Transurethral Microwave Thermotherapy (TUMT) in the Treatment of Benign Prostatic Hyperplasia: A Preliminary Report.

BACKGROUND One treatment option for benign prostatic hyperplasia (BPH) is transurethral microwave thermotherapy (TUMT). Unfortunately, TUMT has been increasingly marginalized recently. The aim of this study was to evaluate erectile function and urinary symptoms in patients after TUMT for BPH and compare the results with those of patients on pharmacological treatment for BPH. MATERIAL AND METHODS The study group consisted of 840 patients with BPH treated with TUMT and a control group consisting of 1040 patients who underwent pharmacotherapy. Erectile dysfunction was evaluated using the International Index of Erectile Function-5 questionnaire and the Individual Postoperative Erectile Assessment (IPEA) questionnaire, which was created by the authors for this study. Urinary symptoms were evaluated using the International Prostate Symptom Score (IPSS) questionnaire. RESULTS More than 50% of all patients experienced an improvement in urinary symptoms after TUMT, compared with only approximately 30% in the control group. Differences in each of the IPSS symptom scales between the TUMT and control groups were statistically significant (P<0.031, P<0.041, and P<0.025 for mild, moderate, and severe symptoms, respectively). Improvement in erectile dysfunction after TUMT was also statistically significant (P<0.0001, P<0.0001, P<0.05 for mild, moderate, and severe erectile dysfunction, respectively). Based on the IPEA questionnaire, approximately 24% of the TUMT group reported significant improvement in erectile function, while a decrease in erectile function was reported in the control group. CONCLUSIONS TUMT may still be a valuable option in the treatment of BPH. TUMT may be especially suitable for patients who expect to improve urinary symptoms without decreasing erectile function.

Endothelial Markers: Thrombomodulin and Von Willebrand Factor and Risk of Kidney Thrombosis After Transplantation.

OBJECTIVE: Endothelial disturbance is well known as one of the causes of thrombosis. This study measured von Willebrand factor (vWF) and soluble thrombomodulin (sTM) in renal vein blood to evaluate for the risk of thrombosis after kidney transplantation. METHODS: A cross-sectional study that included 61 consecutive recipients of kidney transplant. The sTM and activity of vWF were evaluated in blood of the renal vein at the time of reperfusion. RESULTS: The renal vein blood had higher values of vWF activity and sTM concentration than the peripheral blood. In the first minutes of reperfusion, the concentration of thrombomodulin was the highest but activity of vWF was the lowest. As the reperfusion continued, thrombomodulin gradually decreased, but vWF increased. The strong correlations of TMs and vWF with warm ischemia were observed (r = 0.5577 and r = 0.3429, respectively). Thrombosis was found in about 10% of all recipients. However, other complications, such as delayed graft function or ureter necrosis, were associated with high values of vWF and sTM. They were correlated with increased sTM concentration and activity of vWF (P < .006 and P < .05, respectively). This was confirmed by analysis of the receiver operator characteristic curve. The area under the curve values for TMs and vWF were 0.762 and 0.602, respectively (P < .0001 and P < .015, respectively). The cutoff points for sTM and vWF were 14.89 ng/mL and 129.89%, respectively. Positive prediction value sTM and vWF were 76% and 66% and negative prediction value 69% and 59%, respectively. CONCLUSIONS: The endothelium of a transplanted kidney could be involved in the pathogenesis of renal thrombosis. Endothelial protection during harvesting can greatly contribute to the improvement of transplantation outcomes. The renal pool of sTM and vWF could be a useful marker of the risk of renal thrombosis.

Tissue Factor and Risk of Complications After Kidney Transplantation.

OBJECTIVE: Tissue factor (TF) is a membrane component of many cells and a strong activator of blood coagulation. Damage to the cells induces an increase in its expression and concentration in blood plasma. The injury and breakdown of the cells is inseparably connected with the harvesting and preservation of the kidney. PURPOSE: The aim of the study was an analysis of TF in the renal vein after of restoration of circulation in the transplanted kidney. An additional goal was to investigate the impact of warm ischemia on TF. MATERIALS AND METHODS: The examined group included 61 kidney recipients. Blood was taken from the renal vein in the first minute during reperfusion. Simultaneously, blood from a peripheral vein was also drawn. Apart from tissue factor (TF), I also examined thrombin/antithrombin complexes and fragments 1+2 of prothrombin. RESULTS: In blood from renal veins, I noticed higher level of TF, thrombin/antithrombin complexes and fragments 1+2 of prothrombin in comparison with blood from peripheral veins (P < .0048, P < .016, P < .046, respectively). The 29 recipients (47% of the total) with postoperative complications had much higher concentrations of TF than others (P < .019). TF showed a strong positive correlation with the time of warm ischemia (r = 0.53864, P < .05). CONCLUSIONS: The donor kidney appeared to be one of the main sources of TF in the blood of recipients. Warm ischemia significantly increased its concentration in renal vein blood. This concentration of TF may be associated with damage to the kidney. TF significantly increased the risk of postoperative complications.

Useful Points of Geometry and Topography of the Lumbar Triangle for Transversus Abdominis Plane Block.

BACKGROUND: A new look at the topography of the lumbar triangle becomes a challenge for modern anesthesia. The aim of this study was to redefine the topography of the lumbar triangle for transverse abdominis plane block. MATERIAL AND METHODS: We explored 74 lumbar regions in 37 preserved cadavers (17 F and 20 M). RESULTS: The lumbar triangle was identified in 66 (89%) out of all explored cadavers' lumbar regions. The predominant triangle was the acute-angled shaped. It was identified in 39 (59%) out of all explored lumbar regions. The second type of dissected triangles had the obtuse-angled shaped. Most triangles of acute-angled shaped and obtuse-angled shaped (36) had medium surface (range from 3 cm2 to 6 cm2), which accounted for 55% of all dissected lumbar triangles. The mean surface of the lumbar triangle was 3.6±2.2 cm2. Based on other measurements, we demonstrated that the majority of the lumbar triangles (62 triangles) were beyond the posterior axillary line. CONCLUSIONS: According to the obtained results, the randomized searching for lumbar triangle should be limited to the area situated beyond of the posterior axillary line. The region situated anteriorly to the midaxillary line was defined in the study as the critical area for finding the lumbar triangle. Outcomes from the study revealed that the size and the location of the lumbar triangle as the gate for the transverse abdominal plane block may be responsible for difficulties encountered by anesthetists. Thus, establishing the area with the highest probability of localization of the lumbar triangle can improve both safety and efficiency of transversus abdominis plane block.

[Transverse abdominal plane - anatomical and clinical aspects]. / Przestrzen poprzeczna brzucha - aspekty anatomiczno-kliniczne.

In medicine spectacular progress can be observed at many stages, which sometimes requires the redefinition of already known anatomical structures. One of them is the transverse abdominal plane, which was the focus of anaesthetists. It was observed that anaesthetics introduced locally into this plane have similar power to a traditional epidural procedure or spinal anaesthesia. The concept of the trans- verse abdominal plane is a relatively new anatomical term which was introduced into clinical medicine by anaesthetists. Because of the potential performance of anaesthetic pro- cedures through access to the transverse abdominal plane, there has been a growing interest not only expressed by anaesthetists, but also anatomists who wish to explore new anatomical aspects of this plane. It is generally believed that anatomical studies will provide more information on this plane, which can contribute to a wider spread of this pro- cedure among anaesthetists.

[Assessment of sexual dimorphism of finger length ratio (2D:4D) ]. / Ocena dymorfizmu plciowego wskaznika dlugosci palców (2D:4D).

INTRODUCTION: Studies on many populations have shown that the length of the second finger (2D) compared to the fourth (4D), expressed as the finger length ratio (2D:4D), might be characteristic for sexual dimorphism. It was also found that the values of 2D:4D differ significantly between examined populations. It is thought that the value of 2D:4D is determined in early foetal life under the influence of genetic factors and the strong influence of sex hormones. It has been proven that the values of 2D:4D are related to, for instance, sexual orientation, and artistic and sporting ability. Recently, increasing interest in the clinical signifi- cance of finger length ratio in the diagnosis of somatic and mental disorders has been observed. For example, it was found that values of 2D:4D in individuals suffering from congenital adrenal hyperplasia or autism were significantly lower compared to healthy subjects. The aim of the study was to determine sexual dimor- phism in finger length ratio among representatives of the Polish population. MATERIALS AND METHODS: The study group comprised 115 people (57 females and 58 males). Anthropometric meas- urements were taken from the second and fourth finger of the right and left hands - from the point of dactylion (da) to pseudophalangion (pph) using analogue callipers. We calculated the significance of differences in 2D:4D between males and females separately for the right and left hands. RESULTS: In both hands mean 2D:4D values were lower in males than in females. The difference in the right hand reached the statistical significance level with p < 0.05. CONCLUSIONS: Among the subjects from the examined population the 2D:4D ratio shows trends characteristic for sexual dimorphism.

Impact of kidney donor hemostasis on risk of complications after transplantation--preliminary outcomes.

BACKGROUND: This study analyzes the influence the of kidney donor hemostasis on the risk of complications in the kidney recipient after transplantation. MATERIAL AND METHODS: We enrolled 38 deceased kidney donors, of whom 14 donors died from a physical injury and the others died from ischemic or bleeding central nervous system stroke. The donors were categorized into 2 subgroups. If the recipient's postoperative period proceeded smoothly, the kidney donor was assigned to the uncomplicated donors (UD) group. If the recipient's postoperative period was complicated, the donor was assigned to the complicated (CD) Group. The CD group of consisted of 9 donors who died from strokes or bleedings and 2 who died from physical injury. We examined the antithrombin (AT) protein C (PC), complexes of thrombin/antithrombin (TAT), fragments F1+2 of prothrombin (F1+2), plasminogen (Pl), complexes of plasmin/antiplasmin (PAP), and D-dimers (D-d). RESULTS: In the CD group had decreased activity of AT, PC, and Pl and increased activity of F1+2, TAT, and D-d. The UD group had a higher level of PAP. The CD group had evidence of intensive blood coagulation, but the UD group had evidence of fibrinolysis. Fisher's exact test revealed an increased risk in recipients who received a kidney from the CD group. CONCLUSIONS: The hemostasis of the kidney donors had a correlation with the occurrence of some complications in the kidney recipients, especially complications connected with activation of blood coagulation. It seems that the activation of fibrinolysis could be positive prognostic factor, but this requires further investigations.

Rhinitis as a cause of respiratory disorders during pregnancy.

Rhinitis is a common disease of women during pregnancy. It can start in almost any gestational week and disappears after delivery. The main symptoms are sneezing, nasal congestion or running nose. The diagnosis is usually based on history, physical examination, blood tests, and exclusion of the other more common types of rhinitis. The etiology remains to be clarified. The rhinitis may be caused by numerous substances and hormones secreted during pregnancy (PGH, VIP, estrogen, progesterone). They lead to changes in the nasal mucosa in the form of increased activity of serous-mucous glands and increase of their vasculature. The best treatment is using saline irrigations, exercise, and mechanical alar dilators. The nasal decongestants provide only temporary relief. The aim of this study was to evaluate the prevalence of pregnancy rhinitis. The study was conducted on 117 pregnant women in the province of the West Pomerania in 2009-2010. The information was obtained from interviews, questionnaires, and data contained in pregnancy records. About 39% of pregnant women suffered from pregnancy rhinitis. Most such ailments were found during 13th and 21st week of gestation. Doctors should pay more attention to symptoms which result from pregnancy rhinitis, which are reported by their patients. The quality of prenatal care understood as an education of pregnant women as far as pregnancy rhinitis is concerned, is much insufficient. Pregnancy rhinitis significantly affects quality of life of pregnant women and, as a result, it may affect fetal development.

Effect of preservation solutions UW and EC on the expression of matrix metalloproteinase II and tissue inhibitor of metalloproteinase II genes in rat kidney.

Matrix metalloproteinases and tissue inhibitor of metalloproteinases play an important role in the regulation of mesangial cell proliferation and may be involved in ischemia-reperfusion injuries. Preservation solutions are thought to diminish the ischemic injury and appropriate choice of the solution should guarantee a better graft function and good prognosis for graft survival. The aim of the study was to examine the effect of preservation solutions UW and EC on the expression of matrix metalloproteinase II and tissue inhibitor of metalloproteinase II genes in rat kidney. The study was carried out on Wistar rat kidneys divided into 3 groups: kidneys perfused with 0.9% NaCl (control group), with UW, and with EC preservation solution. The results show an enhancement of MMP-2 and TIMP-2 gene expression after 12 min of cold ischemia. This increase was more expressed in kidneys preserved with UW solution in comparison with kidneys perfused with EC solution and 0.9% NaCl. After 24 h of cold ischemia the expression of MMP-2 and TIMP-2 genes in kidney perfused with UW solution decreased, while in kidneys perfused with EC it was increased. After warm ischemia the MMP-2 and TIMP-2 gene expression increased, whereas it was significantly lower in kidneys perfused with EC solution.

[Founding of the Polish Society of Cardiothoracic Surgeons: continuation of the history of the West Pomeranian section of the Polish Association of Surgeons]. / Powstanie Polskiego towarzystwa kardio-torakochirurgów-- kontynuacja historii zachodniopomorskiego oddzialu towarzystwa chirurgów polskich.

On occasion of the 120th anniversary of the founding of the Polish Association of Surgeons, we present the scientific and educative activities of the West Pomeranian Section of the Association during its 60 years of existence. The aim of this work is to present the profile of Prof. Tomasz Grodzki, one of the founders of the Polish Society of Cardiothoracic Surgeons and head of the Department of Thoracic Surgery at the hospital in Szczecin-Zdunowo. Attention is devoted to his educative and scientific contributions and to the role played by Prof. Grodzki in the development of thoracic surgery in the province of West Pomerania. In cooperation with the Department of Cardiosurgery, Second Clinical Hospital in Szczecin, Professor Grodzki, as head of the Thoracic Surgery Ward at the hospital in Szczecin-Zdunowo, organized the First Founding Congress of the Polish Society of Cardiothoracic Surgeons in April 26-28, 2002.

[Management of small bowel obstruction caused by a gallstone]. / Wysoka niedroznosc przewodu pokarmowego spowodowana kamieniem zólciowym--doswiadczenia wlasne.

Bowel obstruction caused by a gallstone is a rare pathology in the abdomen. The high mortality associated with this condition has prompted the authors to present their experience over the past two years against the background of published case reports. This paper presents three different ways of management of gallstone ileus: enterolithotomy; two-stage surgery--enterolithotomy followed by cholecystectomy; one-stage surgery--enterolithotomy combined with cholecystectomy and fistula repair. The authors report on a case which was successfully managed with enterolithotomy only and discuss arguments in favor of each procedure. Enterolithotomy appears to be the safest approach in gallstone ileus, leaving time to qualify the patient for further surgery on the basis of clinical status and symptoms.

[57th Congress of the Polish Association of Surgeons in September 6-9, 1995. A contribution to the history of the West Pomeranian Branch of the Polish Association of Surgeons]. / 57. Zjazd Towarzystwa Chirurgów Polskich--6-9 wrzesnia 1995 roku-- przyczynek do historii Zachodniopomorskiego Oddzialu Towarzystwa Chirurgów Polskich.

The scientific and educational activity of the West Pomeranian Branch of the Polish Association of Surgeons during its 60 years of existence is presented on occasion of the 120 anniversary of the Polish Association of Surgeons. We present the profile of Professor Seweryn Wiechowski, the first head of the Department of Cardiosurgery in Szczecin, as well as his educational and research contributions and role he played in the development of general surgery and cardiosurgery in West Pomeranian. Professor Seweryn Wiechowski, acting as president of the Polish Association of Surgeons in 1993-1995 organized the 57th Congress of the Polish Association of Surgeons in September 6-9, 1995 held for the first time in Szczecin.

Association of the rs10918594 of nitric oxide synthase 1 adaptor protein (NOS1AP) polymorphisms with the graft function after kidney transplantation.

BACKGROUND: The purpose of this study was to investigate the relationship of nitric oxide synthase 1 adaptor protein (NOS1AP) polymorphism with serum creatinine level and occurrence of delayed graft function (DGF) in kidney transplant recipients. MATERIAL/METHODS: This prospective observational study included 75 kidney transplantations. The data from 40 kidney donors (8 females, 32 males) included sex, age, and cause of death. Donors fully met multi-organ transplantation criteria. Recipient data included sex, age, cause of renal insufficiency, and time and number of hemodialyses prior to transplantation. Applying polymerase chain reaction restriction fragments length polymorphism method, we investigated rs10918594 NOS1AP polymorphism among the 75 kidney recipients. The function of every transplanted kidney was correlated with this polymorphism. We defined DGF as requirement for at least 1 hemodialysis after kidney transplantation. We investigated the association of NOS1AP polymorphism with the recipient serum creatinine levels at day 1 and 180 days after kidney transplantation and the occurrence of DGF. RESULTS: The analysis of variance showed higher serum creatinine levels in kidney recipients with GG genotype compared with the CC_CG genotype at day 1 and at day 180 post-transplantation. Occurrence of DGF in the post-operative period in kidney recipients with the variant genotypes CG compared with the GG_CC genotype was higher, although these differences were no statistically significant. CONCLUSIONS: Our data suggests no statistically significant association of the rs10918594 polymorphism of nitric oxide synthase 1 adaptor protein (NOS1AP) with the graft function after kidney transplantation.

The effect of preservation solutions UW and EC on the expression of renin I, angiotensinogen and angiotensin I-converting enzyme genes in rat kidney.

BACKGROUND: Ischemia/reperfusion injury in organ transplantation is a multifactor process that may lead to delayed graft function (DGF), and has a significant impact on short- and long-term graft survival. The activation of the renin-angiotensin system may be important in the pathophysiology of DGF. Preservation solutions are thought to diminish the ischemic injury, and appropriate choice of the solution should contribute to improved graft function and better prognosis for graft survival. The aim of this study was to examine the effect of preservation solutions UW and EC on the expression of renin I, angiotensinogen and angiotensin I-converting enzyme genes in rat kidney. MATERIAL/METHODS: The study was carried out on Wistar rat kidneys divided into 3 groups: kidneys perfused with 0.9% NaCl (control group), with UW preservation solution, and with EC preservation solution. We investigated the expressions of renin I, angiotensinogen- and angiotensin I-converting enzyme genes in kidneys perfused with EC and UW solutions after 12 min (minutes) and 24 h (hours) of cold ischemia and 30 min of warm ischemia. RESULTS: The perfusion with UW and EC solution caused an increase of renin I, angiotensinogen and angiotensin I-converting enzyme genes expression in kidneys. This increase was enhanced in kidneys perfused with UW solution in comparison with kidneys perfused with EC solution. The 24 h preservation with UW solution resulted in a decrease of renin-angiotensin activity increased in cold ischemia. CONCLUSIONS: UW preservation of 24 h decreased renin-angiotensin system activity activated in cold ischemia but not in warm ischemia.

[Diagnostic difficulties in gastrocolic fistulas as a complication of surgical management of peptic ulcer: case report]. / Trudnosci w ustaleniu rozpoznania przetoki zoladkowo-okrezniczej powstalej w nastepstwie chirurgicznego leczenia choroby wrzodowej--opis przypadku.

A gastrointestinal fistula is a late complication of peptic ulcer disease and forms when gastric resection is inadequate or vagotomy is incomplete or not performed. Such cases are extremely rare and are occasionally reported in the literature. We present a patient with a gastrocolic fistula which developed 7 years after partial gastrectomy due to pyloric stenosis as a sequella of peptic ulcer. Nonspecific clinical symptoms and ambiguous radiographic findings delayed the diagnosis of gastrocolic fistula. The patient was operated; "en bloc" resection of the fistula with partial resection of the transverse colon and stomach supplemented with truncal vagotomy was done. The possible cause of recurrence of peptic ulcer in this patient was that vagotomy was not done during the first surgical intervention. Thus, the gastrocolic fistula became a late complication of the recurrence of peptic ulcer. Diagnostic difficulties in gastrocolic fistulas are presented and surgical management of this complication is discussed.