Zbigniew Krasiński

University of Lodz, Łódź, Łódź Voivodeship, Poland

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Publications (32)37.34 Total impact

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    ABSTRACT: Ovarian cancer (OC) is associated with a high risk of venous thromboembolism (VTE) in both, pre- and postoperative period. The aim of the study was to analyse the efficacy and the safety of an early prophylaxis with dalteparin in patients with OC qualified to surgery.
    International angiology: a journal of the International Union of Angiology 08/2014; 33(4):365-71. · 1.46 Impact Factor
  • Kardiologia polska 01/2013; 71(8):869-74. · 0.54 Impact Factor
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    ABSTRACT: BACKGROUND: To compare the level of difficulty of four techniques of endovenous thermal ablation (EVTA) of the great saphenous vein and the echogenicity of the tip of the working device in vivo. METHODS: Sixty patients qualified to the EVTA of the great saphenous vein were randomly assigned to treatment with an 810-nm axial diode laser [endovenous laser ablation (EVLA) 810] with two different delivery systems: 4-F introducer, 0.018" guidewire, 22-G needle (EVLA810-1) and 4-F introducer, 0.035" guidewire, 19-G needle (EVLA810-2); a 1470-nm radial diode laser (EVLA1470); or radiofrequency ablation (RFA; ClosureFAST). The level of difficulty of four stages of the procedure-cannulation of a vein, advancement of the working part to the saphenofemoral junction (SFJ), visualization of a tip of the working part at SFJ, and difficulty of performing the ablation and delivering the planned linear energy density-was subjectively assessed. An objective comparison of visibility of working parts in ultrasonography was performed with analysis of grayscale median. RESULTS: The cannulation of a distal segment of the obliterated vein was the most difficult in EVLA810-1, P = 0.015. The delivery of a working part to the SFJ was the least problematic in RFA and EVLA1470, P = 0.024. The visualization of the working tip at the SFJ was the most difficult in RFA, P = 0.028. The application of desired amount of energy was the easiest in RFA, P = 0.038. The EVLA1470 presented the best echogenicity. CONCLUSIONS: Although all the examined techniques have advantages and disadvantages, EVTA with the 1470-nm diode laser with radial optic fiber seems to be the easiest.
    Annals of Vascular Surgery 10/2012; · 0.99 Impact Factor
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    ABSTRACT: 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. 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. 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. 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.
    Foot & Ankle International 10/2012; 33(10):832-7. · 1.47 Impact Factor
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    ABSTRACT: J Clin Hypertens (Greenwich). 2012;14:701-710. ©2012 Wiley Periodicals, Inc. The authors aimed to determine the effect of the time of hypotensive drug administration on the progress of degenerative changes within the optic nerve in patients with hypertension and glaucoma. Two groups were included in the study: group A comprised patients-dippers taking drugs in the mornings, and group B comprised patients-nondippers taking drugs both in the mornings and in the evenings. After 6 months, group B showed significant drops in nocturnal diastolic blood pressure (BP) (month 1=73.27 mm Hg vs month 6=67.50 mm Hg), nocturnal mean BP (89.34 vs 84.65 mm Hg), and minimum diastolic BP (50.74 vs 44.03 mm Hg). Group B also showed significant reductions in nocturnal ocular perfusion pressure (43.0 vs 39.73), retinal nerve fiber layer thickness (131.31 vs 113.12 μm), and flow in the eye vessels. Taking hypotensive drugs in the evening may significantly decrease blood flow in the eye arteries, cause degenerative changes within the optic nerves, and result in greater loss in the field of vision.
    Journal of Clinical Hypertension 10/2012; 14(10):701-10. · 2.36 Impact Factor
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    ABSTRACT: In spite of the fact duplex Doppler ultrasonography is recognized as an scanning technique equivalent to other imaging methods for preoperative diagnostics of the lower extremity arteries, in many centres its use is limited to screening. was to the determine usefulness of arterial duplex mapping for preoperative diagnostics in patients with peripheral artery occlusive disease (PAOD). In 2008-2009, 103 patients with PAOD symptoms (129 limbs) were examined in a prospective, non-randomized study. DUAM was performed in all limbs, DSA in 90, CT-angio in 29, and revascularisation procedures in 116 limbs. Problems with completing DUAM occurred in 10,1% of cases, including 1.5% of examinations of no diagnostic value. Consistency of DUAM and DSA results was found in 94.6% of cases, and consistency of DUAM results and the range of actually performed ranges was found in 97.8% of cases. Consistency of DUAM and CT-angio results was recorded in 68.0% of cases. The comparison between individual examinations and the actually performed procedures showed consistency of 96.5% for DUAM and 72.4% for CT-angio. DUAM usefulness for detecting and defining lesions in lower extremity arteries is similar to that of DSA and CT-angio. This examination may be successfully used in preoperative diagnostics, particularly for intravascular procedures, which makes possible to reduce exposition to radiation and minimalize diagnostics costs.
    Polish Journal of Surgery 06/2012; 84(6):276-84.
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    ABSTRACT: 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.
    Blood pressure 03/2012; 21(4):240-8. · 1.26 Impact Factor
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    ABSTRACT: 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). 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. 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. 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.
    Medical science monitor: international medical journal of experimental and clinical research 12/2011; 17(12):CR719-27. · 1.22 Impact Factor
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    ABSTRACT: The aim of the study was to compare clinical and duplex Doppler results of treatment of varicose veins with four methods of endovenous thermal ablation (EVTA).Material and methods. The results of treatment of varicose veins with 980 nm laser (EVLA980) in 67 extremities, with a radiofrequency ablation (RFA) in 43 extremities, with 810 nm laser (EVLA810) in 46 extremities and with 1470 nm laser (EVLA1470) in 15 extremities were prospectively analyzed. The data on patients' demographics, weight, stage of the venous disease, type of anesthesia, duration of the procedure, linear energy density (LED) applied, intra- and postoperative complications were collected. Thromboprophylaxis was not routinely administered. The patients were followed clinically and with duplex Doppler for 12 (1-24) months.Results. Technical success was achieved in 99% of limbs. The procedure was carried out under local anesthesia in 140 (91%) of patients. In 17 patients bilateral procedure was performed. There were one gastroenemius muscle vein thrombosis and one protruding thrombus from sapheno-femoral junction in EVLA810. No other serious complications were observed. A median LED was higher in EVLA810 than in EVLA980 and EVLA1470, 86.8 (82-94), 59.2 (45.4-74.4) and 58.8 (53-67.7) J/cm, respectively (p<0.001), though only in EVLA980 was below the intended range. Recanalization rates were 7% after EVLA980, 2% after EVLA810 and 0% after RFA and EVLA1470, p=0.14. The vein shrinking was fastest after EVLA1470. Neither neovascularization nor formation of arteriovenous fistulas was observed. Permanent saphenous nerve paresthesia occurred in two patients after RFA.Conclusions. All methods of ambulatory EVTA are safe and effective once the adequate linear energy density is applied.
    Polish Journal of Surgery 11/2011; 83(11):597-605.
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    ABSTRACT: 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. 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. 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). 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.
    Medical science monitor: international medical journal of experimental and clinical research 11/2011; 17(11):MT97-103. · 1.22 Impact Factor
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    ABSTRACT: The number of body injuries keeps growing and that is mostly due to increasing number of car accidents. How to prevent thrombosis in such cases is still under discussion with the biggest issue being the proper timing. Most of the input to such discussion usually comes from extrapolating data from other studies, which is hardly of help for treatment of such group of patients. The authors focus on collection and analysis of most recent data and recommendations that are available in literature. They show that low-molecular-weight heparins are by far the most common, if not sole pharmacologic means of thromboembolism prevention in patients with numerous body injuries.
    Ortopedia, traumatologia, rehabilitacja. 06/2011; 13(3):229-40.
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    ABSTRACT: A pseudoaneurysm of the superior mesenteric artery (SMA) is a rare and life-threatening condition of various etiology. Even unruptured it can cause severe health problems or death. We report a 71-year-old male with a SMA pseudoaneurysm who was successfully treated with a transarterial thrombin injection secured with an embolic protection device used in carotid angioplasty. To our knowledge, this is the first case of a SMA pseudoaneurysm treated by this method.
    CardioVascular and Interventional Radiology 02/2011; 34(1):198-201. · 2.09 Impact Factor
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    ABSTRACT: Possible development of recurrent varicose veins (RVV) is one of the main reasons for abandonment of patients to undergo varicose veins surgical treatment. Regardless of the increase in the number of the treatment the primary method of improving the surgical technique is to identify the causes of earlier failures. The aim of this study was to determine the mechanisms responsible for the development of recurrent varicose veins after surgical treatment of primary varicose veins. We studied 507 patients (680 limbs) with primary varicose veins of the lower limbs operated in the years 1996-2007 using the classical technique. The results of pre-and postoperative signs, duplex studies and operational protocols were analyzed. Follow-up was 36-156 months (mean 89.7 +/- 31.2 months). RVV development was observed in 36.9% of operated limbs. Irregularities of surgical techniques and neovascularization were responsible for the development of changes to 87.6% and disease progression in the development of changes in 27.4% of limbs with RVV. At 15.5% of limbs with RVV occurred more than one cause of relapse. In logistic regression combined effects of several factors shown to exist only significant relationship between development and the presence of RVV stumps in sapheno-femoral junction (SFJ) and the presence of inefficient SFJ tributaries of the stumps. The risk of development of new varicose veins was independent on the correctness of the implementation of the first treatment. The most common cause of development of RW were imperfections of surgical treatment, principally in the form of leaving the stumps with insufficient SFJ tributaries, or the development of neovascularization. It appears that improving the quality of treatment may favorably affect the development of a decreased incidence of recurrent varicose veins.
    Przegla̧d lekarski 01/2011; 68(3):161-6.
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    ABSTRACT: Abdominal aortic aneurysm (AAA) often coexists with re- nal artery stenosis (RAS). Such patients need an individu- alized approach in choice of treatment. Endovascular re- pair of infrarenal AAA has become in recent years a gener- ally accepted alternative to open surgery. In treatment of RAS, percutaneous techniques have largely replaced surgi- cal revascularization. In the article a case of patient witha high level of perioperative risk and refractory hypertension is presented, who was successfully treated with simultane- ous endovascular repair of AAA and RAS.
    Nadcisnienie Tetnicze 01/2011; 15(3):184-187.
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    ABSTRACT: 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. 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). 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. 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.
    Blood pressure 12/2010; 20(3):171-81. · 1.26 Impact Factor
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    ABSTRACT: 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. 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. 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. 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.
    Phlebology 12/2010; 26(2):56-61. · 2.07 Impact Factor
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    ABSTRACT: To evaluate the relationship between the biomechanical properties and the structure of elastic components in different veins used for vascular reconstruction. In vitro experimental study. Groups of 30 samples of incompetent saphenous veins (rSV), competent saphenous veins (cSV) and femoral veins (FVs) were compared following immunohistochemical staining for the presence of collagen types I, III and IV and elastin. The percentage area of transverse section of veins occupied by each type of collagen and elastin was measured using a computer-image-analysis system connected to a microscope. For all three groups of veins, the storage modulus, E', and the loss modulus, E'', were measured with a mechanical analyser, DMA-242, and changes in the function of temperature and frequency, and duration of exposure to the applied force were determined. The rSV showed the highest percentage share of collagen I and the lowest percentage share of collagen IV. These samples also showed the greatest expression of elastin and the highest elastin to collagen ratio. The rSV were also found to have the highest E' and E'', and during the long-term exposure achieved maximum stiffness in the least time as compared to cSV and FV. The histological structure directly influences the biomechanical properties of venous wall with rSV showing least compliance and cSV the greatest compliance.
    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 08/2010; 40(2):224-9. · 2.92 Impact Factor
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    ABSTRACT: 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. 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). 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. 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.
    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 08/2010; 40(2):202-8. · 2.92 Impact Factor
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    ABSTRACT: The literature concerning the threshold for intervention in asymptomatic popliteal aneurysm is inconsistent. The purpose of this study was to identify factors related to the clinical course of popliteal aneurysms. We analyzed the influence of patients' age and sex, diameter of the aneurysm, atherosclerotic risk factors, use of antiplatelet medications and statins, lipid profile, and the presence of other aneurysms on the symptoms and status of the popliteal aneurysm (patent or thrombosed). Of 86 cases of popliteal aneurysms in 61 patients, 18 were asymptomatic, 22 were associated with intermittent claudication, 26 with acute limb ischemia, 10 with critical limb ischemia, and 10 with nonischemic symptoms. There was a trend of borderline statistical significance for smaller diameter in asymptomatic popliteal aneurysms. It was not possible to discriminate between cases with and without limb-threatening symptoms, or patent versus thrombosed popliteal aneurysm based on the diameter of the aneurysm. The 58 cases with hypercholesterolemia less frequently presented with limb-threatening symptoms (32.8%) compared with the 28 patients without hypercholesterolemia (60.7%, P=.02), and more often had patent aneurysms (55.2% versus 28.6%, P=.04). Patients with patent popliteal aneurysms were younger (P=.047) and were more frequently on statins (30% versus 12.5%, P=.063). Expectations regarding clinical course and indications for intervention in popliteal aneurysm should not be based on its diameter. Statins may have a beneficial influence on the clinical course of popliteal aneurysms, but further investigations are required.
    Medical science monitor: international medical journal of experimental and clinical research 05/2009; 15(5):CR231-5. · 1.22 Impact Factor
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    ABSTRACT: The purpose of the study was to analyze changes in in-hospital mortality of patients with ruptured abdominal aortic aneurysm (RAAA) during an 18-year period. A retrospective analysis of 246 patients with RAAA in the years 1987-2005 was performed. The patients were divided into groups that consisted of 111 patients treated in the years 1987-2000 (group I) and 135 patients treated in the years 2001-2005 (group II). The in-hospital mortality rates of all patients and of operated patients in both groups were analyzed. Preoperative variables such as age, gender, size of the aneurysm, duration of symptoms, distance to the vascular surgery department, full blood count, serum creatinine and urea concentrations, and systolic and diastolic blood pressures, as well as the number of all AAAs and RAAAs treated per year, were compared between the groups. The Mann-Whitney U-test and Fisher exact test were used to analyze differences in continuous and categorical variables, respectively. The in-hospital mortality of all patients was significantly lower in group II (p = 0.006) The difference in in-hospital mortality of operated patients was of borderline statistical significance (p = 0.07). The proportion of nonoperated patients decreased from 21% to 6% (p = 0.0008). The patients from group II had significantly higher preoperative levels of hemoglobin, hematocrit, erythrocytes, and platelets, as well as higher systolic and diastolic blood pressure and smaller diameter of aneurysm. The number of both all aneurysms and RAAAs per year was significantly higher in group II. The improved preoperative status of the patients and more aggressive surgical approach are associated with reduction in in-hospital mortality of patients with RAAA. The increased experience of the center may also improve outcome of RAAA.
    Annals of Vascular Surgery 02/2008; 22(1):25-9. · 0.99 Impact Factor