Aortoenteric fistulas — case report series from the Department of Surgery of the 4. Military Clinical Hospital in Wroclaw over the years 2010–2016

Background. Aortoenteric fistulas constitute a rare, but severe clinical problem involving a pathologicalconnection between the abdominal aorta and gastrointestinal tract. We distinguish primary and, much morefrequent, secondary fistulas. All such fistulas require urgent surgical treatment. Currently, the most commontreatment method involves open in situ prosthesis replacement or an extra-anatomical by-pass. Endovascularprocedures offer an alternative to open surgery, but remain controversial. Material and methods. The analysis included 6 surgical procedures in 5 patients with aorto-duodenal fistulatreated at the Department of Surgery of the 4. Military Clinical Hospital over the years 2010–2016. Opensurgery was performed in 4 cases, while 2 patients underwent stentgraft implantation. Diagnostics consisted ofan angio-CT and upper gastrointestinal tract endoscopy. All patients were diagnosed with radiological signs ofprosthesis infection, 2 of 6 patients died during the perioperative period. Surgical complications were observedin 5 of 6 cases (83%). Results. Endovascular treatment was associated with a reduction in the number of early postoperative complicationsand shortening of hospital stay. Conclusions. Based on the results and literature data, stentgraft implantation into the aorto-duodenal fistulaappears to be a viable alternative treatment method

Cystic adventitial disease of the popliteal artery in a young woman — a case report

Zwyrodnienie torbielowate przydanki jest rzadką chorobą ściany naczyń krwionośnych. Występuje najczęściej w tętnicy podkolanowej i może powodować objawy przewlekłego lub ostrego niedokrwienia. W pracy przedstawiono przypadek 38-letniej kobiety, bez istotnego wywiadu chorobowego, u której przez 5 miesięcy rozwijały się objawy przewlekłego niedokrwienia kończyn dolnych z dystansem chromania 100–150 m. Na podstawie wyników badań obrazowych USG metodą duplex Doppler oraz rezonansu magnetycznego zdiagnozowano zwyrodnienie torbielowate przydanki. Pacjentkę leczono operacyjnie, usunięto zmiany torbielowate oraz wykonano plastykę tętnicy podkolanowej z użyciem łaty. Po zabiegu objawy kliniczne ustąpiły. Kontrolne badania USG obrazowały prawidłowy przepływ krwi w obrębie tętnicy podkolanowej. Od 12 miesięcy pacjentka pozostaje pod kontrolą poradni angiochirurgicznej bez nawrotu objawów.Cystic adventitial disease is a rare disease of the blood vessel walls. It occurs most commonly in the popliteal artery and can cause symptoms of chronic or acute ischaemia. We present a case of 38-year-old woman with no significant medical history who developed symptoms of chronic ischaemia of the lower limbs with claudication distance of 100–150 meters in last 5 months. Based of imaging studies, duplex Doppler ultrasound method and magnetic resonance, we diagnosed cystic adventitial disease. The patient was treated surgically by removal of cystic lesions and popliteal artery angioplasty using a patch. After the treatment all the clinical symptoms have subsided. Control ultrasound investigation revealed the normal blood flow within the popliteal artery. The patient was followed-up in our vascular surgery clinic for 12 months without recurrence of symptoms

Multicenter registry of Impella-assisted high-risk percutaneous coronary interventions and cardiogenic shock in Poland (IMPELLA-PL)

Background: Impella is a percutaneous mechanical circulatory support device for treatment of cardiogenic shock (CS) and high-risk percutaneous coronary interventions (HR-PCIs). IMPELLA-PL is a national retrospective registry of Impella-treated CS and HR-PCI patients in 20 Polish interventional cardiological centers, conducted from January 2014 until December 2021.Aims: We aimed to determine the efficacy and safety of Impella using real-world data from IMPELLA-PL and compare these with other registries.Methods: IMPELLA-PL data were analyzed to determine primary endpoints: in-hospital mortality and rates of mortality and major adverse cardiovascular and cerebrovascular events (MACCE) at 12 months post-discharge.Results: Of 308 patients, 18% had CS and 82% underwent HR-PCI. In-hospital mortality rates were 76.4% and 8.3% in the CS and HR-PCI groups, respectively. The 12-month mortality rates were 80.0% and 18.2%, and post-discharge MACCE rates were 9.1% and 22.5%, respectively. Any access site bleeding occurred in 30.9% of CS patients and 14.6% of HR-PCI patients, limb ischemia in 12.7% and 2.4%, and hemolysis in 10.9% and 1.6%, respectively.Conclusions: Impella is safe and effective during HR-PCIs, in accordance with previous registry analyses. The risk profile and mortality in CS patients were higher than in other registries, and the potential benefits of Impella in CS require investigation

Rule-based system for solving functional harmony exercises

praca inżyniersk

Endoscopic esophageal self-expanding stent implantation WallFlex™ (boston scientific) in the management of a gastrocutaneous fistula, as a complication of sleeve bariatric gastrectomy

The study presented a case of a gastrocutaneous fistula, as a result of bariatric sleeve gastrectomy. The discussion considered the main pathogenesis, etiology, diagnostics and endoscopic treatment using the implantation of covered esophageal stents. Special attention was placed upon the multifactorial origin of this life-threatening clinical condition, typical for bariatric surger

Endoscopic esophageal self-expanding stent implantation WallFlex™ (boston scientific) in the management of a gastrocutaneous fistula, as a complication of sleeve bariatric gastrectomy

The study presented a case of a gastrocutaneous fistula, as a result of bariatric sleeve gastrectomy. The discussion considered the main pathogenesis, etiology, diagnostics and endoscopic treatment using the implantation of covered esophageal stents. Special attention was placed upon the multifactorial origin of this life-threatening clinical condition, typical for bariatric surger