Novel surgical procedure in design of advancement endorectal flap in the surgical treatment of complex anal fistulas.

INTRODUCTION: Anal fistula is a common disease with incidence of 5.6 per 100,000 women and 12.3 men. It is most often of cryptoglandular origin. The aim of this study is to evaluate our experience with patients treated for complex anal fistula with our own complex surgical procedure with advancement endorectal flap. METHODS: 524 patients with complex anal fistulas who were sent to our surgical clinic from January 2005 to the end of December 2022 were in- cluded in the study. We established the diagnosis by detecting the fistula tract by physical examination, anoscopy, probing the fistula tract and endorectal ultrasonography. We performed a complex operation together with the construction of the advancement endorectal flap in our own modification for all patients. RESULTS: Primary surgical intervention in a group of 326 patients with complex anal fistulas (excluding patients with Crohn's disease) was successful in 283 (87%) patients. We identified advancement endorectal flap defect in the postoperative period in 17 (5.2%) patients, soiling in 16 (4.9%) and flatus incontinence in 9 (2.7%) patients. In a group of 120 patients after multiple surgeries (excluding patients with Crohn's disease), our surgical procedure was successful in 92 (76.6%) patients. In the postoperative period, we identified a advancement endorectal flap defect in 6 (5%) patients, soiling in 8 (6.6%) and flatus incontinence in 3 (2.5%) patients. CONCLUSIONS: The construction of the advacement endorectal flap was curative and without affecting the level of anal continence in 87% of patients after primary surgical intervention and in 76.6% after multiple surgical procedures. Complex surgery with the construction of the advancement endorectal flap according to our procedure preserves the function of the sphincters and has a relatively low percentage of recurrences. The number of previous surgical interventions had no affect on the level of anal continence.

Gallbladder carcinoma - when to use laparoscopic approach?

AIM: To assess how laparoscopy has altered the presentation of patients with gallbladder cancer and determine whether radical resection in patients with gallbladder cancer is beneficial. METHOD: 47 patients underwent surgery because of suspected gallbladder cancer. Cancer was found incidentally in 29 patients (61.7 %) during routine laparoscopic cholecystectomy using frozen biopsy. Gallbladder cancer had been diagnosed preoperatively in the other 18 patients (38.3 %). RESULTS: Patients in whom carcinoma was found incidentally at laparoscopic cholecystectomy had a significant increase in survival when compared with those who were admitted electively with a known diagnosis. All patients who presented with a known diagnosis had stage II or higher, and 38.3 % of these were in stage IV. However, 58.6 % of those patients who were found incidentally were in stage I or II. The overall 2-year survival for all patients was 45 %; those discovered incidentally at laparoscopic cholecystectomy (Tis-T2) had a 2-year survival of 87 %. CONCLUSION: Laparoscopic cholecystectomy resulted in an earlier discovery of gallbladder cancer in some patients, resulting in increased probability of survival. Adjunctive radical surgical resection, either at the time of cholecystectomy or subsequently, increases survival significantly in early stage disease (Tab.2, Fig. 2, Ref. 24). Text in PDF www.elis.sk Keywords: gallbladder carcinoma, laparoscopic approach.

[Concomitance of acute cholecystitis and acute appendicitis]. / Koincidencia akútnej cholecystitídy a akútnej apendicitídy.

Acute appendicitis and acute cholecystitis are among the most common diagnoses that general surgeons operate. However, they are only rarely described simultaneously. Authors describe the course of disease, diagnostics and surgery solution of disease. They report, that there are many factors, which play important role in the process of diagnostics and treatment of patient. They emphasis individual access not only of patients view, but also individual acces and view of surgeon. Because of rare coincidence of both diseases, there are many questions, but answers miss.Key words: acute cholecystitis acute appendicitis coincidence.

Musculoskeletal symptoms of the neck and shoulder among dental practitioners.

OBJECTIVES: Musculoskeletal symptoms of the neck and shoulder represent a condition whose basic characteristic is pain. These conditions are very often present in dental health professionals. The aim of the paper was to determine presence of discomforts in areas of head, neck, shoulders, upper back and upper limbs at health professionals in area of dentistry, as well as discomfort localisation and methods of treatment. METHODS: The research included 45 health professionals (dentists, dental assistants and dental technicians) employed at Dental Clinic of Vojvodina. The information was collected via questionnaire for analysis musculoskeletal disorders. RESULTS: Most of the dentists (75.9%) and the dental assistants (90.9%) as well as nearly half of the dental technicians (40%) experience discomforts in area of the neck, which are occasional, present in all three working positions and this discomforts are a little more frequent at women. The present musculoskeletal disorders are followed by headache, whose presence is statistically more significant compared to the other symptoms. The headache is usually located in the occipital part, it occurs individually or joined with other symptoms. Due to said discomforts the examinees in 59.4% of the cases don't contact the doctor. Medical therapy prevails in opposition to physical therapy. CONCLUSION: The discomforts deriving from the cervical part of the spine are present at great percentage of our examinees. Considering the fact that the said discomforts affect performing both professional and everyday activities, its prevention is necessary in order to avoid the consequences they carry.

Conversions in laparoscopic cholecystectomy.

Authors in this article emphasize the wide use of laparoscopic cholecystectomy in gall bladder surgery. Indications for laparoscopic operations are increasing. In spite of increasing practical experience of surgeons, availability of new instruments, advances of techniques, this problem of conversion is always actual. The question of conversion may depend on subjective and objective causes. It's the decision of the surgeon whether a conversion is necessary taking into account uncomplicated operation and postoperative state of the patient. In the Surgery clinic of FN Nitra 2078 cholecystectomies were performed in the period from 1.1.2002 to 31.1. 2007. Out of this number, there were 1535 (74%) laparoscopic operations and 543 (26%) classic operations. From the group of 1535 laparoscopic operations conversion was necessary in 89 patients (5.7%) (Tab. 4, Ref. 9).

[Choledochal cyst complication of pregnancy]. / Cysta choledochu ako komplikácia gravidity.

Authors in this case report describe rare complication of pregnancy. Ultrasound examination showed cystic lesion in abdominal cavity. It was indicated caesarean section because of deterioration of patient's condition. After the removal of foetus it was peroperative found cystic lesion in subhepatal area in right mesogastrium. Cystic lesion compressed stomach, colon transverse and loops of small intestine. After the revision of abdominal cavity and local finding surgeon detected choledochal cyst. It was resected and sutured hepaticojejunoanastomosis.

Application of 16S rDNA-DGGE to examine the microbial ecology associated with a social wasp Vespula germanica.

Invertebrates host numerous bacteria, with interactions ranging from pathogenesis to symbiosis. While certain symbiotic relationships have been well studied, little is known about the dynamics of these bacterial communities. Denaturing gradient gel electrophoresis (DGGE) was used to examine the bacterial microflora associated with the eusocial wasp Vespula germanica. DGGE profiles of larval guts revealed a variable microflora, suggesting that V. germanica is not dependent on a particular suite of mutualists. The variation in profiles was not related to season, nest size or macrohabitat. Sequences corresponding to Lactococcus, Lactobacillus, a novel Leuconostoc and two Rickettsiella grylli strains were obtained. DGGE proved to be a useful technique for characterizing the wasp microflora. Given the importance of microbial communities to invertebrates, there is much to be gained from the application of such techniques.

Three machine learning techniques for automatic determination of rules to control locomotion.

Automatic prediction of gait events (e.g., heel contact, flat foot, initiation of the swing, etc.) and corresponding profiles of the activations of muscles is important for real-time control of locomotion. This paper presents three supervised machine learning (ML) techniques for prediction of the activation patterns of muscles and sensory data, based on the history of sensory data, for walking assisted by a functional electrical stimulation (FES). Those ML's are: 1) a multilayer perceptron with Levenberg-Marquardt modification of backpropagation learning algorithm; 2) an adaptive-network-based fuzzy inference system (ANFIS); and 3) a combination of an entropy minimization type of inductive learning (IL) technique and a radial basis function (RBF) type of artificial neural network with orthogonal least squares learning algorithm. Here we show the prediction of the activation of the knee flexor muscles and the knee joint angle for seven consecutive strides based on the history of the knee joint angle and the ground reaction forces. The data used for training and testing of ML's was obtained from a simulation of walking assisted with an FES system [39]. The ability of generating rules for an FES controller was selected as the most important criterion when comparing the ML's. Other criteria such as generalization of results, computational complexity, and learning rate were also considered. The minimal number of rules and the most explicit and comprehensible rules were obtained by ANFIS. The best generalization was obtained by the IL and RBF network.

[Transmission of acquired immunodeficiency syndrome among intravenous drug abusers in Belgrade]. / Sirenje sindroma stecene imunodeficijencije u Beogradu medju osobama koje koriste droge intravenskim putem.

The prevalence of HIV infection among intravenous drug addicts (IVDAs) was 11% in Belgrade in 1997 (500 IVDAs). There are only two ways of transmission of HIV infection among IVDAs: the use of contaminated needles and syringes and sexual intercourse with an infected partner. We established in the counselling office for IVDAs that only 47.8% of them were injected with their own devices, 43% shared somebody's equipment, and 9.2% used other routes for drug taking. Condoms or safe sex were exceptional. Only 10.17% used condoms regularly; 12.5% from time to time and 77.32% never. Among 391 interviewed IVDAs 7% were not sexually active during the last year, 40% had one constant partner, 32% had intercourses with 2 to five partners, and 21% were promiscuous (more than 5 partners over one year). Fifty five were seropositive against HIV. Ten of them were promiscuous and used no condom. There is some evidence that the majority of IVDAs after twelve years of post seroconversion (average age between 35 and 45), stopped their sexual activity. The prostitution of female IVDAs in order to finance their own and their partners supply of drugs is found in 3% of cases. This study can be helpful in implementing a selective and individual approach to some IVDAs with risk behaviour, who accept treatment, to prevent the spreading of infection.

Colonic vasoactive intestinal polypeptide (VIP) in ulcerative colitis--a radioimmunoassay and immunohistochemical study.

BACKGROUND/AIMS: In this study, we present radioimmunoassay data describing the concentration of Vasoactive Intestinal Polypeptide (VIP) in both plasma and colonic biopsies, as well as immunostaining of VIPergic innervation in mucosal biopsies of normal subjects and patients with ulcerative colitis (UC). PATIENTS AND METHODS: Thirty three patients with UC and 17 healthy subjects were investigated. All UC patients suffered from active disease. Fasting circulating levels of VIP in plasma as well as tissue concentrations were measured by radioimmunoassay. For the immunohistochemistry, polyclonal antibody against VIP and the streptavidin-biotin peroxidase complex technique were carried out. RESULTS: Overall plasma VIP concentrations in the UC patients were similar to those in the controls. Significantly decreased concentrations of VIP were found in UC of rectum compared to the normal tissue. However, both plasma VIP values and tissue concentrations were found to be significantly lower in patients expressing minimal or mild active disease according to clinical activity index (AI) and histological activity index (HAI), but marked increase of plasma VIP was clear in UC patients with moderate or severe AI and HAI. There was a trend towards increased tissue concentrations of VIP in the group of patients with moderate or severe AI and HAI. Our immunohistochemical analysis of VIP fibers and nerve cell bodies revealed consistently weaker VIP-immunoreactivity in the rectum in UC patients with minimal or mild HAI. Simultaneously, in the rectal biopsies from UC patients with moderate and severe disease, the fibers in the lamina propria and ganglion cells in the submucous plexus were markedly increased in density and in degree of immunostaining. Very strong immunoreactivity was also found in inflammatory cells of the lamina propria as well as in the epithelial layer of the biopsies from UC patients with obvious disease. CONCLUSIONS: Our study shows clearly the heterogeneity in the response of VIP plasma level as well as rectum concentration and distribution in UC patients at different stages of the active disease. The possible role of VIP in the colon suggests that further studies of the alterations of this gut peptide may be useful in the understanding of UC pathophysiology.