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W Kostewicz

Publications and source records attributed to W Kostewicz.

10 recordsLinked to original sources
PubMed2004

Progress of local symptoms of superficial vein thrombosis vs. duplex findings.

BACKGROUND: Risk of subsequent deep vein thrombosis (DVT) following superficial vein thrombosis (SVT) is not fully appreciated. Mechanisms, time relations and risk factors for DVT arising upon earlier SVT remain unclear. The aim of this study was to analyze time relations between local symptoms of lower limb superficial vein thrombosis, duplex findings and onset of deep vein thrombosis during clinically evident course of SVT. PATIENTS AND METHODS: 46 patients with early (onset less than 72 hours prior to inclusion) clinical diagnosis of SVT, confirmed ultrasonographically were included in this prospective, multicenter study. Progress of pain, erythema and swelling in relation to subsequent ultrasound changes in size and localization of thrombus at 0, 7, 14 and 21 day of study has been recorded. RESULTS: Local symptoms subsided completely during 3 weeks. At that time thrombus disappeared completely only in 26% of cases, in remaining cases decreased in size from average 117.5 mm to 43.0 mm. Thrombus regression was similar to venous blood outflow direction--proximal to femoral area. Thrombus propagation was observed following regression of local symptoms of SVT. 4 cases of DVT (8.7%) were diagnosed at 2-11 days. CONCLUSIONS: Local, clinically detectable symptoms of SVT regress incomparably quicker than thrombus in affected veins. Risk of further thrombus propagation extends well beyond the period of intensive local symptoms of SVT. Regression of thrombus in femoral area requires significantly more time than in popliteal or calf segment. Thrombus propagation is directed with blood flow towards femoral segment.

Adult↗
PubMed1998

[False aneurysms of lower extremity arteries: noninvasive preop diagnosis with magnetic resonance angiography and Doppler ultrasonography].

The purpose of this study was to work out a diagnostic algorithm to be used in patients surgically treated because of a false aneurysm of arteries supplying the lower limb. The study includes preoperative vessel evaluation as well as treatment results assessment with MRA and US methods. Examinations included until now 16 patients with clinical false aneurysm suspicion. Most cases presented false aneurysms being complications after arterial graft implantation, in two patients, who were not previously operated, diagnosed false aneurysms were the result of injury. We performed 23 examinations (7 of which were postoperative treatment result evaluation examinations). Examinations were performed on MR equipment with a 1.5 T field induction. The 2D TOF with traveling presaturation method was used. Primary data and reconstructed (MIP) angiograms were analyzed by a radiologist having no access to clinical information and previous examination results. Ultrasound duplex doppler examinations were performed with 7 MHz linear probe. The MRA examinations visualized 7 false aneurysms of the lower Y-graft junction. Clinical verification, ultrasonography examinations and surgery confirmed the existence of 6 aneurysms of the Y-graft as well as 5 out of 6 diagnosed in the ileofemoral graft junctions area. The post-traumatic aorta aneurysm and the postarteriographic femoral aneurysm were also confirmed. Two false positive MRA diagnoses were due to dilatation of the artery below the graft junction, in one case it was a dilatation of the vessel below a stenosis. Furthermore, the MRA helped diagnosing stenoses and occlusions in femoral arteries and common iliac artery.

Adult↗
PubMed1997

[Iatrogenic reasons for conversion after laparoscopic cholecystectomy].

The authors discusses causes of conversion after laparoscopic cholecystectomy (LC). 16 cases of technical and emergency conversions have been presented. The link between the experience of the surgeon and the frequency of such conditions has been emphasized. It has been established that emergency conversion is a complication in LC, while technical conversion negatively affect this technique but is likely to reduce the number of major complications.

Adolescent↗
PubMed1996

[Laser laparoscopic cholecystectomy].

Clinical use of the Polish Nd-YAG laser with "naked fibre"--type tip in the laparoscopic cholecystectomy is discussed. Eleven subsequent patients with the symptomatic cholelithiasis confirmed with ultrasonography have been operated with this technique. Laser served mainly to dissect gall bladder from the liver. Biliary duct and cystic artery have been clipped. No complications of the laparoscopic laser cholecystectomy have been noted. Gall bladder wall has been perforated in 3 patients operated with contact technique. However, there have been no technical problems, and further preparation of the gall bladder has been successfully completed with laser in all cases. A value of laser in laparoscopic cholecystectomy seems lower than that of electrocautery. However, a non-contact photocoagulation in the hemostasis of blood vessels in gall bladder removal site seems promising. Laser prolongs the duration of surgery and markedly increases its cost. Further investigations are required to evaluate laparoscopic laser cholecystectomies as the effects of laser beam in the abdominal cavity remains unknown.

Adult↗
PubMed1994

[Results of intra-arterial administration of PGE1 prostaglandin].

On the basis of own clinical material the results are presented of intra-arterial administration of PGE1 prostaglandin (Prostavasin) to 18 patients with chronic lower limb ischaemia in II, III and IV stage of the disease according to Fontaine. In the group of 15 patients (four treated as outpatients) Prostavasin was administered in multiple infusions of 20 micrograms of the drug, according to the schema recommended by the producer. Three very good, six good and three poor results were observed. The best results were seen in young patients with persisting pulse over the popliteal artery. The presented method of treatment was assessed as safe, with the possibility of application, in selected cases, on outpatient basis.

Adult↗
PubMedDate not supplied

False aneurysms of the proximal anastomosis of the arterial prosthesis and the abdominal aorta.

Due to a false aneurysms of the aortic-prosthetic anastomosis ten patients aged 42-74 years underwent surgery. In three patients, an aneurysm occurred twice. One was operated on after the aneurysm had ruptured. Six patients were treated for hypertension. In the course of the primary procedure, in six cases aortic-bifemoral grafts were implanted, in four--an aortic-femoral, and in two aortic-biiliac grafts were used. In six patients end-to-end anastomoses were performed, and in four--end-to-side. Surgical corrections due to the occurrence of a false aneurysm were performed 3 months to 10 years after the original surgery. On reoperation, purulent matter was found in the site of the prosthesis. In two patients, aortic-intestinal fistulas were detected, and in one--an aortic-cecal fistula. In six patients the anastomoses were totally separated. In the course of 13 procedures performed in false aneurysms, five times replaced, single sutures were applied to the entire circumference of the anastomosis in four cases, including one case where an oblong patch was also used, in three cases an extra segment was sutured between the aorta and the previously implanted prosthesis, and the aneurysmal sac was filled with wire in one patient. Eight patients were reoperated, including three repeated procedures due to a false aneurysm of the proximal anastomosis. Moreover, the patency of prostheses was restored, abscesses were surgically opened and procedures were performed in the colon. Four patients have survived, including one with bilateral amputation of lower limbs. The most common cause of death was myocardial infarction. Two patients died due to massive hemorrhage, and one as a result of uremia.

Adult↗
PubMedDate not supplied

Application of transcutaneous oxymetry in vascular surgery.

Our study is aimed at the assessment of transcutaneous oxygen pressure tension measurements (tcpo2) application in relation to evaluation of results of vascular operations upon chronic ischaemic limbs and choice of amputation level if necessary. 269 patients were examined. All measurements were performed with the help of Hellige Oxymonitor SM 361 and a Polish one. A Clark-type electrode was attached to the surface of the skin at the dorsum of the foot and 1/3 upper tibia level (10 cm below lower margin of the patella). In several cases 1/3 lower thigh level was examined too. The clinical status of patients appeared to reflect tcpo2 values. Correct process of healing was observed to start from tcpo2 critical value of 40 mmHg. Tcpo2 method seems very useful for assessment of results of blood-flow reconstruction operations and choice of most advisable level for chronic ischaemic limb amputation.

Adult↗
PubMedDate not supplied

[Usefulness of transcutaneous oximetry in vascular surgery].

The assessment is presented of the value of transcutaneous oximetry in vascular surgery and in choosing the level of ischaemic limb amputation. Transcutaneous measurements of oxygen pressure (tcp02) were performed in 172 patients operated on for chronic ischaemia of the lower limbs before and three weeks after the operation. The studied subjects had the following operations done: bifurcated or unilateral aortofemoral bypass, femoropopliteal bypass, restoration of patency of the iliac and femoral arteries, lumbar sympathectomy, lower limb amputation. The studies were carried out using Hellige SM 361 oxymonitor and a similar Polish device. For oximetric measurements superficial skin sensor (Clark's polarographic electrode) was used, which was applied into the dorsum of the foot and medial crural surface. Transcutaneous oximetry seems to be a useful method for the assessment of the results of operations restoring blood flow in lower limb arteries. It makes possible to evaluate the results of lumbar sympathectomy. Transcutaneous measurements of oxygen pressure are also a useful method for the assessment of results of amputation of chronically ischaemic lower limb.

Adult↗