Po drugiej stronie Araksu – sytuacja Południowego Azerbejdżanu

Publikacja stanowi wybór tekstów prezentowanych w ramach Ogólnopolskiej Konferencji Naukowej „Państwo w państwie? Terytoria autonomiczne, państwa nieuznawane i ruchy separatystyczne w przestrzeni międzynarodowej” (Łódź 2014). Jak pisze recenzent książki, dr hab. Łukasz Donaj: „Państwa są wciąż podstawowymi jednostkami organizacji świata, a przez stulecia były właściwie jedynymi uczestnikami w stosunkach międzynarodowych. W dalszym ciągu ich rola w stosunkach międzynarodowych jest dominująca, chociaż niewątpliwie widoczne są objawy osłabienia. Obecnie coraz wyraźniej zauważane są procesy ewolucji tradycyjnej roli państwa w stosunkach międzynarodowych. Państwo, będące specyficzną formą organizacji życia społecznego, stara się przystosować do zmian zachodzących w jego wnętrzu i w środowisku”

Wybory jako element demokratyzacji na obszarze byłego Związku Radzieckiego, na przykładzie Republiki Azerbejdżanu

Udostępnienie publikacji Wydawnictwa Uniwersytetu Łódzkiego finansowane w ramach projektu „Doskonałość naukowa kluczem do doskonałości kształcenia”. Projekt realizowany jest ze środków Europejskiego Funduszu Społecznego w ramach Programu Operacyjnego Wiedza Edukacja Rozwój; nr umowy: POWER.03.05.00-00-Z092/17-00

When and how should we treat cesarean scar defect — isthmocoele?

The reported number of cesarean sections in Poland is approximately 30% and is associated with increasing number of early and late complications. The myometrial discontinuity at the site of previous cesarean section is known in the literature as “isthmocoele”, “niche”, “pouch” or cesarean scar defect. In most cases presence of isthmocoele has no clinical significance, but in some patients it may cause abnormal uterine bleeding, dysmenorrhea, dyspareunia, pelvic pain or be associated with secondary infertility. This defect may be treated by laparoscopy, hysteroscopy or vaginal surgery

Zabiegi laparoskopowe z użyciem materiałów syntetycznych w leczeniu zaburzeń statyki narządu rodnego – przegląd literatury

Objectives: The main aim of the article was to describe laparoscopic mesh procedures for the treatment of pelvic organ prolapse, as well as evaluate their role, outcomes and limitations. Material and methods: In February 2014, online search of English-language literature in PubMed was performed. This paper presents the analysis of reports published over the last decade that included at least 50 patients with a minimum of 12 months of follow-up. Results: Numerous laparoscopic techniques to restore proper anatomy in patients with pelvic organ prolapse have been described. Laparoscopy provides a number of important advantages, including enhanced visualization of the pelvic anatomy, reduction of adhesion formation, lower morbidity and blood loss, decreased postoperative pain, smaller incision and quicker recovery. Nonetheless, this access is technically more difficult than an open or vaginal surgery due to two-dimensional vision and decreased degrees of freedom. It requires high level of laparoscopic suturing skills and longer operative time, especially at the beginning of the learning curve. Conclusions: Laparoscopic sacrocolpopexy, hysteropexy and lateral suspension are interesting and effective options for the treatment of pelvic organ prolapse, providing a number of important advantages characteristic for endoscopic techniques.Cel pracy: Celem pracy jest opis zabiegów laparoskopowych z użyciem materiałów syntetycznych w leczeniu zaburzeń statyki narządu rodnego, ocena ich skuteczności i ograniczeń w stosowaniu. Materiał i metody: W lutym 2014 roku dokonano przeglądu literatury anglojęzycznej dostępnej w bazie PubMed. W poniższej publikacji poddano analizie wyniki badań opublikowanych w ciągu ostatnich 10 lat, przeprowadzonych na grupie co najmniej 50 pacjentek, u których efekt zabiegu został oceniony po minimum 12 miesiącach od operacji. Wyniki: W leczeniu zaburzeń statyki narządu rodnego zostało opisanych wiele technik laparoskopowych. Laparoskopia daje możliwość lepszej wizualizacji struktur anatomicznych, redukuje ilość zrostów oraz dolegliwości bólowych po operacji, zmniejsza utratę krwi i przyczynia się do szybszego powrotu do zdrowia. Ten typ operacji jest jednak trudniejszy od zabiegów pochwowych lub wykonywanych z klasycznego dostępu ze względu na dwuwymiarowe widzenie i ograniczoną swobodę ruchów, jak również wymaga umiejętności laparoskopowego szycia i dłuższego czasu operacji zwłaszcza na początku nauki. Wnioski: Laparoskopowa sakrokolpopeksja, histeropeksja i boczne podwieszenie macicy są interesującymi i skutecznymi metodami leczenia zaburzeń statyki narządu rodnego dającymi przy tym korzyści typowe dla zabiegów endoskopowych

Risk factors of permanent hypoparathyroidism after total thyroidectomy and central neck dissection for papillary thyroid cancer: a prospective study

Introduction: Inadvertent removal of, or damage to the parathyroid glands in the course of operations on the anterior neck compartment are responsible for over 80% of cases of chronic hypoparathyroidism (HypoPT). This study searched for factors related to the development of permanent HypoPT after total thyroidectomy and central neck lymphadenectomy in patients with thyroid carcinoma. Material and methods: In total, 89 of 103 screened patients met the study’s criteria and were put under prospective one-year observation. Demographic and surgical factors as well as the biochemical parameters of mineral homeostasis, controlled both preoperatively and postoperatively, were subject to statistical analysis. In line with contemporary guidelines, postoperative hypocalcaemia, rather than an abnormally low serum parathormone (PTH) concentration, was considered a diagnostic criterion of HypoPT. Results: On postoperative day one (POD1), serum concentration of PTH decreased below the normal range (< 12 pg/mL) in 29 patients and was undetectable in 19 patients (< 6 pg/mL). At one year postoperatively, 12 patients with undetectable POD1 PTH required treatment for hypocalcaemia and were diagnosed with permanent hypoPT. All the other patients regained normocalcaemia. Relative risk of permanent HypoPT associated with undetectable POD1 PTH was 88.75. A significant difference in median POD1 serum calcium concentration between the patients with undetectable POD1 PTH and those with detectable POD1 PTH was found (p < 0.001). The difference between the POD1 serum calcium in patients with permanent or transient HypoPT in the subgroup with undetectable POD1 PTH did not reach the level of statistical significance (median, 1.82 mmol/L vs. 1.96 mmol/L). At one month postoperatively, in patients who later developed permanent HypoPT, serum calcium was lower than it was in all other patients (p = 0.167). At one year postoperatively, serum concentration of PTH was in the normal range in 10 of 12 patients with permanent HypoPT; however, it was significantly lower than it had been before the operation and distinctly lower than it was in patients who regained normocalcaemia. The number of parathyroid glands either dissected or autotransplanted did not affect the development of permanent HypoPT. Conclusions: Undetectable POD1 PTH is an important risk factor of permanent HypoPT. The main cause of permanent HypoPT was irreversible damage to the left in situ parathyroid glands

Hysterectomy trends for benign indications over a 15-year period in an academic teaching center in Poland: a retrospective cohort study

Objectives: The aim of the study was to evaluate changes in the operative trends for various types of hysterectomy due to benign indications, between 2001 and 2015, at the 2nd Department of Gynecology, Medical University of Lublin, as compared to the National Health Service (NHS) registry in Poland. Material and methods: A retrospective cohort study was conducted. Data from the Internal Hospital Discharge Registry and Pathological Results Registry have been compared to the NHS database, which has been available nationwide since 2009. Results: The study group included 5629 women who underwent hysterectomy due to benign indications. During the study period, the following number of procedures were performed: total abdominal hysterectomy — 344 (6.11%), total abdominal hysterectomy with bilateral salpingo-oophorectomy — 1760 (31.27%), total vaginal hysterectomy — 563 (10.00%), subtotal abdominal hysterectomy — 2536 (45.05%), and laparoscopically-assisted subtotal hysterectomy (LASH) — 426 (7.57%). The abdominal route, with the preference for subtotal abdominal hysterectomy, was the main approach to hysterectomy. Symptomatic fibroids were the most common indication for the procedure. Comparison of data collected over the last five years revealed a significant difference in the approach to hysterectomy in favor of subtotal abdominal hysterectomy (SAH) and LASH. Conclusions: Less invasive techniques of hysterectomy (LASH, SAH), which are the preferred choice at the 2nd Department of Gynecology (Lublin), are safe and effective options of treating benign conditions. We are of the opinion that these ap­proaches should be offered to patients instead of more radical techniques. Proper training of physicians may influence the decision-making process in favor of minimally invasive techniques

Bladder injury during sling operation in the treatment of SUI – review of literature and case report

Introduction: Sling operations have been performed for over 15 years. In recent years these operations have become the gold standard in the treatment of stress urinary incontinence (SUI) due to their efficacy, safety and low invasiveness. Approximately 4% of women will undergo a surgery for SUI in the course of their life. As with any surgical intervention, there may be some technical problems, as well as intra- and postoperative complications, the most common of which is bladder injury. Other complications encountered during mid-urethral slings procedures include bleeding (retropubic or vaginal hematomas), urethral perforation, urinary tract infections, postoperative vaginal or urethral erosions, bowel perforation, chronic pelvic pain, wound infection, nerve injury, transient and persistent voiding dysfunction such as de novo urgency, incomplete bladder emptying or urinary retention. Below we present a case of a patient with diagnosed vesicovaginal fistula after sling operation (TVT-tension-free vaginal tape). Upon admission the patient reported dysuria, persistent urinary leakage and abnormal, abundant vaginal discharge. Objectives: Case report and review of literature concerning surgical treatment of stress urinary incontinence and its complications. Materials and Methods: Analysis of medical documentation of the patient treated at the Second Department of Gynecology, Medical University of Lublin. Review of abstracts or papers in the Medline database related to surgical treatment of urinary incontinence and its complications. Conclusions: Bladder perforation is one of the most common complications of the retropubic approach for MUS placement. The presence of mesh within the bladder may arise from direct bladder perforation or from subsequent erosion of the sling. Such lesions do not cause any serious health consequences for patients on condition they are detected intraoperatively and appropriately repaired, but when unrecognized, they results in the development of considerable symptoms and negatively influence the quality of patient life. Improperly treated, it can lead to development of an abnormal communication between the urinary bladder and the anterior wall of the vagina - vesicovaginal fistula. We should suspect unrecognized bladder injury in case of patients with any persistent voiding symptoms after a sling procedure such as long lasting dysuria, persistent urinary leakage, hematuria, recurrent infections, chronic pain and voiding difficulties. Diagnosis and treatment of vesicovaginal fistula is long lasting and difficult for the patient and the surgeon. Futh-Mayo operation is an effective treatment method for the majority of vesicovaginal fistulas. During this operation we suture all layers of fistula separately (bladder, perivesical fascia and vaginal wall). Although with this operation we solve one problem, the patient still might suffer from recurrent SUI. Alternative methods of treatment which can be offered to patients after unsuccessful SUI operation are periurethral injections with bulking agents or electrical stimulation of the pelvic floor muscles. Both methods are effective in the therapy of recurrent SUI. In our case periurtehral injection of BulkamidR did not provide a total cure. Therefore, we completed the treatment with electrical stimulation of the pelvic floor muscles using patient-controlled electrodes placed in the vagina to stimulate muscles with current frequency of 50 Hz, amperage between 0-60 mA and duration of 250 μs. This procedure produced a series of changes in the stimulated area and enabled to cure the incontinence

Choice of medical specialty and personality traits measured with the EPQ-R(S) in medical students and specialist doctors

Objective: The study was conducted to examine the differences between personality traits of medical students choosing future specialties and among specialist doctors. Methods: Two groups were tested: students and specialist doctors, totaling 87 people. The former consisted of 5th and 6th year medical students (48 people), and the latter included doctors of various specialties (39 people). All statistical analyses were performed using Statistica 10 software. Statistical significance was set at p <0.05. The Eysenck Personality Questionnaire Revised Short form (EPQ-R(S)) was used to conduct personality assessments. Results: In the student group, there were no differences in the personality traits measured with the EPQ-R(S) depending on their preferred specialty (surgical, non-surgical, pediatric, internal medicine specialties or areas which do not require contact with the patient). In the group of doctors, there were no differences in personality traits measured with the EPQ-R(S) pediatric and surgical specialists. Internal medicine specialists had a significantly higher level of extraversion. Conclusion: Personality traits are not the most important factor influencing the choice of the professional path in young Polish doctors. Contrary to the stereotypes prevailing in the medical environment, also among specialist doctors, the personality-related differences are not so obvious. The results of this study can be used in medical career counseling, in order to help young medical students to choose their future career paths