Change in mechanical bowel obstruction demographic and etiological patterns during the past century: observations from one health care institution.

OBJECTIVE: To compare epidemiological analysis concerning sex, age, location of blockage, and frequency of occurrence of etiological factors in 2 groups of patients treated for mechanical bowel obstruction 100 years apart. DESIGN: Epidemiological analysis of patients undergoing an operation for small-bowel obstruction (SBO) or large-bowel obstruction (LBO) from 1868 to 1898 (group 1) and from 2000 to 2003 (group 2). SETTING: Second Clinic of Surgery of the Jagiellonian University Medical College. PATIENTS: One hundred ninety-three patients in group 1 and 207 in group 2. MAIN OUTCOME MEASURE: Change in demographic and etiological patterns of mechanical bowel obstruction during the past 100 years. RESULTS: In both groups, the prevalence of bowel obstruction was similar in particular segments of the intestine (approximately 75% for SBO and 25% for LBO). The primary cause of SBO in group 2 remained incarcerated abdominal hernia (30.8% for group 1 compared with 55.0%). The second most common cause of SBO was intraperitoneal adhesions (29.4% compared with 34.4%). Isolated small-bowel volvulus as the cause of bowel obstruction decreased significantly (P ≤ .05) (16.8% compared with 2.7%). Significant changes were also observed in the etiology of LBO. A century ago, the most common cause was volvulus of the sigmoid colon or of the cecum (72.0%); in the later group, obstruction was caused by cancer in 80.4% of cases. CONCLUSIONS: During the past 100 years, no changes were observed concerning the location of bowel obstruction or the patients' sex. Etiological factors in SBO and LBO changed significantly. The age of surgical patients also increased significantly.

A case of bilateral persistent sciatic artery with unilateral aneurysm: an 18-year period of graft patency after excision of aneurysm.

BACKGROUND: A persistent sciatic artery (PSA) is a rare vascular anomaly with an estimated incidence of 0.02-0.04% and with a high rate of complications such as aneurysm formation, thromboembolism, and ischemia, that may lead to amputation. CASE REPORT: We present a case of a female patient with complete symptomatic ambilateral PSA and with unilateral aneurysm. The aneurysm was excised and the PTFE graft was interposed at the aneurismal sac (femoro-popliteal bypass could not be performed because of the high degree hypoplasia of the superficial femoral artery). The graft endured continuous compression and stretching during regular daily life of the patient. At check-up 18 years after the operation, the Doppler ultrasound showed a patent graft and no new aneurismal dilatation of the sciatic artery. CONCLUSIONS: To our knowledge the follow-up of the presented case is the longest reported so far in the literature. The uneventful course of the patient confirms that classical aneurysmectomy still constitutes one of the treatment options of PSA aneurysm.

[Use of the percutaneous drainage in the treatment of patients with hepatic abscesses]. / Zastosowanie drenazu przezskórnego w leczeniu chorych z ropniami watroby.

AIM OF THE STUDY: The aim of this study was to review our results in managing liver abscess with the use of sonographically-guided percutaneous drainage. MATERIAL AND METHODS: There were 24 patients (including 12 male and 12 female patients) with liver abscesses treated from 1993 to 2009 in our department. Mean age in the male group amounted to 52 (17-70), while in the female group - 60 (46-72). The group of 22 patients (91,6%) were treated with the use of percutaneously inserted "pigtail drain". RESULTS: The group of 22 patients (11 male and 11 female patients) was treated with the use of percutaneous sonographically-guided drainage. Eschericha coli constituted the most common etiological factor isolated from the purulent content. An average drainage time amounted to 9,5 days. Percutaneous drainage proved ineffective only in 4 patients (2 male and 2 female). In 2 of those cases failure was due to recurrent obstruction of the catheter and in remaining 2--due to migration of the drain outside the abscess. 2 of those patients were treated successfully with another sonographically-guided drainage, while 2 patients required open surgical operation. CONCLUSIONS: Percutaneous sonographically-guided drainage together with antimicrobial therapy constitutes valuable method of choice in the management of liver abscess. The technique has small morbidity and complication ratio allowing avoidance of more invasive surgical interventions.

Changes in the localization of perforated peptic ulcer and its relation to gender and age of the patients throughout the last 45 years.

BACKGROUND: Throughout recent decades there has been noticeable change in the incidence of peptic ulcer disease and its complications. The aim of the present study was to determine the character of changes over the last 45 years in the localization of perforation, in patient age, and in patient gender. METHODS: A group of 881 patients admitted to the Second Department of General Surgery in Krakow, Poland, from 1962 to 2006 were included in the study and constituted the material for the analysis. The study was divided into three time periods (1962-1976, 1977-1991, and 1992-2006) to allow statistical analysis of trends. RESULTS: The general incidence of perforations of peptic ulcer did not show changes; however, the percentage of women with perforated duodenal ulcer markedly increased. Patients with perforated stomach ulcer--regardless of gender--and females suffering from perforated duodenal ulcer were, on the average, about 10 years older than males with perforated duodenal ulcers. The mean age of male and female patients with perforated duodenal ulcer over the last 45 years showed an insignificant upward trend. CONCLUSIONS: (1) The percentage of women with perforated duodenal ulcer continuously and statistically significantly rose. (2) Men with perforated duodenal ulcer were significantly younger than other patients. (3) The mean ages of male and female patients with perforated duodenal ulcer over the last 45 years showed an insignificant upward trend.

[Serum iron level in the patients with inflammatory abdominal diseases]. / Poziom zelaza w surowicy u chorych z ostrymi chorobami zapalnymi narzadów jamy brzusznej.

In our study we investigated serum iron levels in the patients with localized or generalized peritonitis. These values were compared in group of 52 patients with acute peritonitis against group of 39 patients without inflammation within peritoneal cavity. The serum iron levels and Total Iron Binding Capacity (TIBC) was indicated in both group. Acute intraabdominal inflammation induced in all patients a state of hypoferremia. However, medium decline of iron level in patients with acute appendicitis or cholecystitis was smaller compare with that observed among the patients with generalized peritonitis caused by perforation of duodenal ulcer, perforation of large bowel diverticula or perforation of small bowel. It has been suggested that decline in iron serum level observed in those patients can be an element of metabolic response to trauma and represents a part of the innate immune system and thus constitutes the first line defence against infection. However, based on presently available knowledge we can not yet finally evaluate the clinical implication of serum iron monitoring in diagnosis and prognosis of the patients with peritonitis.

[A rare case of the extensive Fournier's gangrene developed in the course of a perianal abscess]. / Rzadki przypadek rozleglej martwicy Fournier'a w przebiegu ropnia okoloodbytniczego.

Fournier's gangrene is a rare necrotising fascitis of the perineum and genitals caused by mixture of aerobic and anaerobic microorganism. Despite appropriate therapy mortality in this disease is still high. We report a case of Fournier's syndrome which developed in the course of a perianal abscess. Due to the aggressive nature of this condition, early diagnosis is crucial. Treatment involves extensive soft tissue debridement and broad-spectrum antibiotic therapy. The clinical applicability of the so called Fournier's gangrene severity index score (FGSIS) was discussed.

[Clinical implication of ischemic preconditioning in protection of reperfused tissues]. / Przydatnosc kliniczna mechanizmu niedokrwiennej adaptacji, "preconditioning" w ochronie reperfundowanych tkanek.

Ischemic preconditioning (IP), has emerged as a powerful experimental method of ameliorating ischemic-reperfusion injury in a variety of organs. Clinical trials using IP have been successfully carried out. They support the existence of IP induced cyto-protection in humans as well. IP induced "ischemia tolerance" and "reperfusion tolerance" mechanisms are presented. The new, recently discovered modifications of IP "remote preconditioning" and "postconditioning" and their possible clinical applications in the ischemia of human: heart, liver, lung, brain, kidney and skeletal muscles are discussed.

[The impact of periodontal infection on systemic inflammatory process and atherosclerosis]. / Wplyw chorób przyzebia na powstanie ogólnoustrojowej reakcji zapalnej i rozwój miazdzycy.

It is becoming increasingly clear that infections and chronic inflammatory conditions, such as periodontitis can be linked with atherosclerotic process. Periodontitis and atherosclerosis have many pathogenetic mechanisms in common. The objective of this based on current knowledge review is to present the putative mechanisms whereby periodontitis which is chronic and inflammatory in nature and initiated by microbial plaque can influence the atherosclerosis. Two main processes in particular are worthy of consideration and may provide the link between these two diseases. Induction of the chronic systemic inflammation has been proposed to be of pathogenetic relevance in the association of infection and atherosclerosis, and may rely in part on the endothelial toxicity of bacterial endotoxin and the action of proinflammatory cytokines (PGE-2, IL-1beta, TNF-alpha). Another well-founded proatherogenetic property of infectious illness may be the induction of autoimmunity and autoagression. It has been suggested that humoral immune cross-reaction of the same antibodies to heat shock proteins (HSP), both bacterial mHSP65 and human endothelial HSP60 may play an important role in the process of vascular endothelial injury. Both of these mechanisms are believed to be a key event in the pathogenesis of artheriosclerosis.

[Periodontitis and systemic disease relationships]. / Zwiazek miedzy chorobami przyzebia, a rozwojem niektórych schorzen systemowych.

Recently, it has been recognized, that oral infection especially periodontitis may affect the pathomechanism and course of a number of systemic diseases, such as: cardiovascular, cerebrovascular diseases, atheromatous peripheral vascular disease bacterial pneumonia, diabetes mellitus, osteoporosis, or cause adverse pregnancy outcome. This review will focus on the current knowledge linking periodontal infections to a set of above mentioned systemic diseases. While a number of their mutual interactions have been already identified, additional research will be required to determine with certainty, whether these associations are casual or coincidental and to evaluate disease pathogenesis and potential therapeutic interventions.

[Mechanical bowel obstruction. Surgical problem at the turn of the XIX-XX century, and the XX-XXI century. One institutional experience]. / Niedroznosc mechaniczna jelit. Problem chirurgiczny na przelomie XIX-XX wieku oraz XX-XXI wieku. Doswiadczenia jednego osrodka.

Comparative analysis was done between a group of 193 patients operated on for mechanical bowel obstruction at the end of the XIX century (prof. A Obalifinski's clinical material), and a group of 207 patients with the same condition operated on between 1.01.1999 - 31.12.2003 (own clinical material). Both groups were operated on at the same surgical institution. A hundred years ago, and at present mechanical bowel obstruction has been appearing (depending on a patient's sex), in the 1:1 relationship. In both analysed periods two third of the patients developed small bowel obstruction, and one third large bowel obstruction. At the end of the XIX century mean age of the operated patient was 41 years. It was equal to the mean survival time span for the general population at that time. The patients operated on at present were about 25 years older. However their mean age is significantly lower compared with the actual mean survival time span for the general population observed now in Poland. In small bowel the main cause of obstruction has still been an incarcerated abdominal hernia (increase from 30.7% up to 55%), followed by intraperitoneal adhesions (increase from 29.5% up to 34.5%). However their etiology has changed, recently all of them are postoperative adhesions. At the end of the XX century we observed significant drop (from 16.8% to 2.7%) in strangulation of the small bowel mesentery as a cause of obstruction. In case of large bowel during the last century there was a definitive change in frequency of different etiological factors causing obstruction. In the XIX century 72% of them was caused by mesentery strangulation of sigma or cecum. whereas at present over 80% of them is caused by cancer. We presented Prof. A. Obalinski's and his associates scientific output, as they were genuine precursors of mechanical bowel obstruction surgery in Poland.

[Erythrocyte concentrations of adenosine triphosphate (ATP) and magnesium, before and after conservative therapy of lower extremities atherosclerosis]. / Stezenia adenozynotrifosforanu (ATP) i magnezu w krwinkach czerwonych przed i po leczeniu zachowawczym miazdiycowego niedokrwienia konczyn dolnych.

37 patients with atherosclerosis of lower extremities and the mean claudication distance of 300-500 m (Fontaine 11 degrees) were subjected to pharmacotherapy with pentoxyfilline 600 mg twice daily, and walking exercise tests on a treadmill. The concentrations of ATP and magnesium ions in erythrocytes were assessed in the patients in resting condition, and after standardized walking exercise tests, 6 and 12 weeks since the beginning of therapy. Applied treatment proved beneficial in protecting the patients against depletion of ATP in their erythrocytes. Hypomagnesemia and accompanying lowered concentrations of ATP were observed in 1/3 of the cases. As the deficiency of ATP can cause functional changes and structural alterations in the erythrocytes and deterioration of the clinical condition of these patients supplementing magnesium ions in these cases seems justified.

[Chlamydia pneumoniae in patients with atherosclerotic ischemia of the lower limbs]. / Chlamydia pneumoniae u chorych z miazdzycowym niedokrwieniem konczyn dolnych.

In the group of patients (n = 19), with advanced atheromatous ischemia of the legs the presence and titres of rum IgG, IgA, and IgM antibodies for Chlamydia pneumoniae (Cp) were measured. Those were compared with controls (n = 12). Additionally in the patients undergoing surgery (revascularisation or amputation), specimens of atheromatous arteries were examined for the presence of Cp. In the general population among the people at the age over 60 years the presence of antibodies was common (IgG 100%, IgA 92%). In the patients with the atheromatous ischemia of the legs the antibodies to Cp were found only in: IgG 79%, IgA 79% of them. In 21% of patients (n = 4) we were able to confirm the presence of Cp in an artery wall. However we found that three of them had undetectable titres of serum IgG, IgA, IgM. In case of an individual patient seropositivity to Cp seems not to be a good marker of active chlamydial infection.

[Maffucci's syndrome with giant tumor of the thoracic wall]. / Zespól Maffucciego z olbrzymim guzem powlok klatki piersiowej.

Maffucci's syndrome is a rare nonhereditary malformation of mesodremal dysplasia origin which consists of multiple hemangiomas of the soft tissue and multiple enchondromas. Only approximately 170 cases of this disease have been reported in the literature. Maffucci's syndrome is known to be associated with tumors of mesodermal origin. Chondrosarcoma, osteosarcoma and angiosarcoma are the most common malignant neoplasms and the benign tumors consist of pituitary adenoma, adrenal cortical adenoma, parathyroid adenoma, thyroid adenoma and breast fibroadenoma. We present a case report of a 26-year old female patient with Maffucci's syndrome and a giant thorax tumor composed of fibroadenoma and canalicular adenoma.

[Actinomycosis of the large bowel]. / Promienica jelita grubego.

Actinomycosis is an infrequent chronic infectious disease. In most cases the diagnosis is made post-operatively because of its unusual clinic presentation. We report three cases of actinomycosis involving large bowel. Based on current literature we review the diagnosis and therapeutic considerations. These should be helpful to the surgeons confronting the rare disease.