Andrzej Lewszuk

ß Thromboglobulin and platelet factor 4 in bronchoalveolar lavage fluid of patients with systemic sclerosis

Objective: To evaluate concentrations of the platelet activation markers β thromboglobulin (BTG) and platelet factor 4 (PF4) in bronchoalveolar lavage fluid (BALF) from patients with systemic sclerosis with and without scleroderma interstitial lung disease (SLD). Methods: BTG and PF-4 were measured by enzyme immunoassay in BALF from 37 patients with systemic sclerosis. Controls were 10 healthy subjects. BALF was collected during routine bronchoscopy from the right middle lobe. SLD was diagnosed by high resolution computed tomography of the lungs. Results: BTG was detected in 11 of the patients with systemic sclerosis (29.7%) and PF4 was found in eight (21.6%). Mean (SD) concentrations of BTG and PF4 in BALF from patients with detectable levels of these platelet activation markers were 106.9 (69.8) and 35.2 (17.4) IU/ml, respectively. The BTG:PF4 ratio was more than 2:1, indicating in vivo release. Both markers were found exclusively in patients with SLD. SLD patients with detectable platelet activation markers had a significantly shorter disease duration than those with undetectable BTG/PF4. Conclusions: The study provides evidence that activation of blood platelets takes place within the lungs of patients with SLD and may contribute to the development of lung fibrosis.

Vertebroplasty of Cervical Vertebra

Summary Background The first vertebroplasty was performed by Harve Deramond in France in 1984 due to a hemangioma of cervical vertebral body. Procedure technique consisted of inserting a needle through the bony palate of the oral cavity. Bone cement injected under pressure not only fills the areas of bone loss. The heat released in the process of crystallization causes denaturation of pathological tissue proteins (metastasis) and disrupts blood supply (hemangiomas). The aim of this study was to evaluate the method of treatment from anterolateral access. Material/Methods In the years 2007–2012 the procedure was performed in 6 men and 9 women aged from 42 to 71 years (mean age: 56.3 years). In 10 cases the reason for vertebroplasty was the vertebral hemangioma, in another 4 – pathological vertebral fractures due to metastases, and in one case – multiple myeloma. Procedures were performed from anterolateral access, under local anesthesia, under x-ray guidance (fluoroscopy). Bone needle was inserted into the vertebral body, followed by injection of PMMA cement. Results In 100% cases pain relief was observed immediately after the procedure and beneficial therapeutic effect was obtained. No life-threatening complications and clinical symptoms were observed. Average length hospital stay amounted to 2.9 days. Conclusions Cervical spine vertebroplasty from anterolateral access seems to be a safe, effective and beneficial method of treatment. It reduces the risk of infection in comparison to the transoral method.

Diagnostyka ultrasonograficzna i wewnątrznaczyniowe udrożnienie tętnicy po embolizacji tętniaka mózgu powikłanej zakrzepem tętnicy szyjnej wewnętrznej

Streszczenie Powiklania zatorowo-zakrzepowe po leczeniu wewnątrznaczyniowym tetniakow mozgu stanowią zagrozenie zycia, ale wciąz leczone są najcześciej zachowawczo. Rzadko stosowaną alternatywą jest interwencja wewnątrznaczyniowa, ktorej skutecznośc ściśle zalezy od czasu jej przeprowadzenia. Niniejszy opis przypadku podkreśla uzytecznośc przezczaszkowej ultrasonografii z kolorowym obrazowaniem przeplywu krwi w szybkim rozpoznaniu roznicowym oraz skutecznośc natychmiastowej interwencji drogą wewnątrznaczyniową. U 50-letniej chorej po zabiegu ponownej embolizacji tetniaka tetnicy szyjnej wewnetrznej doszlo do wystąpienia objawow neurologicznych. Badanie dopplerowskie wykazalo zmniejszenie predkości przeplywu krwi w tetnicy środkowej mozgu, a angiografia – prawie calkowitą niedroznośc tetnicy szyjnej wewnetrznej. Podano heparyne, wykonano pilną trombektomie drogą wewnątrznaczyniową i zalozono do naczynia stent, uzyskując ustąpienie objawow. Przezczaszkowa ultrasonografia dopplerowska z kolorowym obrazowaniem przeplywu krwi pozwala szybko rozpoznac powiklania po embolizacji tetniakow mozgu związane z zaburzeniem przeplywu krwi w naczyniach wewnątrzczaszkowych. Umozliwia to szybką i skuteczną interwencje wewnątrznaczyniową w przypadku powiklan zatorowo-zakrzepowych.Thromboembolism after brain aneurysm embolization involves high morbidity/mortality and its conservative treatment is still a standard policy. We report the practical utility of transcranial colour-coded Doppler sonography (TCCS) in the early diagnosis and effectiveness of prompt intravascular intervention in the treatment of this condition. A 50-year-old woman developed acute neurological deficit after intravascular re-embolization of a brain aneurysm. Severely decreased blood flow velocity in the middle cerebral artery was revealed with TCCS and angiography confirmed nearly complete occlusion of the carotid artery. After heparin administration, intravascular thrombectomy was performed at the same session with implantation of a stent. The symptoms faded away within hours and the patient recovered fully. Prompt intravascular intervention could be a valuable and efficient alternative in the treatment of thromboembolism after embolization of cerebral aneurysm. TCCS enables early differential diagnosis of this potentially devastating sequel.

Late ophthalmological manifestations in patients with subarachnoid hemorrhage and coiling of cerebral aneurysm

Late ocular manifestations of aneurysmal subarachnoid hemorrhage (SAH) have not been previously investigated except for one study which demonstrated that one half of patients subjected to aneurysm clipping suffer from symptoms of visual pathway impairment. We assessed ophthalmological status of patients after 1-4.5 years from SAH and aneurysm embolization to identify predictors of damage to the visual pathways. Complete ophthalmological examination, static perimetry, and visual evoked potentials (VEPs) were performed in 74 patients (26 men, 48 women, aged 19-76 years), who constituted a consecutive sample of 129 patients treated with aneurysm embolization in the years 2008-2010. The following independent variables: sex, age, time from SAH to embolization, size and site of aneurysm, score in Glasgow Coma Scale, Glasgow Outcome Scale, Hunt-Hess and Fisher scales were subject to univariate and multivariate statistical analyses to study their influence on the ocular outcome. 40 patients (54%) demonstrated visual field defects appearing as multiple peripheral foci and constricted field, affecting both eyes. Among these subjects, 12 patients had severe defects in the visual field, 20 had deterioration in VEPs, and 9 had decreased visual acuity. Older age and high score in Hunt-Hess and Fisher scales were identified as predictors for visual field defects and disturbances in VEPs. More than half of the survivors of SAH and aneurysm embolization suffer from a permanent defect in visual function. Damage of visual pathway correlates with severity of SAH and older age of patients.

Ocena skuteczności leczenia endowaskularnego zwężeń i niedrożności tętnicy biodrowej wspólnej oraz zewnętrznej przy użyciu stentu samorozprężalnego Jaguar SM

Summary The goal of this work was to assess the effectiveness of endovascular treatment of common and external iliac artery stenosis/occlusion classified according to TASC using a self-expanding stent Jaguar SM. The study group included 95 patients (61 men and 34 women) who underwent treatment for stenosis or occlusion of lower limb arteries at the Department of Radiology of the University Hospital in Bialystok and the Diagnostic Radiology Department of the Central Clinical Hospital of the Ministry of Interior (MSWiA) in Warsaw between 2005 and 2007. All arterial lesions were of atherosclerotic etiology. The shortest stenotic fragment was 10 mm long and the longest occluded arterial fragment did not exceed 90 mm. Morphological classification of iliac artery lesions in treated patients was performed according to TASC II classification and included 10 patients with type A, 39 cases of type B, 36 with type C and 10 patients with type D lesions. Endovascular procedure failed to restore flow in five patients with TASC type D lesions, who were later referred for surgery. One patient suffered a complication – vessel perforation during predilatation, and had a stentgraft implanted. In 95% of patients stents were expanded using a balloon after implantation. Good results were achieved in practically all patients who underwent stent implantation. Patients were subjected to follow-up clinical and imaging evaluation during next 1–24 months. Success rate of the performed procedures as well as in a 30-day observation period was 100% in case of stenosis and 80% in case of vessel occlusion. A follow-up after 12 and 24 months showed patency of treated vessels in 84% and 76% of patients, respectively.

[Coexistence of scleroderma-like syndrome and idiopathic myelofibrosis in a 54-year-old female patient: case report].

Systemic sclerosis (SSc) is characterized by immunological disturbances, vascular damage and overproduction of extracellular matrix by stimulated fibroblasts. It has been postulated that immunological reactions involved in the pathogenesis of SSc may promote the development of malignancies. Coexistence of this disease with neoplasmatic processes is relatively frequent. In our report we describe a case a 54-year-old woman with scleroderma-like syndrome, which has preceded the occurrence of idiopathic myelofibrosis by many years. Owing to multiple repeated diagnostic tests we managed to diagnose this disease at the early stage, which enabled effective therapy with remission of blood dyscrasia as well as inhibition of skin lesions and lung fibrosis.