Andrzej Modrzejewski

Polymorphism of matrix metalloproteinase genes (MMP1 and MMP3) in patients with varicose veins

Background.  Several risk factors for varicose veins have been identified: female gender, combined with obesity and pregnancy, occupations requiring standing for long periods, sedentary lifestyle, history of deep‐vein thrombosis and family history. However, no specific gene variants related to a wide prevalence of varicosities in general population have been identified. Extracellular matrix composition, predominantly maintained by matrix metalloproteinases (MMPs), may affect the vein‐wall structure, which may lead to dilation of vessels and cause varicosities.

Cholesterol 7α-Hydrolase (CYP7A1) c.−278A>C Promoter Polymorphism in Gallstone Disease Patients

There is growing evidence that gallstone formation may be genetically determined. Cholesterol 7alpha-hydrolase (CYP7A1) is an enzyme that catalyzes the first, rate-limiting reaction of cholesterol catabolic pathway. Recently, a common c.-278A>C polymorphism (rs3808607:G>T) has been described in CYP7A1 gene, associated with altered plasma lipid levels. The aim of this study was to verify the finding that CYP7A1 polymorphism may be associated with gallstone disease. Frequency and distribution of the studied alleles did not differ significantly between the patients (-278C; minor allele frequency: 0.45) and the controls (0.48). No significant gender-related differences of allele frequencies or distribution were noted. We conclude that CYP7A1 promoter polymorphism is not a valuable marker of gallstone disease susceptibility in a Polish population.

Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency.

The quality of life (QoL) in patients with advanced venous insufficiency (including venous stasis ulcers, skin discoloration, stasis eczema, and lipodermatosclerosis) assessed using the Clinical Etiological Anatomical Pathophysiological (CEAP) and Venous Clinical Severity Score (VCSS) classifications is presented. Also, disease features such as: intensity of pain, edema and inflammatory response that exerted the most profound effect on different domains of QoL are reported. The global QoL in patients with lower leg venous ulcerations was relatively similar to that observed in other patients with chronic venous insufficiency. The presence of venous ulcerations was associated with lower QoL in a Physical domain. Significant correlations were found between pain intensity and the values of Physical, Physiological, Level of Independence and Environmental domains, between edema intensity and Social domain as well as between the intensity of inflammatory response and Physical and Spiritual domains.

Migration of a foreign body into the colon and its autonomous excretion

Summary Background The frequency of foreign body retention in the abdominal cavity ranges from 1 in 100 to 1 in 3000 surgeries performed. Worldwide literature describes only a few cases of the migration of misplaced surgical gauze into the colon. Case Reports The first case is a 60-year-old patient following laparoscopic cholecystectomy, who excreted (on his own) a cotton sheet 30×65 cm after 26 weeks, which did not possess a radiological locator. The latter fact caused diagnostic difficulties in interpreting ultrasonography, CT-scans and abdominal X-rays. Colonoscopy after 4 months following the excretion of the sheet showed flat, stretched ulceration of the colonic wall near the hepatic turn. The second case is a 76-year-old who had undergone several abdominal surgeries, including a classical cholecystectomy and extirpation of the uterus along with related tissues, as a result of cancer and with subsequent radiotherapy. The reason for the last intervention was an occlusion, which required a resection due to abscesses inside the peritoneal cavity. Abdominal pain continued after the surgery. Uroscopy and abdominal X-rays were performed 3 months later, which confirmed the presence of foreign matter in the abdominal cavity. Conclusions Most foreign objects that have migrated into the colon will be excreted autonomously, which warrants a conservative assessment. Radiologically-tagged materials should be used, which will greatly ease identification in cases of suspected retention of surgical materials in the abdominal cavity.

Postoperative interstitial hernia as a cause of obscure incisional wound site pain

An interstitial hernia is one in which the hernia sac is located between the layers of the abdominal wall. The analysis of contemporary literature shows that interstitial hernias are most often seen in children as a type of inguinal hernia and often accompany undescended testis. The hernia sac is usually located between the external-oblique and internal-oblique muscles in a lateral-cephalic direction. The authors present 3 cases of interstitial hernia found during laparoscopic exploration of the front abdominal wall done due to incisional wound site pain. No previous diagnosis of hernia was considered in all the cases. Hernias were found as complications of appendectomy and wound healing after radiotherapy of uterine and cervical cancer. In conclusion, in obscure wound site pain, the presence of an interstitial postoperative hernia should be considered as a possible reason for the complaint. Laparoscopic examination of the anterior abdominal wall during adhesiolysis in patients with abdominal pain enables proper diagnosis and treatment.

Temperature changes in selected areas of body surface induced by systemic cryostimulation.

BACKGROUND The aim of this study was to assess the distribution and dynamics of temperature changes on the surface of selected body parts after systemic cryostimulation. The changes that occurred as a reaction to the 1st, 5th, and 10th session of a series of 10 sessions were also analyzed. METHODS The study group consisted of 24 students (12 women and 12 men, ∼21 yr of age) from the University School of Physical Education in Krakow. They were treated in a cryogenic chamber at the Rehabilitation Center in Krakow once daily for 10 d. The mean temperature in the chamber was -130°C ± 10°C and the session duration was 3 min. Thermovisual examination of temperature distribution in the selected parts of the upper and lower extremities was conducted before and immediately after a session on the 1(st) (S1), 5(th) (S2), and 10(th) (S3) day of treatment. All thermograms were digitally recorded using a Flir Therma CAM TM Sc500 camera. RESULTS On the 5th day of treatment, the examined group demonstrated the smallest mean temperature changes (4.57°C-17.31°C for the anterior part of the upper extremities in men and the posterior part of the lower extremities in women, respectively) before and after cryostimulation. The most significant temperature changes were observed in the group of women (6.80°C-20.08°C for the posterior parts of the upper extremities on S2 and the lower extremities on S3, respectively). CONCLUSION There is an important difference in response to cryogenic temperature between men and women in a series.

Acute limb ischaemia during myocardial infarction

Wystąpienie ostrego niedokrwienia kończyny (ALI, acute limb ischaemia) wiąże się ze znacznym ograniczeniem lub zatrzymaniem przepływu w tętnicach kończyny dolnej. Jedną z przyczyn ALI może być zatorowość (35–40%) sercopochodna w przebiegu np. migotania przedsionków lub zawału serca (80%). Objawy ostrego niedokrwienia kończyn dolnych zależą od liczby i średnicy naczyń, które uległy całkowitemu zamknięciu lub zwężeniu, a także od umiejscowienia przeszkody, jakości krążenia obocznego i stanu naczyń przed wystąpieniem objawów ostrego niedokrwienia. Po 10–15 minutach masywnego niedokrwienia pojawiają się zaburzenia czucia, do których dołączają się zaburzenia ruchowe, a w stanach zaawansowanych występuje rozległa martwica tkanek. Według standardów ESC już w stopniu II ALI (wg klasyfikacji SVS) zaleca się niezwłoczną rewaskularyzację, by nie dopuścić do nieodwracalnych procesów w obrębie niedokrwionej kończyny. Poniższy przypadek opisuje jedną z opcji terapeutycznych w leczeniu ostrego niedokrwienia możliwą do przeprowadzenia w pracowni hemodynamicznej. Pacjent w wieku 62 lat, z wielopoziomową miażdżycą w obrębie tętnic kończyn dolnych, tętnicy podobojczykowej lewej i tętnicach szyjnych, po wielokrotnych zabiegach angioplastyki w obrębie tętnic kończyn dolnych, trafił do szpitala z powodu objawów ostrego zawału z uniesieniem odcinka ST ściany dolnej. W wykonanej pilnie koronarografii (z dostępu promieniowego lewego) ujawniono zamkniętą świeżym zakrzepem prawą tętnicę wieńcową, którą poddano zabiegowi angioplastyki z implantacją metalowego stentu. W trakcie zabiegu doszło do krótkotrwałego nagłego zatrzymania krążenia w mechanizmie częstoskurczu komorowego, który poddano skutecznej kardiowersji, uzyskując powrót rytmu zatokowego. Po odzyskaniu przytomności pacjent zgłosił silny ból i nasilające się zaburzenia czucia w obrębie kończyny dolnej lewej. W badaniu przedmiotowym stwierdzono bladą, porażoną i zimną kończynę, bez wyczuwalnego tętna na tętnicach obwodowych. Natychmiast po zakończeniu zabiegu wieńcowego wykonano angiografię lewej kończyny dolnej, która ujawniła zamknięcie tętnicy biodrowej wspólnej, nieco powyżej implantowanego wcześniej stentu (ryc. 1). Zadecydowano o podaniu celowanej trombolizy — alteplazy, przez cewnik pozostawiony tuż nad skrzepliną. Terapię rozpoczęto dotętniczym bolusem 10 mg alteplazy, a następnie kontynuowano 2-godzinny wlew 30 mg leku za pomocą pompy infuzyjnej podłączonej do cewnika pozostawionego w tętnicy biodrowej. Podczas infuzji alteplazy pacjenta przewieziono na Oddział Intensywnej Opieki Kardiologicznej, gdzie wkrótce zaobserwowano ustąpienie dolegliwości bólowych kończyny. Po zakończeniu wlewu wykonano kontrolną angiografię, która ujawniła przywrócenie przepływu w tętnicy biodrowej zewnętrznej lewej (ryc. 2) i obwodowe ubytki perfuzji w zakresie tętnicy strzałkowej. W badaniu przedmiotowym stwierdzono, że powróciło tętno na tętnicach udowej, podkolanowej i grzbietowej stopy. Po kilku dniach hospitalizacji pacjent został wypisany do domu z zaleceniem kontroli w Poradni Chirurgicznej. Podstawowe znaczenie w ALI ma szybkie postawienie diagnozy i wdrożenie leczenia rewaskularyzacyjnego. Tromboliza celowana przez cewnik umieszczony w tętnicy powinna zostać rozważona w każdym przypadku ALI w stopniu łagodnym do umiarkowanego, a także u pacjentów z wysokim ryzykiem związanym z leczeniem chirurgicznym. W omawianym przypadku obydwa elementy zostały spełnione. Szybka interwencja przywracająca drożność naczynia nie pozwoliła rozwinąć się martwicy tkanek, a dodatkowo dotyczyła pacjenta z ostrym zawałem serca, u którego operacja wiąże się z dużym ryzykiem powikłań.

Physical attractiveness and self-assessment before and after breast augmentation.

BackgroundThis study verifies selected opinions on breast cosmetic surgery in the population of Polish women. Materials and MethodsA total of 78 women aged 20 to 48 years were surveyed between 2008 and 2010 before and after breast augmentation surgery using a questionnaire. The &khgr;2 and Wilcoxon signed rank tests were used for statistical analysis. Most were married and single women aged approximately 30 years and residents of large cities. ResultsThe significance of professional success in the hierarchy of values and the level of self-assessment increased after surgery (P = 0.0000 and 0.0213, respectively). The distribution of responses concerning the expectations of surgery and the evaluation of their fulfillment changed significantly (P = 0.0031). In general, the satisfaction with one’s life after surgery also increased (P = 0.0000). ConclusionsA well-thought-out decision on breast cosmetic surgery positively affects at least several spheres of psychosocial functioning and fulfills most women’s expectations.

Surgical instrument left inside abdomen

Leaving surgical instruments in the patients body is one of the most difficult situations in the professional career of an operator and it can also have severe consequences for the patient. Contrary to world literature, there are no reports of such incidents in Polish publications. Lack of such reports creates an illusion that leaving surgical instruments in the patients body does not happen in Poland, which is an unsubstantiated thesis. This paper presents two cases of leaving hemostats in the abdominal cavity. According to the authors, similar publications may facilitate critical assessment of the existing rules for inspecting instruments and surgical material by surgical teams. Importantly, confirming the compliance of instruments and material by surgical nurses is not the only criterion of assessment in this matter for the operator.

Consent for Surgery in View of an Ambigious Court Decision - Case Report.

Guardianship courts seem to issue decisions in case of the need to obtain consent for surgery, amongst other things, when the patient is unable to consciously express written consent, and at the same time does not have a legal representative or a statutory representative does exist, but settlement with him is impossible. The presented study case demonstrated the abnormalities of applying court procedures, as well as the responsibilities and dilemmas posed in front of a surgeon. A specialist surgeon wanted to help the patient and he was able to accomplish his mission.