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1
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Comparison of the Quality of Patients' Life After the Classical and Laparoscopic Cholecystectomies

100%
Gembal P., Zubilewicz T.
Polish Journal of Surgery
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2008
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vol. 80
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issue 11
585-593
EN
In Poland cholecystolithiasis is the most frequent cause of surgical treatment and a significant growth in the number of cholecystectomies has been observed since the laparoscopic method was introduced. Recently there has been noted an increased interest in such issues as the quality of life connected with health and the impact of particular therapeutic methods on the quality of patients' lives.In order to measure the quality of life, the instruments (forms) - or so-called health profiles are used. In respect of this quality of life, one of the forms mostly acknowledged in the world is the questionnaire SF36, which is also applied in the field of the gall-bladder surgery.The aim of the study was to compare the quality of patients' lives before and after the surgical treatment of cholecystolithiasis with the use of the classical and the laparoscopic methods by means of the SF36 form.Material and methods. The research was conducted among patients treated in the Surgery Department of the Hospital in Mielec from June 2005 to June 2006.The patients were divided into two groups: A - 42 people are the patients treated by the classical method of cholecystecomy, B - 46 people are the patients subjected to the laparoscopic method of cholecystecomy. Both groups of patients fulfilled the questionnaire twice: first, before the surgical procedure, and then three months after the operation. Additionally, during the second survey, the patients estimated subjective alteration of the quality of life three months after the surgery.Results. A statistically significant increase in the physical and mental components as well as in a total quality of life was stated in both groups. A higher increase in the general quality of life was estimated in the group of patients treated by the laparoscopic method. In the subjective estimation of the alteration of the quality of life three months after surgery, there was also recognized the growth of it in both groups of patients.Conclusions. An increase in the life quality of the patients with diagnosed cholecystolithiasis has been observed after both methods of cholecystectomy respectively. A greater increase of this quality analyzed by means of the questionnaire SF36® has been noticed in case of the laparoscopic method especially in the physical component.
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New Method of Forced Implantation of Permanent Catheters for Hemodialysis into Critically Stenosed or Occluded Central Veins

81%
Przywara S., Iłżecki M., Terlecki P., Zubilewicz T.
Polish Journal of Surgery
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2015
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vol. 86
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issue 9
405-409
EN
The aim of the study was to report a novel technique of forced implantation of catheters for hemodialysis into critically stenosed or occluded central veins, without preceding angioplasty or stenting. Material and methods. Sixteen patients with central venous occlusive disease, requiring urgent hemodialysis underwent this procedure. Catheterization of stenosis - occlusion was initially performed with soft guidewire, subsequently exchanged to stiff guidewire. Forced insertion of dilators, peel-off sheath throughout the stenosis or occlusion and finally implantation of the catheter completed the procedure. Our technique does not require pre-procedural angioplasty or stent deployment. Results. In all patients postoperative hemodialysis was managed with satisfactory adequacy. No early or late complications related to the procedure occurred. We did not observe any clinically significant aggravation of symptoms of central vein stenosis or occlusion. Complications, not-related to the procedure included one, late skin entry site infection and one, late catheter thrombosis. These were managed without the necessity of catheter exchange. Conclusions. Our technique of forced implantation of catheters for hemodialysis into critically stenosed or occluded central veins without previous balloon predilatation or stenting is simple and diminishes the total cost of the procedure. Provides quick vascular access for hemodialysis in life threatening situations.
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The Role of Apolipoprotein (A) In Pathogenesis and Clinical Course of Deep Venous Thrombosis

81%
Chrapko M., Skwarzyński A., Karakuła W., Zubilewicz T.
Polish Journal of Surgery
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2015
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vol. 86
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issue 11
518-522
EN
Deep venous thrombosis is widespread disease, which complications, like: pulmonary embolism and postphlebitis syndrome areimportant social problem. There are many well-known and accurately described risk factors, though in many cases etiology remains unexplained. Further research into causes of deep venous thrombosis seem to be fully justified. The aim of the study was the evaluation of the influence of apolipoprotein (a) serum level in patients with deep venous thrombosis and the changes of its concentration during the treatment. Materials and methods. 26 patients with newly diagnosed deep venous thrombosis (DVT) were enrolled to the study. Diagnosis of DVT was established by use of physical examination and duplex Doppler. Measurements of apolipoprotein (a) and D-dimers serum level were recorded on the following days, starting from the day of the initial diagnosis: 1, 7, 14 and 84. Results. Statistically significant increase of the level of serum apolipoprotein (a) has been found during properly conducted treatment. Conclusions. Alterations of the concentration of serum apoliprotein (a) during the deep venous thrombosis treatment, indicates the involvement of apolipoprotein (a) in pathogenesis of deep venous thrombosis.
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Percutaneous Endovascular Abdominal Aortic Aneurysm Repair Within the Infrarenal Region. Preliminary Report

81%
Iłżecki M., Zubilewicz T., Terlecki P., Przywara S.
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vol. 85
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issue 10
563-568
EN
The aim of the study was to thoroughly evaluate the closure device ProStar XL in terms of its efficiency and safety in the percutaneous endovascular treatment of abdominal aortic aneurysms in the infrarenal section of the body. Additionally, it was crucial to assess if there were any occurrences of regional complications at any step of the procedure. It was also important to stipulate the estimated hospitalization period as well as the overall cost of the PEVAR treatment with the use of ProStar XL. Material and methods. The analysis included 21 cases with PEVAR performed in the infrarenal region. The final success was achieved in 98.2% of the cases. One PEVAR case (that constituted 0.2% of this group) was unsuccessful because of the bleeding while the placement of the sutures with the use of ProStar XL was being performed. Results. This resulted in the emergency treatment of the CFA with the continuous stitch (Prolene 5-0). During the postoperative period the above described patient was given 2 units of the Packed Red Blood Cells (PRBC). However, this complication (unexpected bleeding) did not influence the length of the hospitalization period in any significant way. Conclusions. Percutaneous vascular closure device ProStar XL used in the treatment of the common femoral artery (CFA) constitutes a necessary and safe supplement for Endovascular Aortic Aneurysm Repair (EVAR). The implementation of ProStar XL closure device proves to significantly shorten the hospitalization period after the EVAR treatment. Additionally, the safety of the entire procedure is exponentially linked to the experience of the operating surgeon.
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The evaluation of the effectiveness of Tachosil in the treatment of lymphorrhea of the postoperative wound in the selected group of patients, after vascular reconstructive surgeries – preliminary report

81%
Iłżecki M., Zubilewicz T., Przywara S., Terlecki P.
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vol. 85
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issue 12
687-692
EN
Lymphorrhea of a postoperative wound after vascular reconstructive surgeries does not occur frequently but it accounts for a major complication. It should be brought to attention that during the intraoperative period it is impossible to diagnose any damages within the lymphatic system of the operated area. Additionally, the treatment of lymphorrheawith thermal abrasion does not usually bring the desired outcome. Therefore, the extended time of the postoperative wound treatment with the lymphatic drainage constitutes a standard method in such cases. The aim of the study was to evaluate the effectiveness of Tachosil surgical patch in the treatment of lymphorrhea of the postoperative wound in a selected group of patients who have undergone vascular reconstructive surgeries. Additionally, the aim of the study was to analyze the results and draw conclusions pertaining to the validity and effectiveness of the treatment with the use of Tachosil surgical patch. Material and methods. The observed group included 10 patients with lymphorrhea developed during the postoperative period. 6 of the observed patients have undergone the vascular reconstructive surgery with the implantation of the vascular prosthesis (distal femoropopliteal reconstruction bridge - 3 patients; iliofemoral reconstruction bridge - 1 patient; angioplasty of the common femoral artery (CFA) with the use of the prosthetic patch - 1 patient; the implantation of the bifurcated (type Y) aortofemoral prosthesis - 1 patient). The remaining patients in the observed group have undergone the restoration of patency of the CFA. Additionally, 1 patient has undergone the resection of the pseudo aneurysm in the distal part of the iliofemoral prosthesis. The vascular reconstructive surgery required the denudation and isolation of the common femoral artery from the surrounding tissue as a step 1. The persisting lymphorrhea of the postoperative wound, in the volume of more than 200 ml per day during the first 3 postoperative days, indicated the necessity for the inguinal wound revision. In addition, Tachosil surgical patch was applied at that time. The drain was placed over Tachosil patch. Results. Complete stop of lymphorrhea was shorter by 4.87 days in patients treated with the use of Tachosil in comparison to control group. These patients also had an average hospitalization time shorter by 3.88 days than patients in the control group. Conclusions. Early intervention in the cases of lymphorrhea of the postoperative wound allows planning and conducting successful treatment. The use of Tachosil surgical patch in the treatment of lymphorrhea of the postoperative wound shortens the treatment and hospitalization periods. The use of Tachosil in the treatment of postoperative lymphorrhea appeared to be significantly more effective than the standard drainage method of treatment. Results obtained through this study pave the way for the research on other possible applications of Tachosil in the cases of lymphorrhea after vascular reconstructive surgeries.
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The changes of plasma thrombin-antithrombin complex in the patients with peripheral arterial disease undergoing surgical revascularization

71%
Kęsik J. J., Wroński J., Feldo M., Terlecki P., Zubilewicz T.
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vol. 85
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issue 11
638-643
EN
In patients with severe lower limb ischemia the coagulation and fibrinolytic systems have been found to be activated preoperatively. The aim of the study was to evaluate the changes of TAT level as a selected coagulation factor, before, during and after surgical revascularization and the analysis of the impact of coexisting diseases on the coagulation during the procedure. Material and methods. 50 patients with PAOD, in Fontaine stages IIb to IV (29 men and 21 women; median age 65.8 years, ASA II/III) undergoing elective surgical revascularization were studied. Two groups of patients were compared: 20 undergoing reconstruction on aorto-femoral and 30 on femoropopliteal level. Blood samples were collected 5 times: 24 hours before the operation; intraoperatively after artery exposure; after heparin administration and clamping; after reperfusion and -24 hours postoperatively. Results. Elevated values of TAT (10.5 g/l ±7.1) were found before the operation. The elevated value of TAT increased intraoperatively (25.1 g/l ±44.58; p<0.001) (norm 1-4.1 g/l) and maintaining higher levels after the surgery. The significant correlations between plasma level of TAT and ischemia degree were found. Also the correlation between intraoperative increase of TAT and the duration of surgery was noticed. No significant differences between two analysed groups were observed. Conclusions. The results indicate the activation of coagulation and prothrombotic state in the patients with advanced arteriosclerosis. During the surgical revascularisation permanent increase of activation of blood coagulation was observed. This activation depends on duration of the procedure and maintains increased one-day after the operation. Our findings may explain the unexpected occurrence of early thrombotic complications after technically successful vascular reconstructions.
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The new era in the treatment of deep vein occlusion

71%
Kęsik J. J., Terlecki P., Feldo M., Pietura R., Zubilewicz T.
Polish Journal of Public Health
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2015
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vol. 125
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issue 1
36-38
EN
A non-invasive, conservative treatment has been a standard in treating acute and chronic deep vein thrombosis. This treatment turned out to be ineffective, particularly in the hip area. Also, it was demonstrated that it does not influence the frequency of manifestations of post-thrombotic syndrome. Previous attempts to surgically reconstruct deep veins, unlike arteries reconstruction, yielded no positive results and also increased hemorrhagic and embolic complications. Currently, already in the period of the acute thrombosis of deep veins, the methods of early re-canalization, both with the application of targeted thrombolisis, as well as of pharmacomechanical methods, are applied. Thanks to a wide array of image examination methods applied in pre-operational and intra-operational diagnostics optimum, it is possible to plan a revascularising treatment in the sick individuals suffering from the already developed manifestations of the post-thrombotic syndrome. The development of endovascular methods, made possible thanks both to the surgeons’ experience in the re-canalization field, as well as constant improvements of stents dedicated to the venous system, allowed for effective use of these techniques in curing the occlusion of deep veins. It was the case with the arterial system and works here as well. Applying the hybrid proceeding, combining opened techniques and endovascular ones, works very well in selected cases.
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Efficacy Evaluation Of Bio Trombina ® 400 In Mini Mall Y Invasive Treatment of Complications (Pseudoaneurysms), After Venipuncture for Diagnostic Purposes. Authors’ Own Experience – Case Study of 38 Patients

62%
Iłżecki M., Zubilewicz T., Przywara S., Wojtak A., Kęsik J. J., Olejniczak-Nowakowska M., Terlecki P.
Polish Journal of Surgery
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2015
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vol. 86
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issue 8
359-363
EN
Common use of venipuncture on upper and lower limbs for diagnostic purposes (such as coronarography or arteriography), and also during the course of treatment (angioplasty), very often bares a complication in the form of pseudoaneurysms. According to various reports, the incidence of pseudoaneurysms ranges from 0.005% to 0.5% of all vascular procedures requiring arterial cannulation (Common Femoral Artery, Brachial Artery, Radial Artery). The use of Bio Trombina® 400 in the embolization of pseudoaneurysms allows minimally invasive and effective treatment. The aim of the study was to evaluate the efficacy of pseudoaneurysm embolization with the use of Trombina 400, authors’ own experience. Material and methods. In the years 2011 - 2013, the authors of this study performed 38 vascular interventional procedures involving pseudoaneurysms as complications of venipuncture in upper and lower limbs for diagnostic and treatment purposes. All procedures involved the direct injection of thrombin into the chamber of the pseudoaneurysm under the guidance of USG Doppler (6.2 MHz linear head). 34 cases presented single chamber pseudoaneurysms while 4 cases involved multi- chamber pseudoaneurysms, which required several thrombin reinjections (Bio Trombina® 400) into each of the chambers. Pseudoaneurysm maximum size of 4 cm was set as an inclusion criterion for the embolization procedure. Furthermore, all pseudoaneurysms with a significantly wide tract in transverse dimensions were treated as an exclusion criterion because of high risk of the peripheral arteries embolization. Results. Initial success was observed in 36 patients (94.73%) in the first day after the procedure, 1 patient (2.63%) underwent thrombin reinjection procedure in the second day after the first embolization. Another patient (2.63%) underwent an open procedure in which the Common Femoral Artery was accessed, the clot evacuated, and CFA was sutured with continuous suture Prolene 6-0. Conclusions. 1. Embolization of pseudoaneurysms with USG Doppler-guided thrombin injection is an effective course of treatment for complications of cannulation. 2. The safety of pseudoaneurysm embolization depends on a surgeon’s experience. It is also crucial to keep in mind the inclusion and exclusion criteria for this type of procedure (the size of a pseudoaneurysm, the width of its base). 3. Furthermore, its cost effectiveness and short hospitalization period make pseudoaneurysm embolization an effective and valuable alternative to the classic approach.
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Cide-AGene Expression in Patients with Obesity Qualified for Endovascular Treatment of Abdominal Aorta Aneurysm

52%
Feldo M., Kocki J., Feldo J., Łukasik S., Bogucki J., Skwarzyński A., Wroński J., Kęsik J., Zubilewicz T.
Polish Journal of Surgery
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2015
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vol. 86
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issue 10
473-478
EN
CIDE-A gene and the genes of LRP group play a key role in the regulation of the body weight and lipid metabolism in mammals. CIDE-A is defined as a potential human obesity gene and the LRP1 gene is associated with the development of abdominal aortic aneurysm (AAA). The aim of the study was to define the role of CIDE-A gene in patients with dyslipidemia and asymptomatic AAA. Material and methods. The study group consisted of 38 subjects, including 27 men and 11 women qualified for endovascular aneurysm repair (EVAR). The subjects with abdominal aortic aneurysm were enrolled in the study group, depending on the body mass index (BMI); in obese patients (BMI > 30). The control group (n = 16) included subjects without lipid disorders. One-step isolation of RNA from lymphocytes and adipose tissue cells was performed using the modified TRI method by Chomc-zynski and Sacchi, and then the gene expression was tested by real-time PCR. Results. The highest mean relative of the gene expression for CIDE-A was reported in subjects with the normal body weight. The lowest mean relative of the gene expression for CIDE-A was observed in the group of obese patients with aortic aneurysm and lipid disorders. A high negative correlation (r = -0.7101) in the gene expression for CIDE-A was observed in the group of obese patients with aortic aneurysm, depending on the BMI. Conclusions. Due to the important role of the CIDE-A gene and Cide-A protein in the development of metabolic syndrome, obesity and the accompanying vascular lesions such as abdominal aortic an-eurysm, seen in this context, the tested gene and protein Cide-A represent a potential therapeutic target in these diseases.
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Selected factors of fibrinolysis in the Buerger’s disease

52%
Terlecki P., Feldo M., Przywara S., Iłżecki M., Kęsik J. J., Borowski G., Wroński J., Zubilewicz T.
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vol. 85
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issue 11
630-637
EN
Thrombangiitis obliterans (TAO marked by coexistence of thrombotic and inflammatory changes of neurovascular tract has evoked a considerable dispute concerning pathogenesis of this disease. The aim of the study was to define the level of activation of fibirinolitic system in course of TAO disease by means of determination its basic constituents as well as to examine the essence of level of fibrinolysis disorders in pathogenesis and development of this disease. Material and methods. Fifty patients with thrombangiitis obliterans (TAO), 30 patients with peripheral occlusive disease - PAOD (ASO) and 20 healthy volunteers (K) have been subjected to the examination. We determined the activity some factors of fibrinolysis: t-PA, PAI-1, PAP, plasminogen, α2-antiplasminogen, D-dimmer as well as euglobulin lysis time. The analysis comprised 7 features and 8 factors of variability: a membership to a group of patients, sex, age, smoking, aggravation of the disease within last 3 months, occurrence of Raynaud’s symptom, a degree of ischemia according to Fontaine, time the disease lasted. Results. The significant differences between the average were checked by means of t-Student test or variance analysis (ANOVA) and co-relation rate r (Pearson). We concluded that the average value of PAI-1 in the group TAO was significantly higher than in comparison with ASO group. The increased values were revealed in case of 76 % of patients. The euglobulin lysis time was vitally extended in case of 60% of patients in ASO group. In all three groups higher levels of α2-antiplasmin were detected in case of elderly patients compared to the younger ones. Conclusions. The obtained results allow us to ascertain the state of potentially weakened fibrinolysis in case of patients with Buerger’s disease as well as with PAOD.
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CIDE-A gene expression in patients with abdominal obesity and LDL hyperlipoproteinemia qualified for surgical revascularization in chronic limb ischemia

52%
Feldo M., Kocki J., Łukasik S., Bogucki J., Feldo J., Terlecki P., Kęsik J., Wroński J., Zubilewicz T.
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vol. 85
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issue 11
644-648
EN
According to the latest data, CIDE -A gene plays a key role in the regulation of body weight in both humans and mice, and therefore it is regarded a potential candidate gene for human obesity. The aim of the study was to define the role of CIDEA gene in patients with dyslipidemia and symptomatic limb ischemia. Material and methods. The study group contained 28 patients, including 17 men and 11 women. Patients were enrolled in the study group, depending on the value of body mass index (BMI); there was BMI>30 for obese patients. The group included untreated patients (n=14) and patients (n=14) receiving atorvastatin 20 mg/day for at least three months prior to the initiation of the study. The control group (n=16) contained patients with no lipid disorders. A one-step isolation of RNA from lymphocytes and adipose tissue cells was carried out using the TRI method modified by Chomczyński and Sacchi. Next, gene expression was tested using real-time PCR. Results. The highest mean relative expression of CIDE -A gene occurred in patients with normal body weight. The lowest mean relative expression of CIDE-A gene was observed in obese patients with lipid disorders. A high negative correlation (r=-0.7919) of CIDE -A gene expression, depending on BMI, was reported in the group of obese patients with lipid disorders. Conclusions. Due to an important role of Cide-A protein demonstrated in the development of metabolic diseases such as obesity, metabolic syndrome, type 2 diabetes and their vascular complications, CIDE -A gene and protein are potential therapeutic targets in the case of these diseases.
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The gene expression of class III inhibitors of apoptosis in arteriosclerotic disease

42%
Gil-Kulik P., Niedojadło A., Feldo M., Karwat J., Kotuła L., Chomik P., Dudek I., Filas M., Wojcieszek A., Zubilewicz T., Bogucka-Kocka A., Kocki J.
Polish Journal of Public Health
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2015
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vol. 124
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issue 1
38-41
EN
Introduction. Recent research shows that programmed cell death has great importance in the pathomechanism of atherosclerosis. The BIRC5 and BIRC6 genes belong to Class III IAPs with the anti-apoptotic effect. The proteins display multidirectional action. According to the available literature, in addition to the effect of apoptosis inhibition they also display other properties. It is suggested that they play an important role in the processes of proliferation and cellular differentiation. Aim. The aim of the study was to assess the expression of the BIRC5 and BIRC6 genes in normal peripheral blood lymphocytes and in peripheral blood lymphocytes of patients diagnosed with atherosclerosis. Material and methods. The analysis was carried out on RNA samples obtained from peripheral blood lymphocytes of 21 patients with diagnosed atherosclerosis. The specific fragment of the analysed gene was obtained through amplification with the use of cDNA synthesised in the reaction of reverse transcription. The test of expression was conducted with the use of the Real-Time PCR method. In the studied cases, the level of expression of the analysed gene was compared to the level of expression of the reference gene, B2M. Results. The study showed that mRNA of the BIRC5 and BIRC6 genes is present in the cells of patients with atherosclerosis, as well as in the cells of healthy individuals. The cells taken from the patients with atherosclerosis were mainly characterized by an increased gene expression in comparison to the normal cells. Conclusion. Increased BIRC6 and BIRC5 gene expression in the cells of the patients with atherosclerosis can suggest an increased amount of the inhibitor protein BRUCE and survivin, and also decreased sensitivity of cells to apoptosis. In the case of the patients who had significantly higher expression of the BIRC6 gene in lymphocytes compared to the norm, hypertension and diabetes mellitus were more common
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