The risk of renal function deterioration in abdominal aortic stent graft patients with and without previous kidney function failure - an analysis of risk factors.

PURPOSE: Kidney failure influences the treatment outcomes of abdominal aortic aneurysm (AAA). A prospective study of renal function before and after aortic stent-graft treatment was performed. Special attention was paid to the influence of preoperative kidney function as well as the impact of the radiological follow-up. MATERIAL AND METHODS: A total of 214 endovascularly treated AAA patients were included. In all cases, pre- and postope-rative estimated glomerular filtration rate (eGFR) and serum creatinine were noted. Patients were prospectively followed up for a minimum of two years. RESULTS: The baseline eGFR was 69.38 ± 16.29 ml/min/1.73 m2. Chronic kidney disease at baseline was noted in 29% of patients. In the direct postoperative period, acute kidney injury was identified in 8.4% of cases. Additional endo-vascular procedures within two years of observation were performed in 5.6% of cases, and over the two years of follow-up, in the study group from one to six angio-computed tomographic scans (angio-CT) per patient were performed. The mean eGFR value after the 24-month follow-up was significantly lower than the preoperative value. Among the factors influencing kidney function, an angio-CT during the same hospital stay of the primary stent-graft procedures was identified. The type of stent-graft, contrast volume during the primary procedure, need for reintervention, concomitant disease presence, and statin use did not show statistical significance. CONCLUSIONS: Angio-CT followed by stent-graft implantation over a short time interval (within the same hospitalisation) significantly worsened renal function in the late follow-up and should be avoided in elective AAA cases.

Evaluation of factors affecting persistence of atrial fibrillation in patients with concomitant atrial flutter treated with percutaneous radiofrequency current ablation of the right atrial cavotricuspid isthmus.

BACKGROUND: Atrial fibrillation (AF) and atrial flutter (AFL) often coexist. In some patients, AF remission is seen after successful percutaneous radiofrequency current ablation of the cavotricuspid isthmus (CTI). AIM: To evaluate factors affecting AF remission in patients with typical AFL and concomitant AF who underwent CTI ablation. METHODS: The study included consecutive 69 patients with typical AFL and concomitant clinically documented AF who underwent successful CTI ablation in 2003-2010. Based on the follow-up data from medical records and telephone interviews, the patients were divided into two groups: with persistent AF (group A) and with remission of AF (group B). This distinction was based on arrhythmia symptoms reported by the patient, such as palpitation or irregular heartbeat, and confirmed electrocardiographically (12-lead ECG or Holter monitoring). RESULTS: Group A included 47 patients, and group B included 22 patients. The two groups did not differ significantly in regard to the New York Heart Association (NYHA) functional class and concomitant diseases including diabetes, ischaemic heart disease, previous myocardial infarction and arterial hypertension. The two groups also did not differ by echocardiographically determined mean left ventricular ejection fraction (LVEF) and left atrial dimension (43.5 ± 9.27 vs. 39.27 ± 5.76, p = 0.075). Multivariate logistic regression did not identify any independent risk factors of AF persistence after CTI ablation. Univariate logistic regression also did not show arterial hypertension, type 2 diabetes, previous myocardial infarction, LVEF, left ventricular dimension or age to affect AF persistence after successful ablation. CONCLUSIONS: Based on the results of our study, we were unable to identify factors determining remission of AF coexisting with AFL in patients after percutaneous CTI ablation. These findings may indicate the need for complex ablation procedure (involving both CTI and pulmonary venous ostia ablation) in patients in whom these two arrhythmias coexist.

Protein metabolism in the synovial membrane in the hip osteoarthritis.

BACKGROUND: Osteoarthritis (OA), and particularly osteoarthritis of the hip (coxarthrosis), together with hypertension and diabetes, belong to the most common lifestyle diseases. Usually the determination of a clear reason for the degenerative changes is impossible. However, the role of reactive oxygen species (ROS) that can affect the protein metabolism and thus cause the degradation of the joint connective tissue structures has been recently frequently pointed out. The aim of this study was to compare the activity of selected enzymes and albumin and protein level in the synovial membrane obtained during hip replacement surgery due to coxarthrosis. MATERIAL/METHODS: The reference group consisted of patients after traumatic femoral neck fracture, without osteoarthritis in the medical record. Collected sections of the synovial membrane were prepared for biochemical tests according to the authors' methodology. RESULTS: In the synovial membrane of patients with hip osteoarthritis significantly higher activity of superoxide dismutase (SOD) and glutamate dehydrogenase (GLDH) was observed, as well as increased activity of prolidase and lower activity of acid phosphatase activity compared with the reference group. The concentration of total protein and albumin in the synovial membrane was similar in both groups. CONCLUSIONS: Increased SOD activity indirectly indicates ROS participation in OA pathogenesis. Coexisting protein metabolism disorders of the synovial membrane may contribute to the degradation of the articular cartilage.

Metabolism and protein transformations in synovial membrane of a knee joint in the course of rheumatoid arthritis and degenerative arthritis.

BACKGROUND: In the course of musculoskeletal system diseases, such as rheumatoid arthritis and degenerative arthritis a chronic inflammatory process develops, which deteriorates all the joint elements and leads to the movement insufficiency of a patient. In case of both of theses diseases, etiology is multi-factor and still not known thoroughly. It is suggested that in the process of degradation of a joint cartilage, active form of oxygen take part. Their excessive production contributes to oxidation imbalances in cells and an oxidative stress. Under the activity of fee radicals, among others, activation of proteolytic enzymes participating the collagen degradation starts. The aim of this work is to compare parameters characteristic a cell metabolism and protein transformations taking place in the course of the aforementioned musculoskeletal system diseases. MATERIAL/METHODS: The material tested consisted of fragments of synovial membrane of a knee joint taken from 36 women suffering from rheumatoid arthritis and 24 women suffering from osteoarthritis during the procedure of knee-joint endoprothesoplastic surgery. Then the material was subject to the author's methodology of preparations of synovial membrane for biochemical markings. RESULTS: In the group of patients suffering from rheumatoid arthritis significantly higher protein and sulfhydryl groups concentrations were achieved. Moreover, an increase of activity of manganese isoenzyme of superoxide dismutase, glutamate dehydrogenase and enzymes participating in the process of collagen degradation--prolidase and acid phosphatase was observed. CONCLUSIONS: In the course of rheumatoid arthritis a speed of cell metabolism increase, which leads to a higher intensity of protein turnover in cells.