Gender as a predictive factor in cholecystectomy - is it true or false?

INTRODUCTION: Cholecystolithiasis is one of the most frequent disorders of the human digestive system in a present population. It is common to point out that male gender is one of strong risk factors for complications during cholecystectomy, however the debate about that seems to be still open. AIM OF THE STUDY: The aim of this study was to compare the values related to the course and treatment effects between gender in patients undergoing cholecystectomy, based on own material. MATERIALS AND METHODS: The study encompassed 504 patients who were admitted to General Surgery And Polytraumatic Injury Department of University Hospital in Kraków, Poland between 2013 and 2018, with the initial diagnosis of cholecystolithiasis (scheduled cases) and acute cholecystitis (emergency cases). The patients underwent surgical gallbladder removal. In this group there were 326 (64.7%) female and 178 (35.3%) male patients. RESULTS: Statistically significant differences between both genders were found containing age, type of admission, numeric rating scale of pain during admission, results in American Society of Anesthesiologists physical status classification system, outcomes in Acute Physiology And Chronic Health Evaluation II severity-of-disease classification system, percentage of conversions, mortality, period of time from admission to surgical procedure, mean duration of the procedure, blood tests and histopathological results. CONCLUSIONS: Subgroups of the cases where determining factor is gender are strongly heterogeneous. Although treatment results were different for both subgroups and these differences were partly statistically significant, it cannot be clearly determined on the basis of a study with such selection of patients, that gender is an independent risk factor for surgical gallbladder removal.

Serum proinflammatory cytokine levels and white blood cell differential count in patients with different degrees of severity of acute alcoholic pancreatitis.

UNLABELLED: Several studies suggest that cytokines and neutrophils play an important role in the pathogenesis of acute pancreatitis (AP). The AIM OF THE STUDY was to assess the systemic release of proinflammatory cytokines and WBC (white blood cells) count with differential in patients with acute alcoholic pancreatitis (AAP) and to characterize the differences between patients with mild and severe forms of the disease. MATERIAL AND METHODS: Thirty-five patients with the mild form of acute alcoholic pancreatitis (MAAP) were compared to 11 patients with severe acute alcoholic pancreatitis (SAAP). Serum levels of IL-6, IL-8, IL-12p40 and WBC differential count were measured every second day during the first week after admission. RESULTS: During the course of the study, the average level of IL-6 was significantly (p<0.05) higher in patients with SAAP than in patients with the mild form of the disease (MAAP). Serum levels of IL-8 and IL-12p40 on admission were higher in patients with SAAP than in patients with MAAP but the difference was not statistically significant. Of all the types of WBCs, neutrophils were significantly (p<0.05) elevated the entire time in SAAP patients when compared to patients with MAAP on 5th and 7th day from admission to hospital. CONCLUSIONS: Patients with SAAP had significantly higher proinflammatory cytokine IL-6 levels and neutrophil counts than patients with MAAP. The results suggest that proliferation and overstimulation of this subset of leukocytes might contribute to the development of the systemic inflammatory response in patients with SAAP.

[Serum iron level in the patients with inflammatory abdominal diseases]. / Poziom zelaza w surowicy u chorych z ostrymi chorobami zapalnymi narzadów jamy brzusznej.

In our study we investigated serum iron levels in the patients with localized or generalized peritonitis. These values were compared in group of 52 patients with acute peritonitis against group of 39 patients without inflammation within peritoneal cavity. The serum iron levels and Total Iron Binding Capacity (TIBC) was indicated in both group. Acute intraabdominal inflammation induced in all patients a state of hypoferremia. However, medium decline of iron level in patients with acute appendicitis or cholecystitis was smaller compare with that observed among the patients with generalized peritonitis caused by perforation of duodenal ulcer, perforation of large bowel diverticula or perforation of small bowel. It has been suggested that decline in iron serum level observed in those patients can be an element of metabolic response to trauma and represents a part of the innate immune system and thus constitutes the first line defence against infection. However, based on presently available knowledge we can not yet finally evaluate the clinical implication of serum iron monitoring in diagnosis and prognosis of the patients with peritonitis.

[Surgical treatment of the lower extremities varicose veins throughout the ages]. / Zabiegowe leczenie zylaków konczyn dolnych na przestrzeni wieków.

The authors describe a historical review of surgical treatment of varicose veins from antiques to modern methods. Diseases of the veins have been recognized and attempts of their surgical resection have been described since antiquity. Hippocrates wrote about surgical treatment of varicose veins, Celsus and also Galien himself described varicose veins ligatures. The end of 19th century with Trendelenburg and Madelung was a start of modern period of varicose vein surgery. Parallel to surgical the less invasive methods of varicose veins treatment developed and gave a base for modern sclerotherapy.

Blood serum levels of proinflammatory cytokines in patients with different degrees of biliary pancreatitis.

BACKGROUND: Proinflammatory cytokines play a fundamental role in the local and systemic inflammatory responses in the initial stages of acute biliary pancreatitis (ABP) and in the development of severe forms of the disease. OBJECTIVES: The aim of the present study was to assess the systemic release of proinflammatory cytokines and to characterize differences between patients with mild ABP (MABP) and severe ABP (SABP). PATIENTS AND METHODS: In the current study, 54 patients with MABP were compared with 14 patients with SABP. Serum levels of tumour necrosis factor-alpha, interleukin (IL)-1beta, IL-6, IL-8 and IL-12p40 were measured every second day after admission for one week. RESULTS: The tumour necrosis factor-alpha level was similar in all days of analysis in patients with MABP but was lower compared with SABP patients. The level of IL-1beta was higher at admission in patients with MABP. The level of IL-6 peaked on admission day in both groups, but in patients with SABP, the obtained values were higher. The level of IL-8 on admission day was slightly higher in patients with MABP and systematically decreased when measured on the following days (the third, fifth and seventh days of the study). An increased level of IL-8 during the third, fifth and seventh days of the investigation was seen in SABP patients. The level of IL-12p40 was slightly higher in patients with MABP on the day of admission. CONCLUSIONS: The levels of some proinflammatory cytokines are higher in patients with SABP than in patients with MABP. The most consistent difference between the two groups was that the levels of IL-6 were significantly higher in patients with SABP throughout the study. Serum concentration of IL-6 may be helpful as a marker of severity and outcome of ABP.

[Minimally invasive techniques in the treatment of acute biliary pancreatitis]. / Ostre zólciowe zapalenie trzustki leczone technikami maloinwazyjnymi.

43 cases of consecutive bilary acute pancreatitis were treated by early endoscopic sphincterotomy and laparoscopic cholecystectomy within first 48 hours after admission. The basic cause of disturbance of bile outflow was microlithiasis. Course of the disease was monitored by level of proinflammatory interleukins in the blood serum of analysed patients. Marked decrease of their level after endoscopic sphincterotomy was observed. This decrease was progressed after laparoscopic cholecystectomy followed by continuos closed lavage of abdominal cavity. Our results indicated that minimally invasive techniques should be done in the early stage of mild and moderate cases of acute biliary pancreatitis.