4th Military Clinical Hospital

Wrocław, Poland

4th Military Clinical Hospital

Wrocław, Poland

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Voors A.A.,University of Groningen | Davison B.A.,Momentum Research Inc. | Felker G.M.,Duke Clinical Research Institute | Ponikowski P.,4th Military Clinical Hospital | And 7 more authors.
European Journal of Heart Failure | Year: 2011

Aims We aimed to determine the relation between baseline systolic blood pressure (SBP), change in SBP, and worsening renal function (WRF) in acute heart failure (AHF) patients enrolled in the Pre-RELAX-AHF trial. Methods and resultsThe Pre-RELAX-AHF study enrolled 234 patients within 16 h of admission (median 7 h) for AHF and randomized them to relaxin given intravenous (i.v.) for 48 h or placebo. Blood pressure was measured at baseline, at 3, 6, 9, 12, 24, 36, and 48 h and at 3, 4, and 5 days after enrolment. Worsening renal function was defined as a serum creatinine increase of <0.3 mg/dL by Day 5. Worsening renal function was found in 68 of the 225 evaluable patients (30). Patients with WRF were older (73.5 ± 9.4 vs. 69.1 ± 10.6 years; P 0.003), had a higher baseline SBP (147.3 ± 19.9 vs. 140.8 ± 16.7 mmHg; P 0.01), and had a greater early drop in SBP (37.9 ± 16.0 vs. 31.4 ± 12.2 mmHg; P 0.004). In a multivariable model, higher age, higher baseline creatinine, and a greater early drop in SBP, but not baseline SBP, remained independent predictors of WRF. Furthermore, WRF was associated with a higher Day 60 (P 0.01), and Day 180 (P 0.003) mortality. ConclusionsWorsening renal function in hospitalized AHF patients is related to a poor clinical outcome and is predicted by a greater early drop in SBP. © 2011 The Author.

Krasowski G.,Opole University of Technology | Krasowski G.,The Surgical Center | Miodonski M.,Provincial Hospital | Seweryn-Serkis K.,Krapkowice Health Center | Janus W.,4Th Military Clinical Hospital
Wideochirurgia I Inne Techniki Maloinwazyjne | Year: 2013

This paper describes a case of a patient suffering from Hodgkin's disease and treated by means of minimally invasive surgery: laparoscopic splenectomy. The performance of laparoscopic splenectomy led to a complication in the form of a pancreatic cyst. The cyst was subjected to endoscopic procedures (endoscopic retrograde cholangiopancreatography, with a shaft to the pancreatic tract) and percutaneous drainage. The application of the above methods allowed for a quick introduction of causative treatment. Because in the case in question open surgery methods would impede the introduction of systemic treatment, minimally invasive surgery techniques (laparoscopy and endoscopy) were applied and are discussed below.

Dawiskiba T.,Wroclaw Medical University | Deja S.,University of Opole | Mulak A.,Wroclaw Medical University | Zabek A.,Wroclaw University of Technology | And 13 more authors.
World Journal of Gastroenterology | Year: 2014

AIM: To evaluate the utility of serum and urine metabolomic analysis in diagnosing and monitoring of inflammatory bowel diseases (IBD). METHODS: Serum and urine samples were collected from 24 patients with ulcerative colitis (UC), 19 patients with the Crohn's disease (CD) and 17 healthy controls. The activity of UC was assessed with the Simple Clinical Colitis Activity Index, while the activity of CD was determined using the Harvey-Bradshaw Index. The analysis of serum and urine samples was performed using proton nuclear magnetic resonance (NMR) spectroscopy. All spectra were exported to Matlab for preprocessing which resulted in two data matrixes for serum and urine. Prior to the chemometric analysis, both data sets were unit variance scaled. The differences in metabolite fingerprints were assessed using partial least-squares-discriminant analysis (PLS-DA). Receiver operating characteristic curves and area under curves were used to evaluate the quality and prediction performance of the obtained PLS-DA models. Metabolites responsible for separation in models were tested using STATISTICA 10 with the Mann-Whitney-Wilcoxon test and the Student's t test (α = 0.05). RESULTS: The comparison between the group of patients with active IBD and the group with IBD in remission provided good PLS-DA models (P value 0.002 for serum and 0.003 for urine). The metabolites that allowed to distinguish these groups were: N-acetylated compounds and phenylalanine (up-regulated in serum), low-density lipoproteins and very low-density lipopro-teins (decreased in serum) as well as glycine (increased in urine) and acetoacetate (decreased in urine). The signifcant differences in metabolomic profiles were also found between the group of patients with active IBD and healthy control subjects providing the PLS-DA models with a very good separation (P value < 0.001 for serum and 0.003 for urine). The metabolites that were found to be the strongest biomarkers included in this case: leucine, isoleucine, 3-hydroxybutyric acid, N-acet-ylated compounds, acetoacetate, glycine, phenylalanine and lactate (increased in serum), creatine, dimethyl sul-fone, histidine, choline and its derivatives (decreased in serum), as well as citrate, hippurate, trigonelline, tau-rine, succinate and 2-hydroxyisobutyrate (decreased in urine). No clear separation in PLS-DA models was found between CD and UC patients based on the analysis of serum and urine samples, although one metabolite (formate) in univariate statistical analysis was signif-cantly lower in serum of patients with active CD, and two metabolites (alanine and N-acetylated compounds) were signifcantly higher in serum of patients with CD when comparing jointly patients in the remission and active phase of the diseases. Contrary to the results obtained from the serum samples, the analysis of urine samples allowed to distinguish patients with IBD in remission from healthy control subjects. The metabolites of importance included in this case up-regulated aceto-acetate and down-regulated citrate, hippurate, taurine, succinate, glycine, alanine and formate. CONCLUSION: NMR-based metabolomic fingerprinting of serum and urine has the potential to be a useful tool in distinguishing patients with active IBD from those in remission. © 2014 Baishideng Publishing Group Co., Limited. All rights reserved.

PubMed | 4th Military Clinical Hospital and Institute of Cardiology
Type: Journal Article | Journal: The Journal of heart valve disease | Year: 2016

Degenerated and dysfunctional prosthetic valves are usually replaced surgically. However, repeated cardiac surgery can cause prohibitive risk, especially in patients with many associated co-morbidities. Transcatheter valve-in-valve implantation (TVIV) is a novel, technically very challenging, but less invasive alternative treatment for patients with unacceptably high surgical risk of degenerated prosthetic valves. The method is attractive because it takes advantage of the presence of the degenerated prosthesis, which serves as an anchoring zone. Here, the case is presented of TVIV in an 82-year-old female with significant stenosis of a biological mitral prosthesis. In 2011, Himbert et al. were the first to successfully insert a transcatheter heart valve in the mitral ring using a transfemoral approach. To date, only a small case series has been reported on the effectiveness of TVIV using a transfemoral venous access and a trans-septal anterograde approach. The present patient was the first in which TVIV was performed in Poland and Eastern Europe.

Litarski A.,4th Military Clinical Hospital | Janczak D.,Wroclaw Medical University | Cianciara J.,4th Military Clinical Hospital | Merenda M.,4th Military Clinical Hospital
Polski Przeglad Chirurgiczny/ Polish Journal of Surgery | Year: 2011

Spontaneous bacterial peritonitis is caused by infection of ascitic fluid without any apparent intraabdominal source of infection. The disease most commonly occurs in patients with cirrhosis and 70% of cases of infections are caused by pathogenes from gastrointestinal tract. The article presents the case of 38-year-old patient with spontaneous peritonitis who was treated surgically. The primary nature of the disease was confirmed by laparotomy and bacteriological examination results (Streptoccocus pneumonia) of ascitic fluid. After 54 days of hospitalisation and undergoing re-laparotomy, he was discharged in good condition.

Piwkowski P.,4th Military Clinical Hospital | Kolodziejczyk A.,4th Military Clinical Hospital | Macioszek A.,4th Military Clinical Hospital | Polczynska K.,Medical University of Gdańsk | Zebrowski J.,4th Military Clinical Hospital
Nuclear Medicine Review | Year: 2011

BACKGROUND: Wilms' tumour is the most frequent renal malignancy in children. There is no worldwide consensus regarding treatment and PET-CT role in this neoplasm. The aim of this report is to demonstrate the potential role of PET-CT in chemotherapy efficacy assessment and recurrence diagnosis. CASE description: a 7-year-old boy was diagnosed with blastemic type Wilms' tumour and underwent neoadjuvant chemotherapy, nephrectomy, and adjuvant chemotherapy in compliance with SIOP protocol. Three years later the patient underwent surgical resection of the metastasis and chemoradiotherapy. Nine months later tomography and PET-CT were performed (during the third month of the treatment due to a second recurrence). The results were equivocal but within four months the boy underwent surgical resection of a third recurrence. Fourteen months later a second PET-CT revealed an active disease with extensive involvement of the left lung and pleura. The patient was referred to oral palliative chemotherapy. DISCUSSION: Equivocal PET-CT results during chemotherapy should be interpreted with caution. The first, during third line chemotherapy, was equivocal; however, an early massive recurrence three months later indicates that treatment was ineffective. The second PET-CT examination fourteen months later, as the only modality, depicted massive progression of the disease. This suggests the value of this examination in recurrence diagnosis. CONCLUSIONS: PET-CT seems to be valuable technique in recurrence detection in patients with histologically unfavourable tumours. Equivocal results of PET-CT should raise suspicion of recurrence even in recently treated patients. The timing of CIM and PET-CT should be considered individually - no universal and reliable schedule exists. Copyright © 2011 Via Medica.

Garcarek J.,Wroclaw Medical University | Kurcz J.,Wroclaw Medical University | Guzinski M.,Wroclaw Medical University | Janczak D.,4th Military Clinical Hospital | Sasiadek M.,Wroclaw Medical University
Advances in Clinical and Experimental Medicine | Year: 2012

Background. Percutaneous transhepatic biliary drainage (PTBD) is a method of biliary tree decompression, applied as palliative treatment in patients with malignant biliary tree critical stenosis/obstruction, but also as a potentially curative treatment in patients with non-malignant biliary tree stenosis. Novel instrumentation dedicated to PTBD has been designed in recent years, which makes it possible to perform more advanced procedures in patients with severe extensive malignant biliary tree stenosis/obstruction. Objectives. The first primary goal of the study was to compare both the rate and types of short- and long-term complications in patients who had undergone PTBD between 2000 and 2006 with patients treated between 2007 and 2011. The second primary goal of the study was to work out an original algorithm of efficient management in patients undergoing PTBD. An additional goal was to assess the efficacy of PTBD and the overall survival of the patients. Material and Methods. One-hundred twenty-eight consecutive PTBD procedures performed between 2000 and 2006 in patients with malignant biliary jaundice were analyzed retrospectively. Similarly, retrospective analysis of 73 consecutive procedures in patients with malignant biliary jaundice performed between 2007 and 2011 was carried out. Subsequently, the results of both subsets were compared to each other. The PTBD procedure was guided fluoroscopy each time. PTBD involved external biliary drainage and/or stenting of the strictured/occluded segments of extra- and intrahepatic biliary ducts. Results. The analysis demonstrated a statistically significant decrease in the overall incidence of short- and long-term complications in patients undergoing PTBD in 2007-2011 in comparison to the subset treated in 2000-2006. Among the early complications, a significant decrease in sub- and pericapsular contrasted bile leaks was shown. The evaluation of long-term complications demonstrated lower incidence of the falling out of the draining catheter. The implementation of novel instrumentation made it possible to perform biliary stenting in 63.7% cases of common bile duct (CBD) obstruction (vs. 37.5% in procedures carried out in 2000-2006). However, no statistically significant difference in survival between the two analyzed subsets was demonstrated. Conclusions. The analysis of rate and types of complications made it possible to establish authors own algorithm of management in different types of biliary obstructions and strictures. The modification of procedure technique, postinterventional management and usage of the new generation of low-profile instrumentation for percutaneous access dedicated to PTBD has resulted in a significant reduction of the complication rate in the last 5 years. Higher frequency of CBD stenting improves the quality of life in this subset of patients. © Copyright by Wroclaw Medical University.

PubMed | 4th Military Clinical Hospital
Type: Journal Article | Journal: Medical ultrasonography | Year: 2016

Transthoracic echocardiography (TTE) has become one of the most important diagnostic tools in the treatment of criticallyill patients. It allows clinicians to recognise potentially reversible life-threatening situations and is also very effective in themonitoring of the fluid status of patients, slowly substituting invasive methods in the intensive care unit. Hemodynamic assessmentis based on a few static and dynamic parameters. Dynamic parameters change during the respiratory cycle in mechanicalventilation and the level of this change directly corresponds to fluid responsiveness. Most of the parameters cannot be used inspontaneously breathing patients. For these patients the most important test is passive leg raising, which is a good substitutefor fluid bolus. Although TTE is very useful in the critical care setting, we should not forget the important limitations, not onlytechnical ones but also caused by the critical illness itself. Unfortunately, this method does not allow continuous monitoringand every change in the patients condition requires repeated examination.

PubMed | 4th Military Clinical Hospital and Wroclaw Medical University
Type: Case Reports | Journal: Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego | Year: 2015

Hodgkin Lymphoma (HL) is a neoplastic disease of the lymphatic system, primary involving lymph nodes and extranodular organs. Despite successful combined chemotherapy, a proper and prompt diagnosis remains a difficult challenge. The case report documents the case of a 52-year-old patient, who had been diagnosed in various internal medicine wards for nonspecific diseases during last two years. Due to the worsening of patients general condition and suspected inflammatory, probably purulent, abdominal process, he was operated twice. Unexplained symptoms of the uncertain origin resulted in the further lack of successful diagnosis and therapy. The patient died from multiple organ failure on the 2nd day after the second operation. The final histopathological and immunohistochemical examination of the liver biopsy revealed the primary cause of death, i.e. Hodgkin lymphoma. The thorough analysis of the patients documentation revealed a full-featured image of the classic HL. A special emphasis was placed upon misleading symptoms and difficulties in correct interpretation of more sophisticated diagnostic methods. The significant features of these patients can provide sufficient guidance to proper diagnosis and treatment of this rare disease.

PubMed | 4th Military Clinical Hospital, Polish Academy of Sciences, University of Illinois at Chicago and Nicolaus Copernicus University
Type: | Journal: Histology and histopathology | Year: 2017

The epineural sheath is a promising naturally occurring material for enhancement of peripheral nerve regeneration. Based on a literature search there is a limited number of reports on the biological and immunological properties of human epineurium. The goal of this study was to assess, using immunocytochemical methods, the immunological (HLA class I and II antigens, T lymphocytes, macrophages), proangiogenic (VEGF, CD31), and neurogenic (GFAP, S-100) properties of human epineurium isolated from ilioinguinal nerves (n=19) taken from deceased donors, and from sciatic nerves (n=12) taken from limbs amputated due to critical ischemia. Our studies confirmed reduced expression of HLA class II antigens on the infiltrating cells, a reduced number of T lymphocytes, and greater vessel density in the epineurium obtained from deceased organ donors. Macrophages were more abundant in the epineurium isolated from the amputated limbs. We found that the epineurium harvested from peripheral nerves of the deceased donors showed negligible immunogenic and increased proangiogenic properties compared to the epineurium of nerves taken from amputated limbs. These findings support the rationale to use human epineurium obtained from deceased donors as a new biological material for enhancement of peripheral nerve repair for potential clinical application in regenerative medicine.

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