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Biomedical subjects

T Wróblewski

Publications and source records attributed to T Wróblewski.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

Morphologic features of hepatitis C recurrence in patients after orthotopic liver transplantation-preliminary analysis of our case observations.

INTRODUCTION: Hepatitis C virus (HCV) recurrence is almost universal in patients after liver transplantation. The diagnosis of reinfection is more difficult than that of a primary process, as shown by our pathomorphologic analysis of cases of HCV recurrence. MATERIAL: During 5.5 years, 240 liver biopsies included 54 obtained from liver transplant recipients with primary HCV infections, among whom 26 (56.5%) had clinical signs and symptoms of hepatitis. Nineteen patients from this population underwent 30 liver biopsies. In addition, seven biopsies were performed in five patients without clinical signs of reinfection. RESULTS: In 44.2% of patients with HCV recurrence and 15% without reinfection, the intensity of the primary process in the native livers was assessed as high. Reinfection was found in all patients with liver carcinoma and 67% with hepatocyte dysplasia. Histologic signs of infection were estimated as minimal (n = 4), mild (n = 19), or moderate (n = 4). In five patients with reinfections and one without recurrence, histologic manifestations of acute rejection were also observed. In conclusion, HCV was the indication for liver transplantation in 22.4% cases. Clinical manifestation of recurrence was found in 56.5% of the patients, who tended to be older than those without disease recurrence. Upon microscopy, lobular lesions predominated over the portal changes. Factors predisposing to HCV recurrence were coexistence of other liver disorders, a high intensity of the inflammatory process, hepatocyte dysplasia, and/or hepatocellular carcinoma in the native liver and acute rejection episodes.

Adult↗
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Two-stage transjugular intrahepatic porta-systemic shunt for patients with cirrhosis and a high risk of portal-systemic encephalopathy patients as a bridge to orthotopic liver transplantation: a preliminary report.

AIM: Placement of a transjugular intrahepatic porta-systemic shunt (TIPS) is a therapeutic option for the management of bleeding esophageal varices. However, the procedure is associated with an increased risk of portal-systemic encephalopathy (PSE). In this study, a two-stage modification of the standard TIPS technique was introduced for the management of variceal bleeding in cirrhotic patients with a high risk of PSE before liver transplantation. METHODS: The modified procedure was applied to four patients with cirrhosis, portal hypertension, and ascites. Two had a history of encephalopathy after variceal bleeding; the other two were encephalopathic at the time of the first stage of the modified procedure. In the first stage, a 6-mm diameter intrahepatic shunt was created using a Palmaz-Schatz stent. One month later, in the second stage, the lumen of the shunt was expanded to a diameter of 10 mm. RESULTS: Both stages of this TIPS procedure were undertaken without any associated adverse events. In particular, neither stage was followed by a deterioration of neurologic status. From completion of the second stage to undertaking orthotopic liver transplantation (a period of 2 to 6 months), no rebleeding from esophageal varices occurred. CONCLUSIONS: A two-stage TIPS procedure to reduce portal hypertension enables a more gradual adaptation to post-TIPS hemodynamic and metabolic changes than occurs after creation of a conventional TIPS. A two-stage TIPS procedure may be the method of choice for treating bleeding from esophageal varices in patients who have a high risk of developing PSE and give them a chance for liver transplantation.

Adult↗
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Posttransplant lymphoproliferative disorder: morphological picture and diagnostic difficulties.

Posttransplant lymphoproliferative disorder (PTLD) is a well-known complication of both solid organ and bone marrow transplantation. It includes a wide spectrum of proliferative changes ranging from reactive hyperplasia, borderline lesions to malignant lymphomas. PTLD develops in 1% to 10% of transplant recipients. We present 10 cases of PTLD. Five developed after renal, four after liver, and one after heart transplantation. Among the early lesions, we diagnosed two reactive plasmacytic hyperplasias; one infectious mononucleosis-like PTLD; one polymorphic lesion; and one "mixed" case of plasmacytic hyperplasia in one tonsil with a polymorphic PTLD in the second one. Among the lymphomas, we observed three diffuse large B-cell lymphoma (DLBCL); one mantle lymphoma; and one Hodgkin lymphoma-like PTLD. The morphological pictures of six PTLD cases were typical and posed no diagnostic problems. In the one case of plasmacytic hyperplasia, the lymph node morphology was atypical with atrophy of lymphoid components accompanying plasma cell proliferation. Contrary to a good prognosis of early, reactive PTLD, this patient experienced a rapid course and succumbed to sepsis. The most difficult case was a rare Hodgkin lymphoma-like PTLD, which was diagnosed only by a bone marrow biopsy. Because of its noncharacteristic immunophenotype, it was primarily diagnosed as an anaplastic lymphoma of the T-cell type. After additional immunohistochemical studies (BOB and OCT2), we established the final diagnosis of Hodgkin lymphoma-like PTLD. Due to the increasing number of organ transplantations, doctors of various specialties may encounter PTLD.

Adult↗
PubMedDate not supplied

Pathomorphological features of acute rejection in patients after orthotopic liver transplantation: own experience.

INTRODUCTION: Acute hepatic allograft rejection remains an important problem following liver transplantation. Liver biopsy specimens show a combination of characteristic changes, first observed by Snover as a diagnostic triad: portal inflammation, bile duct damage, and central or portal vein endothelial inflammation (endothelitis or endothelialitis). The aim of this study was to describe our histopathological assessment of liver transplants. MATERIALS AND METHODS: In the period between September 2000 and June 2004, we evaluated 150 liver biopsy specimens from 105 liver recipients. RESULTS: Acute rejection was diagnosed in 26.6% of liver biopsies taken from 31.4% patients who demonstrated clinical symptoms of liver damage. In 90% of cases the rejection was described as minimal or mild, and in 10% as moderate. There was no episode of severe acute rejection. Only four biopsies (10%) showed nothing but Snover triad changes. In 9 (22.5%) cases only acute rejection was diagnosed; the remaining showed in addition to acute rejection the possibility of other concomitant pathologies: viral infection in 15 cases (37.5%), biliary flow obstruction in 11 cases (28.5%), functional cholestasis in two cases (5%), and ischemic complications in three cases (7.5%). CONCLUSIONS: Histologically confirmed acute rejection episodes were diagnosed in 14.9% liver recipients. Liver biopsy specimens, aside from Snover triad features, often showed other unspecific morphological changes. Differentiation of acute rejection from other accompanying diseases is sometimes difficult, requiring precise clinical data and pathologist experience.

Acute Disease↗
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[Angiogenic activity of mononuclear cells in the peripheral blood of patients with ischemic heart disease].

In the paper the cell-mediated phase of the immune response was assessed in ischaemic heart disease (IHD). The assessment was based on the angiogenesis test in which new capillaries are formed from the already existing vascularization. The process is mediated by mononuclear cells from peripheral blood, and is induced by degradation products appearing as a result of ischaemic injury to the tissues. The test was carried out in 71 patients with IHD and in 65 clinically healthy subjects. A significant fall was demonstrated of the angiogenic activity of mononuclear cells isolated from the peripheral blood of IHD patients as compared with controls (p less than 0.001). No effect was method of disease duration, its form or treatment on angiogenesis. The obtained results may suggest a failure of the immune system competent in this process in IHD. Perhaps this is related to a special form of IHD.

Adult↗
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Chemotactic activity of neutrophil granulocytes in old people in health or with symptoms of infection.

Clinical observations point out that the inflammatory process follows a different course in old people as compared to young persons. In the studies on the mechanisms responsible for this difference the chemostatic activity of polymorphonuclear granulocytes was assessed in peripheral blood in healthy elderly persons and in people in the same age group with evidence of infections, mainly of bacterial origin. A decrease was demonstrated of the chemotactic activity of polymorphonuclears in healthy persons aged over 65 years, as compared to young people, and even a more pronounced reduction of this activity in old people with infections. The observed disturbances of the functions of phagocytic cells may be one of the causes of less effective antibacterial defense in the organism during the process of ageing.

Adult↗
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The use of segmental pressure index and transcutaneous oxygen tension in the diagnosis of peripheral arterial occlusive disease in geriatric patients.

Twenty elderly patients of both sexes complaining of exercise--induced or rest pain in limbs were studied in order to evaluate the presence of peripheral vascular occlusive disease (PAOD). The analysis of results was made on the basis of segmental pressure index (SPI) and transcutaneous oxygen pressure measurement (TcPO2). Seventeen limbs fell into the category of critical vascular insufficiency with TcPO2 below 30 mm Hg. In 10 limbs SPI volumes could not be obtained due to technical problem to take adequate Doppler signal equal to systolic pressure in a segment of the limb. We failed to find a good correlation between both techniques of measurements used.

Aged↗
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The influence of endurance training on left ventricular and catecholamine excretion at rest in elderly persons.

To determine whether physical exercise improves left ventricular performance, changes nervous sympathetic tone in elderly persons, systolic time intervals (STIs), QT/QS2 ratio and adrenaline and noradrenaline urine excretion were measured at rest in elderly persons before and after 6 weeks of endurance training. The indexes of total electromechanical systole, LV ejection time (LVET) preejection period (PEP), PEP/LVET ratio remained significantly unchanged. After training QT/QS2 ratio as an index of sympathetiotone significantly decreased. Comparison of data noradrenaline and adrenaline excretion revealed higher values in the control group after 6 weeks of observation. In the trained group excretion of catecholamines was not significantly changed over the training period. These findings indicate that endurance training does not alter LV performance and diminish sympathetical tone evidenced by QS/QT index at rest. Adrenaline and noradrenaline excretion does not correlate with the changes of sympathetic nervous tone.

Aged↗
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[Endoscopy of the upper segment of the digestive tract in patients over 70 years of age (preliminary retrospective analysis of indications and results)].

Sixty three individuals aged over 70 years were included into the preliminary analysis of both indications to and the results of endoscopic examinations of the GI upper portion. Most frequently, the indications included abdominal pain and dyspeptic symptoms. The first endoscopic examination revealed normal macroscopic picture in only 14% of the examined patients. Peptic ulcers were most frequent pathology. Indications and the results of endoscopic examinations do not differ from those in the younger age groups.

Age Factors↗
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The contractile response of the normal and atherosclerotic aortic strips to noradrenaline, and potassium ions.

In order to explain whether the arterial smooth muscle exhibits altered contractile properties in atherosclerosis, normal and atherosclerotic rabbit aortic strips were exposed to noradrenaline (NA) and potassium chloride (KCl). The experiments were repeated with normal blood and the containing an excess of free fatty acids (FFA) added to the bath. Contraction induced by NA was markedly enhanced in the atherosclerotic trips. In contrast the response of atherosclerotic aorta strips to KCl was reduced. Excess FFA blood added to the bath with NA normalized the previously enhanced contractile response in atherosclerotic aortic strips. An opposite change in KCl induced contraction was observed under the some conditions namely increased response occurred. We conclude that the enhanced reaction of atherosclerotic aortic strips to NA depending on a specific mechanism might be reversed by elevation of FFA in blood.

Animals↗
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Echocardiography application in experiments on small laboratory animals.

Rabbit heart echocardiogram was compared with autopsy measurements for assessing the accuracy of the non-invasive method in small animals. The correlation coefficient of these measurements was 0.72 for p less than 0.01. Besides that, the site of ultrasound probe application for heart visualization from the left and right side of the chest was determined. It is stressed that the rules accepted for echocardiographic investigations in man must be applied with caution and criticism to the animals because of different shape of the heart and chest wall.

Animals↗
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Left ventricular wall motion determined by echocardiography in elderly subjects.

Few data regarding the aging-associated alteration in shortening of cardiac fibres are available. To investigate this problem echocardiographic examination in older, healthy, physically active subjects were performed to measure the parameters of left ventricle at rest. The measurements were made of the posterior wall excursion (PWE), mean posterior wall velocity (mean PWV) and maximal posterior wall velocity (PWVM). It was found, that aging involves reduction of all the analysed parameters. These findings suggest that aging in healthy, physically active man reduces shortening of left ventricular fibres and the amplitude of ventricular wall excursion in resting state.

Age Factors↗