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The changes of plasma thrombin-antithrombin complex in the patients with peripheral arterial disease undergoing surgical revascularization

100%
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.
2
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The Impact of Nissen-Rossetti Fundoplication on the Perfusion in Microcirculation of the Gastric Fundus

86%
Przywara S., Wallner G., Dąbrowski A., Skoczylas T., Wroński J., Michalak K., Zymon R.
Polish Journal of Surgery
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2007
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vol. 79
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issue 9
581-586
EN
The aim of the study was to investigate the impact of Nissen-Rossetti fundoplication on the blood flow in the microcirculation of the gastric fundus.Material and methods. Eight patients undergoing Nissen-Rossetti fundoplication were included in the study. Perfusion in the gastric fundus was measured intraoperatively with laser Doppler flowmetry. An adhesive, flat, silicon probe was attached to the serosa in the same anatomical location during every measurement. Microcirculatory blood flow was recorded before and after fundoplication without ligation and division of the short gastric vessels.Results. In each patient, fundoplication led to increases in resting perfusion. Hyperperfusion was evoked by two mechanisms: increase in average blood flow and increase in vasomotion's amplitude and frequency.Conclusions. Fundoplication constitutes a new distribution of blood flow in the microcirculation of the gastric fundus, irrespective of its indication as a treatment of reflux disease or a supplement to cardiomyotomy in patients with achalasia. The procedure, when correctly performed, leads to local reactive hyperemia. Decreases in fundal perfusion suggest that the fundoplication wrap was created under excessive tension and may lead to dysphagia and local ischemia with consequences on motility of the lower esophagus. Thus, the assessment of change in perfusion of the gastric fundus after fundoplication might be a valuable tool in the routine quality control for appropriate performance of the fundoplication wrap.
3
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Cide-AGene Expression in Patients with Obesity Qualified for Endovascular Treatment of Abdominal Aorta Aneurysm

73%
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.
4
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Selected factors of fibrinolysis in the Buerger’s disease

73%
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.
5
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CIDE-A gene expression in patients with abdominal obesity and LDL hyperlipoproteinemia qualified for surgical revascularization in chronic limb ischemia

73%
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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