Role of intraoperative neuromonitoring of the recurrent laryngeal nerves during thyroid reoperations of recurrent goiter.

Reoperations of the thyroid gland are challenging to any surgeon. Such procedures are technically difficult and involve higher risk of complications than primary procedures. Recurrent laryngeal nerve (RLN) palsy is one of such complications The aim of the study was to evaluate the effectiveness of intraoperative neuromonitoring (IONM) in preventing RLN palsy during recurrent goiter operations. MATERIAL AND METHODS: We retrospectively analyzed the results of thyroid reoperation performed at the Department of Endocrine, General and Vascular Surgery of Medical University of Lodz in the period from January 2014 to June 2016. The study included 80 patients, who were divided into 2 groups: group A consisted of 27 patients, who had undergone surgery with the use of IONM, while group B included 53 patients, in whom RLN was identified visually. During statistical analysis we took into account the number of nerves at risk, not the number of patients. There were 47 nerves at risk In group A and 86 in group B. We analyzed whether application of IONM had any effect on the frequency of RLN palsy and procedure duration. RESULTS: The frequency of RLN palsy was 10.64% (5/47) in group A and 15.12% (13/86) in group B (no statistical significance, p=0,47). Mean operation time was shorter in group B 71.29 ± 17.125 minutes vs. 75.75 ± 17.94 minutes in group A (no statistical significance, p=0,377). CONCLUSION: Use of IONM did not significantly reduce the occurrence of RLN palsy and procedure duration.

Assesment of inflammatory response intensity in early postoperative period in patients after hernioplasty operated on with classic stoppa method and videoscopic TEP method.

THE AIM OF THE STUDY was comparison of inflammatory response intensity through estimation of CRP, IL-6 and WBC concentration in blood serum in patients before and after inguinal hernia operations with Stoppa and TEP method. MATERIAL AND METHODS. The study involoved 117 patients operated on inguinal hernia between 2006-2008. The patients were divided into two groups. In the first group (group I - 56) Stopp'a method was used, in the second (group II - 61) TEP method. The patients selection was coincidental. All examined patients were men between 25-75 years old (mean age 54.3). Moreover, the operation's time, state of postoperative wound, the average hospitalization time and intensity of pain were estimated. The observations were directed over two weeks after operation. RESULTS. The inflammatory response estimated with CRP, IL-6 concentration in blood serum was considerably higher in patients operated with Stoppa method. There wasn't observed a relevant difference in increase of white blood cells' concentration in both groups. Moreover, the patients operated on with TEP method experienced lower pain. In group, operated on with Stoppa method, 3 cases of wound healing complications were observed. The operation's time was considerably shorter in the first group. The hospitalization time, was considerably shorter in patients operated on with videoscopic method. CONCLUSIONS. The operation of inguinal hernia with TEP technique in comparison with Stopp'a method is connected with considerably lower inflammatory response of organism, what directly involve with postoperative pain abridgment and reduction of hospitalization time. Moreover it may have influence on frequency of postoperative complications related with wound healing.

[Assessment of the selected, late phase of angiogenesis factors' concentration in colorectal cancer patients]. / Ocena stezenia wybranych czynników poznego etapu angiogenezy u chorych na raka jelita grubego.

UNLABELLED: Angiogenesis is a process of new blood vessels creating based on existing already vascularisation. This composed and multistage mechanism, which is responsible for growth of the tissues and organs, plays a crucial role in neoplasia. The exact role of particular cells, cytokines and extracellular matrix in cancerogenesis is still discussing. An identification of it is the key to searching the antiangiogenic substances breaking simultaneously neoplastic proliferation. THE AIM OF THE STUDY was to compare the angiopoietin-1(Ang-1), angiopoietin-2 (Ang-2) and Tie-2 receptor (rec. Tie-2) concentrations in the serum of colorectal cancer patients with concentrations of these factors in the serum of healthy people. Moreover the aim of the study was to assess the correlation between the concentrations of these factors and stage of clinical neoplasm progression. MATERIAL AND METHODS: The study included 35 patients hospitalized in the Department of General Surgery due to confirmed by histopatological examination colorectal cancer, between 2006 to 2007. The group of examined patients consisted of 9 women and 26 men with ages between 39 to 81 (average 67.20+/-8.85). The control group consisted of 11 healthy people. The examinations relied on the 10 ml of blood sampling from all the patients, in fasting state, one day before the operation. 10 ml of blood, in the healthy group was also sampled in fasting state. Afterwards all blood samples, 30 minutes after collecting, were centrifuged with velocity 6000 rotation per minute. The gaining serum was freezed in temperature -80 degrees C. The concentrations of Ang-1, Ang-2 and rec.Tie-2 were measured with ELISA method. RESULTS: Among examined patients with colorectal cancer, the statistically significant, higher concentration of Ang-2 in comparison with control group was revealed (6239.7+/-3482.3 pg/ml vs. 2954.9+/-9624.2 pg/ml). The concentration of Ang-2 among the patients from III and IV group according to the clinical and pathomorfological progression classification was statistically significant, higher than in I and II group of the patients (III: 8668,8+/-4938.57 pg/ml; IV: 9002.1+/-5380.92 pg/ml vs. I: 4672.3+/-1808.7 pg/ml; II: 5284.8+/-3204.2 pg/ml). The concentration of Ang-1 and rec. Tie-2 in blood of all the patients with colorectal cancer didn't statistically differ from the control group (Ang-1: 42339.9+/-20197.2 pg/ml vs. 48976.4+/-2284.5 pg/ml; rec.Tie-2; 14.4+/-5.1 vs. 16.8+/-6.2 ng/ml). CONCLUSIONS: The concentration of Ang-2 in the colorectal patients was statistically higher than in the control group. The increase concentration of Ang-2 correlated with the stage of colorectal cancer's clinical progression. The higher concentration of Ang-2 may eventually become a helpful marker in diagnostic and assessment of colorectal cancer's clinical progression stage.

[Treatment of cholecysto- and choledocholithiasis--own experiences]. / Leczenie kamicy dróg zólciowych--doswiadczenia wlasne.

UNLABELLED: Cholecystolithiasis is a serious problem of contemporary medicine. The most common operations in gastroenterologic surgery are gallbladder operations because of calculosis. The most common complications after gallbladder operations are bleeding from site of the gallbladder and bile leakage, but the most serious complication is a bile ducts injury. THE AIM: The assessment of complications quantity after cholecystectomy due to cholecystolithiasis. Observation of operation's profile changes during last 10 years. MATERIAL AND METHODS: From January 1997 to December 2006 in Department of Surgery in MSWiA Hospital in Lodz and in Departments of Surgery in Leczyca and Piotrkow Trybunalski 6845 cholecystectomy were made including 4215 laparoscopic operations. RESULTS: Complications were observed in 12.6% patients. Suppuration of the wound and postoperative hernias occurred more often after classic operations, in the other hand blood and bile leakage from site of the gallbladder were more often observed after laparoscopic operations. The ratio of complications after classic operations to laparoscopic operations was about 15.4% to 6.1%. Conversion was made in 11.5%. During first 5 years conversion was made in 17.6%, in the next 5 years average number of complications drop to 5.4%. CONCLUSIONS: Nowadays laparoscopic cholecystectomy is a standard procedure in symptomatic and asymptomatic cholecystolithiasis. It's a safe operation, burden with a little amount of complications made during acute as well as chronic course of disease. Laparoscopic technique requires a lot of care and in the event of operator's doubts should be replace with classic operation.

[Assessment of VEGF and VEGF receptor concentrations in patients with benign and malignant thyroid tumors]. / Ocena stezen naczyniowo-sródblonkowego czynnika wzrostu (VEGF) oraz jego rozpuszczalnych receptorów (sVEGFR-1,sVEGFR-2) w surowicy krwi u chorych z lagodnymi i zlosliwymi guzami tarczycy.

Neoangiogenesis is a significant event in a cascade of growth and progression of solid tumors. Assessment of the tissue expression and measurement of the concentrations of angiogenic and antiangiogenic factors, contributing to this process, in body fluids, can be used not only for an early diagnosis of tumors and their staging but also as an important parameter of treatment efficiency evaluation. The aim of this study is to evaluate the concentrations of crucial angiogenic cytokine VEGF and its soluble receptors in peripheral blood of patients with benign and malignant thyroid tumors. The study comprised 35 patients with thyroid cancer and 10 patients with follicular neoplasm, both diagnosed by means of ultrasound-guided fine-needle aspiration biopsy. For these patients surgical treatment was instituted. The examined angiogenic factors were determined preoperatively and 4 weeks after the surgical procedures. The results were compared with the control group which comprised 10 healthy individuals. Analysing obtained results, we demonstrated high VEGF concentrations and low soluble VEGF receptor concentrations in patients with benign and malignant thyroid tumors. This fact confirms a vital role of VEGF in angiogenesis of thyroid tumors and a hypothetical antiangiogenic activity of its soluble receptors. Disequilibrium of the above-mentioned angiogenic factor concentrations is probably essential for the growth and progression of benign and malignant thyroid tumors.