Autogenne przeszczepy fragmentów nadnerczy na modelu zwierzęcym

Wstęp: Jednym z powikłań po leczeniu operacyjnym guzów nadnerczy jest niewydolność kory nadnerczy. Szczególnie istotne jest to po usunięciu obydwu nadnerczy. Człowiek bez prawidłowej substytucji hormonalnej umiera - można temu zapobiec, przeszczepiając całe nadnercza lub ich część, np. komórki kory nadnerczy. W przypadku guzów nowotworowych przeszczep całego nadnercza nie wchodzi w rachubę, można natomiast przeszczepić komórki z wolnej od nowotworu części kory. Potwierdzenie skuteczności takich przeszczepów może skutkować w warunkach klinicznych uniknięciem konieczności terapii substytucyjnej hormonami kory nadnerczy u chorych po usunięciu nadnerczy. Materiały i metody: Wykonano autogenne przeszczepy nadnerczy na 3 grupach szczurów Sprague Dawley. U 1. grupy zwierząt określono fizjologiczne stężenia kortykosteronu. Zwierzęta te nie były operowane. W 2. grupie szczurów usunięto obydwa nadnercza. Oznaczono stężenie kortykosteronu po obustronnej adrenalektomii oraz zdolność zwierząt do przeżycia bez nadnerczy. Grupa 3. była podzielona na 2 części. W 1. podgrupie wykonano jednoczasową obustronną adrenalektomię wraz z przeszczepem fragmentów nadnercza w sieć większą. W 2. podgrupie wykonano najpierw jednostronną prawostronną adrenalektomię z jednoczasowym przeszczepem nadnercza w sieć większą, a następnie po miesiącu wykonano lewostronną adrenalektomię. W trakcie doświadczenia oznaczano stężenie kortykosteronu w 4 punktach czasowych. Wyniki: Uzyskano statystyczną różnicę między stężeniem kortykosteronu u szczurów po dwuczasowym przeszczepie nadnercza a szczurami po obustronnej adrenalektomii, jednak wyniki te dalekie były fizjologicznym stężeniom

Autogenous transplants of adrenal fragments in an animal model

Introduction: Adrenal insufficiency is a typical complication after surgical treatment of adrenal tumors, especially after the removal of both adrenal glands. Human beings are not able to survive without adrenal glands and without proper hormonal substitution. Autotransplantation of a fragment of the adrenal gland may prevent this complication. This can be done by transplanting the entire adrenal glands or its fragment, such as the adrenal cortex cells. In the case of adrenal tumors, the entire adrenal gland can not be transplanted. However, it is possible to transplant cells from the tumor-free part. Successful adrenal autografts may result in a new treatment of adrenal insufficiency. Materials and Methods: Autograft transplantation was performed on 3 groups of Sprague Dawley rats. In the first group, physiological corticosterone concentrations were determined. These animals were not operated. In the second group, both adrenal glands were removed. Corticosterone concentrations were determined after bilateral adrenalectomy. The third group was divided into two parts. In the first subgroup, bilateral adrenalectomy was performed simultaneously with adrenal transplant into the omentum. In the second subgroup, right adrenalectomy was performed simultaneously with and adrenal transplant into the omentum followed a month later by left adrenalectomy. During the experiment, corticosterone concentrations were measured at 4 time points. Results: The statistical difference between corticosterone concentrations in rats after two timed adrenalectomies and rats after bilateral adrenalectomy was statistically different, but these results were far from physiological concentrations

Patients Subject to Surgery due to Acute Abdominal Disorders during the Period between 2001-2004

was to evaluate the clinical spectrum of emergency surgery for acute abdominal disorders and their outcome. Material and methods. The study group comprised 1426 patients, aged between 10 and 92 years subject to emergency surgery, due to an acute abdomen during the period 2001-2004. Analysis comprised age, sex, concomitant diseases, ASA scale classification, postoperative diagnosis, type of surgery, complications, mortality and duration of hospitalization. Patients were divided into two age groups: <60 and ≥60 years. Results. Appendicitis was the most common diagnosis (52.9%) in patients under 60 years, while cholecystitis (32.5%) and ileus (30.9%) in patients over 60 years. Complications were observed in 14.8% patients, the most common being related with wound healing (5.6%). The mortality rate amounted to 5.7%. Mortality was most often associated with bowel obstruction (29.2%), surgery for acute bowel ischemia (25.5%), and bowel perforation (20.7%). The mean duration of hospitalization was 7.9 days. Conclusions. 1. In comparison to elective surgery, emergency abdominal operations, particularly in elderly patients are related with a higher mortality rate. 2. In elderly patients, the high mortality rate and substantial number of complications is associated with the advanced primary disease and severe coexisting comorbidities, which significantly reduce the overall health condition

Physician as an Infective Vector at a Department of Surgery

This study was designed to assess the degree of risk of bacterial transmission from physician to patient through hands, equipment and enclosing surfaces (shoe soles). Material and methods. The study was conducted in the Clinical Department of General and Oncological Surgery UM in Łódź. In days 16.10.2013, 17.10.2013, 18.10.2013 there were done swabs from hands, stethoscopes and soles of shoes from the same group of physicians before and after doctor's rounds. The presence of alert-pathogens in swabs was regarded as positive result. Results. Isolates included mostly aerobic saprophytic bacilli and Staphylococcus species coagulase-negative. There were detected a singly cases of Acinetobacter Baumani and Escherichia coli. Alert-pathogens were found in 4 (16%) swabs taken from hand before doctor's rounds and in 7 (28%) swabs taken after rounds. Stetoscopes were contaminated by alert-pathogens in 3 (12%) cases before doctor's rounds and in 3 (12%) cases taken after doctor's rounds. Soles of shoes were contaminated by alert-pathogens in 14 (56%) cases taken before and 16 (65%) cases taken after doctor's rounds. Conclusions. 1. Physicians are important factor of bacterial transmission in hospital. 2. Hands, stetoscopes and particularly soles of shoes of medical staff is the source of infection

Evaluating the Prognostic Value of Selected Prognostic Scales in Patients Operated on Due to Peritonitis

The aim of the study was to assess the usefulness of prognostic scales: ASA (American Society of Anesthesiologist), MPI (Meinheim Peritonitis Index), MOFS (the Multiple Organ Failure Score) and SPI (the Simple Prognostic Index) in the prognosis of the course of disease in patients operated on for peritonitis. Material and methods. The study was conducted in the Clinical Department of General and Oncological Surgery of the Medical University in Łódź between January 2009 to December 2010. During this period 263 patients were operated on for peritonitis. Before surgery all patients were classifed into particular groups according to the above mentioned prognostic scales according to their criteria. Results. There were 29 (11%) deaths. ASA ≥4 (p30 (p<0.0001) MOFS ≥2 (p<0.0001), SPI II, III, IV (p<0.0001) were important risk factors of death. Conclusions. 1. ASA, MPI, MOFS and SPI scales are of high signifcance in predicting the outcome in patients operated on for peritonitis. 2. The ASA scale in spite and due to its simplicity is adequate enough to be used in everyday practice in patients operated on for peritonitis. 3. The MPI scale is most suitable in the scientifc aims and in comparing the outcomes of patients operated on for peritonitis

Early predictors of post – thyroidectomy hypoparathyroidism

Thyroid surgery is the most commonly performed procedure in the field of endocrine surgery. Studies are still ongoing on the development of a single algorithm for diagnosis and care of patients at risk of postoperative hypoparathyroidism. The aim of the study was to determine the biochemical marker that would allow the most accurate diagnosis of patient groups at risk of developing hypoparathyroidism and to identify risk factors for this disorder. Material and methods. The prospective study included 142 consecutive patients undergoing total thyroidectomy for benign goiter from January 1st 2014 to December 31st 2015. Serum intact parathyroid hormone (iPTH), total calcium (Ca), phosphate (P), and magnesium (Mg) levels have been measured preoperatively and at 1, 6, 24, and 48 h postoperatively. Results. Clinical symptoms of hypoparathyroidism developed in 25 (17.6%) of 142 patients. The best diagnostic accuracy for hypoparathyroidism based on ROC curves was obtained for iPTH at 6h (AUC 0.942; 95% CI: 0.866-1.000, p 65% or iPTH level at 6h <1.57 pmol /l. A postoperative decline in iPTH levels is an independent risk factor for the development of hypoparathyroidism. Preoperative higher concentrations of Ca and iPTH are protective factors for the development of this disorder

Niedoczynność przytarczyc po całkowitym wycięciu tarczycy – wczesne markery prognostyczne

Operacje tarczycy to najczęściej wykonywane procedury w zakresie chirurgii endokrynologicznej. Podejmowane są próby stworzenia jednolitego algorytmu diagnostyki i opieki nad chorymi zagrożonymi pooperacyjną niedoczynnością przytarczyc. Celem pracy było wyznaczenie markera biochemicznego, który najdokładniej posłużyłby do określenia grupy pacjentów zagrożonych pooperacyjną niedoczynnością przytarczyc oraz identyfikacją czynników ryzyka tego powikłania. Materiał i metodyka. Do prospektywnego badania włączono 142 kolejnych pacjentów poddanych całkowitemu wycięciu tarczycy od 1 stycznia 2014 do 31 grudnia 2015 r. z powodu wola. Stężenia natywnego PTH (iPTH), wapnia całkowitego (Ca), fosforanów (P) oraz magnezu (Mg) były mierzone w surowicy przed operacją oraz w 1, 6, 24 i 48 godzinie po zabiegu. Wyniki. Objawy kliniczne niedoczynności przytarczyc wystąpiły u 25 (17,6%) ze 142 badanych pacjentów. Największą wartość prognostyczną dla niedoczynności przytarczyc na podstawie krzywych ROC miało stężenia iPTH w 6 h (AUC 0,942; 95%Cl: 0,866-1,000, p65% lub stwierdzenie stężenia iPTH <1,57 pmol/l w 6 h po operacji. Spadek stężenia iPTH po zabiegu jest niezależnym czynnikiem ryzyka wystąpienia niedoczynności przytarczyc. Przedoperacyjne wyższe stężenia Ca oraz iPTH są czynnikami ochronnymi dla wystąpienia tego powikłania

Health risk to medical personnel of surgical smoke produced during laparoscopic surgery

Objectives: During laparoscopic cholecystectomy, the removal of the gall bladder, pyrolysis occurs in the peritoneal cavity. Chemical substances which are formed during this process escape into the operating room through trocars in the form of surgical smoke. The aim of this study was to identify and quantitatively measure a number of selected chemical substances found in surgical smoke and to assess the risk they carry to medical personnel. Material and Methods: The study was performed at the Maria Skłodowska-Curie Memorial Provincial Specialist Hospital in Zgierz between 2011 and 2013. Air samples were collected in the operating room during laparoscopic cholecystectomy. Results: A complete qualitative and quantitative analysis of the air samples showed a number of chemical substances present, such as aldehydes, benzene, toluene, ethylbenzene, xylene, ozone, dioxins and others. Conclusions: The concentrations of these substances were much lower than the hygienic standards allowed by the European Union Maximum Acceptable Concentration (MAC). The calculated risk of developing cancer as a result of exposure to surgical smoke during laparoscopic cholecystectomy is negligible. Yet it should be kept in mind that repeated exposure to a cocktail of these substances increases the possibility of developing adverse effects. Many of these compounds are toxic, and may possibly be carcinogenic, mutagenic or genotoxic. Therefore, it is necessary to remove surgical smoke from the operating room in order to protect medical personnel

Health risk to medical personnel of surgical smoke produced during laparoscopic surgery

Objectives: During laparoscopic cholecystectomy, the removal of the gall bladder, pyrolysis occurs in the peritoneal cavity. Chemical substances which are formed during this process escape into the operating room through trocars in the form of surgical smoke. The aim of this study was to identify and quantitatively measure a number of selected chemical substances found in surgical smoke and to assess the risk they carry to medical personnel. Material and Methods: The study was performed at the Maria Skłodowska-Curie Memorial Provincial Specialist Hospital in Zgierz between 2011 and 2013. Air samples were collected in the operating room during laparoscopic cholecystectomy. Results: A complete qualitative and quantitative analysis of the air samples showed a number of chemical substances present, such as aldehydes, benzene, toluene, ethylbenzene, xylene, ozone, dioxins and others. Conclusions: The concentrations of these substances were much lower than the hygienic standards allowed by the European Union Maximum Acceptable Concentration (MAC). The calculated risk of developing cancer as a result of exposure to surgical smoke during laparoscopic cholecystectomy is negligible. Yet it should be kept in mind that repeated exposure to a cocktail of these substances increases the possibility of developing adverse effects. Many of these compounds are toxic, and may possibly be carcinogenic, mutagenic or genotoxic. Therefore, it is necessary to remove surgical smoke from the operating room in order to protect medical personnel

Imaging of Uveal Melanoma—Current Standard and Methods in Development

Uveal melanoma is the most common primary intraocular malignancy in adults, characterized by an insidious onset and poor prognosis strongly associated with tumor size and the presence of distant metastases, most commonly in the liver. Contrary to most tumor identification, a biopsy followed by a pathological exam is used only in certain cases. Therefore, an early and noninvasive diagnosis is essential to enhance patients’ chances for early treatment. We reviewed imaging modalities currently used in the diagnostics of uveal melanoma, including fundus imaging, ultrasonography (US), optical coherence tomography (OCT), single-photon emission computed tomography (SPECT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), fundus autofluorescence (FAF), as well as positron emission tomography/computed tomography (PET/CT) or magnetic resonance imaging (MRI). The principle of imaging techniques is briefly explained, along with their role in the diagnostic process and a summary of their advantages and limitations. Further, the experimental data and the advancements in imaging modalities are explained. We describe UM imaging innovations, show their current usage and development, and explain the possibilities of utilizing such modalities to diagnose uveal melanoma in the future