[Surgical intraduodenal drainage of bile duct: an introductory report]. / Operacyjny dodwunastniczy drenaz drogi zólciowej--doniesienie wstepne.

UNLABELLED: Reconstructing operations, performed on extrahepatic bile ducts, usually need protection of anastomosis by means of drainage. Classic Kehr's drainage is loaded with the risk of complications. Since 1993 the authors have been applying the alter way of drainage: an intraduodenal drainage by endoprothesis Y (DEY). Endoscopical removal of the drain was performed in 3-4 months after the operation. This way of drainage was used between III 1993--V 1997 in 23 patients. We did not observed any complications or pancreas reactions. Clinical control of patients was made after operation with ECW. In 4 cases the results of treatment were unsuccessful. In other 16 patients results of performed operations were favourable. CONCLUSION: Proposed way of protection of bile duct's reconstruction's site using DEY decreases the number of complications connected with classic Kehr's drainage.

Gastrectomy in the rat using two modifications of esophagojejunal anastomosis. general status, local histological changes and relationships to bone density.

Gastrectomy (GX) was carried out in the male rat according to the Longmire and the Roux-en-Y procedure. The focus of the postoperative investigations was to evaluate the influence of post-GX morphological changes occurring at the site of two types of end-to-end esophagojejunal anastomosis (with and without invagination), in particular food intake, body weight gain, food efficiency, hematocrit and bone density. GX failed to alter food intake, fasting blood glucose, alpha-amino nitrogen, or free fatty acids, but led to uniformly decreased body weight, food efficiency and serum gastrin, and increased serum osteocalcin, indicating high turnover osteopenia. However, irrespective of the type of (digestive tract) reconstruction (Longmire or Roux-en-Y), the invagination anastomosis was associated with lower mortality, fewer complications, less early postoperative weight loss, less intensive tissue changes at the anastomotic site, and improvement of bone density and hematocrit. Bivariate and multivariate regression analysis revealed that bone density was negatively influenced by epithelial hyperplasia of the anastomotic tissue, while hematocrit was positively influenced by bone density. In contrast, food intake appeared to have no influence. It was concluded that (1) the histological status of the esophagointestinal anastomosis varies depending on the surgical technique applied and (2) the type of anatomical reconstruction of the digestive tract (Longmire vs. Roux-en-Y) and food intake may be of minor importance for the bone and hematological status of GX rats. Future investigations are justified to clarify whether esophagojejunal proinflammatory tissue factors may contribute to the GX-mediated damage of bone mineral and bone marrow, thereby leading to low body weight.

[Diagnostic difficulties in a case of malignant carcinoma of the small intestine. Clinical reports]. / Trudnosci diagnostyczne w przypadku nowotworu zlosliwego jelita cienkiego. Doniesienia kliniczne.

The paper presents clinical findings in four patients with malignant tumours originally arising from the jejunum, which have been diagnosed and surgically treated in the Department of Alimentary Tract Surgery during the last six years. Diagnostic problems and the patients' postoperative course have been presented. One patient had a metastatic malignancy which turned out to be the Sister Mary Joseph tumour.

Aminoalkanolic derivatives of xanthone with potential antiepileptic activity.

Synthesis, physicochemical and anticonvulsant properties of some aminoisopropanoloxy derivatives of 2-xanthone are described. The compounds were prepared by the amination of 2-[(2,3-epoxy)-propoxyl]-xanthone or 2-(3-chloro-2-hydroxy-propoxy)-xanthone. The obtained compounds were evaluated for anticonvulsant activity in the maximal electroshock (MES)- and subcutaneous pentylenetetrazole (scMet)-induced seizures and for neurotoxicity in the rotorod test in mice and rats. The most promising compounds seem to be the 3-(tert.-butyl-amino) (3), 3-[N-methyl-(tert.-butyl)-amino] (12) and 3-[4-(benzyl)-1-piperazinyl (5) substituted 2-hydroxy-1-(2-xanthonoxy)-propane from which 3 and 5 were active in both the anticonvulsant tests. The protective index (TD50/ED50) in MES in mice for 3 and valproate, as for 12 and phenytoin or carbamazepine, is similar.

Preliminary comparison of behavioral and biochemical effects of chronic transcranial magnetic stimulation and electroconvulsive shock in the rat.

To confirm the assumption that repetitive rapid-rate transcranial magnetic stimulation (TMS) induces the functional and structural changes analogous to those which are evoked during electroconvulsive shock (ECS), we compared now the effects of treatments with TMS and ECS on the behavioral responses in rats. We also tested the reactivity of the cyclic adenosine monophosphate (AMP) generating system in cerebral cortical slices. TMS similarly to ECS shortened the immobility time in the forced swimming test and produced a depression of responsiveness of the noradrenaline-stimulated cyclic AMP generating system, although the significance of the latter effect was borderline. In contrast to ECT, TMS produced no such immediate behavioral effects as analgesia and depression of the early phase of locomotor activity. The data suggest that TMS produces in rats some responses that are regarded as predictive for antidepressant activity, similar to those produced by ECS, but less adverse effects.

[The effect of non-parallel distractor fixation to bone on deformities of the limb axis in bone lengthening of the limb]. / Wplyw nierównoleglego mocowania dystraktora do kosci na deformacje osi anatomicznej wydluzanego segmentu konczyny.

The paper presents causes of limb axis deflecting during bone lengthening. It has been proved mathematically, that axis deflection is caused by incorrect setting up the distractor (i.e. not parallel to the bone axis) irrespective of the structure of apparatus used.

[Evaluation of bone mass density after extensive resections within the alimentary tract]. / Ocena ubytku masy kostnej po rozleglych resekcjach przewodu pokarmowego.

The authors have examined a group of 30 patients at 24-36 months after extensive resections within the alimentary tract. The bone density assessment has been done. The results were compared to those obtained from another group of 30 patients awaiting sinister operations. Bone loss was found in all postoperative patients. However, it was statistically significant only in patients after pancreatoduodenectomy.

[Biostatic endoprosthesis of the esophagus for prevention of leakage and stenosis at the site of anastomosis]. / Biostatyczna endoproteza przelyku w zapobieganiu nieszczelnosci oraz zwezeniu w miejscu zespolenia.

The authors present the results of using endoprosthesis made of bowine fascia which was conserved in special way. The endoprosthesis was used to cure salivary fistula in the place of anastomosis oesophagus with its replacement of the neck. The endoprosthesis was used to prevent leakness or stenosis in difficult operative circumstances and to pass the substitutive oesophagus in non-anatomical way. Prophylactic using of the endoprosthesis in technical difficulties caused by operative circumstances prevents leakness and stenosis in the place of anastomosis.

[Experimental evaluation of vascularization by various methods of forming a synthetic stomal pseudosphincter]. / Doswiadczalna ocena unaczynienia róznie wytworzonego sztucznego zwieracza przetoki kalowej.

Authors presents the own method of formation of the stomal pseudosphincter using a pedunculated intestinal flap devoid of mucosa. The experimental and clinical evaluation of blood supply of the sphincter was carried out by means of the doppler and fluorescence method. The study revealed no impairment of the blood supply of the sphincter and it's connect function.

[Comparison of early results for pancreato-jejunal and pancreato-gastric anastomosis after pancreatoduodenectomy]. / Porównanie wczesnych wyników zespolenia trzustkowo-jelitowego i trzustkowo-zoladkowego po wycieciu glowy trzustki wraz z dwunastnica.

The aim of the study was to compare two types of anastomosis of the pancreatic stump with the digestive tract after pancreatoduodenectomy. 64 patients have been studied. Eighteen of them underwent pancreatoduodenectomy followed by the anastomosis of the pancreatic stump with the posterior wall of the stomach, in 46 patients pancreato-jejunal anastomosis has been done. Short term results of those two types of anastomosis did not differ significantly. Pancreato-gastric anastomosis seems to be technically easier, can be endoscopically controlled and does not impair recovery of gastric motility.

[Evaluation of the usefulness of dressings made from chitosan and lyophilized human placenta on wound healing]. / Ocena przydatnosci opatrunków wytworzonych z chitozanu i liofilizowanego lozyska ludzkiego w gojeniu ran.

The goal of this study is evaluation in experimental and clinical circumstances of biological dressings obtained form lyophilized human placenta and chitosan. The therapeutic specificities of human placenta where confirmed in the course many years' observation in The Department of Surgery of the Digestive Tract. The reservation arose only because of inconvenience in using placenta fragile after lyophilization. The product was obtained in the course of studies which were performed in common with The Chemical Fibres Institute in Lódz. This product (which was a combination of placenta and chitosan) was free of defects considering defects of lyophilized placenta. The experimental part of study was performed on 50 female rats of Wistar strain. It was compared healing of wound 2 cm2 area provided with tested dressing and the other controlled wound. The result was evaluated on the ground of postoperative survival and the macroscopic and microscopic evaluation. In the clinical part of the study the experimental model was made by wounds provided by sutures passed by all layers on special "small drains" which under drains make bedsores placed symmetrically on both sides of incision line. The evaluation was performed randomly putting on one of these sides of tested dressing. There was evaluated the speed of demarcation, growth of granulation tissue and epithelialization. The evaluation was compared with standard dressing. Combination of therapeutic specificities of lyophilized human placenta with proper mechanical specificities of chitosan made possible to obtain comfortable and efficient dressing. In the clinical part of the study on the ground of macroscopic evaluation it was found that the process of the healing in tested group becomes shorter of about 48 hours.

[Total gastrectomy using Longmire's and Roux method. Evaluation of the invagination technique for esophageal-jejunal anastomosis]. / Calkowite wyciecie zoladka sposobem Longmire'a i Roux. Ocena inwaginacyjnej techniki zespolenia przelykowo-jelitowego.

582 patients were gastrectomized between 1976 and 1996 in the Department for Gastrointestinal Surgery in Katowice/Poland for gastric cancer. Before 1985 esophago-jejunal anastomosis have been accomplished using a simple end-to-end or special end-to-side (Schreiber-Eichfuss) method with jejunoplication. Thereafter we used an end-to-end invagination method with 4-5 cm deep intussusception of the first raw of sutures into jejunum. Comparison of the occurrence of short and long term complications at the site of esophago-jejunal anastomosis showed that invagination technique is safer that the previous one. It is associated with the lower rate of short and long term complications (dehiscence, stenosis, oesophagitis). Details of the surgical procedure facilitating the accomplishment of the tight and safe anastomosis are presented.

[Evaluation of stomach emptying under extreme obstruction of gastrointestinal transit treated with gastro-intestinal or duodenal-intestinal anastomosis]. / Ocena oprózniania zoladkowego w warunkach wysokiej niedroznosci przewodu pokarmowego leczonej zespoleniem zoladkowo-jelitowym lub dwunastniczo-jelitowym.

The purpose of the present study was to compare gastric emptying in two groups of dogs in which a gastrojejunal or duodenojejunal Roux-en-Y anastomosis was performed over the site of an experimental obstruction in the distal duodenum. The experiment was carried out on 10 mongrel dogs. Gastric emptying was assessed twice in each dog before the experiment (control examination); the solid phase of the test meal was labelled with 99mTc. Following a control examination, the dogs were divided into two groups of 5 animals each, and subjected to the above mentioned surgical procedures. Postoperative gastric emptying was carried out 3 weeks after the operation, and then at 3 and 6 months following the procedure. The following parameters describing quantitatively gastric emptying were determined: mean transit time MTT0-60. MTT0-120 and total mean transit time MTT0-180. The comparison of these parameters revealed statistically significant differences confirming delay of gastric emptying in dogs with a gastrojejunal anastomosis.

[Duodenojejunostomy in the symptomatic treatment of neoplastic obstruction of the duodenum--clinical observations]. / Zespolenie dwunastniczo-czcze w objawowym leczeniu nowotworowych niedroznosci dwunastnicy--spostrzezenia kliniczne.

The aim of the study was to evaluate the value of duodenojejunostomy and gastrojejunostomy in the treatment of neoplastic obstruction in the distal part of the duodenum. From 1992-1996, 37 patients (15 women, 22 men, aged 31-76 years) underwent a palliative operation for pancreatic cancer infiltrating the distal part of duodenum. Roux-en-Y procedure was used to create anastomoses between the duodenal bulb and jejunal loop. In 13 patients only alimentary by-pass was made whereas in the remaining 24 biliary decompression was also performed. The results were compared with the outcome in 26 patients in whom gastrojejunal side-to-side anastomosis been made. The advantage of Roux-en-Y duodenojejunostomy is that it does not interfere with gastric emptying and thus prevents jejuno biliary reflux and the consequent complications. Improvement of nutrition and quality of life in patients with inoperable pancreatic cancer, were noticed with this method.

[Behavioral and biochemical effects of magnetic brain stimulation and electroshock in rats]. / Behawioralne i biochemiczne efekty stymulacji magnetycznej mózgu i elektrowstrzasów u szczurów.

It was proposed that the repetitive rapid-rate transcranial magnetic stimulation (TMS) induces the functional and structural changes analogous to those which are evoked during the electroconvulsive treatment. Presently, we compared the effects of 8 daily treatments with TMS (t = 5 min, B = 0.1 T, trise = 200 microseconds, f = 50 Hz) and electroconvulsive shock (ECS) (t = 0.5 s, I = 150 mA, f = 50 Hz) on the behavior of rats in the forced swimming test (24 h after the last treatment), the exploratory activity test (0-10 min), the basal locomotor activity test (11-30 min), and the tail flick test (2 h after the last treatment). We also tested (24 h after the treatment) the reactivity of the cyclic AMP generating system in cerebral cortical slices. Statistical significance of the results was estimated by ANOVA and t-Student test. The immobility time in the forced swimming test was shortened after TMS and ECS to 86 and 75% of control values, respectively (p < 0.05 and p < 0.01). Both ECS and TMS depressed the basal locomotor activity (by 60 and 80%, resp.), and ECS, but not TMS, diminished also the exploratory activity by 70% (p < 0.01) only ECS induces analgesia, prolonging tail-flick latency by 90% (p < 0.01). ECS diminished the accumulation of the noradrenaline-stimulated cyclic AMP in the cortex slices (by 35%; p < 0.05). The effect after TMS was similar but statistically not significant (87% of control values). The data suggest that TMS produces in rats some responses that are regarded as predictive for the antidepressant activity, similar to those produced by ECS, but less side effects.

Effect of chronic mild stress on circadian rhythms in the locomotor activity in rats.

The purpose of this study was to assess whether the chronic mild stress (CMS) procedure, as a realistic animal model of depression, affects the rhythms of the locomotor activity in rats. Rhythm parameters (period, mesor, amplitude, acrophase, and percent rhythm) were estimated from the best-fitted cosine function curves. Period is the length, mesor is the mean level, amplitude (A) is the extent, acrophase is the timing of the rhythm; percent rhythm represents the variability estimated by the cosine regression and expressed as a percentage of the total variability of raw data. The animals were kept on the 12 L : 12 D cycle during 13 weeks of the experiment and subjected to CMS for first 4 weeks. In week 5 the rats were under the constant light for 24 h a day (LL), and in week 9, under the constant darkness (DD). In LD 12:12 CMS decreased the activity in the dark phase by approximately 50% (p < 0.01) and did not change the activity in the light phase, resulting in a drop of the 24 h activity by about 40% in comparison to controls. The amplitude of diurnal variations of the activity was highly statistically different from zero at p(A = 0) < 0.0001, and the percent rhythm was in range of 40-75% in both the CMS and control groups. The mesor and the amplitude of the diurnal rhythm (with a period of 24 h) in the CMS rats were significantly (p < 0.001) lower than those in the control. In LL, the activity of both groups was diminished about 50% during the subjective dark phase. On the other hand, in the subjective light phase the activity of CMS rats only was diminished. The percent rhythm for the CMS and control rats was 30 and 58%, respectively, and values of mesor, amplitude, and acrophase for both groups were highly statistically different. In DD, the activity in the CMS group was statistically significantly lower in both the subjective dark and light phases. In contrast to the results from LL, the cosine curves from DD were similarly shifted in relation to the subjective light-dark cycle. After a restoration of the LD cycle the levels of the 24-h activity of both groups became equal in the 13th week, but the light and dark phase differences between the groups were still statistically significant (p < 0.05). The present results indicate that CMS exerts distinct and prolonged disturbances of the diurnal and circadian rhythms of the locomotor activity in the rats.

The effect of amitriptyline on the cell-mediated immunity of stressed rats.

The effects of single and repeatedly administered amitriptyline (10 mg/kg ip) on the ability of the splenocytes of the restraint-stressed (for 2.5 h) Sprague-Dawley rats to induce the Graft versus Host (GvH) reaction in vivo and to respond to the concanavalin A (Con A) stimulation in vitro were studied. In acute experiments single immobilization, amitriptyline administration, or single amitriptyline treatment of the previously stressed rats did not change the reactivity of splenocytes to both mitogen and alloantigens. On the other hand, in the "chronic" experiment, when rats were stressed 2.5 h daily for five days with or without concurrent amitriptyline treatment, a statistically significant decrease in the reactivity of splenocytes to Con A and increase in the reactivity to alloantigens were visible only in the stressed, but not in stressed, amitriptyline treated animals.

[Hepatocholangiocarcinoma]. / Hepatocholangiocarcinoma.

In a 48-year-old man, using imaging methods, the presence was shown of a tumour in the right hepatic lobe. The serum AFP and DCP concentrations--the serological markers of hepatocellular cancer--were significantly increased, however, the histological examination of liver biopsy specimen demonstrated the structure of a cancer originating from the bile canaliculi. The material for study obtained during laparotomy and autopsy made possible the demonstration of the structure typical of both cholangiocellular carcinoma and hepatocellular carcinoma in separate foci. The mixed form of hepatocholangiocellular carcinoma is extremely rare and difficult for diagnosis which induced us to report own case.

[Surgical course in patients with diabetes]. / Zabieg operacyjny u chorych na cukrzyce.

A retrospective analysis is presented of 388 patients with diabetes mellitus treated in a gastrointestinal surgery department in the years 1975-1988. In the patients 473 diseases were diagnosed which could be the basis for surgical treatment. Our of 388 patients, 254 were treated surgically and 375 operations were performed in them; 46 patients had multiple operations. The highest per cent of deaths was found in the group of patients with diabetic gangrene of the lower limbs which reached 10.4%, while in all patients the mortality was 4.3%. Finally it is suggested that only the approach to the diabetic patients as to high-risk patients enables obtaining of a satisfactory result of surgical treatment.