Zbigniew Krasiński

Poznan University of Medical Sciences, Posen, Greater Poland Voivodeship, Poland

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Publications (47)52.66 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Although leukocyte elastase is suspected to be involved in the damage of vein wall during chronic venous disease, the equilibrium between this protease and its inhibitor, alpha1-antitrypsin, has not yet been evaluated. The aim of the present study was to determine the relationship between leukocyte elastase and alpha1-antitrypsin, in the blood of patients with chronic venous disease. The concentration and the activity of leukocyte elastase along with the activity of alpha1-antitrypsin were evaluated in the blood of 55 chronic venous disease patients. The results were compared with those obtained in 33 healthy age and sex-matched volunteers. A significant decrease in the leukocyte elastase activity that correlated with an increased alpha1-antitrypsin activity was observed in the serum of patients with mild clinical symptoms of chronic venous disease. The results of the study did not confirm a hypothesis about an important role of proteolytic activity of leukocyte elastase in the vein wall injury mechanism. They show that the leukocyte elastase-alpha1-antitrypsin balance is rather shifted toward antiprotease activity, especially in an early stage of chronic venous disease. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
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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. · 1.01 Impact Factor
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    ABSTRACT: Background Aortic cross-clamping during abdominal aortic aneurysm (AAA) open repair leads to development of ischemia-reperfusion injury. Electron paramagnetic resonance spectroscopy (EPR) spin-trapping is a valuable method of direct measurement of free radicals. The objective of the study was to evaluate the results of EPR as a direct method of free radical measurement and degree of inflammatory response in open operative treatment of patients with AAA and aorto-iliac occlusive disease (AIOD). Material and Methods The study was performed on a group of 32 patients with AAA and 25 patients with AIOD scheduled for open repair. Peripheral venous blood for EPR spectroscopy and for SOD, GPx, ox-LDL, Il-6, TNF-alfa, CRP, and HO-1 were harvested. Selected parameters were established accordingly to specified EPR and immunohistochemical methods and analyzed between groups by Mann-Whitney U test and Wilcoxon matched-pairs signed-ranks test with Bonferroni correction. Results Free radicals level was correlated with the time of the aortic cross-clamping after the reperfusion of he first and second leg in AAA (r=0.7; r=0.47). ox-LDL in AAA decreased 5 min after reperfusion of the first leg (32.99 U/L, range: 14.09-77.12) and 5 min after reperfusion of the second leg (26.75 U/L, range: 11.56-82.12) and 24 h after the operation (25.85 U/L, range: 14.29-49.70). HO-1concentration increased to above the level before intervention 24 h after surgery. The activities of GPx and SOD decreased 5 min after the first-leg reperfusion in AAA. Twenty-four hours after surgery, inflammatory markers increased in AAA to CRP was 14.76 ml/l (0.23-38.55), IL-6 was 141.22 pg/ml (84.3-591.03), TNF-alfa was 6.82 pg/ml (1.76-80.01) and AIOD: CRP was 18.44 mg/l (2.56-33.14), IL-6: 184.1 pg/ml (128.46-448.03), TNF-alfa was 7.74 pg/ml (1.74-74.74). Conclusions EPR spin-trapping demonstrates temporarily elevated level of free radicals in early phase of reperfusion, leading to decrease antioxidants in AAA. Elevated free radical levels decreased 24 h after surgery due to various endogenous antioxidants and therapies.
    Medical science monitor: international medical journal of experimental and clinical research 01/2014; 20:2453-60. DOI:10.12659/MSM.890774 · 1.22 Impact Factor
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    ABSTRACT: The aim of the study was to characterize the changes in the microcirculation in patients with varying severity of atherosclerotic ischaemia of the lower limbs (PAOD). Material and methods. The study included 27 healthy subjects, 79 patients with PAOD category 0 and 1 according to the Rutherford classification, and 137 patients with PAOD category 3 and 4. The study evaluated cutaneous blood flow, flowmotion bonds, percutaneous partial pressure of oxygen and flow-mediated vasodilation. Results. Even mild PAOD exhibits a worse systemic vascular function expressed as a reduction in the scope of flow-mediated vasodilation, and locally in TcpO2 decrease. Increase in local changes in advanced forms of PAOD were observed as further reduction in TcpO2 and a drastic reduction or exhaustion of the functional microcirculatory reserve. Among the evaluated risk factors for atherosclerosis only diabetes and smoking significantly modified perfusion, which resulted in a significant decrease in the values of vasodilation and TcpO2. Conclusions. The study revealed the occurrence of adverse changes in microcirculation, also in patients with poorly discernible signs of limb ischaemia. It can be assumed that these may also occur in the patients who underwent a haemodynamically effective revascularization.
    Acta Angiologica 01/2014; 20(4):133-140.
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    ABSTRACT: Objectives: This prospective, non-randomised study was aimed at the assessment of prevalence of thromboembolic events in vascular patients routinely receiving anti-thrombotic prophylaxis following surgical revascularisation of the lower extremities. Material and methods: This study included 105 patients operated on for aortoiliac occlusive disease. Postoperatively all patients received pharmacological antithrom-botic prophylaxis with low-molecular-weight heparin. Sonographic examination of the veins of low extremities was routinely performed three times: one day before the surgery, on the discharge day and 30 days after hospital discharge. Results: Thromboembolic complications were found in 21 patients (19.05%), including 18 patients with deep venous thrombosis and 3 with pulmonary embolism. Thromboembolic events were more prevalent in older patients (68.22 vs. 62.65 years), those with necrotic lesions of the limbs, with lower preoperative concentration of hemoglobin (7.89 vs. 8.61 mmol/l), higher of fibrinogen (455 vs. 357 mg/dl) and of platelet count (334 vs. 250 × 10 9 /l). Other risk factor comprised the number of trans-fused packed red blood cell units (3.39 vs. 1.45 units) and plasma units (1.61 vs. 0.39 units), and the length of stay in the intensive care unit (4.78 vs. 2.24 days). Conclusions: Vascular patients develop thromboembolism very often, despite pharmacological prophylaxis. Thus, routine scanning for deep vein thrombosis before hospital discharge in order to exclude thrombosis should be considered in this group. Also, an extended post-discharge thromboprophylaxis in these patients should be considered.
    Przegl?d Flebologiczny 01/2014; DOI:10.5114/pr.2014.48905
  • Kardiologia polska 01/2013; 71(8):869-74. DOI:10.5603/KP.2013.0204 · 0.52 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; 27(3). DOI:10.1016/j.avsg.2012.04.021 · 1.03 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. DOI:10.1111/j.1751-7176.2012.00694.x · 2.96 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. DOI:10.3113/FAI.2012.0832 · 1.63 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. DOI:10.2478/v10035-012-0047-7
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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. DOI:10.3109/08037051.2012.666423 · 1.61 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. DOI:10.12659/MSM.882132 · 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. DOI:10.2478/v10035-011-0095-4
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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. DOI:10.12659/MSM.882033 · 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.
    06/2011; 13(3):229-40.
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    21st European Meeting on Hypertension and Cardiovascular Prevention. Milan, Italy, June 17-20, 2011., Journal of Hypertension; 06/2011
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    ABSTRACT: vessels of the eyeball and orbit and changes in the optic nerve among patients with AH and POAG. Material and Methods: The study was conducted on a group of 69 patients with glaucoma and treated, controlled hypertension. All the patients in the survey were examined both subjectively and objectively. Additionally, 24-h blood pressure records were taken. During the ophthalmic examination the thickness of the nerve fibers and the degree of visual field defects were assessed. Intraocular pressure was measured many times during the day. The Ultrasound-Doppler was used to estimate peak systolic velocity, end-diastolic velocity and the vascular resistance index in the ophthalmic, central retinal and short posterior ciliary arteries. Because of the value of NBPF the patients were divided in two groups: non-dippers (NBPF to 10%) and dippers (NBPF > 10%). Conclusion : In patients with glaucoma and well-controlled hypertension, a normal nocturnal blood pressure fall of more than 10% is associated with a greater visual field defect and greater degeneration of the optic nerve fibers which may be the result of reduced perfusion in the ophthalmic and central retinal arteries in this group of patients. The excessive lowering of blood pressure at night should be avoided in patients with glaucoma and hypertension. Results Results: : The nocturnal blood pressure fall is associated with significant progress of primary open angle glaucoma in hypertensive patients Introduction:
    21st European Meeting on Hypertension and Cardiovascular Prevention. Milan, Italy, June 17-20, 2011.; 06/2011
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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. DOI:10.1007/s00270-009-9791-4 · 1.97 Impact Factor
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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.
  • Journal of Hypertension 01/2011; 29:e254. DOI:10.1097/00004872-201106001-00709 · 4.22 Impact Factor