Rajmund Adamiec

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.

Proteins from the 18 glycosyl hydrolase family are associated with kidney dysfunction in patients with diabetes type 2

Abstract Objectives: To investigate chitotriosidase (CHIT1) activity and chitinase-3-like protein 1 (YKL-40) concentration in plasma of type 2 diabetic patients and evaluate their relationship with kidney dysfunction. Materials and methods: 94 diabetic subjects and 33 controls were enrolled in the study. Plasma CHIT1 activity and YKL-40 concentration were measured along with routine laboratory parameters. Results: Levels of CHIT1 and YKL-40 in plasma of type 2 diabetic patients increased progressively with the degree of albuminuria. CHIT1 discriminated normoalbuminuric subjects from those with abnormal albuminuria better than YKL-40. Conclusions: CHIT1represent a supportive biomarker connected with development of diabetic vascular complications, especially kidney dysfunction.

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.

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.