Zbigniew Krasiński

A marked fall in nocturnal blood pressure is associated with the stage of primary open-angle glaucoma in patients with arterial hypertension

Abstract Introduction. The aim of this study was to assess blood flow in the vessels of the eyeball and changes in the optic nerve in patients with arterial hypertension and primary open-angle glaucoma. Material and Methods. The patients were divided into groups: 1 (night blood pressure, BP, fall, NBPF, not more than 10%; non-dippers); 2 (NBPF 10–15%, dippers) and 3 (NBPF>15%; extreme dippers). Results. In the group of dippers and extreme dippers, perfusion pressure was significantly lower than that in the non-dippers group, there was reduced thickness of the nerve fibers and a greater decrease in the visual field. Significant relationships between peak systolic, end-diastolic flow in the ophthalmic and central retinal arteries and night perfusion pressure, thickness of nerve fibers, and a loss of visual field were observed. Conclusion. In patients with glaucoma and well-controlled hypertension, a nocturnal BP fall of more than 10% is associated with a greater visual field defect and greater degeneration of the optic nerve fibers. Low minimum diastolic pressure and the level of nocturnal BP fall, but not the absolute value of average arterial BP at night, should be included in the group of specific risk factors in patients with hypertension and open-angle glaucoma. These findings also suggest avoiding excessive lowering of BP at night in this group.

The aetiology and influence of age and gender on the development of advanced chronic venous insufficiency in the population of patients of semi-urban county outpatient vascular clinic in Poland

Objective To determine the aetiology and influence of age and gender on the development of advanced chronic venous insufficiency in patients of semi-urban county outpatient vascular clinic. Methods One hundred and fourteen patients with venous ulcers were divided, based on the ultrasound examination, into group 1 or group 2, with or without post-thrombotic lesions in the deep venous system, respectively. The control group consisted of 352 patients with varicose veins and without leg ulceration. The demographic data and thrombotic risk factors were compared between the groups. Results Group 1 patients (n = 109) were older than group 2 patients (n = 5) and control group patients, 64.7 versus 47.2 years (P = 0.016) and versus 53.8 years (P < 0.001), respectively. The percentage of women did not differ between group 1 and the control group, but was lower in group 2 (P = 0.01). The history of lower limb fracture or severe trauma increased the risk of post-thrombotic syndrome (PTS) in patients with venous ulcer. Conclusion In the population studied, the venous leg ulcer develops mainly due to primary varicose veins and its risk increases with age and is equal for both sexes. PTS should be suspected in younger patients with a history of severe trauma or leg fracture.

Effects of the time of antihypertensive drugs administration on the stage of primary open-angle glaucoma in patients with arterial hypertension

Many patients with glaucoma suffer from arterial hypertension (AH). It has been proved that both AH and low blood pressure (BP) at night are important vascular risk factors for primary open-angle glaucoma (POAG). The aims of this study were to assess the severity of pathological changes within the optic nerve and characteristics of blood flow in selected arteries of the eyeball and orbit in patients with POAG and controlled hypertension, in relation to the time of hypotensive drugs administration. Eighty-eight patients with POAG and treated, controlled hypertension were examined. The patients were divided into two subgroups, consisting of group A (n = 43), in whom hypotensive drugs were dosed only in the morning and group B (n = 45), in whom hypotensive drugs were also taken in the evening. In patients who were taking hypotensive drugs also in the evening (group B), there was a statistically significant lower mean perfusion pressure at night, a greater visual field loss and reduced amplitude of evoked potentials. Our analysis showed significantly worse changes in the parameters relating to the optic nerve in patients taking hypertensive medicines in the evening and also significantly lower perfusion pressures at night.

Monitoring of Systemic Inflammatory Response in Diabetic Patients with Deep Foot Infection Treated with Negative Pressure Wound Therapy

Background: The purpose of this study was to establish the safety of negative pressure wound therapy (NPWT) in the treatment of acutely debrided, deep diabetic foot infections (DDFI) and to determine the value of inflammatory markers in monitoring of treatment of these infections with negative pressure wound therapy. Methods: A group of ten patients with DDFI treated by radical surgical debridement and simultaneous NPWT was prospectively studied. During the debridement, a deep tissue sample was obtained and sent for microbiological testing. The patients were followed clinically for 10 days and NPWT dressings were changed every 2 to 3 days or sooner when indicated. The peripheral blood samples were obtained before the radical debridement and 3 and 10 days afterwards and concentrations of white blood cell, neutrophils, lymphocytes and C-reactive protein (CRP) were measured. The changes in concentration of inflammatory markers were analyzed with a Friedman test. Results: In all but one patient the presence of DDFI was confirmed by the culture results. At baseline, the elevated WBC and neutrophil concentrations were observed only in half of the patients while the CRP concentration was elevated in nine patients. During followup, all patients showed a favorable clinical evolution and statistically significant decrease of WBC, neutrophils and CRP (p < 0.001). There were not statistically significant changes in lymphocyte count. Conclusion: NPWT can be safely applied in acutely debrided DDFI. CRP seems to be the most adequate parameter for both diagnosis and monitoring of treatment of DDFI. Level of Evidence: IV, Case Series

Serum iron concentration and plasma oxidant-antioxidant balance in patients with chronic venous insufficency.

Summary Background The aim of this study was to evaluate serum iron concentration and influence of this element on biomarkers of oxidative stress in patients affected by chronic venous insufficiency (CVI). Material/Methods Serum iron (SI) concentration and plasma parameters of oxidant–antioxidant balance (i.e., malonyldialdehyde [MDA], uric acid [UA] concentration, and total antioxidant capacity [TAC]) were compared between 35 patients divided into appropriate groups and 23 healthy individuals. Results The subgroups analysis showed that SI concentration was significantly higher only in patients with shorter duration of CVI in comparison with the control group (P=0.013). Significant, negative correlation was found between SI concentration and duration of the disease (r=−0.422, P=0.014), age of the patients (r=−0.542, P=0.001) and BMI (r=−0.408, P=0.018). Mean value of MDA concentration and TAC capacity were higher in patients with CVI in comparison with healthy individuals (P<0.05). UA concentration was decreased, especially in CVI patients with mild clinical stage of disease and shorter CVI duration (P=0.047; P=0.034). There was no significant correlation found between SI concentration and the parameters of oxidant–antioxidant balance. Conclusions High concentration of MDA and low UA level in blood of CVI patients suggests that oxidative stress plays an important role in the pathogenesis of the disease. The increase in SI concentration observed in the early stage of CVI can enhance free radicals formation; however, direct evidence has not been provided by the present study.

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.

Observations on Degenerative Changes Within the Optic Nerve in Patients With Primary Open Glaucoma and Arterial Hypertension: 6-Month Follow-Up

J Clin Hypertens (Greenwich). 2012;14:701–710. ©2012 Wiley Periodicals, Inc.

Clinical factors increasing radiation doses to patients undergoing long-lasting procedures: Abdominal stent-graft implantation

Summary Background An important negative factor of EVAR is the radiation acquired during long-lasting procedures. The aim of the study was to document the radiation doses of EVAR and to discuss potential reasons for prolongation of radiological procedures. Material/Methods Dose-area product (DAP) (Gy cm2) and air kerma (AK) (Gy) obtained during EVAR from 92 patients were analyzed retrospectively in regards to body mass index (BMI), angulations of aneurysm neck, length of aneurysm neck and occurrence of tortuosity of iliac arteries. Results Total AK for fluoroscopy differed significantly between normal BMI (373 mGy) and BMI 25–29.9 (1125 mGy) or BMI >30 (1085 mGy). Iliac artery tortuosities >45° and short aneurysm necks caused higher doses of total AK (1097 mGy and 1228 mGy, respectively) than iliac artery tortuosities <45° and long aneurysm necks (605 mGy and 720 mGy, respectively). Conclusions The main factors contributing to a high radiation dose being acquired by patients during EVAR are: BMI >25, tortuosity of iliac arteries >45° and short aneurysm necks.

Serum from Varicose Patients Induces Senescence-Related Dysfunction of Vascular Endothelium Generating Local and Systemic Proinflammatory Conditions

Although the role of endothelium in varicose vein development is indisputable, the effect of the pathology on biological properties of endothelial cells remains unclear. Here we examined if the presence of varicose veins affects senescence of endothelial cells (HUVECs) and, if so, what will be the local and systemic outcome of this effect. Experiments showed that HUVECs subjected to serum from varicose patients display improved proliferation, increased expression of senescence marker, SA-β-Gal, and increased generation of reactive oxygen species (ROS), as compared with serum from healthy donors. Both increased SA-β-Gal activity and ROS release were mediated by TGF-β1, the concentration of which in varicose serum was elevated and the activity of which in vitro was prevented using specific neutralizing antibody. Senescent HUVECs exposed to varicose serum generated increased amounts of ICAM-1, VCAM-1, P-selectin, uPA, PAI-1, and ET-1. Direct comparison of sera from varicose and healthy donors showed that pathological serum contained increased level of ICAM-1, VCAM-1, P-selectin, uPA, and ET-1. Calendar age of healthy subjects correlated positively with serum uPA and negatively with P-selectin. Age of varicose patients correlated positively with ICAM-1, VCAM-1, and ET-1. Collectively, our findings indicate that the presence of varicose veins causes a senescence-related dysfunction of vascular endothelium, which leads to the development of local and systemic proinflammatory environment.

Effects of Intermittent Pneumatic Compression on Reduction of Postoperative Lower Extremity Edema and Normalization of Foot Microcirculation Flow in Patients Undergoing Arterial Revascularization

Background In patients with chronic leg ischemia, the beneficial effect of arterial revascularization can be significantly decreased due to postoperative leg swelling. The aim of this study was to assess the effects of intermittent pneumatic compression (IPC) on skin flow normalization in patients undergoing revascularization procedures due to chronic leg ischemia. Material/Methods We evaluated 116 patients with chronic leg ischemia. The patients were divided into groups according to the performed treatment (endovascular or surgical) and implementation of IPC postoperatively. The leg edema assessment and microcirculation flow assessment were performed pre- and postoperatively, using percutaneous O2 pressure (TcpO2), cutaneous blood perfusion (CBP) measurements, and skin flow motion assessment. Results In patients who did not receive IPC, a decrease in CBP value was observed in the 1st postoperative assessment. Among patients receiving IPC, the CBD value increased at the 1st and 2nd postoperative measurements, especially in the surgical group. The lowest TcpO2 values were observed in by-pass surgery group without IPC postoperatively. Conclusions The benefits of the by-pass procedure in patients with leg ischemia can be significantly reduced by postoperative edema. Among patients with postoperative leg edema, local tissue blood perfusion can be improved by the use of IPC, which can result in decreased local leg swelling, as well as improved skin blood perfusion and TcpO2.