The Length of Leukocyte and Femoral Artery Telomeres in Patients with Peripheral Atherosclerosis.

The length of telomeres (TLs) that protect chromosome ends may reflect the age of cells as well as the degree of genetic material damage caused by external factors. Since leukocyte telomere length is associated with cardiovascular diseases, the aim of this study was to evaluate whether leukocyte TL reflects femoral artery wall telomeres of patients with atherosclerosis and lower limb ischemia. Samples of femoral artery wall and blood were collected from 32 patients qualified to surgical revascularization. The analysis included blood and artery wall telomere length measurement and biochemical parameters. The study indicated that there was a moderate correlation between artery wall TL and leukocyte TL. Leukocyte TL was, on average, two times shorter than artery wall TL and correlated with the number of white blood cells. In turn, artery TL was impacted by total cholesterol level. The results suggest that the length of leukocyte telomeres may reflect artery wall TL and indirectly reflect the processes taking place in the artery wall in patients with atherosclerosis.

The effect of the calibre and length of needle on the stability of sclerosing foam.

OBJECTIVES: Little is known how calibre and length of needles affect the stability of sclerosing foam. METHODS: Foams were made of 0.5%, 1%, 2% and 3% polidocanol, and 0.2%, 0.5%, 1% and 3% sodium tetradecyl sulfate (STS), which were mixed with air in the proportion of 4:1. These foams were ejected through needles with the length of: 4 mm, 6 mm and 13 mm, and diameter of: 0.26 mm, 0.3 mm and 0.4 mm. RESULTS: Foams made of more concentrated polidocanol were more stable. Regarding STS an opposite relationship was revealed. Foams made of polidocanol were more stable if ejected through a longer needle, while the length of needle did not significantly affect stability of STS foams. Foams ejected through 0.26 mm diameter needles were very unstable. In the case of 0.5% polidocanol, 0.3x6mm needle provided atypically stable foam. CONCLUSION: In order to inject maximally stable foam, calibre and length of needle should be taken into account.

Non-invasive tunnelled catheter reposition (NTCR): A simple and safe method to restore central tunnelled catheter function for haemodialysis.

Despite all efforts, still many end-stage kidney disease (ESKD) patients are dialysed using a central tunnelled catheter (CTC) as vascular access. When the CTC blood flow becomes ineffective, a number of protocols are advised. However, all of them are time- and cost-consuming. The manoeuvre of a non-invasive tunnelled catheter reposition (NTCR) was introduced to restore the CTC function. NTCR was based on gentle movements of the CTC, with or without a simultaneous flushing of the CTC lines, which resulted in a quick reposition of the CTC tip. This study comprises the analysis of a total of 297 NTCRs, which were performed in 114 patients, thus enabling an effective blood flow after 133 procedures (44.7%).Partially effective blood flow followed 123 procedures (41.4%), and it failed altogether in 41 cases (13.9%). Overall, 86% of conducted NTCRs improved the CTC patency to perform a haemodialysis session. The procedure could be successfully repeated, with a similar result after the first and the second attempt. Complications were observed only after 3.4% of all interventions. The novel NTCR manoeuvre was safe and effective in the majority of the CTC dysfunction episodes. It seemed to reduce fibrinolytic usage, allowed an immediate haemodialysis session commencement, therefore, it might save both the costs and the nursing staff time.

Tunnelled Haemodialysis Catheter Removal: An Underappreciated Problem, Not Always Simple and Safe.

BACKGROUND: Optimal care of patients treated with a central tunneled catheter (CTC) as vascular access for hemodialysis requires a number of procedures. One of them is CTC removal, usually carried out using mostly the cut-down method (CDM) and the traction method (TM). The procedure seems to be simple and safe; however, occasionally, serious complications may occur. To eliminate the risk of such events, we have introduced a modified cut-down method (MCDM). METHODS: The study included the analysis of retrospective results of 143 CTC removal procedures, 76 of which were performed using the standard cut-down method (CDM), and in 67 cases, the modified cut-down method (MCDM) was applied. RESULTS: As minor side effects occurred in patients treated with both methods with comparable frequency, serious complications were observed only in the CDM patients group. CONCLUSIONS: In our opinion, the new MCDM procedure is the simplest and safest method of CTC removal.

Management of bleeding in patients hospitalized in the intensive cardiac care unit: expert opinion of the Association of Intensive Cardiac Care and Section of Cardiovascular Pharmacotherapy of the Polish Cardiac Society in cooperation with specialists in other fields of medicine.

Nowadays, the intensive cardiac care unit (ICCU) provides care for patients with acute coronary syndrome, acute and exacerbated chronic heart failure, cardiogenic shock, sudden cardiac arrest, electrical storm, as well as with indications for urgent cardiac surgical treatment. Most of these patients require the use of 1, 2, or frequently even 3 drugs that act on the blood coagulation pathway. While antithrombotic drugs prevent thromboembolic events, they are associated with a higher risk of bleeding. In this population of patients, bleeding may often have a worse impact on prognosis than the primary disease. In this expert opinion of the Association of Intensive Cardiac Care, we presented practical guidelines on the management of bleeding in patients hospitalized at the ICCU, including bleeding risk reduction and treatment recommendations. Because of multiple comorbidities and diverse organs that may be the source of bleeding, we provided also recommendations from specialists in other fields of medicine. We hope that this document will facilitate the management of one of the most challenging populations at the ICCU.

[Morbidity of lower limbs obliterating atherosclerosis in the population of Opole Region]. / Zachorowalnosc na miazdzyce zarostowa tetnic konczyn dolnych w populacji Opolszczyzny.

UNLABELLED: The objective of this study was to evaluate morbidity of lower limbs obliterating atherosclerosis in the population of Opole Region. The subject of the study was the population of patients admitted and treated in the Voivodship Medical Center in Opole between 1992-1994 (1st period) and 2000-2002 (2nd period). MATERIAL AND METHODS: Material includes detailed data about 1114 patients: 387 treated between 1992-1994 and 727 treated in period 2000-2002. The analysis was made on base of documentation of the Department of General and Vascular Surgery in the Voivodeship Medical Center in Opole. Patients filled special prepared questionnaires. The completed data were intoducted to the computer database and submitted to mathematical and statistical comparative analysis with regard to both examined periods. RESULTS: The study confirmed that the major cause of chronic lower limbs ischaemia is obliterating atherosclerosis. It was found in 91% of cases in both periods. Significant increase in atherosclerosis of the lower limbs morbidity was confirmed. The most voluminous group in this study ware patients more than 65 years of age, wih elementary or elementary professional education. Significant increase in incidence was also noted in patients inhabiting rural areas and in population of women. In between 2000-2002 the percentage of patients admitted with early phase of the disease increased significantly where compared to the first period. CONCLUSIONS: Significant increase of morbidity on atherosclerosis of the lower limbs needs planning of responsible local governors in Opole Region suitable financial expend to prevent and treat this disease.

Use of dacron vascular prosthesis impregnated with salts of silver, in treatment of extraanatomical axilla-femoral by-pass's infection. Infections in vascular surgery.

We presented a case of use a dacron prosthesis, bonded with collagen and impregnated with salts of silver in the treatment of extraanatomical axilla-femoral by-pass infection, by-pass was made at 78-years-old patient cause of an acute ischaemia of the lower extremity caused by an inoperative inflammatory aneurysm of abdominal aorta and iliac arteries. Firstly intentional antibiotics were administered. The patient was again admitted to hospital and operated on after an ineffective preventive treatment. The infected prosthesis was replaced by a new, salts of silver impregnated dacron one with increased infection resistance. The clinical effect was successful.