Polski konsensus interdyscyplinarny dotyczący diagnostyki i leczenia choroby uchyłkowej

Artykuł przedstawia interdyscyplinarny konsensus na temat diagnostyki i leczenia choroby uchyłkowej okrężnicy opracowany przez grupę ekspertów powołanych przez Polskie Towarzystwo Gastroenterologii i Polskie Towarzystwo Chirurgów Polskich

Conscious sedation for transcatheter implantation of atrial septal occluders with two- and three-dimensional transoesophageal echocardiography guidance — a feasibility and safety study

Background: General anaesthesia may have negative impact on patient mortality and morbidity, as well as overall procedure costs, in atrial septal occluder (ASO) implantation. Aim: We sought to evaluate the safety, efficacy, and feasibility of conscious sedation for transcatheter implantation of ASOs. Methods: A total of 122 patients referred for transcatheter implantation of ASO were included. Mean patient age was 51 ± 15 years, and 43 (35%) patients were male. The initial dose of midazolam was 2 mg and fentanyl dose was 25 μg. Additional doses of midazolam and fentanyl were administered, if necessary. Patient responsiveness was assessed every 10 min, and the sedatives doses were titrated in order not to exceed grade 3 sedation in the Ramsey scale. Results: Atrial septal occluders were successfully implanted in the majority of patients (98.4%). In two (1.6%) cases the proce­dure failed because of too small patent foramen ovale (PFO) diameter (n = 1, 0.8%) or device instability (n = 1, 0.8%). The mean duration of procedure was 47.6 ± 28.4 min and was similar for ASD and PFO closure (p = 0.522). The overall mean dose of midazolam was 4.7 ± 2.2 mg (63.9 ± 32.5 μg/kg) and fentanyl was 30.0 ± 11.9 μg (0.43 ± 0.17 μg/kg). Median entrance dose of radiation at the patient plane was 25 (interquartile range: 16–57) mGy, and did not differ between ASD and PFO procedures (p = 0.614). The majority of patients were free of complications (91.0%). The following early complications were observed: transient ischaemic attack (n = 2, 1.6%), supraventricular arrhythmias (n = 4, 3.3%), left atrial thrombus formation (n = 1, 0.8%), symptomatic bradycardia (n = 1, 0.8%), and femoral venous bleeding (n = 5, 4.1%). After mean follow-up of 386 days residual shunt was observed in eight (6.6%) patients. Conclusions: Conscious sedation for transcatheter implantation of ASO is a feasible, safe, and efficient technique, allowing successful PFO and ASD closure in the majority of patients.Background: General anaesthesia may have negative impact on patient mortality and morbidity, as well as overall procedure costs, in atrial septal occluder (ASO) implantation. Aim: We sought to evaluate the safety, efficacy, and feasibility of conscious sedation for transcatheter implantation of ASOs. Methods: A total of 122 patients referred for transcatheter implantation of ASO were included. Mean patient age was 51 ± 15 years, and 43 (35%) patients were male. The initial dose of midazolam was 2 mg and fentanyl dose was 25 μg. Additional doses of midazolam and fentanyl were administered, if necessary. Patient responsiveness was assessed every 10 min, and the sedatives doses were titrated in order not to exceed grade 3 sedation in the Ramsey scale. Results: Atrial septal occluders were successfully implanted in the majority of patients (98.4%). In two (1.6%) cases the proce­dure failed because of too small patent foramen ovale (PFO) diameter (n = 1, 0.8%) or device instability (n = 1, 0.8%). The mean duration of procedure was 47.6 ± 28.4 min and was similar for ASD and PFO closure (p = 0.522). The overall mean dose of midazolam was 4.7 ± 2.2 mg (63.9 ± 32.5 μg/kg) and fentanyl was 30.0 ± 11.9 μg (0.43 ± 0.17 μg/kg). Median entrance dose of radiation at the patient plane was 25 (interquartile range: 16–57) mGy, and did not differ between ASD and PFO procedures (p = 0.614). The majority of patients were free of complications (91.0%). The following early complications were observed: transient ischaemic attack (n = 2, 1.6%), supraventricular arrhythmias (n = 4, 3.3%), left atrial thrombus formation (n = 1, 0.8%), symptomatic bradycardia (n = 1, 0.8%), and femoral venous bleeding (n = 5, 4.1%). After mean follow-up of 386 days residual shunt was observed in eight (6.6%) patients. Conclusions: Conscious sedation for transcatheter implantation of ASO is a feasible, safe, and efficient technique, allowing successful PFO and ASD closure in the majority of patients

Template chart detection for stoma telediagnosis

The paper presents the concept of using color template charts for the needs of telemedicine, particularly telediagnosis of the stoma. Although the concept is not new, the current popularity and level of development of digital cameras, especially those embedded in smartphones, allow common and reliable remote advice on various medical problems, which can be very important in the case of limitations in a physical contact with a doctor. The article focuses on the initial stages of photo processing for the needs of telemedicine, i.e., on the assumptions and the process of designing the appropriate template and detecting it in photos for stoma telediagnosis. Research on the developed algorithms for the location of fiducial markers and reference color fields, carried out on the basis of over 2,000 photos, showed a very high tolerance to scene exposure, lighting conditions and the camera used. The obtained results allowed the initial image intensity normalization of the stoma area as well as correct localization and measurement of changes detected on the skin and the mucosa, which, in the opinion of doctors, significantly increased the diagnostic value of the photographs

Endoskopowe zaopatrzenie przetoki dwunastnicy u chorego operowanego z powodu urazu jamy brzusznej

Biorąc pod uwagę wszystkie pourazowe uszkodzenia struktur jamy brzusznej, obrażenia dwunastnicy występują stosunkowo rzadko, ale jeżeli pojawią się, to w zdecydowanej większości sytuacji towarzyszą im uszkodzenia innych ważnych narządów. W przypadku operacyjnego zaopatrywania urazów dwunastnicy istnieje duże ryzyko wystąpienia zagrażających życiu powikłań. Jednym z najczęściej obserwowanych jest przetoka dwunastnicza. W jej leczeniu w niektórych przypadkach zarówno podstawowe, jak i zaawansowane zabiegi operacyjne w połączeniu z intensywnym leczeniem zachowawczym są niewystarczające. Postęp technik endoskopowych z wykorzystaniem nowoczesnego instrumentarium pozwolił na zastosowanie tego typu procedur w zaopatrywaniu uszkodzeń o różnej etiologii w zakresie przewodu pokarmowego. Celem niniejszej pracy jest przedstawienie skutecznego endoskopowego zamknięcia pourazowej przetoki dwunastnicy

The Role of the XPF Gene Polymorphism (Xrcc4) Ser835ser in the Risk of Malignant Transformation of Cells in the Colorectal Cancer

Participation of DNA repair systems in the pathogenesis of cancer has been a suspected phenomenon for a long time. Decreased efficiency in DNA repair translates to their ability to fix and consequently leads to mutations and the process of carcinogenesis. Linking individual polymorphisms of DNA repair systems with an increased risk of colorectal cancer will allow the classification of patients to high-risk groups and their placement under preventive program. The aim of the study was to determine the effect of XPF gene polymorphism Ser835Ser on increasing the risk of colorectal cancer in the Polish population. Material and methods. as the material blood collected from 146 patients diagnosed with colon cancer was used. The control group consisted of 149 healthy subjects. Genotyping was performed by Taq- Man method. Results. The results indicate that genotype TCC/TCT is associated with an decreased risk of colorectal cancer (OR 0.574; CI 95% 0.335-0.984; p=0.043). Conclusions. Based on these results, we conclude that the XPF gene polymorphism Ser835Ser may be associated with a decreased risk of colorectal cance

Endoscopic management of duodenal fistula in a patient operated after abdominal injury

Post-traumatic duodenal injuries constitute a relatively rare group among this type of lesions reported in the abdominal structures. In the vast majority of cases, a post-traumatic duodenal injury is accompanied by damage to other important organs. The surgical management of duodenum injuries poses a high risk of life-threatening complications with duodenal fistula among the most common. In some cases, the combination of basic and advanced surgical procedures and intensive conservative treatment is insufficient to treat the complication. The progress in endoscopic techniques and the application of modern instruments have allowed for the use of these procedures to manage gastrointestinal injuries of various aetiology. The aim of the study is to present an effective endoscopic occlusion of post-traumatic duodenal fistula

Czynniki ryzyka 30-dniowej pooperacyjnej śmiertelności po operacjach raka jelita grubego

30-dniowa pooperacyjna śmiertelność jest czynnikiem odzwierciedlającym jakość leczenia. Wszystkie działania mające na celu zmniejszenie częstości jej występowania prowadzą do poprawy jakości leczenia. Celem pracy było wskazanie czynników ryzyka 30-dniowej pooperacyjnej śmiertelności na podstawie przebadanej grupy chorych operowanych z powodu raka jelita grubego w jednym ośrodku zajmującym się chirurgią jelita grubego. Materiał i metodyka. Do badania włączono chorych operowanych z powodu raka jelita grubego (RJG) w latach 2008‑2014. Badanie miało charakter retrospektywny, 30-dniowa śmiertelność była punktem końcowym badania. Wszystkie dane uzyskano z prospektywnej bazy danych. Wyniki. W okresie objętym badaniem operowano grupę 1744 chorych z powodu RJG. 30-dniową śmiertelność pooperacyjną odnotowano u 65 chorych (3,5%). W analizie wieloczynnikowej stwierdzono, że zaawansowanie procesu nowotworowego i gorszy stan ogólny pacjenta przed operacją były istotnymi czynnikami ryzyka 30-dniowej śmiertelności: OR 2,35; 2,01‑2,57 95%CI, p=0,03 i OR 2,18; 1,95‑2,41 95%CI; p=0,01. Operacja ze wskazań pilnych znamiennie zwiększała ryzyko śmiertelności w ciągu 30 dni po operacji: OR 2,64; 2,45‑2,87 95%CI; p=0,009. Niskie stężenie albumin w surowicy krwi i obecność cukrzycy były dodatkowymi czynnikami zwiększającymi ryzyko 30-dniowej śmiertelności: OR 1,65; 1,52‑1,78 95%CI; p=0,01 i OR 1,67; 1,41‑1,82 95%CI; p=0,03. Odsetek śmiertelności był wyższy po zabiegach resekcyjnych niż po zabiegach paliatywnych: 4,21% vs 1,57%; p=0,002. Wnioski. Chorzy operowani ze wskazań pilnych, pacjenci z zaawansowaną chorobą nowotworową i w ciężkim stanie ogólnym powinni być oceniani i przygotowywani do operacji przez wielospecjalistyczny zespół. Dodatkowo, aby zmniejszyć ryzyko śmiertelności pooperacyjnej, decyzję o rodzaju i rozległo- ści zabiegu muszą podejmować doświadczeni chirurdzy

Soil Sealing on Example of the Jedrzychow Residential Area in Zielona Gora, Poland

The progressing urbanization leads to the growth of buildings within the cities and taking up new areas for investments. Uncontrolled urban sprawl entails a number of consequences resulting in the soil sealing of the areas which has been permeable so far. Cutting off deeper soil layers from gas exchange and access to water causes a reduction in biological activity and biodiversity. That is why EU considers soil sealing as one of the main problems of the 21st century