Analiza patogenów i ich lekowrażliwości u pacjentów z zespołem stopy cukrzycowej leczonych chirurgicznie

 Wstęp. Cukrzyca jako jedna z najczęstszych chorób cywilizacyjnych wywiera znaczący wpływ nie tylko na poszczególne jednostki, lecz także na całe społe­czeństwo. Nieprawidłowy metabolizm cukrów może prowadzić do szeregu powikłań dotykających cały organizm. Z chirurgicznego punktu widzenia leczenie powikłań cukrzycy, poza optymalizacją leczenia hi­perglikemii, sprowadza się do leczenia zespołu stopy cukrzycowej. Zespół ten rozwija się na podłożu mikro­neuroangiopatii i doprowadza do powstania zmian martwiczych będących doskonałym miejscem rozwoju dla szeregu bakterii. Odpowiednia antybiotykoterapia stanowi jeden z ważniejszych elementów całego po­stępowania interdyscyplinarnego w leczeniu zespołu stopy cukrzycowej. Materiał i metody. W niniejszej pracy, w celu określe­nia optymalnej antybiotykoterapii, oceniano wyniki wykonanych posiewów pobranych ze zmian ropno­-martwiczych (ocena dotyczy tylko pierwszego wyho­dowanego izolatu od danego pacjenta). Wyniki. U wszystkich 61 chorych stwierdzano naciek zapalny skóry i tkanek miękkich, któremu w większości towarzyszyły rany stóp/podudzi gojące się po drobnych interwencjach chirurgicznych. U prawie połowy cho­rych wyhodowano jeden patogen, a u pojedynczego chorego — aż osiem patogenów chorobotwórczych. Najczęściej identyfikowanymi były: Staphylococcus aureus, Enterococcus faecalis, Staphylococcus koa­gulazonegatywny (inny niż S. Cohni, S. epidermidis, S. werneri, S. haemoliticus). Wnioski. Zakażenie tkanek miękkich w zespole stopy cukrzycowej jest zwykle powodowane przez kilka rodzajów bakterii, z których najczęściej hodowany to Staphylococcus aureus. Na podstawie uzyskanych wyników wydaje się, że optymalnym początkiem an­tybiotykoterapii byłoby zastosowanie amoksycyliny z kwasem klawulanowym

Sukcesja leśna i zalesianie gruntów rolnych jako aktualne wyzwanie prac urządzeniowo-rolnych

Wyłączenie gruntów z produkcji rolnej uwarunkowane jest wieloma czynnikami – zarówno warunkami przyrodniczymi (jakość gleby, odległość od większych kompleksów leśnych), jak i pozaprzyrodniczymi – struktura działek rolnych, ich powierzchnia i kształt, zmiana struktury demograficznej mieszkańców wsi (migracja do miast, podejmowanie pozarolniczej działalności gospodarczej). Grunty wyłączone z produkcji rolnej podlegają sukcesji wtórnej co wpływa (niekorzystnie) na przyległe grunty nadal użytkowane rolniczo. Istotne jest rozpoznanie przyczyn wyłączania gruntów z produkcji rolnej oraz inwentaryzacja takich obszarów w ramach programów prac urządzeniowo-rolnych poprzedzających scalenia i wymiany gruntów. Pozwala to na właściwe sterowanie rozwojem obszarów wiejskich oraz poprawę struktury przestrzennej gospodarstw rolnych. Przeprowadzenie prac scaleniowych umożliwia racjonalną gospodarkę gruntami rolnymi – możliwe będzie wskazanie obszarów, które z różnych względów wyłączone z produkcji rolnej tworzyć mogą „bufory” między kompleksami leśnymi a gruntami rolnymi

Jednoznaczne określanie współrzędnych punktów osnowy stabilizowanej przy zakładaniu ewidencji gruntów

The article discusses the problem of unambiguous determination of the geodetic control network points’ coordinates in the State Geodetic Coordinate System 2000, fixed during works related to the establishment of land records. The solutions and measurement methods applied in this respect, in accordance with the applicable standards, in many cases do not allow the correct identification of the boundary points of land plots in the process of their designation. The data provided by the district centres of surveying and cartographic documentation (PODGiK) concerning the point coordinates of measurement networks established for the purpose of creating land records in the period following World War II present a lot of problems for geodetic contractors. Due to the lack of unambiguous coordinates of the geodetic network points, undertaking additional work is often required, including the identification of geodetic network points and verifying the compliance of their position in the field, based on the archival data. These are time-consuming activities, and they do not always bring the intended effect. The present article contains the results of the research on the compliance of archival data with the actual location of points in geodetic networks, in several selected precincts of the Świętokrzyskie region. On the basis of the analyses we have carried out, discrepancies were determined within the data constituting the PODGiK resources, and a solution was proposed to obtain coordinates of geodetic network points that could be considered correct.Artykuł porusza problematykę jednoznacznego określania współrzędnych punktów osnów pomiarowych w Państwowym Układzie Współrzędnych Geodezyjnych 2000 stabilizowanych w trakcie prac związanych z zakładaniem ewidencji gruntów. Stosowane w tym zakresie rozwiązania i metody pomiarowe, zgodne z obowiązującymi normami w wielu przypadkach nie pozwalają na prawidłową identyfikację punktów granic działek ewidencyjnych w procesie ich wyznaczenia. Dane udostępniane przez powiatowe ośrodki dokumentacji geodezyjnej i kartograficznej (PODGiK), dotyczące współrzędnych punktów osnów pomiarowych zakładanych w celach tworzenia ewidencji gruntów w okresie po II wojnie światowej stwarzają dziś wiele problemów dla wykonawców prac geodezyjnych. Z uwagi na brak jednoznacznych współrzędnych punktów osnów, wymagane jest często podjęcie dodatkowych prac obejmujących identyfikację punktów osnowy oraz kontrolę zgodności ich położenia w terenie na podstawie danych archiwalnych. Są to czynności czasochłonne i nie zawsze przynoszą zamierzony efekt. W niniejszym artykule zawarto wyniki badań zgodności danych archiwalnych z rzeczywistym położeniem punktów osnów pomiarowych w kilku wybranych obrębach ewidencyjnych województwa świętokrzyskiego. Na podstawie przeprowadzonych analiz określono rozbieżności pomiędzy danymi stanowiącymi zasób PODGiK oraz zaproponowano rozwiązanie pozwalające na uzyskanie współrzędnych punktów osnów pomiarowych, które będzie można uznać za właściwe

Impact of the forest succession on efficiency of the arable land production

The paper presents the studies involving analysis of changes in shape of parcels of arable land under the influence of forest succession. The object of the research is the village Grębosze located in Świętokrzyskie voivodeship. The study material will cover all arable land existing in the studied village. The source of data were numerical registry maps from 1998 and 2013. The basic element of research, enabling comparison of changes in the efficiency of the production process are continuous parts of the parcels covered by one form of use. In the course of the output data processing and determination of the necessary technical parameters for the tested surface elements, the specialized tools and statistics were used. The studies were related to the evaluation of formation of these surface structures on the basis of their shape meter in the form of the so-called costs of cultivation. The obtained results make it possible to tell, to what extent the changes resulting from the consequences of the secondary forest succession influence the process of cultivation of neighbouring arable land

Analysis of pathogens and their susceptibility in patients with diabetic foot syndrome treated surgically

  Introduction. Diabetes is one of the most common civilization diseases, which has a significant impact on particular individuals but also on society as a whole. Improper metabolism of sugars can lead to a number of complications affecting the whole body. From a surgical point of view treatment of diabetes complications, apart from optimizing the treatment of hyperglycaemia, is limited to the treatment of diabetic foot syndrome. The syndrome develops on a basis of microneuropathy, leading to development of necrotic lesions which are the perfect breeding ground for a number of bacteria. Adequate antibiotic therapy is one of the most important elements of all interdisciplinary therapy in treatment of diabetic foot syndrome. Material and methods. In the present study, results of obtained swab cultures were evaluated to assess optimal antibiotic treatment, evaluating only the first bred isolate from the patient. Results. In all 61 patients inflammatory infiltration of skin and soft tissues was observed, most of which accompa­nied by foot/leg wounds that healed after minor surgical interventions. A single pathogen was isolated in nearly half of the patients. In one patient, eight pathogens were isolated. The most commonly identified pathogens  were Staphylococcus aureus, Enterococcus faecalis, Co­agulase-negative staphylococcus (other than S. Cohni, S. Epidermidis, S. Werneri, S. Haemoliticus). Conclusions. Soft tissue infections in the diabetic foot syndrome are most frequently caused by several types of bacteria, most commonly Staphylococcus aureus. Based on the provided results, it appears that the op­timal start of antibiotic therapy would be the use of amoxicillin with clavulanic acid. (Clin Diabetol 2017; 6, 6: 189–194

Comparison of Early Results of Surgical Treatment in Patients with Pancreatic Cancer

Pancreatic tumours are a serious medical and social issue. Patients come to the doctor too late, when the disease is well advanced. The most frequently applied method of surgical treatment is pancreatoduodenectomy (Whipple procedure). The most frequently used technique of pancreatoduodenectomy is the Child-Waugh method. The procedure can be performed in a classic way or as modified by Traverso (with preservation of the pylorus).Material and methods. Between August 2008 and June 2011, in the Department of Thoracic, General and Oncologic Surgery of Medical University in Łódź, a total of 79 patients with pancreatic tumours were hospitalized. In 61, pancreatoduodenectomy was performed. The patients were divided into two groups, depending on the diagnosis and the procedures performed: group 1 comprised patients in whom the pylorus was resected (n = 43); group 2 comprised patients in whom the pylorus was preserved (Traverso-Longmire procedure; n = 18).Results. Mean duration of surgery was about 3 hours and 50 minutes in both groups. Mean duration of hospitalization after the procedure was 15.6 days in group 1 and 12.2 days in group 2 (p 0.05).Conclusions. There are specific indications for each method of surgical treatment, however, it seems that both techniques of pancreatic resection can be recommended as standard surgical treatment, and the number of complications after both procedures is similar

Effectiveness of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease after lobectomy due to non-small cell lung cancer — a single-center retrospective study

Introduction: The procedure of lung parenchyma resection may result in impairment of physical capacity and quality of life. In patients with operable non-small cell lung cancer (NSCLC), lobectomy is an elective procedure. Chronic obstructive pulmonary disease (COPD) is a common coexisting condition in patients with NSCLC. Effectiveness of post-operative pulmonary rehabilitation (PR) in patients who underwent lobectomy due to NSCLC and suffering from COPD as compared to individuals without COPD has not been determined yet. The aim of the study was to compare effectiveness of post-operative PR in patients with COPD after lobectomy due to NSCLC (COPD[+] L [+]) with individuals with COPD without lung parenchyma resection (COPD(+) L(–)) and those who underwent lobectomy due to NSCLC and not suffering from COPD (COPD[–] L[+]).Material and methods: Thirty-seven patients with non-small cell lung cancer (21 patients with and 16 patients without COPD) who underwent lobectomy and 29 subjects with COPD referred to the Lung Diseases Treatment and Rehabilitation Centre in Lodz in 2018–2019 were included in this retrospective analysis. The patients participated in a 3-week inpatient pulmonary rehabilitation (PR) program which included breathing exercises, physical workout, relaxation exercises, education, psychological support and nutrition consulting. The evaluation included lung function measurements, six-minute walking test (6MWT) and the St. George’s Respiratory Questionnaire (SGRQ) score. The results obtained before the rehabilitation were compared to those achieved after the 3-week PR program and compared between the study groups.Results: A significant increase in the distance covered during 6MWT was observed in all the three groups studied: COPD(+) L(+) (Δ = 62.52 ± 14.58 m); COPD(–) L(+) (Δ = 73.67 ± 11.58 m); and COPD(+) L(–) (Δ = 59.93 ± 10.02 m) (p < 0.001 for all). Similarly, a statistically and clinically significant improvement in the total SGRQ score was recorded: COPD(+) L(+) ∆ = –12.05 ± 3.96 points; p < 0.05 and COPD(–) L(+) ∆ = –12.30 ± 4.85 points; p < 0.01 and COPD(+) (L–) ∆= –14.07 ± 3.36 points (p < 0.001). No significant differences in the outcome improvement between the study groups were identified.Conclusions: The results of the study show that COPD(+) L(+) patients gained benefits from post-operative PR comparable to COPD(+) L(–) and COPD(–) L(+) subjects by improving their physical capacity and quality of life

Effectiveness of Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease after Lobectomy Due to Non-Small Cell Lung Cancer—A Single-Center Retrospective Study

Introduction: The procedure of lung parenchyma resection may result in impairment of physical capacity and quality of life. In patients with operable non-small cell lung cancer (NSCLC), lobectomy is an elective procedure. Chronic obstructive pulmonary disease (COPD) is a common coexisting condition in patients with NSCLC. Effectiveness of post-operative pulmonary rehabilitation (PR) in patients who underwent lobectomy due to NSCLC and suffering from COPD as compared to individuals without COPD has not been determined yet. The aim of the study was to compare effectiveness of post-operative PR in patients with COPD after lobectomy due to NSCLC (COPD[+] L [+]) with individuals with COPD without lung parenchyma resection (COPD(+) L(–)) and those who underwent lobectomy due to NSCLC and not suffering from COPD (COPD[–] L[+]). Material and methods: Thirty-seven patients with non-small cell lung cancer (21 patients with and 16 patients without COPD) who underwent lobectomy and 29 subjects with COPD referred to the Lung Diseases Treatment and Rehabilitation Centre in Lodz in 2018–2019 were included in this retrospective analysis. The patients participated in a 3-week inpatient pulmonary rehabilitation (PR) program which included breathing exercises, physical workout, relaxation exercises, education, psychological support and nutrition consulting. The evaluation included lung function measurements, six-minute walking test (6MWT) and the St. George’s Respiratory Questionnaire (SGRQ) score. The results obtained before the rehabilitation were compared to those achieved after the 3-week PR program and compared between the study groups. Results: A significant increase in the distance covered during 6MWT was observed in all the three groups studied: COPD(+) L(+) (Δ = 62.52 ± 14.58 m); COPD(–) L(+) (Δ = 73.67 ± 11.58 m); and COPD(+) L(–) (Δ = 59.93 ± 10.02 m) (p < 0.001 for all). Similarly, a statistically and clinically significant improvement in the total SGRQ score was recorded: COPD(+) L(+) ∆ = –12.05 ± 3.96 points; p < 0.05 and COPD(–) L(+) ∆ = –12.30 ± 4.85 points; p < 0.01 and COPD(+) (L–) ∆= –14.07 ± 3.36 points (p < 0.001). No significant differences in the outcome improvement between the study groups were identified. Conclusions: The results of the study show that COPD(+) L(+) patients gained benefits from post-operative PR comparable to COPD(+) L(–) and COPD(–) L(+) subjects by improving their physical capacity and quality of life

Advanced Anal Squamous Cell Carcinoma -Radiotherapy or Surgery?

Rezumat Carcinom scuamos anal avansat -radioterapie sau chirurgie? Premize: Cancerul rectal aei anal este a treia cauzã de deces în Polonia. Adenocarcinomul este cea mai frecventã tumorã din acest grup. Carcinomul scuamos este relativ rar. Acest tip de carcinom afecteazã mai degrabã anusul decât rectul. Deaei leziunea este perceputã a nu fi foarte malignã aei a fi responsivã la radioterapie, unele cazuri pot necesita tratament chirurgical. grupul pacienåilor operaåi rata medie de supravieåuire a fost de 48 luni (mediana a 14-74 luni) în timp ce pentru grupul de pacienåi tratat conservator rata de supravieåuire medie a depãaeit 55 luni (mediana a 17-82 luni, p=0,23). Rata medie de supravieåuire fãrã boalã la 5 ani a fost similarã cu a grupului general în timp ce complicaåiile postoperatorii au apãrut la 66% din intervenåiile chirurgicale aei la 27% din procedurile de teleradioterapie. Concluzii: asocierea radioterapiei cu chimioterapia poate fi metoda de elecåie în tratamentul carcinomului scuamos anal. Chirurgia este necesarã în cazurile avansate, la care nu se observã regresia completã dupã radiochimioterapie. Rezecåia abdomino-perinealã a rectului este o intervenåie chirurgicalã care poate fi acompaniatã de numeroase complicaåii. Totuaei, aceasta rãmâne o metodã terapeuticã necesarã în cazurile descrise. Material aei Cuvinte cheie: carcinom anal, APR (rezecåie abdominoperinealã a rectului), radioterapie, carcinom scuamos anal avansat Abstract Background: Anal and rectal cancers occupy the third position of death causes in Poland. Adenocarcinoma is the most frequent among the tumours in this group. Squamous cell carcinoma can be relatively less common. This kind of carcinoma may rather affect the anus than the rectum. Although the lesion is perceived as not very malignant and as such responsive to radiant energy therapy, some cases may require surgical treatment. Results: For the total number of 18 patients with anal squamous cell carcinoma the mean observation period was 5.5 years, in the group of the operated patients the mean survival rate was 48 months (the median of 14-74 months) while for the group of the patients treated conservatively the mean survival rate amounted to 55 months (the median of 17-82 months, p=0.23). The mean 5-year disease-free survival rate was rather similar to the same rate of the general group, whereas the post-operative complications occurred in 66% of surgical procedures and 27% of teleradiotherapeutic procedures. Conclusions: Combined radiotherapy and chemotherapy can be the method of choice in treating anal squamous cell carcinoma. Surgery should be used in advanced cases, when complete regression on radiochemotherapy cannot be observed. The abdomino-perineal resection of the rectum is the kind of a procedure that may be accompanied with a vast number of complications. Nevertheless, it still remains a necessary therapeutic method in the described cases

Assessment of quality of life in patients with non-operated pancreatic cancer after videothoracoscopic splanchnicectomy

Introduction: Pancreatic tumours are a crucial medical issue. The majority of patients report sick in the late stage ofcarcinoma clinical advancement, which considerably limits the possibility of surgical treatment. Pancreatic cancerpatients with no other alternative but palliative treatment constitute a large group.Aim: To assess pain intensity levels and quality of life of pancreatic cancer patients after videothoracoscopic splanchnicectomy.Material and methods: Between 2001 January and 2010 November in the Department of Thorax, General Surgery andOncology of the Medical University of Lodz 262 patients with pancreatic tumours were hospitalized. In 121 casesgrade 3 and grade 4 tumours were observed. Hundred and twenty-one videothoracoscopic procedures of sympathetictrunk and ganglion excision were performed in 89 patients.Results: Before the procedure the pain intensity level according to VAS was 5.66 (3.9-7.2; SD 1.24) in the trial groupand 5.46 (4.1-7.1; SD 1.15) in the control group. The quality of life average assessment in both groups did not differ statistically(p = 1.07) and was 46.3 (32-66; SD 0.92) in patients before the operation and in the control group 50.3(41-63; SD 0.75). On the 7th postoperative day the pain intensity on average was 2.33 (1.2-3.9; SD 0.78) and 4.57(3.6-5.5; SD 0.69) respectively. One week after the procedure the quality of patients’ life was estimated at 64.1(39-83; SD 1.38) and in the control group at 52.2 (42-65; SD 0.71); the differences are significant (p < 0.05). Thirty daysafter the procedure 12 patients did not t ake any painkillers (13.5%), and in the others a considerable decrease of thetaken drugs was observed. On average, the pain intensity was estimated at 1.78 (0.6-3.6; SD 0.68). The quality of life,on the other hand, improved considerably in relation to the state prior to the procedure, but increased insignificantlyin relation to the state on the 7th postoperative day to 70.9 (52-88; SD 1.14).Conclusions: Splanchnicectomy is a safe method of cancer pain treatment in patients with advanced pancreatictumours. Videothoracoscopic excision of visceral nerve thoracic section contributes to the statistically significantdecrease of cancer pain intensity and considerably improves the quality of patients’ lives