Outcome of pleurodesis using different agents in management prolonged air leakage following lung resection.

BACKGROUND AND AIMS: Prolonged air leaks (PAL) are a common problem after pulmonary resection. PAL can be a source of significant complications. One of the treatment options is chemical pleurodesis. MATERIAL AND METHODS: The efficiency of three methods of treatment of PAL after lung resection was evaluated. In Iodine_ group aqueous iodine solution (lat.Tinctura Jodi) was applied intrapleurally (30 patients); in Doxycycline_group (34 patients) 200 mg of Doxycyclin was given and in Drainage_group 35 patients were applied Lidocaine solution only. RESULTS: The group investigated was similar with regard to age [F = 0.04, P = 0.96] and the amount of air leakage (approx. 462 mL/min). The shortest drainage time and hospital stay was observed in the Iodine_group [10.57, P < 0.001]. However, this therapy was connected with strongly perceptible chest pain (P < 0.0001]). The number of case of pneumothorax recurrence was low and it was the same was seen in other methods of treatment [F = 0.87, P = 0.42]. Allergic reactions were not observed. The number of episodes of tachycardia, hypotension, dyspnea, pneumonia, subcutaneus empyema, fluid collection, emphysema, pneumothorax recurrence and number of re-thoracotomies were statistically similar in all three methods of treatment. CONCLUSION: Iodine pleurodesis can be considered as one of possible treatment methods of PAL after lung resection as it showed favorable results compared with Doxycycline pleurodesis or drainage alone regarding duration of air leakage, hospitalization and pneumothorax recurrence with only slightly increased pleural pain.

Oesophageal perforation - therapeutic and diagnostics challenge. Retrospective, single-center case report analysis (2009-2015).

BACKGROUND: Esophageal perforation is a life-threatening condition of a complex etiology. No clear guidelines are available regarding the management of this condition. In this study, we review publications related to esophageal perforation, and analyze patients treated for this condition at our Department of Thoracic, General and Oncological Surgery. OBJECTIVE: The objective of the study was to retrospectively assess and analyze management methods for esophageal perforations of different etiologies. All patients were treated in the Department of Thoracic, General and Oncological Surgery in years 2009-2015. Patients with perforations resulting from post-operational leaks within surgical anastomoses were excluded from the study. Material, methods, results: The analysis involved a total of 16 cases of esophageal ruptures. All cases were treated in years 2009-2015. Patients with perforations resulting from postoperative leaks within surgical anastomoses following elective surgeries for either oncological or non-oncological causes were excluded. The most common reason for esophageal rupture was iatrogenic injury (7 cases, 44%). Other causes included Boerhaave syndrome (5 cases, 31.2%), blunt trauma (2 cases, 12.5%), abscess perforation (1 case, 6.2%), and ulcer perforation (1 case, 6.2%). Ten patients underwent surgery, and the rest underwent esophageal prosthesis placement, of whom 2 cases required drainage of the mediastinum and pleural cavity. The mortality rate in the study group was 9/16 cases (56.2%). CONCLUSIONS: Esophageal perforation poses a significant interdisciplinary challenge regarding diagnostic workup, selection of treatment methods, and management of potential postoperative complications. This retrospective study was conducted in a single center. Although the analyzed period was long, we found only 16 cases. In spite of a variety of etiologies present, we found several statistically significant results of potential clinical value. 1. Most perforations that are not diagnosed within 48 hours affected the lower part of the esophagus and presented with unclear symptoms and imaging findings 2. Delaying diagnosis and treatment beyond 24 hours was associated with a higher mortality rate.

Cervical esophageal rupture after blunt trauma resulting from a car accident.

Traumatic perforation of the cervical esophagus due to blunt trauma is a very rare condition which continues to be associated with significant mortality rates. The symptoms and signs of this injury are often masked by or ascribed to more common blunt thoracic injuries. This paper presents a case of cervical esophageal perforation secondary to blunt trauma resulting from a car accident. The injury was diagnosed early by computed tomography examination, and the patient underwent prompt and successful surgical repair performed to prevent the development of descending mediastinitis.

A very unusual case of attempted suicide.

We would like to present a case report of a very unusual suicide attempt. A 48-year-old female patient tried to commit suicide by stabbing herself with a kitchen knife into her neck. Suicide by self-stabbing is uncommon, constituting only 1-3% of suicide attempts. Patients with self-inflicted stab wounds may have a higher incidence of surgical interventions based on the stab location. Surprisingly, the mortality associated with this kind of wound is low. Most medical centers have very limited experience with this infrequent injury. There are only a few case reports and small series published in the literature of the subject.

Evaluation of Patient Feedback following Laparoscopic Cholecystectomy based on Information Described in the Informed Consent form Developed by the Association of Polish Surgeons.

UNLABELLED: The cholecystectomy procedure is the most routinely performed intervention in general surgery. The current international gold standard is via the laparoscopic approach. It is a safe, minimally-invasive procedure; however, it is associated with complications in 1% of cases. The aim of the study was to analyze patient feedback, by means of a survey, to determine how much knowledge patients possessed about their disease state and proposed surgical intervention, based primarily on information contained within the informed consent form developed by the Association of Polish Surgeons. MATERIAL AND METHODS: This study involved the participation of 51 patients who underwent laparoscopic cholecystectomy, indicated by a diagnosis of gallstones, in the years 2014 and 2015. RESULTS: Despite having signed the informed consent form, there was considerable variation among the responses given to the survey by the 51 patients in this study. Some patients' responses were tangential to the questions asked; many patients did not respond to any of the sub points. CONCLUSIONS: Given that this study is based on a small sample size of patients, it must be presumed that the process by which the patient declares his or her informed consent requires further consideration with respect to the means by which it is obtained. The authors of this study thus recommend that multimedia resources be harnessed as part of the process of obtaining the informed consent of patients prior to surgical intervention.

Comparison of effectiveness of electrocautery and phenol application in partial matricectomy after partial nail extraction in the treatment of ingrown nails.

UNLABELLED: Ingrowing nail also known as onychocryptosis is a common health problem. This disease mostly affects young people, often carrying a considerable amount of socio-economic implications. It's foot problem that usually manifests as inflammation of tissue along the side of a toenail. The aim of the study was to asses and to compare effectiveness of electrocautery and phenol application in partial matrixectomy after partial nail extraction in the treatment of ingrown toenails. MATERIAL AND METHODS: The group of 60 patients with ingrowing toenail which was randomized into two groups underwent partial matrixectomy in surgical outpatient clinic between 2009-2013. This group of patients was under surgical observation for 100 days in outpatient clinic. RESULTS: In all operated patients we obtained surgical success however we had 13 recurrences during the follow up period, 5 in the phenolization group and 8 in the electrocoagulation group. CONCLUSIONS: There was statistically significant difference between these two techniques, which indicated that matrix phenolization is connected with shortened healing time vs the matrix electrocoagulation.

Acute mediastinitis: evaluation of clinical risk factors for death in surgically treated patients.

BACKGROUND: Acute mediastinitis (AM) is the most lethal form of infection within the thorax. The authors of this study, using statistical tools, made an attempt to determine the most important clinical risk factors in retrospective material of patients treated surgically due to AM. METHODS: A total of 44 consecutive patients with AM were subjected to surgery. The aetiology was differentiated: iatrogenic (19), traumatic (11), descending mediastinitis (9) and neoplastic (5). A statistical analysis was performed using chi-square test with Yates correction and analysis of variance test to investigate the correlation between mortality and selected risk factors such as age, gender, aetiology, microbiology, delay between the diagnosis and surgery, coexisting diseases and the kind and number of post-operative complications. RESULTS: The general death rate was 31.82%. Aetiology was associated with mortality: neoplastic (100%), descending (33.3%), iatrogenic (26.3%) and post-traumatic (9.1%). The following types of bacteria were isolated: aerobes (65.9%), anaerobes (25%) and mixed flora (9.1%). The prognosis was not related to age, gender or the kind of the pathogen. The risk of death increased depending on the number of preoperative co-morbidities (P = 0.0446), particularly on the occurrence of a neoplasm (P = 0.0104). Early qualification for surgery (<24 h) resulted in lower death rate (P = 0.085). Manifestation of more than two post-operative complications (P = 0.0007) should be listed as one of the most negative risk factors. CONCLUSIONS: The knowledge of negative prognostic factors can appear to be a crucial tool enabling one to work out a better therapeutic strategy for high-risk patients with AM.

[Thoracic sympathectomy performed by videothoracoscopic technique]. / Zabiegi sympatektomii piersiowej wykonywane metoda wideotorakoskopowa.

UNLABELLED: Thoracic sympathectomy is a method for a segmental elimination of functions of the sympathetic system by the excision of its Th2-Th3 ganglia. The procedure can be performed both using open and videoscopic technique. OBJECTIVE: The purpose of the study was the evaluation of efficacy of videoscopic thoracic sympathectomy. MATERIAL AND METHOD: From 1993 to 2003 we performed 53 videoscopic thoracic sympathectomies in patients with Raynaud's syndrome and upper limb hyperhidrosis. RESULTS: In all patients that underwent thoracic sympathectomy we obtained a positive reaction to a segmental excision of the sympathetic trunk. Patients with Raynaud's showed a significant improvement in symptoms in 76% of cases after a 4-year observation while patients with hyperhidrosis in 100%. The time of hospitalisation was 3.5 days in average. Postoperative complications were observed in two patients (3.7%). Videoscopic thoracic sympathectomy provides good therapeutic and cosmetic results and deserves more common use compared with open technique.

[Analysis of complications after laparoscopic cholecystectomy on the basis of our thirteen-years experience]. / Analiza powiklan cholecystektomii laparoskopowej na podstawie trzynastoletnich doswiadczen wlasnych.

UNLABELLED: The objective of study is to present and discuss complications observed in our patients after laparoscopic cholecystectomy throughout nine years of using this technique. MATERIAL AND METHODS: Between 1992 and 2003, 3146 laparoscopic cholecystectomies were performed in our clinic for symptomatic or complicated cholecystolithiasis. The number of laparoscopic cholecystectomies (LC) increases constantly compared to open cholecystectomies (OC). At the beginning the ratio of LC to OC was 1:20, then 1:1, for a short time, and it is 10:1 presently. Approximately 280 LC and merely 30 OC are carried out in our clinic annually. RESULTS: The most common complications of LC in our material were suppuration of a infraumbilical wound (23) and umbilica hernia (14). A common bile duct injury was observed in nine cases and intraoperative haemorrhage in 11 patients. Infrahepatic abscess (2), bile peritonitis (2), digestive tract injury (1) and abdominal wall haemorrhage (1) appeared rarely. Conversion into an open technique had to be done in 91 cases (2.89%) but only in 34 cases due to intraoperative complications. No deaths connected with LC were observed. CONCLUSIONS: The number of complications after laparoscopic cholecystectomy is not higher than after open cholecystectomy. Laparoscopic cholecystectomy is a save operative technique in the hands of an experienced surgeon.

[The assessment of hepatic portal flow using Doppler's technique in patients after laparoscopic cholecystectomy]. / Ocena watrobowego przeplywu wrotnego metoda Dopplera u chorych po cholecystektomii laparoskopowej.

UNLABELLED: A decrease in hepatic portal flow was observed within two days after open cholecystectomy but such an analysis was not done for laparoscopic cholecystectomy. OBJECTIVE: To answer the following problems: 1. Is there any difference between the volume of hepatic portal flow in patients with cholecystolithiasis and without it. 2. Does hepatic portal flow change within two days after laparoscopic cholecystectomy compared with its preoperative value. MATERIAL AND METHODS: 30 patients without hepatic parenchyma diseases were qualified for the study (21 cases of cholecystolithiasis and 9 cases without cholecystolithiasis). In the group of patients with cholecystolithiasis a maximal portal velocity (Vmax) was measured by Doppler's technique and the diameter of the portal vein (D) before laparoscopic cholecystectomy and 1 and 2 days postoperatively. In the group without cholecystolithiasis these values were measured once. On the basis of Vmax a mean velocity (Vmean = 0.57 x Vmax) of portal flow was calculated. Using Vmean and D values a volume of portal flow was calculated. RESULTS: A mean hepatic portal flow volume in patients with cholecystolithiasis was 725+/-187 ml/min and without it 792+/-229 ml/min. The difference between these values was not statistically significant. No statistically significant differences were also found between values of preoperative and postoperative hepatic portal flow volume. CONCLUSIONS: No statistically significant difference was found between hepatic portal flow volume in patients with and without cholecystolithiasis. Hepatic portal flow does not change significantly within 2 days after laparoscopic cholecystectomy.

[The results of treatment of acute haemorrhagic necrotizing pancreatitis in the own material]. / Wyniki leczenia martwiczo-krwotocznej postaci ostrego zapalenia trzustki w materiale wlasnym.

AIM OF WORK: The retrospective estimation of surgical procedure and the results of treatment of haemorrhagic necrotizing pancreatitis in the own material. MATERIAL AND METHODS: The estimated group consist of 161 patients from the clinic treated for heavy grade of acute pancreatitis. Characteristics which qualified patients to the chosen group were: aggravating general condition, biochemical parameters of disease's progression, results of radiological investigations (USG, CT of abdomen) and bacteriological culture from peritoneal cavity. RESULTS: 142 patients (88.2%) were surgically treated in different duration periods of illness (from 0 to 53 day of illness). Firstly, they were intensively treated with conservative treatment. After about 9.6 days they were operated on (from 0 to 51 day of treatment). Clinical symptoms such as: rapid aggravating general condition of patients, septic shock, as well as infected necrosis in radiological and bacteriological investigations, were indication to surgical intervention. The methods of surgical treatments were: laparotomy and flow drainage 73 patients, closed drainage 31 patients, repeated relaparotomy 25, Bradley's method 13. Mortality in the group of operated patients was 5.9%. The most common causes of death were: respiratory insufficiency 29.4%, multiorgan insufficiency 21.6%, circulatory insufficiency 13.8%, insufficiency of kidneys 9.8% CONCLUSIONS: The authors suggest that the most important in deciding about necessity and time of surgical intervention of haemorrhagic necrotizing acute pancreatitis are individual clinical characteristics of patients. The lowest mortality was in the group of operated patients in later period of illness and who did not required reoperation.