Redox perturbations in yeast cells lacking glutathione reductase

Cellular redox homeostasis has a major effect on cell functions and its maintenance is supported by glutathione and protein thiols which serve as redox buffers in cells. The regulation of the glutathione biosynthetic pathway is a focus of a lot of scientific research. However, still little is known about how complex cellular networks influence glutathione homeostasis. In this work was used an experimental system based on an S. cerevisiae yeast mutant with a lack of the glutathione reductase enzyme and allyl alcohol as a precursor of acrolein inside the cell to determine the cellular processes influencing glutathione homeostasis. The absence of Glr1p slows down the growth rate of the cell population, especially in the presence of allyl alcohol, but does not lead to complete inhibition of the cell's reproductive capacity. It also amends the GSH/GSSG ratio and the share of NADPH and NADP⁺ in the total NADP(H) pool. The obtained results show that potential pathways involved in the maintenance of redox homeostasis are based from one side on de novo synthesis of GSH as indicated by increased activity of γ-GCS and increased expression of GSH1 gene in the Δglr1 mutant, from the other hand, on increased the level of NADPH. This is because the lower ratio of GSH/GSSG can be counterbalanced with the NADPH/NADP⁺ alternative system. The higher level of NADPH can be used by the thioredoxin system and other enzymes requiring NADPH to reduce cytosolic GSSG and maintain glutathione redox potential.

Neurological symptoms associated with cerebral hyperperfusion syndrome after CEA and CAS--one centre study

BACKGROUND

There are two equivalent in efficacy methods of the treatment of carotid artery stenosis: endarterectomy (CEA) and stenting (CAS), in which the blood flow increases in most patients by 20-40% over baseline, in some exceeding 100% and being symptomatic and leading to cerebral hyperperfusion syndrome (CHS).

AIM

The aim of this study is to analyze the structure of neurological symptoms associated with CHS in patients with carotid artery revascularization.

PATIENTS AND METHODS

Retrospective analysis included 1386 consecutive patients treated in the Department of General and Vascular Surgery between 2005 and 2011, with 625 of them were subjected to CEA and 761 to CAS. If neurological symptoms occurred, patients were consulted by a neurologist and ultrasonography (USG) examination and CT were performed. Neurological symptoms in patients with new onset of headache ipsilateral to the carotid revascularization were extracted from medical records and nursing documentation.

RESULTS

Neurological symptoms attributed to CHS were observed in 66 (10.6%) of CEA and 61 (8.0 %) of CAS group. The frequency was similar in both groups (p = 0.43). The occurrence of epileptic attacks was similar in both study groups. The only difference was the less frequent falling of the lip in CAS group. Transient bradycardia and/or hypotension were observed in CAS (8.8% vs. 10.4% and 1.3% vs. 1.3%, respectively). No difference in stroke appearance between groups were found.

CONCLUSIONS

The occurrence of neurological symptoms attributable to cerebral hyperperfusion syndrome after carotid artery revascularization in short term observation is similar regardless of the method used.

The influence of Body Mass Index on chronic venous disorders therapy

AIM

Obesity is of importance among the risk factors predisposing for chronic venous disorders (CVD). Little is known how obesity affects the management of CVD. As the data concerning the treatments of CVD in the obese are incomplete, we performed an analysis of the different CVD therapies managements with respect to body mass index and the obesity.

METHODS

We analyzed 9797 CVD patients from of a previous large national CVD survey, in regard to their Body Mass Index (BMI), CVD class and CVD therapies. Among them 2213 patients presented class I, 516 class II or morbid obesity.

RESULTS

BMI was significantly associated with the method of CVD therapy. Logistic regression showed that venoactive drugs are preferentially used except in class I obesity patients but also when therapy is managed by general practitioner. Logistic regression analysis showed that class II and morbid obesity is associated with more frequent prevalence of previous surgical procedures related to CVD (OR=2.62 with 95% confidence interval of [2.16-3.17]) and topical agent use, (OR=1.77, [1.38-2.25]) but with a significant decreased compliance with compression therapy (OR=0.74, [0.61 - 0.89]), regardless of the clinical course of the disease, and socio-demographic factors. While class I obesity increased the adherence with VADs.

CONCLUSION

The therapy of CVD is affected by body mass index. Class II and morbid obese CVD patients are less frequently compliant with compression therapy but are willing to accept surgical procedures and the use of topical agents.

Compliance in pharmacotherapy in patients with chronic venous disorders

AIM

The aim of this study was to evaluate the factors that limit the use of venoactive drugs (VADs), especially in patient with chronic venous disorders (CVD) noncompliant with compression therapy in a nationwide survey.

METHODS

Analysis included 5134 CVD patients compliant with compression therapy and 4663 of those not accepting such method of therapy, participating in a large survey.

RESULTS

Venoactive drugs (VADs) and topical agents were used significantly less frequently by patients noncompliant with compression therapy compared to the compliant population (95.2% vs. 97.7%, P<0.001 and 70.1% vs. 79.9%, P<0.001, respectively). There were also less patients on two VADs concurrently in these subgroups (14.6% vs. 24.6%, P<0.001 respectively). Logistic regression analysis confirmed that noncompliant also have decreased adherence to Ruscus aculeatus extracts (OR=0.870), micronized purified flavonoid fraction (MPFF) preparations (OR=0.886), and topical agents (OR=0.877), but not horse chestnuts seed extracts. Coexisting obesity and other chronic illnesses were among the factors that decreased the use of Ruscus aculeatus extracts and micronized purified flavonoid fraction (MPFF) preparations. The use of topical agents was reduced with age, male sex, patients with coexisting chronic illnesses, obesity and adverse to accepting compression therapy. Additionally diuretics, antiplatelet agents and low-molecular weight heparins were less frequently used in the noncompliant population.

CONCLUSIONS

Patients who are not compliant with compression therapy are more frequently not adherent to pharmacological therapy. Coexisting obesity and other chronic illnesses demonstrate decrease in adherence to CVD pharmacotherapy.

Compliance with compression stockings in patients with chronic venous disorders

OBJECTIVE

The aim of this large survey was to evaluate non-compliance with compression stockings in chronic venous disorder (CVD) patients.

METHOD

A total of 16,770 CVD patients participated in this study.

RESULTS

Compression stockings were used by 25.6% of CVD patients and 46.6% of the patients were never prescribed compression therapy. Compression stocking use was found to increase with the clinical stage of CVD. The percentage of patients using compression stockings during control visits increased to 37.4%. Furthermore, 5.3% of the patients coming to control visits discontinued the use of compression stockings owing to high cost, sweating, itching, cosmetic reason, oedema exacerbation, exudation lesions of lower legs and application difficulty. Past episodes of vein thrombosis (OR = 0.80), of stroke (OR = 0.28) and of varicose veins surgery (OR = 0.28) were decreasing, while the management by a general practitioner was increasing the risk (OR = 1.36) of compression therapy cessation.

CONCLUSION

(1) Compression stockings are too rarely prescribed and often unaccepted at early stages of CVD; (2) The common reason for discontinuation of compression therapy is its high cost.

Toll-like receptors and the tendency of normal mucous membrane to transform to polyp or colorectal cancer

The aim of this study was to identify differences in Toll-like receptor (TLR) expression patterns in normal and diseased tissues of patients with polyps and colorectal cancer. Eight patients were included in the study group (aged 38 to 72 years). Sixteen HG-U133A oligonucleotide microarrays were analysed including four of colonic polyps, four of adenocarcinoma with different degree of histological differentiation (2 poorly and 2 highly differentiated), and eight of macroscopically normal tissue. The levels of selected TLR mRNA transcripts were analysed. An analysis of all per cent variability values with regard to malignancy stage increasing from polyp to stages I to III adenocarcinoma, and normal colon mucosa shows a statistically significant relationship for TLR2 (increasing) and TLR3 (decreasing). In polyps, copy numbers of TLR3, TLR4 and TLR5 mRNA were the highest and TLR7 mRNA the lowest. In normal colon mucosa of polyposis patients the highest mRNA copy numbers were observed for TLR3, and the lowest for TLR7. TLR3 may serve as a marker of colon tissue metaplasia and may indicate the tendency of normal tissue to form polyps transforming to colorectal cancer.

Self-expandable metallic stents in the treatment of post-esophagogastrostomy/post-esophagoenterostomy fistula

Esophageus or gaster resection in patients with malignant disease is still a treatment of choice. It is obvious that each surgical procedure in these patients carries some possibility of complications. Esophageo-gastric or esophageo-jejuno anastomosis has a 4-27% frequency of fistula occurrence. All these result in 65% mortality in cases of poorer prognosis. The aim of this paper is not to present all types of complications but to objectively analyse the usefulness of the covered stent placement in the treatment of anastomotic fistulas. We present six patients who were treated for postoperative fistula of esophageo-gastric anastomosis (1 case) or esophageo-jejuno anastomosis (5 cases). All patients were treated with stapler suture for digestive tract reconstruction after malignancy removal during the primary surgical procedure. Signs and symptoms of suture leak between 5-8 days post-surgery were observed. Conservative therapy was not effective. Thus a new method of treatment was employed - covered stent placement. The procedure was performed under X-ray control. In all treated patients there was change for the better and quick reduction of secretion from the fistulas was observed. All patients were discharged from the department after several days and all had survived at 30 days follow-up. Covered esophageal stent placement seems to be a safe and promising method of treatment for patients with anastomotic fistula which significantly reduces mortality and improves quality of live. Our experiences confirms that of other investigators.

Smooth Muscle Cell Apoptosis in Primary Varicose Veins

OBJECTIVES

One of the important factors responsible for vessel wall remodelling is programmed cell death. In the paper the role of smooth muscle cell (SMC) apoptosis in primary varicose veins (PVV) is investigated.

MATERIAL AND METHODS

Vein specimens were obtained from 40 patients with PVV. In each case proximal and distal (upper crural) great saphenous veins (GSV) were harvested. Morphometric computer assessed quantitative evaluation of SMCs, collagen and elastin content was carried out. Apoptotic cells were detected by TUNEL assay. The levels of p53, BAX, BCLl-2 and p21 mRNA expression were assessed by real time RT-QPCR and the presence of respective proteins in the vessel wall was confirmed by immunohistochemistry.

RESULTS

In the proximal GSV segments a significant increase of p53, p21 and BCL-2 mRNA levels was found in PVV patients. In the distal segments BAX and BCL-2 expression levels were higher. Taking into account the patient age, elevated p53 mRNA expression level was noticed in the distal incompetent GSVs of young PVV patients. In this group a statistically significant increase in the apoptotic index (APIx) within the vein media was found which correlated positively with p53 mRNA expression level. There was no increase of the apoptotic activity in elderly patients that led to the structural changes increase. In proximal GSV segments, despite SMC amount reduction or presence of structural changes in perivalvular wall region, no increase of the APIx with was noticed.

CONCLUSIONS

P53-related apoptosis is one of the regulatory mechanisms of vein wall homeostasis maintenance. During varicose vein development its activation is related to the early stages of the disease. In the further course, the down-regulation of the SMC apoptosis within the vein media leads to the structural changes increase. The reduction of the SMC population corresponding to an increase of p21 expression in proximal saphenous vein segments suggests that the cell cycle disturbances may lead to the 'weakness' of the proximal GSV wall. Valve injury is not the only factor leading to the varicose veins occurrence.

The effect of prolonged ischaemia and cryopreservation on the cell viability of human aortic and femoral artery allografts

The viability of the human arterial allograft cells depends on the time and method of vessel procurement and storage. In this study, an evaluation of the effect of the duration of 4 degrees C ischaemia and cryopreservation on human aortic and femoral artery allograft viability was performed. After the isolation of arterial wall cells, the identification of cultured cells was performed using mRNA analysis for estimation of smooth-muscle markers of differentiation: desmin and heavy-caldesmon. The viability of cells from the medial layer of the aortic wall ranged from 74 to 90% (61-79% for femoral arteries). Cold ischaemia time (from harvesting until the beginning of the preparation) is a statistically significant factor influencing smooth muscle cell viability. Smooth muscle cells represented the majority of live cell population.

[Repeated excision of abdominal aortic aneurysm--case report]

A case of 69-year-old male patient with recurrent abdominal aortic aneurysm is described. The patient had been successfully operated on for infrarenal abdominal aortic aneurysm 4 years before, and 2 months postoperatively dilatation of juxtarenal part of abdominal aorta was diagnosed in ultrasonic examination. Due to progressive enlargement of juxtarenal aneurysm the patient was admitted to hospital again and operated on. Excision of aneurysm with implantation of both renal arteries to the prosthesis was done. The perioperative course was uneventful. Authors emphasize the importance of evaluation of abdominal aorta after operative treatment of aneurysm (ultrasonic, CT, MRI) to diagnose recurrent aneurysms.

[Is a post-cholecystectomy syndrome the result of inappropriate preoperative diagnosis?]

The occurrence of the postcholecystectomy syndrome is very often connected with inappropriate preoperative diagnostics. One of the reasons might be the presence of gastric or duodenal ulcer, what can be connected with peri- and late postoperative complications. The prospective analysis of 250 patients admitted to the Department because of cholelithiasis was performed. In 28.8% of cases endoscopical changes in the upper alimentary tract were recognized. That is why, in patients qualified for cholecystectomy the upper alimentary tract endoscopy should be performed.

Neoplastic lesions of the human liver in relation to the activity of the cytochrome P-450 dependent monooxygenase system

We studied the activity of Mixed function oxidase (MFO) in human livers affected by cancer. We determined the content of cytochrome P-450 and b5, as well as the activity of their corresponding reductases, according to generally accepted methods. Liver fragments corresponding with a) healthy tissue, b) tissue at the cancer border and, c) cancerous tissue were collected during surgery from patients with liver cancer. We noted that the developing liver cancer decreased the level of cytochrome P-450, even by a magnitude order. The activity of its corresponding reductase was higher in cancerous than in healthy tissues. Cytochrome b5 behaved in an analogous manner, although the decrease in its content was less significant. NADH-cytochrome b5 reductase activity changes were insignificant.

[Inflammatory abdominal aortic aneurysm]

The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

Thrombocytosis after prophylactic administration of enoxaparin: unexpected findings in a Polish prospective multicenter trial on the efficacy and safety of enoxaparin in the prevention of postoperative thromboembolism

BACKGROUND

Heparin-related thrombocytopenia is a common complication of heparin administration and therefore platelet count was monitored in our study.

METHODS

EXPERIMENTAL DESIGN

Prospective multicentre study.

SETTING

14 Departments of General, Thoracic or OrthopaedicSurgery, Poland.

PATIENTS

290 patients--150 general or thoracic surgery patients aged above 40 years, and 140 orthopaedic surgery patients aged between 18 and 60 years.

INTERVENTIONS

All patients received 20 mg (general and thoracic surgery) or 40 mg of enoxaparin (orthopaedic surgery) once daily subcutaneously both before surgery and during postoperative immobilisation.

MEASURES

Platelet count was evaluated prior to surgery and on the 5th, 7th, 11th and 15th day following the operation.

RESULTS

There was neither thrombocytopenia nor heparin-induced thrombosis. Paradoxically, postoperative platelet count in most cases increased slightly but statistically significantly, but in some however, even above 600 G/l, nevertheless in these patients no thrombotic complications occurred. Postoperative thrombocytosis was greater in patients with neoplasms as well as those with excessive perioperative blood loss and transfusions.

CONCLUSIONS

As platelet count was not the main topic of our study, the presented data should be regarded only as preliminary. Further investigations to resolve the cause of the observed phenomenon of thrombocytosis are therefore necessary.

[The infection of the vascular prosthesis treated by the human cryopreserved allograft implantation: a case report]

75 years old patient was admitted to the Department with infection of the previously implanted bifurcated aorto-bifemoral by-pass. Periprosthetic retroperitoneal abdominal abscess in the US--colour doppler examination was recognized. Unilateral femoral pulse was present--the patient after femoral amputation of the right leg. In the first step of the treatment, the drainage of the periprosthetic abscess was performed. Because of poor results of the local and pharmacological treatment and bleeding from the prosthesis, in the next step, human cryopreserved aorto--femoral allograft was implanted "in situ". Simultaneously, bifurcated prosthesis was evacuated. In the postoperative period, healing of the inquinal wounds was excellent. There were no problems connected with peripheral circulation. The patient was discharged from the hospital on the 24th post-operative day in the good local and general condition. Homograft is an efficient and promising alternative for the treatment of severe vascular prosthesis infections.

[Missed abdominal neoplasms during laparoscopic cholecystectomy and herniorrhaphy--analysis of material]

The authors present 9 cases of overlooking abdomen cavity neoplasma during laparoscopic cholecystectomy (L. Ch.) 8 patients had L. Ch. in other laparoscopic centers. Localisation of the tumors concerned: head of pancreas in 3 cases, posterior wall of stomach in 3 patients and splecic flexurae of colon in 2 cases. Patient was reoperated because of: painless jaundice in 3 cases, bleeding from upper part of digestive tract in 3 cases, acute or subacute intestinal obstruction in 2 cases. The period of time between the L. Ch. and a reoperation was: 2 weeks up to 2 months in patients with tumor of large or small bowel, 1 month up to 1 year in patients with head of pancreas carcinoma and 2 months up to 14 months in patients with stomach neoplasma. None of the patients complained about symptoms of neoplastic illness before the L. Ch. Small, deeply located or unapproachable for the examination tumors of an abdominal cavity might be easily overlooked during L. Ch.

CONCLUSIONS

1. Perhaps better anamnesis and more extensive diagnostic procedures (G. endoscopy, ERCP, CT) might have caused earlier discovery of the malignancies in some of these patients. 2. During laparoscopic control of abdomen cavity overlooking of neoplastic illness, particularly in patients aged over 40 is possible.

[Analysis of mortality risk factors in patients with ruptured abdominal aortic aneurysm]

The purpose of the study was to estimate which factors could have effect on successful outcome of surgery in patients operated on for ruptured abdominal aortic aneurysm (RAAA). The analysis referred to 66 patients operated upon from 1992 to 1995. The specification of all factors which could bring the influence on the successful result of the surgical treatment, was done. The statistical analysis was taken using the Yule-Kendall test and according to it for each factor the risk coefficient Q (from 0.8 to 1.0) was suggested. The group of factors conditioning in each case the failure of surgical procedure was noticed. There were differences in mortality after surgical treatment of RAAA -from 41.2% to 83.3%, mean 63.6%. The mortality of 100% was ascertained in patients with Q above 3.5. The correlation between number of patients with expected risk factors and increasing mortality rate was done. This method is useful for explaining divergences in results of surgical treatment in patients with RAAA and may be helpful for qualification of patients for surgical procedure.

[Second look in abdominal surgery]

The paper presents authors experience and indications for an elective relaparotomy performed as the second-look laparotomy after primary operation. 12 patients with vascular or surgical diseases were operated on for: abdominal neoplastic tumors (2 patients), elective abdominal aneurysm (2 patients), ruptured abdominal aneurysm (2), abdominal aneurysm ruptured into the inferior caval vein (1), ruptured aneurysm of the iliac artery (1), abdominal aortic coarctation with visceral arteries abnormality (1), thrombosis of the superior mesenteric artery (1) and peritonitis because of intestinal ischaemia and necrosis (2 patients). In all cases an elective relaparotomy was done on the 1st or 2nd postoperative day. 5 patients died, in 4 cases complications found during second look relaparotomy required surgical treatment (2 of this patients died, two other were successfully treated). The authors discuss indications and advantages of elective second-look laparotomy in abdominal surgery according to the anticipated risk factors and patients condition.

A comparison of the clinical usefulness of CA 19-9 and CA 50 in the diagnosis and monitoring of gastrointestinal cancers

We compared serum levels of CA 19-9 and CA 50 in 108 patients with malignant neoplasms of the stomach, pancreas, liver, and colon with the serum levels in 60 patients with benign gastrointestinal diseases, and 10 healthy subjects. Increased serum levels of CA 19-9 and CA 50 were found in 51.8 and 62% of the cancer patients, respectively. The results of CA 19-9 and CA 50 assays in the nonneoplastic group showed less specificity. False positive results were noted in 11.7% of CA 19-9 tests and in 31.6% of CA 50 tests. We concluded that in gastrointestinal cancer, the CA 19-9 test should be performed initially. CA 50 determination can be useful, but the lower specificity of the test should be taken into consideration. CA 50 should be recommended only for postoperative monitoring, especially in patients with normal CA 19-9 serum levels.

[Popliteal artery entrapment syndrome]

The popliteal artery entrapment syndrome is observed in about 0.5% of patients suffering from intermittent claudication, most often in young fit people. Significant diagnostic problems are the reason of frequent underestimation of the patients complaints. The development of the disease may further lead to lower leg arteries thrombosis or popliteal artery aneurysm. The latter condition is caused by abnormal course of the popliteal artery. Preliminary diagnostic procedures may comprise the examination with most simple Doppler apparatus. The diagnostic should be confirmed with the use of colour-Doppler ultrasonography or computed tomography (with contrast). The treatment of choice is an operation restoring normal anatomy within the popliteal space.

[Surgical course in patients with diabetes]

A retrospective analysis is presented of 388 patients with diabetes mellitus treated in a gastrointestinal surgery department in the years 1975-1988. In the patients 473 diseases were diagnosed which could be the basis for surgical treatment. Our of 388 patients, 254 were treated surgically and 375 operations were performed in them; 46 patients had multiple operations. The highest per cent of deaths was found in the group of patients with diabetic gangrene of the lower limbs which reached 10.4%, while in all patients the mortality was 4.3%. Finally it is suggested that only the approach to the diabetic patients as to high-risk patients enables obtaining of a satisfactory result of surgical treatment.

[Isotope methods in diagnosis of portal vein occlusion]

The dynamic intravenous hepato-scintigraphy with pertechnetate Tc-99m enables a quantitative evaluation of portal and arterial blood flow in the liver. A case is presented of thrombotic occlusion of the portal vein with rapidly growing oesophageal varices in which hepato-scintigraphy showed the absence of portal blood flow in the liver, being the decisive diagnostic method. Using the dynamic transrectal porto-scintigraphy an evaluation was done of the degree of collateral circulation development in the area of the inferior mesenteric vein, obtaining indirect information about localization and duration of portal vein occlusion.

Nuclear control of the messenger RNA expression for mitochondrial ATPase subunit 9 in a new yeast mutant

A new temperature-sensitive nuclear mutant of Saccharomyces cerevisiae altered in the expression of the mitochondrially encoded ATPase 9 gene was identified. Analysis of several mitochondrial transcripts reveals the selective loss of the messenger RNA for the ATPase 9 subunit under restrictive temperature conditions. This defect results in a respiratory deficiency of the yeast cells. RNA synthesis studied with isolated mitochondria gives first evidence that the mitochondrial transcription process does not react in a temperature-sensitive way. Therefore, it is concluded that the loss of the transcript is due to specific posttranscriptional degradation. Further on it is demonstrated that all the observed effects in the mutant are caused by only one mutated nuclear gene. The mutant strain was transformed with a genomic yeast library and a complementary DNA fragment was obtained. Molecular characterization of the respective DNA clone identified a new gene, which we propose to call NCA1 (Nuclear Control of ATPase messenger RNA expression). Complete inactivation of this gene by insertion mutagenesis in the chromosome leads to a permanent respiratory defect of the cell. Localization of the insertion locus in the yeast genome and complementation studies with the temperature-sensitive mutant indicate that the two mutations are allelic.