30 research outputs found
Wieloetapowe, wewnątrznaczyniowe leczenie ostrego, jatrogennego niedokrwienia kończyny dolnej u pacjenta z penetrującym owrzodzeniem aorty
Introduction. Acute limb ischaemia (ALI) is a potentially treatable disease of the arteries. ALI can be caused by many
factors. A rare cause of ALI is embolisation due to a penetrating aortic ulcer (PAU). The endovascular approach has
made progress as an alternative treatment for ALI. However, using only one method of treatment may not be enough
to salvage the limb.
Case report. We present a case of an iatrogenic, intraoperative embolisation of the lower limb arteries after left external
iliac artery (EIA) stenting in a patient with a potential source of embolisation from a PAU. In the treatment process, we
performed an elective percutaneous transluminal angioplasty, left EIA stenting, and emergency intra-arterial thrombolysis.
The patient was discharged from the clinic in a good condition and without limb ischaemia. After one month,
an aortic stent graft was implanted to supply abdominal aortic aneurysm with PAU. Control angiography of computed
tomography of the abdominal aorta and lower limb arteries was performed, and a correct stent graft and stent patency
in left EIA was demonstrated.
Conclusions. Endovascular treatment of acute limb ischaemia may require the use of different techniques to solve the
problem, especially in complicated cases. Catheter directed thrombolysis is an effective method of treatment in an
iatrogenic, distal embolisation. Stent graft implantation seems to be an effective method of eliminating emboli sourced
from the aortic ulcer.Wstęp. Ostre niedokrwienie kończyn (ALI) jest jedną z najbardziej niebezpiecznych, ale potencjalnie wyleczalnych choróbspowodowanych zaburzeniami drożności tętnic. Przyczyną ALI może być ostry zakrzep, zator, uraz (w tym jatrogenny) lubrozwarstwienie. Rzadką przyczyną jest zatorowość spowodowana przez penetrujące owrzodzenie aorty (PAU). Metodywewnątrznaczyniowe i techniki otwarte w leczeniu ALI stosuje się zależnie od dostępności tętnic i drożności na obwodzie.Zastosowanie tylko jednej metody leczenia może nie wystarczyć do uratowania kończyny.Opis przypadku. Zaprezentowano przypadek jatrogennej, śródoperacyjnej zatorowości tętnic kończyny dolnej po stentowaniulewej tętnicy biodrowej zewnętrznej (EIA) z prawdopodobnym źródłem materiału zatorowego pochodzącymz PAU. Wykonano planową przezskórną angioplastykę wieńcową z posadowieniem stentu w lewej EIA oraz trombolizędotętniczą w trybie pilnym. Pacjenta wypisano z kliniki w dobrym stanie ogólnym, bez cech niedokrwienia kończyny. Pomiesiącu implantowano stentgraft, wyłączając PAU. Kontrolna angiografia tomografii komputerowej aorty brzusznej oraztętnic lewej kończyny dolnej wykazała prawidłowy przepływ przez stentgraft, przez stent w lewej EIA oraz przez tętnicekończyn dolnych.Wnioski. Wewnątrznaczyniowe leczenie ALI może wymagać zastosowania różnych technik, zwłaszcza w skomplikowanychprzypadkach. Tromboliza dotętnicza jest skuteczną metodą leczenia jatrogennej, dystalnej zatorowości. Wszczepieniestentgraftu wydaje się pewną metodą zapobiegającą zatorowości z owrzodzenia aorty.Sława kluczowe: ostre niedokrwienie kończyn dolnych, tętniak aorty brzusznej, penetrujące owrzodzenie aorty,tromboliza dotętnicz
Using our own developed stent in the palliative treatment of obstruction in the left half of the colon due to ovarian cancer
Objectives: An assessment of implantation efficacy and safety of self-developed self-expanding stent in patients with an ovarian cancer induced by intestinal obstruction.
Material and methods: The study of the stenting efficacy and safety was realized prospectively. The group consisted of 13 patients with left half colon obstruction due to an inoperable metastatic ovarian carcinoma. All the patients had a histopathologically diagnosed ovarian carcinoma and were treated in the past both surgically and systemically. Stenting was preceded by a Computed Tomography (CT) scan confirming and locating the obstruction. Patients with a multilevel intestinal obstruction were disqualified.
Results: Nine stents were implanted in the rectosigmoid; 4 stents were implanted in an externally compressed rectum. One migration of implanted stent was observed. In one case 2 stents were implanted due to an insufficient coverage of the stricture. The decompression of the obstruction of the gastrointestinal tract was achieved in 11 patients (85%).
Conclusions: 1) The implantation of our own developed, self-expanding stent is effective and safe. 2) The implantation of the stent in patients with an inoperable ovarian cancer causing an obstruction of the gastrointestinal tract is an effective procedure limiting postoperative complications and improving life comfort by avoiding stoma
Treatment of iatrogenic iliac artery rupture during endovascular surgery
Recently a growing number of endovascular operations are associated with an increased number of iatrogenic
vascular injuries. The aim of the study is to analyse the treatment of iliac artery damage during angioplasty.
Method. In the period 2002–2009, 328 patients underwent endovascular surgery of iliac artery stenosis,
219 men and 109 women aged from 47 to 85 years. Qualified patients displayed IIB, III, and IV stage of
ischaemia by Fontaine. The collected information concerned details of the performed procedures, possible
complications and ways of solving problems. Results. In 132 cases, endovascular surgery consisted of extension
of the iliac artery using a stent, while in 196 no stent was applied. Iatrogenic injury to the iliac artery
during the angioplasty occurred in six patients. In four cases, there was damage to the common iliac artery,
and in the next two patients to the external iliac artery. In four cases, there was damage to the artery during
endovascular expansion, and in two cases after stent implantation. In four cases, the damage to the artery
was treated by an endovascular method, in two patients a stent was implanted, in one patient a stent-graft
was introduced, and in one case a spillage was sealed using a balloon. Two patients underwent classic surgery
due to symptoms of hypovolaemic shock caused by bleeding into the retroperitoneal space; in one case
arterial damage was sutured, and in the second patient an aortal-femoral bypass graft was implanted. Of
the patients supplied by an intravascular method, in one case, because of the very large retroperitoneal haematoma
and the compression symptoms associated with it, surgical drainage was necessary. In the remaining
cases, the postoperative course passed without complications. Among the patients who underwent classic
surgery there was one case of deep vein thrombosis. All patients achieved satisfactory haemodynamic and
clinical effects. There were no deaths. Conclusions. 1. Each instance of iatrogenic iliac artery injury during
endovascular surgery requires an individual approach. 2. An attempt to repair damage by an intravascular
method is the treatment of choice in haemodynamically stable patients. 3. In cases of large retroperitoneal
bleeding, patients require immediate conversion to classical surgery.
Acta Angiol 2011; 17, 2: 150–157Wstęp. Rosnąca ostatnio liczba operacji wewnątrznaczyniowych wiąże się również ze zwiększoną liczbą
jatrogennych uszkodzeń naczyń. Celem pracy jest analiza sposobu postępowania przy uszkodzeniach tętnic
biodrowych w czasie angioplastyki.
Materiał i metoda. W latach 2002–2009 operowano wewnątrznaczyniowo 328 chorych ze zwężeniami
tętnic biodrowych, w tym 219 mężczyzn i 109 kobiet w wieku 47–85 lat. Do operacji kwalifikowano chorych
w IIB, III i IV stadium niedokrwienia według klasyfikacji Fontaine’a. Zbierano informacje na temat szczegółów
przeprowadzonych zabiegów, ewentualnych powikłań i sposobów rozwiązywania problemów.
Wyniki. W 132 przypadkach wykonano poszerzenie wewnątrznaczyniowe tętnicy biodrowej ze stentem, zaś
w 196 bez stentu. Do jatrogennego urazu tętnic biodrowych w miejscu przeprowadzanej angioplastyki doszło u 6
chorych. W 4 przypadkach stwierdzono uszkodzenie tętnicy biodrowej wspólnej, w kolejnych 2 — tętnicy biodrowej
zewnętrznej. U 4 chorych do uszkodzenia tętnicy doszło podczas wewnątrznaczyniowego poszerzenia, zaś w 2
przypadkach po wszczepieniu stentu. U 4 chorych uszkodzenie tętnicy leczono metodą wewnątrznaczyniową,
u 2 osób implantowano stent, u 1 pacjenta — stentgraft, zaś w 1 przypadku uszczelniono wyciek za pomocą
balonu. Dwóch chorych ze względu na objawy wstrząsu hipowolemicznego spowodowanego krwawieniem do
przestrzeni zaotrzewnowej operowano klasycznie, w jednym przypadku zszyto uszkodzenie tętnicy, zaś u drugiego
chorego wszczepiono pomost aortalno-udowy. Spośród chorych zaopatrzonych metodą wewnątrznaczyniową
w jednym przypadku ze względu na bardzo dużego krwiaka zaotrzewnowego i objawy uciskowe z nim związane
konieczne było przeprowadzenie jego chirurgicznego drenażu. U pozostałych przebieg pooperacyjny upłynął
bez powikłań. Wśród operowanych klasycznie u 1 chorego stwierdzono zakrzepicę żył głębokich. U wszystkich
pacjentów uzyskano zadowalający efekt hemodynamiczny i kliniczny. Nie zanotowano zgonów.
Wnioski. 1. Każdy przypadek jatrogennego urazu tętnicy biodrowej podczas operacji wewnątrznaczyniowej
wymaga indywidualnego podejścia. 2. Próba wewnątrznaczyniowej naprawy uszkodzenia jest postępowaniem
z wyboru u chorych w stanie stabilnym hemodynamicznie. 3. W przypadku dużych krwawień do przestrzeni
zaotrzewnowej konieczne jest natychmiastowe przeprowadzenie operacji klasycznej.
Acta Angiol 2011; 17, 2: 150–15
Evaluation of urgent multivisceral resections due to complications resulting from an advanced ovarian cancer
Background: Unlike other solid tumors (i.e. pancreas, gallbladder, stomach), an ovarian cancer is responsive to a systemic treatment with platinum derivates in 80% of patients. This apparent chemosensitivity justifies a broader surgical approach. A cytoreductive, ”tumor-debulking” surgery is defined as an attempt to remove in a maximum degree all visible and detectable lesions. Despite treatment, the advancement of the disease very often leads to complications defined as “surgical” and life-threatening.
Objectives: The aim was to evaluate the efficacy and safety of palliative surgery in advanced ovarian cancer implicating acute surgical diseases of the abdominal cavity.
Material and methods: Between years 2005 and 2014 were operated 118 patients with an advanced ovarian cancer (FIGO III-IV) implicating acute and directly life-threatening diseases of the abdominal cavity, involving 132 surgical operations. The causes of these operations were: obstruction of the gastrointestinal tract — 91 patients; perforation of the gastrointestinal tract — 15; gastrointestinal bleeding — 9; intussusceptions — 3.
Results: Retrospective data for the 118 patients were analyzed. Safety and the perioperative mortality rate were assessed. Serious postoperative complications were recorded in 31 patients (anastomotic stoma — 9; bleeding requiring repeated surgery —3; recurring gastrointestinal obstruction — 16; liver failure after partial hepatic resection — 3). Systemic complications in the form of respiratory failure and cardiovascular disorders requiring cardiological treatment — 21. All patients required clinical nutrition, both parenteral and enteral. Deaths recorded — 3. 39 patients were rehospitalized within 30 days of surgery. 7 deaths were recorded in this group.
Conclusions: Combining lifesaving surgery with cytoreduction allows further adjuvant treatment. Early rehospitalization occurring within less than 30 days is linked to increased mortality
Prostate cancer with different ERG status may show different FOXP3-positive cell numbers
Prostatic carcinoma is the most frequent cancer in males in the Western world. A significant proportion of these cancers have a recurrent translocation involving ETS family genes, which leads to the overexpression of ERG transcription factor. Prostate cancers, which bear this mutation, differ in a number of features, including tumor microenvironment. One of the components of the tumor microenvironment is FOXP3 positive lymphocytes, which may participate in breaking immunosurveillance and promoting tumor growth.
The aim of the study was to analyze the relationships between ERG expression, number of FOXP3 positive cells and other features of the tumor.
The study group consisted of 65 cases. Tissue microarrays composed of 2 mm tissue cores were used for immunohistological evaluation. Immunohistochemistry for ERG and FOXP3 was performed according to the routinely applied protocol. The FOXP3 positive cells were counted and the results were expressed as the number of cells per mm2.
The average number of FOXP3 positive cells was 33.30/mm2 for all cases, 21.43/mm2 for the ERG negative and 42.28/mm2 for the ERG positive group (p < 0.02). There were no significant relationships between FOXP3 positive cell count and any other parameters studied.
Our results suggest that the immune response may differ between ERG negative and ERG positive prostatic carcinomas
Retained neuroprotection filter after stenting of the internal carotid artery
Retained neuroprotection filter after carotid stenting (CAS) is an extremely rare complication. We report thecase of a 61-year old patient with an accidentally retained neuroprotection filter after urgent CAS. The patientdid not consent to open surgical removal of the retained basket. We did not observe any flow disturbances inthe filter and the patient remains asymptomatic in ten years follow-up. In some cases, the neuroprotectionfilter left in the internal carotid artery may not cause cerebral flow disturbances or occlusion of the stent. Incase of the poor neurological or general condition of the patient, we can wait for its improvement or stenting
Stężenie interleukiny 2 i interleukiny 10 u pacjentów z cukrzycą typu 2 i rakiem okrężnicy
Introduction. The risk of colon cancer (CC) development is increased significantly among patients with type 2 diabetes (T2DM). A mechanism responsible for a higher prevalence of CC among diabetic patients may be associated with disturbances of the immune system. Cytokines — interleukin-2 (IL-2) and interleukin-10 (IL- -10) play relevant role in the immune response. The aim of this study was to investigate the differences in the immunological state in terms of IL-2 and IL-10 levels among groups of patients with T2DM, patients with CC, patients with T2DM and CC and patients without these diseases. Material and methods. 80 patients were included in the tests and split into 4 groups: group 1 — 24 patients with T2DM, group 2 — 24 patients with CC, group 3 — 10 patients with CC and T2DM, and group 4 — 22 persons without T2DM or CC. Colonoscopy was performed for all the patients. All cases of colon cancer were confirmed by histopathological examination. Laboratory measurements included blood tests such as fasting glucose, insulin, C-peptide and HbA1c. The serum concentration of IL-2 and IL-10 was determined by the immunoenzymatic (ELISA) method. Results. The concentration of IL-2 was statistically higher in the group of patients with T2DM and CC than in the groups of patients without those diseases (4.21 ± 1.61 SE pg/ml vs. group 1 — 1.57 ± 0.44 SE pg/ml, group 2 — 1.64 ± 0.27 SE pg/ml, group 4 — 1.95 ± 0.47 SE pg/ml; p < 0.05). There were no statistically significant differences in the concentrations of IL-10 in patients with T2DM and CC compared with other subjects. The level of fasting glucose and HbA1c in the groups of patients with T2DM (group 1) and T2DM with CC (group 3) was statistically higher than in the groups of patients without T2DM. There were no statistically significant differences between the groups in levels of insulin, C-peptide and HOMA-IR. Conclusions. The concentration of IL-2 was statistically higher in the group of patients with T2DM and colon cancer than in other groups. Elevated level of IL-2 can be a marker of an increased risk of CC in people with type 2 diabetes. It might be useful in indicating a group of patients with differences in immune system particularly susceptible to the development of colon cancer.
Wstęp. U chorych na cukrzycę stwierdza się istotnie zwiększone ryzyko raka jelita grubego. Mogą być za to odpowiedzialne m.in. zaburzenia układu immunologicznego. Istotną rolę w odpowiedzi immunologicznej odgrywają cytokiny — interleukina 2 (IL-2) i interleukina 10 (IL-10). Celem pracy była ocena stężenia we krwi wybranych cytokin — IL-2 oraz IL-10 — u pacjentów z cukrzycą typu 2 i rakiem jelita grubego w porównaniu z osobami z cukrzycą typu 2 bez raka jelita grubego, z rakiem jelita grubego bez cukrzycy oraz bez obu tych patologii.
Materiał i metody. Do badania włączono 80 chorych, których podzielono na 4 grupy — grupa 1 (24 osoby) z cukrzycą typu 2, grupa 2 (24 osoby) — z rakiem jelita grubego bez cukrzycy, grupa 3 (10 osób) —– z rakiem jelita grubego oraz cukrzycą typu 2, grupa 4 (22 osoby) — grupa kontrolna bez cukrzycy oraz bez raka jelita grubego. Wszyscy pacjenci mieli wykonaną kolonoskopię. U osób z nowotworem jelita grubego potwierdzono rozpoznanie w badaniu histopatologicznym. Przeprowadzono badania laboratoryjne obejmujące ocenę glikemii na czczo, stężenie insuliny i peptydu C oraz odsetek hemoglobiny glikowanej HbA1c. Stężenie IL-2 i IL-10 oznaczano metodą immunoenzymatyczną, stosując zestawy Human IL-2 ELISA KIT i Human IL-10 (DIACLONE Research, Francja).
Wyniki. W grupie osób z cukrzycą typu 2 i rakiem jelita grubego stwierdzono statystycznie wyższe wartości stężenia interleukiny 2 (4,21 ± 1,61 SE pg/ml) w porównaniu z innymi grupami pacjentów (grupa 1 — 1,57 ± 0,44 SE pg/ml, grupa 2 — 1,64 ± 0,27 SE pg/ml, grupa 4 — 1,95 ± 0,47 SE pg/ml; p < 0,05). Nie stwierdzono istotnej statystycznie różnicy pomiędzy badanymi grupami pod względem stężeń IL-10. Obserwowano statystycznie istotny wyższy poziom glikemii na czczo oraz hemoglobiny glikowanej w grupach z cukrzycą typu 2 oraz z cukrzycą typu 2 z towarzyszącym rakiem jelita grubego. Nie wykazano statystycznie istotnej różnicy pomiędzy grupami w poziomach insulinemii, peptydu C ani wskaźnika HOMA-IR.
Wnioski. W grupie osób z cukrzycą typu 2 i rakiem jelita grubego stwierdzono statystycznie wyższe wartości stężenia interleukiny 2 w porównaniu z innymi grupami. Podwyższone stężenie IL-2 w surowicy krwi może być wskaźnikiem zwiększonego ryzyka raka jelita grubego u osób z cukrzycą typu 2. Można zasugerować, że pacjenci z cukrzycą typu 2 oraz podwyższonym stężeniem IL-2 w surowicy krwi powinni być objęci szczególnym nadzorem onkologicznym
Mast cells influence neoangiogenesis in prostatic cancer independently of ERG status
A significant proportion of prostatic adenocarcinomas show recurrent translocation leading to ERG expression. Previously we found that ERG+ cases have higher microvessel density than negative ones. One factor influencing angiogenesis in cancer is mast cells. The aim of the present study was to evaluate the relationship between microvessels, mast cells and ERG status.
Tissue microarrays prepared from 113 radical prostatectomy specimens were analyzed with immunohistochemistry for CD31, tryptase and chymase. Vascular profiles and tryptase-positive and chymase-positive cells were counted.
The average number of tryptase-positive cells was 28.93/mm 2 and chymase-positive cells 9.91/mm 2 . The average number of CD31+ vascular profiles was 352.66/mm 2 . The average number of tryptase-positive cells was 26.35/mm 2 for ERG– cases and 32.12/mm 2 for ERG+ cases. The average number of chymase-positive cells was 8.14/mm 2 for ERG– cases and 12.06/mm 2 for ERG+ cases. The average number of CD31+ vascular profiles was 321.34/mm 2 for ERG– cases and 390.74/mm 2 for ERG+ cases. The number of CD31+ vascular profiles was positively correlated with the number of tryptase-positive and chymase-positive cells (R = 0.26 and R = 0.20).
In summary, we demonstrated an interrelationship between mast cells, microvascular density and ERG status in prostatic carcinoma
The analysis of distributions of effective strain and flow stress in longitudinal sections of cold backward extruded copper cans for different punch-face shapes
The paper presents computer modelling results of researches on cold backward extrusion of copper cans. The calculations were carried out using the commercial code QFORM-2D, based on the Finite Element Method (FEM). The simulation of cold backward extrusion process was performed for different punch-face shapes (flat; flat and conical with conical angle 900 and 1500; as well as concave). On the basis of obtained results, the analysis of distributions of effective strain and flow stress in longitudinal sections of cold backward extruded copper cans was conducted