Wacław Majewski

Copper and zinc concentrations and the activities of ceruloplasmin and superoxide dismutase in atherosclerosis obliterans.

The relationships among concentrations of copper and zinc, the oxidase activity of ceruloplasmin (Cp) in serum, and Cu,Zn-SOD (superoxide dismutase) activity in erythrocytes were investigated in men with atherosclerosis obliterans (AO) and a control group. The oxidase activity of Cp was measured with o-dianisidine dihydrochloride as a substrate, and Cu,Zn-SOD activity in erythrocytes by using the RANSOD kit. The lipid profile and uric acid concentration were determined in AO and control groups.The results showed higher copper and zinc concentrations in serum in the AO group (20.0±3.5 and 18.0±3.2 µmol/L, respectively) in comparison with the control group (15.6±2.3 and 14.7±1.9 µmol/L). The Cp activity in serum was higher in the AO group (174.2±61.8 U/L) than in the control group (93.7±33.9 U/L), and a significant difference was found in the activity of Cu,Zn-SOD in erythrocytes (2389±1396 and 1245±365 U/g Hb, respectively) between both groups.The activity of Cu,Zn-SOD was positively correlated with copper in the control group (r=0.73), but not in AO, and negatively with uric acid concentration (r=−0.63) in the AO group. The oxidase activity of Cp was correlated with copper, but not zinc, in AO and control groups (r≥0.65). Negative correlation coefficients were calculated for uric acid and copper and zinc concentrations in the AO group (−r≥0.61).Increased copper concentrations and oxidase activity of Cp in serum in AO and the activity of Cu,Zn-SOD in erythrocytes could result from atherosclerotic disease, accompanied by chronic ischemia of a lower limb. These results suggest also that relationship between copper concentration and Cu,Zn-SOD activity in erythrocytes found in the serum of healthy subjects may be disturbed in pathologic conditions.

C-reactive protein and α-1-acid glycoprotein in monitoring of patients with chronic arterial occlusion of the lower limbs

C-reactive protein (CRP) and alpha-1-acid glycoprotein (AGP) levels were studied in the sera of 107 patients with chronic arterial ischaemia of the lower limbs. Depending on the degree of ischaemia, patients were divided into four groups: (i) intermittent claudication--20 patients; (ii) rest pain and ankle pressure above 50 mmHg--12 patients; (iii) rest pain and ankle pressure below 50 mmHg--25 patients; (iv) peripheral necrosis--50 patients. Reconstructive surgery was performed in 84 patients and primary major amputation in 23 cases. Levels of CRP and AGP increased with the severity of ischaemia. In uncomplicated cases, CRP and AGP concentrations decreased to normal values 7-10 days after surgery. In a group of 23 patients with postoperative necrotic complications, significant increases in CRP and AGP levels were found 7-10 days after surgery. These proteins, especially CRP, may be clinically useful in monitoring patients during the postoperative period with a CRP level greater than 50 mg/l predictive of complications with a sensitivity of 83% and a specificity of 94%.

Patients' Radiation Doses During Thoracic Stent-Graft Implantation: The Problem of Long-Lasting Procedures

BACKGROUND This article investigates patient radiation doses during implantation of thoracic stent-graft. Aortic stengraft implantation can be disturbed by many factors, which, in turn, lead to prolongation of the procedure time and, as a consequence, increase the radiation dose. METHODS Measurements of radiation length (fluoroscopy and exposure), air kerma (AK) in grays, and dose-area product in grays·square centimeters were conducted simultaneously in 100 patients. The patients were analyzed retrospectively, regarding their body mass index (BMI), type of aneurysms, number of stent-graft parts, angulation of aorta, and coverage of the left subclavian artery. RESULTS Mean total dose-area product value for this kind of treatment was 361 Gy·cm2. This was caused by the fact that total mean AK was high for the cohort analyzed and reached 797 mGy. For 23 patients total AK was between 1 and 2 Gy, and for 3 it exceeded 2 Gy. In the remaining group, the maximal radiation dose was very high and exceeded 3 Gy. The total AK of patients with BMI within the range of 25 to 29.9 kg/m2 and with BMI greater than 30 kg/m2 significantly increased in comparison with the group of patients with BMI between 18 and 24.9 kg/m2 (p=0.00005 and 0.000001, respectively). During the study, a good correlation between AK and fluoroscopy time (r=0.6) and for AK (or dose-area product) and exposure time (r=0.66 or 0.81, respectively) was observed. CONCLUSIONS The main factors contributing to a high radiation dose being acquired by patients during thoracic stent-graft were BMI greater than 25 kg/m2, number of parts of the stent-graft, and angulation of the neck of aneurysm exceeding 60 degrees.

Diagnosis of Type III Endoleak and Endovascular Treatment with Aortouniiliac Stent-Graft

The present report describes a case of type III endoleak from a tear in the fabric of a Zenith bifurcated stent-graft approximately 6 months after implantation. The reason of the fabric tear was unknown. The complication was successfully treated by aortouniiliac stent-graft implantation followed by creation of a femorofemoral bypass.

Patients’ Radiation Doses During the Implantation of Stents in Carotid, Renal, Iliac, Femoral and Popliteal Arteries

OBJECTIVES AND DESIGN The aim of the study was to document the radiation doses to patients during the implantation of stents in various arteries and to discuss potential reasons for prolongation of radiological procedures. MATERIALS AND METHODS Measurements of air kerma (Gy) and dose-area product (Gy cm²) (DAP) were carried out simultaneously on a sample of 345 patients, who underwent different interventional radiological procedures involving angioplasty with stenting of 73 carotid (21.5%), 22 renal (6.5%), 160 iliac (45%), 63 femoral (18.6%) and 27 popliteal (7.9%) arteries. RESULTS The highest mean air kerma values for fluoroscopy and exposure were found for renal angioplasty (340 and 420 mGy, respectively). With regard to total DAP values, the highest were obtained for renal (148 Gy cm²) and iliac/The Inter-Society Consensus for Management of Peripheral Arterial Disease (TASC) II C (199 Gy cm²) stent implantation. The lowest values were for carotid (53 Gy cm²), iliac/TASC II A (6.3 Gy cm²) and femoral/TASC II A (53 Gy cm²) arteries. For 3.5% of the patients, the air kerma was between 1 and 1.5 Gy and for 1.5%, it was between 1.5 and 2 Gy. CONCLUSIONS In procedures performed on the arteries of the lower limbs, a significantly higher dose was received by patients with TASC II C lesions. With regard to the number of stents implanted, the total DAP value was 50% higher for simultaneous three-stent implantation than for one or two stents.

Arylesterase and paraoxonase activity of paraoxonase (PON1) affected by ischemia in the plasma of patients with arterial occlusion of the lower limbs.

OBJECTIVES The aim of the study was to evaluate the effect of different degrees of chronic ischemia of the lower limbs on PON1 activity in plasma, in relation to different substrates. DESIGN AND METHODS The studied group consisted of patients with chronic arterial occlusion of the lower limbs due to atherosclerosis. The paraoxonase and arylesterase activities of PON1 were measured according to the Karen Gan method. RESULTS PON1 arylesterase activity was affected by ischemia of the lower limbs depending on its degree. In the group with critical ischemia decreased PON1 activity was observed in comparison with that in the moderate ischemia group and the control group (50.05+/-21.40 U/mL and 82.59+/-29.27 U/mL, 85.30+/-35.05 U/mL, respectively). CONCLUSIONS The results revealed a reverse relationship between PON1 activity and the progress of atherosclerosis to the ischemic level. The present study demonstrates, for the first time, that the arylesterase activity of PON1 is affected by critical ischemia of the lower limbs.

C-reactive protein and α1-acid glycoprotein in monitoring of patients with acute arterial occlusion

C-reactive protein (CRP) and alpha 1-acid glycoprotein (AGP) levels were studied in sera of 75 patients with acute arterial occlusion. Depending on the degree of ischaemia, patients were divided into two groups: grade I--26 patients--and grade II--49 patients. All patients were treated surgically; 42 embolectomies, 17 endarterectomies and 16 bypasses were performed. After surgery in 19 patients various complications were observed. The concentration of both proteins at the time of admission was higher in the serum of patients with grade II than with grade I ischaemia. Similarly the concentration of both proteins was significantly higher in the sera of the patients admitted after 8 h than in patients admitted within 8 h of the onset of ischaemia. CRP and AGP levels were significantly higher in the serum of patients with ischaemia of the lower limb than in those with ischaemia of the upper limb. In all patients 2-3 days after surgery a significant increase in serum CRP and AGP was observed. In uncomplicated cases on days 7-10 the values of both proteins decreased below the level observed at the time of admission. However, in patients who experienced postoperative complications high levels of both serum proteins (especially CRP) were found on days 7-10. Complications were detected with a sensitivity and specificity of 84 and 95%, respectively, using a CRP level of 49 mg l-1 as the cut-off point.

Traumatic Inferior Gluteal Artery Aneurysm Managed with Emergency Transcatheter Thrombin Injection

Pseudoaneurysms of the inferior gluteal artery (IGA) are rare and are often caused by trauma. Treatment options vary and include surgery, ultrasound-guided percutaneous thrombin injection, and endovascular procedures such as stent-graft placement, coil embolization, and glue injection. We report a 70-year-old male who presented to the hospital after a road accident with a posttraumatic pseudoaneurysm that was treated by endovascular thrombin embolization. To the best of our knowledge, this is the first reported case of inferior gluteal artery false aneurysm treated by this method.

Effect of Surgical Treatment on Lipid Peroxidation Parameters and Antioxidant Status in the Serum of Patients with Peripheral Arterial Disease

The various risk factors for peripheral arterial disease (PAD) are almost identical to those for atherosclerosis and include abnormal levels of lipids or lipoproteins. Lipid peroxidation parameters and total antioxidant capacity in the serum of male patients with PAD before surgery as well as 3–5 days and 7–10 days after surgery were measured. We also compared these parameters with those in a group of patients receiving simvastatin therapy. Concentrations of lipid hydroperoxides (LOOHs) and malondialdehyde, the total antioxidant capacity (assessed by ferric reducing antioxidant power assay), concentration of thiol (-SH) groups, and ceruloplasmin activity were determined spectrophotometrically in PAD patients treated surgically (Group I) or pharmacologically (Group II). The patients before surgical treatment had significantly higher concentrations of malondialdehyde but lower ceruloplasmin activity than those observed in Group II, treated with simvastatin. No significant differences before surgery in ferric reducing antioxidant power or thiol concentrations were found between the two groups. However, in Group I, both ferric reducing antioxidant power and thiol group concentrations decreased 3–5 days postoperatively, and ceruloplasmin activity increased 7–10 days after surgical treatment. The presented results demonstrate diverse oxidative stress responses to surgical treatment and confirm the beneficial effects of statin therapy in PAD.

Morphological and Mechanical Changes in Juxtarenal Aortic Segment and Aneurysm Before and After Open Surgical Repair of Abdominal Aortic Aneurysms

OBJECTIVE The aim of study was to assess how the ultrastructure of the wall of aortic aneurysms, sac and neck influences aortic wall distensibility and proximal dilatation 2 years after open repair. METHODS Biopsies for electron microscopy were taken from aneurysmal sac and neck of 30 patients. Patients were assessed by computed tomography (CT) and ultrasound for aneurysm diameter and distensibility (M-mode ultrasonography). RESULTS Postoperative CT of the aortic stump distinguished two groups. Group I (n = 11) with little enlargement, median 1 mm (1-3 mm) and group II (n = 19) with significant aortic enlargement, median 5.2 mm (4-12 mm). In group II, changes in elastic fibres in the aneurysm neck were comparable to, but as extreme as in the aneurysm sac. For group I, the distensibility of the aneurysmal sac was significantly lower than in the neck or at the renal arteries. For group II, the distensibility in both the neck and sac was significantly lower than at the juxtarenal segment (p = 0.01). The biopsies of group II patients showed the extensive degeneration of normal architecture, which was associated with altered wall distensibility in both the aneurysmal neck and sac. CONCLUSIONS Disorganisation and destruction of normal aortic architecture at the ultrastructural level are associated with decreasing aortic distensibility. Low aortic neck distensibility is associated with proximal aortic dilatation at 2 years postoperatively.