"Primary bacterial culture of bile and pancreatic juice in tumor related jaundice (TROJ) - is ascending cholangitis always our fault?"

INTRODUCTION: TROJ (tumor-related obstructive jaundice) is one of the most common indications for endoscopic retrograde choleopancreatography (ERCP) with endoscopic biliary stenting. Despite the effectiveness of this procedure, especially in palliative patients, it is not without flaws. Ascending bacterial cholangitis, a common stenting complication, occurs in about 0.5-1.7% of cases. The authors' intention was to investigate whether this complication occurs solely due to the procedure or whether it is a result of an underlying bacterial infection in the dilated, obstructed bile and pancreatic ducts. METHODS: Sixteen patients with painless obstructive jaundice related to a tumor located in or in the proximity of the bile duct were enrolled for this study. Prior to endoscopic palliative stenting we harvested bile and pancreatic fluid and the proceeded with the initial procedure. RESULTS: In 14 cases (87.5%) we managed to restore the patency of the bile duct endoscopically. Additionaly, we observed that in 13 cases (81.25%) bacteria were present in the bile and/or pancreatic fluid. The most common pathogen was Streptococcus mitis - present in 7 cases (43.75%). The most effective antibiotics for discovered S. mitis strains were cefuroxime and vancomycin. CONCLUSION: Primal bacterial pathogenes may be present in obstructed bile and pancreatic ducts prior to endoscopic intervention. The connection between Streptocccus mitis and TROJ needs further investigation.

Endoscopic treatment of leaks after laparoscopic sleeve gastrectomy using MEGA esophageal covered stents.

BACKGROUND: Sleeve gastrectomy has become one of the main bariatric procedures over the last few years. This can be explained by the relative simplicity and high effectiveness of this method. Yet, it causes complications as any other method. Staple line leaks are the most frequent ones. According to different sources, this complication may occur with 0-7% frequency. Until 2013, surgery was the only effective treatment method for this complication. However, reoperations considerably increased treatment cost and patient morbidity. The aim of this study is to present the possibilities of endoscopic treatment of leaks after laparoscopic sleeve gastrectomy. METHODS: From 2014 to 2016 14, cases of leaks following sleeve gastrectomy were diagnosed in our Department in Lódz. All of them were treated with MEGA stent in order to cover the leak site. Due to severe peritonitis, 3 patients had to undergo surgery prior to implantation of the prosthesis. Another patient underwent an unsuccessful attempt of leak closing via OTSC method prior to implantation of the prosthesis. Patients were nourished from the 3rd day after the surgery. On average, prostheses were removed on the 34th day after the implantation. RESULTS: The leak was fully sealed in 13 out of 14 cases. In 10 cases the leak was fully healed. There were 2 cases of patients' deaths: the result of a multi-organ failure in one case and early esophageal perforation in the other one. The overall success rate was 90.9%. CONCLUSION: Sealing leaks occurring after sleeve gastrectomy with MEGA stents represent an effective method and should become the technique of choice.

Gastric perforation as a complication after BioEnterics intragastric balloon bariatric treatment in obese patients--synergy of endoscopy and videosurgery.

The BioEnterics intragastric balloon (BIB) is one of the most common bariatric procedures in obese patients in Europe. Associated gastric perforation is a rare, yet very dangerous, complication. We report a case of such a complication after BioEnterics intragastric balloon insertion in a 60-year-old female patient and subsequent cooperation between an endoscopist and bariatric videosurgeon in her treatment.

Assessment of the efficacy and safety of low frequency, low intensity magnetic fields in patients after knee endoprosthesis plasty. Part 1: in vitro safety.

The purpose of this in vitro study was to assess the potential influence of low frequency, low intensity magnetic fields (rectangular pulse, 5 mT, 30 Hz) applied in therapy on the temperature, contact electric potential, and magnetization in knee endoprosthesis, which might be dangerous for implantation and stability of knee prosthesis, and later slacking it off, causing postoperative complications. The experimental investigation was carried out on a knee endoprosthesis which had been placed in a container with physiological saline. The prosthesis located inside the container was under the exposure of the magnetic field applied by a solenoid. The results indicated that magnetic fields did not influence thermal and electromagnetic properties of knee endoprosthesis in vitro. The magnetic fields of examined parameters should not be dangerous for implantation and stability of knee endoprosthesis.

Assessment of the efficacy and safety of low frequency, low intensity magnetic fields in patients after knee endoprosthesis plasty. Part 2: a clinical study.

The purpose of this clinical study was to assess low frequency, low intensity magnetic fields in the enhancement of the physical rehabilitation of patients after knee endoprosthesis surgery. The study included 62 patients who underwent total knee arthroplasty. Group A consisted of 32 patients who were physically rehabilitated. Group B consisted of 30 patients who were physically rehabilitated and treated additionally with pulsing magnetic fields (5 mT, 30 Hz, 20 min once a day, 5 days weekly). Therapy lasted 3 weeks for both groups. The rehabilitation process was evaluated using a goniometer, tensometer, goniometric pendulum test, Lysholm scale for knee function, and a visual analogue scale (VAS) questionnaire for pain and activity. The changes of measured rates were comparable in both groups. Low frequency and low intensity magnetic fields of examined parameters were not demonstrated to effectively improve the rehabilitation of patients after knee endoprosthesis surgery.

[Bile duct infections as a late complication after endoscopic sphincterotomy]. / Zakazenia dróg zólciowych jako pózne powiklanie sfinkterotomii endoskopowej.

UNLABELLED: Nowadays endoscopic sphincterotomy (SE) is considered to be a "gold standard" in the treatment of residual choledocholithiasis and biliary pancreatitis. Nevertheless patients after invasive procedures concerning bile ducts with destruction of Oddi's sphincter often have increased succeptibility to chronic infections of bile ducts. AIM: Assessment of the influence of SE on bacterial colonization, development of main bile duct chronic inflammation and recurrent choledocholithiasis. MATERIAL AND METHODS: We included to the study 50 patients with main bile duct lithiasis, who underwent endoscopic cholangiopancreatography (ERCP). Among them there were 32 women in age from 45 to 87 (mean 69.7 +/- 12.3) and 18 men in age from 39 to 84 (mean 59.8 +/- 11.56). The studied group was divided into 3 subgroups: In I (control) group were included 10 patients diagnosed with ERCP techniques because of jaundice of unknown origin. Those patients did't have ERCP or operative revision of bile ducts before, but all of them underwent cholecystectomy in the past. Each II and III group consisted of 20 patients, who underwent SE before 12-24 and 25-36 months earlier respectively. Sterile uodenoscope was inserted to the region of major duodenal papilla, and then a sterile brush was used to collect material to cytological smear (brushing) from main bile duct. In all groups 2 ml of bile were taken by a catheter to a syringe. On the basis of radiograms from ERCP findings, the width of main bile duct was assessed. In all patients blood cell count, aspartate and alanine aminotransferases, gammaglutamyltranspeptidase, alkaline phosphatase, amylase, bilirubin, C-reactive protein and procalcitonine levels were measured. RESULTS: In our study all 40 patients with previously performed endoscopic sphincterotomy (SE) had bacterial colonization in bile ducts, mostly with Gramm negative pathogens. The most virulent pathogens vere cultured from bile duct swabs from patients after two or more revisions of common bile duct, and after a longer time from sphincterotomy. Those patients had multibacterial bile duct infections (Escherichia coli + Pseudomonas aeruginosa; P. aeruginosa + Enterococcus faecalis; E. faecalis + Enterobacter cloacae + Candida albicans; P. aeruginosa + E. cloacae). E. coil and E. faecalis were most frequently cultured (20 and 16 cases respectively). It was observed that with length of time from endoscopic sphincterotomy, the width of main bile duct and also amount of cultured pathogens and their virulency grow. Elevated transaminases activity and serum procalcitonine levels were observed in studied groups. 9 patients after previous sphincterotomy had recurrent lithiasis. CONCLUSIONS: Sphincterotomy contributes to colonization of main bile duct with pathogenic bacteria. With length of time from endoscopic sphincterotomy, and amount of performed endoscopic sphincterotomies the amount of cultured pathogens, their virulency and drug resistance grow. Chronic infection of bile ducts after endoscopic sphincterotomy causes higher risk of recurrent lithiasis.

[Early results of rehabilitation after repair of the anterior cruciate ligament with open surgical or arthroscopic method]. / Wczesne wyniki usprawniania chorych po rekonstrukcji wiezadla krzyzowego przedniego metoda artroskopowa i otwarta.

The purpose of the study was to evaluate the methods of rehabilitation in patients who had undergone a plastic procedure (open or arthroscopic surgery) of the anterior cruciate ligament (ACL). The value of objective measurement methods used for monitoring the rehabilitation process was also assessed, with particular attention to the usefulness of goniometric pendulum test. All patients underwent rehabilitation in the Department of Motor Organ Rehabilitation at the Upper Silesian Rehabilitation Center in Ustron. For the purpose of the rehabilitation process evaluation, the condition of patients: goniometry and the pendulum test were performed twice, i.e. at admission and then at termination of rehabilitation. A modification of the Lysholm Scale and a subjective knee questionnaire (WAS) were also used. In group of healthy subjects only the pendulum test was done. Based on the obtained results it was found that the convalescence period needed to achieve the best ultimate capability within the knee joint mainly depended on the operative technique. However, appropriate kinesitherapy may affect the rate of convalescence in the group of patients with less favorable surgical outcome. In patients who had undergone a reconstruction of the anterior cruciate ligament, goniometric pendulum test is an effective tool to aid the evaluation of rehabilitation results; the test adds to the assessment done by the well-known subjective methods.

[Early results of rehabilitation after endoprosthetic replacement of the knee joints]. / Wczesne wyniki usprawniania chorych po endoprotezoplastyce stawu kolanowego.

The purpose of this research was evaluation of magnetic field influence of low frequency on the process of rehabilitation of patients after endoprosthesis plasty of knee joints. The research evaluated usefulness of objective and subjective measurement methods to estimate progress of patients rehabilitation after endoprosthesis plasty of knee joints. The object of research were patients after endoprosthesis plasty of knee joints that were accepted for rehabilitation to the Unit of Motion Organs Rehabilitation of the Upper Silesian Rehabilitation Center "Repty" in Ustron. For the purpose of the rehabilitation process evaluation, the condition of patients was goniometry and the pendulum test were performed twice, i.e. at admission and then at termination of rehabilitation. A modification of the Lysholm Scale and a subjective knee questionnaire (VAS) were also used. On the ground of obtained results one can affirm that important role in therapeutic rehabilitation after endoprosthesis plasty of knee joint, plays adequately matched kinesitherapy, however one cannot confirm any influence of alternating magnetic field of selected parameters. Measurement methods both subjective and objective proved to be useful and effective in evaluation of rehabilitation progress in described cases.

[Retrospective analysis of post-endoscopic retrograde cholangiopancreatography mortalities]. / Retrospektywna analiza zgonów po procedurach endoskopowej wstecznej cholangiopankreatografii.

Endoscopic retrograde cholangiopancreatography (ERCP) which belongs to routine investigations of the biliary tract may lead to a possible development of various complications terminating occasionally in death. The authors analyses the causes of death in 6 patients (1.06%) who died following ERCP procedures performed for various reasons. They were solely woman. Deaths were most often caused by acute pancreatitis (in 3 cases), perforation of the duodenum, hemorrhage from the carcinoma of the ampulla of Vater, and acute cholangitis. Emphasis was laid on the significance of accurate and purposeful indications for performing ERCP. It was pointed out that the ERCP equipment intended for being used only once has been utilized many times for economic reasons. It is of the highest importance that the ERCP procedures are carried out in well equipped and specialized centers by adequately trained and highly experienced endoscopists.