Ultrastructural aspects of acute pancreatitis induced by 2, 2'-azobis (2-amidinopropane) dihydrochloride (AAPH) in rats.

Pathophysiology of acute pancreatitis (AP) has not been clearly established; nevertheless, accumulating evidence implicates highly reactive oxygen species (ROS) as important mediators of exocrine tissue damage. In this study, we used a water-soluble radical initiator, 2,2 -azobis-(2-amidinopropane) dihydrochloride (AAPH), to investigate the consequences of oxidative stress insult to the rat pancreas. The detailed characterisation of acini ultrastructural changes in the early course (3, 6, 12, 24 h) of AAPH-induced pancreatitis (40 mg/1 kg body weight) was performed. Considerable damage to the mitochondria in acinar cells manifested by increased translucence of the matrix, partial destruction of cristae, and formation of myelin figures were noted. At the same time, focal dilation, degranulation of rough endoplasmic reticulum, and reduced number of zymogen granules was observed. The most prominent ultrastructural feature was accumulation of highly polymorphic cytoplasmic vacuoles in acinar cells. Double membrane-bound autophagosomes, different in size and shape, with sequestered organelles, autophagolysosomes, and large, empty, single-membrane-bound vacuoles were observed within the cytoplasm. The results indicate that intensive and impaired autophagy mediates pathological accumulation of vacuoles in acinar cells. The rat model of acute pancreatitis induced by AAPH is useful to investigate the early events of oxidative stress insult to the pancreas.

[The choice of treatment in multiple pancreatic pseudocysts]. / Wybór sposobu postepowania w mnogich torbielach rzekomych trzustki.

The authors present their own experience in the treatment of 4 patients (3F, IM) with multiple pancreatic pseudocysts. The diagnosis was based on ultrasound and CT. In 4 patients 2, 2, 3, and 3 pseudocysts were found respectively. One patients was cured using two pig-tail catheters within 3-5 days. Two patients had internal drainage. One of them had 3 pseudocysts, two were anastomosed with the stomach (Jurasz operation) and the third one with jejuneum. The other patient had cystocystostomy and so created cyst was then anastomosed with the stomach applying Jurasz's method. In the 3rd patient with 3 pseudocysts pancreatectomy was done. This case was complicated by pancreatic fistula, but finally good result was achieved. In the follow up time (2, 3, 5 years and 5 months) there was no recurrence of the pseudocysts and the patient's condition was good.

[Treatment results for inguinal hernia repair with the mesh-plug method]. / Wyniki leczenia przepuklin pachwinowych metoda mesh-plug.

In the years 1992-1996 367 operations were performed in 350 patients aged 15-88. The type of the hernia was classified according to Gilbert's classification in Rutkow's modification. Type 2 and 3 was the most often (136 and 102 patients respectively). Recurrent hernia after classical operations were treated in 33 patients. Local, epidural or subarachnoid anesthesia was applied in 93% of patients In 75% of patients no analgetics were administered within first 24 hours after operation. In the remaining only traditional analgetics were given. Early complications were noted in 6 patients: wound infections, scrotal oedema, hydrocele. The time of operation was 35 minutes and the time of hospitalization was 2-5 days. Patients returned to their normal activity within 2 weeks. In the follow up period 1-5 years only 2 recurrences of hernia were noted (0.5%).

[Mesh-plug operation for treating inguinal hernia. Randomized studies]. / Operacje mesh-plug w leczeniu przepuklin pachwinowych. Badania randomizowane.

In the period from October 1996 to April 1997 a prospective randomized study of one hundred patients with inguinal hernia was performed. 50 patients underwent the Bassini procedure (group I) and others tension-free mesh-plug repair (Lichtenstein in Rutkow's modification) (group II). The type of hernia was classified according to Gilbert's classification in Rutkow's modification. We used t- Student test and Mann-Whitney's test to evaluate significant differences. There was no significant difference in patients' age, types of hernia or the type of anesthesia between to groups. The time of operation was significantly shorter in group II (median 51.8 min) than in group I (median 63 min). During the post operative period more patients from group I required narcotic analgetics (64% versus 22%). The rate of complications was similar (8% and 6% respectively). Hospital stay was significantly shorter in group II-median 4 days versus 6 days in group I. Rehabilitation to normal activity and return to work was also shorter in group II-median 2 weeks versus 3 weeks (not statistically significant). During the follow up period 1-17 months no recurrences were observed.

[Early and late evaluation of Jurasz's operation]. / Wczesna i odlegla ocena operacji Jurasza.

In the years 1971-1996, 102 patients were treated for pancreatic pseudocysts. In 42 cases pancreatocystogastrostomy modo Jurasz was done. 12 patients operated on in the years 1971-83 were included in group I--retrospective trial, other 30 patients treated in the years 1984-96 were included to group II (prospective trial). Postoperative course was uneventful in 38 patients, remaining 4 (9%) had the following complications: bleeding from gastric mucosa 2x, or from the cysts 1 x, mechanical ileus 1x. Hospital mortality was 7% (3 patients). The cause of the death was: sepsis, pulmonary oedema, cardiac arrest. Pancreatic enzymes monitoring in the postoperative period and controlled USG and endoscopic tests (group II) indicate that emptying of the cysts takes place mainly during first 3-4 days and it's closure is completed within two weeks. The follow up period is 1 month to 13 years (mean 5 years). Recurrence of the cyst was noted only in 1 patient 2%.

[Diagnosis of pancreatic neoplasm--possibilities and limitations]. / Diagnostyka raka trzustki--mozliwosci i ograniczenia.

75 consecutive patients treated for pancreatic cancer were submitted to prospective trial. 1 to 12 weeks passed from the onset of symptoms before diagnosis was established. 61 (81%) patients were admitted due to symptoms and 14 (19%)--due to USG findings. Sensitivity and selectivity of imaging techniques was as follows: USG-87% and 73%, ERCP-72% and 72%, CT-100% and 82% respectively. Staging of the lesions estimated by CT (AJCC/TNM scale) 34 patients qualified as stage I, 15 as stage II, 14 as III and 12 as stage IV. Surgery was undertaken in 71 patients and resective procedures in 32 of them (43%). The final diagnosis was established by one biopsy in 21 patients, and in the further 8 cases 2-3 biopsies were necessary. In 3 cases cancer cells were found only during histological examination of the whole resected specimen. The follow up in resected group was 1-30 months. One year survival was 72%, actuarial survival is 38%.

[Results of treating liver cysts]. / Wyniki leczenia torbieli watroby.

In the years 1974-96, 27 patients aged 31-74 were treated for symptomatic pseudocysts. The duration of symptoms ranged from 3 months to 20 years. Patients were complaining for: pain in the upper abdomen (82%), feeling of fullness (59%), nausea and vomiting (41%), weight loss (23%). Diagnosis was confirmed by USG and CT except of two patients who were diagnosed during emergency surgery because of the cyst rupture. Multiple cysts were present in 4 patients others had single cysts. The treatment comprised: excision of the cyst in 13 patients, excision with partial right lobectomy in 4, fenestration in 5 (laparoscopically in two), marsupialisation of ruptured cyst in one and in remaining 4 puncturing or transcutaneous drainage. Good result of treatment was achieved in all cases. Histologic examination of the cysts revealed: serosal cyst in 18, echinococcal in 2, adenoma originating from bile ducts epithelium in the remaining. The follow up period is 3 months to 21 years. No recurrence of the cyst was noted.

[Repeated laparotomy for acute necrotizing pancreatitis]. / Powtarzana laparostomia w zakazonej martwicy trzustki.

In the period of 1984-1996, 569 patients were treated for acute pancreatitis and 37 of them (6.5%) developed infected pancreatic necrosis (IPN). All these patients were submitted to repeated laparotomies according to Bradley's procedure. The IPN was caused by: bile duct stones--in 11 cases, alcohol abuse-14, ERCP-6, trauma-1, in 6 cases the etiology was cryptogenic. The accuracy of imaging tests was: USG-62%, CT-100%. Sepsis was present in all cases, and multiorgan insufficiency-in 25 patients. Hospital mortality was 30% (11 patients). The most frequent reason of death was multiorgan insufficiency. The actuarial survival was 26 patients (70%).

[Development of renal transplantation in the Gdansk center]. / Rozwój transplantacji nerek w osrodku Gdanskim.

The kidney transplantation is one of the renal replacement therapy methods, which prolongs live of the patients with the end stage renal disease for many years. Moreover, this method is well known, safe and not so expensive as dialysotherapy. Our purpose was to present the 15-year activity of the transplantation center in Gdansk. The first renal transplantation took place on the 31st of March 1980 and there have been 137 renal transplantations in Gdansk until now. We can divide the time between the 31st of March 1980 and the end of 1994 into two periods: I from 31.03.80 to 31.12.89 and II from 1991 to 1994. During the first were 46, and during the second were 91 renal transplantations performed. It means that since the second half of 1991 the activity of the center in Gdansk has increased. The graft function was noted in 29 patients (63%) during the first period and in 75 (82%) during the second. The acute graft failure was observed in the most of the cases mentioned above. The 5-year living of the transplanted patients and the dialysed patients is comparable and amounts to 90%. Infections were the main reason of death during the first period, and cardiovascular complications during the second. The 5-year graft's functioning is 60%. Nowadays the results of the kidney transplantation center in Gdansk are good and comparable with the results of other centers in Poland and Europe. Our center, as similar ones in Poland is prepared to extend the kidney transplantation activity. So it is necessary to intensify an effort to gain more organs for transplantations.

[A case of purulent peritonitis treated by the "in the open" method]. / Przypadek ropnego zapalenia otrzewnej leczony metoda "na otwarto".

A 35-year-old man is described who had diffuse purulent peritonitis resulting from duodenal ulcer perforation. Due to the extent and progression of inflammatory changes the abdominal wall was not sutured and the peritoneal cavity was repeatedly controlled. The patient was operated on as an emergency case in the 49th hour after appearance of clinical symptoms. About 5 1 of pus was found in the peritoneum, with fibrin-caused adhesions between intestinal loops with their segmental occlusion. The hole in the duodenal wall was sutured with single sutures, the abdominal cavity was washed with about 10 1 of. 0.02% hibitane solution. Further controls of the abdominal cavity were done on days 3 and 5 after operation removing a small abscess between intestinal loops on the 3rd day and reducing recent ileus due to gumming up of loops on days 3 and 5. During the last control the Child-Philips procedure was done in anticipation of another ileus. After finding of complete absence of inflammatory peritoneal changes the abdominal wall was closed ith sutures. The patient was discharged on the 30th day with a healed surgical wound. Control examination after 7 months showed a very good general condition and linear scar at the site of duodenal perforation.