis impla... more Background. The study was performed to examine the healing process of a vascular prosthesis implanted into the arterial system and the formation of neointima. Materials and methods. The study was conducted on 16 dogs in which PTFE prostheses of 6 mm diameter had been implanted in the aortofemoral region. The animals underwent autopsy after 6 months. The prosthesis together with the aorta and the femoral artery was explanted in order to perform tests of the proximal and distal anastomosis area under the light and the transmission electron microscopes. Results. It was confirmed that the inner membrane (intima) of the distal anastomosis was thicker. The results were highly statistically significant (p = 0.0000000002824). Contrary to the proximal anastomosis, the area of the distal anastomosis revealed the presence of macrophages and granulocytes, being the markers of the active inflammatory reaction. Additionally, there were more myofibroblasts in this area and collagen deposits were bigger. Conclusions. The differences between the proximal and distal anastomosis are the result of haemodynamic processes. Tangential stress, appearing parallel to the blood flow, is much more prominent in the distal anastomosis area as opposed to the shear stress, appearing perpendicular to the vessel. Therefore, neointimal thickening in the area of distal anastomosis is caused by haemodynamic factors and the biological incompatibility of the prosthesis and the artery (compliance mismatch). Prolonged stimulation of the inflammatory process causes the formation of neointima as well as the increased collagen production, hypertrophy and thickening of the inner membrane. All of these result in haemodynamic disturbances, the increase of the vascular resistance and the turbulent blood flow. They, in turn, may become the cause of clinical complications such as thrombosis of the prosthesis, late prosthesis infection and formation of the aneurysm in the area of anastomosis.
Advances in Clinical and Experimental Medicine, 2008
Background. Gene therapy is a new approach in the treatment of cardiovascular diseases such as at... more Background. Gene therapy is a new approach in the treatment of cardiovascular diseases such as atherosclerosis, restenosis, hypertension, and thrombotic disease. Non−viral delivery systems have low transfection efficiency, especially in primary cells such as vascular endothelial cells. To improve the delivery efficiency of genetic mater− ial into cells by non−viral carriers, further investigations are required. Objectives. The purpose of this study was to evaluate non−viral transfection reagents with respect to transfection efficiency and cytotoxicity in the HUVEC line. The transcriptional activities of the CMV and SV40 promoters in human endothelial cells were also analyzed and compared. Material and Methods. Four commercially available transfection reagents (ExGen 500, jetPEI TM , FuGENE ® HD, and Metafectene TM PRO) and EGFP−encoding plasmid were studied. In vitro transfection efficiency in the HUVEC line was assayed by the number of EGFP−expressing cells using fluorescence micro...
Advances in clinical and experimental medicine : official organ Wroclaw Medical University
Chronic limb ischemia is a serious clinical problem. Patients who do not qualify for standard tre... more Chronic limb ischemia is a serious clinical problem. Patients who do not qualify for standard treatment may benefit from novel gene therapies. This study evaluated angiogenesis following intramuscular injections of angiogenic plasmid Ang-1 in Fisher rats. Twenty rats had plasmids injected intramuscularly in their hind limbs. The study group consisted of 10 animals which received the Ang-1 plasmid, while the control group consisted of 10 rats that received an empty plasmid. All the animals were euthanized after 12 weeks and tissue samples from the hind limb thigh muscles and internal organs were harvested for histological and immunohistochemical examinations. To assess the angiogenesis the number of vessels in the hind limb muscles visualized by the SMA and FVIII markers was counted for each animal in five separate microscopic fields. There were no pathological lesions or any signs of neoplastic angiogenesis in any of the 20 rats. The number of vessels visualized by the FVIII marker ...
Acta Angiologica, 2005
Implantation of a vascular prosthesis is the therapy of choice in patients with abdominal aortic ... more Implantation of a vascular prosthesis is the therapy of choice in patients with abdominal aortic aneurysms and in patients with atheromatous lesions either occluding the lumen of the aorta and iliac arteries or substantially narrowing it. Epidemiologic studies show an increasing number of patients with aneurysms of the abdominal aorta below the renal arteries. This results from more profound diagnostic methods on one hand, and on the other-from the ageing of the population. Patients undergoing routine abdominal aortic surgery often present myocardial ischemic disease, past myocardial infarctions, arterial hypertension, impaired pulmonary gas exchange, diabetes and cerebral vessels insufficiency. Therefore, planned for the heaviest vascular surgery, they belong to the group at greatest operative risk. The aim of this thesis was to show the present stateof-the-art of clamping and releasing the clamp in the abdominal part of the aorta, the impact of the occlusion on life-sustaining organs and procedures aimed at minimization of haemodynamic changes occurring during the most overburdening phases of the surgery. The crucial role of proper preoperative procedures is stressed, including cardiologic diagnostics up to coronarography when reasonable, as well as optimization of the patient's condition before surgery. The authors present general principles of anaesthesia in this kind of surgery considering up to date knowledge about the benefits of combined general and epidural anaesthesia compared to sole general anaesthesia, appropriate pain control, adequate fluids dosing as well as monitoring during the postoperative period. The importance of cooperation within a multidisciplinary team, consisting of a surgeon, anaesthetist, cardiologist and, when necessary, nephrologist or neurologist, is stressed.
Chirurgia Polska, 2002
Streszczenie Infekcja po wszczepieniu protez z materiałów sztucznych stanowi ogromny problem w ch... more Streszczenie Infekcja po wszczepieniu protez z materiałów sztucznych stanowi ogromny problem w chirurgii naczyniowej. W pracy przedstawiono 2 przypadki zakażenia protezy naczyniowej aortalno-dwuudowej, ograniczone do dystalnej części ramienia. Ze względu na brak efektu leczenia przy zastosowaniu metod klasycznych chorych operowano, wymieniając zakażony odcinek na homograft tętniczy. Kontrola pooperacyjna wykazała ustąpienie infekcji.
Acta Angiologica, 2006
Background. Background. Background. Background. Background. In this paper, 50 cases of massive ao... more Background. Background. Background. Background. Background. In this paper, 50 cases of massive aorto-ilio-femoral graft infection treated by the replacement of infected prosthesis with arterial homograft in the
Chirurgia Polska, 2003
Wstęp: Autorzy w pracy przedstawili własną modyfikację dostępu operacyjnego w leczeniu infekcji p... more Wstęp: Autorzy w pracy przedstawili własną modyfikację dostępu operacyjnego w leczeniu infekcji protez naczyniowych. Wymiana zakażonej protezy naczyniowej, często protezy aortalno-dwuudowej jest ciężkim zabiegiem operacyjnym, szczególnie trudnym w przypadku przetoki aortalno-dwunastniczej. Materiał i metody: Badanie objęło 37 chorych leczonych operacyjnie z powodu infekcji protezy naczyniowej aortalno-dwuudowej dakronowej. Pierwsza grupa (7 chorych) z dostępem pośrodkowym i druga grupa (30 chorych) z własną modyfikacją dostępu. W przedstawionej modyfikacji stosuje się cięcie skośne od łuku żebrowego lewego do kolca biodrowego górnego prawego i odsłania przestrzeń zaotrzewnową wypreparowując aortę brzuszną na wysokości odejścia tętnic nerkowych. Wyniki: W drugiej grupie uzyskano skrócenie czasu zabiegu operacyjnego i zmniejszenie utraty krwi. Wnioski: Własny dostęp operacyjny ułatwia wymianę zakażonej protezy i ewentualną operację na przewodzie pokarmowym.
Advances in clinical and experimental medicine : official organ Wroclaw Medical University
There is no data available explaining the correlation between the intensity of exercise training ... more There is no data available explaining the correlation between the intensity of exercise training and kidney transplant recipients' health and fitness condition. A retrospective study was performed using a questionnaire form. The questionnaire was filled out by members of the Polish department of the World Transplant Games Federation and the Polish Association of People on Dialysis and After Kidney Transplantation. 167 patients (Age: 36 ± 11 yrs, Males: 52%) were enrolled in the study. Even two hours of exercise per week after the transplantation statistically significantly ameliorated the recipients' self-reported health (p = 0.007) and fitness condition (p < 0.0001). The amount of time devoted weekly to sports positively correlated with the patient's health and fitness condition (p = 0.00325 and p = 0.00123 respectively). People who did not exercise had higher BMI levels than those who practiced sports (25.8 ± 5.2 and 24 ± 3.99 respectively, p = 0.0003) but the weekl...
Polski przeglad chirurgiczny, 2012
Inflammatory mediators play an important role in thrombosis etiopathology. Diagnostic radioisotop... more Inflammatory mediators play an important role in thrombosis etiopathology. Diagnostic radioisotopic tests can be used to assess the activity of thrombo-inflammatory process. The aim of the study was to assess the suitability of Tc-99m HMPAO labelled leukocyte scintigraphy in the diagnostics of deep vein thrombosis. The study covered 45 patients with lower limb deep vein thrombosis treated in 2009 at the Department of Vascular, General and Transplantological Surgery of the Wrocław Medical University. Scintigraphic test were performed during the first few days after the onset of symptoms and 8 weeks later. All patients with active deep vein thrombosis had higher levels of TC-99m-HMPAO markers in sick limbs. After 8 weeks, 93% of patients still had elevated levels of radioisotope in limbs with an active thrombosis process. However, the levels of markers were clearly lower than in the acute phase of thrombosis. 1. In the chronic phase of thrombosis, 93% of patients still have higher lev...
Polimery w medycynie, 2011
The chronic lower limbs ischaemia is caused mainly by arteriosclerosis. After insufficient conser... more The chronic lower limbs ischaemia is caused mainly by arteriosclerosis. After insufficient conservative treatment only the surgical intervention can salvage the limb. The revascularisation surgery can be performed by open surgery with implantation of the prosthetic bypass or by endovascular angioplasty with stent. This second method seems to be the best alternative for the patients with several concomitant systemic diseases. Nevertheless it is limited by presence of the long-distance arteriosclerotic lesions. The resolve of that problem is use of new generation of long endovascular covered stents. They can be succesfuly used in aorto-femoral and femoro-popliteal segment. Their efficiacy is simmilar to traditional prosthetic grafts.
Polimery w medycynie, 2011
In order to determine the processes arising during the healing in vascular grafts the following e... more In order to determine the processes arising during the healing in vascular grafts the following experiment was desinged in 16 dogs. The animals underwent implantation of unilateral bypass aorto-femoral (straight prosthesis from politetrafluoroethylrne--PTFE). After the 6 months all the animals sacrificed and vascular grafts were dissected and exam in electron microscopy. There were significant differences in the histological findings in structure of neoitima between the proximal and distal anastomoses vascular prostheses. There were evidence of presence of fibroblasts but not macrophages in proximal anastomoses The histological structure of the proximal anastomoses indicates that inflammatory processes was ended during the prosthesis healing. There were presence of macrophages and myofibroblasts, some in the active secretion of collagen in distal anastomoses. Theses images of vascular anastomoses of artery with politerafluoroeth-ylene prosthesis corresponds to the chronic inflammato...
Polimery w medycynie, 2009
There is a methods of surgical treatment of secondary enteroaortal fistula after infection of vas... more There is a methods of surgical treatment of secondary enteroaortal fistula after infection of vascular prostheses with the use silver prosthesis and great omentum. Secondary enteroaortal fistula is the most serious complication followed infection of vascular prosthesis, with high risk of death rate regardless of different operative methods. Patients is operated and the dracon prosthesis was exchanged to arterial homograft, which is more resistant to infections or subclavio-femoral bypasses. Removing of intestinal fistula included resection of duodenum and gastroenterotomy or duodenorrhaphy. The modification of duodenal fistula provision relies on duodenorraphy and protection of that area and prosthesis with pediculated flap of gastrocolic omentum conducted retrocolicaly in retroperitoneum space. The retrocolical and retroperitoneal omentoplasty seems to be a practical modification of aorto-duodenal fistula treatment with useful protection of duodenal plastic.
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2007
The paper presents the results of our hybrid gene-cell therapy in case of critical lower limb isc... more The paper presents the results of our hybrid gene-cell therapy in case of critical lower limb ischemia. Eighteen patients with critical limb ischemia were enrolled to the study. The bone marrow from each patient was harvested. It had been incubated with VEGF165 gene plasmid for two hours before it was administrated intramuscularly into patient's lower limb. In the study we evaluated: safety, clinical outcomes of the therapy, venous blood VEGF protein concentration before and after (at: 7th, 14th, 28th and 90th day) administration of the stem cells. We obtained samples of muscles from the patients who underwent the limb amputation, which were examined histological and by PCR (Polymerase Chain Reaction) for detection of plasmid genes. We observed very good clinical outcomes of the therapy. In ten of eighteen patients (-55%) critical lower limb ischemia symptoms subsided--they saved their limbs. The serum VEGF concentration was higher than in healthy controls (p < 0.05). We obse...
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2006
In the study we assessed the clinical and histological benefits of gene therapy in no-option pati... more In the study we assessed the clinical and histological benefits of gene therapy in no-option patients with critical lower limb ischemia. We administrated VEGF165 (Vascular Endothelial Growth Factor) plasmid to 10 patients. The plasmid was injected intramuscularly into lower limb. In the study we evaluated: clinical outcomes, venous blood VEGF protein concentration before and after (7th, 14th, 28th and 90th day) administration of plasmid. From patients who required amputation we obtained samples of muscles, which were examined histological and by PCR (Polymerase Chain Reaction) for detection of plasmid genes. Only two patients from the group did not require amputation due to the therapy. In eight patients the operation was essential. Serum VEGF concentration was higher than in healthy controls (p < 0.05). We observed increase of the concentration of the cytokine on the 14th day an decrease on the 90th day after administration of plasmid (p < 0.05). Histological analysis did not...
Polimery w medycynie, 2006
The purpose of this study is to evaluate of the use of and silver-coated medical prosthesis in ca... more The purpose of this study is to evaluate of the use of and silver-coated medical prosthesis in cases of the massive vascular graft infection. In this paper the use of silver-coated medical prosthesis (29 patients) of massive dacron graft infection in Departament of Vascular, General and Transplantation Surgery In Wroclaw University of Medicine In the years 1999-2004 is presented. For lack of tissue material and because of the exclusion of extraanatomic bypass application, in situ replacement was attempted using silver-coated dacron vascular prosthesis more resistant to infection. Before and after the surgery in all patients imaging studies were performed. Duplex-Doppler Ultrasound demonstrated perigraft fluid collections and the scintigraphy with use of Technetium-labeled leukocytes revealed vast migration to the infected prosthesis. The remission of the symptoms of infection was obtained. In the postoperative follow up no perigraft fluid collections were observed. In the most cases...
Polimery w medycynie, 2004
In this paper the treatment of arterial complications of the Thoracic Outlet Syndrome (TOS) is pr... more In this paper the treatment of arterial complications of the Thoracic Outlet Syndrome (TOS) is presented. The investigation of 14 patients treated in the Department of Vascular, General and Transplantological Surgery of the Wroclaw Medical University for arterial complications of the TOS (as upper limb ischemia and/or the subclavian artery aneurysm in 14 patients) was performed. In case of complications associated with compression of the subclavian artery the operation consisted of resection of the first rib and accessory osseous and muscular pathological elements using supraclavicular and/or infraclavicular approach with implantation of externally supported ringed vascular polytetrafluoroethylene bypass (PTFE) were performed. The therapy results were estimated with use of The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire of American Academy of Orthopedic Surgeons. In case of upper limb ischemia the improvement of blood flow was obtained after the subclavian-brachi...
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2004
In order to study pathogenesis of vascular prosthesis healing process the following experiment wa... more In order to study pathogenesis of vascular prosthesis healing process the following experiment was designed. 16 dogs underwent implantation of unilateral straight aorto-femoral teflon (PTFE, polytetrafluoroethylene) by-pass. After 6 months all dogs were killed, dissected and vascular prostheses with margin of adjacent aorta and femoral artery were collected for further study. Areas of proximal and distal anastomosis were examined immunohistochemically. Presence of coagulation factor VII, and C3 complement factor were studied. The obtained results were analyzed statistically by means of t-Student test. Factor VII as well C3 were found in areas of both proximal and distal anastomosis. Concentration of all two substances in proximal and distal anastomosis was compared. No statistically valid differences in factor VII concentration in proximal and distal anastomosis were found, whereas amounts of C3 factor as well as degree of extracellular matrix infiltration were markedly higher in di...
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2004
There is growing experimental evidence that Chlamydia pneumoniae is a risk factor and contribute ... more There is growing experimental evidence that Chlamydia pneumoniae is a risk factor and contribute to the development of atherosclerosis of carotid artery. This process might cause stenosis of carotid artery and TIA or stroke. Aim of this study was to evaluate the frequency of Ch. pneumoniae infection in carotid artery stenosis patients and in control group-healthy artery from multiorgan donors. From each of 84 patients undergoing carotid endarterectomy the samples were analyzed by nested PCR for Ch. pneumoniae DNA. Furthermore we determined DNA Ch. pneumoniae in carotid artery from 20 multiorgan donors. In control group-healthy artery the PCR for Ch. pneumoniae was negative in all samples. Ch. pneumoniae was detected in 57 patients (67.85%) with symptomatic carotid artery stenosis, however in 27 patients (32.15%) the PCR test was negative. We did not observe infection of Ch. pneumoniae in healthy carotid artery-control group. We noted great frequency of infection in patients with ste...
Folia morphologica, 2003
Cases of massive purulent infection of vascular prosthesis are demonstrated in this study. Infect... more Cases of massive purulent infection of vascular prosthesis are demonstrated in this study. Infected prosthesis was substituted by arterial homograft, harvested during multi-organ procurement, and stored by the cold ischaemia method. In the follow-up period, the patients were divided into two groups, those treated with immunosuppression (n = 16) and those treated without immunosuppressive drugs (n = 13). The patients underwent resurgery, during which a fragment of arterial wall was taken for electron microscopic examination. In the group with immunosuppression, the presence of the following structures was observed: endothelial cells, the intima, with a great number of elastic and collagen fibrils with fibrinogen inclusions, and active phagocyting myoblasts and myofibroblasts. In the group without immunosuppression electron microscopic examination showed the total destruction of the wall of the ruptured arterial homograft - absence of endothelium and sparse, damaged fibroblasts of the...
Polish Journal of Surgery, 2012
in Wrocław 3 Kierownik: prof. dr hab. m. sąsiadek the aim of the study was to analyse early resul... more in Wrocław 3 Kierownik: prof. dr hab. m. sąsiadek the aim of the study was to analyse early results of treatment of acute type B aortic dissection. material and methods. 59 patients, treated between 1998 and 2011, were divided into four groups. Group I comprised ten patients in whom hybrid procedures were performed: extra-anatomical bypass graft from the brachio-cephalic trunk to the left carotid artery in six patients, transposition of the left carotid artery to the right one in two patients, and reversed Y prosthesis from the brachio-cephalic trunk to both carotids in the remaining 2 patients, to facilitate stent-grafting. Group II comprised 13 patientsin whom endovascular procedures were performed (stent-grafting). Group III comprised 21 patients in whom conventional surgery was done. Group IV comprised 15 patients who were treated conservatively. Results. In group I, a very good clinical outcome, without complications, was achieved in six patients (60% of cases). The total mortality rate was 40%. One patient died on the operation table, following stent-grafting, due to the rupture of the aortic arch. Two patients died as a result of brain damage (cerebral aneurysm rupture in one, and ischemic stroke in the other). In one patient, an aorto-oesophageal fistula developed. In group II, one patient died during endovascular procedure. Another patient suffered from type 1 endoleak, requiring repeated endovascular surgery.In group III, 15 patients (72%) died. Moreover, four patients required acorrective cardiac surgery (Bentall procedure)which in three patients resulted in death. Thus, the total mortality rate in this group was as high as 85%. In group IV, the mortality rate was13%. Conclusions. We noticed a clear superiority of endovascular procedures over conventional surgeriesfor acute type B aortic dissection. Hybrid procedures for acute, complicated type B aortic dissection evidently reduce mortality and postoperative morbidity. Uncomplicated acute type B aortic dissections should be treated conservatively at intensivecare units.