[Venous aneurysm as a therapeutic problem: various management strategies in selected patients: our experience]. / Venöses Aneurysma als therapeutisches Problem. Behandlungsmöglichkeiten. Die Vorgehensweise bei den gewählten Kranken - unsere Erfahrung.

Venous system aneurysms appear relatively rarely, and are even more rarely diagnosed, especially if asymptomatic. In the material of our clinic we provide a variety of practices in three patients with venous aneurysms depending on the location, symptoms and main disease. In some patients the occurrence of pulmonary embolism is the first symptom of venous aneurysms, having influence on the selection of further diagnostics, conservative treatment, as well as on endovascular or operating procedure. The proper diagnosis of a venous aneurysm takes place in case of doubling or tripling of the diameter of the basic dimension of the lumen, often with the presence of thrombotic material. Asymptomatic venous aneurysms are usually detected during routine pre-operative diagnosis also including duplex-Doppler studies. In the presence of pulmonary embolism positive angio-CT and scintigraphy raise the suspicion of venous aneurysm unless any other reason is apparent. There is no standard treatment of venous aneurysms. This has to do with the relatively low epidemiology, diversity of location, difficulties in determining the proper primary and secondary aetiology, anatomy and coexisting diseases. Despite the many unknowns a few issues should be considered before appropriate treatment is undertaken. Undoubtedly, the shape itself, the location and size of the aneurysm with the presence or not of thrombotic material are of great value in evaluating the risk of complications, including possibly lethal pulmonary embolism, local symptoms of venous hypertension and possible complications of surgery. In this paper we present 3 patients treated for venous aneurysms located in different regions: popliteal vein, brachial vein and iliac internal vein.

Histopathological Relevance of Angiotensin II Type 1 Receptor in Renal Transplant Biopsy.

The occurrence of anti-angiotensin II type 1 receptor (AT1R) antibodies is thought to be a risk factor for transplant injury, but the relationship of AT1R to graft loss in renal transplantation has not been assessed. The aim of our study was to evaluate the expression of AT1R and its relationship with graft loss in patients who had a renal transplant biopsy for cause. METHODS: AT1R immunoreactivity was analyzed in 170 renal transplant biopsies. Immunohistochemical evaluation of AT1R expression was performed on 4 µm-thick paraffin sections mounted on silanized slides. AT1R expression was analyzed in 5 compartments: 1. glomeruli, 2. renal blood vessels (small and intermediate arteries), 3. peritubular capillaries, 4. tubular epithelium, and 5. interstitium based on a 3-step scale. RESULTS: Initially we checked 170 consecutive samples of biopsies for the immunoreactivity of the AT1R. The study finally included 118 renal transplant patients in 1-year observation after the biopsy. The renal allograft biopsy was performed between 6 days and 24 years after transplantation and the diagnosis was based on Banff criteria. We observed positive immunostaining of AT1R in tubular epithelium in 26.3% (42/118) of patients. A total of 7 patients had staining assessed as 2 and 35 as 1. One year post-biopsy graft loss in the AT1R (+) patients was 35.7 % (15/42) compared to 14.5% (11/76) in the AT1R (-) group (P = .008). CONCLUSIONS: The expression of AT1R in tubular epithelium of the biopsy for cause was associated with significantly higher graft loss. The relevance of AT1R should be considered for better transplant immunological risk assessment.

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.

[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.

[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.