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1
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Aspergillus Arterial Emboli in a Patient After Coronary Artery By-Pass Grafting

100%
Dzieciuchowicz Ł., Brzeziński J., Oszkinis G.
Polish Journal of Surgery
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2007
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vol. 79
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issue 8
555-558
EN
In this report, a 74-year old male with atypical emboli of the aortic and superior mesenteric arteries is presented. In the period preceding the occurrence of emboli, patients complained of malaise, low grade fever and weight loss. Incidentally, the patient underwent coronary artery bypass grafting two years prior to presentation. The pathologic examination of the embolus revealed the presence of typical Aspergillus spp hyphae. The presence of Aspergillus spp antigen in the patient serum was confirmed by an immunoenzymatic test. The transthoracic echocardiography did not show any signs of endocarditis or vegetations on the valves. Transesophageal echocardiography and angio-CT demonstrated lesions consistent with Aspergillus aortitis in the ascending aorta. The basic clinical features of Aspergillus aortitis and aspergillus emboli are discussed in this report.
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Critical Upper Limb Ischemia Caused by Initially Undiagnosed Thoracic Outlet Syndrome - Case Report

100%
Dzieciuchowicz Ł., Włodarczyk W., Oszkinis G.
Polish Journal of Surgery
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2012
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vol. 84
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issue 3
158-162
EN
A case of a progressive ischemia of the right upper extremity in a 57-year-old male caused by primarily undiagnosed compression of a subclavian artery by an accessory cervical rib is presented. Critical limb ischemia persisting for 7 years despite conservative treatment and a thrombectomy of upper extremity arteries and thoracic sympathectomy, led to a loss of three fingers and development of a non-healing ulceration of right upper extremity. Eventually a cervical rib resection together with a subclavio-brachial venous bypass graft permanently reversed the critical limb ischemia and allowed the ulceration to heal.The presented case underscores the importance of an early surgical intervention in patients with upper limb ischemia and anatomic abnormalities in a thoracic outlet.
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Increased Frequency of Ace Gene DD Genotype in Normotensive Male Smokers with Abdominal Aortic Aneurysm

88%
Waliszewski K., Słomski R., Oszkinis G., Majewski W., Pawlaczyk K.
Polish Journal of Surgery
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2007
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vol. 79
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issue 5
368-374
EN
The aim of the study was to assess whether the association between abdominal aortic aneurisms (AAAs) and the angiotensin-converting enzyme (ACE) DD genotype is changed in male smokers.Material and methods. The ACE I/D polymorphism was examined by PCR in 112 subjects with AAA and in 50 control subjects. The frequency of ACE genotypes (II, ID and DD) in the patient group was assessed in subgroups divided on the basis of blood pressure, smoking and sex.Results. A significant increase in the frequency of ACE DD genotypes has been found in all AAA patients studied (odds ratio OR=2.6; range 1.3-5.6, p <0.0002) when compared to the remaining ACE genotypes (ID and II) and the control group. The respective values were higher when all 74 male smokers with AAA were assessed (OR=3.6; p <0.006). No increase in ACE DD genotype frequency was seen in all females (38) and male nonsmokers when compared to the respective control group (n=16) (OR=1.4; p <0.75).In the group of normotensive AAA patients, the proportion of ACE DD genotype in relation to the remaining ACE genotypes (ID and II) was found to be higher than in the general AAA patient population (odds ratio OR=6.14; range 2.5-14.9, p <0.0001). In 32 normotensive male smokers with AAA, the respective values were higher (OR=8.3).Conclusions. An increased frequency of the ACE DD genotype in normotensive male smokers may account in large part for the increase in DD genotype occurrence noted in all AAA patients.
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The Usefulness of Topical Negative Pressure (TNP) As a Supporting Method for the Surgical Treatment of Venous Ulcers with the use of Middle-Split Thickness Skin Graft

76%
Zieliński M., Pukacki F., Oszkinis G., Gabriel M., Waliszewski K., Majewski W.
Polish Journal of Surgery
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2008
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vol. 80
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issue 3
124-131
EN
The most effective method of treatment for venous ulcers resistant to conservative therapy is operation.The surgical procedure consists of resection of the entire ulceration followed by perforated middle-split thickness skin graft transplant. Postoperative treatment requires both long term elevation of the patient's leg and frequent dressing changing.The aim of the study was to assesses the effectiveness of TNP as a method supporting surgical treatment.Material and methods. From 2004 to 2006 in the Poznań Clinic of General and Vascular Surgery of Medical University, 25 patients (16 women and 9 men) were treated for venous ulcers resistant to conservative treatment. The patients' ages varied from 50 to 82 years (average: 69), and the time of ulceration presence ranged from 6 months to 6 years (average: 2 years and 5 months). Patients were divided into two groups: all patients in group I (n=14) underwent surgical treatment with the use of middle split thickness skin grafting, whereas all patients in group II (n=11) underwent surgical treatment with support of TNP - VAC® Subsequent parameters, including the time of hospitalization, time and effectiveness of skin graft healing, and patient's subjective comfort of the therapy, were analyzed.Results. The average hospitalization time was significantly shorter in group II than group I (18 vs 24 days, p<0.0005). The average healing time in group II was significantly shorter than that in group I (31 vs 42 days, p<0.00002). Additional skin grafting was necessary in four cases from group I but none from group II. Subjective therapy comfort was higher among patients from group II than group I.Conclusions. TNP is a useful method supporting the surgical treatment of venous ulcers that are resistant to conservative treatment.
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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.
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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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Utility of Measurements of Abdominal Perfusion Pressure as a Measure of Isovolemic Status and Intestinal Perfusion in Patients with Ruptured Aortic Aneurysm

76%
Bieda K., Pukacki F., Zieliński M., Sobczyński P., Oszkinis G., Hartman-Sobczyńska R., Majewski W.
Polish Journal of Surgery
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2011
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vol. 83
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issue 8
443-448
EN
Ruptured abdominal aorta aneurysm of ten results in intraabdominal hypertension (IAH). When IAH exceeds 20 mm Hg, intestinal ischemia can result that is a common cause of severe postoperative complications, including death.The aim of the study was to evaluate utility of measurement of abdominal perfusion pressure (APP) to estimate intestinal perfusion and isovolemic status in patients undergoing surgical treatment for ruptured abdominal aorta aneurysm.Material and methods. A group of 40 patients of either sex, aged 47 - 93 years (average age 70 ± 10) was treated at an Intensive Care Unit after surgical reconstruction of abdominal aorta due to ruptured aortic aneurysm. The study was prospective. The following were measured: parameters of intraabdominal pressure (intraabdominal pressure - IAP, abdominal perfusion pressure - APP); parameters of intestinal perfusion - tonometric (intramucosal gastric carbon dioxide partial pressure PgCO2, intramucosal-arterial difference in carbon dioxide partial pressure - Pg-aCO2); hemodynamic parameters (mean arterial pressure - MAP, central venous pressure - CVP).Results. A statistically significant correlation was demonstrated between parameters of visceral perfusion and abdominal perfusion pressure. Pearson correlation coefficient for APP/PgCO2 and APP/Pg-aCO2 was negative and was - 0.4664 and - 0.3498, respectively.Conclusions. Abdominal perfusion pressure is an useful parameter in the evaluation of intestinal perfusion in IAH patients after surgical treatment of ruptured aortic aneurysm. MAP reflects current physiological body reserves at a critical stage of the disease, informing about possibility to provide visceral perfusion and indirectly, about adequacy of fluid replacement therapy. In intraabdominal hypertension, CVP is falsely elevated, making it of low utility in the evaluation of volemic status and intestinal perfusion.
8
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Changes in Transmission of Lower Limbs Nerves After Varicose Veins Operations with Saphenous Vein Stripping

64%
Oszkinis G., Jaworucka-Kaczorowska A., Huber J., Kaczorowski P., Wiertel-Krawczuk A., Pukacki F., Zieliński M., Snoch M., Majewski W.
Polish Journal of Surgery
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2008
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vol. 80
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issue 8
404-412
EN
The injury of the lower limb nerves is a very frequent complication after the varicose veins surgical treatment. The stripping of the great saphenous vein can cause the lesion of saphenous nerve and other lower limb nervesThe aim of the study was to establish the relationship between the percentage of the nerve injuries at the long stripping of great saphenous vein and to estimate the impact of this surgical treatment on the quality of patient's life.Material and methods. The neurophysiological examinations which included 80 patients were performed four times- before the operation, 2 weeks, 3 and 6 months after the operation. The following neurophysiological examinations were used: the sensory conduction velocity studies (SCV), the intensity of current-stimulus duration curves (IC-SD) and the von Frey filaments examination, the electroneurography (ENG, M-wave studies) and electromyography (EMG). The questionnaire to estimate the quality of life among the patients after the varicose veins operations was also conducted.Results. 30 patients (36%) were found to be injured with the saphenous nerve. These disorders persisted among 17 patients (21.25%) 3 months and among 11 patients (13.75%) 6 moths after the operation. In 38 patient (47.5%) 2 weeks after the operation, 24 of patients (30%) 3 months after the operation and in 15 patients (18.75%) 6 months after the operation showed the abnormalities which were usually located near the medial ankle. The paraesthesia which occured among 32 patients (40%) did not worsen the quality of life and only one patient wouldn't agree to repeated operation. In 6 patients (7.5%) there was found hyperaesthesia which had the significantly bad impact on patient's life and 5 of them (83.33%) wouldn't agree to such an operation once again. There were also observed the temporary disorders of the tibial nerve (7 patients - 8.75%) and the peroneal nerve (17 patients - 21.25%).Conclusions. The varicose veins operations have the significantly bad influence on the saphenous nerve transmission and can cause a transient injury of the tibial and peroneal nerves. The sensory disorders usually concern the region of the medial ankle. The operation doesn't significantly worsen the patient's quality of life but the sort of sensory disorders has the influence on patient's estimation.
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Contemporary Indications and own Results of Surgical Treatment of occlusions of the initial section of the Left subclavian artery

64%
Pukacki F., Zieliński M., Oszkinis G., Juszkat R., Gabriel M., Słowiński M., Zapalski S., Majewski W.
Polish Journal of Surgery
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2010
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vol. 82
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issue 5
272-278
EN
Symptomatic occlusion of the initial section of the subclavian artery, resistant to intravascular treatment, is an indication for a surgery as it exacerbates the verterbrobasilar insufficiency and creates the risk of peripheral embolism. Reconstructive surgery fixes the reversed blood flow in the vertebral artery, alleviates neurological and limb ischemia symptoms.The aim of the study was to retrospectively evaluate the results of surgical treatment of the occlusion of the initial section of the subclavian artery using transposition or subclavian-carotid by-pass with a PTFE.Material and methods. Retrospective analysis covered 55 patients operated on between June 1996 and August 2008 for occlusion of the left subclavian artery. 39 patients underwent a subclavian artery transposition (SCT) and the remaining 16 had a subclavian-carotid by-pass (SCB) using a PTFE. Indications for surgery included ischeamic symptoms in the upper limb and impaired vertebrobasilar circulation. Clinical symptoms occurred in the following order: vertebrobasilar insufficiency and upper limb ischemia (62%), upper limb ischemia symptoms (22%), vertebrobasilar insufficiency (16%).Results. There were no early deaths (by day 30). Ischemia was lifted in 100% of the patients operated using transposition and in 93% of those with a by-pass. In the perioperative period, one patient had a bypass thrombosis, and 2 patients had a transitional brain ischemia. These incidents affected patients who underwent subclavian-carotid by-pass. In the late postoperative period, 12 patients (21.81%) died due to cardiological complications and 7 patients (12.72%) for other causes, and none of them was related to the primary surgery. All patients with transposition have maintained the primary patency, with average follow-up period of 73 months (23-138). In the group with a by-pass, occlusion occurred in 3 patients in the first follow-up month. These incidents had no effect on survival rates. For the remaining 14/16 patients from the SCB group the average primary patency was 63.4 (8-104) months.Conclusions. Subclavian-carotid transposition is a safe and effective method of upper limb revascularization. It is technically more difficult than the by-pass but ensures a better short-term and long-term result.
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