Does the type of a centre in which the resection of extensive tumours of the limbs and truck is performed, affect the patients’ survival?

Nowoczesna chirurgia rekonstrukcyjna opiera się na odpowiednim wykorzystaniu dostępnych metod rekonstrukcyjnych, w tym mikronaczyniowych. Zaplanowanie odpowiedniej operacji rekonstrukcyjnej daje możliwość wykonania maksymalnie szerokiej resekcji, co dodatkowo zwiększa radykalność zabiegu. Ostatnimi czasy zaznacza się tendencja do wykonywania rozległych resekcji nowotworów w ośrodkach nie dysponujących bogatym doświadczeniem w tego rodzaju procedurach. Istnieje obawa, że, z uwagi na brak możliwości wykonania jednoczasowej rekonstrukcji, zakres resekcji może być niewystarczający do uzyskania pełnej radykalności zabiegu. W oparciu o wyniki badań 71 chorych leczonych w Klinice Chirurgii Onkologicznej i Rekonstrukcyjnej w latach 2006 – 2017 z powodu rozległych zmian nowotworowych tułowia i kończyn wykazano, że chorzy leczeni pierwotnie (zabieg resekcyjny) poza Instytutem charakteryzowali się znacząco krótszym czasem przeżycia do wznowy. Powyższe wyniki stanowią głos potwierdzający zasadność przeprowadzania rozległych zabiegów resekcyjno – rekonstrukcyjnych w przypadku zaawansowanych zmian nowotworowych, w ośrodkach o bogatym doświadczeniu w tym zakresie

Adjuvant radiotherapy post microvascular reconstructive surgery (MRS) for patients with locally advanced head and neck cancer – when and how?

For many decades palliation (radiotherapy, chemotherapy or symptomatic treatment) was the only therapeutic solu­tion for locally very advanced head and neck cancer. In the mid 70s, H. Buncke carried out pioneering microvascular reconstructive surgery (MRS) as a radical treatment. Since that time, the MRS has been accepted around the world as a successful radical therapy, not only for head and neck (H&N) cancers. A part of the H&N cancers need however post­-MRS radiotherapy (RT). Based on the 20 year experience of the Institute of Oncology in Gliwice with MRS (about 2500 patients), D. Bula has defined local recurrence risk factors. Dutch studies convincingly documented the prognostic value of the estimated molecular profiles of the resected margins as additional risk factors. The use of conventional 2.0 Gy/ fraction post-MRS-RT result in a high risk of the inserted reconstructive flap necrosis or rejection. Therefore, a novel IMRT­-VMAT technique with 50 Gy given in 1.5–1.6 Gy/fraction has been designed which allows to almost eliminate the flap from the irradiated volume and therefore minimizes recurrence and/or flap rejection to almost zero. The present paper shows objectively selected a cluster of patients being the candidate to post-MRS safe and effective VMAT radiotherapy

Adjuvant radiotherapy post microvascular reconstructive surgery (MRS) for patients with locally advanced head and neck cancer – when and how?

For many decades palliation (radiotherapy, chemotherapy or symptomatic treatment) was the only therapeutic solu­tion for locally very advanced head and neck cancer. In the mid 70s, H. Buncke carried out pioneering microvascular reconstructive surgery (MRS) as a radical treatment. Since that time, the MRS has been accepted around the world as a successful radical therapy, not only for head and neck (H&N) cancers. A part of the H&N cancers need however post­-MRS radiotherapy (RT). Based on the 20 year experience of the Institute of Oncology in Gliwice with MRS (about 2500 patients), D. Bula has defined local recurrence risk factors. Dutch studies convincingly documented the prognostic value of the estimated molecular profiles of the resected margins as additional risk factors. The use of conventional 2.0 Gy/ fraction post-MRS-RT result in a high risk of the inserted reconstructive flap necrosis or rejection. Therefore, a novel IMRT­-VMAT technique with 50 Gy given in 1.5–1.6 Gy/fraction has been designed which allows to almost eliminate the flap from the irradiated volume and therefore minimizes recurrence and/or flap rejection to almost zero. The present paper shows objectively selected a cluster of patients being the candidate to post-MRS safe and effective VMAT radiotherapy

Novel, self-made and cost-ective technique for closed-incision negative pressure wound therapy

Background: It has been suggested that applying the negative pressure wound therapy (NPWT) to a closedsurgical incision may hasten the healing of the incision and decrease the incidence of wound healing complications. The goal of this study is to present the new idea of a simple, self-made, low-cost wound vacuum dressing for closed-incision NPWT that may become an alternative to currently manufactured medicalindustry products.Method: We designed a simple dressing for closed-incision NPWT from gauze pads, polyurethane adhesive film, stoma paste, and a drain tube. Negative pressure was created using a standard 50 ml syringe connected to the drain. First, the dressing was applied to the wound model and on the healthy volunteer. Finally, the dressing was applied to 10 patients after low anterior rectal resection. The vacuum dressing was left in place for 3 days, then changed and placed once more for the next 3 days.Results: We did not observe any adverse effects associatedwith the dressing. All postoperative wounds healed properly. 18 out of 20 dressings were still air-tight 72h post-placement.Conclusions: This simple, self-made dressing for NPWT is safe and effective and may decrease the wound infection rate. However future studies are needed to confirm that hypothesis

Human ADSC xenograft through IL-6 secretion activates M2 macrophages responsible for the repair of damaged muscle tissue

Background: Adipose-derived mesenchymal stromal cells (ADSCs) are multipotent stromal cells. The cells secrete a number of cytokines and growth factors and show immunoregulatory and proangiogenic properties. Their properties may be used to repair damaged tissues. The aim of our work is to explain the muscle damage repair mechanism with the utilization of the human adipose-derived mesenchymal stromal cells (hADSCs). Methods: For the hADSCs isolation, we used the subcutaneous adipose tissue collected during the surgery. The murine hind limb ischemia was used as a model. The unilateral femoral artery ligation was performed on 10–12-week-old male C57BL/6NCrl and NOD SCID mice. The mice received PBS− (controls) or 1 × 106 hADSCs. One, 3, 7, 14 and 21days after the surgery, we collected the gastrocnemius muscles for the immunohistochemical analysis. The results were analyzed with relevant tests using the Statistica software. Results: The retention time of hADSCs in the limb lasted about 14 days. In the mice receiving hADSCs, the improvement in the functionality of the damaged limb occurred faster than in the control mice. More new blood vessels were formed in the limbs of the mice receiving hADSCs than in limbs of the control mice. hADSCs also increased the infiltration of the macrophages with the M2 phenotype (7-AAD−/CD45+/F4/80+/CD206+) into the ischemic limbs. hADSCs introduced into the limb of mice secreted interleukin-6. This cytokine stimulates the emergence of the proangiogenic M2 macrophages, involved, among others, in the repair of a damaged tissue. Both macrophage depletion and IL-6 blockage suppressed the therapeutic effect of hADSCs. In the mice treated with hADSCs and liposomes with clodronate (macrophages depletion), the number of capillaries formed was lower than in the mice treated with hADSCs alone. Administration of hADSCs to the mice that received siltuximab (human IL-6 blocker) did not cause an influx of the M2 macrophages, and the number of capillaries formed was at the level of the control group, as in contrast to the mice that received only the hADSCs. Conclusions: The proposed mechanism for the repair of the damaged muscle using hADSCs is based on the activity of IL-6. In our opinion, the cytokine, secreted by the hADSCs, stimulates the M2 macrophages responsible for repairing damaged muscle and forming new blood vessels

Effectivness of quality management systems in health care on the example of Cracow Specialist Hospital John Paul II

The dissertation describes issue of quality management systems' effectiveness in health care. The aim of this study was to determine whether quality measured by patient satisfaction rate has an impact on the efficiency in financial terms. The theoretical part provides information about the principles of functioning of health care, quality management systems implemented in the sector and characteristic of the analyzed hospital. First stage of the practical part was an analysis of patent satisfaction researches conducted between year 2001 and 2008. Second part consisted of financial analysis made on the base of hospital financial statements for the years 2000- 2009. In the last part of the study was constructed a model that measure relations between quality and financial indicators. On the basis of studies carried out was made an conclusion that patients satisfaction may affect on the economic efficiency of the hospital.W pracy została podjęta problematyka efektywności systemów zarządzania jakością w służbie zdrowia. Celem pracy było ustalenie czy jakość mierzona poziomem satysfakcji pacjentów ma wpływ na efektywność w sensie finansowym. W części teoretycznej przedstawiono informacje dotyczące zasad funkcjonowania opieki zdrowotnej, systemów zarządzania jakością wdrażanych w omawianym sektorze oraz scharakteryzowano badany szpital. W pierwszym etapie części praktycznej dokonano analizy wyników badań satysfakcji pacjentów prowadzonych w szpitalu w latach 2001-2008. Drugi etap części praktycznej polegał na przeprowadzeniu analizy finansowej na podstawie sprawozdań finansowych szpitala. W ostatniej części badań skonstruowano model w którym oceniano wpływ jakości mierzonej poziomem satysfakcji pacjentów na efektywność. Na podstawie przeprowadzonych badań ustalono czy satysfakcja pacjentów może wpływać na efektywność ekonomiczną szpital

Expression profiles of MGMT, p16, and APC genes in tumor and matching surgical margin from patients with oral squamous cell carcinoma

The aim of the study was to assess the expression of MGMT, p16, and APC genes in tumors and matching surgical margin samples from 56 patients with primary OSCC. We also analyzed the association of the clinical variables with the expression of the studied genes. After RNA isolation and cDNA synthesis gene expression levels were assessed by quantitative reverse transcription (qRT)-PCR. Two-sided parametrical Student's t-test for independent groups with equal/unequal variances showed no statistically significant differences in genes' expression in tumor compared to margin samples. No association was found between the genes' expression and clinical parameters, except for MGMT, whose low expression was probably associated with smoking (0.87 vs 1.34, p=0.065). 'Field cancerization' is an area with genetically or epigenetically altered cells and at the same time a risk factor for cancer. Disturbances in gene expression could also be the source of damages leading to cancerization. In conclusion, it is important to mention that the field remaining after a surgery may pose an increased risk of cancer development. It may be suggested that the diagnosis and treatment of cancers should not be concentrated only on the tumor itself, but also on the cancer field effect. Therefore, further molecular analysis on surgical margins and additional research regarding their assessment are required

Use of a Fibula Free Flap for Mandibular Reconstruction in Severe Craniofacial Microsomia in Children with Obstructive Sleep Apnea

This is a retrospective study describing a multi-stage protocol for the management of severe mandibular hypoplasia in craniofacial microsomia (CFM) with accompanying obstructive sleep apnea (OSA). Patients with severe mandibular hypoplasia require reconstruction functionality and esthetical features. In the cohort, reconstructions based on free fibular flaps (FFF) may be the most effective way. Patients aged 4–17 years with severe mandibular hypoplasia were treated with FFF, which initially improved the respiratory function assessed on polysomnography (AHI). In the next stages of treatment of cases with respiratory deterioration, it was indicated to perform distraction osteogenesis (DO) of the mandible and the structures reconstructed with FFF. All surgeries were planned in accordance with virtual surgery planning VSP. The aim of the study was to prospectively assess the effectiveness of multi-stage mandibular reconstruction in craniofacial microsomia with the use of a free fibula flap in terms of improving respiratory failure due to obstructive sleep apnea (OSA). The FFF reconstruction method, performed with virtual surgical planning (VSP), is proving to be an effective alternative to traditional methods of mandibular reconstruction in patients with severe CFM with OSA