Laparoscopic sleeve gastrectomy - 7 years of own experience.

INTRODUCTION: Laparoscopic sleeve gastrectomy is a procedure frequently chosen by patients and surgeons that carries the risk of serious complications that are difficult to treat. AIM: To describe the operations performed by us, considering complications and their management. MATERIAL AND METHODS: We performed 565 laparoscopic sleeve gastrectomies. Standard surgical technique was used. A 34 Fr calibration tube was used. An additional reinforcing suture was applied over the staple line. RESULTS: There was no need for conversion. In 7.79% of patients, infarcts of the posterior pole of the spleen were observed, whereas 8 patients (1.42%) developed gastric fistulas in the His angle region. In 3 cases, it led to development of an abscess in the posterior splenic pole region and 2 of these developed secondary gastric fistulas of typical location. In total, there were 5 deaths among the patients who had been operated on - 3 due to septic complications in the course of fistula, 1 due to encephalopathy and 1 as a result of myocardial infarction. CONCLUSIONS: Sleeve gastrectomy is an effective and safe method of obesity treatment. The causes of the most severe complication - gastric fistula - cannot be established unequivocally. Infarcts of the posterior pole of the spleen, as a potential cause of fistulas, deserve particular attention. In our opinion, primary closure of the fistula by suturing is an inappropriate method of management, whereas the best results are obtained with temporary gastrointestinal tract prosthesis.

Own experience improving port implantation in laparoscopic adjustable gastric banding.

INTRODUCTION: Laparoscopic adjustable gastric banding (LAGB) is a method frequently used for treating obesity. It requires periodic band regulation associated with the need for port puncture. However, there is always a substantial risk of port rotation. AIM: This publication presents a solution of the problem for a MiniMizer Extra band. MATERIAL AND METHODS: One thousand one hundred and twenty-four individuals were operated on for obesity in the Department of Gastroenterological, Oncological and General Surgery of the Medical University of Lodz between 2005 and 2009. In 637 patients LAGB was performed. These LAGB patients were divided into three groups. In group I (20 patients) MiniMizer Extra bands were placed without port stabilization. In the second group (292 patients) MiniMizer Extra band placement with port stabilization was commenced. In the third group (325 patients) bands of other manufacturers (AMI, Inamed, Midband, Obtech) were used without port stabilization. The port was implanted into the subcutaneous tissue in the left subcostal region, medial to the left working tool trocar position. RESULTS: Port rotation was observed on the very first band adjustment in 3 (0.92%) and 11 (55%) patients with a band other than MiniMizer Extra (n = 325) and the first 20 patients with a MiniMizer Extra band. A different technique of port stabilization was applied in a further 292 patients on MiniMizer Extra band placement and no port rotation was noted. CONCLUSIONS: We believe that MiniMizer additional port stabilization is necessary for its frequent rotation. Simultaneously, application of our method is easy, does not prolong the procedure significantly and secures comfortable access to the port.

Gastric cancer after laparoscopic adjustable gastric banding: case report.

Gastric cancer in patients who have undergone bariatric surgery is rare. The authors present a case of stomach cancer in a patient 6 years after adjustable silicone gastric band placement. The tumour was located below the band, not in its direct vicinity. Aetiological and risk factors of stomach cancer incidence in obese patients are discussed in this case study.

C-reactive protein as a marker of postoperative septic complications.

THE AIM OF THE STUDY: was to answer the question whether or not determination of C-reactive protein in patients after serious abdominal surgeries can be prognostic of septic complications. MATERIAL AND METHODS: 36 patients who underwent elective surgeries were included in the study. The patients were included either in the group where no postoperative SIRS developed or in the group where postoperative SIRS did occur. In the seven-day period after the surgery, in 26 patients SIRS was found, and in 10 - sepsis was suspected (according to the ACCP/SCCM definitions). In patients who underwent abdominal surgeries blood concentration of C-reactive protein was determined prior to the surgery (measurement '0'), and then on postoperative days 1, 2, 3, 5 and 7. RESULTS: The test for two variables (C-reactive protein on postoperative days five and seven) showed statistically significant difference, and for one variable (C-reactive protein on day three) - difference at the limit of significance. Thus, it was found that in the postoperative SIRS group the level of C-reactive protein is higher than in the non-SIRS group. CONCLUSIONS: Serial measurements of C-reactive protein are useful in the first week after surgery, as they can be prognostic of postoperative septic complications. Such complications can be anticipated if CRP on postoperative day 5 is higher than 1/2 of the maximum CRP concentration on day 2 or day 3, or CRP > 150 mg/L as of postoperative day 3. Unfortunately, the severity of the disease cannot be projected based on C-reactive protein level.

Gastric perforation as a complication after BioEnterics intragastric balloon bariatric treatment in obese patients--synergy of endoscopy and videosurgery.

The BioEnterics intragastric balloon (BIB) is one of the most common bariatric procedures in obese patients in Europe. Associated gastric perforation is a rare, yet very dangerous, complication. We report a case of such a complication after BioEnterics intragastric balloon insertion in a 60-year-old female patient and subsequent cooperation between an endoscopist and bariatric videosurgeon in her treatment.

[Hemobilia caused by ruptured hepatic artery aneurysm--case report]. / Hemobilia spowodowana peknieciem tetniaka tetnicy watrobowej--opis przypadku.

The article reports a rare case of hemobilia caused by ruptured hepatic artery aneurysm. Based on clinical symptoms, USG and ERCP common bile duct stones have been diagnosed primary. Because of no response to initial treatment (ERCP) and appearing a new clinical symptom - bleeding in the upper gastrointestinal tract, another tests have been applied which results let us estabilish final diagnosis. The diagnostic problems of the hemobilia are discussed.

[Pyoderma gangrenosum--an interdisciplinary diagnostic problem]. / Piodermia zgorzelinowa--interdyscyplinarny problem diagnostyczny.

Pyoderma gangrenosum is a rare, chronic, progressive and noninfectious necrosis of skin with an unclear etiology. It usually coexists with the systemic disorders. Clinically it appears as a rapidly spreading ulceration in a various location. Pyoderma gangrenosum often starts as pustule, nodule or local inflammation which suggest the diagnosis of bacterial infection of skin such as furuncle or phlegmon so patients with early symptoms could be refered to surgical units. We presented the case of pyoderma gangrenosum which affected a 47-year-old woman. Due to the presumptive diagnosis of phlegmon of the patient's right arm she was initially admitted to surgical ward. Sometimes there are many difficulties with an early diagnosis of pyoderma gangrenosum because of its rarity, distinctness of clinical pictures, lack of characteristic histology and laboratory tests. We would like to emphasize that pyoderma gangrenosum should be always included to the differential diagnosis of a rapidly progressing ulceration of skin especially if there is no response to standard therapy.

[Laparoscopic cholecystectomy for acute cholecystitis]. / Przydatnosc techniki laparoskopowej w leczeniu ostrego zapalenia pecherzyka zólciowego.

UNLABELLED: Laparoscopic cholecystectomy is considered the "gold standard" for the planned treatment of symptomatic cholecystolithiasis. Currently this method is used in 88% of cholecystectomy according to world database. There are evidences that laparoscopic cholecystectomy for acute cholecystitis is a quite safe method which is not connected with many complications. AIM OF THE STUDY: Assessment of the post-operative complication risk and hospitalization time in cases of acute cholecystitis had undergone laparoscopic cholecystectomy in comparison with classic cholecystectomy. Evaluation of non-specific inflammation process based on C-reactive protein (CRP) levels in patients' serum analysis. MATERIAL AND METHODS: Eighty patients (58 women and 22 men) aged 22-74 (mean 53.6) were included to the study. They were undergone cholecystectomy in the Department of Gastroenterological, Oncological and General Surgery because of acute cholecystitis. There were two groups of patients: 38 patients who underwent laparoscopic cholecystectomy (group I) and 42 patients who underwent "classic" cholecystectomy (group II). No statistical differences of clinical and demographic characteristics were found in the studied groups. There was also the third group of patients distinguished in the study - the control group of 42 patients who underwent "planned" laparoscopic cholecystectomy because of chronic cholecystolithiasis. The patients were qualified for the groups I and II in accordance with randomization rule. The CRP-level of the patients' serum was evaluated in the group I and II twice: before and in the 2nd day after cholecystectomy. RESULTS: The mean operating time was significantly shorter in the group I (laparoscopic cholecystectomy) compared with the group II ("open" cholecystectomy) 63.24 and 86.31 minutes respectively (p < 0.05) and 58 minutes in the control group. The mean period of hospital stay was also significantly shorter in the group I (4.12 day) compared with the group II (7.19), (p < 0.05), however there was no statistically significant difference between group I and the control group (3.1 day). The level of serum CRP measured before surgery was not significantly different in groups I and II although in the 2nd day after the operation statistically significant difference between studied groups was obtained: patients who were undergone laparoscopy (group I) had a lower level of serum CRP. CONCLUSIONS: Laparoscopic cholecystectomy is a safe method of treatment both acute cholecystitis and chronic cholecystolithiasis.

Perioperative comparison of the MiniMizer extra band with the other laparoscopic gastric bands.

BACKGROUND: Laparoscopic adjustable gastric banding is a widely used operation for morbid obesity. The most frequent complications of this operation are band migration and pouch dilatation (slippage). The use of the newly introduced MiniMizer Extra band with a unique gastric wall fixation system and a two-degree closure may decrease the postoperative complication rate. Very early (perioperative) results are hereby reported. METHODS: From February 2005 through October 2005, 50 classical bands (Obtech-Ethicon, AMI, Midband, Inamed) and 10 MiniMizer Extra bands were inserted in our department. Bands were chosen randomly. Complications in the very early postoperative period were studied. RESULTS: No statistically significant differences between surgery times were noted--classical bands mean 36 min (20-60), and MiniMizer Extra bands mean 34 min (25-55). No statistically different rates of perioperative complications were noted, with only 2 very minor intraoperative complications in the entire series. CONCLUSIONS: The absence of problems in the perioperative period allows the use of the MiniMizer Extra band as an alternative to classical bands for short- and long-term comparison.

[Evaluation of neutrophil-lymphocyte ratio usefulness in the diagnosis of appendicitis]. / Wartosc wskaznika neutrofilowo-limfocytarnego w diagnostyce zapalenia wyrostka robaczkowego.

UNLABELLED: The aim of the study was the evaluation ofneutrophil-lymphocyte ratio usefulness in the diagnosis of appendicitis. MATERIAL AND METHODS: The study concerned 469 patients: 280 (59.7%) women and 189 (40.3%) men (mean age 34 + 18 years), who underwent operation due to suspicion of appendicitis, in the years 1997-2003. Retrospective analysis ofintraoperative diagnoses, pathological reports and laboratory tests was performed. Optimal values ofneutrophil-lymphocyte (N/L) ratio and leukocytosis, according to sensitivity and specificity in appendicitis diagnosis, were chosen and then compared among patients with different stages of appendicitis. The results were evaluated according to their statistical significance. RESULTS: Optimal values of N/L ratio and leukocytosis, according to sensitivity and specificity, were > or = 3.5 for N/L and > or = 12000/mm3 for leukocytosis. N/L ratio > or = 3.5 occurred to have much higher sensitivity (77.5% vs. 55%) but lower specificity (73.3% vs. 81.6%) than leukocytosis. Both leukocytosis and N/L had satisfactory values of prediction and likelihood ratio for positive ad negative results. CONCLUSIONS: (1) N/L ratio has higher sensitivity than leukocytosis, especially in appendicitis phlegmonosa and gangrenosa. (2) Both leukocytosis and N/L ratio have quite high specificity. In cases other than appendicitis that have similar clinical symptoms and are ultimately diagnosed intraoperatively, the N/L ratio and leukocyte count are rarely elevated above 3.5 and 12000/mm3 respectively. (3) Due to easiness of calculation and still high rate of false positive and negative diagnoses, N/L ratio is worth using in establishing the diagnosis of appendicitis.

[Bile duct infections as a late complication after endoscopic sphincterotomy]. / Zakazenia dróg zólciowych jako pózne powiklanie sfinkterotomii endoskopowej.

UNLABELLED: Nowadays endoscopic sphincterotomy (SE) is considered to be a "gold standard" in the treatment of residual choledocholithiasis and biliary pancreatitis. Nevertheless patients after invasive procedures concerning bile ducts with destruction of Oddi's sphincter often have increased succeptibility to chronic infections of bile ducts. AIM: Assessment of the influence of SE on bacterial colonization, development of main bile duct chronic inflammation and recurrent choledocholithiasis. MATERIAL AND METHODS: We included to the study 50 patients with main bile duct lithiasis, who underwent endoscopic cholangiopancreatography (ERCP). Among them there were 32 women in age from 45 to 87 (mean 69.7 +/- 12.3) and 18 men in age from 39 to 84 (mean 59.8 +/- 11.56). The studied group was divided into 3 subgroups: In I (control) group were included 10 patients diagnosed with ERCP techniques because of jaundice of unknown origin. Those patients did't have ERCP or operative revision of bile ducts before, but all of them underwent cholecystectomy in the past. Each II and III group consisted of 20 patients, who underwent SE before 12-24 and 25-36 months earlier respectively. Sterile uodenoscope was inserted to the region of major duodenal papilla, and then a sterile brush was used to collect material to cytological smear (brushing) from main bile duct. In all groups 2 ml of bile were taken by a catheter to a syringe. On the basis of radiograms from ERCP findings, the width of main bile duct was assessed. In all patients blood cell count, aspartate and alanine aminotransferases, gammaglutamyltranspeptidase, alkaline phosphatase, amylase, bilirubin, C-reactive protein and procalcitonine levels were measured. RESULTS: In our study all 40 patients with previously performed endoscopic sphincterotomy (SE) had bacterial colonization in bile ducts, mostly with Gramm negative pathogens. The most virulent pathogens vere cultured from bile duct swabs from patients after two or more revisions of common bile duct, and after a longer time from sphincterotomy. Those patients had multibacterial bile duct infections (Escherichia coli + Pseudomonas aeruginosa; P. aeruginosa + Enterococcus faecalis; E. faecalis + Enterobacter cloacae + Candida albicans; P. aeruginosa + E. cloacae). E. coil and E. faecalis were most frequently cultured (20 and 16 cases respectively). It was observed that with length of time from endoscopic sphincterotomy, the width of main bile duct and also amount of cultured pathogens and their virulency grow. Elevated transaminases activity and serum procalcitonine levels were observed in studied groups. 9 patients after previous sphincterotomy had recurrent lithiasis. CONCLUSIONS: Sphincterotomy contributes to colonization of main bile duct with pathogenic bacteria. With length of time from endoscopic sphincterotomy, and amount of performed endoscopic sphincterotomies the amount of cultured pathogens, their virulency and drug resistance grow. Chronic infection of bile ducts after endoscopic sphincterotomy causes higher risk of recurrent lithiasis.

[Lipid peroxidation product as prognostic factors in acute necrotizing pancreatitis]. / Produkty peroksydacji lipidów jako czynniki rokownicze w ostrym martwiczym zapaleniu trzustki.

UNLABELLED: The aim of the study is the assessment of the role of oxygen free radicals (OFRs) in the pathology of acute pancreatitis (AP). MATERIAL AND METHODS: It has been accomplished based on the analysis of lipid peroxidation products' and hydrogen peroxide blood concentration in 60 patients with AP. Spectrometric and spectrofluorometric methods were used. Patients were divided into 2 groups. Group 1 consisted of 42 patients, who survived the 30 day observation period. Group 2 included patients, with a systematic deterioration resulting in death. All patients were subjected to surgery between the 15th and 30th day of observation because of septic syndrome signs. On 1st, 5th, 10th, and 15th day of treatment we measured concentrations of lipid peroxidation products such as: conjugated dienes (CD), malonyl dialdehyde (MDA), Schiff's bases, lipid peroxides (LOOH), and hydrogen peroxide. RESULTS: We observed high levels of CDs and MDA throughout the entire observation period as well as increase in lipid and hydrogen peroxide serum concentrations in patients with poor prognoses. Shiff's bases serum concentrations presented a non-characteristic pattern of changes. CONCLUSIONS: Lipid peroxidation products' metabolism path observed in our study suggests a substantial role of oxygen free radicals in acute pancreatitis pathology. Authors claim, that the assessment of lipid peroxidation product serum concentrations may be a useful marker for prognosing in most severe forms of acute pancreatitis.

[The role of selected enzymes and acute phase proteins in necrotizing pancreatitis]. / Zachowanie sie wybranych enzymów i bialek ostrej fazy w martwiczej postaci ostrego zapalenia trzustki.

THE AIM: Despite potent clinical manifestation of acute necrotizing pancreatitis symptoms, its severity estimation and prognosis based on laboratory tests proves to be difficult. In general, the key role in disease diagnostics is attributed to enzymes secreted by this organ. However, this opinion doesn't find confirmation in all cases. MATERIAL AND METHODS: A-amylase, C-reactive protein, and lipoprotein (a) serum concentration changes were evaluated in 60 patients treated in our department because of necrotizing pancreatitis. Observation period was 30 days and the severity of disease was taken into account. All patients were divided onto 2 groups. Group 1 contained 42 individuals who survived the 30 day observation period. Group 2 consisted of 18 patients with poor prognoses, who died. All patients were operated on between 15th and 30th day of treatment. Overall condition was monitored by means of Ranson and APACHE II scores. RESULTS: The decrease in alpha-amylase activity was noted in both groups; however the differences between groups lost its significance from the 5th day on. Initially, the pancreatic lipase activity was increased in both groups, but the differences showed no significance. In subsequent days of study those differences became statistically significant. On the contrary, differences between subsequent measurements appeared as late as in the fourth time point. C-reactive protein serum concentrations were significantly higher in poorly prognosing patients. In group 1 patients these concentrations underwent a gradual normalization. In Group 2 lipoprotein (a) serum concentration increased reaching 100 mg/dL at the end of observation. CONCLUSIONS: The study shows lack of feasibility of alpha-amylase serum concentration assessment as a method of pancreatic necrosis extent determination in patients with necrotizing pancreatitis. High level of lipase proves the existence of inflammatory reaction, but unspecific one regarding acute pancreatitis. Although CRP levels change non-specifically during acute pancreatitis, they are extremely high at the early stage of pancreas necrosis. Serum level of Lp (a) increases in necrotizing pancreatitis along with overall patient standing deterioration. Low levels of mentioned parameters do not exclude the diagnosis of most severe form of acute pancreatitis.

[Hyperlipoproteinemia in necrotizing pancreatitis]. / Hiperlipoproteinemia w martwiczym zapaleniu trzustki.

UNLABELLED: Oxygen free radicals (OFR) generated during necrotizing acute pancreatitis (NAP) make an impact on cholesterol, phospholipids, and triglyceride metabolism. These compounds are poorly soluble in body fluids and form proteolipid complexes called lipoproteins. The aim of this study is to investigate the lipoprotein metabolism in accordance to NAP severity. MATERIALS AND METHODS: Sixty patients with NAP were included to this study, 41 males and 19 females. Patients mean Ranson score exceeded 7 points. The severity of the disease and overall patient standing changes were monitored by means of APACHE II score. In all patients indications for surgery performed between 15th and 30th day of observation were signs of infection. All patients were divided into 2 groups. Group I included 42 patients, who survived the 30-day observation period. Group 2 was made of 18 patients who died. The total high density lipoproteins (HDL) and low density proteins (LDL) of lipoprotein fraction concentrations were measured on 1st, 5th, 10h, and 15th day of treatment. Concentrations of cholesterol, triglyceride, and phospholipids were measured in isolated fractions. RESULTS: HDL concentrations measured by means of cholesterol, triglyceride, and phospholipids levels decreased insignificantly in group 1, while in group 2 respective levels were significantly higher and increased along with patient deterioration. Lipoprotein levels showed correlation with patient APACHE II score. CONCLUSIONS: In the most severe NAP the decrease of high-density and increase of low-density lipoprotein fraction were observed. The assessment of lipoprotein metabolism derangement may be a useful prognostic factor in NAP.

[Serum anti-oxidative barrier in acute pancreatitis]. / Bariera antyoksydacyjna osocza w ostrym zapaleniu trzustki.

UNLABELLED: Serum anti-oxidative barrier is a factor determining active oxygen form suppression. The aim of this study is to investigate superoxide dismutase (SOD) and glutathione peroxidase (GP) serum level changes as a marker of its enzymatic barrier efficiency in patients with acute pancreatitis (AP) evaluated by means of Ranson score. MATERIAL AND METHODS: Fifty patients with AP were divided onto 2 groups. Group 1 consisted of 22 patients with moderate AP, whose overall standing varied from 3 to 6 points according to Ranson. Group 2 was made of 28 patients with severe AP and 6 or more Ranson scores. Serum activities of SOD and GP were measured on 1st, 3rd 7th, and 10th day of treatment using Martin oxidation method in the former, and Rice-Evans spectrophotometry method in the latter case. RESULTS: Blood SOD activity in Group 1 patients underwent gradual normalization; however in all time intervals it remained statistically higher than in Group 2. The activity of GP was lower than normal in both groups. In moderate AP patient group GP activity differences became statistically significant as late as on the 7th and 10th day of study. Both patient groups differed significantly regarding the GP serum activity. Serum anti-oxidative barrier activity in patients with severe AP was significantly lower than in patients with moderate form of the disease. CONCLUSIONS: Along with patient amelioration and inflammation regression the activity of anti-oxidative serum enzymes increased. The estimation of anti-oxidative stress parameters may be useful in disease dynamics monitoring which affects treatment modality.

[Lipid peroxidation products in experimental peritonitis]. / Produkty peroksydacji lipidów w doswiadczalnym zapaleniu otrzewnej.

UNLABELLED: Oxygen free radicals attribute to the peroxidation of lipids forming the cellular wall. These processes are manifested by means of phospholipid (PL), triglyceride (TG), and cholesterol (CH) concentration changes. Simultaneously, as a result of arachidonic acid peroxidation, conjugated dienes (CD) and malonyl dialdehyde (MDA) are released. The aim of the study is to investigate these changes in the course of experimental peritonitis (EP). MATERIALS AND METHODS: In 100 rats experimental peritonitis was elicited by means of cecal ligation and puncture (CLP). All animals were split to 2 groups. Group 1 consisted of 40 animals, which survived the 3-day observation period. In group 2 there were 60 rats, which died. Blood was collected in 6-, 12-, 24- 48- 72-hour intervals after surgery or until animal death. Results. Cholesterol concentration changed insignificantly in Group 1 in all time points. Its decrease was statistically significant in Group 2. Triglyceride and PL concentrations insignificantly increased in Group 1. This increased was significant in Group 2. Highest CD concentrations (1.74 IU in Group 1 and 1.89 IU in Group 2) were measured in the early inflammatory phase. In Group 1 MDA concentrations decreased insignificantly, in Group 2--the differences were statistically significantly. The differences of measured parameters were significantly between Group 1 and Group 2. Negative correlation between CD. and TG or CD. and PL was obtained in Group 2 after performing the Pearson test. The correlation between CD. and CH was weak positive. CONCLUSIONS: Lipid peroxidation product blood concentrations vary in the course of diffuse peritonitis along with sepsis aggravation. Conjugated dienes' extinction and malonyl dialdehyde concentration are highest in the initial phase of sepsis. Lipid metabolism product concentrations correlate with arachidonic acid peroxidation product levels. The oxygen free radical reaction initiates lipid peroxidation disorders on the molecular level in patients with sepsis.

[Laparoscopic cholecystectomy--the method of choice in the elderly]. / Cholecystektomia laparoskopowa metoda z wyboru u osób w wieku podeszlym.

The aim of the study was the comparison and assessment of the results of gallbladder excision performed with the classical and laparoscopic methods in persons after age of 70. A total of 242 patients with mean age of 76.1 years operated on in the years 1999-2002, were analysed. 150 of them were operated with the laparoscopic and 92 with the classical methods. The frequency of postoperative--surgical and general--complications and the presence of concomitant diseases associated with old age were compared. Laparoscopic procedures are distinguished for an almost six fold decrease in the percentage of complications (6 vs. 35%) loaded comparably with concomitant diseases. Patients operated with laparoscopic methods had suffered from cardiac infarctions twice as often in their past history (17 vs. 8%). The method of laparoscopic gallbladder excision proved to be beneficial also in persons of advanced age.

[Lymphoscintigraphy as a method of choice for the assessment of lymphatic oedema of the lower limbs]. / Limfoscyntygrafia jako metoda z wyboru dla oceny obrzeku limfatycznego konczyn dolnych.

Among various pathologic conditions characterized by swelling of the lower limbs, lymphatic oedema is that of more frequent occurrence. The oldest method used in the examination of the lymphatic system besides its clinical assessment is colour lymphography based on the application of methylene blue. A more accurate method was employment of iodic contrast media visualised on roentgenological plates. Nowadays disturbances of lymphatic drainage are almost exclusively examined by means of lymphoscintigraphy with the use of radioactive markers. The study discusses the technique of this examination as well as the criteria of the assessment of the results obtained.

[The influence of pentoxifylline on the course of experimental peritonitis]. / Wplyw pentoksyfiliny na przebieg doswiadczaneigo zapalenia otrzewnej.

The influence and relation between pentoxifylline (PTX) dose and time of administration and mortality rate of animals with experimental peritonitis (EP) were studied. Forty-five rats used in this study. Experimental peritonitis was elicited in study animals. All animals were divided onto 3 groups. The sorting was made according to drug dose and moment of administration. Group 1--the control one--consisted of non-treated animals with EP. Animals from group 2 received 50 mg of PTX per kg of body weight before cecal ligation and puncture (CLP). In group 3 PTX was administered in a dose of 250 mg/kg 8 hrs after CLP. The influence of PTX inactivating phosphodiestherase as a cyclooxigenas inhibitor on the behavior of C-reactive protein, II-11beta, TNFalph and its soluble sTNF-R type I p55 and type II p75 receptors' study animal serum concentrations was estimated. The influence of administered drugs on the course of EP was assessed by means of animal survival period and CRP serum concentration dynamics observation. Thirty-three percent of control group animals survived the experiment compared to 53.3% in group 2 and 46.6% in group 3. The study proved that PTX administration in animals with EP caused TNFa serum concentration decrease, however not changing the overall animal survival rate. On the contrary, cycloooxygenase inhibitors decrease arachidonic acid peroxidation product cytotoxicity in experimental peritonitis.

[Effect of arachidonic acid peroxidation products on the development of gastroesophageal reflux disease]. / Wplyw metabolitów peroksydacji kwasu arachidonowego na rozwój choroby refluksowej przelyku.

Oxygen free radicals trigger arachidonic acid peroxidation. The end-products of this reaction are malonyl dialdehyde (MDA) and conjugated dienes (CDs). The pattern of changes of MDA and CD concentrations in serum and esophagus mucosa homogenates were estimated in patients with GERD. The study was conducted on a group of 92 patients. They were divided into a non-esophagitis and co-existent esophagitis subgroup. The presence of inflammation was confirmed by means of pathomorphological examination. Results were verified against upper gastrointestinal tract endoscopy outcomes. The measurements were taken before and 8 weeks after anti-GERD treatment. Results were compared against 20 patients awaiting hernia repair. In both groups MDA serum concentrations before treatment were significantly different from the control group (2.02 nmol/mL in group I and 3.92 nmol/mL in group II). It decreased significantly after treatment in group II (2.72 nmol/mL) and insignificantly in group I. Also DS serum concentrations before treatment was significantly different comparing to the control group (1.34 nmol/mL in group I, and 2.13 nmol/mL in group II). Like MDA, dienes' concentrations decreased significantly after treatment in group II and insignificantly in group I. MDA and DS tissue concentrations were always higher than the serum ones. Both before and after treatment they displayed statistically significant differences between the esophagitis and non-esophagitis groups. Oxygen free radicals measured by means of MDA and DS serum and tissue homogenate concentrations rise significantly in patients with GERD compared to the control group. Arachidonic acid peroxidation products' concentrations were significantly higher in patients with GERD and esophagitis than in the non-esophagitis group.