Żanna Fiodorenko-Dumas

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.

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.

Risk assessment of deep vein thrombosis with D-dimer level in patients eligible for vascular surgery

Objectives: Venous thrombosis represents a major clinical problem, both because of its high incidence and the fact that is often complicated with fatal pulmonary embolism. D-dimer level is the diagnostic parameter used to exclude venous thrombosis and to confirm thrombosis revealed by diagnostic imaging studies. The aim of this study was to assess D-dimer levels in a group of patients scheduled for femoropopliteal bypass and to compare results of this laboratory test to those obtained in a group of volunteers without lower limb ischaemia. Material and methods: The study group consisted of 102 patients presenting with lower limb ischaemia (50 with stage IIb according to Fontaine’s classification and 52 with stage III) and 49 individuals in the control group. Results: Levels of D-dimer differed significantly between the groups. In patients presenting with Fontaine’s stage IIb, Fontaine’s stage III, and in control group they were, respectively: 0.87 ±0.31 μg/ml, 0.90 ±0.95 μg/ml, and 0.44 ±0.21 μg/ml. Conclusions: In comparison with healthy controls, D-dimer levels were significantly higher in patients presenting with lower limb ischaemia.

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.

Spine pain in the firefighter profession

BACKGROUND Musculoskeletal disorders mainly affecting the spine constitute one of the major social problems. Frequently, they constitute the cause of prolonged absence at work. Working in a fire brigade is specific because of the physical strain, working time under adverse conditions or stress related to rescue operations. MATERIAL AND METHODS The study group comprised 61 firefighters, 60 men (98.36%) and 1 woman (1.64%). The age of examined firefighters ranged 20–56 years old. The average age of the examined persons was 33.77 years old and the average working service in a fire brigade was 9.59 years. The following research instruments were applied as the study methods: own survey, the Numerical Rating Scale, the International Physical Activity Questionnaire (IPAQ) – long version and the Oswestry Disability Index (ODI) questionnaire. The Pearson correlation coefficient at significance level of p < 0.05 was used for determining the dependencies among the variables. RESULTS Knowledge of ergonomic lifting and handling principles concerning heavy loads was reported by 84% of the group, the remaining 16% declared ignorance of such rules. The dependence of pain on the length of service of the examined was insignificant and amounted to 0.281 Pearson’s r. The results of the ODI questionnaire did not significantly change statistically with age. CONCLUSIONS The IPAQ confirmed the high level of physical activity of the study population. Even though the study group was small, the results of ODI showed a minor degree of disability. Med Pr 2018;69(4):365-373