Maciej Rabczyński

Imaging difficulties in Takayasu arteritis - case report and review of the literature.

Summary Background: Takayasu arteritis is an inflammatory disease of large-diameter arteries. Aorta and its branches are most frequently affected. Takayasu arteritis occurs mainly in young women and, if left untreated, leads to fatal complications. Digital subtraction angiography (DSA) is considered the gold standard in imaging of Takayasu arteritis. Case Report: A thirty-five-year-old woman was admitted to the hospital with transient loss of consciousness, effort-associated vertigo, upper limb weakness and temporary vision problems. On admission, there was no pulse on the left radial artery while there were bruits over subclavian arteries. Imaging of the aortic arch (computed tomography angiography, DSA) revealed stenoses of its main branches, indicating Takayasu arteritis. Conclusions: Computed tomography angiography (CTA) performed with a 64-slice unit revealed high effectiveness in localization of vascular wall and lumen pathologies resulting from Takayasu arteritis. Thanks to this fast diagnostic method, it is now possible to perform successful monitoring of patients with Takayasu arteritis and to plan possible interventional treatment.

Connection between Heat Shock Proteins 60/65 and Diabetic Vascular Complications

Introduction: Diabetes mellitus, as a metabolic disease, is closely associated with the development of atherosclerosis lesions. The share of heat shock proteins and antibodies in the HSP -60/65 atherogenesis in patients with type 2 diabetes is still an area subject to numerous studies. Material and methods: The study was conducted in the group of 46 patients with type 2 diabetes mellitus with macrovascular complications and 62 patients with atherosclerosis. The control group was comprised of a cohort of healthy volunteers in the corresponding age. Tissue material acquired during the planned endarterectomy from the internal carotid artery was used to measure the serum levels of anti HSP 60/65, the plasma levels of vWF, and to perform the immunohistochemistry study. Results: There was a higher concentration of anti HSP-60/65 in the group of patients with type 2 diabetes mellitus with macrovascular complications and patients with atherosclerosis without the endocrinopathies than in the control group (55.67 ± 65.43 vs. 26.09 ± 13.85, 82.98 ± 26.09 vs. 111.18 ± 13.85). Immunohistochemical method allowed observing a strong correlation between the concentration of antibodies to HSP60/65 in the blood serum and the protein expression of HSP 60/65 in the carotid arterial wall. The concentration of antibodies to HSP 60/65 was associated with the increase in the concentration of von Willebrand factor - marker of endothelial dysfunction (R=0.388, p<0.01). Conclusions: The research indicated an additional connection between the serum level of antibodies to HSP 60/65 and of vWF, in patients with type 2 diabetic mellitus with macrovascular complications, suggesting their influence on endothelial cell damage in the course of diabetic vascular complications.

Critical ischemia of the fingers in an auto mechanic as a result of occupational exposure

Hypothenar hammer syndrome is a rare cause of ischemic fingers observed mainly in young men smoking cigarettes and it is associated with repeated trauma of the ulnar artery in the area of the hypothenar eminence of the dominant-hand arm, resulting in a deficit of blood supply with the occurrence of hand symptoms typical for chronic and sometimes critical ischemia. Artery injury in this location is most often the result of multiple repetitions of the same activity being mostly the result of occupational exposure. We present a case of a 27-year-old car mechanic admitted to the hospital with symptoms of critical ischemia of the fingers III, IV, and V of the right hand, which resolved after conservative treatment.

Prognosis of morbidity on type 2 diabetes according to the FINDRISC questionnaire — preliminary study

Introduction. Diabetes is not only an issue related to secretory organs or complications permanently attached to any ongoing disease process, but it is also an issue of public health as it is one of the four top priority non-contagious diseases the entire world is fighting against. The aim of this research was to assess the risk of possible diabetes incidence amongst a group of test subjects which may occur in the next decade. The study was based on a FINDRISC questionnaire. Material and methods. The research group were comprised of 100 responders at the ages of 18 to 88, including 70 female and 30 male subjects. The mean age of the men was 47.6 ± 19.98 years, while for the women it was 53.61 ± 18.31 years. Results. The results obtained in the questionnaire showed that the risk of diabetes incidence increased in subjects who turned 55 years of age in comparison to the younger responders. The risk of developing diabetes increased with the increase of BMI at the correlation coefficient 0.657 and p < 0.001. Conclusions. Genetic affinity was determined to be an irrelevant variable in the risk of developing diabetes. Both BMI and the age were strong factors determining the future risk of diabetes incidence.

Evaluation of blood prothrombotic parameters under the influence of physical activity

Introduction. Blood is a suspension of cellular components in plasma. Its viscosity is affected by haematocrit, the aggregation ability of erythrocytes and the viscosity of plasma, conditioned by high-molecular fibrinogen proteins or lipoprotein. The increase of blood viscosity occurs in the course of many diseases leading to the formation of atherosclerotic lesions. Material and methods. The study involved 50 patients with femoral-popliteal type of occlusion in stage IIB according to Fontaine’s classification. Before the training, the patients underwent a treadmill test evaluating claudication distance. The proposed training included physical exercise performed 3 times a week and lasting 30 minutes for a period of 6 months. Before and after the training, venous blood samples for laboratory tests were taken to determine the values of haematocrit, haemoglobin, as well as phosphatase and calcium D-dimers. The purpose of the study was to evaluate the impact of training on selected blood rheological parameters. In addition, the change in BMI values and the length of distance of relative claudication were evaluated in the prospect of changes in laboratory values. Results. The applied training contributed to the reduction of selected blood parameters. Statistical significance was observed at p < 0.0001 for D-dimers, haematocrit and phosphatase. The changes in BMI values were reflected in the results of D-dimers and phosphatase. A statistical significance also occurred in the case of the extension of claudication distance and changes in the values of D-dimers, haematocrit and phosphatase. Conclusions. The supervised training had an impact on the reduction of prothrombotic blood parameters. Health-oriented physical exercise can contribute to body weight decrease and painless distance extension.

Acute visceral vein thrombosis as a manifestation of complex inherited thrombophilia

We present a case of man with portal vein thrombosis associated with complex inherited thrombophilia. The paper emphasises diagnostic and therapeutic difficulties in patients with visceral vein thrombosis.