42 results on '"Cnotliwy, M"'
Search Results
2. Spatial differences of matrix metalloproteinase-2 and matrix metalloproteinase-9 within abdominal aortic aneurysm wall and intraluminal thrombus
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Siennicka, A., Zuchowski, M., Mariusz Kaczmarczyk, Cnotliwy, M., Clark, J. S., and Jastrzebska, M.
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Aged, 80 and over ,Male ,Tissue Inhibitor of Metalloproteinase-1 ,Matrix Metalloproteinase 9 ,Humans ,Matrix Metalloproteinase 2 ,Female ,Thrombosis ,Aorta, Abdominal ,Middle Aged ,Aged ,Aortic Aneurysm, Abdominal - Abstract
Formation of an abdominal aortic aneurysm is a complex process involving aortic wall degradation. The matrix metalloproteinases (MMPs) mainly involved in this process are MMP-2 and MMP-9. Most aneurysms contain an intraluminal thrombus. It is suggested that the thrombus' thickness correlates with the risk of aneurysm rupture and may be a new prognostic factor. The purpose of the present study was to investigate enzyme protein levels in thick (A1) and thin (B1) segments of the thrombus and aneurysm wall sections A (adjacent to A1) and B (adjacent to B1). Aneurysm samples from one aneurism sac were collected from 36 patients that underwent aneurysm repair. MMP-2, MMP-9 and a tissue inhibitor of metalloproteinases (TIMP-1) were measured using enzyme-linked-immunosorbent assay of protein extract. MMP-9 concentrations were significantly higher in B1 samples compared with A1 (113.4 ± 118.0 versus 63.0 ± 61.2, P = 0.004), A(113.4 ± 118.0 versus 31.7 ± 30.0, P0.001) or B (113.4 ± 118.0 versus 39.5 ± 41.5, P0.001). Likewise MMP-9/TIMP-1 ratio was elevated in B1 compared with A1 (18.9 ± 27.8 versus 9.1 ± 10.6, P = 0.017), A (18.9 ± 27.8 versus 2.5 ± 2.2, P0.001) or B (18.9 ± 27.8 versus 3.6 ± 4.5, P0.001). MMP-2 and TIMP-1 were higher in A compared with A1 (18.4 ± 8.5 versus 7.2 ± 7.6, P0.001; 14.3 ± 5.9 versus 8.5 ± 5.4, P0.001, respectively) and B1 (18.4 ± 8.5 versus 5.2 ± 2.9, P0.001; 14.3 ± 5.9 versus 8.9 ± 4.9, P0.001, respectively) as well as in B compared with A1 (15.9 ± 7.3 versus 7.2 ± 7.6, P0.001; 13.0 ± 5.0 versus 8.5 ± 5.4, P0.001, respectively) and B1 (15.9 ± 7.3 versus 5.2 ± 2.9, P0.001; 13.0 ± 5.0 versus 8.9 ± 4.9, P = 0.003, respectively). There were significant correlations between thin thrombus TIMP-1 and thrombus thickness (β = -0.24, P = 0.021) and between thin thrombus MMP-9/TIMP-1 ratio and thrombus thickness (β = 1.75, P = 0.003). Our study has revealed that the presence of thrombi with thin segments in the aneurysm sac, associated with higher proteolytic activity, could possibly be used as a potential indicator of a rupture site.
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- 2016
3. Research update for articles published in EJCI in 2008
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Anderwald, C., Ankersmit, H. J., Badaoui, A., Beneduce, L., Buko, V. U., Calo, L. A., Carrero, J. J., Chang, C. Y., Chang, K. C., Chen, Y. J., Cnotliwy, M., Costelli, Paola, Crujeiras, A. B., Cuocolo, A., Davis, P. A., de Boer, O. J., Ebenbichler, C. F., Erridge, C., Fassina, G., Felix, S. B., García Gómez, M. C., Guerrero Romero, F., Haider, D. G., Heinemann, A., Herda, L. R., Hoogeveen, E. K., Hörl, W. H., Iglseder, B., Huang, K. C., Kaser, S., Kastrati, A., Kuzniatsova, N., Latella, G., Lichtenauer, M., Lin, Y. K., Lip, G. Y., N. H., Lu, Lukivskaya, O., Luschnig, P., Maniscalco, M., Martinez, J. A., Müller Krebs, S., Ndrepepa, G., Nicolaou, G., Peck Radosavljevic, M., Penna, Fabio, Pintó, X., Reiberger, T., Rodriguez Moran, M., Schmidt, A., Schwenger, V., Spinelli, L., Starkel, P., Stehouwer, C. D., Stenvinkel, P., Strasser, P., Suzuki, H., Tschoner, A., van der Wal, A. C., Vesely, D. L., Wen, C. J., Wiernicki, I., Zanninelli, G., Zhu, Y., Interne Geneeskunde, MUMC+: MA Interne Geneeskunde (3), RS: CARIM School for Cardiovascular Diseases, Anderwald, C, Ankersmit, Hj, Badaoui, A, Beneduce, L, Buko, Vu, Calo, La, Carrero, Jj, Chang, C, Chang, K, Chen, Y, Cnotliwy, M, Costelli, P, Crujeiras, Ab, Cuocolo, Alberto, Davis, Pa, De Boer, Oj, Ebenbichler, Cf, Erridge, C, Fassina, G, Felix, Sb, García Gómez, Mc, Guerrero Romero, F, Haider, Dg, Heinemann, A, Herda, Lr, Hoogeveen, Ek, Hörl, Wh, Iglseder, B, Huang, K, Kaser, S, Kastrati, A, Kuzniatsova, N, Latella, G, Lichtenauer, M, Lin, Y, Lip, Gyh, Lu, N, Lukivskaya, O, Luschnig, P, Maniscalco, M, Martinez, Ja, Müller Krebs, S, Ndrepepa, G, Nicolaou, G, Peck Radosavljevic, M, Penna, F, Pintó, X, Reiberger, T, Rodriguez Moran, M, Schmidt, A, Schwenger, V, Spinelli, Letizia, Starkel, P, Stehouwer, Cda, Stenvinkel, P, Strasser, P, Suzuki, H, Tschoner, A, Van Der Wal, Ac, Vesely, Dl, Wen, C, Wiernicki, I, Zanninelli, G, and Zhu, Y.
- Abstract
Eur J Clin Invest 2010; 40 (9): 770-789.
- Published
- 2010
4. Postoperative B-type natriuretic peptide for prediction of major cardiac events in patients undergoing noncardiac surgery: systematic review and individual patient meta-analysis
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Rodseth, R. N., Biccard, B. M., Chu, R., Lurati Buse, G. A., Thabane, L., Bakhai, A., Bolliger, D., Cagini, L., Cahill, T. J., Cardinale, D., Chong, C. P., Cnotliwy, M., Di Somma, S., Fahrner, R., Lim, W. K., Mahla, E., Le Manach, Y., Manikandan, R., Pyun, W. B., Rajagopalan, S., Radovic, M., Schutt, R. C., Sessler, D. I., Suttie, S., Vanniyasingam, T., Waliszek, M., and PJ Devereaux
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Aged, 80 and over ,Heart Failure ,Heart Diseases ,Myocardial Infarction ,Brain natriuretic peptide (BNP) ,Middle Aged ,Risk Assessment ,Perioperative Care ,Postoperative Complications ,ROC Curve ,Risk Factors ,Natriuretic Peptide, Brain ,Odds Ratio ,Humans ,Postoperative Period ,Biomarkers ,Aged - Abstract
It is unclear whether postoperative B-type natriuretic peptides (i.e., BNP and N-terminal proBNP) can predict cardiovascular complications in noncardiac surgery.The authors undertook a systematic review and individual patient data meta-analysis to determine whether postoperative BNPs predict postoperative cardiovascular complications at 30 and 180 days or more.The authors identified 18 eligible studies (n = 2,051). For the primary outcome of 30-day mortality or nonfatal myocardial infarction, BNP of 245 pg/ml had an area under the curve of 0.71 (95% CI, 0.64-0.78), and N-terminal proBNP of 718 pg/ml had an area under the curve of 0.80 (95% CI, 0.77-0.84). These thresholds independently predicted 30-day mortality or nonfatal myocardial infarction (adjusted odds ratio [AOR] 4.5; 95% CI, 2.74-7.4; P0.001), mortality (AOR, 4.2; 95% CI, 2.29-7.69; P0.001), cardiac mortality (AOR, 9.4; 95% CI, 0.32-254.34; P0.001), and cardiac failure (AOR, 18.5; 95% CI, 4.55-75.29; P0.001). For greater than or equal to 180-day outcomes, natriuretic peptides independently predicted mortality or nonfatal myocardial infarction (AOR, 3.3; 95% CI, 2.58-4.3; P0.001), mortality (AOR, 2.2; 95% CI, 1.67-86; P0.001), cardiac mortality (AOR, 2.1; 95% CI, 0.05-1,385.17; P0.001), and cardiac failure (AOR, 3.5; 95% CI, 1.0-9.34; P = 0.022). Patients with BNP values of 0-250, greater than 250-400, and greater than 400 pg/ml suffered the primary outcome at a rate of 6.6, 15.7, and 29.5%, respectively. Patients with N-terminal proBNP values of 0-300, greater than 300-900, and greater than 900 pg/ml suffered the primary outcome at a rate of 1.8, 8.7, and 27%, respectively.Increased postoperative BNPs are independently associated with adverse cardiac events after noncardiac surgery.
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- 2013
5. Research update for articles published in EJCI in 2008
- Author
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Anderwald, C, Ankersmit, HJ, Badaoui, A, Beneduce, L, Buko, VU, Calo, LA, Carrero, JJ, Chang, CY, Chang, KC, Chen, YJ, Cnotliwy, M, Costelli, P, Crujeiras, AB, Cuocolo, A, Davis, PA, de Boer, OJ, Ebenbichler, CF, Erridge, C, Fassina, G, Felix, SB, and Garcia
- Published
- 2010
6. The Prognostic Value of Pre-Operative and Post-Operative B-Type Natriuretic Peptides in Patients Undergoing Noncardiac Surgery
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Rodseth, RN, Biccard, BM, Le Manach, Y, Sessler, DI, Buse, GAL, Thabane, L, Schutt, RC, Bolliger, D, Cagini, L, Cardinale, D, Chong, CPW, Chu, R, Cnotliwy, M, Di Somma, S, Fahrner, R, Lim, WK, Mahla, E, Manikandan, R, Puma, F, Pyun, WB, Radovic, M, Rajagopalan, S, Suttie, S, Vanniyasingam, T, van Gaal, WJ, Waliszek, M, Devereaux, PJ, Rodseth, RN, Biccard, BM, Le Manach, Y, Sessler, DI, Buse, GAL, Thabane, L, Schutt, RC, Bolliger, D, Cagini, L, Cardinale, D, Chong, CPW, Chu, R, Cnotliwy, M, Di Somma, S, Fahrner, R, Lim, WK, Mahla, E, Manikandan, R, Puma, F, Pyun, WB, Radovic, M, Rajagopalan, S, Suttie, S, Vanniyasingam, T, van Gaal, WJ, Waliszek, M, and Devereaux, PJ
- Abstract
OBJECTIVES: The objective of this study was to determine whether measuring post-operative B-type natriuretic peptides (NPs) (i.e., B-type natriuretic peptide [BNP] and N-terminal fragment of proBNP [NT-proBNP]) enhances risk stratification in adult patients undergoing noncardiac surgery, in whom a pre-operative NP has been measured. BACKGROUND: Pre-operative NP concentrations are powerful independent predictors of perioperative cardiovascular complications, but recent studies have reported that elevated post-operative NP concentrations are independently associated with these complications. It is not clear whether there is value in measuring post-operative NP when a pre-operative measurement has been done. METHODS: We conducted a systematic review and individual patient data meta-analysis to determine whether the addition of post-operative NP levels enhanced the prediction of the composite of death and nonfatal myocardial infarction at 30 and ≥180 days after surgery. RESULTS: Eighteen eligible studies provided individual patient data (n = 2,179). Adding post-operative NP to a risk prediction model containing pre-operative NP improved model fit and risk classification at both 30 days (corrected quasi-likelihood under the independence model criterion: 1,280 to 1,204; net reclassification index: 20%; p < 0.001) and ≥180 days (corrected quasi-likelihood under the independence model criterion: 1,320 to 1,300; net reclassification index: 11%; p = 0.003). Elevated post-operative NP was the strongest independent predictor of the primary outcome at 30 days (odds ratio: 3.7; 95% confidence interval: 2.2 to 6.2; p < 0.001) and ≥180 days (odds ratio: 2.2; 95% confidence interval: 1.9 to 2.7; p < 0.001) after surgery. CONCLUSIONS: Additional post-operative NP measurement enhanced risk stratification for the composite outcomes of death or nonfatal myocardial infarction at 30 days and ≥180 days after noncardiac surgery compared with a pre-operative NP measurement alone.
- Published
- 2014
7. Doxycycline Treatment of Groin Lymphatic Fistulae Following Arterial Reconstruction Procedures
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Cnotliwy, M., primary, Gutowski, P., additional, Petriczko, W., additional, and Turowski, R., additional
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- 2001
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8. [Early death in vascular surgery: an ongoing prognostic problem].,Wczesny zgon w chirurgii naczyniowej. Aktualny problem prognostyczny
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Kazimierczak, A., Sledź, M., Renata Guzicka Kazimierczak, Gutowski, P., and Cnotliwy, M.
9. [The Self -Complete of Leeds Assessment Neuropathic Symptoms and Signs: an attempt to adapt it for Polish population]
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Cnotliwy, M., Jurewicz, A., Gołąb -Janowska, M., Arkadiusz Kazimierczak, and Głazek, W.
10. Endarterectomy - The most common method of large internal carotid artery stenosis treatment - Benefits and risks,Endarterektomia jako najczȩstsza metoda leczenia dużych zwȩżeń tȩtnicy szyjnej wewnȩtrznej - Korzyści i zagrożenia
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Jabłońska, J., Trojnacka, B., Kazimierz Ciechanowski, Gutowski, P., Cnotliwy, M., Szumiłowicz, H., and Szumiłowicz, G.
11. Crossed bypass femoro-femoralis in patient with external iliac artery occlusion in the course of septic hemorrhage after renal graft explantatation
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Sieńko, J., Tejchman, K., Cnotliwy, M., Aleksander Falkowski, Nowacki, M., and Ostrowski, M.
12. Efficacy of P-POSSUM calculator in prediction of early results and cost of treatment in vascular surgery,Przydatność skali P-POSSUM w prognozowaniu wynikówi kosztów leczenia w chirurgii naczyniowej
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Kazimierczak, A., Śledź, M., Gutowski, P., Renata Guzicka Kazimierczak, Cnotliwy, M., Zeair, S., and Samad, R.
13. Meaning of catabolic markers in acute limb ischemia,Znaczenie markerów katabolizmu w ostrym niedokrwieniu kończyn dolnych
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Kazimierczak, A., Sługocki, L., Gutowski, P., Cnotliwy, M., Kazimierczak, S., Śledź, M., Samad, R., Renata Guzicka Kazimierczak, and Jȩdrzejczak, T.
14. The advantages of the introduction of a medical electronic file system in vascular surgery,Korzyści z zastosowania elektronicznego systemu dokumentacji medycznej w chirurgii naczyniowej
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Kazimierczak, A., Cnotliwy, M., Gutowski, P., Śledź, M., Renata Guzicka Kazimierczak, and Jewiarz, A.
15. [Latent chronic kidney disease in the material of the Department of Vascular Surgery, Pomeranian Medical University in Szczecin. An important clinical problem].,Utajona przewlekła choroba nerek w materiale Kliniki Chirurgii Naczyniowej Pomorskiego Uniwersytetu Medycznego w Szczecinie. Istotny problem kliniczny
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Kazimierczak, A., Sledź, M., Renata Guzicka Kazimierczak, Gutowski, P., and Cnotliwy, M.
16. Association of Aneurysm Tissue Neutrophil Mediator Levels with Intraluminal Thrombus Thickness in Patients with Abdominal Aortic Aneurysm.
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Siennicka A, Adamowicz M, Grzesch N, Kłysz M, Woźniak J, Cnotliwy M, Galant K, and Jastrzębska M
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- Humans, Neutrophils pathology, Aortic Aneurysm, Abdominal pathology, Thrombosis pathology
- Abstract
An intraluminal thrombus (ILT), which accumulates large numbers of neutrophils, plays a key role in abdominal aortic aneurysm (AAA) pathogenesis. This study aimed to compare levels of selected neutrophil inflammatory mediators in thick and thin ILT, plus adjacent AAA walls, to determine whether levels depend on ILT thickness. Neutrophil mediator levels were analysed by enzyme-linked immunosorbent assays in thick and thin segments of ILT, plus adjacent aneurysm wall sections, taken from one aneurysm sac each from 36 AAA patients. In aneurysmal walls covered by thick ILT, neutrophil elastase and TNF-a levels were significantly higher, as were concentrations of IL-6, in thick ILT compared to thin layers. Positive correlations of NGAL, MPO, and neutrophil elastase were observed between thick ILT and the adjacent wall and thin ILT and the adjacent wall, suggesting that these mediators probably infiltrate thick AAA compartments as well as thin. These observations might support the idea that neutrophil mediators and inflammatory cytokines differentially accumulate in AAA tissues according to ILT thickness. The increased levels of neutrophil mediators within thicker AAA segments might suggest the existence of an intensified proinflammatory state that in turn presumably might preferentially weaken the AAA wall at that region.
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- 2022
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17. Homocysteine-Enhanced Proteolytic and Fibrinolytic Processes in Thin Intraluminal Thrombus and Adjacent Wall of Abdominal Aortic Aneurysm: Study In Vitro.
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Siennicka A, Zuchowski M, Chełstowski K, Cnotliwy M, Clark JS, and Jastrzębska M
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- Aged, Aged, 80 and over, Aortic Aneurysm, Abdominal pathology, Female, Humans, Male, Matrix Metalloproteinase 2 metabolism, Middle Aged, Plasminogen metabolism, Thromboplastin metabolism, Thrombosis pathology, Tissue Plasminogen Activator metabolism, Aortic Aneurysm, Abdominal metabolism, Fibrinolysis, Homocysteine metabolism, Proteolysis, Thrombosis metabolism
- Abstract
Homocysteine (Hcy) may affect the pathogenesis of abdominal aortic aneurysms (AAAs) through enhancement of proteolysis and an impaired coagulation/fibrinolysis system. Intensified haemostatic capacity may promote local proteolytic degradation of the aortic wall. This study aimed to examine the effects of Hcy on haemostatic and proteolytic processes in samples of thick and thin fragments of the ILT and underlying walls. Subjects and Methods . Thirty-six patients who underwent AAA surgery were enrolled. Aneurysm tissue sections were incubated with DL-Hcy (100 and 500 μ mol/L) in a series of experiments and analyzed for concentration/activity of proteolytic and haemostatic markers by enzyme-linked immunosorbent assay. Results . Incubation of wall underlying thin ILT segments (B) with DL-Hcy resulted in an increase of active MMP-2 levels compared to control tissue (9.54 ± 5.88 versus 7.44 ± 4.48, p=0.011). DL-Hcy also induced t-PA and plasminogen concentration increases in thin thrombus sections (B1) compared to control tissue (respectively: 1.39 ± 1.65 versus 0.84 ± 0.74, p=0.024; 11.64 ± 5.05 versus 10.34 ± 5.52, p=0.018). In contrast, wall adjacent to thick thrombus segments (A) showed decreases in MMP-2 and TF activities compared to control (respectively, 5.89 ± 3.39 versus 7.26 ± 5.49, p=0.046; 67.13 ± 72.59 versus 114.46 ± 106.29, p=0.007). In thick ILT sections (A1), DL-Hcy decreased MMP-2 activity and t-PA and plasminogen concentrations compared to control tissue (respectively, 2.53 ± 2.02 versus 3.28 ± 2.65, p=0.006; 0.67 ± 0.57 versus 0.96 ± 0.91, p=0.021; 9.25 ± 4.59 versus 12.63 ± 9.56, p=0.017). In addition, analysis revealed positive correlations at all sites between activities/concentrations of MMP-2, TF, and PAI-1 measured in control tissues and after incubation with DL-Hcy. Conclusions . These data indicate the potential for excess Hcy to enhance damage of arterial wall in thinner AAA segments as a result of the increased activity of MMP-2 and fibrinolytic factors.
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- 2018
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18. Tissue factor levels and the fibrinolytic system in thin and thick intraluminal thrombus and underlying walls of abdominal aortic aneurysms.
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Siennicka A, Zuchowski M, Kaczmarczyk M, Cnotliwy M, Clark JS, and Jastrzębska M
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- Aged, Aorta, Abdominal diagnostic imaging, Aorta, Abdominal pathology, Aortic Aneurysm, Abdominal diagnostic imaging, Aortic Aneurysm, Abdominal pathology, Aortic Aneurysm, Abdominal surgery, Aortography methods, Computed Tomography Angiography, Dilatation, Pathologic, Female, Humans, Male, Middle Aged, Plasminogen analysis, Thrombosis diagnostic imaging, Thrombosis pathology, Thrombosis surgery, Tissue Plasminogen Activator analysis, Vascular Remodeling, alpha-2-Antiplasmin analysis, Aorta, Abdominal chemistry, Aortic Aneurysm, Abdominal blood, Fibrinolysis, Thromboplastin analysis, Thrombosis blood
- Abstract
Background: The hemostatic system cooperates with proteolytic degradation in processes allowing abdominal aortic aneurysm (AAA) formation. In previous studies, it has been suggested that aneurysm rupture depends on intraluminal thrombus (ILT) thickness, which varies across each individual aneurysm. We hypothesized that hemostatic components differentially accumulate in AAA tissue in relation to ILT thickness. Thick (A1) and thin (B1) segments of ILTs and aneurysm wall sections A (adjacent to A1) and B (adjacent to B1) from one aneurysm sac were taken from 35 patients undergoing elective repair., Methods: Factor levels were measured using enzyme-linked immunosorbent assay of protein extract., Results: Tissue factor (TF) activities were significantly higher in thinner segments of AAA (B1 vs A1, P = .003; B vs A, P < .001; B vs A1, P < .001; B vs B1, P = .001). Significantly higher tissue plasminogen activator was found in thick thrombus-covered wall segments (A) than in B, A1, and B1 (P = .015, P < .001, and P < .001, respectively). Plasminogen concentrations were highest in ILT. Concentrations of α
2 -antiplasmin in thin ILT adjacent walls (B) were higher compared with wall (A) adjacent to thick ILT (P = .021) and thick ILT (A1; P < .001). Significant correlations between levels of different factors were mostly found in thick ILT (A1). However, no correlations were found at B sites, except for a correlation between plasmin and TF activities (r = 0.55; P = .004)., Conclusions: These results suggest that higher TF activities are present in thinner AAA regions. These parameters and local fibrinolysis may be part of the processes leading to destruction of the aneurysm wall., (Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)- Published
- 2018
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19. An unusual case of aortic rupture after deployment of a bare stent in the treatment of aortic dissection in a patient with giant-cell arteritis.
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Rynio P, Kazimierczak A, Gutowski P, and Cnotliwy M
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Giant-cell arteritis is associated with a higher risk of aortic aneurysm and aortic dissection formation. We present a women with aortic dissection type B treated with a stent graft and bare-metal stent implantation. After the stent deployment we noticed aortic rupture, which was successfully treated with implantation of an additional stent graft. This report highlights the difficulty of endovascular therapy in patients with giant-cell arteritis. We have to bear in mind that chronic inflammation of the aorta leads to a more fragile aortic wall than normal. We recommend the use of a stent graft over a bare-metal stent and gentle use of a balloon catheter.
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- 2017
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20. [The Self -Complete of Leeds Assessment Neuropathic Symptoms and Signs: an attempt to adapt it for Polish population].
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Cnotliwy M, Jurewicz A, Gołąb -Janowska M, Kazimierczak A, and Głazek W
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- Humans, Osteoarthritis, Poland, ROC Curve, Surveys and Questionnaires, Translating, Neuralgia diagnosis, Nociceptive Pain diagnosis, Pain Measurement methods
- Abstract
Introduction: The Self -Complete of Leeds Assessment Neuropathic Symptoms and Signs (S -LANSS) questionnaire is a tool for screening patients with neuropathic pain, which can be completed without a physician’s assistance. Until now, a Polish version of the S -LANSS has not been available. The aim of the study was to translate the English version into the Polish language and to validate it for the Polish population., Materials and Methods: A total of 101 subjects; 51 with chronic neuropathic pain in the course of different neurological diseases, and 50 patients with osteoarthritis and nociceptive pain were included in the study. All of them completed a version of the S -LANSS questionnaire translated into the Polish language. Test sensitivity and specificity were calculated on the basis of statistical analysis., Results: The sensitivity of the S -LANSS scale with the cut -off of ≥11 points was 62%, and the specificity was 77%. The estimated area under ROC curve AUC (95% CI) = 0.729 (0.63–0.809)., Conclusions: The Polish version of S -LANSS could be used as a tool for screening patients with neuropathic pain. The diagnosis should be confirmed in neurological examination and other appropriate diagnostic methods.
- Published
- 2016
21. N-terminal pro-B-type Natriuretic Peptides' Prognostic Utility Is Overestimated in Meta-analyses Using Study-specific Optimal Diagnostic Thresholds.
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Potgieter D, Simmers D, Ryan L, Biccard BM, Lurati-Buse GA, Cardinale DM, Chong CP, Cnotliwy M, Farzi SI, Jankovic RJ, Lim WK, Mahla E, Manikandan R, Oscarsson A, Phy MP, Rajagopalan S, Van Gaal WJ, Waliszek M, and Rodseth RN
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- Biomarkers blood, Humans, Prognosis, Heart Diseases blood, Heart Diseases diagnosis, Natriuretic Peptide, Brain blood, Peptide Fragments blood
- Abstract
Background: N-terminal fragment B-type natriuretic peptide (NT-proBNP) prognostic utility is commonly determined post hoc by identifying a single optimal discrimination threshold tailored to the individual study population. The authors aimed to determine how using these study-specific post hoc thresholds impacts meta-analysis results., Methods: The authors conducted a systematic review of studies reporting the ability of preoperative NT-proBNP measurements to predict the composite outcome of all-cause mortality and nonfatal myocardial infarction at 30 days after noncardiac surgery. Individual patient-level data NT-proBNP thresholds were determined using two different methodologies. First, a single combined NT-proBNP threshold was determined for the entire cohort of patients, and a meta-analysis conducted using this single threshold. Second, study-specific thresholds were determined for each individual study, with meta-analysis being conducted using these study-specific thresholds., Results: The authors obtained individual patient data from 14 studies (n = 2,196). Using a single NT-proBNP cohort threshold, the odds ratio (OR) associated with an increased NT-proBNP measurement was 3.43 (95% CI, 2.08 to 5.64). Using individual study-specific thresholds, the OR associated with an increased NT-proBNP measurement was 6.45 (95% CI, 3.98 to 10.46). In smaller studies (<100 patients) a single cohort threshold was associated with an OR of 5.4 (95% CI, 2.27 to 12.84) as compared with an OR of 14.38 (95% CI, 6.08 to 34.01) for study-specific thresholds., Conclusions: Post hoc identification of study-specific prognostic biomarker thresholds artificially maximizes biomarker predictive power, resulting in an amplification or overestimation during meta-analysis of these results. This effect is accentuated in small studies.
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- 2015
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22. Electrophysiological, hemodynamic, and metabolic response to open procedure or endovascular repair of infrarenal aortic aneurysms.
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Biernawska J, Kaczmarczyk M, Kotfis K, Cnotliwy M, Zegan-Barańska M, Zukowska A, Greczan A, and Zukowski M
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- Aged, Aortic Aneurysm, Abdominal mortality, Biomarkers blood, Blood Vessel Prosthesis Implantation mortality, Electrocardiography, Ambulatory, Electrophysiology, Female, Hemodynamics, Humans, Hydrogen-Ion Concentration, Lactates blood, Male, Middle Aged, Poland epidemiology, Postoperative Complications epidemiology, Prospective Studies, Risk Factors, Treatment Outcome, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis Implantation methods, Cardiovascular Diseases epidemiology, Endovascular Procedures mortality
- Abstract
Background: The occurrence of cardiovascular diseases in the group of patients undergoing vascular surgery because of abdominal aorta aneurysm is very high. Endovascular procedures are regarded as hemodynamically safer for the patients. The aim of this study was to compare the changes in electrophysiological, hemodynamic, and metabolic parameters depending on the type of operation, using invasive hemodynamic monitoring and Holter electrocardiography recording., Methods: A prospective, observational, nonrandomized study was conducted to compare dynamic changes of electrophysiological parameters (dominant rhythm, arrhythmia, corrected QT interval (QTc), invasive blood pressure, electrolytes, and acid-base balance in defined points during perioperative time in 2 groups: vascular prosthesis implantation group (91 patients) and stent-graft implantation group (83 patients)., Results: The study group comprised 174 consecutive adult Caucasian patients (mean age 64.4 ± 8.9 years in stent-graft group and 70.0 ± 7.5 years in vascular prosthesis implantation group). Although patients in the stent-graft implantation group were younger, they were diagnosed with lower limbs vascular atherosclerosis, type 2 diabetes mellitus, and a lower left ventricle ejection fraction more often than patients in the open procedure group. During the open procedure, higher blood pressure amplitudes (P = 0.00009), higher decrease in pH (P = 0.049), increase in the arterial lactate level (P = 0.00002), prolonged QTc values (P = 0.001), more frequent ventricular extrasystoles (P = 0.005), and cardiovascular deaths were observed, when compared with those observed during the endovascular aneurysm repair., Conclusions: When compared with the chosen techniques, the one for infrarenal abdominal aneurysm was found to be associated with significant differences in electrophysiological, hemodynamic, and metabolic parameters., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
23. The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery: B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: a systematic review and individual patient data meta-analysis.
- Author
-
Rodseth RN, Biccard BM, Le Manach Y, Sessler DI, Lurati Buse GA, Thabane L, Schutt RC, Bolliger D, Cagini L, Cardinale D, Chong CP, Chu R, Cnotliwy M, Di Somma S, Fahrner R, Lim WK, Mahla E, Manikandan R, Puma F, Pyun WB, Radović M, Rajagopalan S, Suttie S, Vanniyasingam T, van Gaal WJ, Waliszek M, and Devereaux PJ
- Subjects
- Biomarkers blood, Global Health, Humans, Incidence, Peptide Fragments blood, Postoperative Period, Preoperative Period, Prognosis, Cardiovascular Diseases blood, Cardiovascular Diseases epidemiology, Cardiovascular Diseases etiology, Natriuretic Peptide, Brain blood, Postoperative Complications blood, Postoperative Complications epidemiology, Postoperative Complications etiology, Surgical Procedures, Operative
- Abstract
Objectives: The objective of this study was to determine whether measuring post-operative B-type natriuretic peptides (NPs) (i.e., B-type natriuretic peptide [BNP] and N-terminal fragment of proBNP [NT-proBNP]) enhances risk stratification in adult patients undergoing noncardiac surgery, in whom a pre-operative NP has been measured., Background: Pre-operative NP concentrations are powerful independent predictors of perioperative cardiovascular complications, but recent studies have reported that elevated post-operative NP concentrations are independently associated with these complications. It is not clear whether there is value in measuring post-operative NP when a pre-operative measurement has been done., Methods: We conducted a systematic review and individual patient data meta-analysis to determine whether the addition of post-operative NP levels enhanced the prediction of the composite of death and nonfatal myocardial infarction at 30 and ≥180 days after surgery., Results: Eighteen eligible studies provided individual patient data (n = 2,179). Adding post-operative NP to a risk prediction model containing pre-operative NP improved model fit and risk classification at both 30 days (corrected quasi-likelihood under the independence model criterion: 1,280 to 1,204; net reclassification index: 20%; p < 0.001) and ≥180 days (corrected quasi-likelihood under the independence model criterion: 1,320 to 1,300; net reclassification index: 11%; p = 0.003). Elevated post-operative NP was the strongest independent predictor of the primary outcome at 30 days (odds ratio: 3.7; 95% confidence interval: 2.2 to 6.2; p < 0.001) and ≥180 days (odds ratio: 2.2; 95% confidence interval: 1.9 to 2.7; p < 0.001) after surgery., Conclusions: Additional post-operative NP measurement enhanced risk stratification for the composite outcomes of death or nonfatal myocardial infarction at 30 days and ≥180 days after noncardiac surgery compared with a pre-operative NP measurement alone., (Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
24. Postoperative B-type natriuretic peptide for prediction of major cardiac events in patients undergoing noncardiac surgery: systematic review and individual patient meta-analysis.
- Author
-
Rodseth RN, Biccard BM, Chu R, Lurati Buse GA, Thabane L, Bakhai A, Bolliger D, Cagini L, Cahill TJ, Cardinale D, Chong CP, Cnotliwy M, Di Somma S, Fahrner R, Lim WK, Mahla E, Le Manach Y, Manikandan R, Pyun WB, Rajagopalan S, Radovic M, Schutt RC, Sessler DI, Suttie S, Vanniyasingam T, Waliszek M, and Devereaux PJ
- Subjects
- Aged, Aged, 80 and over, Biomarkers blood, Heart Diseases mortality, Heart Failure blood, Heart Failure epidemiology, Heart Failure mortality, Humans, Middle Aged, Myocardial Infarction blood, Myocardial Infarction epidemiology, Myocardial Infarction mortality, Odds Ratio, Postoperative Complications mortality, Postoperative Period, ROC Curve, Risk Assessment methods, Risk Assessment statistics & numerical data, Risk Factors, Heart Diseases blood, Heart Diseases epidemiology, Natriuretic Peptide, Brain blood, Postoperative Complications blood, Postoperative Complications epidemiology
- Abstract
Background: It is unclear whether postoperative B-type natriuretic peptides (i.e., BNP and N-terminal proBNP) can predict cardiovascular complications in noncardiac surgery., Methods: The authors undertook a systematic review and individual patient data meta-analysis to determine whether postoperative BNPs predict postoperative cardiovascular complications at 30 and 180 days or more., Results: The authors identified 18 eligible studies (n = 2,051). For the primary outcome of 30-day mortality or nonfatal myocardial infarction, BNP of 245 pg/ml had an area under the curve of 0.71 (95% CI, 0.64-0.78), and N-terminal proBNP of 718 pg/ml had an area under the curve of 0.80 (95% CI, 0.77-0.84). These thresholds independently predicted 30-day mortality or nonfatal myocardial infarction (adjusted odds ratio [AOR] 4.5; 95% CI, 2.74-7.4; P < 0.001), mortality (AOR, 4.2; 95% CI, 2.29-7.69; P < 0.001), cardiac mortality (AOR, 9.4; 95% CI, 0.32-254.34; P < 0.001), and cardiac failure (AOR, 18.5; 95% CI, 4.55-75.29; P < 0.001). For greater than or equal to 180-day outcomes, natriuretic peptides independently predicted mortality or nonfatal myocardial infarction (AOR, 3.3; 95% CI, 2.58-4.3; P < 0.001), mortality (AOR, 2.2; 95% CI, 1.67-86; P < 0.001), cardiac mortality (AOR, 2.1; 95% CI, 0.05-1,385.17; P < 0.001), and cardiac failure (AOR, 3.5; 95% CI, 1.0-9.34; P = 0.022). Patients with BNP values of 0-250, greater than 250-400, and greater than 400 pg/ml suffered the primary outcome at a rate of 6.6, 15.7, and 29.5%, respectively. Patients with N-terminal proBNP values of 0-300, greater than 300-900, and greater than 900 pg/ml suffered the primary outcome at a rate of 1.8, 8.7, and 27%, respectively., Conclusions: Increased postoperative BNPs are independently associated with adverse cardiac events after noncardiac surgery.
- Published
- 2013
- Full Text
- View/download PDF
25. Haemostatic factors and intraluminal thrombus thickness in abdominal aortic aneurysm. Is secondary fibrinolysis relevant?
- Author
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Siennicka A, Drozdzynska M, Chelstowski K, Cnotliwy M, and Jastrzebska M
- Subjects
- Aged, Aorta, Abdominal surgery, Aortic Aneurysm, Abdominal physiopathology, Aortic Aneurysm, Abdominal surgery, Biomarkers blood, Disease Progression, Female, Humans, Male, Middle Aged, Plasminogen Activator Inhibitor 1 blood, Severity of Illness Index, Thromboxane B2 blood, Tomography, X-Ray Computed, Aorta, Abdominal diagnostic imaging, Aortic Aneurysm, Abdominal blood, Aortic Aneurysm, Abdominal diagnostic imaging, Fibrin Fibrinogen Degradation Products analysis, Fibrinolysis, Thrombosis etiology, Tissue Plasminogen Activator blood
- Abstract
Many circulating haemostatic markers have been investigated in relation to the abdominal aortic aneurysm (AAA) size, growth as well as intraluminal thrombus (ILT) size. However, the results of these studies seem to be uncertain and inconsistent. The first aim of the present study was to compare the haemostatic parameters of fibrinolysis and some of thrombotic markers in patients with AAA and controls. We also examined the relationship between those parameters and both maximum aneurysm diameter and intraluminal thrombus thickness. Tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), fibrinogen (Fb), D-dimer, prothrombin fragments 1 and 2 (F1+2), thromboxane B2 (TXB2) and lipids profile were measured in 36 patients with AAA and 30 controls. The mean maximum aortic diameter in patients with the AAA was 59±12 mm (range 42-100). The mean ILT thickness was 32±10 mm (range 8-56). Among haemostatic factors, t-PA and D-dimer levels, but not PAI-1, were significantly higher in subjects with the AAA. There was a strong positive correlation between thickness of intraluminal thrombus and maximum aneurysm size (r=0.69, p<0.0001), and the negative relationship between t-PA and ILT thickness (r= -0.53, p=0.001) as well as aneurysm diameter (r= -0.38, p=0.023). Higher plasma concentrations of t-PA and D-dimer support the hypothesis that the secondary fibrinolysis plays an important role in the pathogenesis of the aortic abdominal aneurysm formation. In addition, the negative correlation between t-PA plasma level and ILT thickness suggests that thrombotic/fibrinolysis imbalance may favour accelerated formation of intraluminal thrombus and possibly aneurysm progression.
- Published
- 2013
26. [Latent chronic kidney disease in the material of the Department of Vascular Surgery, Pomeranian Medical University in Szczecin. An important clinical problem].
- Author
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Kazimierczak A, Sledź M, Guzicka-Kazimierczak R, Gutowski P, and Cnotliwy M
- Subjects
- Atherosclerosis diagnosis, Comorbidity, Female, Gastrointestinal Hemorrhage epidemiology, Glomerular Filtration Rate, Humans, Incidence, Kidney Failure, Chronic diagnosis, Male, Poland, Retrospective Studies, Stroke epidemiology, Surgery Department, Hospital statistics & numerical data, Vascular Surgical Procedures statistics & numerical data, Atherosclerosis epidemiology, Atherosclerosis surgery, Kidney Failure, Chronic epidemiology, Postoperative Complications epidemiology
- Abstract
Introduction: The percentage of patients with diagnosed chronic renal failure is many times smaller than the percentage of the latent disease. The rate of cardiovascular complications in latent kidney disease is significantly higher. The aim of this work was to determine the percentage of patients with renal failure among patients with peripheral atherosclerosis treated at our Department and to study rate (GFR) below the influence of reduced glomerular filtration rate (GFR) below 60 mL/min/1.73 m2 on the risk of early complications after vascular surgery., Material and Methods: A retrospective analysis of 1096 patients was done. 652 patients were operated, 321 underwent endovascular procedures, including angiography, antiglobulin test (PTA), and fibrinolysis, and 123 were conservatively treated. There were no significant differences between these groups as regards biochemical parameters prior to treatment., Results: Approximately 2% of patients presented with chronic renal failure at admission. However, GFR in more than 30% (370) of them was lower than 60 mL/min/1.73 m2. The incidence of myocardial infarction and pneumonia was more than three-fold greater in patients with reduced GFR (1.89 vs. 0.55, p = 0.042; 4.59 vs. 1.38, p = 0.0017, respectively). The incidence of gastrointestinal bleeding increased more than 18 times (3.78 vs. 0.28, p = 0.00002) and the incidence of stroke increased six times (2.43 vs. 0.41, p = 0.0032) in these patients., Conclusions: Latent renal failure is present in more than one-third of patients treated for peripheral atherosclerosis. GFR below 60 mL/min/1.73 m2 is associated with a higher risk of cardiovascular complications and postoperative gastrointestinal bleeding. Glomerular filtration rate should be routinely calculated at admission to hospital.
- Published
- 2011
27. Enhanced matrix-degrading proteolytic activity within the thin thrombus-covered wall of human abdominal aortic aneurysms.
- Author
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Wiernicki I, Stachowska E, Safranow K, Cnotliwy M, Rybicka M, Kaczmarczyk M, and Gutowski P
- Subjects
- Aged, Aged, 80 and over, Aortic Aneurysm, Abdominal complications, Aortic Aneurysm, Abdominal diagnostic imaging, Aortic Aneurysm, Abdominal surgery, Aortic Rupture enzymology, Aortic Rupture etiology, Aortography methods, Enzyme-Linked Immunosorbent Assay, Female, Humans, Male, Middle Aged, Poland, Prospective Studies, Thrombosis pathology, Tissue Inhibitor of Metalloproteinase-1 analysis, Tomography, X-Ray Computed, Up-Regulation, Aortic Aneurysm, Abdominal enzymology, Extracellular Matrix metabolism, Leukocyte Elastase analysis, Matrix Metalloproteinase 8 analysis, Matrix Metalloproteinase 9 analysis, Thrombosis enzymology
- Abstract
Objective: The maintenance of an arterial elastin's integrity is essential in the prevention of abdominal aortic aneurysm (AAA) development. So far, the effect of intraluminal thrombus (ILT) thickness on the elastolytic activity within the AAA wall has not been studied. In the present study the hypothesis that thin thrombus is associated with enhanced proteolytic activity within human AAA wall was investigated., Methods: The specimens for analysis, from both thin (< or = 10 mm) thrombus-covered and thick (> or = 25 mm) thrombus-covered wall, had been taken from 40 patients undergoing elective repair of AAA. We evaluated neutrophil elastase activity with the enzymatic assay. Concentrations of active matrix metalloproteinase-9 (MMP-9), total matrix metalloproteinase-8 (MMP-8), and tissue inhibitor of matrix metalloproteinases-1 (TIMP-1) were measured by ELISA. Biochemical parameters were compared with the Wilcoxon signed-rank test., Results: Statistical analysis showed that the activity of elastase (P<0.0001) as well as concentrations of active MMP-9 (P=0.001), total MMP-8 (P<0.0001) and active MMP-9/total TIMP-1 ratio (P=0.002) were significantly higher in the thin thrombus-covered wall. Furthermore the TIMP-1 was found to have a lower concentration in the thin thrombus-covered in comparison with the thick thrombus-covered wall (P=0.003). There was a significant positive correlation between measurements in AAA wall sites with thin and thick thrombus for elastase, TIMP-1, MMP-9/TIMP-1 ratio, and a borderline correlation was observed for MMP-8. Active MMP-9 concentration did not correlate between sites., Conclusion: The current study demonstrates the differentiation of protease activity within the same AAA wall and its enhancement within the thin thrombus-covered aneurysm wall., (Copyright 2010 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2010
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28. [Early death in vascular surgery: an ongoing prognostic problem].
- Author
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Kazimierczak A, Sledź M, Guzicka-Kazimierczak R, Gutowski P, and Cnotliwy M
- Subjects
- Aged, Female, Humans, Logistic Models, Male, Prognosis, Prospective Studies, Risk Factors, Survival Rate, Postoperative Complications mortality, Risk Assessment methods, Vascular Surgical Procedures mortality
- Abstract
Introduction: Prediction of complications in surgery is commonly done. There are conflicting reports concerning the usefulness of risk scales (P-POSSUM, APACHE, SAPS, ASA, Goldman, etc.) in vascular surgery. We decided to take a fresh look at preoperative risk factors of early death in the context of the usefulness of some parameters which have not been included in existing risk calculators., Material and Methods: The study group consisted of 1270 patients treated at the Department of Vascular Surgery, General Surgery, and Angiology, Pomeranian Medical University in Szczecin, during one year. METHOD This was a prospective non-randomized study. All data recorded at admission and data from P-POSSUM, ASA, Goldman, and ECOG-Zubroda-WHO scales were analyzed. Statistics were done with discriminant, multivariate, and logistic tests., Results: There were 42 early deaths in the group. The following independent risk factors were involved in early death: ASA > 2 (OR = 18.31), persistent atrial fibrillation (OR = 5.75), leukocytosis (OR = 13.31), glomerular filtration rate (GFR) < 30 mL/min/1.73 m2 (OR = 5.78), systemic inflammatory response syndrome (SIRS) (OR = 11.36), emergency admission (OR = 38.62), critical limb ischemia (OR = 4.87), acute limb ischemia (OR = 8,98), abdominal aortic aneurysm (OR = 4.4), and ruptured aortic aneurysm (OR = 10.59). Logistic regression exposed the influence of five factors: ASA III, ASA IV, persistent atrial fibrillation, leukocytosis, GFR < 30 mL/kg/1.73 m2, and ruptured aortic aneurysm. The P-POSSUM calculator was found to be an accurate predictor of early death although the predicted death rate was insignificantly higher than the observed rate., Conclusion: Risk scales of early death currently used in vascular surgery need to be "refreshed". Creation of the Polish National Vascular Surgery Register seems to be unavoidable.
- Published
- 2010
29. Crossed bypass femoro-femoralis in patient with external iliac artery occlusion in the course of septic hemorrhage after renal graft explantatation.
- Author
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Sieńko J, Tejchman K, Cnotliwy M, Falkowski A, Nowacki M, and Ostrowski M
- Subjects
- Anastomosis, Surgical methods, Escherichia coli Infections etiology, Femoral Artery pathology, Femoral Artery surgery, Humans, Iliac Artery pathology, Iliac Artery surgery, Kidney Diseases surgery, Male, Middle Aged, Renal Artery pathology, Renal Artery surgery, Reoperation, Hemorrhage etiology, Kidney Transplantation adverse effects, Nephrectomy adverse effects, Peripheral Vascular Diseases etiology, Sepsis etiology
- Abstract
Blood vessel complications are one of most important problems in patients after renal transplantation. They influence graft chances and they are also often direct life threat, requiring fast diagnosis and immediate surgical treatment. Described case concern septic hemorrhage in vessel junction region after transplant nephrectomy, reoperated 5 times because of this complication. We discuss occurrence and severity of septic hemorrhages, usual coexisting complications, ways of surgical treatment, course of infections leading to hemorrhage and similar cases reported. As the most frequent surgical techniques we found bypass axillo-femoralis, femoro-femoralis suprapubic and through formanen obturatorius and this kind of treatment as the most effective.
- Published
- 2006
30. [Permanent local nerve injuries after carotid endarterectomy].
- Author
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Cnotliwy M, Gasińska M, Petriczko W, Gutowski P, and Szych Z
- Subjects
- Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neck innervation, Postoperative Complications etiology, Cervical Plexus injuries, Cranial Nerve Injuries etiology, Endarterectomy, Carotid adverse effects
- Abstract
Unlabelled: Functional assessment of nerves, especially motor rami of cranial nerves, in patients at postoperative period after carotid endarterectomy (CEA), is particularly important in case of necessity of contralateral carotid artery surgery. Bilateral damage to recurrent laryngeal or hypoglossal nerve is a potentially life-threatening complication. Sensory disturbances due to intraoperative injuries of cervical plexus branches may cause residual discomfort in numerous patients. The aim of this study was the assessment and comparison of frequency of persistent (for more than 12 months postoperatively) manifestations of cranial and cervical nerves injuries in patients after CEA performed either in the standard or eversion technique. A prospective study evaluating cranial and cervical nerves dysfunction after carotid endarterectomies in 144 out of 193 patients operated on from January 1999 until June 2001 was undertaken at the Department of General and Vascular Surgery, Pomeranian Medical University in Szczecin, Poland. CEA was performed in the standard way (i.e. by primary closure) in 92 patients, while 52 others were operated on by eversion technique. Neurological examination with careful functional assessment of cranial nerves: V, VII, IX, X, XII and cervical plexus, was performed according to a standard protocol within two follow-up periods: 3 to 6 and 12 to 18 months after discharge from the hospital., Results: Dysfunction of recurrent laryngeal nerve and hypoglossal nerve were registered 12 to 18 months after CEA with similar incidence of 1.4%. There was no sign of residual damage to other cranial nerves. Sensory disturbances in the area supplied by cervical plexus, mainly transverse cervical and greater auricular nerve, were diagnosed in 26% of patients. There were no statistically significant differences in local neurological complication rates between patients operated on according to standard and eversion procedures., Conclusions: 1. Permanent damage of cranial nerves refers to small group of patients after carotid endarterectomy and concern predominantly recurrent laryngeal nerve and hypoglossal nerve. 2. Majority of local neurological complications are injuries to cervical plexus branches. 3. Eversion carotid endarterectomy is not related to higher incidence of local neurological deficits compared to standard procedure.
- Published
- 2005
31. [Endarterectomy--the most common method of large internal carotid artery stenosis treatment--benefits and risks].
- Author
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Jabłońska J, Trojnacka B, Ciechanowski K, Gutowski P, Cnotliwy M, Szumiłowicz H, and Szumiłowicz G
- Subjects
- Humans, Risk Factors, Carotid Stenosis surgery, Endarterectomy methods
- Abstract
Endarterectomy is the most common method of large internal carotid artery stenosis treatment. Regarding a still increasing number of procedures, performed an appropriate qualifying scheme is needed. There are many studies conducted to find an optimal method of this risk assessment. Because of population life span lengthening the management with procedures performed on elderly with accompanying age-related diseases arises is necessary. Authors have revised currently used methods of patients preoperative condition assessment as well as schemes of their monitoring peri- and postoperatively.
- Published
- 2004
32. Abdominal aortic aneurysm: association between haptoglobin phenotypes, elastase activity, and neutrophil count in the peripheral blood.
- Author
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Wiernicki I, Gutowski P, Ciechanowski K, Millo B, Wieczorek P, Cnotliwy M, Michalak T, Hamera T, and Piatek J
- Subjects
- Aged, Aortic Valve Stenosis blood, Female, Haptoglobins genetics, Humans, Leukocyte Count, Male, Middle Aged, Neutrophils cytology, Pancreatic Elastase metabolism, Phenotype, Poland, Aortic Aneurysm, Abdominal blood
- Abstract
To investigate the role of genetic factors on susceptibility to atherosclerotic arterial disease, the influence of haptoglobin phenotypes (Hp) on serum elastase activity, neutrophil count, and elastin concentration in the aorta was measured in patients with abdominal aortic aneurysm (AAA; n=52) and aortoiliac atherosclerotic occlusive disease (AOD; n=37). Findings (serum elastase activity, peripheral blood neutrophil count) were compared to a control group (CG) of 37 subjects without atherosclerosis. Hp phenotyping performed by starch-gel electrophoresis produced a haptoglobin-hemoglobin complex of three phenotypes: Hp1-1, Hp2-2, and Hp2-1. Distribution of Hp phenotypes was similar in the three study groups (AAA, AOD, CG). Significant increases in serum elastase activity and neutrophil count was measured in Hp2-1 phenotype of AAA patients. Although the aorta wall of aneurysm patients contained less (p<0.001) elastin than that of AOD patients, no significant difference of aorta elastin concentration between the three Hp phenotypes, including Hp2-1, was measured. The postulated association of AAA susceptibility with Hp2-1 phenotype was supported by the study data that demonstrated an increase in serum elastase activity in patients undergoing AAA repair.
- Published
- 2001
- Full Text
- View/download PDF
33. [Verification of the diagnosis of Buerger's disease in outpatients].
- Author
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Cnotliwy M, Gasińska M, Bogucki W, Gutowski P, and Sych Z
- Subjects
- Ambulatory Care, Diagnosis, Differential, Female, Femoral Artery physiopathology, Humans, Ischemia diagnosis, Leg blood supply, Male, Popliteal Artery physiopathology, Severity of Illness Index, Thromboangiitis Obliterans physiopathology, Thromboangiitis Obliterans diagnosis
- Abstract
The aim of the paper was to estimate the correctness of thromboangiitis obliterans (TAO) diagnosis in ambulatory patients. 99 patients with initial diagnosis of TAO selected from 3137 outpatients, have been examined in consulting unit for vascular diseases, from 1996 to 1998. Burger's disease has been diagnosed in 26 patients in accordance with Shionoya's criteria. Applying the point scoring system suggested by Papa et al., certain diagnosis could be made in 21 patients and probable on in 3 patients. Of the remaining patients, it is interesting to note that manual examination revealed absence of pulsation at femoral and popliteal arteries in 60% of patients and 42% of patients demonstrated atherosclerosis risk factors. On the other hand superficial thrombophlebitis and Raynaud's phenomenon have been rarely diagnosed in 5 and 18% respectively.
- Published
- 2001
34. [Factors influencing the length of hospital stay of patients qualified for elective carotid endarterectomy].
- Author
-
Cnotliwy M, Turowski R, Sych Z, Gutowski P, and Sobuś A
- Subjects
- Adult, Aged, Carotid Artery Diseases epidemiology, Carotid Artery Diseases surgery, Comorbidity, Diabetes Mellitus, Type 1 epidemiology, Diabetic Angiopathies epidemiology, Diabetic Angiopathies surgery, Female, Humans, Male, Middle Aged, Poland, Preoperative Care statistics & numerical data, Retrospective Studies, Risk Factors, Endarterectomy, Carotid statistics & numerical data, Length of Stay statistics & numerical data
- Abstract
The aim of this retrospective study was to identify the factors affecting long hospital stay of patients who underwent carotid endarterectomy. The analysis was based on 233 records of all patients operated on between 1995 and 1998. We have found that the main reasons of lengthened preoperative hospitalization were: insulin dependent diabetes and admission on the day excluding the chance of operation in a short time. Postoperatively, monitoring in intensive care unit and unfounded delay of discharge were the leading reasons of prolonged hospital stay.
- Published
- 2000
35. [The treatment of acute lower limb ischemia].
- Author
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Gutowski P, Sołtys J, Rać M, Szmania A, and Cnotliwy M
- Subjects
- Acute Disease, Adult, Aged, Aged, 80 and over, Child, Humans, Male, Middle Aged, Retrospective Studies, Extremities blood supply, Extremities surgery, Ischemia surgery
- Abstract
In 1988-1997 297 patients were operated on acute limb ischemia. In 131 patients ischemia was caused by arterial embolism, in 144 patients by acute arterial thrombosis, in 20 patients by arterial trauma and in 2 patients acute aortic dissection. Acute limb ischemia causes 12.8% risk of death especially in elderly and when the reason for ischemia is acute occlusion of aortic bifurcation. The majority of patients with acute arterial thrombosis requires arterial reconstruction.
- Published
- 1999
36. [Anticardiolipin antibodies in patients with Buerger's disease].
- Author
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Cnotliwy M, Gutowski P, Szumiłowicz H, Kucharska E, Jastrzebska M, and Ostanek L
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Pentoxifylline therapeutic use, Retrospective Studies, Thromboangiitis Obliterans diagnosis, Thromboangiitis Obliterans drug therapy, Vasodilator Agents therapeutic use, Antibodies, Anticardiolipin immunology, Thromboangiitis Obliterans immunology
- Abstract
The aim of this study was to estimate the incidence of occurrence of anticardiolipin autoantibodies in patients with thromboangitis obliterans (TAO). Patients with Buerger's disease had statisticaverified significant higher frequency of anticardiolipin IgM antibodies than control group. This antibody may play a role in pathogenesis of TAO, although this results should be verified because of the small number of patients and diagnostic criteria.
- Published
- 1999
37. [The pathogenesis of abdominal aortic aneurysm and polymorphism of haptoglobin and inflammatory factor].
- Author
-
Wiernicki I, Millo B, Ciechanowski K, Cnotliwy M, Gutowski P, Sobuś A, Graczewski J, and Hamera T
- Subjects
- Aged, Alleles, C-Reactive Protein genetics, Female, Humans, Male, Middle Aged, Retrospective Studies, Aortic Aneurysm, Abdominal genetics, Haptoglobins genetics, Inflammation Mediators physiology, Polymorphism, Genetic genetics
- Abstract
52 patients were operated on for abdominal aortic aneurysm and 38 for aortic occlusion disease. Haptoglobin (Hp) phenotypes were determined in all these patients. Hp and C-reactive protein (CRP) concentrations were determined in each phenotype. On the basis of the statistical analysis the highest percentage of elevated CRP concentrations was found in patients with abdominal aortic aneurysm and phenotype Hp 2-1.
- Published
- 1999
38. [Time and conditions of cerebral ischemic symptoms appearing during carotid endarterectomy under local anesthesia].
- Author
-
Gutowski P, Cnotliwy M, and Kupicz H
- Subjects
- Aged, Anesthesia, Local, Female, Humans, Male, Middle Aged, Retrospective Studies, Time Factors, Brain blood supply, Brain Ischemia diagnosis, Carotid Stenosis surgery, Endarterectomy, Carotid methods, Intraoperative Care
- Abstract
In the 1994-1997 238 carotid endarterectomies (CEA) were performed under regional anaesthesia (cervical block) for carotid artery stenosis. In 30 CEA indwelling shunt was necessary. Among 30 patients with shunt 19 (63%) had a stroke before surgery, then 9 (30%) had contralateral internal carotid artery occlusion. Among entire group of 238 patients with CEA 56 (23.5%) had a stroke before surgery and 27 (11.4%) contralateral internal carotid artery occlusion. In our opinion the strongest factor influencing neurological deficiency after clamping trial, is a history of stroke before surgery and in a less degree contralateral internal carotid artery occlusion. The mean time of the neurological deficit during clamping trial was 27 seconds and varied from 5 to 100 sec. and never appeared after 2 minutes of mentioned trial. For that reason we consider 2 minutes clamping trial as sufficient for detection of neurological deficit during CEA under local anaesthesia.
- Published
- 1998
39. [Prolonged abdominal aortic aneurysm rupture penetrating the lumbar spine].
- Author
-
Gutowski P, Cnotliwy M, Trojnacka B, and Szumiłowicz G
- Subjects
- Aged, Aged, 80 and over, Aneurysm, Ruptured surgery, Aortic Aneurysm, Abdominal surgery, Back Pain etiology, Chronic Disease, Female, Humans, Male, Middle Aged, Prevalence, Radiography, Retrospective Studies, Aneurysm, Ruptured diagnosis, Aneurysm, Ruptured epidemiology, Aortic Aneurysm, Abdominal diagnosis, Aortic Aneurysm, Abdominal epidemiology, Lumbar Vertebrae diagnostic imaging
- Abstract
The prevalence of prolonged rupture of aortic aneurysm was estimated in a group of 65 patients operated for ruptured abdominal aortic aneurysm (AAA). Patients with chronically contained rupture AAA were hemodynamically stable. Contained rupture of an AAA should be considered in patients presenting unexplained back pain and when radiograms suggest the degenerative changes within spine.
- Published
- 1997
40. [Evaluation of various diagnostic methods in aortic-iliac graft infection].
- Author
-
Gutowski P, Szumiłowicz G, and Cnotliwy M
- Subjects
- Anastomosis, Surgical adverse effects, Angiography, Aorta, Abdominal surgery, Endoscopy, Gastrointestinal, Humans, Iliac Artery surgery, Prosthesis-Related Infections etiology, Technetium Tc 99m Exametazime, Tomography, X-Ray Computed, Ultrasonography, Blood Vessel Prosthesis Implantation adverse effects, Prosthesis-Related Infections diagnosis
- Abstract
Aortoenteric anastomotic fistulae and paraprosthetic aortic-iliac graft infections are rare but devastating and potentially lethal complication of aortic graft surgery. Although the incidence of these complications is reported to be less then 1-4%, the difficulty in diagnosis and management has led to high mortality rates and extensive morbidity. In our opinion computed tomography, 99m Tc-HM-PAO-labeled white blood cell scan and upper GI tract endoscopy are a most useful adjuncts to the diagnosis of all types of aortic graft infection, like paraprosthetic-enteric fistula or graft infection without intestinal communication.
- Published
- 1997
41. [Results of treating a late thrombosis in a vascular prosthesis after surgical repair of an aorto-femoral arterial segment with atherosclerosis].
- Author
-
Cnotliwy M
- Subjects
- Adult, Aged, Anastomosis, Surgical adverse effects, Arteriosclerosis surgery, Female, Graft Occlusion, Vascular surgery, Humans, Male, Middle Aged, Reoperation, Thrombosis surgery, Vascular Patency, Aorta, Abdominal surgery, Blood Vessel Prosthesis adverse effects, Femoral Artery surgery, Thrombosis etiology
- Abstract
During a four-year period from 1987-1990 as many as 43 patients were operated on at the Department of General and Vascular Surgery PMA, Szczecin for occluded aorto-femoral grafts. Late thrombosis occurred in 6.2% of patients who underwent aorto-femoral bypass grafting. That was the most frequent indication for reoperations. The author concludes that extra-abdominal graft thrombectomy via the groin, resection of the old anastomosis and insertion of a piece of new graft to the deep femoral artery produce the best clinical results. The cumulated index of patency of prostheses after 24 months was 38%.
- Published
- 1994
42. [Symptomatic aneurysm of the abdominal aorta with coexistent horseshoe kidney].
- Author
-
Gutowski P, Sikorski A, Cnotliwy M, and Michalak T
- Subjects
- Aged, Aortic Aneurysm, Abdominal surgery, Humans, Male, Aortic Aneurysm, Abdominal complications, Kidney abnormalities
- Abstract
A case of the 66 years old patient with an expanded, symptomatic abdominal aortic aneurysm has been reported. During an urgent operation a horseshoe kidney lying in the front of aneurysm was detected. The kidney was mobilised and good access to the aneurysm was achieved without division of the renal isthmus.
- Published
- 1993
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