[Pelvic fractures coexistent with multiple trauma--own diagnostic and therapeutic algorithm]. / Zlamania miednicy skojarzone z mnogimi obrazeniami ciala--wlasny algorytm diagnostyczno leczniczy.

Pelvic fractures determine one from greatest diagnostic and therapeutic problems in complex of multiple injures. Pelvic fractures observes one-self at 20-30% patients with multiple injures of the body. These injuries are attended for prognostic factor of severity status in this to group of patients. Using at presence diagnostic and therapeutic methods appear continually insufficient. Testifies about this high mortality in these patients. Aim of study was presentation of own manner of diagnostic and therapeutic treatment at patients with pelvic fractures coexisting with multiple injuries, and confirmation of legitimacy early reposition of pelvic fracture and external stabilisation. Investigated group of patients embraced 201 ill with multiple injuries of the body attended in years 1999-2003. Pelvic fractures were recognised at 42 (20.9%) patients. Severity of injury according to Injury Severity Score carried out 54 points. Immediate closed reposition under X-ray inspection and anterior external stabilisation executed at 12 (28.5%) most heavy patients. In this group 5 (41.6%) of the patients survived. Diagnostics and treatment one passed according to settled by authors of algorithms in which one important criterium of conduct was state stability of the circulatory system. One turned also attention on necessity wider usages of angiographic investigations of pelvic blood vessels and their immobilisation. One acknowledged that conduct according to worked out algorithms arranges and makes easy process of diagnosis and treatments. One confirmed advantages early closed reposition of pelvic fractures and their external stabilisation at unstable patients, as intervention saving life.

[Complications of left colonic diverticula]. / Powiklania uchylków lewej polowy okreznicy.

Diverticula constitute the most common anatomical abnormality of the colon. They are usually located on the left side of the colon, especially within the sigmoid colon. Most of them remain asymptomatic and only 10-25% of the patients can develop complications--inflammatory ones or bleeding. Both types of complications have similar morbidity, but patients who suffer from bleeding are on the average 10 years older as compared to group of patients who develop inflammatory complications. Vast majority of patients suffering from bleeding can be treated conservatively with overall mortality 2.8%. Mortality in the group of patients requiring an emergency/immediate operation for perforation of the diverticulum reached 18.2%. None of the patients suffering from diverticulitis without peritoneal signs on physical examination died--all of them were successfully treated conservatively. Therefore most of the complications of the colon can be treated conservatively, and surgical operation remains method of choice only in cases of massive bleeding or perforations.

[Surgical treatment of chronic venous insufficiency in own material]. / Chirurgiczne leczenie przewleklej niewydolnosci zylnej w materiale wlasnym.

Nowadays most issues regarding venous disorders are described as chronic venous insufficiency (CVI)-which is defined as all symptoms that manifestate as impaired blood outflow from the lower limbs or in general the result of blood stasis in the deep and superficial venous system. Due to the fact that the symptomatology of venous diseases is wide, the treatment should be multioriented and often as well multi-specialized. The treatment of CVI needs a good understanding of the etiology of the primary insufficiency of the superficial and the deep venous systems. The main purpose of the surgical therapy is to remove the reflux in the great saphenous vein and the perforating veins. Additionally, during the surgical treatment the various veins should be removed in a way that gives the best cosmetic effect. In this article we presented the analysis of different surgical treatments in patients diagnosed with CVI 2-4 grade according to CEAP scale. The patients were hospitalized in our Clinic between april 1998 and april 2003. This group consisted of 311 patients, among them were 257 patients with primary varices, 25 patients with recurrent varices and 29 with postthrombotic syndrome. The choice of surgery was based on clinical examination and the result of venous USG. The most frequent (62%) surgical therapy was removal of the great saphenous vein with miniphlebectomy. To make the treatment more efficient we used the endoscopic method of obliteration of the insufficient perforating veins in lower limbs, called subfascial endoscopic perforating surgery (SEPS).

[Petit's triangle hernia clinically mimicking gluteal abscess]. / Przepuklina ledzwiowa trójkata Petita pod kliniczna postacia ropnia posladka.

Lumbar hernias are a very uncommon variety of abdominal wall defects. Diagnosis similar as obturatory hernia is often delayed until laparotomy. We describe a case of a 58 year old woman with parietal incarceration of the descending colon within a hernia in the inferior lumbar triangle (Petit's), under clinical form of a giant gluteal abscess.