The Effects of Chronic Immunosuppressive Treatment on Morphological Changes in Cardiac Tissue and the Balance between Matrix Metalloproteinases (MMP-2 and MMP-9) and Their Inhibitors in the Rat Heart.

Using different three-drug immunosuppressive treatment regimens in a rat model, we aimed to determine the effects of long-term therapy on metalloproteinase-2 and metalloproteinase-9 activity and the expression of their inhibitors, as well as to assess the morphology of the animals' cardiac tissue. Our results suggest that chronic use of immunosuppressive drugs disrupts the balance between the activity of MMPs and TIMPs. Depending on the type of drug regimen used, this leads to abnormalities in the cardiac structure, collagen fiber accumulation, or cardiomyocyte hypertrophy. The information obtained in the present study allows us to conclude that the chronic treatment of rats with the most common clinical immunosuppressive regimens may contribute to abnormalities in the myocardial structure and function. The results presented in this study may serve as a prelude to more in-depth analyses and additional research into the optimal selection of an immunosuppressive treatment with the lowest possible risk of cardiovascular complications for patients receiving organ transplants.

Vitamin D Status in Patients before Thyroidectomy.

Thyroid neoplasms (tumors) are the most common pathology of the endocrine system that requires surgery, and in most cases changes are benign. The surgical treatment of thyroid neoplasms consists in total, subtotal, or one lobe excision. Our study aimed to assess the concentration of vitamin D and its metabolites in patients before thyroidectomy. The study included 167 patients with thyroid pathology. Before the thyroidectomy procedure calcidiol (25-OHD), calcitriol (1,25-(OH)2D), and vitamin D binding protein (VDBP), as well as basic biochemical parameters, were measured using an enzyme-linked immunosorbent assay kit. Data analysis showed that the cohort of patients has a significant 25-OHD deficiency and proper concentration of 1,25-(OH)2D. Before the surgery, more than 80% of patients have extreme vitamin D deficiency (<10 ng/mL), and only 4% of the study group has proper 25-OHD concentration. Patients undergoing thyroidectomy are exposed to many complications, including calcium reduction. Our research has shown that patients prior to surgery have a marked vitamin D deficiency, an indicator that may affect their subsequent convalescence and prognosis. The results suggest that determination of vitamin D levels prior to thyroidectomy may be useful for potential consideration of supplementation when vitamin D deficiency is marked and needs to be incorporated into the good clinical management of these patients.

Local Infiltration Anaesthesia with a Bloodless Operative Field (WALANT). Presentation of the Technique and its Use in Hand Surgery.

Local infiltration anaesthesia with a bloodless operation field (WALANT) allows for performing hand surgery without a tourniquet. This effect is obtained through an injection of greater than standard volume of the anaesthetic solution composed of lignocaine and adrenaline. The addition of adrenaline induces spasm of small arteries within the infiltration area, which inhibits bleeding and allows visualization of most of the subtle but important structures in the hand and fingers. This article presents a method of preparation of the anaesthetic solution and the technique of anaesthesia for several common procedures in hand surgery. In 2019, our centre performed 340 operations under WALANT anaesthesia, with no serious complications observed. Data from the literature are presented showing that this technique is attracting increasing popularity worldwide. Our centre was the first in Poland to introduce the WALANT method to hand surgery.

An analysis of patient's and disease related factors predictive of the outcomes of surgery for carpal tunnel syndrome.

PURPOSE: Outcomes of surgery for carpal tunnel syndrome may differ in relation to certain factors like age, duration of symptoms, clinical and electrophysiological severity. The objective of this study was an investigation into the hypothesis that several factors are predictive of results of surgical treatment of the condition. METHODS: The pre- and postoperative records of 1,117 patients: 909 women (81 %) and 208 men (19 %) with a mean age of 63 years were analysed. Outcomes recorded in the sensory and functional severity scores of the Levine questionnaire were dichotomized into achieving or not-achieving a minimally clinically important difference. The effect of selected variables: sex, age, duration of symptoms, clinical and electrophysiological severity of and presence of comorbidities on outcomes of surgery at 6 months was investigated. RESULTS: Univariate and multivariate analysis of covariates based on sex, age, duration of the disease and its clinical severity showed female gender and worse baseline symptom severity scores to be significant predictors for an improvement following carpal tunnel syndrome surgery. It showed also younger age, shorter duration of symptoms and higher baseline symptom severity scores to be predictive of a greater improvement of total grip strength, and younger age to be predictive of a greater pain cessation following surgery. CONCLUSION: Of all considered patient's and disease related factors, the baseline clinical severity expressed in the Levine symptom severity scores had appeared to be the strongest predictor of better outcomes of surgery for carpal tunnel syndrome.

The results of the treatment of hand - Outcomes of the treatment of hand degloving injuries with greater omentum flaps.

Degloving injury consists in tearing out the soft-tissue integument from skeleton of the hand, with accompanied nerves and vessels. The whole hand degloving has bad reputation and one of worst prognosis, even worse than total hand amputation. The range of possible salvage procedures in these cases is limited and their outcomes are unsatisfactory. One of the suitable methods is wrapping the skinned hand with pedicled or free greater omentum flap, retrieved from the abdominal cavity. The article reports outcomes of the treatment of 5 patients at a mean of 8 years after total degloving of their hands and coverage with omental flaps. All flaps healed uneventfully, but in none of the patients the whole length of the fingers was preserved. Division of stumps of 3 fingers was possible in one patient, two others had three-digital hands and remaining two had only separated thumb. Dexterity of injured hands was limited with a mean of score DASH questionnaire of 43 points. Quality of life as measured by SF-36 questionnaire was fair (58 and 53 points in physical and mental domain, respectively). Regardless this, all patients were satisfied with achieved outcomes and all returned to work, which was a confirmation of the effectiveness of the method used in their treatment.

Undergraduate microsurgical training: a preliminary experience.

Microsurgical training is organised almost exclusively in a post-graduate setting, usually for residents of various surgical specialities. The aim of this study was to present an undergraduate microsurgical training model directed toward medicine students of clinical years. Curriculum design and results. Two six-participant groups of students interested in training were recruited. The programme consisted of 15 three-hour classes (2 hours' work under the microscope) and divided into basic and advanced training parts. The simulation model used in this course was a chicken thigh. The basic training programme consisted of placing sutures on a latex glove followed by preparation of a chicken thigh neurovascular bundle and performing femoral nerve and artery anastomoses. The advanced part of the training consisted of practising the acquired skills and the introduction of new techniques such as end-to-side arterial anastomosis, artery and nerve repair with vein conduit. A "6-stitches test" was used as an outcome measure of the acquired microsurgical skills. After 15 weeks and 30 hours of training and performing 31 anastomoses the undergraduate microsurgical course was completed. CONCLUSION: The results of this study show that the undergraduate, facultative microsurgical training is effective in acquiring microsurgical skills, competence and confidence for participating students.

Familial occurrence of carpal tunnel syndrome.

The objective of this study was to investigate the incidence of familial carpal tunnel syndrome in patients admitted to the authors' institution for carpal tunnel release. Questionnaires completed by 120 patients: 92 women (77%) and 28 men (23%) at a mean age of 56 years at their baseline clinical examination were reviewed. Familial occurrence of the disease was noted in 21 patients (17%): 16 women and five men. Three family members were affected in three patients, two relatives in eight patients, and one relative in 10 patients, giving a total of 35 affected relatives. The patients' sisters (n = 16) were the most commonly involved, followed by mothers (n = 12), daughters (n = 2), brothers (n = 2), grandmothers (n = 2) and an aunt (n = 1). Bilateral manifestation of the disease was noted in 19 patients (90%) and in 31 (88%) of their affected relatives. The results suggest that carpal tunnel syndrome shows a moderate tendency to familial occurrence and, if so, it usually manifests bilaterally.

Percutaneous K-wires vs palmar locking plate fixation for different types of distal radial fractures: a comparison of the outcomes of two methods to controll our guidelines.

The objective of the study was a comparison of the outcomes of K-wire vs plate fixation for distal radial fractures used according to the proposed institutional algorithm. Fracture configurations A2, A3, B1, B2, C1 and some C2 were operated on with K-wire pinning, whereas B3 and some B2, C3 and some C2 were with locking palmar-plate fixation. PATIENTS AND METHODS: Four hundred and sixty-seven patients were non-randomly allocated for either K-wire (n = 363) or palmarplate (n = 104) fixation. The results were assessed at 3 and 12 months by the same outcome measures. RESULTS: At the 3-month assessment, statistically significant differences in grip strength and the DASH scores were noted in favour of the plate-fixation group. At the 12-month assessment, statistically significant differences were observed in the wrist palmar and dorsal flexion, favouring the plate-fixation group. Statistically significant differences were noted in radiological measures of the palmar tilt and the ulnar variance, both favouring the plate-fixation method. Meaningful secondary dislocations were noted in ten patients, all in the K-wire-fixation group. CONCLUSION: We conclude that palmar locking plate fixation in even more severe fractures leads to better radiological and clinical outcomes than K-wire fixation in less severe fractures.

An assessment of quality of the surgical curriculum in Pomeranian Medical University in years 2015-2017.

The objective of this study was assessment of quality of the surgical curriculum in Pomeranian Medical University in years 2015-2017. MATERIAL AND METHODS: A questionnaire-survey has been conducted in a group of 100 of Polish students from the Medical Faculty just before the final test-exam in subject surgery. Main topics of the questionnaire items concerned students' opinion on the expected usefulness of acquired surgical knowledge for future medical practice, acquired manual skills, range of knowledge learned in particular academic years and on understanding the term "skill/competency-oriented teaching" surgery. RESULTS: Knowledge from general and oncologic surgery was scored by students the highest as potentially most useful for future medical practice. Learning manual skills (mostly put stiches on a pig trotter) was considered the most valuable portion of surgical curriculum. Acquiring of manual skills was also believed as the closest of meaning the term "skill/competency-oriented teaching" surgery. Sixth (last) year of studying was considered the most effective in acquiring surgical knowledge. Most responders considered time assigned for teaching surgery in the university curriculum adequate, but not optimally employed. A critical discussion of the results was done in a light of the results of earlier studies and the literature. CONCLUSIONS: Outcomes of this study showed the students' expectations in teaching surgery in the medical university curriculum and what was a grade of its performance. Awareness of this may have effect on modification of the curriculum and methods of undergraduate teaching surgery.

Factors involved in the clinical profile of carpal tunnel syndrome.

Clinical presentation of carpal tunnel syndrome may differ in relation to certain factors like sex, age, duration of symptoms and severity of compression. The objective of this study was an investigation into the hypothesis that several distinct factors are predictive of the clinical profile for the condition. The records of 1,117 patients: 909 women (81 %) and 208 men (19 %) with a mean age of 63 years, were analysed. The whole group was divided into subgroups, depending on the variables analysed: sex, age, duration of the condition, severity of symptoms, severity of electrophysiological abnormalities and occurrence or lack of comorbidities. RESULTS: Of all the considered variables, the Levine symptom scores had the greatest impact on the condition's clinical profile: the higher scores the more severe pain, poorer sensation, weaker grip and worse hand function. Also, ages greater than 80 years had a significant negative effect on most of the considered parameters. None of the remaining analysed variables had a substantial impact on the clinical profile of the condition.

A comparison of outcomes of K-wire vs plate fixation for distal radial fractures with regard to patients' quality of life.

The objective of the study was a comparison of outcomes of K-wire vs plate fixation for distal radial fractures with regard to patients' quality of life. One hundred and two patients, 79 women and 23 men with displaced distal radial fractures, were non-randomly allocated for either K-wire (n=72) or palmar plate (n=30) fixation. In general, simpler fractures were fixed by pins, while plates were used for those that were more severe. No statistically significant differences were seen at 3- and 6-month follow-up assessment in any of the analyzed variables: wrist range of motion, total grip and key-pinch strength, and the DASH and SF-36 scores. We conclude that being guided by the postulated algorithm in treatment-choice of distal radial fractures is a reasonable balance between clinical- and cost-effectiveness. We also failed to find any advantage in health-related quality of life as an outcome measure in distal radial fractures compared to standard measures.

A comparison of outcomes of carpal tunnel release for carpal tunnel syndrome in patients diagnosed with and without electrophysiological studies.

Records were analysed from the institutional database, including 943 patients (1089 hands) with CTS who were operated on in the authors' department over a period of four years (2012 to 2015). The diagnosis of CTS was made solely on the basis of clinical findings in 551 patients (58 %); 392 patients (42 %) also had electrodiagnostic tests performed, for various reasons. Patients were followed-up at 1 and 6 months with assessments that included the Levine scores, filament tests, grip and pinch strength. No significant differences in Levine scores were found at the 1 and 6 month assessments. Statistically significant differences were noted in 3-point pinch strength and sensation: however, these were not clinically meaningful. The results of the study show that the results of carpal tunnel release in patients with typical symptoms are no better after electrodiagnostic tests.

Perforation of the Peptic Ulcer Localized in the Proximal Jejunum - Case Report.

Non-traumatic perforation of the digestive tract occurs most often in the duodenum and stomach (peptic ulcer), as well as the colon (diverticulitis, cancer or ischemic lesions). Perforation of the small bowel is very rare. The Authors of the study presented a case of proximal jejunum perforation, which occurred in a patient with a history of duodenal peptic ulcer disease. Diagnosis posed no difficulties, and treatment included the excision of the ulceration and suturing of the bowel. The patient recovered without complications and the histological examination failed to reveal the nature of the ulcer. However, based on the medical history, one may suppose that it might be of peptic etiology, which makes this case exceptional.

The usefulness of the surgical knowledge and skills acquired via the university curriculum for doctors' medical practice several years after graduation.

BACKGROUND: Teaching surgery during university curriculum comprises transferring theoretical knowledge traditionally and simultaneously acquiring manual skills, i.e., suturing, stitch removal, limb immobilization, catheterization, and assisting operations. Observations of doctors several years after graduation led to the reflection that teachers' ideas about surgical knowledge and skills that are useful in daily practice frequently fail to meet the facts of the case. The objective of this study was to determine which part of the surgical knowledge and skills taught via the university surgical curriculum proved to be useful in the daily practice of young doctors. MATERIAL AND METHODS: A custom-made questionnaire was designed and mailed to 200 randomly chosen doctors who had graduated from the medical faculty at the authors' university 5 to 6 years previously. The questionnaire comprised 9 items concerning the knowledge and skills that proved to be the most useful in participants' daily practice, regardless of their specialty. RESULTS: A total of 64 completed questionnaires were returned (32% of 200 sent) and were the subject of analysis. The most useful knowledge in daily practice was that acquired from general surgery, followed by oncological and vascular surgery. The most useful was knowledge about the rational interpretation of clinical symptoms and signs acquired from examination of the patient, followed by arriving at an accurate diagnosis through logical analysis, and next developing "oncological sensitivity" to diagnosing neoplasms. The most effective teaching model was specialized outpatient clinic rounds, followed by training manual skills on a model and classical ward-round teaching. The most frequently learned (acquired) manual skills were removal of stitches, rectal examination, and examination of the abdomen. Of these skills, the most useful in daily practice appeared to be removal of stitches, catheterization of the urinary bladder, and wound suturing. Learning and practicing manual skills followed by classical ward-round teaching was considered "skill-/competency-oriented teaching" surgery by all respondents. CONCLUSION: The results of this study show some discrepancy between the knowledge and skills taught during university surgical curriculum and their actual usefulness in the daily practice of graduates. Awareness of this should have an effect on modification of the curriculum and methods for undergraduate surgery teaching.