[Should we operate goiter in the elderly?]. / Czy operowac wole u chorych w wieku podeszlym?

The aim of this study was to compare the elderly patients group to the group of others undergoing surgical treatment due to goitre regarding type of goitre, extent of surgical procedures and postoperative follow-up (including early postoperative complications). 5872 patients with various type of goitre (between 1984 and 1998) were surgically treated, among them were 5244 (89.3%) females and 628 (10.7%) males (sex ratio as 8.1:1). The mean age was 46.1 (10 to 95 years). 278 (4.7%) patients were above 70 years of age (235-84.5% females and 43-15.5% males), their mean age was 73.7 years. The increase of malignant goitre was evident among the elderly patients (19.9% vs 5.5%). The dominant types were anaplastic cancers and malignant non-Hodgkin lymphomas. Much more frequently a giant goitre was diagnosed (20% vs 6.1%). It was localised substernally (39.6%) or intrathoracic (4.7%). The elderly prepared properly underwent surgical treatment quite well. Among early postoperative complications in the elderly dominant were surgical ones (6.8%), most frequently the injuries of the recurrent laryngeal nerve (4.67% vs 1.14%). Perioperative mortality regarded mostly the elderly with disseminated anaplastic cancer (3.6% vs. 0.2%). Surgical treatment of goitre in the elderly is a safe and justified method. High incidence of malignant tumours especially anaplastic cancers among the elderly should encourage to operation as early as possible.

[Acute appendicitis in Crakow population]. / Ostre zapalenie wyrostka robaczkowego w populacji Krakowa.

UNLABELLED: In spite of decreasing morbidity, acute appendicitis (AA) is still found the most frequent cause of so called acute abdomen. This study presents the retrospective estimation of 1515 patients treated surgically in ten years period, admitted to hospital with the initial diagnosis of AA. In 1339 patients the initial diagnosis was confirmed during surgery. This group was divided into three subgroups: 1. Without perforation, 2. With perforation or abscess presence, 3. With diffuse peritonitis. In our study 60% of patients were male, however in the group aged over 70 we found the majority were females. The mean age was 16.7 years and in half of the cases patients were under 20. The incidence for Cracow population was 61.6 new cases in group of 100,000 inhabitants per one year (74.7 for males and 49.7 for females). The risk of appendix perforation or diffuse peritonitis was higher in extreme age groups. Mortality rate we found as 0.9%, but the risk of death was significantly higher in patients with advanced AA, or in the group over 70. Percentage of missed diagnoses was found as 11.6, and there was an advantage of female (female 19.2%, male 5.7%). Wound infection was dominant with the frequency rising along with the progression of AA. CONCLUSIONS: 1. The morbidity of AA in Cracow population in years 1989-1998, was 61.6/100,000/year on average and showed decreasing trend. 2. General mortality in AA remains at a stable and does not exceed 1%. It is most frequent in patients over 70 irrespectively of the form of AA.

The assumption of the supportive function by the fibula as a consequence of acquired untreated tibial pseudarthrosis.

The authors present a case of acquired, untreated pseudarthrosis of the tibia which resulted in adaptation to the weight-bearing function by the fibula. The case described shows the adaptation abilities of the bone tissue which, when subjected to unusual loading, undergoes the necessary reconstruction.

[Treatment approach for substernal and intrathoracic goiter. Personal experience]. / Taktyka postepowania w wolu zamostkowym i sródpiersiowym. Doswiadczenia wlasne.

The retrospective analysis of 489 cases of substernal and intrathoracic goiters among 4122 patients undergoing surgical treatment between 1984 and 1996 due to various thyroid gland diseases including clinical data, surgical technics and early postoperative complications was performed. The surgical procedures of substernal and intrathoracic goiter amounted to 11.9% of all thyroid gland surgery. In 468 (95.5%) patients goiter was situated substernally, in 22 (4.5%) intrathoracicaly. The mean age and time of goiter growth in that location exceeded over 10 years the location of goiter within the neck. In preoperative examination the X-ray of chest and trachea were essential. Routine ultrasonography and thyroid gland scyntigraphy were scarcely helpful as the retrosternal and mediastinal region were often omitted. The jugular access was dominant (98.6%), sternotomy was performed in 1.4% of cases due to big disproportion between size of the goiter and size of the upper inlet into the chest. The surgical complications, similarly as in goiter within the neck (no cases of pneumothorax were observed), included the single-side paresis of recurrent laryngeal nerve in 3.7% of patients, in 0.2% hypoparathyroidism, in 1% bleeding requiring reoperation and in 0.2% esophageal fistula (self-healed). The surgical treatment of retrosternal and intramediastineal goiter was safe and a total number of complications was comparable to that one in a group of patients under-going surgery due to goiter within the neck. Most of surgical procedures was possible to perform using the jugular access. In a small number of cases because of difficulties related to the anatomical conditions the access was reached through the oblong sternotomy.

[Two cases of rare abdominal hernias]. / Dwa przypadki rzadkich przepuklin brzusznych.

Two cases of rare abdominal hernias were presented: sciatic and obturator. Both presented cases confirm diagnostic difficulties, often leading to delay in therapy. The best way to reduce mortality in these patients seems to be the increase of number of preoperative diagnoses. In obturator hernia's diagnosis the attention is payed to Romberg's symptom, although in sciatic--to symptoms of sciatic nerve irritation or anuria. All diagnostic doubts should be solved with the help of herniography or pelvic CT.

[Postoperative wound infections. I. Population data and risk factors]. / Zakazenia ran pooperacyjnych. Czesc I. Dane ogólne i czynniki ryzyka.

UNLABELLED: Postoperative wound infection is one of the most essential problems in surgical department related to surgery. The occurrence of infection depends on different factors related to both, the patient and his disease, and treatment organisation as well. The aim of this study was to establish the postoperative wound infection rate and to assess the correlations between age, sex, wound contamination, time and mode of operation, type of anaesthesia, duration of preoperative hospitalisation, wound drainage and the season of the year and development of postoperative wound infections. Patients undergoing surgery in the 3rd Surgical Department of the Collegium Medicum of the Jagiellonian University during one year were prospectively investigated. From the study population, 66 patients with, wounds of the head and 7 patients who died within three days after surgery without wound infection signs were excluded. The healing of each wound was observed during the patient's hospitalisation and 30 days after discharge from hospital, and in orthopedic patients 6 months after discharge. The total number of 132 infected wounds was identified. The population of 1352 wounds healed without any complications was a control group. All the data were recorded in a Wound Infection Register Card and were collected in the computer database. The data were statistically analysed. Relations between single factor and postoperative wound infection were evaluated using chi2 statistics and in the small number Fisher's exact probability test. Analysis of variance for continuous variables was used. Odds ratios and corresponding 95% confidence intervals were computed for all variables. The overall wound infection rate was 8.9%. The mean hospitalisation time was 18 days and was doubled in the group with wound infection (p < 0.001). The mean age of the whole population was 48.1.77 (5.2%) patients died after surgery. The relationship between sex, duration and mode of operation, duration of preoperative stay in hospital, wound contamination, kind of wound drainage and postoperative wound infection rate was significant. CONCLUSIONS: 1. The time of hospitalisation was twice longer in the infected group of patients with infected wounds in comparison to the control group. 2. Male sex, longer preoperative stay in hospital, duration of operation longer than one hour, emergency mode of operation, contaminated and dirty infected operation in traditional wound classification system and open (passive) drainage were statistically significant factors which influenced occurrence of postoperative wound infection.

[Postoperative wound infections. II. Risk factors related to surgery]. / Zakazenia ran pooperacyjnych. Czesc II. Czynniki ryzyka zwiazane z operacja.

UNLABELLED: Postoperative wound infection is the most frequent complication of surgical treatment. The occurrence of infection depends on many factors, but the most important is bacterial contamination of wound according to the site of operation. The aim of this study was to establish wound infection rate and to determine the relationship between site of operation, wound contamination and the other surgery related factors and postoperative wound infection risk. The material was 1527 surgically treated patients in the 3rd Surgical Department of the Collegium Medicum of the Jagiellonian University during one year. From the study population were excluded 66 patients with wounds of the head and 7 patients who died within three days after surgery without wound infection signs. The healing of each wound was observed during the patient's hospitalisation and 30 days after discharge from hospital, and in orthopedic patients 6 months after discharge. The total number of 132 infected wounds was identified. The population of 1352 wounds healed without any complications was a control group. Data were recorded in a Wound Infection Register Card and were collected in the computer database. The data were statistically analysed. Relations between single factor and postoperative wound infection were evaluated using chi2 statistics and in the small group Fisher's exact probability test. Odds ratios and corresponding 95% confidence intervals were computed for all variables. The overall wound infection rate was 8.9%. The significant factors (p < 0.05) were gastrointestinal operation, reoperation, intraoperative X-ray examination, haematoma of the wound after operation, skeletal traction prior to surgery and implantation of prosthetic material in clean wounds. CONCLUSIONS: 1. Wound contamination, site of operation (GI tract), open drainage, reoperation, intraoperative X-ray examination and postoperative haematoma of the wound are statistically significant risk factors which influence postoperative wound infection rate. 2. Postoperative haematoma of wound is the most important local risk factor of wound infection after surgery.

[Postoperative wound infections. IV. Flora and clinical course of postoperative wound infection]. / Zakazenia ran pooperacyjnych. Czesc IV. Flora oraz przebieg kliniczny zakazenia rany pooperacyjnej.

Each wound infection may be coursed in few clinical manifestations and may concern either skin with subcutaneous tissue (superficial infection) or deeper layers-fascias, muscles (deep infection). The aim of this study was to evaluate the form of infection and its clinical course, and moreover, to find the specific flora of infected wounds. The material was 1527 surgically treated patients in the 3rd Surgical Department of the Collegium Medicum of the Jagiellonian University during one year. 66 patients with wounds of the head and 7 patients who died within first three days after surgery without wound infection signs were excluded from the study population. The healing of each wound was observed during the patient's hospitalisation and 30 days after discharge from hospital, and in orthopedic patients 6 months after discharge. The total number of 132 infected wounds was identified. The population of 1352 wounds healed without any complications was a control group. All the data were recorded in a Wound Infection Register Card and were collected in the computer database. The data were statistically analysed. Relationships between single factors and postoperative wound infection were evaluated using chi-square statistics and in the small number Fisher's exact probability test. Analysis of variance was used for continuous variables. Odds ratios and corresponding 95% confidence intervals were computed for all variables. Postoperative wound infection was found in 132 (8.9%) cases, including 76 (57.6%) in males and 56 (42.4%) in females. The average age was 50.9 years. The period of hospitalisation ranged from 3 to 119 days, with the mean of 31.9 days in comparison to 16.3 days in the control group.

[Postoperative wound infections. III. Patient related risk factors]. / Zakazenia ran pooperacyjnych. Czesc III. Czynniki ryzyka zwiazane z chorym.

UNLABELLED: A nosocomial infection is determined by plenty of factors, such as a kind of flora and its virulence, hygiene standard, efficacy of material and instruments sterilisation, technical terms of work organisation in hospital, and other staff and patient related factors. The aim of this study was to establish the risk factors of postoperative wound infection related to patient. The material was 1527 surgically treated patients in the 3rd Surgical Department of the Collegium Medicum of the Jagiellonian University during one year. 66 patients with wounds of the head and 7 patients who died within three days after surgery without any wound infection signs were excluded from the study population. The healing of each wound was observed during the patient's hospitalisation and 30 days after his discharge from hospital, and in orthopedic patients 6 months after discharge. The total number of 132 infected wounds was identified. The population of 1352 wounds healed without any complications was a control group. All the data were recorded in a Wound Infection Register Card and were collected in the computer database. The data were statistically analysed. Relationships between single factor and postoperative wound infection were evaluated using chi-square statistics and in the small group Fisher's exact probability test. Odds ratios and corresponding 95% confidence intervals were computed for all variables. The overall wound infection rate was 8.9%. The significant factors (p < 0.05) were radiotherapy prior to operation, malnutrition, renal failure, respirator treatment, colostomy, tracheostomy in contaminated wounds and neoplastic disease in dirty wounds. Antibiotic therapy and the presence of remote active infection at the time of operation were found also risk factors. CONCLUSION: Statistically significant risk factors of the postoperative wound infection related to patient's condition appeared malnutrition, radiotherapy prior to surgery, renal failure, artificial ventilation, presence of colostomy and coexisting another nosocomial infection at the operation.

[Wound dehiscence as a problem of the surgery department]. / Wytrzewienie jako problem oddzialu chirurgicznego.

UNLABELLED: Eventration is still the great surgical problem. Although it is not very often, but may course serious complication leading to death. The aim of this study is the retrospective analysis of patients undergone surgery in the III Department of Surgery in 1982-1995 (14 years). During this period eventration was observed with 61 patients, constituting 1% of laparotomies performed in this period. Among the re-operated on, there were 40 males and 21 females. In 6 cases this complication occurred twice and in 1 case - three times. The age of patients ranged from 29 to 95, the average being 61.5. The usual time spent in the Hospital was 35.9 days. There were 51 patients (83.6%) admitted and operated in the surgical casualty. Among those there were cases of diffuse peritonitis, bowel obstruction, gastro-intestinal hemorrhage etc. In 40% of patients the eventration occurred in 5 days after surgery (the average time was 6.5 days). Eventration was not found after 2 weeks following the operation. Wound infection, the most common cause of dehiscence, was observed in 29 cases (47.5%). During the reoperation, in 10 patients we diagnosed bowel obstructions, in 6 - jejunal fistula and in other 6 - abdominal abscess. 24 (39.3%) patients died in the period following the operation because of septicemia, cardiovascular and respiratory deficiency. In 1/3 cases there were pulmonary complications. Authors draw attention to the prevention of wound dehiscence as well as to the additional suturing procedure which has been successfully used in their Department. CONCLUSION: Wound dehiscence is the surgical complication with the high risk of death.

[Treatment of goiter in adolescents in surgical practice--personal observations]. / Leczenie wola u mlodocianych w praktyce chirurgicznej--spostrzezenia wlasne.

Fifty one patients 12-19 years old were operated on because of different thyroid diseases (1.7% of total amount 3029 patients after surgical treatment). There was no post-operative complication (except of 2 cases of temporary vocal cord paresis). Late results of surgical treatment in adolescents were not significantly different then in other groups. Presence of the symptoms of clinical or subclinical hypothyreosis or rarely recurrence of thyrotoxicosis in patients with toxic nodular goitre after surgical treatment, however, makes the treatment worst, particularly important in this age group. Suppression therapy of thyroid hormones was administrated in all patients with simple nodular goitre and with thyroid cancer. All patients were followed up in our outpatient clinic. During the follow-up from 6 months to 10 years no recurrence of goitre or thyroid cancer was observed.

[Mortality in acute appendicitis. (Risk yesterday and today)]. / Smiertelnosc w ostrym zapaleniu wyrostka robaczkowego. (Ryzyko wczoraj i dzis).

An analysis is presented of deaths of patients operated on in the III Department of Surgery, Medical Academy in Cracow, for acute appendicitis (AA). In the years 1980-1988 962 patients were operated on with preliminary diagnosis of AA which was confirmed intraoperatively in 749 cases. In the group of patients with AA confirmed intraoperatively 14 patients died (1.9%). The most frequent postoperative complications and, at the same time, the most important cause of death were purulent complications. In the paper a detailed analysis is presented of all cases of AA leading to death. It is stressed that advanced age and extensiveness of inflammatory changes are significant factors of high risk of death.

[Surgical treatment of goiter in older people]. / Chirurgiczne leczenie wola u ludzi starszych.

Experiences are reported connected with surgical treatment of goitre in 84 patients aged over 65 years. Deaths occurred exclusively in patients with thyroid malignant tumours, and the most frequent postoperative complication was paresis of the recurrent laryngeal nerve. Owing to adequate preparation of patients for operation and correct postoperative management the old age of the patient, is not increasing significantly the surgical risk.