Marek Durlik

Mossakowski Medical Research Centre Polish Academy of Sciences, Ochotnica, Lesser Poland Voivodeship, Poland

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Publications (54)73.18 Total impact

  • Transplantation 09/2014; 98(5):e42-3. · 3.78 Impact Factor
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    ABSTRACT: Abstract Background: The manual lymphatic drainage in lymphedema has proved to be successful; however, this method cannot be applied to millions of patients around the world. The only solution is to offer inexpensive, easily accessible mechanical devices for pneumatic compression (IPC). These devices should be designed on parameters of edema fluid hydromechanics. Recent data point to high pressures and long time of compression. Aim: To validate the effects of 3 years daily high pressure, long inflation time IPC therapy in terms of decrease of limb circumference/volume, tissue elasticity, histological changes, and incidental complications. Methods: A group of 18 patients with unilateral leg lymphedema stage II to IV was treated for a period of 3 years using an 8-chamber sleeve, sequential inflation of chambers to 100-120 mmHg for 50 sec (total 400 sec). Limb circumference and tissue tonicity were measured at monthly intervals. Correlation between decrease in calf and thigh circumference and increase in elasticity was done. Results: The treatment revealed durable permanent decrease of limb circumference and increased elasticity of tissues. The improvement was most expressed in the calf above the ankle and mid-calf. No complications as thigh ring or chronic genital edema were observed. There was no direct correlation between the decrease in limb circumference and increase in elasticity, most likely due to different mass of fibrous tissue. Conclusions: IPC takes over the permanently missing function of the obliterated lymphatics by squeezing edema tissue fluid to the regions with normal lymphatic drainage. The limb circumference is decreased or at least does not further increase, elasticity of tissue is increased and maintained. No complications in limb tissues were observed. The long-term, high pressure IPC, long inflation timed therapy can be safely be recommended to patients with lower limb lymphedema.
    Lymphatic Research and Biology 06/2014; 12(2):103-9. · 2.33 Impact Factor
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    ABSTRACT: Pancreatic cancer is a neoplasm characterised by poor prognosis. The only effective, possible treatment is radical surgery, but most patients do not qualify for surgery because of delayed diagnosis.
    01/2014; 9(2):105-8.
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    ABSTRACT: Biological medical products are drugs whose active components are produced only by living, genetically modified organisms or live cell cultures. Patents and exclusivity for most biopharmaceuticals has either expired or will expire soon, which enables biotechnological companies to introduce similar biological products. The problem of replacing a biological medicine with a biosimilar in the course of therapy remains open. In this statement, the Working Group of the Polish National Consultant in Gastroenterology, in the absence of data regarding bioequivalence in patients with inflammatory bowel disease, does not recommend switching from original biological medicine to its biosimilar analogue in the course of treatment in inflammatory disease patients; however, this may change after receiving the results of controlled studies regarding bioequivalence in this group.
    Przegląd Gastroenterologiczny 01/2014; Prz Gastroenterol(Vol. 9, No 1):1-3. · 0.08 Impact Factor
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    ABSTRACT: Abstract Background: The mobile intercellular fluid flowing to and in the lymphatics contains filtered plasma products and substances synthesized and excreted by tissue cells. Among them are signaling proteins such as cytokines, chemokines, enzymes, and growth factors. They act locally in autocrine and paracrine systems regulating cell metabolism, proliferation, and formation of the ground matrix. They play an immunoregulatory role in infections, wound healing, and tumor cell growth. Methods and Results: In this study we measured the concentration of selected cytokines, chemokines, tissue enzymes, and growth factors in tissue fluid/lymph drained from normal human leg soft tissues. Legs exposed to infections and trauma often result in development of lymphedema. Lymph was drained from superficial calf lymphatics using microsurgical techniques. Our studies showed generally higher concentrations of cytokines, chemokines, enzymes, and growth factors in lymph than in serum. The total protein L/S ratio was 0.22, whereas that of various lymph signaling proteins ranged between 1 and 10. Conclusions: This indicates that in addition to proteins filtered from blood, local cells contribute to lymph concentration by own production, depending on the actual cell requirement. Moreover, there were major individual differences of lymph levels with simultaneous stable serum levels. This suggests existence of a local autonomous regulatory humoral mechanism in tissues, not reflected in serum.
    Lymphatic Research and Biology 12/2013; 11(4):203-10. · 2.33 Impact Factor
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    ABSTRACT: Abstract Pneumatic compression of tissues with lymph stasis is, aside from the manual massage, a commonly used therapeutic modality in limb lymphedema. A number of pneumatic devices have been constructed. There is lack of reports of comparative studies determining inflation pressure levels, inflation/deflation cycle times, and total pumping times. Aim: We tried to answer the question how high compression pressure and how long compression timing should be applied to the limb soft tissues to reach tissue fluid (TF) head pressure above 30 mmHg, necessary to initiate proximal flow. Methods: TF pressures were measured subcutaneously during intermittent pneumatic compression in the lymphedematous limbs stage II to IV. Pressures of 50, 80, and 120 mmHg and timing 5, 20, and 50 sec were applied. Results: a) the TF head pressures were lower than those in inflated chambers, b) inflation time of 5 and 20 sec was not long enough to generate TF head pressures above 30 mmHg, even if the compression pressures were as high as 120 mmHg, c) the 50 sec timing allowed to reach head pressures above 30 mmHg; however, they remained always lower than in the compression chamber, d) TF head pressures differed at various levels of the limb depending on the soft tissue mass, e) deflation of the inflated whole sleeve for 5 and 20 sec was followed by high end pressures, whereas that of 50 sec brought about pressure drop to 0, facilitating refilling with TF of the distal parts of the massaged limb. Conclusions: Our observations point to the necessity of applying high pressures and compression times over 50 sec, to generate effective TF pressures and provide enough time for creating TF flow. Short inflation times generate TF pressures as in one-chamber devices that preclude its effectiveness compared to the multi-chamber devices.
    Lymphatic Research and Biology 12/2013; 11(4):227-32. · 2.33 Impact Factor
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    ABSTRACT: Confocal laser endomicroscopy (CLE) is a new technique, which allows subsurface histological diagnosis at a cellular and subcellular level in vivo and could provide histological diagnosis during endoscopic examination. Up to now histological examination of the tissue sample is the only definitive way of diagnosis and monitoring organ rejection after transplantation. In case of pancreas transplantation percutaneous pancreas biopsy under imaging control is still the method of choice for obtaining tissue samples. However in 73-89% of biopsy attempts, it was shown that the duodenal histology predicts the initial diagnosis of rejection of the pancreas, usefulness of transplanted duodenum biopsies for graft rejection monitoring was also described. The histology technique is time consuming, and the therapeutic decision could not be made quickly, in spite of clinical necessity. In this paper we described feasibility of visualization and biopsy of donor duodenum and detection of microscopic changes in 2 cases of transplanted duodenum, expressed as destruction of the villi and dispersed goblet cells in comparison to a microscopic view of their own healthy duodenum No or only small, endoscopically non-significant macroscopic changes in transplanted duodenum in those patients were observed. In both cases, the histological examination confirmed acute organ rejection. We demonstrated for the first time that CLE is promising and effective method to detect acute phase of organ rejection and also for follow up in those patients.
    Videosurgery and Other Miniinvasive Techniques / Wideochirurgia i Inne Techniki Malo Inwazyjne 12/2013; 8(4):366-8. · 0.76 Impact Factor
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    ABSTRACT: Abstract The improvement of laparoscopic techniques that we witnessed over the last decade, also applied to pancreatic surgery. Both worldwide and in Poland, increasingly more patients with lesions located within the body and tail of the pancreas are treated using laparoscopic distal pancreatectomy. The aim of the study was to compare the outcomes of laparoscopic and open distal pancreatectomy. Material and method. Between January 2009 and March 2013, 107 patients underwent distal pancreatectomy at a single institution: 39 using laparoscopic technique and 68 using open technique. This was a retrospective study. Results. There were no significance differences with regard to duration of the surgical procedure, duration of hospitalization and complication rate between both groups. Statistically significant difference was found for the incidence of spleen preservation in patients undergoing laparoscopy, due to better visualization of the structures. In the group of patients with pancreatic cancer there was no significance difference in the incidence of malignancy found in the surgical margin. Our results are similar to that presented in the literature. Conclusions. Laparoscopic distal pancreatectomy is a safe method, with a higher rate of spleen preservation among the patients with the lesion located in the body and tail of the pancreas.
    Polish Journal of Surgery 10/2013; 85(10):589-97.
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    ABSTRACT: This paper discusses 38 statements on the diagnosis and treatment of ulcerative colitis in adults. Treatment statements report recommendations on medical treatment and surgery. The members of the Working Group of the Polish National Consultant in Gastroenterology and the Polish Society of Gastroenterology voted on the statements using a 5-grade score, where A meant total approval, B approval with any exception, C approval with serious exception, D disapproval with any exception and E total disapproval. Results of the voting are presented with a brief comment on each statement.
    Przeglad Gastroenterologiczny. 07/2013; 8(1):1-20.
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    ABSTRACT: Abstract There are controversial views as to whether intratumoral or peritumoral lymphatics play a dominant role in the metastatic process. Most clinical observations originate from studies of colon cancer. Colon contains mucosa and submucosa rich in lymphatics and with high lymph formation rate. This seems to be a prerequisite for easy metastasis of cancer cells to regional lymph nodes. However, there are other tissues as pancreas with a rudimentary lymphatic network where cancer metastasis formation is as intensive as in colon cancer. This contradicts the common notion that intratumor lymphatics play major role in metastases. We visualized interstitial space and lymphatics in the central and peripheral regions of colon and pancreas tumors using the color stereoscopic lymphography and simultaneously immunohistochemical performed stainings specific for lymphatic and blood endothelial cells. The density of open and compressed lymphatic and blood vessels was measured in the tumor core and edge. There were very few lymphatics in the colon and pancreas tumor core but numerous minor fluid "lakes" with no visible connection to the peritumoral lymphatics. Lining of "lakes" did not express molecular markers specific for lymphatic endothelial cells. Dense connective tissue surrounding tumor foci did not contain lymphatics. Peritumoral lymphatics were irregularly distributed in both types of tumor and only sporadically contained cells that might be tumor cells. Similar lymphoscintigraphic and histological pictures were seen in colon and pancreas cancer despite of different structure of both tissues. This suggests a uniform reaction of tissues to the growing cancer irrespective of the affected organ.
    Lymphatic Research and Biology 09/2012; 10(3):112-7. · 2.33 Impact Factor
  • Marek Durlik, Katarzyna Gardian
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    ABSTRACT: Pancreatic adenocarcinoma is the fourth most common cancer occurring in both women and men. In Poland, within the past ten years the number of deaths from pancreatic cancer increased by 29%.The aim of the study was to determine the correlation between the activity of metalloproteinase (MMP) 2 and 9 and progression and aggressiveness of pancreatic cancer.Material and methods. Tissue samples were collected from 36 patients with diagnosed pancreatic adenocarcinoma who underwent Whipple resection. Tumor tissues were analyzed by gel zymography, zymography in situ and immunohistochemistry.Results. The activity of MMPs was found mainly in cancer cells. Active form of MMP2 (62 kDa) was present in 88% of cases and MMP9 (83 kDa) in 38% of cases. By contrast, immunohistochemical staining revealed the presence of metalloproteinase 9 in all studied tissues. MMP activity was assessed against histological grade of the tumor. In the case of group G1 there was no activity of matrix metalloproteinase 9. By comparing the activity we concluded that the activity of MMPs in tumors with the highest degree of differentiation is significantly lower than in G2 and G3. Metalloproteinase 9 expression analysis revealed no significant differences between the groups of various degrees of histological maturity. The level of expression did not differ between the groups N0 and N1.Conclusion. Lack of metalloproteinase 9 activity in group G1 may indicate that MMP9 is activated only in higher tumor grades. We have shown that an active form of MMP2 is found in all histological grades, which supports its involvement in the development of pancreatic cancer. Metalloproteinases are attractive target of anticancer therapy but not only the level of expression of metalloproteinases should be taken into account but also their level of activity and factors associated with their activation.
    Polish Journal of Surgery 08/2012; 84(8):377-82.
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    ABSTRACT: The aim of the study was to evaluate complication during and after surgical procedure without connection with transplantation among patients after kidney, kidney and pancreas transplantation with stable function of graft. 54 patients underwent 62 surgical procedures without connection with transplantation procedure. Main characteristic: standard immunosuppressive treatment, main age 51.1±13.95 years, men 77.4%, hospitalization time 5.27±3.31 day, group 1 - 55 procedures among patients after kidney transplantation, group 2 - 7 procedure among patients after kidney and pancreas transplantation. Procedures from general surgery comprised 60% [cholecystectomy 19 (51%), left hemicolectomy 1 (3%), esophagus removal 1 (3%), hernia repair 8 (22%), nefrectomy 3 (8%), pancreas transplantation in patients with functional renal graft 1 (3%), laparotomy 4 (11%), vascular surgery 27% (correction of arteriovenosus fistula 13 (76%), by-pass surgery 1 (6%), embolectomy 1 (6%), implantation of aortal - iliac stentgraft 1 (6%), surgery of iliac artery 1 (6%)]. There has been no difference between parameters measured before and after procedure: creatinine (p=0.93), GFR (p=0.07), urea (p=0.25), glycaemia (p=0.322), glycated hemoglobin (p=0.3), C-peptide (p=0.3). In both groups were no differences in levels of creatinine (p=0.78) and urea (p=0.23), measured in the next years after surgical procedure. Mortality 0%, lost of graft 0%, in - hospital morbidity 10 (16.2%) (hematoma 1.6%, endocavitary electrode 1.6%, wound healing defect 16.2%). Morbidity in group 1 - 12.7%, group 2 - 48.8%, p=0.04. Surgical procedures performed in a specialist center do not impaire prognosis of patients with stable function of graft, after kidney, kidney and pancreas transplantation.
    Polish Journal of Surgery 04/2012; 84(4):196-201.
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    ABSTRACT: Research over the last twenty years has yielded much insight into pancreatic cancer biology, but it has neither improved diagnostics methods nor the way of treatment. The question remains as to what the critical deciding factor is in making pancreatic cancer such an aggressive disease. Pancreatic tumor tissue came from 36 patients. To assess lymphatic vessels color lymphangiography and immunohistochemistry were used. Activity of matrix metalloproteinases was studied with gel and in situ zymography. Expression of growth factors and infiltrating immune cells were investigated using immunohistochemistry. Our study revealed that the structures that correspond to lymphatic vessels were not observed in tumor center but only at the edge of the tumor. All studied growth factors were present in tumor tissue. We found that the difference in expression between G2 and G3 stage was statistically relevant in cases of c-Met receptor. Inflammatory cells were present around neoplastic glands and also strongly around nerves infiltrated by cancer cells. The number of infiltrating macrophages in tumor tissue was significantly higher in group with metastases to lymph nodes. We showed two factors that influence pancreatic cancer progression and invasion: c-Met receptors and macrophages infiltrating tumor tissue. Based on our analysis, this indicates that epithelial-mesenchymal transition might be crucial in the progression of pancreatic cancer.
    Journal of Cancer. 01/2012; 3:285-91.
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    ABSTRACT: Introduction. In spite of intensive research during many years, pancreatic adenocarcinoma remains one of the deadliest cancers. The surgical intervention remains main possibility of treatment because chemotherapy and radiotherapy has a minimal impact on long-term survival. We are still looking for the weak points of this devastating disease. Materials and Methods. Pancreatic tumor tissue samples were collected from 36 patients. Immunohistochemistry staining was used to evaluate expression of growth factors and immune infiltrates. Activity of MMP2 and MMP9 was assessed by gelatin zymography on 7.5% SDS-PAGE gel with 0.1% gelatin. Results. All growth factors were strongly expressed in pancreatic tumor tissue. We found that level of expression of c-Met receptor was higher for G3 tumors than for G2 tumors. Also we found that active MMP2 was present at all stages of tumor while active MMP9 just at more advanced tumors. Abundant immune cells infiltration was distinctive for tumor tissue, especially macrophages were infiltrating tumor tissue. We found that amount of macrophages was associated with lymph nodes metastases. Conclusion. In our research we demonstrated that among many factors influencing tumor microenvironment c-Met receptor, infiltrating macrophages and MMP2 have significant influence on development and invasion of pancreatic cancer.
    Gastroenterology Research and Practice 01/2012; 2012:585674. · 1.62 Impact Factor
  • Pancreatology 01/2012; 12(6):516. · 2.04 Impact Factor
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    ABSTRACT: The main cause of a negative response to grafting is immune rejection connected with a reaction to the donor's antigens. The process of rejecting transplanted organs is a whole-body process. The reaction of the organism begins when the donor's antigens reach the recipient's lymphatic organs via blood or lymph. The donor's genetic material (DNA) is detected in the recipient's blood and lymphoid tissues even a few months after transplant rejection. Microchimerism occurs when in an individual patient the cells and genetic material from both the donor and recipient are present and the cell count of one of these is overrepresented. Such situations can occur after blood transfusions, grafts or pregnancies. It is suggested that this phenomenon could have an influence on tolerance, prolonged graft survival or the rejection process. The results of many experiments are thus far equivocal; therefore further research is needed elucidate the process and mechanisms of graft rejection and its molecular aspects.
    Annals of transplantation: quarterly of the Polish Transplantation Society 12/2011; 16(4):134-7. · 0.82 Impact Factor
  • Transplantation 01/2010; 90. · 3.78 Impact Factor
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    ABSTRACT: Hyperhomocysteinemia occurs in approximately 60-70% of renal transplant recipients and is associated with increased risk of cardiovascular events, mortality and kidney allograft loss. In normal subjects N-acetylcysteine (NAC) given either orally or intravenously markedly reduces plasma total homocysteine (tHcy) level. In cardiac transplant recipients it was reported, that oral treatment with NAC does not affect Hcy levels. We have therefore, investigated the effect of intravenous NAC on plasma tHcy levels in renal transplant recipients. Eleven renal transplant recipients who had normal plasma levels of vitamin B12 and folic acid, were treated with intravenous NAC or placebo in a crossover manner. Intravenous administration of NAC significantly reduced plasma tHcy (p=0.0008). Decrease in tHcy was related to its initial concentration. Intravenous NAC profoundly reduces tHcy level in renal transplant recipients. Further research is needed to establish the effect of orally administered NAC on plasma homocysteine concentration in this clinical condition.
    Annals of transplantation: quarterly of the Polish Transplantation Society 01/2009; 14(4):5-9. · 0.82 Impact Factor
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    ABSTRACT: Simultaneous pancreas-kidney transplantation (SPK) is associated with high risk of infectious complications. The aim of the study was to evaluate the incidence of bacterial infections within 3 months after SPK transplantation. 17 patients with type 1 diabetes at the age of 32-54 years (mean age 42.5 +/- 7.1) were retrospectively analyzed within 3 months after SPK. No septic complications were observed in 2 patients (12%). In the remaining 15 patients (88%), at least 1 (from 1 to 5, a total of 30) infection episode was observed during follow-up. The infections were located: only at the surgical site (1 patient--6.7%), only in the urinary tract (6 patients--40%), both at the surgical site and in the urinary tract (7 patients--46.7%), at the surgical site and in blood (1 patient--6.7%). 2 groups of microbes were predominant, namely enterococci represented by 1 species, E. faecium (13 isolates) and the so-called intestinal bacilli, Enterobacteriaceae (19 isolates). No methicillin resistant Staphylococcus aureus strains were isolated. Candida species fungi were isolated only 3 times. In our study only 2 types of infections were observed (urinary tract and surgical site infections) and each of them comprised nearly half of all the septic episodes recorded. Gram-negative bacilli were collected more often than Gram-positive cocci, both from the surgical site and urinary tract infections. All infections ended with full recovery.
    Polskie archiwum medycyny wewnȩtrznej 01/2009; 118(12):700-4. · 2.05 Impact Factor
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    ABSTRACT: Abstract We have noticed that bone marrow transplanted in a vascularized limb graft, providing a continuous supply of donor bone marrow cells (BMC), may prolong the survival time of a skin graft from the same donor. The question arises whether the microchimerism raised plays a role in the prolonged survival of skin allografts. The aim of the study was to follow the development of microchimerism after allogeneic vascularized bone marrow transplantation (VBMTx) concomitantly with the rejection process of transplanted skin. Brown Norway (BN) rats served as donors and Lewis rats as recipients of VBMTx and free skin flap allografts. A hind limb was transplanted, followed by a full-thickness skin graft on the dorsum. Cellular microchimerism was investigated in recipients of VBMTx and skin grafts in blood, spleen, mesenteric lymph node, and bone marrow with the monoclonal antibody OX27 directed against MHC class I polymorphic RT1 on BN cells and quantitatively analyzed in a FACStar. In the VBMTx group, the free skin flap survived 70 days after weaning off cyclosporine A (CsA). An intravenous infusion of BMC in suspension equivalent to that grafted in the hind limb did not prolong skin graft survival after cessation of CsA therapy. Donor-derived cells could be detected in VBMTx recipients as long 70 days after weaning off CsA but not in recipients of i. v. suspension BMC grafting.
    Transplant International 06/2008; 11(S1):S299 - S302. · 3.16 Impact Factor

Publication Stats

127 Citations
73.18 Total Impact Points

Institutions

  • 2012–2014
    • Mossakowski Medical Research Centre Polish Academy of Sciences
      Ochotnica, Lesser Poland Voivodeship, Poland
  • 2004–2012
    • Central Clinical Hospital of the Ministry of Interior in Warsaw
      Warszawa, Masovian Voivodeship, Poland
  • 1990–2012
    • Polish Academy of Sciences
      • Zespół Kliniczno - Badawczy Chirurgii Transplantacyjnej
      Warsaw, Masovian Voivodeship, Poland