The expression profile of angiogenic genes in critical limb ischemia popliteal arteries.

Critical limb ischemia (CLI) represents the most severe form of peripheral arterial disease (PAD) and is the leading cause of non-traumatic amputations in western populations. In recent years, therapeutic angiogenesis has been considered to be a potential treatment option for CLI patients, however the molecular mechanism of ischemia-induced vascularization is still not fully understood. The identification of genetic factors underlying vascular responses to ischemia will improve our understanding of the biological causes of the disease and enhance personalized therapies in the future. In this work, we determined, for the first time, the expression profile of angiogenesis-related genes utilizing unique human material: the popliteal arteries retrieved during lower limb amputation from patients with CLI. Using custom-designed TaqMan Low-Density Array (TLDA) cards we investigated the mRNA level of 90 genes on CLI samples compared to healthy donors. We identified three significantly up-regulated genes in CLI group: matrix metalloproteinase 9 (MMP-9), VE-cadherin (CDH5) and integrin alpha 4 (ITGA4). However, among all investigated genes, only lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1) was significantly reduced. In order to verify whether hypoxic conditions occur in popliteal arteries of CLI patients, we validated the transcription level of selected proangiogenic genes by real-time PCR on a larger number of samples. These results showed that the expression of key genes involved in angiogenesis, such as MMP9, HGF, HIF1A, VEGF-A and FLT1 were elevated in patients with CLI. Moreover, the study revealed that the expression of VEGF-A and FLT1 was associated with activation of HIF1A transcription. In conclusion, our data revealed the alteration in the mRNA level of genes involved in matrix remodelling, cell-cell adhesion as well as endothelial cell migration and proliferation in human popliteal arteries.

Iatrogenic pseudoaneurysm of the popliteal artery following corrective tibial osteotomy.

Due to its anatomical location the popliteal artery is exposed to injury during surgical procedures in the region of the knee joint, in particular during high-level corrective osteotomies of the proximal tibial epiphysis. Nevertheless, posttraumatic (iatrogenic) pseudoaneurysm constitutes a very rare complication of the procedure. Only few reports of such complication have been published and they were usually connected with lateral tibial osteotomy - the accidents after medial osteotomy are seldom. The complication we report was observed in a 52-year-old female patient after corrective osteotomy of the medial portion of the proximal tibial epiphysis. The complication was diagnosed 7 days after surgery on US-examination and subsequently confirmed by emergently performed angio-CT. The patient was referred for urgent reconstructive surgery. No significant complications were observed, neither postoperatively nor during follow-up visits.

In situ revascularisation with silver-coated polyester prostheses and arterial homografts in patients with aortic graft infection--a prospective, comparative, single-centre study.

OBJECTIVE: The aim of our study was to evaluate the effectiveness of in situ revascularisation with the use of arterial homografts and silver-coated prostheses in the treatment of aortic graft infection. MATERIALS: A total of 77 consecutive patients (74 males, three females, mean age: 58 years), hospitalised between 2001 and 2008, were enrolled into the study. Patients were assigned to three groups: group 1 (n = 24)--fresh arterial homograft with subsequent immunosuppression, group 2 (n = 26)--fresh arterial homograft without immunosuppression and group 3 (n = 27)--silver-coated prosthesis. METHODS: The course of infection was assessed by scintigraphy with (99m)Technetium-labelled leucocytes, Duplex-Doppler ultrasound, angio-computed tomography (CT) and microbiological examination. RESULTS: The mean follow-up was 22.8 (±10.1) months. There was a significant decrease in leucocyte accumulation around the graft among all groups (group 1: p = 0.012, group 2: p = 0.006 and group 3: p = 0.021). The postoperative mortality rate in groups 1,2 and 3 was 8%, 23% and 11%, respectively. The postoperative morbidity was 35% in group 2, 16% in group 1 and 7% in group 3. CONCLUSION: Our study suggests that silver-coated prostheses can be as effective as arterial allografts in the treatment of infections of vascular prostheses.

Iatrogenic injuries of the carotid arteries.

BACKGROUND: Iatrogenic trauma of the carotid artery (CA) is a dangerous intraoperative complication, especially during oncological and endocrinological procedures. In these cases massive hemorrhage and severe neurological complications may occur. The outcome of reconstructive procedures is often fatal because of the long delay of surgery after the injuries occuring in non-vascular centers. PATIENTS AND METHODS: In this paper 22 cases of iatrogenic CA trauma will be presented, operated in the period of 1980-2003. Different methods of operation were performed according to the extent of trauma and anatomical changes. RESULTS: In spite of emergency help two patients died. In three cases cerebral stroke was observed. Additionally peripheral nervous damages were noted. CONCLUSIONS: Iatrogenic CA trauma is one of the most dangerous vascular injuries, connected with hemorrhage and neurological complications. We recommend intravenous administration of 5000 units unfractionated Heparin, anatomical artery preparation, then shunt inserting. Autogenous material should be used if possible. For reconstruction of the initial part of internal carotid artery the transposition of the external carotid artery is useful.

The detection of Chlamydia pneumoniae in aneurysm of abdominal aorta and in normal aortic wall of organ donors.

Sixty patients underwent surgery due to abdominal aortic aneurysms; the group included 30 patients with asymptomatic aneurysm and 30 with ruptured aneurysm. A control group comprised 30 organ donors. Surgical specimens derived from aneurysm or aorta fragments were investigated for Chlamydia pneumoniae DNA using PCR. In asymptomatic aneurysms, DNA was found in 9 cases (29%), and in ruptured aneurysms in 14 cases (49%). In the control group, C. pneumoniae DNA was not detected in an aortic wall. These results suggest that healthy aortic wall is not susceptible to chlamydial infection. A large number of aneurysm infections implies C. pneumoniae role in proteolysis and degradation of the aneurysm wall. The biological effect of this process may cause an enlargement of the aneurysm.

Thoughts, feelings, and motivations of bystanders who attempt to resuscitate a stranger: a pilot study.

BACKGROUND: Rates of bystander cardiopulmonary resuscitation remain low nationwide. Possibly, low rates can be explained by examining the reactions of laypersons who attempt to resuscitate a stranger. OBJECTIVE: To examine the thoughts, feelings, and motivations of laypersons who have attempted to resuscitate a stranger. METHOD: Survey methods were used to do a qualitative study of 12 laypersons who had provided bystander resuscitation. A 36-item questionnaire of predominately open-ended questions was used to elicit retrospective information about the laypersons' thoughts, feelings, and motivations during several stages of the resuscitation event. Data were analyzed by using content analysis. RESULTS: Thoughts about the event included curiosity, questioning of personal capability, and recognition of differences between classroom training and real-life events. Feelings included hope, euphoria, pride, relief, satisfaction, hopelessness, doubt, agitation, anger, sadness, and fear. Primary motivations were duty and responsibility, guilt and social pressure, and altruism. All participants reported that they had excellent recall of the event. CONCLUSION: These results provide insight into a population that acts on behalf of the medical community.

Vascular complications after the treatment with Ilizarov external fixators.

Iatrogenic vascular injuries from external fixation in orthopaedics and traumatology are frequent. Three cases of vascular injuries after the treatment with Ilizarov external fixators were treated at our institution. These include two cases of pseudoaneurysms and one case of acute ischaemia of the lower limb. Two patients became symptomatic only after removal of the fixator. In all cases, the diagnosis was made by color flow duplex sonography. All vascular injuries needed surgical repair.

[Iliac-femoral vein thrombosis as a first symptom of the isolated common and internal iliac artery aneurysm]. / Zakrzepica zylna w odcinku biodrowo-udowym jako pierwszy objaw izolowanego tetniaka tetnicy biodrowej wspólnej i tetnicy biodrowej zewnetrznej.

Deep vein thrombosis is often caused by external compression and very rarely it originates in isolated iliac artery aneurysm. This paper presents 3 cases of phlegmasia coerulea dolens caused by iliac aneurysm. The clinical role of abdomen ultrasound, Duplex-Doppler of vein and artery examination were evaluated. All patients underwent artery reconstruction and vein thrombectomy with good results.

[Examination of elastase concentration in the wall of abdominal aortic aneurysms]. / Badania poziomu elastazy w scianie tetniaków aorty brzusznej.

Authors examined concentration of the leukocyte elastase (LE) in serum and walls of atherosclerotic abdominal aorta, ruptured and nonruptured aneurysms of abdominal aorta. Control group included LE level in normal abdominal aortas from multi organ donors. For trial 12589 PMN ELASTASE (2th Version) MERCK IMMUNOASSAY was using. From November of 1994 to December 1997 87 patients were explorated. Our study presents highest level of the LE in sequence: ruptured aneurysms, nonruptured aneurysms, atherosclerotic aortas and normal aortas. We did not confirm any statistic dependence between serum LE levels. Analysis between aneurysms diameter and their LE level, evaluated mutual dependence. Exploration proved connection between expansion and inflammatory genesis of atherosclerosis disease (activity of the PMN-elastasis in vessels wall).

[The management in vascular trauma of extremities]. / Postepowanie w urazach naczyniowych konczyn.

Between 1990-1998 in the Department of Vascular Surgery, Medical Academy in Wroclaw, 104 patients were operated due to artery trauma: 28 women, 76 men. Mean age was 37 years. In 58 cases acute ischaemia occurred, in 46--haemorrhage. Preoperative procedure consisted of preparation and diagnostics, in some cases angiography. Predominantly autogenous material was used for artery reconstruction. In 25 cases prosthetic grafts were implanted. In 53 patients (79.1%) good results were obtained, complications occurred in 14 cases (20.9%).

[Erection disorders after implantation of aorto-bifemoral prosthesis]. / Zaburzenia erekcji po wszczepieniu protezy aortalno-dwuudowej.

In this paper we present sexual complications occurring after implantation of vascular aorto-bifemoral prosthesis. We have sent an inquiry to 1236 men, who were operated in Vascular Department of Medical Academy in Wroclaw in years 1983-1997. We received 659 answers. Additionally 302 patients were examined. We noticed disorders of erection after vascular operation in 350 cases. In 29 cases erection reappeared after operation. Only 112 patients declared correct ejaculation and 137 men have satisfied sexual life. This results present problem of postoperative ischaemia of minor pelvis and trauma to neural plexus of bifurcation of aorta. In cases of younger sexually active men, who need revascularisation of lower extremities by implantation of vascular aortobifemoral prosthesis we suggest endarterectomy of hypogastric artery and/or implantation this artery to prosthesis.

[Buttock claudication as the dominant symptom of atherosclerosis: a case report]. / Chromanie posladkowe jako dominujacy objaw miazdzycy zarostowej tetnic--opis przypadku.

Buttock claudication is rather rare symptom of atherosclerosis. Authors presented a case of 61 year old patient in whom buttock claudication was only one symptom. The patient was surgically treated (endarterectomy of iliac internal artery with ilico-femoral bypass) with excellent result. Authors pointed out necessity of restoration of blood flow through internal iliac artery as a prevention or treatment in buttock claudication.

[Comparison of peritoneal patch and vascular prosthesis monitored with isotopes and parameters of humoral and cell mediated response]. / Porównanie zachowania sie otrzewnej sciennej oraz protezy naczyniowej w ukladzie tetniczym, monitorowane badaniami izotopowymi oraz badaniami odpowiedzi humoralnej i komórkowej organizmu.

The aim of this experimental study was to assess the reaction of peritoneal patch and vascular graft after implantation in arterial system. We compare complement haemolytic activation CH-50%, serum elastase and scintigraphy using Tc99 labeled leukocytes. There were significant differences in parameters of humoral and cell-mediated response between implantation of peritoneal patch and vascular graft. Twelve months later histological examination was made to determine healing processes of implanted materials. The results of this study are encouraging and confirm benefits of peritoneal patch in vascular surgery creating a new possibilities of angioplasty.

[Early cellular and humoral response after vascular prosthesis implantation in the arterial system]. / Wczesna odpowiedz komórkowa i humoralna po wszczepieniu protezy naczyniowej w uklad tetniczy.

The aim of the study was to determine the level of leukocytes activation after the implantation of vascular graft. As an experimental model we used 20 dogs. The aorto-iliac unilateral graft (dacron 6 mm) was implanted to all animals. The adhesion and migration of the leukocytes was estimated postoperatively by scintigraphy using Tc99 labeled leukocytes. The increased migration and adhesion was found in both proximal and distal anastomoses till the 30th postoperative day and it was more intensive in the distal anastomosis.

[Abdominal aortic aneurysm treated concurrently with neoplasms in the abdominal cavity and retroperitoneal space]. / Tetniaki aorty brzusznej leczone jednoczasowo z nowotworami jamy otrzewnowej i przestrzeni zaotrzewnowej.

The authors report 489 patients. With abdominal aortic aneurysms (AAA). Twelve patients underwent operation for AAA and oncological resection in abdominal cavity. In this group were five patients with AAA and colorectal carcinoma. All oncological patients with AAA were operated electively. The reconstruction of AAA and oncological resection were done at the same time. No patient died in the first 30 postoperative days. The authors conclude that AAA repair and oncological resection should be performed simultaneously in elective patients.

[Radioisotopic diagnosis of infected anastomotic groin aneurysms after complications with aorto-bifemoral vascular prosthesis]. / Diagnostyka radioizotopowa tetniaków zespoleniowych w pachwinie po zabiegach wszczepienia protezy aortalno-dwuudowej.

UNLABELLED: Between 1990 and 1996 at the Department of Vascular Surgery, Medical Academy in Wroclaw 34 patients with groin aneurysms were operated. All patients had aorto-bifemoral graft implantation before. The age range between 41 and 81 years. Among patients there were 4 women and 30 men. The diagnosis of groin aneurysm was based on physical and ultrasound examination. In each case scintigraphy with 99Tc labeled leukocytes was performed. Scintigraphic picture showed graft infection in eight (23.5%) patients (group I). In 26 (76.5%) cases (group II) there was no infection on scintigraphy. In group I all patients were operated-the infected graft was excised and then implantation of straight PTFE or venous by-pass "in situ" was performed. In group II all patient were also operated, but through the groin approach only -in 9 cases reconstruction of the anastomosis between graft and artery was done and in 17 cases PTFE by-pass was performed. In group I the results of the treatment were good in 6 cases; in remaining two patients the amputation of the leg had to be done. In group II the results of the operation was good in 24 cases and 2 patients had amputation of the leg. CONCLUSION: Scintigraphy with 99Tc labeled leukocytes is beneficial in the diagnosis of infected groin aneurysms after previous vascular reconstruction.

Prospective validation of artificial neural network trained to identify acute myocardial infarction.

BACKGROUND: Artificial neural networks apply non-linear statistics to pattern recognition problems. One such problem is acute myocardial infarction (AMI), a diagnosis which, in a patient presenting as an emergency, can be difficult to confirm. We report here a prospective comparison of the diagnostic accuracy of a network and that of physicians, on the same patients with suspected AMI. METHODS: Emergency department physicians who evaluated 1070 patients 18 years or older presenting to the emergency department of a teaching hospital in California, USA with anterior chest pain indicated whether they thought these patients had sustained a myocardial infarction. The network analysed the patient data collected by the physicians during their evaluations and also generated a diagnosis. FINDINGS: The physicians had a diagnostic sensitivity and specificity for myocardial infarction of 73.3% (95% confidence interval 63.3-83.3%) and 81.1% (78.7-83.5%), respectively, while the network had a diagnostic sensitivity and specificity of 96.0% (91.2-100%) and 96.0% (94.8-97.2%), respectively. Only 7% of patients had had an AMI, a low frequency but typical for anterior chest pain. INTERPRETATION: The application of non-linear neural computational analysis via an artificial neural network to the clinical diagnosis of myocardial infarction appears to have significant potential.

Cholecystokinin octapeptide and the daily rhythm of vasopressin and oxytocin release.

The daily rhythm of neurohypophysial hormone release was monitored in rats given intracerebroventricularly (i.c.v.) CCK-8 (50 ng/10 microliters--once daily over five days). In animals injected i.c.v. with vehicle solution (0.9% NaCl) plasma oxytocin and vasopressin concentrations were seen to rise significantly over the hours of daylight, decreasing during the night. The changes seen in the neurohypophysial vasopressin and oxytocin content were inversely related to the plasma concentrations. Under i.c.v. treatment with CCK-8, the daily rhythm of the vasopressin and oxytocin release was similar to daily rhythm in the control group; respective figures were, however, reduced for the hypothalamus and neurohypophysis as well as increased for the blood plasma. It is suggested that CCK-8 may be involved in some circadian regulatory processes related to vasopressin and oxytocin release from the rat hypothalamo-neurohypophysial system.

Normal limits for renal mobility in children.

The range of vertical renal mobility measured in the recumbent and erect positions was established in 309 children (232 girls) with normal renal function, ages 2.5 to 15 years, hospitalized because of urinary tract infections. It was found that the degree of renal mobility changed nonsignificantly with age, ranging between 12 and 19 mm approximately. In girls ages 12 to 15 years, the mean renal mobility was greater ranging from 21 mm (left kidney) to 23 mm (right kidney). Excessive renal mobility (calculated in mm as kidney mobility greater than 2 SD over the mean value in a particular age group) was found in 13 patients (4.2% of the studied children) 11 of which were girls. The right kidney alone was involved in 76.9% of these cases. A statistically significant correlation was found between the age, body weight, and height of these patients and the degree of right kidney mobility. Since nephroptosis of the right kidney has also been reported, mainly in adult women, the obtained results suggest that this abnormality is constitutional rather than acquired in adult life.