Management of gastrointestinal stromal tumors: A 10-year experience of a single surgical department.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive system. The primary location of GISTs is mainly the gastrointestinal system. Clinical symptoms are nonspecific and mainly depend on the location and size of the tumor. OBJECTIVES: The aim of this study was to conduct a clinical and pathological analysis of 18 cases of GISTs from the medical records of the Department of Surgery at the 4th Military Teaching Hospital in Wroclaw, Poland. MATERIAL AND METHODS: The medical records were of women and men at the age of 36-84 years who were treated in the Surgical Clinic. The medical data that was gathered included clinical records, histopathological results and the type of surgical treatment. The study also encompassed the anatomical location and size of the tumor as well as microscopic examination of the tumor. RESULTS: In most cases, GISTs were located in the stomach. The most common symptoms were stomachaches and signs of bleeding into the digestive system. Usually, the tumor presented a diameter of <5 cm and a low grade of malignancy. Out of 18 patients, 16 were treated with laparoscopic resection, whereas in the remaining 2 cases, multiorgan resections were carried out, because the tumor was locally advanced. CONCLUSIONS: It is essential to distinguish stromal tumors from other mesenchymal tumors, since GISTs are among the cancers that have a high risk of malignant progression. The conditions for successful treatment are a properly established histopathological diagnosis, accompanied by immunohistochemical tests for CD117, and a combination of antibodies for a differential diagnosis of other mesenchymal tumors.

Results of Sentinel Lymph Node Biopsy in Patients with Breast Cancer in 10-Year Own Material of the 4th Military Teaching Hospital with Polyclinic in Wroclaw.

UNLABELLED: At present, sentinel lymph node biopsy is a standard procedure to assess the advancement of breast cancer and cutaneous melanoma. The aim of the study was to assess the role of the sentinel lymph node biopsy in the treatment of patients with breast cancer in our own material. MATERIAL AND METHODS: Analyzed was medical documentation of 258 patients with initially operable breast cancer, qualified for operation with sentinel lymph node biopsy in 2004-2014 in the Department of Surgery of the 4th Military Teaching Hospital. A few hours prior to the planned surgery, radioisotope (technitium-99 sulfur colloid) was applied in the area of tumor or under the areola. 1-2 hours after administering the tracer, the lymphoscintigraphy with the labelling of the sentinel lymph node on the skin was performed. RESULTS: On the basis of the gathered material, obtained were the following parameters: sensitivity - 100%, and specificity - 94.6%. Four cases were false negative (5.5%). CONCLUSIONS: 1. Marking the sentinel lymph node in breast cancer, based on the single visualisation method with the use of radioisotope, is a useful and effective technique. 2. The factor influencing the results of the sentinel lymph node biopsy (true positive and negative results and false negative result) was the number of the excised lymph nodes except for the sentinel lymph node. 3. Patients with estrogen receptor expression had often metastases to sentinel lymph node (145 cases - 56%). 4. The false negative rate, i.e. 5.5% in our material, is within the limits of acceptability given in the literature. 5. The sentinel lymph node biopsy performed by the experienced surgical team is a reliable diagnostic tool with a low complication rate.

[Implantation of plastic and metal stents to biliary tract in obstructive jaundice in material of Surgery Department of 4th Military Clinical Hospital in Wroclaw]. / Zaopatrywanie dróg zólciowych protezami plastikowymi i metalowymi w nowotworowej zóltaczce mechanicznej w materiale Kliniki Chirurgicznej 4. WSKzP we Wroclawiu.

INTRODUCTION: A method of treatment for malignant bile duct strictures depends on early diagnosis, location and extent of tumor infiltration. Patients eligible for radical surgery should be operated. AIM OF THE STUDY: The authors used plastic and metal prostheses in the treatment of biliary tract cancer cholestasis. MATERIAL AND METHODS: Retrospective analysis was done in 2730 endoscopies performed in the Laboratory of the Department of Endoscopic Surgery, 4th Military Hospital in Wroclaw in 2008-2011. The authors analyzed 441 cases of prosthetic biliary cancer. RESULTS: 223 patients (51%) were treated for pancreatic head tumor, 98 pts (22%)--for papilla of Vater tumor, 85 pts (19%)--due to Klatskin tumor and 35 pts (8%)--due to tumor of the gallbladder. Plastic prostheses were inserted in 228 (65.4%) patients, self-expanding metal prostheses--in 21 patients (4.9%). Dilatation of the bile duct or the inserted prosthesis was performed in 48 (11.1%) pts. 27 patients (6.1%) had endoscopic treatment failure. 32 patients (7.3%) had following complications of biliary prosthesis: bleeding into the bile duct, into the digestive tract--4 cases (1%), the migration of the prosthesis--7 (1.6%), cholangitis--21 cases (4.7%). CONCLUSIONS: Palliative biliary stenting is a safe method that provides efficient drainage of bile. It shows a definitive advantage over percutaneous, biliary transhepatic drainage.

[Use of synthetic mesh in abdominal wall hernias repair]. / Zastosowanie siatek syntetycznych w leczeniu przepuklin brzusznych.

Abdominal hernias repair beside cholecystectomy and appendectomy is the most commonly performed surgical procedure. The crucial problem in surgery treatment of abdominal hernias is its recurrence, especially high in procedures performed without use of synthetic graft. Advances in understanding the etiopathogenesis of abdominal hernias and the introduction of the new surgical techniques have considerably improved the results of its repair. The widely used synthetic mesh is made of durable material and its structure enables easy and safety intraperitoneal implantation also in laparoscopic surgery. Unfortunately the high cost of this procedure limits its use. There is still need for 'ideal' mesh material and high hope for increasing biological graft application in the future.

[Use of polymeric clips in laparoscopic appendectomy]. / Zastosowanie klipsów polimerowych w appendektomii laparoskopowej.

UNLABELLED: The aim of this study was to evaluate efficiency and safety of using non-absorbable polymeric clips in securing the stump of appendix during laparoscopic appendectomy. PATIENTS AND METHODS: We have analyzed patients of Surgical Clinic of 4th Military Clinical Hospital in Wroclaw, who underwent laparoscopic appendectomy from 2006 to 2010. Patients were divided into 3 groups regarding to the way of securing stump of appendix: in group one non-absorbable polymeric clips Hem-o-lok were used, in group two endostaplers Endostapler Flexi and in group three endoloop ligatures or traditional ligatures. Evaluated data included operative time, intra- and postoperative complications, hospital stay and costs of used materials. RESULTS: There were performed 90 laparoscopic appendectomies between 2006 and 2010 in Surgical Clinic of 4th Military Clinical Hospital in Wroclaw. Non-absorbable polymeric clips Hem-o-lok were used in 30 patients, endostaplers in 27 and endoloop ligatures in 33 cases. There were no intra- and perioperative complications such as bowel injury, appendix stump leak or early bowel obstruction. Two cases of postoperative pericaecal (perityphlic) abscess (1 in group one, 1 on group two) were observed, in both cases antibiotic therapy was successive, patients didn't require surgery. Wound infection was observed in 3 cases (2 in group one, 1 in group three). Mean operative time was 70,5 min. in group one (from 40 to 115 min.), in group two 58,5 min. (from 25 to 110 min.), and in group three 76,3 min. (from 40 to 120 min.). Mean hospital stay was 2,6 days in group one (from 2 to 4 days), in group two 2,9 days (from 2 to 7 days.), and in group three 2,88 days (from 2 to 8 days). CONCLUSIONS: Using of non-absorbable polymeric clips Hem-o-lok is an efficient and safe way of securing the stump of appendix during laparoscopic appendectomy, comparing to other methods (endostapler and Endoloop ligature). Advantages of polymeric clips are facility of application (most of surgeons have experience in clips application during performed for many years laparoscopic cholecystectomies) and low cost (comparing to endostaplers).

[Mallory-Weiss syndrome after the use of biliary prosthesis]. / Zespól Mallory-Weiss po zastosowaniu protezy dróg zólciowych.

The Mallory-Weiss Syndrome is a rare complication of endoscopic examination. Upper gastrointestinal bleeding due to the Mallory-Weiss Syndrome usually stops spontaneously. The gastroscopy is an effective procedure (method) of diagnosis and treatment of the syndrome. Presented in this paper is a case of 49-year old woman with an upper gastrointestinal bleeding due to the Mallory-Weiss after biliary prosthesis removal. The choledocholithiasis was the primary reason for the initial insertion of prostheses. The cause of gastrointestinal bleeding was determined on the basis of performed gastroscopy in the early stage of prostheses removal forced by bleeding. The bleeding was effectively stopped with endoclips.

[Application of biliary stents in endoscopic stenting of biliary ducts]. / Zastosowanie protez zólciowych w endoskopowym protezowaniu dróg zólciowych.

Extra hepatic bile ducts with the gallbladder are the center place for many disease processes. In extreme cases of significant strictures of bile ducts and impairment of bile flow, obstructive jaundice occurs. There are benign and malignant biliary strictures. The treatment of obstructive jaundice depends on the removal of blockage using endoscopic and surgical methods which return the efficient bile flow to the digestive tract. The endoscopic treatment from Vater's papilla access using plastic and metal stents is the method of choice. The choice of proper prosthesis depends on the reason for biliary strictures. The plastic stents (straight, pigtail) are applied the most. Due to their low cost, easy insertion to biliary ducts and exchangeability, they are applied in benign and malignant strictures. However, metal stents (Wallstent, Diamond, Z-stent, InStent), due to the wide diameter after expansion and no possibility of removal, are applied only in malignant strictures. Endoscopic insertion of biliary endoprostheses can be burdened with complications. There have been reports of occlusion, migration with duodenal wall injury and hemorrhaging.