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2 Polish Journal of Surgery

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The Impact of Nissen-Rossetti Fundoplication on the Perfusion in Microcirculation of the Gastric Fundus

100%

Przywara S. , Wallner G. , Dąbrowski A. , Skoczylas T. , Wroński J. , Michalak K. , Zymon R.

2007

tom 79

nr 9

581-586

The aim of the study was to investigate the impact of Nissen-Rossetti fundoplication on the blood flow in the microcirculation of the gastric fundus.Material and methods. Eight patients undergoing Nissen-Rossetti fundoplication were included in the study. Perfusion in the gastric fundus was measured intraoperatively with laser Doppler flowmetry. An adhesive, flat, silicon probe was attached to the serosa in the same anatomical location during every measurement. Microcirculatory blood flow was recorded before and after fundoplication without ligation and division of the short gastric vessels.Results. In each patient, fundoplication led to increases in resting perfusion. Hyperperfusion was evoked by two mechanisms: increase in average blood flow and increase in vasomotion's amplitude and frequency.Conclusions. Fundoplication constitutes a new distribution of blood flow in the microcirculation of the gastric fundus, irrespective of its indication as a treatment of reflux disease or a supplement to cardiomyotomy in patients with achalasia. The procedure, when correctly performed, leads to local reactive hyperemia. Decreases in fundal perfusion suggest that the fundoplication wrap was created under excessive tension and may lead to dysphagia and local ischemia with consequences on motility of the lower esophagus. Thus, the assessment of change in perfusion of the gastric fundus after fundoplication might be a valuable tool in the routine quality control for appropriate performance of the fundoplication wrap.

Cide-AGene Expression in Patients with Obesity Qualified for Endovascular Treatment of Abdominal Aorta Aneurysm

84%

Feldo M. , Kocki J. , Feldo J. , Łukasik S. , Bogucki J. , Skwarzyński A. , Wroński J. , Kęsik J. , Zubilewicz T.

nr 10

473-478

CIDE-A gene and the genes of LRP group play a key role in the regulation of the body weight and lipid metabolism in mammals. CIDE-A is defined as a potential human obesity gene and the LRP1 gene is associated with the development of abdominal aortic aneurysm (AAA). The aim of the study was to define the role of CIDE-A gene in patients with dyslipidemia and asymptomatic AAA. Material and methods. The study group consisted of 38 subjects, including 27 men and 11 women qualified for endovascular aneurysm repair (EVAR). The subjects with abdominal aortic aneurysm were enrolled in the study group, depending on the body mass index (BMI); in obese patients (BMI > 30). The control group (n = 16) included subjects without lipid disorders. One-step isolation of RNA from lymphocytes and adipose tissue cells was performed using the modified TRI method by Chomc-zynski and Sacchi, and then the gene expression was tested by real-time PCR. Results. The highest mean relative of the gene expression for CIDE-A was reported in subjects with the normal body weight. The lowest mean relative of the gene expression for CIDE-A was observed in the group of obese patients with aortic aneurysm and lipid disorders. A high negative correlation (r = -0.7101) in the gene expression for CIDE-A was observed in the group of obese patients with aortic aneurysm, depending on the BMI. Conclusions. Due to the important role of the CIDE-A gene and Cide-A protein in the development of metabolic syndrome, obesity and the accompanying vascular lesions such as abdominal aortic an-eurysm, seen in this context, the tested gene and protein Cide-A represent a potential therapeutic target in these diseases.