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Effects of Saline and Other Peritoneal Lavage Solutions on the Morphology and Function of in Vitro Mesothelial Cells

100%
Winckiewicz M., Połubińska A., Staniszewski R., Bręborowicz A.
Polish Journal of Surgery
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2007
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vol. 79
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issue 8
540-547
EN
The aim of the study was to evaluate the effects of 0.9% NaCl and other solutions suitable for peritoneal lavage on in vitro viability and fibrinolytic activity of human peritoneal mesothelial cells.Material and methods. Mesothelial cells were isolated from the intra-operatively collected greater omentum specimens and then cultured. Subsequently, eight cultures (n=8) were incubated for six hours with M199 culture medium (control group) or culture medium with the addition of 0.9% NaCl, PD fluid Gambrosol-Trio 10 or Hanks' solution. Immediately after exposure to the studied solutions, the amount of LDH released by the cultured cells was determined. Then, cultured cells were incubated for the next 24 hours; after this period their metabolism and fibrinolytic activity were determined by means of IL-6, t-PA and PAI-1 levels. Levels of these substances were compared to the amount of total cellular protein that was determined simultaneously.Results. Hanks' solution showed no significant influence on cellular culture architecture and mesothelium metabolism. PD fluid Gambrosol-Trio 10 damaged mesothelial cell structure and function as manifested by an increased release of LDH and enhanced t-PA synthesis, as well as decreased production of IL-6 and PAI-1. Exposure to 0.9% NaCl solution was found to cause a disturbance in cellular adhesion without significant structural damage (marked changes in cellular morphology without increased LDH release) and significant metabolism impairment as presented by reduced production of t-PA, IL-6 and PAI-1.Conclusions. Saline solution and PD fluids should not be used for peritoneal lavage. Further investigations are required to identify the least harmful solution for mesothelial cells suitable for application in intra-operative peritoneal lavage.
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Endovascular Treatment of Symptomatic Stenosis of the Brachiocephalic Trunk

76%
Juszkat R., Pukacki F., Wachal K., Oszkinis G., Staniszewski R., Zieliński M., Majewski W.
Polish Journal of Surgery
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2007
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vol. 79
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issue 1
12-18
EN
The aim of the study was to present our own endovascular treatment results in cases of patients suffering from symptomatic stenosis of the brachiocephalic trunk.Material and methods. During the period between March 2000 and October 2004, 14 patients underwent angioplasty accompanied by stent implantation. The above-mentioned procedure was performed, due to critical, symptomatic stenosis of the brachiocephalic trunk. The patients were diagnosed and placed into different procedural groups based on the physical examination and radiological imaging examinations (Doppler ultrasound and DSA). The immediate and long-term results were evaluated with the physical examination and Doppler ultrasound examination performed at 3-, 6- and 12-months after the procedure.Results. In every patient, the immediate results were positive. Intraoperative DSA angiography confirmed that the artery was dilated. Preoperative clinical symptoms of cerebral and collateral circulation insufficiency in the upper extremity were limited (5/14) or totally regressed (9/14) during the postoperative period. During the intra- and postoperative period, none of the following complications were found: upper extremity arterial embolism, acute arterial thrombosis, dissection or rupture of the brachiocephalic trunk wall, or death. Patients were discharged 2 or 3 days following the procedure. Follow-up examinations confirmed proper blood flow in the brachiocephalic trunk and increased flow in the right vertebral artery. No symptoms of restenosis were found in the area of stent implantation and the stent was not dislocated.Conclusions. Angioplasty accompanied by stent implantation is a safe and efficient treatment method in the case of patients suffering from symptomatic stenosis of the brachiocephalic trunk, particularly in patients with significant operative risk. The hypothesis was confirmed by both perioperative observations and immediate, as well as, long-term patency results.
3
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Traumatic Injuries to Subclavian Arteries Treated with Stentgraft Implantation

76%
Juszkat R., Stanišić M., Dzieciuchowicz Ł., Staniszewski R., Pukacki F., Oszkinis G., Majewski W.
Polish Journal of Surgery
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2007
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vol. 79
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issue 1
29-35
EN
The aim of the study was to present the experience of our centre in endovascular treatment for subclavian artery injuries.Material and methods. In the years 2000-2005, seven patients (five men and two women, aged 28 to 69 years) with traumatic injuries to their subclavian arteries were treated in the Department of General and Vascular Surgery and Department of Radiology. Four patients were diagnosed with post-traumatic aneurysms including one iatrogenic aneurysm following fixation of a fractured clavicle; one patient experienced post-traumatic injury to subclavian artery; one with iatrogenic perforation of subclavian artery with bleeding into pleural cavity; and the last one with another iatrogenic injury resulting from attempts to place a central access line following surgical, restoration of patency within subclavian and axillary arteries. All patients underwent endovascular treatment with the use of self-expanding peripheral stentgrafts (Wallgraft, Boston Scientific, USA).Results. The procedure of stentgraft implantation was successfully performed in all seven patients. In the patient with iatrogenic injury to the subclavian artery, blood extravasation around the stent was observed the next day, which required the stent to be additionally expanded with a balloon catheter. No complications during or immediately after the procedure were detected in any patient. The patient with iatrogenic injury to the subclavian artery following clavicle fracture suffered from thrombosis within the brachial artery during the third week after the procedure.Conclusions. Endovascular treatment of subclavian artery injuries with the use of peripheral stentgrafts is an efficient method that is associated with low complication rates and should be the method of choice in the treatment of subclavian artery injuries.
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