Alterations of aorta intima and media transcriptome in swine fed high-fat diet over 1-year follow-up period and of the switch to normal diet.

BACKGROUND AND AIM: We previously showed that 12-month high-fat diet (HFD) in pigs led to fattening and increased artery intima-media-thickness, which were partly reversed after 3-month return to control diet (CD). The aim of this study was to decipher underlying mechanism of action by using transcriptomic analyses of intima and media of aorta. METHODS AND RESULTS: Thirty-two pigs were divided into three groups: CD for 12 months; HFD for 12 months; switch diet group (regression diet; RD): HFD for 9 months followed by CD for 3 months. After 12 months, RNA was isolated from aorta intima and media for nutrigenomic analyses. HFD significantly affected gene expression in intima, while RD gene expression profile was distinct from the CD group. This suggests that switch to CD is not sufficient to correct gene expression alterations induced by HFD but counteracted expression of a group of genes. HFD also affected gene expression in media and as for intima, the expression profile of media of pigs on RD differed from that of these on CD. CONCLUSIONS: This study revealed nutrigenomic modifications induced by long-term HFD consumption on arterial intima and media. The return to CD was not sufficient to counteract the genomic effect of HFD.

Upper Extremity Lymphedema After Axillary Lymph Node Dissection: Prospective Lymphoscintigraphic Evaluation.

This prospective study was designed to evaluate changes in upper extremity lymphatic drainage after ALND in comparison to the preoperative status using lymphoscintigraphy. The study enrolled 44 women (mean age: 57.95; range: 35-80) with a new diagnosis of unilateral invasive breast carcinoma who had been scheduled to undergo ALND. This was a substudy of the physiotherapeutic project, in which subjects after ALND were randomized into 4 groups treated with: 1) rehabilitation exercises; 2) manual lymphatic drainage; 3) pneumatic compression pump; and 4) education only. Clinical evaluation which included arm measurements and lymphoscintigraphy was performed in every subject before surgery and 3 times after surgery (1-6 weeks, 1 and 2 years after ALND). Follow-up was completed in 44 subjects at 1 year and in 32 subjects at 2 years. Lymphedema diagnosis was made in 4 subjects 1 year after ALND (9%) and in 8 subjects 2 years after ALND (25%). Among them, respectively, only 50% and 62% noticed and reported lymphedema. Quantitative analysis of lymphoscintigrams and photoplethysmography results did not reveal upper extremities lymphatic transport and/or venous function impairment after the ALND procedure. Qualitative analysis of lymphoscintigrams revealed most commonly disappearance of previously functional lymph nodes and appearance of dermal backflow in subjects who developed lymphedema. Conversely, appearance of functional lymph nodes in different locations after ALND may indicate protection from development of upper extremity lymphedema.

The role of mediastinoscopy in the diagnosis of thoracic disease: one-year single center experience.

Our experience of using mediastinoscopy for the diagnosis of enlarged mediastinal lymph nodes or mediastinal mass is presented in this study. We reviewed 54 consecutive patients (34 men and 20 women) with mediastinal pathology of varied etiologies who underwent a standard cervical mediastinoscopy from January to December 2012. The histological results were positive in 32 cases (59.2%), and negative in 22 cases (40.8%). Transient laryngeal recurrent nerve palsy manifested as prolonged hoarseness of voice was the only minor complication in 3 cases (5.5%). The sensitivity of the procedure was 72%, and the specificity was 100%. We recommend the use of a mediastinoscopy in the staging of lung cancer and the diagnosis of mediastinal mass when other non-invasive procedures are ineffective.

A unilateral hemothorax as a presenting manifestation of mediastinal spindle cell sarcoma.

The article presents the case of a 73-year-old female injured in a bicycle accident, who was diagnosed with a left hemothorax. Initially, a chest drain was inserted and the pleural hematoma was evacuated. Then a thoracotomy was performed. A hematoma debridement and decortication with a subsequent tissue biopsy was carried out and a final diagnosis of spindle cell sarcoma was made. There is a brief discussion on the differential diagnosis of spontaneous hemothorax and its management.

Low-dose computer tomography as a screening tool for lung cancer in a high risk population.

The aim of the study was to evaluate the usefulness of low-dose computer tomography as a screening tool for early stage lung cancer. The study was performed in 332 individuals aged 55-70 who were asymptomatic, who had not previously suffered from cancer, and who smoked at least ten packs of cigarettes a year. Baseline and repeated LD-CT scans were performed. Pulmonary nodules were classified according to the size and morphology, and the results were categorized as negative (no nodules observed), semi-positive (nodules of 4 mm or smaller in diameter) and positive (nodules 5 mm or larger). Based on the category of the patient, either a repeat low-dose CT, a bronchoscopy with or without a biopsy, or a PET-CT was performed. The baseline screening showed 59 positive results. Eighteen patients were hospitalized and underwent bronchoscopy and biopsy. One of these patients had Stage I non small cell lung carcinoma (NSCLC) and a lobectomy was performed. Three patients had Stage IV NSCLC and were referred for chemotherapy. We identified 103 semi-positive results. Only 25 of those patients had a repeat scan because of noncompliance. We observed no significant growth of diagnosed nodules in a semi-positive group. Low-dose CT can be used as a screening tool for early stage lung cancer. A high percentage of false-positive results are observed. There are difficulties in diagnosing nodules in patients with post-tuberculosis changes. A high rate of noncompliance was noticed.

Huge alveolar soft part sarcoma of the retroperitoneum - case report.

Alveolar soft part sarcoma (ASPS) is a rare type of neoplasm, typically occurring in adolescents and young adults. Because of the rarity of this disease, there is no standard treatment plan. Chemotherapy and radiotherapy are not effective in this type of malignancy. Surgical excision is considered to be the treatment of choice. We report a case of a young woman with a painless mass in her left lower abdomen. Ultrasonography and CT scan revealed a large (21 cm) hard tumor occupying the left retroperitoneal space, which was surgically excised in our surgery department. The pathological diagnosis was ASPS.

A giant primary thyroid fibrosarcoma in an octogenarian.

We present an 89-year-old patient who was suffering from severe dyspnoea and mild dysphagia due to tracheal and esophagus compression by a giant goitre. The patient was euthyreotic. A total thyroidectomy was successfully performed. The pathology examination revealed fibrosarcoma G1, which is an extremely rare tumor of the thyroid.

Adventitial lymphatics and atherosclerosis.

Lymphatic vessels are important in reverse cholesterol transport and play a crucial role in regression of atherosclerotic plaque in experimental animal models. Therefore, we attempted to analyze adventitial microcirculation including lymphatic vessels and adventitial macrophages in large human arteries in various stages of atherosclerosis. Eighty-one arterial segments of large arteries (iliac arteries and abdominal aortas) were obtained from deceased organ donors. Lymphatic vessels were identified using anti-LYVE-1 and anti-D2-40/podoplanin immunohistochemical staining. Adventitial blood vessels and macrophages were visualized using anti-CD-31 and anti-CD-68. Intimal thickness was measured under 100x magnification with an Olympus BX 41 light microscope using the visual mode analySIS 3.2 software. Lymphatic vessels were counted in each cross section of the examined arteries, and adventitial blood vessels (CD31+) were counted using the "hot spot" method. Statistical analysis was performed with Statistica 9.1 PL software (StatSoft, Cracow, Poland). Mann-Whitney, F-Cox, Chi-square, and Spearman's correlation tests were performed and the differences were considered significant at p < 0.05. Lymphatic and blood vessels in the adventitia of examined arteries were identified and quantified. Significant positive correlations were found between the number of adventitial lymphatics (LYVE-L +) and intimal thickness (r = 0.37; p < 0.05) as well as with age of the subjects (r = 0.3; p < 0.05). Thus, lymphatic vessels are present in the adventitia of large arteries in humans and the number of adventitial lymphatic vessels increases with progression of atherosclerosis as assessed by intimal thickness.

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.

Axillary lymph nodes and arm lymphatic drainage pathways are spared during routine complete axillary clearance in majority of women undergoing breast cancer surgery.

Alterations in axillary lymph nodes (ALNs) after complete axillary lymph node dissection (ALND) in comparison to the preoperative status were evaluated using lymphoscintigraphy performed preoperatively and 1-6 weeks after surgery in 30 women with a new diagnosis of unilateral, invasive breast carcinoma. Analysis of lymphoscintigrams revealed that ALNs after surgery were present in 26 of 30 examined women. In comparison to preoperative status, they were visualized in the same location (12 women), in the same and additionally in different locations (9 women), or only in different locations (4 women). No lymph nodes were visualized in one woman and lymphocoele were in 4 women. Thus, after ALND, a variable number of axillary lymph nodes remain and were visualized on lymphoscintigraphy in the majority of women. The classical ALND, therefore, does not allow complete dissection and removal of axillary nodes with total disruption of axillary lymphatic pathways, accounting in part for the variable incidence and severity of lymphedema after the procedure.

Weight reduction in renal transplant recipients program: the first successes.

INTRODUCTION: Overweight and obesity in kidney graft recipients, both at transplantation and further on, are connected with the development of complications of metabolic syndrome. Hypertension, diabetes, and atherosclerosis are risk factors for chronic allograft nephropathy, shortened graft function, and lower recipient life expectancy. The aim of this study was to present the initial results from a weight reduction in renal transplant recipients program. MATERIAL: Thirty-four overweight and obese kidney transplant recipients were enrolled in the study: 9 overweight (26%), 19 obese (55.8%), and 6 morbidly obese (17.6%). The control group encompassed 418 kidney transplant recipients, in whom fluctuations in body mass and body mass index (BMI) were monitored for 56 months. METHODS: During the first visit, we performed an account of dietary habits and anthropometric measurements. At the second visit following a 6-month interval, patients received dietary guidelines based on an analysis of diet questionnaires. RESULTS: Six months after enrollment, despite not having received dietary guidelines during the first visit, only 27% of study subjects and 80% of controls experienced weight gain. CONCLUSIONS: Patients enrolled in the first step of the weight reduction program had no weight nor BMI increase after 6 months. Recipients having experienced body mass increase constituted only 27% of the study group, whereas increase in body mass occurred in 80% of controls. Reducing body mass accretion in kidney transplant recipients should be the target of preventive measures and nonpharmacological therapeutic interventions conducted by qualified personnel. Greater interest by medical personnel in the issue of body mass increase in recipients may be a strong motivating factor for them to undertake weight loss measures.

Posttransplant overweight and obesity: myth or reality?

UNLABELLED: Posttransplant body mass index (BMI) increase in kidney transplant recipients is an underestimated issue, predisposing to morbidity linked with development of polymetabolic syndrome. AIM: The aim of the study was to assess the incidence of overweight and obesity among endstage renal disease patients before and after kidney transplantation. MATERIAL: Four hundred eighteen kidney graft recipients were enrolled in the study which lasted a mean of 56 months. Inhabitants of Lower Silesia (n = 3855) were used as controls. Overweight was defined as BMI between 25 and 30 kg/m(2) and obesity as >30 kg/m(2). METHODS: Mean BMI calculated in 418 patients, both pretransplant and after a 4.5-year observation period was compared with results of the Lower Silesian population. RESULTS: Mean pretransplant BMI in men (n = 242) and women (n = 189) was lower than in controls: men pretransplant BMI 24.3 kg/m(2) versus 25.7 kg/m(2) in the normal population; women, pretransplant BMI 23.17 kg/m(2) versus 25.2 kg/m(2) in the control group respectively. Mean total pretransplant BMI values increased from 23.82 to 25.9 kg/m(2) at last checkup ("last BMI"). A lesser posttransplant BMI increase was noted in men (7%) compared with women (9.6%). Before transplant, overweight or obesity occurred in 38% (n = 157), after a 4.5-year observation period, 65% (n = 232). CONCLUSIONS: Our observations documented that obesity is a widespread issue in kidney graft recipients, affecting two thirds of the population. It should be the target of preventive measures and nonpharmacologic therapeutic interventions.

Presence of functional axillary lymph nodes and lymph drainage within arms in women with and without breast cancer-related lymphedema.

This pilot study was designed to investigate lymphatic transport in the arms of women after breast cancer treatment without lymphedema and with mild and severe arm lymphedema. Nineteen breast cancer survivors [6 without (Group 1), 6 with mild (Group 2) and 7 with severe (Group 3) lymphedema] were examined. Lymphatic transport in the arm and to axillary lymph nodes were evaluated using quantitative radionuclide lymphscintigraphy. The radioactivity ratio between the operated and unoperated axillae (axillary ratio), and both lymphatic transport and tracer disappearance rates (TDR) from the injection sites were calculated. We found that axillary ratio and lymphatic transport were significantly higher in Groups 1 and 2 compared to 3 and that TDR was not affected in any Group. Additionally, lymphscintigraphy revealed presence of functional axillary lymph nodes within the operated axilla in women without or with mild lymphedema, while in women with severe lymphedema, no axillary lymph nodes were visualized. We conclude from our subjects that breast cancer survivors who did not develop or had mild arm lymphedema have functional lymphatic transport and lymph nodes in the axillary area on the operated side. This suggests that efficient collateral circulation and/or peripheral lymphovenous communications has developed in these subjects which may be preventative for the development of severe lymphedema.

Primary pulmonary MALT lymphoma - case report and literature overview.

OBJECTIVE: Primary pulmonary lymphomas (PPL) are rarely taken into consideration in the differential diagnosis of lung lesions. The aim of this report is to characterize the symptoms, diagnosis and treatment of primary MALT lymphoma of the lung. CASE REPORT: We present the case of a 48-year-old man who was admitted to hospital with a history of coughing, fever, fatigue and non-specific lesions on his chest X-ray. RESULTS: The patient was treated for pneumonia, but showed no improvement. A computer tomography revealed atypical lesions. After an initial examination and tests, no diagnosis could be established. A thoracotomy with an open lung biopsy was performed and MALT lymphoma was finally diagnosed. The patient underwent chemotherapy and showed a significant improvement. CONCLUSIONS: Primary MALT lymphoma is a rare disease and its diagnosis is difficult. There is no non-invasive test that is specific enough, so a proper diagnosis can only be established by a histopathological examination. The disease has a slow and mild course and the response to treatment is satisfactory.

The Appalachian Rural Health Project in Chautauqua County, N.Y., 1973-78.

The Appalachian Regional Commission awarded a 5-year grant to the Chautauqua County Department of Health to establish primary health care services to medically underserved rural areas of the county. Four clinics were opened at various stages as the project grew.What began as an open system multidisciplinary approach to the delivery of primary health care changed abruptly to a closed system in March 1976, when the county medical society members voiced a strong objection to the rural health project. Among other assertions, the medical society claimed that the clinics of the project were "too costly and unnecessary as they now exist." Equally strong voices of community people demanded that the project be allowed to operate. An unprecedented public hearing was held and, as a result, a compromise plan was developed that permitted the medical services of the clinics to be continued, but most of the multidisciplinary components devoted to social development were eventually dropped.By September 30, 1978, when the project grant ended, three of the four clinics had been taken over on a private basis by physicians who had previously been assigned to the clinics and supported by the project.The effects of grassroots support and power of the people in a community in determining their health rights and needs were demonstrated and documented in this pioneer program. It is anticipated that the Chautauqua County experience may be a helpful model in planning other projects that attempt to institute change in the health care delivery system in underserved rural areas.

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.

[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).

[Surgical treatment of primary liver cysts. Personal experience]. / Leczenie chirurgiczne pierwotnych torbieli watroby. Doswiadczenia wlasne.

Nonparasitic liver cysts are diagnosed more often now. The aim of this study was to report the authors' experience with treatment for nonparasitic liver cysts. Retrospective review of medical records of 25 patients with hepatic cyst between 1990 and 1999 was undertaken to determine optimal treatment. Polycystic liver disease (PLCD) occurred in 2 patients and remaining patients had a simple liver cyst. In eight patients liver cyst were diagnosed incidentally and 17 patients were symptomatic. Twenty one patients underwent operations: 9 open deroofing, 5 liver resection (2 segmentectomies and 3 nonanatomical), 4 cyst excision, one case of laparoscopic fenestration and in 2 cases open drainage in infected liver cyst were performed. Four patients with asymptomatic, small (< 2 cm) hepatic cyst had no operative procedures--they were observed with ultrasonography control every six months. There were no perisurgical deaths. The symptomatic recurrence occurred in one patients (4.7%). The complications rate was low (4.7%)--the patient with PLCD had liver abscess and the open drainage were performed. Open surgery is safe and effective for symptomatic liver cyst and complication rate is low. Small and asymptomatic liver cysts should be followed up under ultrasonographic examination.

[Thoracic sympathectomy in the treatment of chronic ischemia of upper extremities and excessive sweating of the palms]. / Sympatektomia piersiowa w leczeniu przewleklego niedokrwienia konczyn górnych oraz nadmiernej potliwosci rak.

The results are presented of treatment of 65 patients with chronic peripheral ischaemia of upper extremities and excessive sweating of the palms, in whom 78 thoracic sympathectomies were done by the Smitwick method in the years 1972-1989. The cause of ischaemia in 45 patients were organic changes (TO, AO), in 18 cases--functional changes (Raynaud syndrome), and in two patients--excessive sweating of the palms. Patients with trophic changes were 72% of those surgically treated. Long-term follow-up (8.5 years on the average) demonstrated a significant improvement in the group of organic changes in 84% of the surgically treated cases, in the group of functional changes in 83.2% of cases, and in excessive sweating of the palms in 100% of cases. In five patients contralateral effect of thoracic sympathectomy was observed. The authors discussed the extent of sympathetic trunk removal. They think that thoracic sympathectomy is a procedure of choice in cases of peripheral ischaemic changes in upper extremities not responding to conservative treatment.

[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.