Leucocytosis as a specific risk predictor after abdominal aortic aneurysm open repair.

INTRODUCTION: Prediction of early death in abdominal aortic aneurysm - open repair is widely described. There is no superiority of any risk stratification tool. Some of the risk calculators are quite accurate, but very complicated (e.g. P-POSSUM, V-POSSUM). Some are simpler but never used in vascular surgery (e.g. ECOG). Therefore, only leucocytosis itself appears to be an independent and highly specific factor in prediction of early death prior to surgery. This might be used as an early warning factor raising surgeons' attention, especially in centers not using any risk calculators on a regular basis. The aim of this study was to comparison of commonly used early death prediction calculators for abdominal aortic aneurysm - open repair. We took into account the following scales: Glasgow Aneurysm Score (GAS), V-POSSUM, Eagle score, American Society of Anesthesia Score, ECOG, Goldman/Detsky. However, we also have been looking for independent risk factors of early postoperative death. MATERIAL AND METHODS: Retrospective analysis of 79 patients who underwent elective open repair of abdominal aortic aneurysm over 3 years (2011-2013 Szczecin, Poland). We have excluded patients treated due to ruptured aneurysms and with the use of a stentgraft. Receiver operating curve analysis was used to asses all prediction abilities. RESULTS: We noted 6 deaths (7.59%). Receiver operating curve analysis confirms good prediction force for V-POSSUM (p = 0.0001, criterion over 1.9%) and GAS (p = 0.0109, criterion over 73 pt.). Areas under curve are respectively 0.806 and 0.743. However, leucocytosis itself over 10 T/L was the most specific (over 88%) risk factor in early death prediction (p < 0.0001). CONCLUSION: V-POSSUM and GAS are suitable risk calculators for abdominal aortic aneurysm - open repair. Leucocytosis discovered prior to the surgery is a highly specific early death predictor.

The role of neck wrinkles for cosmetic effect during carotid artery endarterectomy.

INTRODUCTION: Minimally invasive procedures in carotid endarterectomy are currently preferred. Smaller skin incisions (transverse or longitudinal) and the mapping of carotid artery bifurcation with Doppler ultrasound are promoted. There is a lack of papers about cosmetic effects and patients' preferences. The aim of this study was to qualify natural skin wrinkles as potential anatomical markers of carotid artery bifurcation and scar camouflage. MATERIAL AND METHODS: 50 patients underwent carotid endarterectomy in 2013-2014 in the Vascular Surgery Department of the Pomeranian Medical University in Szczecin. The positions of wrinkles were compared with the anatomical location of carotid artery bifurcation with the use of Doppler - Duplex Ultrasound. Patients' preferences and cosmetic effect were also assessed. RESULTS: 50% of patients declared the cosmetic effect important. Nevertheless, every patient preferred a transverse incision along a wrinkle line. The wound scar was invisible in 76% of cases 3-6 months after surgery. Wrinkles were close, within 1 centimeter, to carotid artery bifurcation in 80% of cases. It was mainly 4-5 cm from the angle of the mandible. Surgical access along wrinkles located 3, 4, 5, 6, 7 cm from the gonial angle was technically easy in 55%, 77%, 79%, 45%, and 21% of cases, respectively. Using ultrasound before surgery allows the planning of the optimal incision in 98% of cases. CONCLUSIONS: Transverse incision hidden in the wrinkles of the neck gives a good cosmetic effect and allows carotid endarterectomy in every case when carotid artery bifurcation is marked prior to surgery.

[Gastric non-Hodgkin's lymphoma--clinical symptoms and diagnostic problems]. / Chloniaki nieziarnicze z pierwotna lokalizacja w zoladku--objawy kliniczne i trudnosci w rozpoznaniu.

INTRODUCTION: Gastric lymphoma takes 70% of lymphomas in gastric tract. Lack of characteristic symptoms and histological changes makes these disease difficult to recognize. The aim of the study was to search for specific constellation of the symptoms due to validation of diagnostic standards. MATERIAL AND METHODS: Retrospective analysis of clinical data for the group of 64 patients treated during 10 years in Hematology Department of Pomeranian Medical University in Szczecin. RESULTS: Recognition of gastric lymphoma in 80% was based on gastrocopy and histopatology examination. Gastrectomy was useful in 14 cases. Classic Ultrasound Abdomen Examination confirmed changes in 40%. Epigastic pain was raported as the most common symptom (54 from 64 patients). Systemic symptom appears in 34/64 patients (usually the loss of the body mass). CONCLUSIONS: 1. Clinical symptoms of non-Hodgkin's lymphoma in gastric localization are not specific. Epigastric pain, nausea and body mass lost are the symptoms the most often reported and physical symptoms do not reflect in systemic disease. 2. The standard of examination should consist of the transesophageal sonography (EUS) completed with multiple biopsy of gastric membrane and Hp tests.

Migration of a foreign body into the colon and its autonomous excretion.

BACKGROUND: The frequency of foreign body retention in the abdominal cavity ranges from 1 in 100 to 1 in 3000 surgeries performed. Worldwide literature describes only a few cases of the migration of misplaced surgical gauze into the colon. CASE REPORTS: The first case is a 60-year-old patient following laparoscopic cholecystectomy, who excreted (on his own) a cotton sheet 30 × 65 cm after 26 weeks, which did not possess a radiological locator. The latter fact caused diagnostic difficulties in interpreting ultrasonography, CT-scans and abdominal X-rays. Colonoscopy after 4 months following the excretion of the sheet showed flat, stretched ulceration of the colonic wall near the hepatic turn. The second case is a 76-year-old who had undergone several abdominal surgeries, including a classical cholecystectomy and extirpation of the uterus along with related tissues, as a result of cancer and with subsequent radiotherapy. The reason for the last intervention was an occlusion, which required a resection due to abscesses inside the peritoneal cavity. Abdominal pain continued after the surgery. Uroscopy and abdominal X-rays were performed 3 months later, which confirmed the presence of foreign matter in the abdominal cavity. CONCLUSIONS: Most foreign objects that have migrated into the colon will be excreted autonomously, which warrants a conservative assessment. Radiologically-tagged materials should be used, which will greatly ease identification in cases of suspected retention of surgical materials in the abdominal cavity.

[Latent chronic kidney disease in the material of the Department of Vascular Surgery, Pomeranian Medical University in Szczecin. An important clinical problem]. / Utajona przewlekla choroba nerek w materiale Kliniki Chirurgii Naczyniowej Pomorskiego Uniwersytetu Medycznego w Szczecinie. Istotny problem kliniczny.

INTRODUCTION: The percentage of patients with diagnosed chronic renal failure is many times smaller than the percentage of the latent disease. The rate of cardiovascular complications in latent kidney disease is significantly higher. The aim of this work was to determine the percentage of patients with renal failure among patients with peripheral atherosclerosis treated at our Department and to study rate (GFR) below the influence of reduced glomerular filtration rate (GFR) below 60 mL/min/1.73 m2 on the risk of early complications after vascular surgery. MATERIAL AND METHODS: A retrospective analysis of 1096 patients was done. 652 patients were operated, 321 underwent endovascular procedures, including angiography, antiglobulin test (PTA), and fibrinolysis, and 123 were conservatively treated. There were no significant differences between these groups as regards biochemical parameters prior to treatment. RESULTS: Approximately 2% of patients presented with chronic renal failure at admission. However, GFR in more than 30% (370) of them was lower than 60 mL/min/1.73 m2. The incidence of myocardial infarction and pneumonia was more than three-fold greater in patients with reduced GFR (1.89 vs. 0.55, p = 0.042; 4.59 vs. 1.38, p = 0.0017, respectively). The incidence of gastrointestinal bleeding increased more than 18 times (3.78 vs. 0.28, p = 0.00002) and the incidence of stroke increased six times (2.43 vs. 0.41, p = 0.0032) in these patients. CONCLUSIONS: Latent renal failure is present in more than one-third of patients treated for peripheral atherosclerosis. GFR below 60 mL/min/1.73 m2 is associated with a higher risk of cardiovascular complications and postoperative gastrointestinal bleeding. Glomerular filtration rate should be routinely calculated at admission to hospital.

[Early death in vascular surgery: an ongoing prognostic problem]. / Wczesny zgon w chirurgii naczyniowej. Aktualny problem prognostyczny.

INTRODUCTION: Prediction of complications in surgery is commonly done. There are conflicting reports concerning the usefulness of risk scales (P-POSSUM, APACHE, SAPS, ASA, Goldman, etc.) in vascular surgery. We decided to take a fresh look at preoperative risk factors of early death in the context of the usefulness of some parameters which have not been included in existing risk calculators. MATERIAL AND METHODS: The study group consisted of 1270 patients treated at the Department of Vascular Surgery, General Surgery, and Angiology, Pomeranian Medical University in Szczecin, during one year. METHOD This was a prospective non-randomized study. All data recorded at admission and data from P-POSSUM, ASA, Goldman, and ECOG-Zubroda-WHO scales were analyzed. Statistics were done with discriminant, multivariate, and logistic tests. RESULTS: There were 42 early deaths in the group. The following independent risk factors were involved in early death: ASA > 2 (OR = 18.31), persistent atrial fibrillation (OR = 5.75), leukocytosis (OR = 13.31), glomerular filtration rate (GFR) < 30 mL/min/1.73 m2 (OR = 5.78), systemic inflammatory response syndrome (SIRS) (OR = 11.36), emergency admission (OR = 38.62), critical limb ischemia (OR = 4.87), acute limb ischemia (OR = 8,98), abdominal aortic aneurysm (OR = 4.4), and ruptured aortic aneurysm (OR = 10.59). Logistic regression exposed the influence of five factors: ASA III, ASA IV, persistent atrial fibrillation, leukocytosis, GFR < 30 mL/kg/1.73 m2, and ruptured aortic aneurysm. The P-POSSUM calculator was found to be an accurate predictor of early death although the predicted death rate was insignificantly higher than the observed rate. CONCLUSION: Risk scales of early death currently used in vascular surgery need to be "refreshed". Creation of the Polish National Vascular Surgery Register seems to be unavoidable.

The influence of substrate peptide length on human beta-tryptase specificity.

Combinatorial chemistry approach was applied to design chromogenic substrates of human beta-tryptase. The most active substrate, Ala-Ala-Pro-Ile-Arg-Asn-Lys-ANB-NH(2), was selected from among over 9 million heptapeptides. The amide of 5-amino-2-nitrobenzoic acid (ANB-NH(2)) attached at the C-terminus served as a chromophore. In order to determine the optimal length of the tryptase substrate, a series of N-terminally truncated fragments of this substrate was synthesized. Pro-Ile-Arg-Asn-Lys-ANB-NH(2), with the determined value of the specificity constant (k(cat)/K(M)) above 9 x 10(6) M(-1) s(-1), appeared to be the most specific substrate of tryptase. This substrate was twice as active as the parent heptapeptide substrate. We postulate that the optimal size of the pentapeptide substrate for the interaction with human beta-tryptase is associated with the unique structure of this proteinase, comprising four almost identical monomer subunits arranged in a square flat ring with its substrate pockets faced inside, forming a tetramer with a central pore that can be penetrated by this short peptide.