Marek Bielecki

Publications of Marek Bielecki

• [The importance of rehabilitation after operative treatment of Dupuytren's disease].

  Authors: Marek Bielecki, Maciej Wysocki

  Wiadomości lekarskie (Warsaw, Poland : 1960). 01/2011; 64(1):26-30.

  Postoperative hand therapy in patients after surgery for Dupuytren's contracture is common in medical practice. Through an effective splinting and exercise program, the surgical outcome can bePostoperative hand therapy in patients after surgery for Dupuytren's contracture is common in medical practice. Through an effective splinting and exercise program, the surgical outcome can be enhanced. The treatment plan must take into account the wide range of reactions to surgery. The management plan must be flexible, more than in most areas of hand surgery. The most important points in hand therapy after surgery for Dupuytren's disease include: 1) early detection of potential postoperative complications--including disturbances in wound healing; 2) edema control; 3) scar management; 4) maintenance of surgical correction; 5) restoration of finger flexion to the degree of preoperative range of motion. The postoperative program of hand rehabilitation depends on type of surgery, and therapist's education. The hand therapist should see all patients initially on removal of the operative dressing and provide advice on a program of active mobilization. Thereafter, patients should be seen routinely at weekly intervals to ensure that recovery of motion is progressing.

• CD163 and its role in inflammation.

  Authors: Krzysztof Kowal, Richard Silver, Emila Sławińska, Marek Bielecki, Lech Chyczewski, Otylia Kowal-Bielecka

  Folia histochemica et cytobiologica / Polish Academy of Sciences, Polish Histochemical and Cytochemical Society. 01/2011; 49(3):365-74.

  Mononuclear phagocytes represent a heterogeneous population of cells with individual subpopulations exerting different pro- or anti-inflammatory functions. CD163 is a monocyte/macrophage specificMononuclear phagocytes represent a heterogeneous population of cells with individual subpopulations exerting different pro- or anti-inflammatory functions. CD163 is a monocyte/macrophage specific marker expressed predominantly on cells which possess strong anti-inflammatory potential. The expression of CD163 is strongly induced by anti-inflammatory mediators such as glucocorticoids and interleukin-10, while being inhibited by pro-inflammatory mediators such as interferon-gamma. CD163-expressing mononuclear phagocytes, as well as soluble CD163, may both take part in downregulating an inflammatory response. It seems, therefore, that CD163 may be an interesting target for therapeutic modulation of the inflammatory response.

• Angiopoietins-1 and -2 are differentially expressed in the sera of patients with systemic sclerosis: high angiopoietin-2 levels are associated with greater severity and higher activity of the disease.

  Authors: Malgorzata Michalska-Jakubus, Otylia Kowal-Bielecka, Grazyna Chodorowska, Marek Bielecki, Dorota Krasowska

  Rheumatology (Oxford, England). 12/2010; 50(4):746-55.

  The aim of the study was to investigate serum concentration of angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) in SSc patients and to correlate Ang-1 and -2 levels with clinicalThe aim of the study was to investigate serum concentration of angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) in SSc patients and to correlate Ang-1 and -2 levels with clinical manifestations. Serum levels of Ang-1 and -2 were determined by ELISA in 47 SSc patients and 27 healthy controls matched for age and sex. In SSc patients, Ang-1 was significantly lower [mean (s.d.): 21,666.09 (11,516.06) pg/ml], while Ang-2 was significantly increased [2739.60 (1009.25) pg/ml] when compared with the control group [Ang-1: 28607.13 (10,506.93) pg/ml; Ang-2: 1706.28 (556.28) pg/ml, P < 0.01, for both comparisons]. No correlation was observed between Ang-1 and -2 levels. Serum concentrations of Ang-2 correlated with the modified Rodnan skin score (P < 0.01, r =0.422), the European Scleroderma Study Group (EScSG) disease activity index score (P < 0.001, r =0.403), ESR (P < 0.05, r = 0.366) and CRP concentration (P < 0.05, r =0.292), and showed inverse correlation with diffusing capacity for carbon monoxide (DL(CO)) (P < 0.01, r = -0.281). Ang-2 was significantly increased in SSc patients with more advanced capillary damage, as indicated by the presence of late capillaroscopic pattern, than in those with less severe microangiopathy (active pattern), and in SSc patients with intermediate/late stage of disease than in SSc subjects with early disease. In multivariate regression analysis, Ang-2 was independently associated with the EScSG activity index [β-coefficient (β = 0.305, P= 0.038], ESR (β= 0.390, P =0.006) and, inversely, with the presence of digital ulcers (β =-0.426, P = 0.003). Differential expression of Ang-1/Ang-2 might contribute to the pathogenesis of SSc. Ang-2 might be a new biomarker of disease activity in SSc.

• Increased production of a proliferation-inducing ligand (APRIL) by peripheral blood mononuclear cells is associated with antitopoisomerase I antibody and more severe disease in systemic sclerosis.

  Authors: Marek Bielecki, Krzysztof Kowal, Anna Lapinska, Pawel Bernatowicz, Lech Chyczewski, Otylia Kowal-Bielecka

  The Journal of rheumatology. 11/2010; 37(11):2286-9.

  A proliferation-inducing ligand (APRIL), a member of the tumor necrosis factor (TNF) family, plays a crucial role in the survival of peripheral B cells, and may contribute to the pathogenesis ofA proliferation-inducing ligand (APRIL), a member of the tumor necrosis factor (TNF) family, plays a crucial role in the survival of peripheral B cells, and may contribute to the pathogenesis of systemic sclerosis (SSc) through upregulation of autoantibody production and maintenance of autoimmune phenomena. We evaluated the capacity of peripheral blood mononuclear cells from patients with SSc (SSc-PBMC) to produce APRIL; and investigated correlations between production of APRIL by SSc-PBMC and clinical and laboratory features of the disease. PBMC from 20 patients with SSc and 14 healthy subjects were incubated in fetal calf serum-supplemented RPMI medium. APRIL levels were determined in cell culture supernatants by ELISA. PBMC from patients with SSc produced significantly more APRIL (961 ± 151 pg/ml/10⁵ cells) than control PBMC (798 ± 219 pg/ml/10⁵ cells; p < 0.01). In patients with SSc, increased production of APRIL was associated with the presence of diffuse skin involvement, scleroderma lung disease, peripheral vasculopathy, greater capillary damage on capillaroscopy, and presence of anti-topoisomerase I (anti-topo I) antibodies. Multivariate regression analysis revealed anti-topo I antibodies as the only independent predictor of high production of APRIL by PBMC. Production of APRIL is increased in SSc-PBMC and is associated with the presence of anti-topo I antibodies and more severe disease. Targeting the APRIL pathway might represent a therapeutic possibility for treatment of patients with SSc, in particular those with anti-topo I antibodies.

• The effect of prophylactic doses of nadroparin and therapeutic doses of betamethasone on skin flap survival in rats.

  Authors: Marek Bielecki, Marta Karpik, Jan Skowroński

  Folia histochemica et cytobiologica / Polish Academy of Sciences, Polish Histochemical and Cytochemical Society. 01/2009; 47(4):673-7.

  Application of pedicle flaps is of great importance in orthopaedics and reconstructive surgery. It has been postulated that anticoagulants or anti-inflammatory treatments may have advantageous effectApplication of pedicle flaps is of great importance in orthopaedics and reconstructive surgery. It has been postulated that anticoagulants or anti-inflammatory treatments may have advantageous effect on pedicle flap survival. The aim of this study was to investigate whether: 1. low-molecular-weight heparin given at prophylactic doses or 2. steroids given at therapeutic doses improve survival of dorsal pedicle flap in rats. Thirty four animals divided into three groups were used for the experiments: Group I (N=12) was treated with low-molecular-weight heparin (nadroparin, 40 IU per kilogram of body mass/day). Group II (N=12) received single injection of betamethasone (intramuscularly, 0.1 mg per kilogram of body mass). Group III (N=10) received sterile saline (0.9% NaCl) subcutaneously as placebo. All animals were housed individually in an environmentally controlled room. After seven days from the operation, 51.7% of the dorsal flaps survived in group I and 48.3% in the group II. These results were comparable to those in the control animals. Our results indicate that neither low dose heparin (nadroparin) used at prophylactic doses nor steroids used at therapeutic doses had any effect on dorsal pedicle flap survival in rats.

• Diminished production of TWEAK by the peripheral blood mononuclear cells is associated with vascular involvement in patients with systemic sclerosis.

  Authors: Marek Bielecki, Krzysztof Kowal, Anna Lapinska, Justyna Chwiecko, Jan Skowronski, Stanislaw Sierakowski, Lech Chyczewski, Otylia Kowal-Bielecka

  Folia histochemica et cytobiologica / Polish Academy of Sciences, Polish Histochemical and Cytochemical Society. 01/2009; 47(3):465-9.

  Widespread vasculopathy and profound fibrosis are key features of the pathogenesis of systemic sclerosis (SSc). We hypothesized that the TNF-like weak inducer of apoptosis (TWEAK), a recentlyWidespread vasculopathy and profound fibrosis are key features of the pathogenesis of systemic sclerosis (SSc). We hypothesized that the TNF-like weak inducer of apoptosis (TWEAK), a recently recognized multifunctional cytokine which regulates angiogenesis and tissue remodeling, may play a role in the development of SSc. The production of TWEAK by the peripheral blood mononuclear cells (PBMC) was investigated, by means of ELISA, in 24 SSc patients and 14 healthy subjects. Moreover, production of TWEAK was correlated with clinical features of SSc. PBMC were isolated using density gradient centrifugation on Histopaque and were cultured in FCS supplemented RPMI medium at 37 degrees C under 5% CO2. Production of TWEAK by PBMC was significantly diminished in patients with more severe microvascular damage, as indicated by the presence of "active" capillaroscopic pattern, compared with SSc patients with less pronounced microangiopathy ("slow" pattern), and healthy subjects. Moreover production of TWEAK correlated inversely with duration of Raynaud's phenomenon. PBMC from patients with scleroderma-related interstitial lung disease tended to produce lower amounts of TWEAK compared with SSc patients without lung involvement but the difference was not significant. The results of our study suggest that diminished production of TWEAK might play a role in the pathogenesis of vascular injury in SSc patients. Whether TWEAK may represent a new therapeutic target in SSc requires further studies.

• [New methods of hand mobilization after operative treatment of flexor tendon injuries]

  Authors: Marek Bielecki, Dorota Lebowska

  Wiadomości lekarskie (Warsaw, Poland : 1960). 02/2007; 60(7-8):346-51.

  The paper presents various methods of physiotherapy after operative treatment of lacerated flexor tendons of the hand. Early physiotherapy is a very important factor in the essential treatment of aThe paper presents various methods of physiotherapy after operative treatment of lacerated flexor tendons of the hand. Early physiotherapy is a very important factor in the essential treatment of a patient after tendon injury. The goal of treatment is to restore an optimal range of motion of the injured finger which enables the patient to have unrestricted finger motion. There are various rehabilitation programs. They are based on passive, active or both of these kinds of finger movements. Each of these methods requires a different position of the hand. The choice of physiotherapy method depends on: type of surgical treatment of the lacerated tendon, the presence of other hand injuries, the level of education of the surgeon and physiotherapist, the patient's age and the possibility of cooperation with the patient.

• Distally based sural artery flap in soft tissue defects of the heel region.

  Authors: Marek Bielecki, Rafał Skowroński, Jan Skowroński

  Ortopedia, traumatologia, rehabilitacja. 07/2006; 8(3):345-9.

  Background. The coverage of tissue defects caused by decubitus ulcers in the remains a challenge for reconstructive surgery. In this article we describe our own experience with the use of theBackground. The coverage of tissue defects caused by decubitus ulcers in the remains a challenge for reconstructive surgery. In this article we describe our own experience with the use of the distally-based superficial sural artery flap. Material and methods. Between 1997 and 2004 we used distally-based superficial sural artery island flaps in 8 patients. In all cases the tissue was prepared as a fasciocutaneous flap. Results. All the flaps have survived. The advantages offered by this flap include constant and reliable blood supply, easy dissection, minimal morbidity of donor site, and preservation of the major arteries in the leg. We observed venous congestion and edema in three flaps, and marginal necrosis in one flap. Conclusions. The distally based sural artery flap is a good method for the treatment of soft tissue defects in the heel region. The procedure is short and can be performed in a single stage without microsurgery. This flap has the potential for reinnervation in demanding patients.

• [Sacral pressure sores and their treatment]

  Authors: Marek Bielecki, Rafał Skowroński, Jan Skowroński

  Chirurgia narzadów ruchu i ortopedia polska. 02/2006; 71(1):51-6.

  INTRODUCTION: Sacral bed sores still present a serious problem in most surgery departments. They occur mainly in elderly patients of limited mobility. The treatment of such sores extends over longINTRODUCTION: Sacral bed sores still present a serious problem in most surgery departments. They occur mainly in elderly patients of limited mobility. The treatment of such sores extends over long periods of time and therefore involves considerable costs. MATERIAL AND METHODS: The material consisted of 11 sacral pressure ulcers treated surgically. The sores occured in 4 severely disabled patients suffering from proximal third femur fractures, 4 patients with traumatic brain injury (treated in the Intensive Care Unit), and 3 patients suffering from bed sores after spinal cord injury. In 6 patients a fasciocutaneous flap was applied to the sores and in 5 cases a pedicled musculocutaneous gluteus maximus flap. The end results were assessed using Seiler's criteria. RESULTS: Complications of the "seroma" type were observed in 3 patients, and in 2 marginal necrosis. In all our patients complete healing was achieved within 2-4 weeks. CONCLUSIONS: On analysing our experience to date in surgical treatment of bed sores we are of the opinion that even extensive sacral sores can be covered with unilateral pedicled flaps provided that they are appropriately planned. Deep sores of the 4th degree sometimes with concomitant osteomyelitis require pedicled muscle flaps or in some cases musculocutaneous flaps to improve local curculation. The preparation of the patient for reconstruction surgery is just as important as the operation itself and therefore such preparation should never be neglected.

• The Oxford II medial unicompartmental knee replacement. A minimum 10-year follow-up study.

  Authors: Jan Skowroński, Jaropolk Jatskewych, Jerzy Długosz, Rafał Skowroński, Marek Bielecki

  Ortopedia, traumatologia, rehabilitacja. 01/2006; 7(6):620-5.

  Background. The first clinical results from unicondylar knee arthroplasty (UKA), which was introduced in the early seventies, were non-conclusive. The development and modernization ofBackground. The first clinical results from unicondylar knee arthroplasty (UKA), which was introduced in the early seventies, were non-conclusive. The development and modernization of unicompartmental implants (mobile bearing models, such as Oxford II), and also stricter qualification criteria for UKA brought about significant improvement in long term outcome. The aim of our study was to assess the long-term outcome of UKA using Oxford II implants, and also to verify the inclusion criteria. Material and methods. The authors present an analysis of long-term outcome in unicompartmental knee arthroplasty in 42 patients, qualified for treatment according to the criteria of Kozin and Scott, and also the designers of the implant. The follow-up assessment was performed a minimum of 10 years after surgery (11.2 years average). Results. The results were assessed using the 100-point HSS scale. Excellent results were achieved in 10 cases, good results in 22 cases, fair results in 6 cases, and poor results in 4 cases. The implant survival rate was 86%. There were some complications related to surgical error or lack of strict compliance with the qualification criteria. Conclusion. UKA late results are comparable to those achieved in TKA, given proper qualification. Also, this procedure can be considered as a definitive solution in older patients.

• The radiological outcomes of total knee arthroplasty using computer assisted navigation ORTHOPILOT.

  Authors: Jan Skowroński, Marek Bielecki, Krzysztof Hermanowicz, Rafał Skowroński

  Chirurgia narzadów ruchu i ortopedia polska. 02/2005; 70(1):5-8.

  Comprehensive radiographic analysis of total knee arthroplasty performed traditionally and with the use of Computer Assisted Navigation (CAN) is presented. The aim of this study was to compare theComprehensive radiographic analysis of total knee arthroplasty performed traditionally and with the use of Computer Assisted Navigation (CAN) is presented. The aim of this study was to compare the precision of implant alignment considering two operating techniques. The analyzed material consisted of 100 radiograms of patients operated on traditional way and 100 knee joint radiograms of patients operated on with a use of CAN. Assessment of postoperative radiograms was carried out in order to analyze coronal mechanical axis and sagittal orientation of both femoral and tibial components. Measurements were taken precisely up to 1 degrees and therefore results were classified as good (0-2 degrees deviation due to mechanical axis), satisfactory (2-4 degrees) and poor (over 4 degrees). The radiological outcome allows to present the following conclusions: CAN allows to minimize the risk of incorrect prosthesis alignment and therefore significantly improves the radiological outcome of total knee arthroplasty. This improvement can lead to better long time "survival" of implant components. The only price one pays for this improvement is 15-20 minute surgery delay, however it needs further studies to determine other possible disadvantages.

• [Applying the posterior fasciocutaneous thigh flap in bed sores treatment]

  Authors: Marek Bielecki, Jan Skowroński

  Chirurgia narzadów ruchu i ortopedia polska. 72(1):51-4.

  The paper presents the possibilities of applying the posterior thigh flap in the treatment of ischial pressure sores. Between 2000 and 2004 the flap was used in three cases treated in theThe paper presents the possibilities of applying the posterior thigh flap in the treatment of ischial pressure sores. Between 2000 and 2004 the flap was used in three cases treated in the Orthopaedics and Traumatology Department of the Medical Universtity in Bialystok. The indications, contraindications, operative technique and advantages of the posterior thigh flap are described. In all three cases the ischial bed sores healed well without recurrences. The posterior fasciocutaneous pedicled flap is a good method of treatment for not too extensive bed sores in the ischial region.This flap can be applied in recurrences found after primary bed sore treatment with another method. However the fasciocutaneous flap has a limited range of transposition as compared with cutaneous flaps.

• Interbody fusion and transpedicular fixation in the treatment of spondylolisthesis.

  Authors: Jan Skowroński, Jerzy Wojnar, Marek Bielecki

  Ortopedia, traumatologia, rehabilitacja. 9(2):149-55.

  BACKGROUND: This is a retrospective analysis of long-term results of treatment of dysplastic, isthmic and degenerative spondylolisthesis with interbody fusion and transpedicular screw fixation.BACKGROUND: This is a retrospective analysis of long-term results of treatment of dysplastic, isthmic and degenerative spondylolisthesis with interbody fusion and transpedicular screw fixation. MATERIAL AND METHODS: Twenty-one patients underwent interbody fusion with the "Bialstab" transpedicular system. Anterior lumbar interbody fusion (ALIF) was subsequently performed in 2 patients. In the remaining patients, posterior lumbar interbody fusion (PLIF) was performed following interbody fusion in the same session. Mean follow up was 22.4 months. Results were evaluated on the basis of a physical examination, the Oswestry questionnaire and the VAS back pain score. Radiologic assessment was based on targeted lateral radiographs to the stabilized segment. RESULTS: The post-operative wound healed without complications in all patients. Clinical outcomes at follow-up were rated as good (10), quite good (9) and poor (2). The average Oswestry score was 14 (range 0-30). The mean VAS score at follow-up was 2.9 (range 0-8). Anatomical slip reposition was performed in 2 patients, partial reposition in 11 patients, and 8 patients were treated with in situ fusion. Radiological evaluation revealed fusion in 17 patients. CONCLUSIONS: 1. Transpedicular fixation with interbody fusion is an effective technique for the treatment of spondylolisthesis. 2. Partial reposition of spondylolisthesis with neural decompression makes it possible to avoid neurological complications. 3. The "Bialstab" fixation system fulfills the criteria for good transpedicular stabilization.