Publications by authors named "Zbigniew Galazka"

46 Publications

Epitaxial BaSnOthin films with low dislocation density grown on lattice matched LaInOsubstrates.

Nanotechnology 2021 Oct 7;32(50). Epub 2021 Oct 7.

Leibniz-Institut für Kristallzüchtung, Max-Born-Str. 2, D-12489 Berlin, Germany.

The use of LaInOwith (110) surface orientation was investigated as a novel orthorhombic substrate for the epitaxial growth of semiconducting BaSnOthin films. On the basis of reflection high-energy electron diffraction, energy dispersive x-ray analysis and inductively coupled plasma-optical emission spectrometry measurements, we revealed that slight Ba doping of LaInOcrystals is beneficial to stabilize the substrate surface, which facilitates the epitaxial growth of well-ordered BaSnOthin films by pulsed laser deposition. Fully strained BaSnOfilms without misfit dislocations found by means of transmission electron microscopy were achieved due to the negligible lattice mismatch between BaSnOfilm and Ba-doped LaInOsubstrate. Electric properties of La-doped BaSnOfilms exhibit a Hall-mobility of 69 cmVsat room temperature and 99 cmVsat 20 K at a constant charge carrier density of 3.8·10cm.
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http://dx.doi.org/10.1088/1361-6528/ac291cDOI Listing
October 2021

Multiple occlusions in extracranial arteries in patients with aortic arch syndrome: is minimally invasive treatment still possible? Technical aspects of the treatment based on our own experience and a review of the literature.

Wideochir Inne Tech Maloinwazyjne 2021 Mar 20;16(1):183-190. Epub 2020 Apr 20.

Department of General, Endocrine, and Vascular Surgery, Medical University of Warsaw, Warsaw, Poland.

Takayasu arteritis is a large vessel vasculitis of granulomatous nature and unknown aetiology affecting predominantly the aorta and its major branches, which may lead to ischaemic symptoms of many organs including the central nervous system. To decrease the risk of neurological complications and improve the quality of life, an arterial revascularisation may be necessary. The treatment options include pharmacotherapy as well as both open surgical and endovascular procedures, which has to be carefully chosen to obtain clinical success. There is an ongoing debate on the advantages, possibilities, and indications for implementing endovascular and open surgical methods, especially in high-risk patients. In this article we present our own experience in the treatment of an unusually complex and high-risk patient with multiple occlusion of supra-aortic branches, focusing on the technical aspects of the procedures and the decision-making process, as well as to confront with contemporary medical knowledge.
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http://dx.doi.org/10.5114/wiitm.2020.94517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7991926PMC
March 2021

A Woman with a 27-Year History of Hyperparathyroidism and Hypercalcemia Who Was Diagnosed with Low-Grade Parathyroid Carcinoma.

Am J Case Rep 2021 Mar 11;22:e930301. Epub 2021 Mar 11.

Department of General, Endocrine and Vascular Surgery, Medical University of Warsaw, Warsaw, Poland.

BACKGROUND Parathyroid carcinoma (PC), accounting for 0.005% of all cancers, is responsible for less than 1% of all cases of primary hyperparathyroidism, and equally affects males and females, usually in 4th or 5th decades of life. PC can occur sporadically and can be associated with congenital genetic syndromes such as hyperparathyroidism-jaw tumor syndrome (HPT-JT), isolated familial hyperparathyroidism, or multiple endocrine neoplasia 1 and 2 syndromes. Surgery is the main treatment, with a limited role of radio- and chemotherapy, which allows 49-77% of patients to survive 10 years. In this work we report the case of a patient with parathyroid carcinoma, whose treatment required 13 surgeries over a period of 27 years, together with radiotherapy and pharmacological treatment. CASE REPORT A 51-year-old woman was first diagnosed with primary hyperparathyroidism in 1993 at the age of 23. From 1993 to present, she underwent 13 surgeries and 33 courses of radiotherapy due to recurrent lesions, which initially had a character of parathyroid adenomas, then parathyromatosis, and finally were diagnosed as parathyroid carcinoma. The patient also required and currently requires complex pharmacological treatment to control the calcemia and manage the complications of the primary disease. Supervision by the multidisciplinary professional medical team allows the patient to lead a normal life with good control of the disease. CONCLUSIONS Parathyroid carcinoma is a rare disease with a number of complications; however, obtaining satisfactory long-term survival with acceptable quality of life is achievable.
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http://dx.doi.org/10.12659/AJCR.930301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957837PMC
March 2021

Intrarenal hemodynamics and kidney function in pheochromocytoma and paraganglioma before and after surgical treatment.

Blood Press 2021 06 15;30(3):172-179. Epub 2021 Feb 15.

Department of Hypertension, National Institute of Cardiology, Warsaw, Poland.

Purpose: Current evidence regarding renal involvement in pheochromocytoma and paraganglioma (PPGL) is scant. More accurate diagnostic methods, such as renal Doppler ultrasound for intrarenal hemodynamic studies, may provide more detailed information on renal function. It might be postulated that renal function in PPGL patients might be altered by high blood pressure and excess secretion of catecholamines. The aim of this prospective study was to assess intrarenal blood flow parameters in PPGL patients included in the prospective monoamine-producing tumour (PMT) study and to evaluate the effects of normalisation of catecholamine production after surgical treatment on long-term renal function.

Materials And Methods: Seventy consecutive patients (aged 46.5 ± 14.0 years) with PPGL were included. Forty-eight patients from the PMT study cohort, matched for age, gender, blood pressure level and presence of hypertension, served as a control group. Renal artery doppler ultrasound spectral analysis included mean resistance index (RRI) and pulsatility index (PI). Forty-seven patients completed 12 months follow-up.

Results: There were no differences in renal parameters such as RRI, PI and kidney function between PPGL and non-PPGL patients as assessed by renal ultrasound, serum creatinine, eGFR and albumin excretion rate. No correlations between kidney function parameters, intrarenal doppler flow parameters and plasma catecholamines were observed in PPGL patients. At 12 months after surgery, no differences in creatinine level, eGFR, albumin excretion rate, RI and PI were found as compared to baseline results.

Conclusions: In contrast to patients with other forms of secondary hypertension, our study did not show differences in intrarenal blood flow parameters and renal function between PPGL and non-PPGL subjects. Intrarenal hemodynamics and renal function did not change after normalisation of catecholamine levels by surgical treatment.
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http://dx.doi.org/10.1080/08037051.2020.1851590DOI Listing
June 2021

The Analysis of Selected Morphological and Hemodynamic Parameters of the Venous System and Their Presumable Impact on the Risk of Recurrence after Varicose Vein Treatment.

J Clin Med 2021 Jan 25;10(3). Epub 2021 Jan 25.

Clinic of Phlebology, 02-034 Warsaw, Poland.

Introduction: The current treatment of venous disease is focused on reflux elimination in main venous trunks, especially in the saphenous vein. However, a high recurrence rate, independent of the method of treatment, suggests that the reason of low effectiveness may be due to a strategy focused on symptoms, without considering their origin.

Method: The aim of study was the comparison of retrospective data from 535 women with venous disease, either after treatment ( = 183) or not treated before ( = 352). The analysis concerned clinical symptoms and the results of the extended diagnostics, including the examination of the lower limb, pelvic and abdominal veins either using duplex-doppler ultrasound as well as venography with computed tomography or magnetic resonance.

Results: The comparison of selected venous system parameters revealed more advanced disease progression in previously treated patients, compared to non-treated individuals (e.g., ipsi- or bilateral incompetence of sapheno-phemoral junction-29.5% vs. 20.4%, at < 0.05 and 13.6% vs. 7.7% at < 0.05, respectively). This difference could be explained by post-treatment alterations in the venous system, an older age and the higher number of pregnancies in the recurrence group. However, both groups did not differ in regards to the symptoms of pelvic venous insufficiency or the frequency of relevant variants/abnormalities in venous system.

Conclusions: Based on the aforementioned findings, we postulate the revision of treatment strategy, which should consider abdominal and pelvic veins as the source of reflux in many female subjects.
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http://dx.doi.org/10.3390/jcm10030455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7865955PMC
January 2021

Adrenal-sparing surgery for a hormonally active tumour - a single-centre experience.

Endokrynol Pol 2020 ;71(5):388-391

Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland.

Introduction: Surgeries that spare the adrenal cortex during adrenalectomy have profound justification. Indications for this type of surgery are fairly strict, and more than 30 years of observations continuously verify the results of the procedure.

Material And Methods: Of a total of 650 adrenalectomies, 22 (3.4%) were adrenal cortex-sparing surgeries. There were 16 women and six men in this group. In 10 cases, surgery was performed for pheochromocytoma, eight cases involved Conn's syndrome, and in four cases - paragangliomas located in the para-adrenal region. Secretory activity was identified in all cases.

Results: Laparoscopic partial adrenalectomy was performed in 20 patients. Conversion to open laparotomy was necessary in two cases. In patients after bilateral resection of pheochromocytoma surgery, glucocorticoids were supplemented for six weeks. No significant surgical complications were observed in this group.

Conclusions: Partial adrenalectomy for minor lesions should be a much more commonly utilised treatment method (of choice). Where bilateral adrenalectomy is necessary, a sparing procedure on one side protects patients from the need for hormonal substitution. The remaining part of the adrenal gland undertakes satisfactory secretory function after six weeks at the latest.
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http://dx.doi.org/10.5603/EP.a2020.0033DOI Listing
June 2021

Volumetric Flow Changes in Extracranial Arteries in a Symptomatic Patient with Significant Bilateral Carotid Artery Stenosis: A Case Study and Literature Review.

Am J Case Rep 2020 Oct 2;21:e927202. Epub 2020 Oct 2.

Department of General, Endocrine and Vascular Surgery, Medical University of Warsaw, Warsaw, Poland.

BACKGROUND Hemodynamically significant carotid artery stenoses are rarely diagnosed in people under 60 years of age, being mainly secondary to other concomitant diseases. Cerebral blood flow volume, which correlates with cerebrovascular reserve and susceptibility of ischemic symptoms occurrence, may aid in the diagnosis and monitoring of patients with carotid artery disease. In this report we present the case of a patient with significant bilateral carotid stenosis, focusing on the ultrasonographically measured changes in blood flow volume in extracranial arteries following surgeries. CASE REPORT A 41-year-old man with a positive history of transient ischemic attack (TIA)  was referred to our department after being diagnosed with significant 80% to 85% right internal carotid artery (ICA) and 60% left ICA stenosis. After successful carotid endarterectomy, the flow volume in extracranial arteries significantly increased (from 755 mL/min to 1053 mL/min) due to an increase of flow volume in the right ICA. With the progression of left ICA stenosis, cerebral blood flow decreased, and the patient presented with a second TIA. Following the successful treatment of the left ICA stenosis (consisting of carotid endarterectomy and stent implantation because neointimal hyperplasia resulted in significant, recurrent 80% left ICA stenosis), an increase in flow volume was observed. CONCLUSIONS Assessment of the blood flow volume in extracranial arteries may be an effective tool in monitoring patients with carotid stenoses. Due to the lack of literature on this topic, further research on cerebral blood flow volume in surgical and non-surgical patients is needed to understand this phenomenon.
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http://dx.doi.org/10.12659/AJCR.927202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540908PMC
October 2020

Left Ventricular Structural and Functional Alterations in Patients With Pheochromocytoma/Paraganglioma Before and After Surgery.

JACC Cardiovasc Imaging 2020 12 16;13(12):2498-2509. Epub 2020 Sep 16.

Department of Hypertension, Institute of Cardiology, Warsaw, Poland.

Objectives: This study sought to evaluate left ventricular (LV) structure and function in pheochromocytoma and paraganglioma (PPGL) patients before and after curative surgery.

Background: Data on catecholamine-induced effects on LV structure and function in patients with PPGL are limited and conflicting.

Methods: The study evaluated 81 consecutive patients with a PPGL, among whom 66 were evaluated 12 months after tumor removal. Fifty patients matched for age, sex, hypertension presence, and blood pressure (BP) levels served as a control group (non-PPGL group). Echocardiography was employed to assess the LV mass index (LVMI), systolic function including speckle tracking echocardiography, and diastolic function.

Results: Patients with PPGL were characterized by higher LVMI (median 103 [interquartile range (IQR): 88 to 132] g/m vs. median 94 [IQR: 74 to 106] g/m; p = 0.006) and frequency of LV hypertrophy (44.4% vs. 24.0%; p = 0.018) compared with the non-PPGL group. Patients with PPGLs were characterized by lower global longitudinal strain (GLS) and early diastolic mitral annular velocity compared with patients in the non-PPGL group (median -17.2% [IQR: 15.6% to 18.9%] vs. median -19.3% [IQR: 17.7% to 20.6%]; p < 0.001; and median 11.1 [IQR: 8.3 to 13.0] cm/s vs. median 12.3 [IQR: 10.6 to 14.6] cm/s; p = 0.018, respectively). Presence of LV hypertrophy and GLS were independently associated with plasma free metanephrine concentrations. In operated patients, there were lower frequencies of LV hypertrophy (39.4% vs. 22.7%; p = 0.003), LVMI (median 98 [IQR: 85 to 115] g/m vs. median 90 [IQR: 76 to 109] g/m; p < 0.001), and the ratio of transmitral early diastolic velocity to early diastolic mitral annular velocity (median 6.8 [IQR: 5.5 to 8.6] vs. median 6.0 [IQR: 5.0 to 7.6]; p = 0.005) but higher values for GLS (median -17.4 [IQR: -15.8 to 19.1] vs. median -18.5 [IQR: -17.1 to 20.1] p < 0.001) after compared with before surgery.

Conclusions: Catecholamine excess in patients with PPGLs can lead not only to LV hypertrophy, but also to impairment of systolic LV function and subclinical alterations of diastolic LV function, independently of BP levels. These structural and functional changes are reversible after surgical intervention.
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http://dx.doi.org/10.1016/j.jcmg.2020.07.017DOI Listing
December 2020

Combined Treatment of Multiple Splanchnic Artery Aneurysms Secondary to Median Arcuate Ligament Syndrome: A Case Study and Review of the Literature.

Am J Case Rep 2020 Aug 11;21:e926074. Epub 2020 Aug 11.

Department of General, Endocrine and Vascular Surgery, Medical University of Warsaw, Warsaw, Poland.

BACKGROUND Median arcuate ligament syndrome (MALS) is a rare and often misdiagnosed condition affecting about 0.4% of the population, typically ages 20-50 years old, and more frequently females. Caused by the compression of the celiac artery and adjacent nervous structures by the median arcuate ligament, it is typically manifested by postprandial abdominal pain, nausea or vomiting, and loss of weight. This condition also results in compensatory increased blood flow in peripancreatic arcades, facilitating formation of true aneurysms of the visceral vessels. CASE REPORT A 45-year-old woman with hypertension and left inferior renal pole cysts was referred to our department due to chronic, recurrent postprandial abdominal pains, nausea, and weight loss of approximately 15 kg in 1 year. A computed tomography (CT) scan demonstrated complete occlusion of the celiac trunk, significant stenosis of the superior mesenteric artery, and multiple aneurysms up to 17 mm in collateral circulatory vessels. Surgical decompression of the median arcuate ligament was performed and venous bypass was implanted between the aorta and the common hepatic artery, resulting in restoration of proper blood in the visceral circulation. Subsequently, 2 endovascular embolizations of visceral aneurysms were successfully performed. In the 48-month follow-up period, there was resolution of symptoms and no aneurysm formation was observed. CONCLUSIONS Endovascular methods should be the treatment of choice in patients with splanchnic artery aneurysms. However, in patients with multiple aneurysms secondary to MALS, arterial reconstruction may be considered prior to performing an endovascular procedure to restore physiological blood flow in the visceral circulation.
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http://dx.doi.org/10.12659/AJCR.926074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440745PMC
August 2020

Volumetric Carotid Flow Characteristics in Doppler Ultrasonography in Healthy Population Over 65 Years Old.

J Clin Med 2020 May 7;9(5). Epub 2020 May 7.

Department of General, Endocrine and Vascular Surgery, Medical University of Warsaw, Zwirki i Wigury 61 street, 02-091 Warsaw, Poland.

Background: Carotid flow velocity criteria are well established, with age being a factor influencing measurements. However, there are no volumetric standards for the flow in extracranial arteries. The aim of the study was related to volumetric flow assessment of extracranial arteries in a healthy population >65 years old.

Methods: Doppler volumetric measurements of internal carotid (ICA), external carotid (ECA) and vertebral arteries (VA) were performed in 123 healthy volunteers >65 years old and compared with 56 healthy volunteers <65 years old.

Results: The continuous decline in cerebral blood flow (CBF) volume was observed ( < 0.00001). Volumetric reference values were established in study groups: 1., 65-69 years: 898.5 ± 119.1; 2., 70-74 years: 838.5 ± 148.9; 3., 75-79 years: 805.1 ± 99.3; 4., >80 years: 685.7 ± 112.3 (mL/min). Significant differences were observed between groups: 1 and 3.4, as well as 3 and 4 ( = 0.0295, < 0.000001, 0.00446 respectively). CBF volume decreases gradually with age: 28-64 years-6.2 mL/year ( = 0.0019), 65-75 years-11.4 mL/year ( = 0.0121) and >75 years-14.3 mL/year ( = 0.0074). This is a consequence of flow volume decline in ICA ( = 0.00001) and to lesser extent ECA ( = 0.0011). The decrease of peak systolic ( = 0.002) and end diastolic ( = < 0.00001) velocities in ICA and peak systolic velocity in ECA ( = 0.0017) were observed.

Conclusions: CBF decreases with ageing. Volumetric assessment of CBF may play an important additional role in diagnostics of patients with carotid stenosis. Doppler assessment of cerebral flow volume may create an interesting tool for identifying patients with diminished cerebrovascular reserve and higher risk of ischemic symptoms occurrence.
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http://dx.doi.org/10.3390/jcm9051375DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291321PMC
May 2020

Retinal arterial remodeling in patients with pheochromocytoma or paraganglioma and its reversibility following surgical treatment.

J Hypertens 2020 08;38(8):1551-1558

Department of Hypertension, Institute of Cardiology, Warsaw.

Objective: Structural abnormalities in resistance arteries are a hallmark of patients with hypertension. In hypertensive patients with pheochromocytoma or paraganglioma (PPGL), it is still a matter of debate whether structural vascular changes are because of elevated blood pressure (BP) or to toxic effects of elevated circulating catecholamines. Hence, the aim of our study was to assess whether catecholamine excess and/or elevated BP affect the structure of small retinal arteries in patients with catecholamine-producing tumors.

Methods: The study included 27 patients with PPGL and 27 hypertensive patients. All patients underwent biochemical tests for catecholamine excess, echocardiography and analyses of scanning-laser-Doppler-flowmetry (SLDF) both at baseline and 12 months following surgical resection of PPGL.

Results: Baseline retinal arterial diameter, arterial wall thickness and wall cross sectional area (WCSA) were higher in patients with PPGL as compared with subjects without PPGL (arterial diameter: 110 ± 16.5 vs. 99.5 ± 10.8 μm, wall thickness: 16.3 ± 6.0 vs. 13.5 ± 4.0 μm, WCSA: 4953.9 ± 2472.8 vs. 3784.1 ± 1446.3 μm, P < 0.05). Significant correlations were noted between wall thickness and WCSA and echocardiographic parameters assessing diastolic and systolic function of left ventricle. No correlations between retinal parameters, BP level and plasma concentrations of metanephrines were observed. In patients with PPGL, there were postoperative decreases in wall thickness (16.4 ± 15.8 vs. 14.8 ± 4.7 μm; P = 0.011) and WLR (0.42 ± 0.13 vs. 0.37 ± 0.10; P = 0.003) at 12 months after surgical removal of tumors.

Conclusion: This is the first study to demonstrate that catecholamine excess is related to thickening of retinal arteries independent of BP and reversible after surgical cure. These data support a role of catecholamines in vascular remodeling in PPGL patients.
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http://dx.doi.org/10.1097/HJH.0000000000002420DOI Listing
August 2020

Undiagnosed Pheochromocytoma Presenting as a Pancreatic Tumor: A Case Report.

Open Med (Wars) 2020 20;15:103-106. Epub 2020 Feb 20.

Department of General, Endocrinological and Vascular Surgery, Medical University of Warsaw, Warsaw 02-097 Poland.

Pheochromocytoma is a rare catecholamine-producing tumor of the adrenal gland. Patients with known pheochromocytoma undergoing surgery require preoperative treatment with alpha-blockers to reduce the risk of intraoperative complications related to catecholamine release. If undiagnosed, pheochromocytoma can lead to life-threatening surgical complications. We report the case of a patient with a suspected solid pseudopapillary neoplasm in the pancreatic tail, for whom pancreatoduodenectomy was scheduled. However, shortly after abdominal incision, hypertensive crisis developed and was followed by severe hypotension requiring intravenous vasopressors, which prompted discontinuation of the operation. Further diagnostic evaluation revealed marked elevations in urinary excretion of methylated catecholamines and suggested that the tumor was in fact a pheochromocytoma extending from the left adrenal gland. After preoperative treatment with doxazosin, the patient underwent lateral transperitoneal laparoscopic adrenalectomy, with no major complications and an uneventful postoperative course. The pathological report confirmed a diagnosis of pheochromocytoma. Due to the potential for life-threatening surgical complications in patients with pheochromocytoma not treated preoperatively with alpha-blockers, this tumor type should be included in the differential diagnosis of abdominal tumors of unknown origin.
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http://dx.doi.org/10.1515/med-2020-0015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053398PMC
February 2020

Geographic disparities in the application of endovascular repair of unruptured abdominal aortic aneurysm - Polish population analysis.

Adv Med Sci 2020 Mar 21;65(1):170-175. Epub 2020 Jan 21.

Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland.

Purpose: Differences between the regions of the same country regarding the management of abdominal aortic aneurysm (AAA) have rarely been published. The aim of the study was to analyze the absolute and relative number of unruptured AAA repairs, utilizing endovascular aneurysm repair (EVAR) vs. open aneurysm repairs (OAR) and compare the AAA patients population from all 16 administrative districts in Poland.

Material And Methods: We used the Polish National Health Fund data of all patients who underwent elective treatment of AAA between 1 January 2011 and 22 March 2016 and analyzed the absolute/relative number of all AAA repairs, OAR, EVAR and incidence of concomitant diseases in distinctive regions. Relationships between the utilization of EVAR and the number of procedures, age, gender and concomitant diseases were studied.

Results: A total of 7805 patients (mean age 70.9 ± 8.1 yrs) underwent OAR (n = 2336) or EVAR (n = 5469). The age and the incidence of concomitant diseases differed significantly between districts. The highest absolute number of all repairs was performed in the Masovian district (n = 1442), while the highest relative number of all repairs in the Lublin district (36.3/100,000 65+/year). The utilization of EVAR ranged from 34.5% to 93.9% and correlated positively with the number of EVAR, age and chronic obstructive pulmonary disease occurrence and negatively with OAR number.

Conclusions: Striking differences in the relative numbers of unruptured AAA repairs and in the population characteristics in various districts of the country point to the possibility of different health needs in the regions and variations in standards of care.
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http://dx.doi.org/10.1016/j.advms.2020.01.003DOI Listing
March 2020

Prevalence of obstructive sleep apnea in patients with peripheral arterial diseases.

Sleep Breath 2020 Sep 14;24(3):1035-1041. Epub 2019 Nov 14.

Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.

Background: The presence of obstructive sleep apnea (OSA), a novel cardiovascular risk factor, contributes to the development of peripheral arterial diseases (PAD). There is a lack of data showing how often these diseases coexist.

Aims: The aim of the study was to determine the prevalence of OSA in the population of patients with PAD.

Methods: Patients previously qualified for the first revascularization due to PAD were included in the study. All patients underwent an overnight sleep study to detect OSA. Diagnosis of OSA was made when the apnea-hypopnea index (AHI) was ≥5 per hour.

Results: From 141 patients (60% men, age 69.6 ± 9.5 years), OSA was diagnosed in 68 patients (48%). OSA occurred in mild form (5 ≤ AHI < 15/h) in 39 cases (28%), in moderate form (15 ≤ AHI < 30/h) in 21 cases (15%), and in severe form (AHI ≥ 30/h) in 8 cases (6%). Patients without OSA had significantly lower body mass index (BMI; 26.9 ± 5.5 vs. 27.7 ± 5.3 kg/m, p = 0.01) and lower hip circumference (97.4 ± 11.7 vs. 98.7 ± 7.4, p = 0.04). There were no differences in the distribution of other investigated cardiovascular risk factors and diseases between these groups. There were no significant differences in OSA distribution or its severity between patients with lower extremity artery disease and carotid artery disease.

Conclusions: The prevalence of OSA in patients with PAD is very high, affecting nearly half of the studied population.
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http://dx.doi.org/10.1007/s11325-019-01950-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426286PMC
September 2020

Surgical treatment of abdominal paragangliomas.

Endokrynol Pol 2019 17;70(6):469-472. Epub 2019 Sep 17.

Department of General, Endocrinological and Vascular Surgery, Medical University of Warsaw, Warsaw, Poland.

Introduction: Extraperitoneal, abdominal paragangliomas most commonly originate from the sympathetic nervous system. Typical features include catecholamine overproduction and the potential for malignancy. Lesions are usually located paravertebrally, but when growing in a more expansive manner they may also appear between the inferior vena cava and aorta. In the authors' opinion this site excludes laparoscopic tumourectomy.

Material And Methods: Twenty-eight patients were selected for surgical management of abdominal paragangliomas in the past eight years at our endocrine surgical centre. This group consisted of 21 (75%) women and seven (25%) men, aged 14 to 84 years (mean 47.9). In 13 (46.4%) cases paroxysmal hypertension was observed. Type 2 diabetes was noted in another 10 (35.7%) patients, and Takotsubo acute coronary syndrome in two (7.1%). Patients were preoperatively qualified for either open surgery or laparoscopic tumourectomy based on visualisation and location of the tumours in imaging studies.

Results: All patients were successfully operated. Eleven (39.3%) patients qualified for laparoscopy, while the remaining 17 (60.7%) were treated with an open surgical approach due to difficult access to the lesion. The mean operative time was 130 minutes for laparoscopy and 120 minutes for laparotomy (p = 0.2). There were no local or general complications after either type of procedure.

Conclusions: The use of laparoscopic access is practically excluded in the treatment of paragangliomas located between the inferior vena cava and aorta, especially at the level of the renal vessels and extending superiorly to the diaphragm.
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http://dx.doi.org/10.5603/EP.a2019.0038DOI Listing
May 2020

Transport Properties and Finite Size Effects in β-GaO Thin Films.

Sci Rep 2019 Sep 11;9(1):13149. Epub 2019 Sep 11.

Novel Materials Group, Humboldt-Universität zu Berlin, Newtonstraße 15, 12489, Berlin, Germany.

Thin films of the wide band gap semiconductor β-GaO have a high potential for applications in transparent electronics and high power devices. However, the role of interfaces remains to be explored. Here, we report on fundamental limits of transport properties in thin films. The conductivities, Hall densities and mobilities in thin homoepitaxially MOVPE grown (100)-orientated β-GaO films were measured as a function of temperature and film thickness. At room temperature, the electron mobilities ((115 ± 10) cm/Vs) in thicker films (>150 nm) are comparable to the best of bulk. However, the mobility is strongly reduced by more than two orders of magnitude with decreasing film thickness ((5.5 ± 0.5) cm/Vs for a 28 nm thin film). We find that the commonly applied classical Fuchs-Sondheimer model does not explain sufficiently the contribution of electron scattering at the film surfaces. Instead, by applying an electron wave model by Bergmann, a contribution to the mobility suppression due to the large de Broglie wavelength in β-GaO is proposed as a limiting quantum mechanical size effect.
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http://dx.doi.org/10.1038/s41598-019-49238-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739305PMC
September 2019

Long-term outcome of renal transplantation: a 10-year follow-up of 765 recipients.

Pol Arch Intern Med 2019 08 30;129(7-8):476-483. Epub 2019 Jul 30.

Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland

Introduction: Renal transplantation is a treatment of choice for patients with end‑stage renal disease. The main goal of transplant care is to achieve the best long‑term patient survival (PS) and graft survival (GS).

Objectives: We aimed to assess the impact of various immunosuppression (IS) protocols on PS and GS following renal transplantation.

Patients And Methods: This was a retrospective single‑center cohort study including a total of 765 consecutive adult renal transplant recipients (RTRs) who underwent transplantation between 1998 and 2003. The primary endpoints included PS and GS. The secondary endpoints were graft function determined by estimated glomerular filtration rate and hospitalization length per patient per year.

Results: Ten‑year PS and GS rates were 88.6% and 78.7%, respectively. The intent‑to‑treat (ITT) group received IS that was later changed, whereas in the group on randomized therapy (ORT), the same IS protocol was maintained during follow‑up. The ITT group had significantly better PS and GS than the ORT group. In the ITT group, patients treated with a combination of tacrolimus (TAC) and azathioprine (AZA), cyclosporine (CSA) and AZA, or CSA and mycophenolic acid metabolites (MPAs) had significantly better PS than those treated with TAC and MPA. The ORT group receiving AZA in any combination also had significantly better PS than MPA‑treated individuals.

Conclusions: The effect of IS protocols on long‑term outcomes varies depending on patient subpopulations. Immunosuppressive therapy solves rejection‑related problems but does not address the increasing mortality of RTRs due to cardiovascular diseases, malignancies, or infections. Therefore, treatment recommendations should be individualized and posttransplant care, provided mainly by internists, should be carefully structured to improve long‑term outcomes of renal transplantation.
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http://dx.doi.org/10.20452/pamw.14914DOI Listing
August 2019

The importance of blood flow volume in the brain-supplying arteries for the clinical management - the impact of collateral circulation.

J Ultrason 2018 ;18(73):112-119

Department of General and Endocrinological Surgery, Medical University of Warsaw, Warsaw, Poland.

Aim: An assessment of increased compensatory blood flow in the brain-supplying arteries in patients with significant carotid artery stenosis.

Materials And Methods: Doppler ultrasound was performed in 218 patients over 60 years of age to evaluate both the degree of brain-supplying artery stenosis as well as the blood flow volume balance in all vessels supplying the brain: the internal carotid artery, the external carotid artery and the vertebral artery. The control group included 94 patients with no stenosis in the extracranial segments and no neurological manifestations, in whom blood flow values were calculated (the internal carotid artery - 290 mL/min, the external carotid artery - 125 mL/min, the vertebral artery - 80 mL/min); the total mean blood flow in the brain-supplying arteries was 985 mL/min. A 33% increase in blood flow was considered compensatory. In addition to the control group, 30 patients with asymptomatic stenosis of less than 50% and 12 patients after endarterectomy with mean blood flow of 920 mL/min and 960 mL/min, as well as two groups of particular interest to us, i.e. 38 patients with no compensatory blood flow increase despite significant stenosis (>50%) with mean blood flow of 844 mL/min and 44 patients with similar stenosis and with compensatory blood flow increase up to 1174 mL/min were included in the analysis.

Results: Comparison of the two groups showed several significant differences: increased blood flow (118% vs. 86% of the norm) in patients with compensated stenosis, an increased number of asymptomatic patients (70% vs. 37%) and a threefold increase in the number of patients with occlusions (15 : 5) in the group of patients with increased blood supply to the brain.

Conclusions: All potential blood-supplying vessels, including the external carotid artery, are involved in brain tissue perfusion in some of the patients with significant stenosis. Determining the degree of compensation may have an important impact on the indications for surgical treatment, which will make a valuable contribution to the current criteria (asymptomatic/symptomatic patients).
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http://dx.doi.org/10.15557/JoU.2018.0016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440511PMC
January 2018

Adrenal cysts - optimal laparoscopic treatment.

Wideochir Inne Tech Maloinwazyjne 2018 Sep 21;13(3):288-291. Epub 2018 May 21.

Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland.

Introduction: Adrenal cysts develop in up to about 0.2% of the overall population. They may account for up to 11% of all pathologies of adrenal glands.

Aim: Is laparoscopic resection of adrenal cysts a method for the treatment of these pathologies?

Material And Methods: In the years 2010-2017, a total of 27 patients underwent surgery due to adrenal cysts; those included 18 (66.7%) women and 9 (33.3%) men aged 29 to 84 years (mean age: 42.7). Cyst diameter ranged from 55 to 130 mm. After exclusion of hormonal hyperactivity, parasitic cysts, or, to the best possible extent, cancer lesions, patients were qualified for adrenal-sparing laparoscopic surgery.

Results: All patients were subjected to laparoscopic surgery. Cystic wall resection was performed in 15 (55.6%) patients while adrenalectomy was performed in the remaining 12 (44.4%) patients. The decision regarding the extent of the surgery was made intraoperatively. Histopathological assessment revealed pathological adrenal lesions in as few as 3 (11.1%) patients, with the rest of the study population, i.e. 24 (88.9%), presenting with normal adrenal tissue.

Conclusions: Laparoscopic resection of adrenal cysts appears to be recommendable as a method for the treatment of these pathologies. It is simpler than adrenalectomy and associated with low risk of any pathological lesion remaining within the adrenal gland following careful intraoperative assessment by an experienced surgeon.
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http://dx.doi.org/10.5114/wiitm.2018.75872DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174168PMC
September 2018

Lateral laparoscopic adrenalectomy in patients with previous abdominal surgery - single-center experience.

Wideochir Inne Tech Maloinwazyjne 2018 Sep 19;13(3):283-287. Epub 2018 Aug 19.

Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland.

Introduction: Lateral transabdominal adrenalectomy (LTA) is the most common minimally invasive technique used to treat patients with adrenal tumors.

Aim: To analyze intra-operative and post-operative complications and reasons for conversion to open surgery in patients who underwent LTA and had previous abdominal surgery.

Material And Methods: Five hundred and nineteen patients underwent LTA in our center between 2005 and 2016. We identified a study group of 150 patients, with previous abdominal surgery. We analyzed the frequency of intra-operative and post-operative complications and the reasons for conversion from laparoscopic to open adrenalectomy.

Results: The patients' mean age was 58; they underwent LTA due to hormonally active tumors (n = 79, 53%) and non-functioning adrenal tumors (n = 71, 47%). The size of adrenal lesions ranged from 20 mm to 90 mm. Seventy-eight (52%) adrenal lesions were found in the right adrenal gland, and 72 (48%) lesions in the left adrenal gland. The mean operating time was 130 min. The mean stay in hospital was five days. The intra-operative complications included blood pressure fluctuations (n = 32), abnormal vascular supply of the adrenal glands causing difficulties with dissections (n = 3), and respiratory problems (n = 1). Two (1.3%) patients had post-operative bleeding at the site of removed adrenal glands; 1 patient had an exacerbation of asthma postoperatively. Of the 150 patients analyzed, 3 (2%) required conversion to open adrenalectomy. The conversions were not caused by abdominal adhesions.

Conclusions: Lateral transabdominal adrenalectomy is feasible and safe in patients with previous abdominal surgery. In our study, conversion from laparoscopic to open adrenalectomy was not caused by abdominal adhesions.
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http://dx.doi.org/10.5114/wiitm.2018.77706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174173PMC
September 2018

Adrenal Incidentaloma - Diagnostic and Treating Problem - Own Experience.

Open Med (Wars) 2018 15;13:281-284. Epub 2018 Aug 15.

General and Endocrine Surgery of Medical University of Warsaw, Warsaw, Poland.

Introduction: Incidentaloma is defined as an tumor diagnosed accidentally using imaging studies performed due to other indications. The aim of this paper was to describe the diagnostic and treatment problems experienced by patients with adrenal incidentaloma in a clinical practice.

Material And Methods: In years 2009-2012 there were 33(16,5%) adrenal tumors diagnosed incidentally out of 200 cases treated due to adrenal pathology. The group consisted of 54 patients aged 27-77. In 15(45,5%) patients the diagnosis was made based on ultrasound examination, while in 18(54,5%) the tumor was visualized in CT/MRI.

Results: Only after the diagnostics was finalized, in which in all cases no signs of hormonal activity were detected, 26(78,8%) patients were qualified for the surgery. In 7(21,2%) cases no indications for such a management were found. The latter group was followed-up and in all patients the indications for the surgery arose due to enlargement of the tumor or/and the existence of hormonal activity. Our observations suggest that the incident finding of adrenal tumor is an indication of long-term observation. The analysis of our material shows that all patients observed needed surgical treatment.

Conclusions: The small adrenal tumors under follow-up have a tendency to enlarge and acquire hormonal activity. Long-term observation significantly increases the costs of treatment in that group, which eventually results in surgical management.
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http://dx.doi.org/10.1515/med-2018-0043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097090PMC
August 2018

Treatment Algorithm of Peripancreatic Arteries Aneurysm Coexisting with Coeliac Artery Lesion: Single Institution Experience.

Biomed Res Int 2018 18;2018:5745271. Epub 2018 Jul 18.

2nd Department of Radiology, Medical University of Warsaw, Banacha 1a st., 02-097 Warsaw, Poland.

Introduction: True aneurysms of peripancreatic arterial arcades (PAAAs) coexisting with celiac axis lesion are often asymptomatic. However, they may rupture regardless of their size and cause life-threatening hypovolemia. No treatment guidelines exist to date. We present a series of 21 patients and our management algorithm.

Material And Methods: For ruptured aneurysms we preformed endovascular embolization. Further treatment was dependent on patient's condition and control studies. In case of unruptured aneurysms, we assessed collateral circulation between superior mesenteric artery and celiac axis in angio-CT. If there was a pathway free from aneurysms, endovascular approach was chosen. Otherwise, surgical or combined treatment was favored.

Results: Endovascular treatment was performed in 14 patients with no complications. Follow-up studies revealed incomplete occlusion of the aneurysms in two cases. Surgical or combined treatment was performed in 7 patients with three serious perioperative complications. They were managed conservatively in two cases and surgically in one. Follow-up studies showed aneurismal dilatation and stenosis of a renohepatic by-pass in one case.

Conclusion: We present our management algorithm of PAAAs. Our results support the leading role of endovascular treatment. We present its limitations favoring surgical or combined treatment. All patients should be carefully followed.
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http://dx.doi.org/10.1155/2018/5745271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6077597PMC
December 2018

Growth mode evolution during (100)-oriented β-GaO homoepitaxy.

Nanotechnology 2018 Sep 9;29(39):395705. Epub 2018 Jul 9.

Paul-Drude-Institut für Festkörperelektronik, Leibniz-Institut im Forschungsverbund Berlin e.V., Hausvogteiplatz 5-7, D-10117 Berlin, Germany.

This work focuses on homoepitaxial growth of β-GaO on (100)-oriented substrates during molecular beam epitaxy. It provides a comprehensive study on the growth mode by combining in situ with ex situ tools. In situ reflection high-energy electron diffraction (RHEED) indicates 2D layer-by-layer mode accompanied by (1 × 1) surface reconstruction. The homoepitaxial layers are grown pseudomorphic with the substrate without in-plane strain as probed by in-plane azimuthal RHEED and out-of-plane synchrotron-based high resolution x-ray diffraction. In contrast to the substrate, stacking faults and twin domains are present in the layer.
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http://dx.doi.org/10.1088/1361-6528/aad21bDOI Listing
September 2018

Effectiveness of unilateral laparoscopic adrenalectomy in ACTH-independent hypercortisolaemia and subclinical Cushing's syndrome - a retrospective study on a large cohort.

Endokrynol Pol 2018 28;69(4):411-415. Epub 2018 Jun 28.

Department of General and Endocrine Surgery, Medical University of Warsaw, Poland.

Introduction: To assess the effectiveness of early unilateral laparoscopic adrenalectomy in ACTH-independent and subclinical hypercor-tisolaemia.

Material And Methods: We conducted a unicentric, retrospective study. Between 2010 and 2015, 356 laparoscopic adrenalectomies were performed in the Department of General and Endocrine Surgery of the MUW. Hypercortisolaemia was found in 50 (14%) patients, while overt hypercortisolaemia was found in 31 patients. In the hypercortisolaemia group, ACTH-dependent hypercortisolaemia was diagnosed in five (10%) and ACTH-independent hypercortisolaemia in 25 patients (50%). One patient with overt hypercortisolaemia had cancer of the adrenal cortex. The remaining 19 (38%) patients had subclinical Cushing's syndrome. For our study, we compared patients with ACTH-independent hypercortisolaemia (n = 25) with those with Cushing's syndrome (n = 19). Patients with ACTH-dependent hyper-cortisolaemia (n = 5) and the patient with cancer of the adrenal cortex (n = 1) were excluded.

Results: Patients from both groups (n = 44) underwent a unilateral transperitoneal adrenalectomy. Good early outcomes were observed in 42 patients (93.3%). In one patient, an additional laparoscopic surgery was necessary on postoperative day 0 due to bleeding. In another patient, on day 22 post-surgery, we found an abscess in the site of the excised adrenal gland, which was drained under laparoscopic guid-ance. In three patients (6.8%) with substantial obesity, temporary respiratory insufficiency of varying degrees occurred. We did not observe any thromboembolic complications. All patients with overt hypercortisolaemia and nine patients with subclinical hypercortisolaemia had secondary adrenal insufficiency postoperatively.

Conclusions: Transperitoneal unilateral laparoscopic adrenalectomy is an efficient and safe treatment option in patients with ACTH- -independent hypercortisolaemia, both overt and subclinical.
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http://dx.doi.org/10.5603/EP.a2018.0039DOI Listing
December 2018

Short- and long-term survival after open versus endovascular repair of abdominal aortic aneurysm-Polish population analysis.

PLoS One 2018 14;13(6):e0198966. Epub 2018 Jun 14.

Department of Internal Medicine, Hypertension and Vascular Diseases, The Medical University of Warsaw, Warsaw, Poland.

Objectives: The aim of the study was to compare short and long-term mortality and readmissions in patients with non-ruptured abdominal aortic aneurysm (AAA) treated with endovascular aortic repair (EVAR) or open aneurysm repair (OAR).

Design: Retrospective survival analysis based on prospectively collected medical records of the national Polish public health insurer.

Materials: In the National Health Fund database we identified all patients who underwent elective open or endovascular treatment of AAA between January 1st 2011 and March 22nd 2016. The data on mortality, selected concomitant diseases and readmissions were collected. A total of 7805 patients (mean age 70.9±8.1 yrs, 85.8% males) underwent OAR (n = 2336) or EVAR (n = 5469). A median follow up was 27.5 months (IQR range 10.0-38.4 months).

Methods: The primary outcome variable was all-cause mortality, secondary outcomes included 30-day mortality and readmissions. Kaplan-Meier (K-M), Cox proportional-hazards and propensity score analyses were performed for primary and secondary outcomes adjusting for repair type of AAA (OAR vs. EVAR), age, sex and concomitant diseases.

Results: EVAR patients had higher all-cause mortality (6.4% vs. 4.6% P = 0.002, adjHR 1.34, 95%CI 1.07-1.67, P = 0.010) compared with OAR. The mortality risks for OAR patients decreased below those for EVAR patients after 9.9 months. Of all the tested confounding factors only age independently and significantly influenced long-term mortality. Readmissions occurred more often in EVAR than in OAR (16.5% vs. 8.4% P<0.001, adjHR 2.15, 95%CI 1.84-2.52, P<0.001) independently from other covariants. Survival and readmissions Kaplan-Meier curves remained statistically different between OAR and EVAR patients after propensity score matching.

Conclusions: Survival benefit of EVAR over OAR disappeared early during the first year after procedure, particularly in patients below 70 years of age, accompanied by an increased frequency of readmissions of EVAR patients. Our data suggest re-evaluation of the strategy for AAA management in vascular units in the country.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198966PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6002078PMC
December 2018

Late type III endoleak after thoracic endovascular aneurysm repair and previous infrarenal stent graft implantation - a case report and review of the literature.

Wideochir Inne Tech Maloinwazyjne 2017 Sep 31;12(3):320-324. Epub 2017 Jul 31.

Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland.

Thoracic endovascular aortic repair (TEVAR) effectively improved the results of thoracic aortic aneurysm treatment. TEVAR is a less invasive procedure that can be performed under local anesthesia with shorter hospital stay. The perioperative morbidity and mortality rates are lower for endovascular than open repair, but the rate of secondary interventions is higher for TEVAR. We report a case of an elderly man with synchronous abdominal and thoracic aortic aneurysms. A type III dangerous endoleak was recognized 3 years after TEVAR. It was successfully repaired during an endovascular procedure. There were no new endoleaks after 12 months of follow-up. TEVAR may be the only option of treatment for risky and elderly patients. However, postoperative monitoring is necessary to exclude different types of endoleaks. Most of them undergo effective endovascular repair.
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http://dx.doi.org/10.5114/wiitm.2017.69239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649506PMC
September 2017

Long-term results of endovascular treatment for May-Thurner syndrome.

Kardiol Pol 2017 ;75(8):815

Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland, Poland.

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http://dx.doi.org/10.5603/KP.2017.0158DOI Listing
December 2017

Comparison of phenoxybenzamine and doxazosin in perioperative management of patients with pheochromocytoma.

Kardiol Pol 2017 17;75(11):1192-1198. Epub 2017 Jul 17.

Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland.

Background: Adrenalectomy with preoperative pharmacological preparation is strongly recommended in patients diagnosed with pheochromocytoma, in order to prevent perioperative complications.

Aim: To compare phenoxybenzamine (PhB) and doxazosin (DOX) in terms of perioperative haemodynamic status in patients with pheochromocytoma, who have been prepared for adrenalectomy.

Methods: Retrospective analysis of 44 patients with pheochromocytoma (aged 16-80 years, 29 females) who underwent adrenalectomy. Patients were divided into two groups: 35 patients on DOX and nine patients on PhB.

Results: Mean time of preparation for surgery was 38.8 days in the DOX group and 18.3 days in the PhB group (p = 0.04). No statistically significant differences between the DOX and PhB groups in intraoperative blood pressure (BP) fluctuations were found: < 170/100 mm Hg (34% vs. 44%, respectively, p = 0.42), ≥ 200/110 mm Hg (40% vs. 22%, respectively, p = 0.28). Mean greatest intraoperative systolic BP (195 ± 53 vs. 166 ± 42 mm Hg, p = 0.21) and diastolic BP (98 ± 20 vs. 89 ± 46 mm Hg, p = 0.21), and mean lowest intraoperative systolic BP (87 ± 13 vs. 79 ± 17 mm Hg, p = 0.25) and diastolic BP (49 ± 8 vs. 46 ± 12 mm Hg, p = 0.60) were not different between the DOX and PhB groups, respectively. Sodium nitroprusside was administrated in 30% DOX vs. 11% PhB patients (p = 0.25). Laparoscopic surgery was conducted in 97% DOX vs. 89% PhB patients (p = 0.64). Postoperative BP drop below 90/60 mm Hg was noted in 48% of the DOX vs. 43% of the PhB group (p = 0.56). Negative correlation was found between the length of DOX administration with maximal intraoperative systolic BP (r = -0.45, p = 0.006) and diastolic BP (r = -0.39, p = 0.019).

Conclusions: There are no clinically relevant differences between patients with pheochromocytoma, who have been prepared for adrenalectomy with DOX or PhB.
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http://dx.doi.org/10.5603/KP.a2017.0147DOI Listing
January 2018

Peripheral ARtery Atherosclerotic DIsease and SlEep disordered breathing (PARADISE) trial - protocol for an observational cohort study.

Kardiol Pol 2017 17;75(12):1332-1338. Epub 2017 Jul 17.

I Katedra i Klinika Kardiologii, Warszawski Uniwersytet Medyczny..

Background: Peripheral arterial disease (PAD) is in fact a group of disease entities with different symptoms and course but a common underlying cause, i.e. atherosclerosis. Atherosclerosis is known to be aggravated by several cardiovascular risk factors, including obstructive sleep apnoea (OSA).

Aim: Following paper is a protocol for the Peripheral ARtery Atherosclerotic DIsease and SlEep disordered breathing (PARADISE) trial, which aims to describe the prevalence of OSA in PAD patients scheduled for revascularisation, and to determine the effect of OSA on the procedure outcomes.

Methods: The PARADISE study is an observational cohort trial. It plans to include 200 consecutive patients hospitalised for revascularisation due to PAD. In every patient an overnight sleep study will be performed to diagnose sleep disorders. Accord¬ing to the results of the test, patients will be divided into two groups: group A - patients with OSA, and group B - patients without OSA (control group). All patients will also be screened for classical and non-classical cardiovascular risk factors. In some of the patients, during surgery, a fragment of atherosclerotic plaque will be collected for further testing. Patients will be followed for one year for adverse events and end-points. Primary end-point of the study will be the failure of revascularisa¬tion defined as recurrence or new onset of the symptoms of ischaemia from the treated region, a need for re-operation or procedure revision, or recurrence of ischaemia signs on the imaging tests.

Discussion: The data obtained will help determine the incidence of OSA in the population of patients with PAD. The au¬thors expect to show that, as with other cardiovascular diseases associated with atherosclerosis, also in patients with PAD the incidence of undiagnosed OSA is high and its presence is associated with elevated cholesterol, inflammatory markers, and higher prevalence of arterial hypertension and poor control of other cardiovascular risk factors. In addition, due to increased oxidative stress and vascular endothelial injury associated with OSA, patients afflicted with this condition will not only have more advanced atherosclerotic lesions, but also in their histopathological examination their atherosclerotic plaque will exhibit evidence of greater instability and adverse morphology. We also expect to show that in patients with OSA, achieving cor¬rect control of cardiovascular risk factors will be more difficult. The study may improve PAD control through assuring better multispecialty care in PAD patients.
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http://dx.doi.org/10.5603/KP.a2017.0150DOI Listing
January 2018
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