Abdominal stab wound with damage to the abdominal aorta and the left lobe of the liver - case report

A case of a 26-year-old man with an abdominal stab wound damaging the abdominal aorta and the left lobe of the liver is presented here. The patient was diagnosed and operated on after an emergency admission. The patient was discharged from the Surgical Ward 10 days after surgery in good general condition and was referred to the out-patient clinic

Pathogenesis of abdominal aortic aneurysms from the vascular surgeon perspective – knowledge summary

Abdominal aortic aneurysms (AAA) affect 2.4% of the population, with men being five times more likely to be affected than women. The development of AAA is linked to changes in the elastin and vascular wall collagen. The enzymes that damage the cell wall are called metalloproteinases. AAA forms as a result of damage to elastic fibres and the loss of the property of reversible deformation of the aortic wall. The degradation of elastin and other stem proteins in the aortic wall is caused by metalloproteinases and serine proteases, accompanied by cysteine proteases and asparagine proteases. Increased calprotectin levels are observed in AAA patients in comparison to patients with a healthy aorta. A significant role in the pathogenesis of AAA and its rupture is played by inflammatory response cells; proteases of the tissue plasma coagulation and fibrinolysis. Plasminogen activator and plasmin accelerate the degradation of the aortic wall. Microbial involvement of C. pneumoniae, Helicobacter pylori, CMV, and HIV is considered in this inflammatory reaction. The local activation of platelets and the plasma coagulation system leads to the formation of a mural thrombus filling the lumen of the aneurysm. The mural thrombus shows a high tissue factor (TF) activity. The formation of AAA is conditioned by a combination of multiple factors. The factors impacting the formation of AAA discovered so far include genetic factors, sex, age, lifestyle (abuse of alcohol, tobacco misuse, obesity, stress), health conditions (hypertension, high cholesterol level, atherosclerosis), and infectious factors: bacteria, viruses, and other microorganisms

Charakterystyka właściwości biomechanicznych ścian aorty brzusznej

Background. The structure of the aorta wall is well adapted to withstand the mechanical loads caused by arterial blood pressure. The most important structural components of the aortic wall are elastin and collagen fibres. Elastin and collagen fibres allow reversible deformation of, and give mechanical strength to, the aorta. Alterations in composition cause changes in the mechanical properties of the aortic wall. Hence, the main aim of this study is the biomechanical assessment and preliminary histological study of the abdominal aortic wall. Material and methods. Specimens were cut from the materials obtained during autopsies, taking research standards into consideration, which were then examined in order to determine the directional material properties. The second part of the materials was intended for histological analysis. Results. It was appreciable that the mechanical strength of the aortic wall is higher in the transversal than in the longitudinal direction, which has a vital meaning for the correct functioning of the organism, and it makes the vessel able to perform reversible deformation under the influence of pulsatile blood pressure. This ability is strongly dependent on the structural composition of the aortic wall. Conclusions. Structural alterations due to atherosclerotic lesions of various degrees lead to a significant increase of stiffness and decrease of mechanical strength of the walls of abdominal aorta.Wstęp. Struktura ścian aorty jest przystosowana do stawiania oporu mechanicznym obciążeniom, które wywoływane są przez ciśnienie tętnicze. Najważniejszymi elementami strukturalnymi ścian aorty są włókna elastynowe i kolagenowe. Odpowiadają one za odwracalne odkształcanie się ścian aorty oraz ich mechaniczną wytrzymałość. Dlatego też głównym celem tej pracy jest ocena biomechaniczna oraz analiza histologiczna ścian aorty brzusznej. Materiał i metody. Z materiału pobranego podczas sekcji zwłok wycinano próbki w celu określenia właściwości mechanicznych ścian aorty brzusznej. Pozostałą część materiału przeznaczono do analiz histologicznych. Wyniki. Odnotowano, że mechaniczna wytrzymałość ścian aorty jest większa w kierunku obwodowym niż wzdłużnym. Cecha ta ma kluczowe znaczenie dla poprawnego funkcjonowania organizmu dzięki zdolności naczynia do odwracalnego odkształcania się pod wpływem tętniczego przepływu krwi w naczyniu. Zdolność ta silnie zależy od struktury naczynia. Wnioski. Zmiany strukturalne spowodowane przez miażdżycę prowadzą do znaczącego wzrostu sztywności i obniżenia wytrzymałości mechanicznej ścian aorty brzusznej

Relationship between the Levels of Calprotectin and Soluble Receptor for Advanced Glycation End Products with Abdominal Aortic Aneurysm Diameter: A Preliminary Clinical Trial

An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta greater than 50% of the diameter of a healthy aorta. Previous experimental studies confirm the effect of calprotectin (CAL) on the onset of arterial pathology. It has been suggested that low levels of soluble receptors for advanced glycation end products (RAGEs) increase levels of cytokines that lead to the inhibition of matrix metalloproteinases (MMPs), affecting AAA formation. This study aimed to analyze the correlation of levels of RAGE and CAL with AAA diameter. A group of 32 patients aged 50–75 with diagnosed AAA was enrolled in the study. This group of patients was further divided into three subgroups based on AAA diameter: (1) 5.5 cm. Peripheral blood was drawn from all participants on admission to measure the serum CAL and RAGE levels. An enumeration survey was performed three months after AAA surgical treatment. CAL and RAGE plasma levels were measured with the enzyme-linked immunosorbent assay (ELISA). The median CAL levels were 2273.0 ng/mL before and 1217.0 ng/mL after treatment. There was a statistically significant decrease in CAL levels following the surgical treatment (p = 0.003). The correlation analysis between CAL levels and RAGE levels before and after surgical treatment showed no statistically significant correlations. In addition, there were no statistically significant correlations between CAL and RAGE levels with AAA size. In conclusion, CAL levels appear to be a significant marker in patients with AAA. There is an almost twofold decrease in CAL levels after AAA excision

A Very Unusual Case of Physical Disability after Spinal Epidural Hematoma in the Course of Sport-Related Head Injury

Spinal epidural hematoma (SEH) is blood accumulation between the dura mater of the spinal canal and the bone of the vertebrae. It is estimated to be an extremely rare incidence, affecting approximately 0.1 of 100,000 patients. When the suspected cause is a sport-related injury in the majority of cases it affects the trauma region. The aim of this case report was to outline the case of a 60-year-old man who was admitted to the Emergency Department due to acute, severe pain in the lumbar region which lasted 30 min. It occurred that 54 h prior to the admission, he suffered a head injury due to sport-related trauma during recreational skiing. When waiting for the laboratory and imaging test results the patient developed bilateral paralysis of the lower limbs. The MR examination results showed SEH at the level Th9-L1; therefore, immediate neurosurgical laminectomy was performed. After 36 months of rehabilitation, the patient can walk independently. In summary, SEH without immediate and appropriate treatment is linked with very poor clinical outcome. Moreover, a high mortality rate of 7% and the fact that more than half of patients do not return to full physical health incentives its inclusion in differential diagnosis every time when symptoms of spinal cord involvement are found. Furthermore, delayed aftermath in the form of paresis of the lower limbs requires long-term and intensive physical rehabilitation

A Very Unusual Case of Physical Disability after Spinal Epidural Hematoma in the Course of Sport-Related Head Injury

Spinal epidural hematoma (SEH) is blood accumulation between the dura mater of the spinal canal and the bone of the vertebrae. It is estimated to be an extremely rare incidence, affecting approximately 0.1 of 100,000 patients. When the suspected cause is a sport-related injury in the majority of cases it affects the trauma region. The aim of this case report was to outline the case of a 60-year-old man who was admitted to the Emergency Department due to acute, severe pain in the lumbar region which lasted 30 min. It occurred that 54 h prior to the admission, he suffered a head injury due to sport-related trauma during recreational skiing. When waiting for the laboratory and imaging test results the patient developed bilateral paralysis of the lower limbs. The MR examination results showed SEH at the level Th9-L1; therefore, immediate neurosurgical laminectomy was performed. After 36 months of rehabilitation, the patient can walk independently. In summary, SEH without immediate and appropriate treatment is linked with very poor clinical outcome. Moreover, a high mortality rate of 7% and the fact that more than half of patients do not return to full physical health incentives its inclusion in differential diagnosis every time when symptoms of spinal cord involvement are found. Furthermore, delayed aftermath in the form of paresis of the lower limbs requires long-term and intensive physical rehabilitation

C-Reactive Protein (CRP) and Health Resort Reaction

Incident tissue-damaging factors trigger a systemic response manifested by inflammatory reaction. Acute-phase proteins are a diagnostic and prognostic marker in various systemic homeostasis disorders. In the course of health resort therapy, a so-called health resort reaction is observed presenting with, e.g., exacerbation of organ-related disorders, elevated body temperature, increased erythrocyte sedimentation rate, and leukocyte counts. The objective of the study was to demonstrate a change in the concentration of C-reactive protein (CRP) as a result of health resort radon therapy as well as to determine the relationship between this change and the phenomenon known as health resort reaction. The study was conducted in Swieradow-Zdroj resort. The study population consisted of patients undergoing radon-active water bath treatment. Standard tests were used to determine CRP levels before the treatment as well as 5 and 18 days into the treatment. The study group consisted of n = 34 patients with osteoarthritis and spondyloarthritis. The control group consisted of 17 employees of the health resort who were also burdened with osteoarthritis or spondyloarthritis yet did not undergo radon therapy and had absolutely no contact with radon materials. The study revealed no statistically significant increase in the concentration of CRP. This trial is registered with NCT03274128. The study was carried out as part of the statutory task SUB.E060.19.001