Rafał Małecki

Thromboangiitis obliterans in the 21st century--a new face of disease.

Thromboangiitis obliterans (TAO) is a relatively rare disease of peripheral blood vessels, affecting small and medium sized arteries and veins. Although the first description of the disease was given by Winiwarter almost 130 years ago, etiology of TAO remains not elucidated. Smoking is considered as a precipitating factor of the disease. We emphasised some particular features of the new face of TAO - significant decrease in incidences, increased disease prevalence among women and coexistence of other than smoking atherosclerotic risk factors (especially disturbances of glucose metabolism). Contemporary methods of treatment were also discussed.

Lipid changes occuring in the course of hematological cancers

The relationship between plasma lipid levels and mortality from cardiovascular diseases has been shown in many studies, but there has been far less investigation into their relationship to non-cardiovascular diseases. The aim of this study was to investigate the lipid profile of individuals with hematological malignancies and its relationship to disease activity. 238 patients were included in the study: 84 with acute leukemia, 62 with non-Hodgkin lymphoma, 35 with Hodgkin’s lymphoma, 32 with multiple myeloma, and 25 with myeloproliferative syndrome. The HDL cholesterol level of the patients differed to that of the individuals in the control group in the active disease period for all the analyzed disorders, but only remained statistically significant in the acute leukemia and non-Hodgkin lymphoma groups during the remission period. Smaller differences were observed for the remaining lipid fractions, except for the triglyceride level, which increased in the active disease period in all the analyzed disorders except non-Hodgkin lymphoma. The most pronounced changes in the lipid fractions occurred in the HDL cholesterol level, and were the most remarkable for acute leukemia.

The Pathogenesis and Diagnosis of Thromboangiitis obliterans: Is It Still a Mystery?

Thromboangiitis obliterans (TAO) is a rare disease of unknown etiology that results in the occlusion of limb arteries located distally to the elbow and knee. Despite the fact that more than one hundred years have passed since its first description, knowledge on the pathogenesis of TAO and precipitating factors is still limited. Due to a lack of decisive noninvasive diagnostic methods and geographical differences in the prevalence of this condition, data on TAO epidemiology also remains sparse. This review presents important evidence on the pathogenesis and the course of the condition, as well as diagnostic modalities, with a focus on differential diagnosis. Theories on the pathogenesis of TAO include the theory of an infectious disease, coagulation disorders and injury to vascular endothelium resulting in activation of the inflammatory response. Differential diagnosis should exclude thoracic outlet syndrome, blue toe syndrome, infectious endocarditis, popliteal entrapment syndrome, Takayasu disease, primary and secondary systemic vasculitis, antiphospholipid syndrome, infection with the anaerobic Clostridium sp. bacilli and some less common conditions.

Altered plasma fibrin clot properties in essential thrombocythemia

Abstract Patients with increased thromboembolic risk tend to form denser fibrin clots which are relatively resistant to lysis. We sought to investigate whether essential thrombocythemia (ET) is associated with altered fibrin clot properties in plasma. Ex vivo plasma fibrin clot permeability coefficient (Ks), turbidimetry and clot lysis time (CLT) were measured in 43 consecutive patients with ET (platelet count from 245 to 991 × 103/µL) and 50 control subjects matched for age, sex and comorbidities. Fibrinolysis proteins and inhibitors together with platelet activation markers were determined. Reduced Ks (−38%, p < 0.0001) and prolonged CLT (+34%, p < 0.0001) were observed in ET. The differences remained significant after adjustment for fibrinogen and platelet count. ET was associated with a slightly shorter lag phase (−5%, p = 0.01) and higher maximum absorbency of the turbidimetric curve (+6%, p < 0.001). The ET patients had higher plasma P-selectin by 193% (p < 0.00001) and platelet factor 4 (PF4) by 173% (p < 0.00001), with higher P-selectin observed in 19 (44%) patients with JAK-2 gene V617F mutation. Higher t-PA (+20%, p < 0.001), 23% higher plasminogen activator inhibitor-1, PAI-1 (+23%, p < 0.01) and unaltered thrombin-activatable fibrinolysis inhibitor, plasminogen and α2-antiplasmin activity were found in the ET group. Ks inversely correlated with fibrinogen, PF4 and C-reactive protein. CLT positively correlated only with PAI-1. Patients with ET display prothrombotic plasma fibrin clot phenotype including impaired fibrinolysis, which represents a new prothrombotic mechanism in this disease.

Assessment of Vascular Function of Hand Allografts

BACKGROUND Insufficiency of blood vessels supplying a limb allograft may lead to loss of the extremity. Thus, a regular evaluation of perfusion of transplants seems a reasonable approach. The purpose of the present study was assessment of allograft perfusion by means of non-invasive methods. MATERIAL/METHODS Six hand allografts transplanted in 5 patients were included in the study group. The transplant procedure occurred on average 45 months before. The study group comprised 2 allografts at forearm level, 2 transplants of the arm, and 1 bilateral transplant of the forearm. Parameters of blood flow using Doppler ultrasonography, impedance plethysmography, Doppler measurement of segmental pressures, optical pulse oscillography (OPO), and thermography were performed in all participants. RESULTS DUS revealed increased resistive index in ulnar arteries of transplant hands compared to native hands and an altered blood supply was confirmed by IP. Flow-mediated dilatation within the transplanted extremity was abnormal in most patients and was inversely correlated with number of episodes of acute rejection. Analysis of oscillographic spectrum revealed flattening of the dicrotic notch in transplant hands. A tendency for lower temperature of the skin of transplanted hands compared to native extremities was also observed. CONCLUSIONS In asymptomatic patients after limb transplantation, non-invasive methods disclosed discreet abnormalities of graft perfusion. Thus, regular measurement of perfusion parameters using these methods appears to be a promising approach to detect early and potentially reversible disturbances of blood supply. Further observational studies are required to determine its clinical significance.

Peripheral circulatory disorders in essential thrombocythemia

A significant number of patients with essential thrombocythemia (ET) complain of symptoms including distal parts of the extremities (e.g., paresthesias or Raynauds phenomenon). The aim of the present study was to examine peripheral circulation in the upper extremities of individuals with ET. The study included 45 ET patients and 30 control subjects. All participants were subjected to thermography, photoplethysmography, impedance plethysmography, and applanation tonometry pulse wave analysis. The patients with ET differed significantly from the control subjects in terms of 3rd finger skin temperature (mean 31.04 vs. 32.45°C), skin temperature gradient (mean 1.82 vs. 0.11°C), photoplethysmographic amplitude (median 0.25 vs. 0.74%), and pulse waveform in the radial artery (more frequent occurrence of type B waveform). Pulse wave parameters correlated with the skin temperature gradient. The study findings imply the altered regulation of peripheral circulation in ET, including a decreased flow and an increased resistance.

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.