Pneumomediastinum and pneumoretroperitoneum as a result of mephedrone intoxication – a case report.

Introduction: Presence of air in mediastinal space, retroperitoneal space or subcutaneously is a rare con- dition in majority caused by trauma of airway or gastrointestinal (GI) tract. Rarely can it occur as a conse- quence after drug usage.  Case Presentation: We report a non-traumatic occurrence of pneumomediastinum, pneumoretroperito- neum and subcutaneous emphysema in a 27 year-old male patient who had been inhaling mephedrone for 4 days. Patient was admitted to Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk. CT scans of neck, chest and abdomen were performed with suspicion of perforation of GI tract or airways. Perforation was excluded by gastroscopic and bronchoscopic examinations. Patient was treated conservatively with fluids and antibiotic therapy because of no abnormalities besides free air in mentioned cavities. During 6 days of hospitalization patient made a steady recovery and was discharged in good condition.  Conclusions: The presence of pneumomediastinum, pneumoretroperitoneum and subcutaneous emphyse- ma associated with mephedrone inhalation has been rarely reported in the literature in the past. There are only a few cases describing such complications and medical management required. By reporting this case we would like to emphasize that mentioned symptoms and history of drug use might seem life-threatening, however, this condition may be self-limiting as well. Therefore, good general state can potentially be indi- cation for a watch-and-wait approach with no surgical intervention necessary. 

Effects of thyroid hormone imbalance on colorectal cancer carcinogenesis and risk — a systematic review

Colorectal cancer (CRC) is the second leading cause of cancer-related death. The prevalence of colorectal neoplasm is increasing. Many studies have shown that thyroid dysfunction may be connected with the higher risk of pancreatic and breast cancer, but only a few described the role of thyroid dysfunction and thyroid hormone (TH) replacement in the development and risk of CRC. The aim of this study is to summarise all findings and potentially elucidate the connection between TH imbalance and colorectal cancer. The systematic review was conducted according to PICO and PRISMA guidelines. We searched MEDLINE, ClinicalTrials.gov, www.clinicaltrialsregister.eu, and Cochrane Library databases using the following keywords: “((((thyroid OR hypothyroidism OR hyperthyroidism OR levothyroxine OR hashimoto OR graves OR thyroidectomy)) AND (colon OR colorectal OR CRC)) NOT hashimoto[Author]) NOT graves[Author])”. No filters were used. Of total of 3054 articles identified by the search strategy, 11 met PICO criteria and were included into the review. Four of those were on cell lines and seven were human studies. Analysis of the included studies revealed an elevated risk of CRC in patients with hypothyroidism with aORs ranging from 1.16 (95% CI: 1.08–1.24, p < 0.001) to 1.69 (95% CI: 1.21–2.36, p = 0.002). Moreover, TH replacement therapy has a protective effect for CRC risk with aOR ranging from 0.60 (95% CI: 0.44–0.81, p = 0.001) to 0.92 (95% CI: 0.86–0.98, p = 0.009). THs seem to play a role in colorectal carcinogenesis. Further studies are warranted to define the exact role of thyroid hormone imbalance in prevention and treatment of CRC

Od preparowania czterogruczołowego do technik małoinwazyjnych. Małoinwazyjna paratyroidektomia jako obecny standard chirurgii pierwotnej nadczynności przytarczyc

Complete surgical resection of hyperfunctioning parathyriod tissue is essential for the treatment of primary hyperparathyroidism. During recent years, minimally invasive surgery has been successfully applied in neck exploration, because of significant developments of guidance by intraoperative scans, the use of quick, intraoperative PTH assay, and also preoperative imaging procedures such as high resolution ultrasonography and sestamibi scintigraphy. The results of operations which are performed with minimally invasive techniques are comparable to those of conventional surgery, and provide advantages with regard to cosmetic result, length of hospitalisation, and reduced post-operative pain.Całkowite chirurgiczne usunięcie nadczynnej tkanki gruczołowej jest kluczowe dla leczenia pierwotnej nadczynności przytarczyc. Podczas ostatnich lat, techniki chirurgii małoinwazyjnej były z sukcesem wprowadzane do preparowania tkanek szyi. Było to możliwe dzięki opracowaniu śródoperacyjnych metod lokalizowania zmienionej tkanki, szybkim testom oznaczającym stężenie PTH w surowicy ,jak również doskonaleniu technik obrazowania przedoperacyjnego, takich jak ultrasonografia wysokiej rozdzielczości czy scyntygrafia z wykorzystaniem sestamibi. Wyniki operacji z wykorzystaniem technik małoinwazyjnych są porównywalne z wynikami technik konwencjonalnych oraz wiążą się z zaletami, takimi jak skrócony okres hospitalizacji, zmniejszenie bólu pooperacyjnego czy lepszy efekt kosmetyczny

Od preparowania czterogruczołowego do technik małoinwazyjnych. Małoinwazyjna paratyroidektomia jako obecny standard chirurgii pierwotnej nadczynności przytarczyc

Podczas ostatnich lat, techniki chirurgii małoinwazyjnej były z sukcesem wprowadzane do preparowania tkanek szyi. Było to możliwe dzięki opracowaniu śródoperacyjnych metod lokalizowania zmienionej tkanki, szybkim testom oznaczającym stężenie PTH w surowiczy, jak również doskonaleniu technik obrazowania przedoperacyjnego, takich jak ultrasonografia wysokiej rozdzielczości czy scyntygrafia z wykorzystaniem sestamibi. Wyniki operacji z wykorzystaniem technik małoinwazyjnych są porównywalne z wynikami technik konwencjonalnych oraz wiążą się z zaletami, takimi jak skrócony okres hospitalizacji, zmniejszenie bólu pooperacyjnego czy lepszy efekt kosmetyczny

Surgical treatment of a non-obese patient with type 2 diabetes – primary experience – a case report

The idea of type 2 diabetes surgical treatment was established in the U.S. and was based on observation of patientsafter bariatric procedures. Exclusion of the duodenum and gastrointestinal anastomosis performed in cases of morbidobesity cause shortened absorption of nutrients, which obviously promotes weight loss. Results of surgical treatmentshowed a beneficial effect on weight loss, resolution of co-morbidities and the reduction of risk of developingcardiovascular diseases and cancer. Analysis of the results of surgical treatment of obese patients with type 2 diabetesconfirmed the usefulness of surgical methods. Surgeons performing these procedures have noticed regression of type 2diabetes within a few weeks and in some cases this phenomenon is even observed during hospitalization [1]. So rapidimprovement is not only the result of the weight loss. Investigators of this phenomenon cannot precisely explainhow a relatively simple procedure could cure diabetes. We present the first experience of our centre based on the operativetreatment of type 2 diabetes in a non-obese patient

Totally videoscopic bilateral, simultaneous lumbar sympathectomy: original modification – preliminary report

Introduction: Lumbar sympathectomy seems to be technically a much more demanding procedure than thoracic sympathectomy.Nevertheless, some patients require this particular procedure. In our centre, the operation is performed nosooner than 12 months after initial thoracic sympathectomy as a simultaneous bilateral retro-peritoneoscopic procedure.Aim: To evaluate early effectiveness of totally videoretroperitoneoscopic lumbar sympathectomy from a posteriorapproach.Material and methods: Between June 2008 and June 2009, there were 12 patients operated on for primary plantarhyperhidrosis in the Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Poland.A bilateral procedure was performed in 6 patients, and in 6 other cases (initial ones) the procedure had to be split dueto too slow progress of the procedure (learning curve).Results: Mean operation time was 92.5 ±27.16 min (for 6 bilateral procedures) and 84 ±20.17 min (for the initial12 unilateral procedures). There was no postoperative mortality. Morbidity involved post-sympathectomy syndromepresenting as moderate burning pain in the buttocks and thighs up to 4 weeks postoperatively. Postoperative stay was1 day in 7 cases and 2 days in 3 cases (due to long train travel awaiting the patient on his/her way home). In themajority of patients, early postoperative results were very good, expressed by both the subjective opinion of thepatient and gravimetric results. In one case dryness of the feet was so severe that the patient had to consult a dermatologist.Conclusions: We believe that videoretroperitoneoscopic lumbar sympathectomy from a posterior approach is a goodmethod of treatment for primary hyperhidrosis with plantar symptoms, but should be reserved for surgeonsexperienced in laparoscopic and retroperitoneoscopic surgery