Publications (15)8.24 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: The aim of the study is to present our own perioperative bridging therapy with low molecular weight heparin (LMWH) for surgical patients with thrombophilia on long-term acenokumarol therapy [oral anticoagulant (OAC)]. In some European countries, the drug used in secondary antithrombotic prophylaxis is acenokumarol. Forty-two patients with inherited thrombophilia and 21 with antiphospholipid syndrome underwent surgery. All patients were on long-term OAC. This OAC was interrupted 2 days before elective surgery and since that day half of the individual therapeutic dose of LMWH was administered. On day of surgery, the LMWH therapeutic dose was divided into two parts. Starting with day 2 after surgery, the patient was again given half of the individual dose of LMWH every 24 h. On day 4, OAC was additionally included. Both drugs were administered until stabilization of international normalized ratio (INR) values within the therapeutic target for 2 consecutive days. LMWH was then interrupted, whereas OAC continued. No symptoms or episodes of venous thromboembolism were observed. No intraoperative or postoperative hemorrhagic complications were reported. The results suggest that our perioperative bridging therapy is safe and effective for prevention of thromboembolic and hemorrhagic complications.
- [Show abstract] [Hide abstract] ABSTRACT: Splenic abscess is a rare condition often difficult to diagnose and always fatal, if untreated. It is frequently concomitant with immunodeficiency, especially in hematological disorders.The aim of the study was to share our own experience in the treatment of splenic abscess and to present the review of current literature on the subject.Material and methods. In the period January-June 1997, 8 patients were treated for splenic abscess at the Department of General and Hematological Surgery of the Institute of Hematology and Transfusion Medicine in Warsaw; (6 men and 2 women; mean age 51.3 years). Six patients reported immunodeficiency disorders in medical interview (immunoglobulin deficiency, alcoholism, leukopenia, agranulocytosis, lymphoproliferative disorders).Prior to operation, chest X-rays as well as US and CT imaging were performed for all patients; all were qualified for splenectomy.Results. In all cases, imaging studies revealed splenomegaly and characteristics suggestive of splenic abscess, in chest X-ray of 6 patients typical abscess changes were also found. Classic splenectomy was performed in all 6 cases. The total mass of spleen removed was 365 g-1560 g, mean of 962 g. Procedure duration was 72 to 135 min, mean of 88,3 min. Patients were transfused 1 to 4 units of red blood cell concentrate, mean of 2.1 units. In patients with perisplenitis, priooperative blood loss was greater and the procedure was extended. In the postoperative period, such complications as deep vein thrombosis of lower extremities, portal vein thrombosis, aggrevation of chronic renal insufficiency and circulatory insufficiency evoked by paroxysmal atrial fibrillation were observed in 4 patients. No deaths were reported. Six patients were discharged in a satisfactory state; 2 were transferred to the hematological department for further treatment due to persisting septic state.Conclusion. Despite a high incidence rate of periooperative complications, classic splenectomy still remains the procedure of choice for splenic abscess treatment.
- [Show abstract] [Hide abstract] ABSTRACT: Antimicrobial resistance due to the continuous selective pressure from widespread use of antimicrobials in humans, animals and agriculture has been a growing problem for last decades. KPC beta-lactamases hydrolyzed beta-lactams of all classes. Especially, carbapenem antibiotics are hydrolyzed more efficiency than other beta-lactam antibiotics. The KPC enzymes are found most often in Enterobacteriaceae. Recently, these enzymes have been found in isolates of Pseudomonas aeruginosa and Acinetobacter spp. The observations of blaKPC genes isolated from different species in other countries indicate that these genes from common but unknown ancestor may have been mobilized in these areas or that blaKPC-carrying bacteria may have been passively by many vectors. The emergence of carbapenem resistance in Gram-negative bacteria is worrisome because the carbapenem resistance often may be associated with resistance to many beta-lactam and non-beta-lactam antibiotics. Treatment of infections caused by KPC-producing bacteria is extremely difficult because of their multidrug resistance, which results in high mortality rates. Therapeutic options to treat infections caused by multiresistant Gram-negative bacteria producing KPC-carbapenemases could be used polymyxin B or tigecycline.
- [Show abstract] [Hide abstract] ABSTRACT: The immediate effect of acute haemorrhage is a significant reduction in tissue blood flow, frequently resulting in haemorrhagic shock. The main aim of resuscitation after bleeding is the immediate restoration of intravascular volume. Intravenous administration of volume expanders should be commenced immediately, regardless of whether they are colloids or electrolytes. The purpose of the study was to analyze haemodynamic changes during intraoperative acute bleeding and to compare the effects of intravenous infusion with 7.5% saline solution to 6% starch solution on the volume resuscitation process. Sixty adult patients, of both sexes, in whom massive loss of blood followed by rapid cardiovascular collapse occurred during elective surgery, were enrolled in the study. In addition to standard fluid transfusion, all patients received either 4 mL kg(-1) of 7.5% NaCl solution or an equal volume of 6% of hydroxyethyl starch. Heart rate (HR) and mean arterial pressure (MAP) were noted. Cardiac output (CO) and systemic vascular resistance (SVR) were measured using a descending aortic blood flow ultrasound monitor. Massive intraoperative haemorrhage resulted in a rapid decrease in CO and SV with a simultaneous increase in HR and SVR in all patients. Injection of hypertonic salt or 6% HAES over 5 min increased the CO and SV. HR and SVR returned quickly to pre-existing levels and remained so until the end of the procedures. Small volume resuscitation with 7.5% saline or starch can be regarded as an efficient and effective method for restoring intravascular volume.
- [Show abstract] [Hide abstract] ABSTRACT: The aim of this study was to evaluate the presence of aac(6')-Ib gene conferring resistance to aminoglycosides in Proteus mirabilis strains. Five isolates had aac(6')-Ib gene. In one case the gene was no-expressed. Three isolates were resistant to all aminoglycosides and minimum inhibitory concentrations were > or = 256 microg/ml. Additionally, all positive strains were resistant to tetracycline and ciprofloxacin.
- [Show abstract] [Hide abstract] ABSTRACT: Aim of the study consisted in the prospective analysis of the efficacy of endoscopic injection therapy combined with intravenous omeprazole, considering the management of a bleeding peptic ulcer. Material and methods. The study group comprised 134 patients with active bleeding from a duodenal ulcer (75 patients), peptic ulcer (50 patients), and anastomotic ulcer (9 patients). Endoscopic injection therapy was indicated in case of the following active bleeding: pulsating (Forrest I a) in 55 patients, and non-pulsating (I b) in 79 patients. Patients with pulsating bleeding were subjected to injections of epinephrine (1:10000 solution) followed by absolute ethyl alcohol. In case of non-pulsating bleeding, only ethyl alcohol was used. Following the endoscopic procedure patients received intravenous omeprazole (40 mg BID) for a period of five days. Results. Primary hemostasis was observed in case of 129 (96.3%) patients. Considering the remaining five patients, three were subjected to emergency surgery, and two died. Rebleeding was noted in 13 (9.7%) patients. The above-mentioned patients were once again subjected to injection therapy: hemostasis was obtained in 10 patients, three required surgical intervention. Definitive hemostatis following endoscopic injection therapy combined with intravenous omeprazole was obtained in 126/134 (93.8%) patients. Six (4.3%) patients required surgical intervention. Total mortality amounted to 3.7% (5/134 patients). Conclusions. Endoscopic injection therapy using epinephrine, ethyl alcohol or both, supplemented by intravenous omeprazole is an effective method, considering bleeding peptic ulcers. The above-mentioned management warrants a high hemostatic efficacy, as well as low bleeding recurrence rate and emergency operations.
- [Show abstract] [Hide abstract] ABSTRACT: Multiple Symmetrical Lipomatosis (MSL), known also as Madelung's disease or Launois-Bensaude syndrome, is a sporadically occurring metabolic disease of unknown etiology, encountered mainly in middle-aged, chronically alcohol-abusing males. Non-encapsulated fatty masses developing symmetrically in the region of the head, the neck, the shoulders, the arms, the back and the chest contribute to the characteristic pseudoathletic body appearance, often wrongly suggesting simple obesity. Apart from the appearance and aesthetic considerations, it is difficulties in swallowing and breathing as well as head and neck motion that constitute the main complaints deciding on the need for hospitalisation and treatment. Surgical debulking of fat masses or liposuction in the case of small lesions seem to be the only, though not fully effective, method of treatment in Madelung's disease. The recurrence of the disease is, however, frequent, irrespective of the treatment applied. We believe that the diagnostics and treatment related problems encountered in Madelung's disease presented here on the basis of the case we describe will contribute to better knowledge of the principles of management and clinical problems to be met in patients in this sporadically occurring and not yet fully recognised disease.
- [Show abstract] [Hide abstract] ABSTRACT: Aim of the study was to investigate hemodynamic disturbances occurring during acute intraoperative circulating blood loss, and to assess the effect of intravenous infusion of 7.5% NaCl solution, considering hemodynamic, blood cell count and electrolyte disturbances. Material and methods. The study group comprised 30 patients following elective surgery who developed massive hemorrhage with sudden, pronounced decrease in basic hemodynamic parameters. Apart from standard fluid transfusions, all patients received 7.5% NaCl intravenous infusions, at a volume of 4ml/kg/bw. The following parameters were assessed: heart rate (HR), cardiac output (CO), mean arterial pressure (MAP), and total systemic vascular resistance (TSVR); blood cell count (CBC), hemoglobin (Hb), hematocrit (Hct), erythrocyte count (RBC), as well as sodium (Na) and potassium (K) concentrations. Results. Hemodynamic results obtained by means of the HemoSonic 100 device demonstrated that in all patients, massive intraoperative hemorrhage resulted in sudden decrease of CO and MAP, with simultaneous increase of HR and TSVR. The intravenous administration of hypertonic saline solution produced a rapid increase of CO and MAP, and decrease of HR and TSYR values. The effect of saline solution administration was stable, and maintained until the completion of the study. Conclusion. The injection of a hypertonic saline solution in case of patients with acute blood loss is a safe and effective method, increasing the circulating blood volume, which is manifested by increased arterial blood pressure, increased cardiac output and improved organ blood flow.
- [Show abstract] [Hide abstract] ABSTRACT: Aim of the study was to evaluate pathomorphological changes in the lungs of dogs following intravenous administration of a 5% solution of ethanolamine. Material and methods. The study group comprised 15 dogs, which did not differ as far as age and body weight were concerned. Animals were randomly assigned to two groups. The first group (control) comprised 7 animals, which received an intravenous 0.9% solution of sodium chloride at a dose of 1ml/ kg/body weight (superior caval vein). The second group comprised 8 animals, which received a 5% solution of ethanolamine, at a dose of 1 ml/kg/body weight. Pulmonary tissue samples were collected before, 2 and 24 hours following the administration of either ethanolamine or 0.9% NaCl. Results. Pulmonary samples collected from control group animals before and after sodium chloride administration revealed normal lung septa. Samples collected from ethanolamine animals, two and 24 hours after its administration demonstrated the presence of numerous monocytes, erythrocytes and platelets in the vascular lumen. The alveolar lumen presented with damaged surfactant myelin tubules and desquamized type II epithelial cells. Conclusion. Based upon the above-mentioned investigations the administration of ethanolamine leads towards pathomorphological changes in the lungs of dogs, similar to those observed in patients with ARDS.
- [Show abstract] [Hide abstract] ABSTRACT: Aim of the study was to evaluate the effects of prophylactic enoxaparin on changes in gasometry, blood count and lung radiology after sclerotherapy of esophageal varices. Material and methods. The study group comprised 30 patients with liver cirrhosis who had received 20 mg of subcutaneous enoxaparin (Clexane®), two hours before sclerotherapy. Prior to the injection of 5% ethanolamine (EO) and 1, 5, 15, 30, 60 and 120 min. after the EO injection, gasometry was performed (pAO 2, pVO 2, pACO 2, pVCO 2, pHA, pHV, SatAO 2, SatVO 2). Additionally, blood parameters (Ht, Hb, RBC, WBC, Pl) were determined before the procedure, 90 min. and 24 h after EO injection. Chest X-rays were performed before and 48 h after the EO injection. The control group comprised 30 patients with liver cirrhosis who had undergone sclerotherapy without previous injection of low-molecular weight heparin. Results. The EO injection in patients without enoxaparin prophylaxis resulted in a long-term, statistically significant decrease in pO 2 (up to 90 min.) and increase in pCO 2, both in arterial and venous blood. Increased pH and decreased saturation were also noted. Patients that received enoxaparin prophylaxis demonstrated mild gasometric changes. However, significantly increased pACO 2 and pH values were observed 15 min. after sclerotherapy. In patients who had not received enoxaparin prophylaxis, the platelet count had decreased by 32.5% without any significant change in other peripheral blood values. Hematocrit and hemoglobin concentrations were also decreased by 3%. However, the platelet count was lower by 13.5%. Radiological changes were similar in both groups (4 control group patients, and 3 study group patients). Conclusions. 1. Administered at a prophylactic dose before esophageal varices sclerotherapy, enoxaparin (Clexane®) prevents the development of severe undesirable changes in gasometric parameters. 2. Enoxaparin (Clexane®) prophylaxis administered before sclerotherapy results in a statistically significant decrease in peripheral blood values following the procedure.
- [Show abstract] [Hide abstract] ABSTRACT: Aim of the study was to prospectively evaluate repeated sclerotherapy procedures in the eradication of esophageal varices and prevention of recurrent bleeding in patients following hemorrhage. Material and methods. Repeated sclerotherapy with the use of 5% ethanolamine oleate as the obliterating agent injected into varices was performed in 191 patients with liver cirrhosis (41 - Child-Pugh's group A, 68 - group B and 82 - group C) and a history of esophageal varices bleeding. The adopted procedural regime consisted in the performance of procedures, according to a strictly defined scheme depending on risk factors of early recurrent bleeding. Results. Total eradication of esophageal varices was noted in 172 patients (90.5%), an average of 12 weeks since the beginning of treatment. The mean number of procedures required to eliminate varices was 5.8. During a one-year follow-up period recurrent bleeding from esophageal varices was reported in 15.2% of patients, with most recurrences developing before eradication treatment completion. Severe complications developed in 11.5% of patients, and mortality associated with complications in 0.5% of patients. Seventeen patients (8.9%) died, prior to eradication completion. One-year survival amounted to 84.8%, while two-year survival - 75.4%. Conclusions. Repeated sclerotherapy is a valuable method of secondary prophylaxis of esophageal varices bleding. It enables variceal eradication and significantly reduces the recurrent bleeding rate. Due to the key role of endoscopic team experience for treatment results, it should be performed in specialized centers having at their disposal alternative methods of management.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: to estimate the influence of successive steps of abdominal surgery and of postoperative course on the components of fibrinolytic system.Design: a prospective open study.Setting: the patients were treated in medical research institute and the laboratory tests were done in postgraduate teaching hospital.Interventions: open cholecystectomy, performed in general anesthesia.Main outcome measures: the plasminogen concentration in plasma was determined by amidolytic method. The concentrations of t-PA antigen, PAI-1 antigen, and PAP complex antigen were measured by enzyme-linked immunosorbent assays [ELISA].Results: the induction of anaesthesia was followed by the decline in plasminogen concentration and this decline was observed until the beginning of intraperitoneal part of operation. The decrease of PAI-1 concentration was encountered also at this period of time but was significant only during surgical opening of abdominal wall. Both variables increased then gradually till the end of investigations, i.e. 7th postoperative day. t-PA and PAP complex increased during the intraperitoneal part of cholecystectomy but their concentrations differed postoperatively. t-PA level declined but the concentration of PAP complex increased until the end of investigations, except of the slight, transient decline on the 1st postoperative day.Conclusion: the early drop of plasminogen concentration cannot be explained by its conversion to plasmin. It is hypothesized that the binding of this zymogen to proteins, endothelial cells, and to subendothelial matrix may be regarded as a cause of its early decline in plasma.We suppose that the surgical maneuvers inside the peritoneal cavity during cholecystectomy resulted in the release of t-PA from endothelial cells of systemic circulation and it is speculated that this release is mediated by cytokines. t-PA level decreased gradually after the end of operation, while PAP complex rose till the end of the 1st postoperative week after a slight, transient decrease on the 1st postoperative day. These latter findings can be explained by the local activation of fibrinolysis in the surgical wound: t-PA remains bound to fibrin inside this wound while plasmin, generated on the fibrin matrix, is released into the circulation as PAP complex.The gradual increase of PAI-1 together with an enhanced production of plasminogen, observed after cholecystectomy up to the 7th postoperative day, can be explained by a delayed systemic response to surgery.
- [Show abstract] [Hide abstract] ABSTRACT: Sclerotherapy of esophageal varices is a procedure which caries high risk of DIC and ARDS syndrome induced by intravenous administration of obliterative agent. The aim of the study was to investigate hematological and arterial and venous gasometric parameters before and after injection of 5% ethanolamine oleate (EO) to the esophageal varices. These investigations were carried out in 9 patients with liver cirrhosis (Child B and C) and in 7 dogs witch were infused with EO to the inferior vena cava. Both patients and animals had the values of pAO2, pVO2, satAO2, satVO2 and platelets count decreased but pACO2 and pVCO2 increased after injection of EO. PhA and phV values increased only in investigated patients but not in dogs in which decreased values of Hb, HT and RBC after EO injection were found. This observation was not confirmed in the treated patients. Conducted investigations show that EO injections to the venous system causes significant changes in the pulmonary function in humans as well as in the dogs.
- [Show abstract] [Hide abstract] ABSTRACT: Background. Background. Background. Background. Background. Chronic venous ulceration (CVU), which is the end stage of the complex of symptoms of chronic venous disease (CVD), is a significant health problem. One of the major causes of CVU is deep venous thrombosis (DVT). Thrombophilia is diagnosed in about 41% of patients with a history of DVT. The aim of this study was to assess the prevalence of inherited thrombophilia (IT) in patients with CVU. Material and methods. Material and methods. Material and methods. Material and methods. Material and methods. During 24 months, a group of 110 patients with CVU and a group of 110 healthy people were studied. There were no significant differences in age or sex between the two groups. All patients in the study group were assessed as C5 or C6 according to CEAP classification. The patients underwent clinical and Doppler ultrasonography examination. Blood was drawn for antithrombin (AT), protein C (PC) and S (PS), factor V Leiden (VL), prothrombin G20210A (PT), LA, and ACL. Results. Results. Results. Results. Results. From the group of 110 CVU patients, IT was diagnosed in 33 (30%), LA in 5 (4.5%), and ACL in 12 (10.9%). Conclusions. Conclusions. Conclusions. Conclusions. Conclusions. Our results suggest that IT might be one of several important thrombotic risk factors which lead to CVU.
Institute of Hematology and Blood Transfusion, WarsawWarszawa, Masovian Voivodeship, Poland