Primary gigantic lipoma of the arm

This paper presents a rare case of a primary gigantic tumour of the right arm in a fifty-seven-year old man. The measurements of the arm tumour were as follows: length - 490 mm, width - 340 mm, circumference - 1080 mm, weight - 7350 grams, while the period of its development was about 20 years. The patient was admitted to hospital as an emergency case suffering from bleeding of superficial tumour vessels and secondary anaemia. The patient was operated on in a planned course of action. During and after the operation no complications were observed while secondary anaemia syndromes receded.Przedstawiono rzadki przypadek ogromnego pojedynczego tłuszczaka prawego ramienia u 57-letniego mężczyzny, który został przyjęty na oddział chirurgii ogólnej w trybie pilnym z powodu obfitego krwawienia żylnego z powierzchownego naczynia skóry nad tłuszczakiem. U pacjenta występowały objawy niedokrwistości wtórnej. Wymiary guza ramienia prawego: długość - 490 mm, szerokość - 340 mm, obwód - 1080 mm, waga - 7350 gramów, okres wzrostu - około 20 lat. Po wyrównaniu parametrów morfologicznych zoperowano pacjenta w trybie planowym; operacja i okres pooperacyjny przebiegały bez komplikacji. Objawy wtórnej niedokrwistości ustąpiły po leczeniu chirurgicznym

Attempt at application of the International Classification of Functioning, Disability and Health (ICF) in the domains of body and structure function and activity and participation in the assessment of the rate of disability in patients with morbid obesity : pilot study

Background. Due to the constant increase in the number of morbidly obese patients, an adequate tool for assessing the functioning and disability of these patients is being sought. The International Classification of Functioning, Disability and Health (IC F) could be that tool. Objectives. The aim of this study is to examine the usefulness of the IC F scale in assessing the functioning of morbidly obese patients in two selected areas in reference to recognized scales. Material and methods . The study group included 76 patients with morbid obesity qualified for bariatric treatment. The ICF was applied to assess the function and limitations of each individual. Two domains of the IC F were selected: Body Functions and Structures and Activities and Participation. The usefulness of the IC F was compared to that of the Barthel and EPQ-R scales. Results . In morbidly obese patients, a correlation between motor functions and IC F and BMI, as well as age, was observed. A significant correlation was observed between BMI and psychomotor control, appropriateness and range of emotions experienced, age and amount of sleep, quality of sleep, memory retrieval and psychomotor functions. Women’s mental functions were significantly worse than those of men. In terms of interpersonal relations, a correlation between BMI and regulating behavior within interactions was observed. Conclusions . The IC F is a useful tool for the study and description of the functioning of patients with morbid obesity. The selected domains are described better than by the previously used Barthel scale. Women with morbid obesity tend to have more impaired mental functioning than morbidly obese men

Dispatching of emergency medical teams to patients with cardiovascular diseases

Wprowadzenie i cel pracy. Akty prawne dedykowane dyspozytorom medycznym nie precyzują rodzaju wezwań, do których powinni zadysponować określony typ zespołów ratownictwa medycznego (podstawowy zespół ratownictwa medycznego – ZRM P; specjalistyczny zespół ratownictwa medycznego – ZRM S) lub odmówić wyjazdu. Ze względu na inny zakres medycznych czynności ratunkowych dysponowanie przekłada się na czas i rodzaj udzielonej pomocy. Celem pracy było określenie, czy rodzaj wezwania ma wpływ na decyzję dyspozytora o rodzaju ZRM realizującego dane zlecenie. Materiał i metody. Przeanalizowano 1560 kart medycznych czynności ratunkowych (KMCR) z 2012 r. z grupy „Problemy kardiologiczne” wg Systemu Wspomagającego Dowodzenie (SWD), ZRM S i P stacjonujących w 2 lokalizacjach, w każdej 1 ZRM S i P, w jednej 2 miesiące był dodatkowy ZRM P. Zgłaszane dolegliwości, objawy, schorzenia pogrupowano na kategorie objawowe: ból w klatce piersiowej, zaburzenia rytmu, zmiany ciśnienia tętniczego, zaburzenia świadomości, duszność, inne. Określono, ilu chorych podało 1, 2 lub 3 i więcej powodów wezwania ZRM, przeanalizowano częstość poszczególnych objawów. Wyniki. Wybrane ZRM zrealizowały ogółem 13 715 wyjazdów, podstawowe – 7254, specjalistyczne – 6461. 1560 dotyczyło grupy „Problemy kardiologiczne” (11,4%). 556 wyjazdów (8%) – ZRM P, 1004 (16%) – ZRM S. 784 osoby (50%) zgłosiły 1 dolegliwość, 644 pacjenci (41%) – 2, a 132 chorych (9%) – 3 i więcej powodów wezwania. Zgłoszono 2468 dolegliwości. Do 83% zleceń z 3 dolegliwościami, 67% z dwoma i 59% z jednym zadysponowano ZRM S. Ból w klatce piersiowej zgłosiło 56% chorych ZRM P i 69% – S. W pozostałych kategoriach dysponowanie obu typami ZRM było podobne. Wnioski. Rodzaj wezwania miał wpływ na wybór zadysponowanego ZRM. W schorzeniach o podłożu kardiologicznym, o potencjalnie wieńcowym charakterze oraz do prawdopodobnie cięższego stanu pacjenta – więcej niż 2 objawy – częściej dysponowano ZRM S.Introduction and objective. Legislation concerning medical dispatchers does not specify the type of calls for paramedic or specialist EMS team, and when they can refuse to attend to a patient. Due to other scope of medical emergency operations the dispatching determines the time and type of aid. The objective is to determine whether the type of call has an impact on the dispatcher’s decision about the type of EMS team. Material and methods. Research was carried out on the basis of medical documentation submitted in 2012 by 5 EMS teams of the Kraków Emergency Service located in 2 places in ‘Nowa Huta’, with one basic and one specialist team in each, and in one of these places for 2 month there was an additional basic EMS team. 1,560 medical rescue procedure cards were analyzed and classified to a group ‘cardiologic problems’. Reported ailments, symptoms, diseases were grouped into the categories: chest pain, arrhythmia, high blood pressure, loss of consciousness, shortness of breath, other. Results. Selected EMS teams undertook a total of 13,715 trips: basic – 7,254, specialist – 6,461. A group of 1,560 constituted ‘Cardiac Problems’ (11.4%), 556 (8%) – basic EMS team, 1,004 (16%) – specialist EMS team. 784 patients (50%) reported one ailment, 644 patients (41%)-2 and 132 patients (9%) – 3 or more reasons. There were 2,468 reported ailments. Specialist EMS teams were dispatched for 83% of the dispatch orders with 3 problems, 67% with two and 59% with a single problem. 56% of patients of the basic EMS teams and 69% of the specialist team reported chest pain; in other categories, the dispatching of both types of EMS teams was similar. Conclusions. The type of call influenced the choice of dispatching the EMS team. In the case of disorders on a cardiologic, potentially coronary background, and probably a more severe patient’s condition – more than 2 symptoms – more often, the specialist EMS teams were dispatched

Wpływ leczenia otyłości olbrzymiej metodą implantacji balonu wewnątrzżołądkowego na wielochorobowość pacjentów

INTRODUCTION: Morbid obesity and its accompanying multimorbidity constitute a significant public health problem. AIM: The aim of the study is to evaluate the effect of endoscopic implantation of an intragastric balloon on the ailments and associated diseases in people with obesity. MATERIAL AND METHODS: The study included 75 people treated by intragastric balloon implantation. The sample selection was purposeful. The patients were qualified for balloon implantation, according to recognized indications for the endoscopic treatment of obesity. All the analyses were performed using Statistica 12. Results for which p < 0.05 were considered as statistically significant. RESULTS: Positive effects of the treatment of obesity by intragastric balloon implantation in relation to comorbidities were observed in 54 patients (62%), 30 people (40%) achieved minimal health improvement, the regression of one serious disease and alleviation others in 24 patients (32%). 21 patients (28%) had no improvement in their health status. None of the patients reported the resolution of all major diseases, but there was also no deterioration in the health of any patient. There was a statistically significant reduction in the incidence of hypertension, type 2 diabetes, spinal pain, osteoarthritis, sleep apnoea, menstrual disorders, impotence and dyspnoea during IGB treatment. CONCLUSIONS: Treatment by endoscopic implantation of an intragastric balloon alleviates the course or reduces the incidence of concomitant diseases in persons with morbid obesity.WSTĘP: Otyłość olbrzymia i towarzysząca jej wielochorobowość stanowią poważny problem zdrowia publicznego. CEL: Celem pracy jest ocena wpływu endoskopowej implantacji balonu wewnątrzżołądkowego na dolegliwości i choroby towarzyszące u osób z otyłością. MATERIAŁ I METODY: Badaniem objęto 75 osób leczonych metodą implantacji balonu wewnątrzżołądkowego. Pacjenci zostali zakwalifikowani do implantacji balonu, zgodnie z uznanymi wskazaniami do endoskopowego leczenia otyłości. Wszystkie analizy przeprowadzono za pomocą Statistica 12. Za poziom istotności statystycznej przyjęto p < 0,05. WYNIKI: Pozytywne efekty leczenia otyłości metodą implantacji balonu wewnątrzżołądkowego w odniesieniu do współistniejących chorób zaobserwowano u 54 pacjentów (62%), 30 osób (40%) osiągnęło minimalną poprawę stanu zdrowia, u 24 pacjentów (32%) ustąpiło co najmniej jedno zasadnicze schorzenie. 21 pacjentów (28%) nie wskazywało poprawy stanu zdrowia. Żaden z pacjentów nie zgłosił ustąpienia wszystkich głównych chorób, ale również nie nastąpiło pogorszenie stanu zdrowia. Podczas leczenia IGB stwierdzono statystycznie istotne zmniejszenie występowania nadciśnienia, cukrzycy typu 2, bólu kręgosłupa, choroby zwyrodnieniowej stawów, bezdechu sennego, zaburzeń miesiączkowania, impotencji i duszności. WNIOSKI: Leczenie otyłości metodą endoskopowej implantacji balonu wewnątrzżołądkowgo zmniejsza częstość współistniejących chorób u osób z otyłością olbrzymią

Impact of Weight Loss Due to Sleeve Gastrectomy on Shear Stress of the Femoral Vein in Morbid Obesity

BACKGROUND: Studies have shown that obesity is associated with venous flow disturbances that lead to changes of the biomechanical forces on the venous wall known as shear stress. We hypothesized that weight loss due to bariatric surgery affects the venous hemodynamics and biomechanical forces on the venous wall. The aim of this study was to evaluate the effects of laparoscopic sleeve gastrectomy (LSG) on the wall shear stress (WSS) and the venous hemodynamics of the femoral vein. METHODS: We studied ten morbidly obese patients who underwent LSG. We investigated venous hemodynamics before, 6 and 12 months after LSG. The femoral vein diameter, cross-sectional area, peak (PeakV) and maximum (TA(max)) velocities, WSS, and shear rate (SR) were assessed. RESULTS: PeakV and TA(max) were significantly lower in the obese patients compared with the control group. WSS and SR were significantly lower in the obese patients compared with the control subjects. Venous hemodynamic parameters increased in the postoperative period at baseline compared with 12 months after surgery: PeakV increased from 17.53 (14.25–20.01) cm/s to 25.1 (20.9–30.1) cm/s (P = 0.04) and the TA(max) from 12.97 (11.51–14.6) cm/s to 18.46 (13.24–24.13) cm/s (P = 0.057). WSS significantly increased from 0.21 (0.19–0.23) Pa at baseline to 0.31 (0.23–0.52) Pa 12 months after surgery (P = 0.031). SR also significantly increased from 47.92 (43.93–58.55) s(−1) at baseline to 76.81 (54.04–109.5) s(−1) 12 months after surgery (P = 0.02). CONCLUSIONS: This study showed that weight loss due to LSG significantly changes the biomechanical forces on the femoral vein generated by blood flow

Influence of Obesity on Anastomotic Leakage After Anterior Rectal Resectionperformed Due to Cancer

Anterior resection for rectal cancer carries the risk of serious complications, especially fistulas at the site of anastomosis. Numerous factors have been shown to impact anastomotic leakage. The results of studies on the influence of obesity on the frequency of anastomotic leakage after rectal resection performed due to cancer have been contradictory. The aim of the study was to evaluate the relationship between body mass index (BMI) and frequency of anastomotic leakage after anterior rectal resection performed due to cancer. Material and methods. This retrospective analysis included 222 subsequent patients who had undergone anterior resection due to cancer with an anastomosis formed with a mechanical suture. The patients were divided into 3 groups depending on their BMI quartile as follows: Group I, BMI 29.38 kg/m2 (upper quartile). Results. Anastomotic leakage occurred in 8 (3.6%) patients. Fistulas occurred in 4 out of 61 patients (6.56%) in group I, which was the highest incidence of fistulas for all 3 groups. In group II, fistulas occurred in 2 out of 55 patients (3.63%), and similarly, in group III, they occurred in 2 out of 106 patients (1.87%). The differences found in the frequency of fistulas between groups were not statistically significant (p=0.31). The logistic regression analysis did not show any relationship between leakage and age (p = 0.55; OR = 1.02; 95% CI: 0.95 - 1.1), sex (p = 0.97; OR = 0.97; 95% CI: 0.22 - 4.25) or BMI (p = 0.27; OR = 0.58; 95% CI: 0.22 - 1.53). Conclusions. The results of our study show that BMI did not have any influence on the frequency of anastomotic leakage after anterior rectal resection performed due to cancer