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Papers by Robert Tworus
Streszczenie Rozwarstwienie aorty typu B może być skutecznie leczone zachowawczo w wielu niepowik... more Streszczenie Rozwarstwienie aorty typu B może być skutecznie leczone zachowawczo w wielu niepowikłanych przypadkach i odsetek ten może wynosić nawet 90% chorych. Wystąpienie dodatkowych objawów bólowych z zakresu klatki piersiowej lub jamy brzusznej powinno nasuwać podejrzenie powikłań naczyniowych. Niedokrwienie trzewi jamy brzusznej jest obserwowane w około 30% przypadków rozwarstwień. Jednoczesne wystąpienie objawów w klatce piersiowej i jamie brzusznej obserwowane jest wyjątkowo rzadko. Mężczyzna 54-letni został przyjęty do kliniki w trybie nagłym z podejrzeniem rozwarstwienia aorty. W wy-konanej angiotomografii stwierdzono rozwarstwienie aorty piersiowej rozpoczynające się tuż poniżej lewej tętnicy podobojczykowej i sięgające tętnic biodrowych zewnętrznych. Chory miał wysokie nadciśnienie tętnicze. Jednocześnie stwierdzono objawy zapalenia otrzewnej i radiologiczne cechy perforacji przewodu pokarmowego. Wykonano pilnie laparotomię stwierdzając ogromny ubytek ścian części przedo...
Background: To assess the quality of images obtained from time-resolved MRA together with the acc... more Background: To assess the quality of images obtained from time-resolved MRA together with the accuracy of this technique in diagnosing vascular diseases and the usefulness of haemodynamic information provided by this method.
Videosurgery and Other Miniinvasive Techniques, 2016
Introduction: Ultrasound-guided foam sclerotherapy (UGFS) of varicose veins is a useful treatment... more Introduction: Ultrasound-guided foam sclerotherapy (UGFS) of varicose veins is a useful treatment option. It is a relatively safe method in the case of limited, small varicose veins. In theory, a justified concern could be raised that the injection of an active drug into the large superficial venous vessels may potentially cause life-threatening consequences. Aim: To assess the safety and efficacy of UGFS using a 2% solution of polidocanol (Aethoxysklerol 2%) in the case of great saphenous vein incompetence. Material and methods: Fifty-two patients with great saphenous vein incompetence underwent ultrasound-guided foam sclerotherapy. The efficacy criterion was the elimination of reflux measured ultrasonographically and withdrawal or decrease of complaints: 1 week, and 1, 3, 6 and 12 months after the treatment. Complications of sclerotherapy were reported during follow-up. Results: Decrease or withdrawal of complaints of chronic venous insufficiency was reported in 96% of cases (50 patients). Disappearance or decrease of varicose veins was noted in all patients (100%). During examination after 12 months, full success of ultrasound was achieved in 38 (73%) cases, and 11 (21%) patients presented a partial desired effect according to the consensus from Tegernsee. Persistence of reflux longer than 1 s in the treated great saphenous vein was reported in 3 (6%) cases. Serious complications, such as deep vein thrombosis, pulmonary embolism, dyspnea, anaphylaxis, or neurological abnormalities, were not recorded. Conclusions: Ultrasound-guided foam sclerotherapy of incompetent great saphenous vein and varicosities with 2% polidocanol was found to be an effective and safe method of treatment during 1 year of observation. However, longer observation is necessary.
Acta Angiologica, 2011
Background. The usage of thoracic endografts in the treatment of thoracic aortic lesions is a uni... more Background. The usage of thoracic endografts in the treatment of thoracic aortic lesions is a universally recognized method. Intentional coverage of the left subclavian artery during deployment of the endograft could be associated with several complications such as stroke, spinal cord ischaemia, left arm ischaemia, and vertebrobasilar ischaemia. This study presents the incidence of complications associated with LSA coverage in 60 patients with LSA covered during placement of thoracic endograft. Additionally, the relationship between incidence of complications and factors such as age and type of pathology is analysed. Material and methods. Sixty patients were qualified to the study, 12 women and 48 men between the ages of 23 and 83 years. The mean age was 56 years. A total of 21 patients were operated on for true aneurysm, 9 for post-traumatic aneurysm, 22 for Stanford B dissection, and 8 for Stanford A dissection. Patients were assessed in terms of presence of stroke, spinal cord ischaemia as well as symptoms associated with left arm ischaemia and vertebrobasilar ischaemia. The incidence of present symptoms was analysed in separate subgroups based on the type of pathology of the aorta due to which patients were operated (true aneurysm, traumatic aneurysm, Stanford type A dissection, and Stanford type B dissection) and age subgroups. Results. In none of the 60 patients enrolled for the study spinal cord ischaemia was observed. Two cases (3.3%) of reversible stroke (RIND reversible ischaemic neurological deficit) and one case (1.6%) of stroke (complete ischaemic stroke CIS) were observed. Regarding symptoms typical for subclavian steal syndrome, dizziness occurred in 10 patients (16.7%), vertigo in 2 patients (3.3%), left arm weakness in 32 patients (53.2%), and coldness-in 26 patients (43.3%). Neither rest pain nor pain after exercise was observed in any case. Statistical analysis did not show any connection between the incidence of complications and age or type of pathology for which the patient had been operated. Conclusions. Planned coverage of the LSA is a safe procedure. In most of cases patients with covered LSA did not require any further reconstructions.
Open Medicine, 2014
Introduction. Pheochromocytomas may cause life-threatening episodes of arterial hypertension and ... more Introduction. Pheochromocytomas may cause life-threatening episodes of arterial hypertension and surgical treatment is obligatory following proper general medical preparation. Material and methods. There were 63 patients in years 2006-2011 operated in the department due to pheochromocytoma. The group comprised 38 women and 25 men of the age range 16-80, mean 44,7. All the specimen were analyzed in pathological examination. The regressive changes that were found were subsequently compared with the clinical course of the pheochromocytoma both in the preoperative period and at the time of the surgery. Results. There were 44 laparoscopic adrenalectomies performed, out of which 5 resulted in conversions to open surgery, while 19 patients were operated primarily via open access. The indications for the open procedures: extraadrenal tumors, fibrotic-infiltrative lesions suggestive of malignancy, vast intratumoral extravasation, and respiratory failure. In all the postoperative specimens pheochromocytomas were found. In 29 cases intratumoral haemorrhages were observed, in 17-tumoral necrosis at different stages, and in 3 cases posthaemorrhagic cystis. In 6 cases the lesions were accompanied by major fibrosis and hyalinization. Conclusions. There is a statistically significant relationship between regressive changes observed within phaeochromocytomas and a reduction of paroxysmal hypertension at the time of adrenalectomy (p=0,012).
Acta Angiologica, 2014
Aortic type B dissection can be treated conservatively in up to 90% of uncomplicated cases. Addit... more Aortic type B dissection can be treated conservatively in up to 90% of uncomplicated cases. Additional symptoms comprising of the pain in the thorax and abdominal cavity may suggest vascular complications. Visceral ischemia is observed in about 30% of aortic dissections. Synchronous symptoms in the thorax and abdomen are very rare situation. A 54-year old male patient was admitted to the clinic on duty with diagnosis of aortic dissection. Angiotomography proved a dissection starting just below the origin of the left subclavian artery and running along the aorta to the external iliac arteries. The patient presented also with very high systemic pressure and abdominal symptoms of diffuse peritonitis. Plain abdominal x-ray proved perforation of his gastroalimentary tract. Emergency laparotomy was performed disclosing a vast defect of gastric walls in the prepyloric region and visible ischemia of mucosa with patches of necrosis reaching up to the half of the stomach. B II resection was performed with anastomosis of the stomach stump to the small intestine on so-called Lahey loop. Histological evaluation did not prove the existence of peptic ulcer. In the postoperative period ischemia of the intestines was observed again. The afferent loop of gastrointestinal anastomosis was shrunken due to this fact. Patient received wide spectrum antibiotics and was maintained on total parenteral nutrition. Apart from this treatment the state of the patient did not change. It was decided that closure of the entry tear in the thoracic aorta was the only way to restore a proper blood flow in it. Aortic stent-graft was implanted to the thoracic aorta descending to the level of the celiac trunk despite the symptoms of septicemia. This endovascular procedure changed the blood flow in the thoracic aorta and improved the inflow to visceral arteries but the patient was operated two more times because of progressing necrosis in the vicinity of intestinal anastomoses with fistulae formation. Finally the patient recovered within three months since admission. He also experienced stroke during his hospital stay. Type B aortic dissection complicated with visceral ischemia requires an urgent surgical treatment. Aortic stent-graft placement seems to be the gold standard in such cases. This treatment should precede formation of intestine necrosis with fistulae and subsequent septic complications. It seems that regaining of the true channel below the stent-graft may require certain time for the shrinking of the false one filled with thrombi does not appear just after the endovascular procedure.
American Journal of Roentgenology, 2006
The aim of this study was to evaluate the diagnostic value of time-resolved contrast-enhanced MR ... more The aim of this study was to evaluate the diagnostic value of time-resolved contrast-enhanced MR angiography in adults with congenital heart disease. Twenty patients with congenital heart disease (mean age, 38 +/- 14 years; range, 16-73 years) underwent contrast-enhanced turbo fast low-angle shot MR angiography. Thirty consecutive coronal 3D slabs with a frame rate of 1-second duration were acquired. The mask defined as the first data set was subtracted from subsequent images. Image quality was evaluated using a 5-point scale (from 1, not assessable, to 5, excellent image quality). Twelve diagnostic parameters yielded 1 point each in case of correct diagnosis (binary analysis into normal or abnormal) and were summarized into three categories: anatomy of the main thoracic vessels (maximum, 5 points), sequential cardiac anatomy (maximum, 5 points), and shunt detection (maximum, 2 points). The results were compared with a combined clinical reference comprising medical or surgical reports and other imaging studies. Diagnostic accuracies were calculated for each of the parameters as well as for the three categories. The mean image quality was 3.7 +/- 1.0. Using a binary approach, 220 (92%) of the 240 single diagnostic parameters could be analyzed. The percentage of maximum diagnostic points, the sensitivity, the specificity, and the positive and the negative predictive values were all 100% for the anatomy of the main thoracic vessels; 97%, 87%, 100%, 100%, and 96% for sequential cardiac anatomy; and 93%, 93%, 92%, 88%, and 96% for shunt detection. Time-resolved contrast-enhanced MR angiography provides, in one breath-hold, anatomic and qualitative functional information in adult patients with congenital heart disease. The high diagnostic accuracy allows the investigator to tailor subsequent specific MR sequences within the same session.
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International angiology : a journal of the International Union of Angiology, 2014
The aim of the study was to examine the association between anatomical patterns of valvular incom... more The aim of the study was to examine the association between anatomical patterns of valvular incompetence and the severity of venous insufficiency in patients with chronic venous disease. A total of 211 consecutive patients (70% females) were referred from the vascular clinic to undergo a Doppler ultrasound examination. The extent and anatomical pattern of valvular incompetence was noted using CEAP criteria. Clinical classes C1-6 for each patient were expressed as a string of binary digits and translated into a clinical ordinal score. In this way, higher grade signs were not obscuring lower grade signs and non-parametric analysis could include a wider range of clinical data. Varicose veins were the main complaint in 33% of the patients. 54% had at least one incompetent deep vein, 80% had incompetent perforators. Clinical severity increased with age, but was not related with gender. The presence of deep venous incompetence did not account for significant increase in signs. Superficial...
Polish Journal of Surgery, 2013
Anastomotic aneurysms may develop after any type of vascular surgery, in different areas of the a... more Anastomotic aneurysms may develop after any type of vascular surgery, in different areas of the arterial system, and require reoperation. The frequency of occurrence of the above-mentioned is estimated at 1-5%. material and methods. During the period between 1989 and 2010, 180 patients with 230 anastomotic aneurysms were subject to surgical intervention at the Department of General and Thoracic Surgery, Warsaw Medical University. The study group comprised 21 (11.7%) female and 159 (88.3%) male patients, aged between 30 and 87 years (mean age -62.8 years). In relation to the number of anastomoses aneurysms were diagnosed in 2.1% of cases. Twenty-four (10.4%) patients were diagnosed with recurrent aneurysms. results. Surgical procedures performed were as follows: artificial prosthesis implantation (119), reanastomosis (40), patch plasty (25), graftectomy (19), prosthesis replacement (9), and stent-graft implantation. 195 (84.8%) aneurysms were subject to planned surgery, while 35 (15.2%) required emergency intervention. 77.8% of patients were diagnosed with aseptic aneurysms, while the remaining 22.2% with infected perioperative aneurysms. Good treatment results were obtained in 149 (82.8%) patients. Limb amputations were performed in 19 (10.5%) cases. Twelve (6.7%) patients died as a consequence of infection and general complications. conclusions. Vascular reoperations are a difficult clinical problem and are burdened with a high rate of complications. The above-mentioned often require complex treatment, in order to improve therapeutic results.
Polish Journal of Surgery, 2012
prof. dr hab. M. Skórski the aim of the study was to evaluate the results of general surgical tre... more prof. dr hab. M. Skórski the aim of the study was to evaluate the results of general surgical treatment of patients over 80 years of age. material and methods. Three hundred and four patients aged 80 to 105 years with general surgical disorders, treated in 2005-2009, were retrospectively included in the study. The collected information included demographic data, coexisting diseases, the mode of admission, the diagnosis, the method and result of treatment, and also potential complications and 30-day mortality. The data were subjected to statistical analysis. Results. The study group included 186 women and 118 men. Two hundred patients (65.8%) were admitted in an emergency setting. The most common causes of immediate hospitalisation were: mechanical ileus (26.5%), gastrointestinal bleeding (22%), trauma (16%), and gall-bladder disorders (8.5%). The remaining 104 (34.2%) patients were operated upon on an elective basis. An emergency operation was required by 121 (60%) of the patients admitted in an emergency setting; the remaining ones were treated conservatively. Hernia plasties (27.5%), cholecystectomies (15.3%), colorectal resections (13.2%), strumectomies (11.2%) and endoscopies (6.1%) predominated among elective surgeries. The total number of complications and mortality were 19.4% and 14.5%, respectively. The number of complications and mortality were significantly higher in the group of patients admitted in an emergency setting (25.5% and 20.5%, respectively) than in patients admitted on an elective basis (8.7% and 2.9%, respectively), p<0.01. The mean duration of hospitalisation was 9.7 days (1 to 60 days), with a small difference between the groups of patients treated on an elective and emergency basis (8.5 and 10.4 days), p=0.181. conclusions. The results of surgical treatment of elderly patients do not significantly differ from the results of treatment of the general population. Much worse results, coupled with a significant increase in mortality, are observed in patients admitted and treated on an emergency basis.
Polski przeglad chirurgiczny, 2014
Anastomotic aneurysms occurs at various levels of arterial system. Determining their location and... more Anastomotic aneurysms occurs at various levels of arterial system. Determining their location and incidence rate required investigation of large patient clinical material. In the years 1989-2010 in local centre 230 anastomotic aneurysms were operated in 180 patients. For 187 (81.3%) patients anastomotic aneurysms were localised in the groin, while for remaining 43 (18.7%) they occurred in other localisations. In aortic arch branch they occurred four times (1.7), in descending aorta--three times (1.3%), in abdominal aorta--14 (6.1%) and in iliac arteries--6 (2.6%). While for anastomosis with popliteal artery they were diagnosed in 16 (7%) patients. Own clinical material was compared with literature data. Anastomotic aneurysms in over 80% of cases occur in the groin, remaining percentage corresponds to other localisations.
Polish Journal of Surgery, 2014
American Journal of Roentgenology, 2006
The aim of this study was to evaluate the diagnostic value of time-resolved contrast-enhanced MR ... more The aim of this study was to evaluate the diagnostic value of time-resolved contrast-enhanced MR angiography in adults with congenital heart disease. Twenty patients with congenital heart disease (mean age, 38 +/- 14 years; range, 16-73 years) underwent contrast-enhanced turbo fast low-angle shot MR angiography. Thirty consecutive coronal 3D slabs with a frame rate of 1-second duration were acquired. The mask defined as the first data set was subtracted from subsequent images. Image quality was evaluated using a 5-point scale (from 1, not assessable, to 5, excellent image quality). Twelve diagnostic parameters yielded 1 point each in case of correct diagnosis (binary analysis into normal or abnormal) and were summarized into three categories: anatomy of the main thoracic vessels (maximum, 5 points), sequential cardiac anatomy (maximum, 5 points), and shunt detection (maximum, 2 points). The results were compared with a combined clinical reference comprising medical or surgical reports and other imaging studies. Diagnostic accuracies were calculated for each of the parameters as well as for the three categories. The mean image quality was 3.7 +/- 1.0. Using a binary approach, 220 (92%) of the 240 single diagnostic parameters could be analyzed. The percentage of maximum diagnostic points, the sensitivity, the specificity, and the positive and the negative predictive values were all 100% for the anatomy of the main thoracic vessels; 97%, 87%, 100%, 100%, and 96% for sequential cardiac anatomy; and 93%, 93%, 92%, 88%, and 96% for shunt detection. Time-resolved contrast-enhanced MR angiography provides, in one breath-hold, anatomic and qualitative functional information in adult patients with congenital heart disease. The high diagnostic accuracy allows the investigator to tailor subsequent specific MR sequences within the same session.
Central European Journal of Medicine, 2014
Introduction. Pheochromocytomas may cause life-threatening episodes of arterial hypertension and ... more Introduction. Pheochromocytomas may cause life-threatening episodes of arterial hypertension and surgical treatment is obligatory following proper general medical preparation. Material and methods. There were 63 patients in years 2006-2011 operated in the department due to pheochromocytoma. The group comprised 38 women and 25 men of the age range 16 -80, mean 44,7. All the specimen were analyzed in pathological examination. The regressive changes that were found were subsequently compared with the clinical course of the pheochromocytoma both in the preoperative period and at the time of the surgery. Results. There were 44 laparoscopic adrenalectomies performed, out of which 5 resulted in conversions to open surgery, while 19 patients were operated primarily via open access. The indications for the open procedures: extraadrenal tumors, fibrotic-infiltrative lesions suggestive of malignancy, vast intratumoral extravasation, and respiratory failure. In all the postoperative specimens pheochromocytomas were found. In 29 cases intratumoral haemorrhages were observed, in 17 -tumoral necrosis at different stages, and in 3 cases posthaemorrhagic cystis. In 6 cases the lesions were accompanied by major fibrosis and hyalinization. Conclusions. There is a statistically significant relationship between regressive changes observed within phaeochromocytomas and a reduction of paroxysmal hypertension at the time of adrenalectomy (p=0,012).
Streszczenie Rozwarstwienie aorty typu B może być skutecznie leczone zachowawczo w wielu niepowik... more Streszczenie Rozwarstwienie aorty typu B może być skutecznie leczone zachowawczo w wielu niepowikłanych przypadkach i odsetek ten może wynosić nawet 90% chorych. Wystąpienie dodatkowych objawów bólowych z zakresu klatki piersiowej lub jamy brzusznej powinno nasuwać podejrzenie powikłań naczyniowych. Niedokrwienie trzewi jamy brzusznej jest obserwowane w około 30% przypadków rozwarstwień. Jednoczesne wystąpienie objawów w klatce piersiowej i jamie brzusznej obserwowane jest wyjątkowo rzadko. Mężczyzna 54-letni został przyjęty do kliniki w trybie nagłym z podejrzeniem rozwarstwienia aorty. W wy-konanej angiotomografii stwierdzono rozwarstwienie aorty piersiowej rozpoczynające się tuż poniżej lewej tętnicy podobojczykowej i sięgające tętnic biodrowych zewnętrznych. Chory miał wysokie nadciśnienie tętnicze. Jednocześnie stwierdzono objawy zapalenia otrzewnej i radiologiczne cechy perforacji przewodu pokarmowego. Wykonano pilnie laparotomię stwierdzając ogromny ubytek ścian części przedo...
Background: To assess the quality of images obtained from time-resolved MRA together with the acc... more Background: To assess the quality of images obtained from time-resolved MRA together with the accuracy of this technique in diagnosing vascular diseases and the usefulness of haemodynamic information provided by this method.
Videosurgery and Other Miniinvasive Techniques, 2016
Introduction: Ultrasound-guided foam sclerotherapy (UGFS) of varicose veins is a useful treatment... more Introduction: Ultrasound-guided foam sclerotherapy (UGFS) of varicose veins is a useful treatment option. It is a relatively safe method in the case of limited, small varicose veins. In theory, a justified concern could be raised that the injection of an active drug into the large superficial venous vessels may potentially cause life-threatening consequences. Aim: To assess the safety and efficacy of UGFS using a 2% solution of polidocanol (Aethoxysklerol 2%) in the case of great saphenous vein incompetence. Material and methods: Fifty-two patients with great saphenous vein incompetence underwent ultrasound-guided foam sclerotherapy. The efficacy criterion was the elimination of reflux measured ultrasonographically and withdrawal or decrease of complaints: 1 week, and 1, 3, 6 and 12 months after the treatment. Complications of sclerotherapy were reported during follow-up. Results: Decrease or withdrawal of complaints of chronic venous insufficiency was reported in 96% of cases (50 patients). Disappearance or decrease of varicose veins was noted in all patients (100%). During examination after 12 months, full success of ultrasound was achieved in 38 (73%) cases, and 11 (21%) patients presented a partial desired effect according to the consensus from Tegernsee. Persistence of reflux longer than 1 s in the treated great saphenous vein was reported in 3 (6%) cases. Serious complications, such as deep vein thrombosis, pulmonary embolism, dyspnea, anaphylaxis, or neurological abnormalities, were not recorded. Conclusions: Ultrasound-guided foam sclerotherapy of incompetent great saphenous vein and varicosities with 2% polidocanol was found to be an effective and safe method of treatment during 1 year of observation. However, longer observation is necessary.
Acta Angiologica, 2011
Background. The usage of thoracic endografts in the treatment of thoracic aortic lesions is a uni... more Background. The usage of thoracic endografts in the treatment of thoracic aortic lesions is a universally recognized method. Intentional coverage of the left subclavian artery during deployment of the endograft could be associated with several complications such as stroke, spinal cord ischaemia, left arm ischaemia, and vertebrobasilar ischaemia. This study presents the incidence of complications associated with LSA coverage in 60 patients with LSA covered during placement of thoracic endograft. Additionally, the relationship between incidence of complications and factors such as age and type of pathology is analysed. Material and methods. Sixty patients were qualified to the study, 12 women and 48 men between the ages of 23 and 83 years. The mean age was 56 years. A total of 21 patients were operated on for true aneurysm, 9 for post-traumatic aneurysm, 22 for Stanford B dissection, and 8 for Stanford A dissection. Patients were assessed in terms of presence of stroke, spinal cord ischaemia as well as symptoms associated with left arm ischaemia and vertebrobasilar ischaemia. The incidence of present symptoms was analysed in separate subgroups based on the type of pathology of the aorta due to which patients were operated (true aneurysm, traumatic aneurysm, Stanford type A dissection, and Stanford type B dissection) and age subgroups. Results. In none of the 60 patients enrolled for the study spinal cord ischaemia was observed. Two cases (3.3%) of reversible stroke (RIND reversible ischaemic neurological deficit) and one case (1.6%) of stroke (complete ischaemic stroke CIS) were observed. Regarding symptoms typical for subclavian steal syndrome, dizziness occurred in 10 patients (16.7%), vertigo in 2 patients (3.3%), left arm weakness in 32 patients (53.2%), and coldness-in 26 patients (43.3%). Neither rest pain nor pain after exercise was observed in any case. Statistical analysis did not show any connection between the incidence of complications and age or type of pathology for which the patient had been operated. Conclusions. Planned coverage of the LSA is a safe procedure. In most of cases patients with covered LSA did not require any further reconstructions.
Open Medicine, 2014
Introduction. Pheochromocytomas may cause life-threatening episodes of arterial hypertension and ... more Introduction. Pheochromocytomas may cause life-threatening episodes of arterial hypertension and surgical treatment is obligatory following proper general medical preparation. Material and methods. There were 63 patients in years 2006-2011 operated in the department due to pheochromocytoma. The group comprised 38 women and 25 men of the age range 16-80, mean 44,7. All the specimen were analyzed in pathological examination. The regressive changes that were found were subsequently compared with the clinical course of the pheochromocytoma both in the preoperative period and at the time of the surgery. Results. There were 44 laparoscopic adrenalectomies performed, out of which 5 resulted in conversions to open surgery, while 19 patients were operated primarily via open access. The indications for the open procedures: extraadrenal tumors, fibrotic-infiltrative lesions suggestive of malignancy, vast intratumoral extravasation, and respiratory failure. In all the postoperative specimens pheochromocytomas were found. In 29 cases intratumoral haemorrhages were observed, in 17-tumoral necrosis at different stages, and in 3 cases posthaemorrhagic cystis. In 6 cases the lesions were accompanied by major fibrosis and hyalinization. Conclusions. There is a statistically significant relationship between regressive changes observed within phaeochromocytomas and a reduction of paroxysmal hypertension at the time of adrenalectomy (p=0,012).
Acta Angiologica, 2014
Aortic type B dissection can be treated conservatively in up to 90% of uncomplicated cases. Addit... more Aortic type B dissection can be treated conservatively in up to 90% of uncomplicated cases. Additional symptoms comprising of the pain in the thorax and abdominal cavity may suggest vascular complications. Visceral ischemia is observed in about 30% of aortic dissections. Synchronous symptoms in the thorax and abdomen are very rare situation. A 54-year old male patient was admitted to the clinic on duty with diagnosis of aortic dissection. Angiotomography proved a dissection starting just below the origin of the left subclavian artery and running along the aorta to the external iliac arteries. The patient presented also with very high systemic pressure and abdominal symptoms of diffuse peritonitis. Plain abdominal x-ray proved perforation of his gastroalimentary tract. Emergency laparotomy was performed disclosing a vast defect of gastric walls in the prepyloric region and visible ischemia of mucosa with patches of necrosis reaching up to the half of the stomach. B II resection was performed with anastomosis of the stomach stump to the small intestine on so-called Lahey loop. Histological evaluation did not prove the existence of peptic ulcer. In the postoperative period ischemia of the intestines was observed again. The afferent loop of gastrointestinal anastomosis was shrunken due to this fact. Patient received wide spectrum antibiotics and was maintained on total parenteral nutrition. Apart from this treatment the state of the patient did not change. It was decided that closure of the entry tear in the thoracic aorta was the only way to restore a proper blood flow in it. Aortic stent-graft was implanted to the thoracic aorta descending to the level of the celiac trunk despite the symptoms of septicemia. This endovascular procedure changed the blood flow in the thoracic aorta and improved the inflow to visceral arteries but the patient was operated two more times because of progressing necrosis in the vicinity of intestinal anastomoses with fistulae formation. Finally the patient recovered within three months since admission. He also experienced stroke during his hospital stay. Type B aortic dissection complicated with visceral ischemia requires an urgent surgical treatment. Aortic stent-graft placement seems to be the gold standard in such cases. This treatment should precede formation of intestine necrosis with fistulae and subsequent septic complications. It seems that regaining of the true channel below the stent-graft may require certain time for the shrinking of the false one filled with thrombi does not appear just after the endovascular procedure.
American Journal of Roentgenology, 2006
The aim of this study was to evaluate the diagnostic value of time-resolved contrast-enhanced MR ... more The aim of this study was to evaluate the diagnostic value of time-resolved contrast-enhanced MR angiography in adults with congenital heart disease. Twenty patients with congenital heart disease (mean age, 38 +/- 14 years; range, 16-73 years) underwent contrast-enhanced turbo fast low-angle shot MR angiography. Thirty consecutive coronal 3D slabs with a frame rate of 1-second duration were acquired. The mask defined as the first data set was subtracted from subsequent images. Image quality was evaluated using a 5-point scale (from 1, not assessable, to 5, excellent image quality). Twelve diagnostic parameters yielded 1 point each in case of correct diagnosis (binary analysis into normal or abnormal) and were summarized into three categories: anatomy of the main thoracic vessels (maximum, 5 points), sequential cardiac anatomy (maximum, 5 points), and shunt detection (maximum, 2 points). The results were compared with a combined clinical reference comprising medical or surgical reports and other imaging studies. Diagnostic accuracies were calculated for each of the parameters as well as for the three categories. The mean image quality was 3.7 +/- 1.0. Using a binary approach, 220 (92%) of the 240 single diagnostic parameters could be analyzed. The percentage of maximum diagnostic points, the sensitivity, the specificity, and the positive and the negative predictive values were all 100% for the anatomy of the main thoracic vessels; 97%, 87%, 100%, 100%, and 96% for sequential cardiac anatomy; and 93%, 93%, 92%, 88%, and 96% for shunt detection. Time-resolved contrast-enhanced MR angiography provides, in one breath-hold, anatomic and qualitative functional information in adult patients with congenital heart disease. The high diagnostic accuracy allows the investigator to tailor subsequent specific MR sequences within the same session.
[
International angiology : a journal of the International Union of Angiology, 2014
The aim of the study was to examine the association between anatomical patterns of valvular incom... more The aim of the study was to examine the association between anatomical patterns of valvular incompetence and the severity of venous insufficiency in patients with chronic venous disease. A total of 211 consecutive patients (70% females) were referred from the vascular clinic to undergo a Doppler ultrasound examination. The extent and anatomical pattern of valvular incompetence was noted using CEAP criteria. Clinical classes C1-6 for each patient were expressed as a string of binary digits and translated into a clinical ordinal score. In this way, higher grade signs were not obscuring lower grade signs and non-parametric analysis could include a wider range of clinical data. Varicose veins were the main complaint in 33% of the patients. 54% had at least one incompetent deep vein, 80% had incompetent perforators. Clinical severity increased with age, but was not related with gender. The presence of deep venous incompetence did not account for significant increase in signs. Superficial...
Polish Journal of Surgery, 2013
Anastomotic aneurysms may develop after any type of vascular surgery, in different areas of the a... more Anastomotic aneurysms may develop after any type of vascular surgery, in different areas of the arterial system, and require reoperation. The frequency of occurrence of the above-mentioned is estimated at 1-5%. material and methods. During the period between 1989 and 2010, 180 patients with 230 anastomotic aneurysms were subject to surgical intervention at the Department of General and Thoracic Surgery, Warsaw Medical University. The study group comprised 21 (11.7%) female and 159 (88.3%) male patients, aged between 30 and 87 years (mean age -62.8 years). In relation to the number of anastomoses aneurysms were diagnosed in 2.1% of cases. Twenty-four (10.4%) patients were diagnosed with recurrent aneurysms. results. Surgical procedures performed were as follows: artificial prosthesis implantation (119), reanastomosis (40), patch plasty (25), graftectomy (19), prosthesis replacement (9), and stent-graft implantation. 195 (84.8%) aneurysms were subject to planned surgery, while 35 (15.2%) required emergency intervention. 77.8% of patients were diagnosed with aseptic aneurysms, while the remaining 22.2% with infected perioperative aneurysms. Good treatment results were obtained in 149 (82.8%) patients. Limb amputations were performed in 19 (10.5%) cases. Twelve (6.7%) patients died as a consequence of infection and general complications. conclusions. Vascular reoperations are a difficult clinical problem and are burdened with a high rate of complications. The above-mentioned often require complex treatment, in order to improve therapeutic results.
Polish Journal of Surgery, 2012
prof. dr hab. M. Skórski the aim of the study was to evaluate the results of general surgical tre... more prof. dr hab. M. Skórski the aim of the study was to evaluate the results of general surgical treatment of patients over 80 years of age. material and methods. Three hundred and four patients aged 80 to 105 years with general surgical disorders, treated in 2005-2009, were retrospectively included in the study. The collected information included demographic data, coexisting diseases, the mode of admission, the diagnosis, the method and result of treatment, and also potential complications and 30-day mortality. The data were subjected to statistical analysis. Results. The study group included 186 women and 118 men. Two hundred patients (65.8%) were admitted in an emergency setting. The most common causes of immediate hospitalisation were: mechanical ileus (26.5%), gastrointestinal bleeding (22%), trauma (16%), and gall-bladder disorders (8.5%). The remaining 104 (34.2%) patients were operated upon on an elective basis. An emergency operation was required by 121 (60%) of the patients admitted in an emergency setting; the remaining ones were treated conservatively. Hernia plasties (27.5%), cholecystectomies (15.3%), colorectal resections (13.2%), strumectomies (11.2%) and endoscopies (6.1%) predominated among elective surgeries. The total number of complications and mortality were 19.4% and 14.5%, respectively. The number of complications and mortality were significantly higher in the group of patients admitted in an emergency setting (25.5% and 20.5%, respectively) than in patients admitted on an elective basis (8.7% and 2.9%, respectively), p<0.01. The mean duration of hospitalisation was 9.7 days (1 to 60 days), with a small difference between the groups of patients treated on an elective and emergency basis (8.5 and 10.4 days), p=0.181. conclusions. The results of surgical treatment of elderly patients do not significantly differ from the results of treatment of the general population. Much worse results, coupled with a significant increase in mortality, are observed in patients admitted and treated on an emergency basis.
Polski przeglad chirurgiczny, 2014
Anastomotic aneurysms occurs at various levels of arterial system. Determining their location and... more Anastomotic aneurysms occurs at various levels of arterial system. Determining their location and incidence rate required investigation of large patient clinical material. In the years 1989-2010 in local centre 230 anastomotic aneurysms were operated in 180 patients. For 187 (81.3%) patients anastomotic aneurysms were localised in the groin, while for remaining 43 (18.7%) they occurred in other localisations. In aortic arch branch they occurred four times (1.7), in descending aorta--three times (1.3%), in abdominal aorta--14 (6.1%) and in iliac arteries--6 (2.6%). While for anastomosis with popliteal artery they were diagnosed in 16 (7%) patients. Own clinical material was compared with literature data. Anastomotic aneurysms in over 80% of cases occur in the groin, remaining percentage corresponds to other localisations.
Polish Journal of Surgery, 2014
American Journal of Roentgenology, 2006
The aim of this study was to evaluate the diagnostic value of time-resolved contrast-enhanced MR ... more The aim of this study was to evaluate the diagnostic value of time-resolved contrast-enhanced MR angiography in adults with congenital heart disease. Twenty patients with congenital heart disease (mean age, 38 +/- 14 years; range, 16-73 years) underwent contrast-enhanced turbo fast low-angle shot MR angiography. Thirty consecutive coronal 3D slabs with a frame rate of 1-second duration were acquired. The mask defined as the first data set was subtracted from subsequent images. Image quality was evaluated using a 5-point scale (from 1, not assessable, to 5, excellent image quality). Twelve diagnostic parameters yielded 1 point each in case of correct diagnosis (binary analysis into normal or abnormal) and were summarized into three categories: anatomy of the main thoracic vessels (maximum, 5 points), sequential cardiac anatomy (maximum, 5 points), and shunt detection (maximum, 2 points). The results were compared with a combined clinical reference comprising medical or surgical reports and other imaging studies. Diagnostic accuracies were calculated for each of the parameters as well as for the three categories. The mean image quality was 3.7 +/- 1.0. Using a binary approach, 220 (92%) of the 240 single diagnostic parameters could be analyzed. The percentage of maximum diagnostic points, the sensitivity, the specificity, and the positive and the negative predictive values were all 100% for the anatomy of the main thoracic vessels; 97%, 87%, 100%, 100%, and 96% for sequential cardiac anatomy; and 93%, 93%, 92%, 88%, and 96% for shunt detection. Time-resolved contrast-enhanced MR angiography provides, in one breath-hold, anatomic and qualitative functional information in adult patients with congenital heart disease. The high diagnostic accuracy allows the investigator to tailor subsequent specific MR sequences within the same session.
Central European Journal of Medicine, 2014
Introduction. Pheochromocytomas may cause life-threatening episodes of arterial hypertension and ... more Introduction. Pheochromocytomas may cause life-threatening episodes of arterial hypertension and surgical treatment is obligatory following proper general medical preparation. Material and methods. There were 63 patients in years 2006-2011 operated in the department due to pheochromocytoma. The group comprised 38 women and 25 men of the age range 16 -80, mean 44,7. All the specimen were analyzed in pathological examination. The regressive changes that were found were subsequently compared with the clinical course of the pheochromocytoma both in the preoperative period and at the time of the surgery. Results. There were 44 laparoscopic adrenalectomies performed, out of which 5 resulted in conversions to open surgery, while 19 patients were operated primarily via open access. The indications for the open procedures: extraadrenal tumors, fibrotic-infiltrative lesions suggestive of malignancy, vast intratumoral extravasation, and respiratory failure. In all the postoperative specimens pheochromocytomas were found. In 29 cases intratumoral haemorrhages were observed, in 17 -tumoral necrosis at different stages, and in 3 cases posthaemorrhagic cystis. In 6 cases the lesions were accompanied by major fibrosis and hyalinization. Conclusions. There is a statistically significant relationship between regressive changes observed within phaeochromocytomas and a reduction of paroxysmal hypertension at the time of adrenalectomy (p=0,012).