Andrzej Bohatyrewicz

Computed Tomographic Angiography and Perfusion in the Diagnosis of Brain Death

INTRODUCTION According to Polish brain death (BD) criteria, instrumental confirmatory tests should be used in certain clinical situations, particularly any case for which clinical examinations seem inadequate. Electrophysiological tests are often unavailable. Therefore, cerebral perfusion testing is the method of choice with four-vessel digital subtraction angiography (DSA), the gold standard. Unfortunately, DSA is an expensive and invasive examination that requires an experienced neuroradiologist and the availability of an angiography suite. Recently, multirow computed tomographic devices became available, even in smaller hospitals in Poland. Despite this fact, computed tomographic angiography (CTA) and computed tomographic perfusion (CTP) are not accepted in BD diagnosis protocols in Poland because of limited experience and a lack of widely accepted criteria. In this situation, we started a multicenter trial to determine the accuracy of CTA and CTP to confirm BD. METHODS We examined 24 patients who fulfilled standard clinical BD criteria. We recognized the absence of brain perfusion in CTA examination following the criteria proposed by the French Society of Neuroradiology, namely, the absence of opacification of M4 middle cerebral artery segments (M4-MCA) and of deep cerebral veins. RESULTS In all of our patients, CTA showed absence of opacification of M4 segments and of deep cerebral veins. In addition, three patients had CTA showing weak opacification of A2 segments of the anterior cerebral artery (A2-ACA) and M2 or M3-MCA. Opacification of the basilar artery or of the posterior cerebral arteries was not noted in any case. In all patients, CTP revealed zero values of regional cerebral blood volume and regional cerebral blood flow. Conventional angiography confirmed cerebral circulatory arrest in all 24 cases. CONCLUSION CTA and CTP seem to be promising radiological examinations for the diagnosis of BD. They may be noninvasive alternatives to conventional cerebral angiography, and to the other instrumental confirmatory tests, that are unavailable or inadequate.

The association of IL-1β, IL-2, and IL-6 gene polymorphisms with bone mineral density and osteoporosis in postmenopausal women

OBJECTIVE Osteoporosis is a common disorder with a strong genetic component. The genetics of osteoporosis impacts on the prediction, diagnosis, prognosis, and treatment of the disease. STUDY DESIGN The aim of the present study was to examine associations between cytokine gene polymorphisms (IL-1beta, IL-2, IL-6) and bone mineral density (BMD) values in postmenopausal women. The study included 226 postmenopausal women with a diagnosed BMD T-score lower than -2.5 SD (mean: -3.02+/-.053) and 224 postmenopausal women with a BMD T-score greater than -2.5 SD (mean: -1.33+/-0.51). RESULTS Among the women with T-scores below -2.5 SD, the BMD values were significantly lower in the carriers of the IL-6 GG genotype compared with those with the CC and GC genotypes (0.70+/-0.38 vs. 0.73+/-0.25 and 0.74+/-0.23 for the lumbar spine, 0.54+/-0.18 vs. 0.56+/-0.15 and 0.58+/-0.22 for the femoral neck). There were no statistically significant associations between the IL-1beta and IL-2 genotypes and BMD values in the group of women with T-scores below -2.5 SD. CONCLUSION The results of the present study suggest an association of the IL-6 -174 G/C polymorphism with osteoporosis in postmenopausal women.

Concentrations of trace elements in bones of the hip joint from patients after hip replacement surgery

The aim of this research was to determine the concentrations of two essential elements (copper (Cu) and zinc (Zn)) and three toxic elements (lead (Pb), cadmium (Cd) and mercury (Hg)) in the hip joint bones of patients from the Chair and Clinic of Orthopaedics and Traumatology at the Pomeranian Medical University in Szczecin. We examined 111 samples of hip joint bones obtained from patients from north-western Poland who had undergone arthroplasty of the femoral head. In cartilage with the adjacent compact bone, and in spongy bone from the examined patients, the concentrations (medians) determined were placed in the following descending sequence Zn>Pb>Cu>Cd>Hg. The concentrations ranged from 86 mg Zn/kg to 0.0020 mg Hg/kg dw. It was found that the concentration of lead in the cartilage with adjacent compact bone was higher in men than in women. In conclusion, it seems that in addition to routine monitoring of the abiotic environment, it is essential to monitor concentrations of heavy metals having a long-term impact in humans.

Oral health and bone mineral density in postmenopausal women

OBJECTIVE The objective of the study was to assess dental and periodontal status in relation to bone mineral density (BMD), and to study cytological changes in oral epithelium. METHODS Thirty-seven postmenopausal women aged 50-70 were given a dental examination and a BMD assessment. RESULTS There was a relationship between the femoral neck BMD and teeth state, a negative correlation between the lumbar BMD and the periodontal disease index (PDI) and between the radius BMD and the papillary bleeding index (PBI). PDI correlated positively with the number of superficial cells in the marginal gingiva smears. Correlation between PDI and parabasal cells and the number of teeth was negative. CONCLUSIONS In observed postmenopausal women, there is a negative association between bone mineral density and teeth state and periodontal indices. Oral epithelium revealed atrophic changes resulting in low keratinization. The study suggests an association between decreasing in bone mineral density, alveolar bone loss and the numbers of various cell types in epithelial smears.

Comparison of concentrations of lead and cadmium in various parts of the femur head in patients after arthroplasty of the hip joint in Northwest Poland.

OBJECTIVE To determine the concentrations of lead (Pb) and cadmium (Cd) in three kinds of materials (cartilage, cortical bone, and cancellous bone) of the femur head obtained from patients in the process of operation. METHODS Concentrations of Pb and Cd were determined in selected parts of the femur head of 30 patients after total hip arthroplasty, using ICP-AES (atomic absorption spectrophotometry). RESULTS Pb contained the highest concentration in cortical bone, while Cd did so in cancellous bone. There were statistically significant differences in the concentrations of both elements between the cartilage and cortical bone, and also differences in the concentration of Pb between the cartilage and cancellous bone. There were no significant differences in the concentrations of Pb or Cd between cortical and cancellous bone. CONCLUSION Comparative studies on toxic metals should take into account both analogous bones and their fragments, as even if they come from the same kind of bones (e.g. femur head), clear differences exist in concentrations of heavy metals related to the sampling site and type of tissue (cartilage, cortical bone, and cancellous bone).

The concentration of manganese, iron, and strontium in hip joint bone obtained from patients undergoing hip replacement surgery

The aim of this study was to determine the concentrations of manganese (Mn), iron (Fe) and strontium (Sr) in the cartilage with adjacent compact bone and spongy bone collected from patients after total hip replacement surgery. In addition, we examined relations between the concentrations of the metals in the bone and selected environmental factors. The concentration of Fe was the highest while Mn concentration was the lowest. The concentrations of Fe in the spongy bone in patients from larger cities were higher than in those living in smaller towns and villages. Significant correlations were found between Fe and Mn concentrations in the cartilage with adjacent compact bone and in the spongy bone, and between Mn and Sr in the spongy bone. In general, Mn, Fe and Sr concentrations in the bones of patients from NW Poland were lower than in other Polish regions and Europe, especially in industrialized countries. In conclusion, it seems that in addition to routine monitoring of the abiotic environment, it is essential to monitor concentrations of heavy metals having a long-term impact in humans.

Effect of ESR1 and ESR2 gene polymorphisms on rheumatoid arthritis treatment with methotrexate

Rheumatoid arthritis (RA) is a complex autoimmune disease with clinical prevalence in women. Moreover, women have poorer response to treatment than men. Possible reasons for gender differences in response to treatment could be explained on the basis of sex hormones and their receptors. The optimal strategy in treatment of RA is to use effective disease modifying antirheumatic drugs (DMARDs) such as methotrexate (MTX). The aim of the present study was to examine the association between polymorphisms in the ESR1 and ESR2 genes and the response to treatment of RA patients with methotrexate. The study was carried out on 156 women diagnosed with active rheumatoid arthritis, treated with MTX. Good responders were defined as patients who were receiving MTX and had a DAS28 of ≤ 2.4 after 6 months of therapy (patients with remission of disease symptoms). Poor-responders were defined as patients who were receiving MTX and had a DAS28 of > 2.4. There were no statistically significant associations of ESR1 and ESR2 gene polymorphisms with response to treatment. The results of the present study suggest that the polymorphisms rs9340799:A>G and rs2234693:T>C in ESR1 gene and rs4986938:G>A and 1256049:G>A in ESR2 gene are not associated with response to RA treatment with MTX.

Gait functional assessment: Spatio-temporal analysis and classification of barefoot plantar pressure in a group of 11-12-year-old children.

Analysis of pedobarographical data requires geometric identification of specific anatomical areas extracted from recorded plantar pressures. This approach has led to ambiguity in measurements that may underlie the inconsistency of conclusions reported in pedobarographical studies. The goal of this study was to design a new analysis method less susceptible to the projection accuracy of anthropometric points and distance estimation, based on rarely used spatio-temporal indices. Six pedobarographic records per person (three per foot) from a group of 60 children aged 11-12 years were obtained and analyzed. The basis of the analysis was a mutual relationship between two spatio-temporal indices created by excursion of the peak pressure point and the center-of-pressure point on the dynamic pedobarogram. Classification of weight-shift patterns was elaborated and performed, and their frequencies of occurrence were assessed. This new method allows an assessment of body weight shift through the plantar pressure surface based on distribution analysis of spatio-temporal indices not affected by the shape of this surface. Analysis of the distribution of the created index confirmed the existence of typical ways of weight shifting through the plantar surface of the foot during gait, as well as large variability of the intrasubject occurrence. This method may serve as the basis for interpretation of foot functional features and may extend the clinical usefulness of pedobarography.

Evidence for proangiogenic cellular and humoral systemic response in patients with acute onset of spinal cord injury

Abstract Context/objective Traumatic spinal cord injury (SCI) leads to disruption of local vasculature inducing secondary damage of neural tissue. Circulating endothelial progenitor cells (EPCs) play an important role in post-injury regeneration of vasculature, whereas endothelial cells (ECs) reflect endothelial damage. Methods Twenty patients with SCI were assessed during the first 24 hours, at day 3, and day 7 post-injury and compared to 25 healthy subjects. We herein investigated EPC and EC counts by flow cytometry as well as the levels of soluble factors (SDF-1, HGF, VEGF, Ang2, EGF, endoglin, PLGF, FGF-2, ET-1, BDNF, IGF-1) regulating their migration and proangiogenic function. To better characterize peripheral blood (PB) cells, global gene expression profiles of PB-derived cells were determined using genome-wide RNA microarray technology. Results We found significantly higher EPC (CD34+/CD133+/VEGFR2+) as well as EC (VEGFR2+) count in PB of patients with SCI within 7 days post-injury and the increased HGF, ET-1, Ang2, EGF, and PLGF plasma levels. Global gene expression analysis revealed considerably lower expression of genes associated with both innate and adaptive immune response in PB cells in patients. Conclusion Collectively, our findings demonstrate that SCI triggers bone marrow-derived EPC mobilization accompanied by increased circulating EC numbers. Significant changes in both chemoattractive and proangiogenic cytokines plasma levels occurring rapidly after SCI suggest their role in SCI-related regenerative responses to injury. Broadened knowledge concerning the mechanisms governing of human organism response to the SCI might be helpful in developing effective therapeutic strategies.

Reversal to Whole-Brain Death Criteria After 15-Year Experience With Brain Stem Death Criteria in Poland

Polish brain-death criteria, similar to the original Harvard criteria, were published in 1984. In 1990, they were converted to brainstem death criteria, and were revised twice, in 1994 and in 1996. However, they could not be used in many complicated clinical situations such as intoxication, metabolic alterations, major facial injury, infratentorial lesions, and cervical spinal cord injury. The new Polish Transplant Act, passed by the Polish Parliament in 2005, recommends implementation of criteria for whole-brain death for brain-death diagnosis. In 2007, the Polish Ministry of Health Commission outlined new Polish brain-death criteria. Optional use of instrumental confirmatory tests was implemented in the new Polish national code of practice for the diagnosis of brain death in adults. In children up to age 2 years, instrumental tests are obligatory. Initially, there were problems in understanding the new, slightly more complicated classifications of primary and secondary brain injuries, infratentorial and supratentorial processes, modified apnea test. A broad commentary that addressed the most frequently asked questions was published in Anesthesiology and Intensive Therapy, the official journal of the Polish Society of Anaesthesiology and Intensive Therapy. This article dealt with most of the problems associated with implementation of the new criteria for diagnosis of brain death.