Anterior overlapping sphincteroplasty--who benefits from the surgery?

UNLABELLED: The aim of the study was to identify clinical factors which could influence the results of overlapping sphincteroplasty. MATERIAL AND METHODS: Between 2003-2009 the group of 78 incontinent patients (59 women, mean age of 61±13 years), was operated on with anterior overlapping anal sphincteroplasty. Only patients with severe incontinence (>16 pts in Wexner scale) were included. Before surgery and in follow-up period anorectal ultrasound, manometry and incontinence assessment were performed and in follow-up period patients additionally fulfilled survey. The study was prospective. Follow up period was more than 36 months. RESULTS: In survey the excellent results related to 52 patients (66.7%), good in 15 (19.2%) and poor in 11 (14.1%). The squeeze pressure improved more significantly in men 33±11 cm H2O vs. 22±14 cm H2O; p=0.039. In patients <50 year squeeze pressure was significantly larger 32±10 cm H2O vs. 25±12 cm H2O; p=0.045. If the width of a defect within sphincter was less than 60° the improvement in squeeze pressure was higher 33±9 cm H2O vs. 22±15 cm H2O; p=0.031. In Wexner scale male patients better responded to surgery than females 6.94±1.8 vs. 5.12±2.2, p=0.048; as well as patients with smaller scar <60° 6.51±1.4 vs. 4.28±2.3; p=0.042. CONCLUSIONS: To succeed in sphincteroplasty the proper qualification to the procedure should be crucial. Clinical assessment prior to surgery with the use of all available non-surgical methods in patients suffer from severe symptoms can help to select optimal group who will benefit from surgery. Male patients may have to obtain better outcome and patients with smaller sphincter defect could likely have also better results from surgery.

Contribution of the -173 G/C polymorphism of macrophage migration inhibitory factor gene to the risk of inflammatory bowel diseases.

UNLABELLED: Inflammatory bowel disease (IBD) represents a heterogeneous group of chronic disorders characterized by inflammation of gastrointestinal tract, typically with a relapsing and remitting clinical course of unknown etiology. Presumably, IBD develops with response exogenous environmental factors only in persons with genetic predisposition. This predisposition was suggested to be associated with polymorphism and mutations in genes encoding proinflammatory immune system proteins. Enhanced production of macrophage migration inhibitory factor (MIF) was found in patients with inflammatory bowel disease (IBD) and mice with experimental colitis. These results suggest that MIF plays a critical role in etiology of the colitis.The aim of the study was determine whether the MIF -173 G/C gene polymorphism is associated with the susceptibility to inflammatory bowel disease (IBD). MATERIAL AND METHODS: A total of 99 IBD patients, including 58 patients with ulcerative colitis (UC) and 41 with Crohn's disease (CD) and 436 healthy controls recruited from the Polish population, were genotyped for MIF polymorphisms. Genotyping of MIF gene polymorphism was performed by a RFLP-PCR. RESULTS: We found an increased risk of UC for the C allele of the MIF-173 G/C polymorphism. The distribution of the genotypes was not significantly different in the CD group compared with the controls. CONCLUSIONS: We demonstrated that the C allele is associated with an increased risk for development of UC. This suggests that the G/C polymorphism in the MIF gene promoter may be a potential risk factor for UC in Polish population.

[Inflammatory fibroid polyp of the stomach--a case report]. / Wlóknisty polip zapalny zokldka--opis przypadku.

Inflammatory fibroid polyp of the stomach is a rare benign mass of unknown etiology, mostly located within the pyloric area. Histopathological findings mainly reveal the presence of mononuclear fusiforme cells forming loose extensive bundles or rotary structures of rotated spirals with abundant amount of eosinophilic cytoplasm. These cells are negatively stained for S-100 protein and desmine and positively stained for CD-34. Symptoms of the disease depend on the localization and the size of the polyp. We report a case of 50-year-old woman with a large inflammatory fibroid polyp with a diameter of 60 x 50 x 40 mm imitating benign gastric tumour. She mainly suffered from abdominal pain and lab tests revealed symptoms of severe anaemia. We performed partial gastrectomy with Hofmeister-Finsterer modification. Postoperative pathological findings certified sings of inflammatory fibroid polyp. During the two year followup period we did not report any signs of recurrence or dissemination. Clinical manifestation of large inflammatory fibroid polyp of the stomach can imitate symptoms of gastric cancer. Partial gastrectomy with an unaltered, healthy wall margin of 2 to 3 cm is sufficient, curative treatment modality in such cases.

[Gastric complaints or postcholecystectomy syndrome?]. / Dolegliwosci gastryczne czy zespól po cholecystektomii?

UNLABELLED: Postcholecystectomy syndrome (PCS) is a complex of symptoms from gastrointestinal tract that could develop and maintain after cholecystectomy. PCS usually consists of: abdominal pain or colic, dyspepsia, constipation or diarrhoea, nausea, bloating, fatty food intolerance. Regarding PSC as disease entity is still a point of many controversies. THE AIM OF THE STUDY: To estimate the prevalence of PCS in patients after cholecystectomy performed in Department of General and Colorectal Surgery of Medical University in Lodz. Material and methods. From the cohort of 243 patients (pts) operated on due to symptomatic cholecystitis the group of 150 pts was surveyed. We included 86 pts who answered the questionnaire. The prevalence of PCS and intensity of symptoms were measured with the use of modified Gastrointestinal Symptoms Rating Scale (GSRS)--only 6 complaints commonly connected with pathology of biliary system were chosen (abdominal pain, rebounding, constipation, urgent diarrhea, nausea, bloating). RESULTS: After cholecystectomy gastric complains were revealed in 32 pts (37.2%). In a group of 12 pts (13.9%) symptoms were noted at the same level of intense. However in 20 pts (23.25%) either more intense or appeared as brand new manifestation. Excessive amount of intestinal gases (93.75%) and bloating (87.5%) were the most common symptoms unlike abdominal pain, heartburn and diarrhea. CONCLUSIONS: Gastric symptoms of PCS occur in one third of pts after elective cholecystectomies. Complete PCS develops after 3 months postoperatively what is likely connected with the change of diet. Excessive amount of intestinal gases, bloating, abdominal pain and diarrhea were the most common symptoms. The most intense complaint is persistent abdominal pain likely indicating comorbidities.

[Comparison of stapling techniques and knot-like sutures in intestinal anastomosis]. / Porównanie szwu mechanicznego ze szwem wezelkowym w zespoleniach jelitowych.

The authors analysed the most common complications in patients after gastrointestinal tract resections. Based on own ten-year clinical practice in stapling technique the complication rate was described including anastomosis insufficiency and stenosis, anastomosis line bleeding, wound infection, and cardio-pulmonary disorders in 636 patients. The observations were compared to standard knot anastomosis in 183 patients. Based on complication analysis the conclusion was drawn, that stapling technique decreases both general and local complication rate of gastrointestinal anastomoses. The use of mechanical suturing technique increases patient survival chance, decreases duration of hospitalisation, and, above all, allows to avoid permanent disability.