Red cell deformability in patients with chronic atheromatous ischemia of the legs.

BACKGROUND: It has been shown that atherosclerosis can cause not only lowering of the perfusion pressure gradient at the macro/micro circulation level, but can bring about untoward rheological changes such as e.g. loss of the red blood cells (RBC) elasticity. This can participitate in mechanism of impairment of the blood flow through the microcirculation as well. The aim of this study was to measure RBC elasticity in the claudicants, and to evaluate the effect of the applied treatment either conservative or surgical revascularisation on this rheological parameter. MATERIAL AND METHODS: RBC deformability was examined in claudicants 83 of them (mean claudication distance 400 m) were treated conservatively (walking exercise on a treadmill and Pentoxyphilline 600 mg b.i.d.) 44 claudicants with the critical leg ischemia (mean claudication distance below 50 m or rest pain) underwent surgical revascularisation. The measurements of RBC elongation (under selected values of the shear stress) were made on entry to the study, after 6 weeks, and 12 weeks of observation. RESULTS: After 12 weeks of conservative treatment, RBC elasticity both at rest and after walking exercise significantly increased. In the patients undergoing surgery mean RBC elasticity both at rest and after walking exercise 12 weeks following surgery was not significantly different compare with the respective levels at the beginning of the study. CONCLUSIONS: In the group of claudicants with less advanced atherosclerosis (conservative group), the treatment brought about significant increase of RBC elasticity. On the contrary in case of the patients with advanced atherosclerosis and critical leg ischemia revascularisation alone appeared to be ineffective in correction of untoward rheologic alteration such as rigidity of the erythrocytes.

Abdominal malignancies missed during laparoscopic cholecystectomy.

BACKGROUND: We present our experience with intra-abdominal malignancies different from gallbladder cancer not diagnosed preoperatively and undiscovered during laparoscopic cholecystectomy METHODS: This study involved retrospective analysis of 10 patients hospitalized in the Second Department of General Surgery between 1993 and 2000. In all of them, laparoscopic cholecystectomy had been performed between one week and 21 months earlier. RESULTS: Primary or metastatic neoplasms were diagnosed in five men and five women patients ages 38 to 79 years. In three patients with colorectal cancer, a radical resection was possible. Nonresectable pancreatic cancer was found in three patients. In one of two patients with gastric cancer, palliative, distal gastrectomy was performed. In a patient who had small bowel cancer with metastasis to the ovary, a radical operation was possible. In one patient, liver metastasis from lung cancer was found. CONCLUSIONS: In patients with atypical symptoms of gallbladder lithiasis, a thorough workup before laparoscopic cholecystectomy should be performed. During the laparoscopic procedure, a detailed examination of the whole peritoneal cavity is essential. In cases of prolonged convalescence after laparoscopic cholecystectomy, a source of symptoms different from cholelithiasis should be suspected.

[Peri-renal pheochromocytoma]. / Guz chromochlonny o pozanerkowej lokalizacji.

Presented is a case of pheochromocytoma with an ectopic or extrarenal localisation in a 47 year old female farmer. The patient was admitted to the 1st Chair and Clinic of Internal Disease, Jagiellonian University Collegium Medicum due to a three year history of hypertension. The bouts of hypertension were characterised by sudden increases of blood pressure to 250/150 mmHg, which occurred after physical exertion but particularly during the night. On physical examination no abnormalities were detected. Laboratory analysis revealed no changes apart from mild hyperglycemia. 24 hour vanillymandelic acid excretion was normal on two successive accounts, but on a third analysis was raised. Fundus examination revealed bilateral hypertensive and diabetic angiopathy. Abdominal ultrasound revealed a tumor in the region of the pancreas with an echogenicity similar to that of the liver. Abdominal CT scan revealed normal suprarenal glands bilaterally. A smooth walled tumor of 55 mm diameter was visualized below the head of the pancreas. Its structure was not uniform with degenerating features. The tumor adhered to the descending and transverse part of duodenum, compressing the vena cava inferior and was in close proximity to the abdominal aorta. After surgical consultation the patient was transferred to the II Clinic of General Surgery Jagiellonian University Collegium Medicum where after pretreatment with alpha and beta blockers, ACE inhibitors, diuretics and Insulin CHOS the patient underwent surgery. Posterior to the duodenum, inferior to the head of the pancreas, between the aorta and vena cava inferior was a polycystic tumor of 80 mm diameter, which was evacuated in its entirety. Histopathology revealed a paraganglioma with an appearance of pheochromocytoma. On a three month follow up visit the patient was without symptoms. Her blood pressure and glycemia were normal despite being without treatment.

Certain parameters of oxygen pulmonary toxicity during hyperoxia.

The results of the investigations on the effect of highly concentrated normobaric oxygen on rabbit lung are reported. Detailed pathomorphological analysis demonstrated that rapidly developing extensive changes of the structural elements of the capillaries and other vessels were the prevalent lesions. These changes are connected, in the light of earlier experiments carried out under identical conditions, with the observed disturbances in the metabolism of pulmonary lipids and suggest pathogenetic correlations between prostaglandins and pulmonary surfactant.