Vitamin D Status in Patients before Thyroidectomy.

Thyroid neoplasms (tumors) are the most common pathology of the endocrine system that requires surgery, and in most cases changes are benign. The surgical treatment of thyroid neoplasms consists in total, subtotal, or one lobe excision. Our study aimed to assess the concentration of vitamin D and its metabolites in patients before thyroidectomy. The study included 167 patients with thyroid pathology. Before the thyroidectomy procedure calcidiol (25-OHD), calcitriol (1,25-(OH)2D), and vitamin D binding protein (VDBP), as well as basic biochemical parameters, were measured using an enzyme-linked immunosorbent assay kit. Data analysis showed that the cohort of patients has a significant 25-OHD deficiency and proper concentration of 1,25-(OH)2D. Before the surgery, more than 80% of patients have extreme vitamin D deficiency (<10 ng/mL), and only 4% of the study group has proper 25-OHD concentration. Patients undergoing thyroidectomy are exposed to many complications, including calcium reduction. Our research has shown that patients prior to surgery have a marked vitamin D deficiency, an indicator that may affect their subsequent convalescence and prognosis. The results suggest that determination of vitamin D levels prior to thyroidectomy may be useful for potential consideration of supplementation when vitamin D deficiency is marked and needs to be incorporated into the good clinical management of these patients.

The effect of unilateral carpal tunnel release on the non-operated contralateral hand.

BACKGROUND: Carpal tunnel syndrome (CTS) is often (60-90%) a bilateral condition. It has been suggested that patients with bilateral disease may benefit in the non-operated hand after unilateral surgery. OBJECTIVES: To investigate the effect of unilateral carpal tunnel release on the non-operated contralateral hand. MATERIAL AND METHODS: In 186 patients with bilateral CTS, a number of measurements were performed prior to surgery. The patients were scheduled for surgery on the other hand operation 3 months after the first. Upon admission, the same measurements were performed on the still unoperated hand. RESULTS: All subjective variables were significantly better in the hand scheduled for operation as compared to the second one. Pain intensity was lower by a mean of 0.8 on a numeric rating scale (NRS); Levine symptom and function scores were lower by a mean of 0.7 and 0.3, respectively. Digital sensibility and grip strength were also better, but the changes were without clinical or statistical significance. Asked directly about the status of the non-operated hand, 109 patients (64%) reported improvement, 40 (23%) noted no change and 21 (13%) deterioration. CONCLUSIONS: Regardless of the reasons for improvement, this study demonstrates that 64% of patients feel partial relief in the non-operated hand after unilateral carpal tunnel release.

The results of the treatment of hand - Outcomes of the treatment of hand degloving injuries with greater omentum flaps.

Degloving injury consists in tearing out the soft-tissue integument from skeleton of the hand, with accompanied nerves and vessels. The whole hand degloving has bad reputation and one of worst prognosis, even worse than total hand amputation. The range of possible salvage procedures in these cases is limited and their outcomes are unsatisfactory. One of the suitable methods is wrapping the skinned hand with pedicled or free greater omentum flap, retrieved from the abdominal cavity. The article reports outcomes of the treatment of 5 patients at a mean of 8 years after total degloving of their hands and coverage with omental flaps. All flaps healed uneventfully, but in none of the patients the whole length of the fingers was preserved. Division of stumps of 3 fingers was possible in one patient, two others had three-digital hands and remaining two had only separated thumb. Dexterity of injured hands was limited with a mean of score DASH questionnaire of 43 points. Quality of life as measured by SF-36 questionnaire was fair (58 and 53 points in physical and mental domain, respectively). Regardless this, all patients were satisfied with achieved outcomes and all returned to work, which was a confirmation of the effectiveness of the method used in their treatment.

Undergraduate microsurgical training: a preliminary experience.

Microsurgical training is organised almost exclusively in a post-graduate setting, usually for residents of various surgical specialities. The aim of this study was to present an undergraduate microsurgical training model directed toward medicine students of clinical years. Curriculum design and results. Two six-participant groups of students interested in training were recruited. The programme consisted of 15 three-hour classes (2 hours' work under the microscope) and divided into basic and advanced training parts. The simulation model used in this course was a chicken thigh. The basic training programme consisted of placing sutures on a latex glove followed by preparation of a chicken thigh neurovascular bundle and performing femoral nerve and artery anastomoses. The advanced part of the training consisted of practising the acquired skills and the introduction of new techniques such as end-to-side arterial anastomosis, artery and nerve repair with vein conduit. A "6-stitches test" was used as an outcome measure of the acquired microsurgical skills. After 15 weeks and 30 hours of training and performing 31 anastomoses the undergraduate microsurgical course was completed. CONCLUSION: The results of this study show that the undergraduate, facultative microsurgical training is effective in acquiring microsurgical skills, competence and confidence for participating students.

Familial occurrence of carpal tunnel syndrome.

The objective of this study was to investigate the incidence of familial carpal tunnel syndrome in patients admitted to the authors' institution for carpal tunnel release. Questionnaires completed by 120 patients: 92 women (77%) and 28 men (23%) at a mean age of 56 years at their baseline clinical examination were reviewed. Familial occurrence of the disease was noted in 21 patients (17%): 16 women and five men. Three family members were affected in three patients, two relatives in eight patients, and one relative in 10 patients, giving a total of 35 affected relatives. The patients' sisters (n = 16) were the most commonly involved, followed by mothers (n = 12), daughters (n = 2), brothers (n = 2), grandmothers (n = 2) and an aunt (n = 1). Bilateral manifestation of the disease was noted in 19 patients (90%) and in 31 (88%) of their affected relatives. The results suggest that carpal tunnel syndrome shows a moderate tendency to familial occurrence and, if so, it usually manifests bilaterally.

Percutaneous K-wires vs palmar locking plate fixation for different types of distal radial fractures: a comparison of the outcomes of two methods to controll our guidelines.

The objective of the study was a comparison of the outcomes of K-wire vs plate fixation for distal radial fractures used according to the proposed institutional algorithm. Fracture configurations A2, A3, B1, B2, C1 and some C2 were operated on with K-wire pinning, whereas B3 and some B2, C3 and some C2 were with locking palmar-plate fixation. PATIENTS AND METHODS: Four hundred and sixty-seven patients were non-randomly allocated for either K-wire (n = 363) or palmarplate (n = 104) fixation. The results were assessed at 3 and 12 months by the same outcome measures. RESULTS: At the 3-month assessment, statistically significant differences in grip strength and the DASH scores were noted in favour of the plate-fixation group. At the 12-month assessment, statistically significant differences were observed in the wrist palmar and dorsal flexion, favouring the plate-fixation group. Statistically significant differences were noted in radiological measures of the palmar tilt and the ulnar variance, both favouring the plate-fixation method. Meaningful secondary dislocations were noted in ten patients, all in the K-wire-fixation group. CONCLUSION: We conclude that palmar locking plate fixation in even more severe fractures leads to better radiological and clinical outcomes than K-wire fixation in less severe fractures.

Successful treatment of paediatric lower limb CRPS by continuous epidural anaesthesia: a report of 2 cases.

CRPS occurs in children less frequently than in adults, but in the last two decades it has become a well-established entity in children and adolescents. The symptomatology, course, responsiveness to treatment and prognosis of the paediatric disease is also different from the "adult" form. The paper presents the successful treatment of two cases of paediatric CRPS involving the lower limb, by continuous epidural anaesthesia with bupivacaine. Both patients developed the condition after minor trauma or overuse. CRPS diagnosis was based on clinical grounds. Both patients presented a history of psychological distress, due to familial problems. In one patient, the initial treatment was lumbar sympathetic block, resulting in immediate and complete recovery. After relapse of the disease at four months, the next intervention included continuous epidural infusion of bupivacaine, with an excellent and rapid response. In the 2nd case, continuous epidural infusion was used primarily with the same, excellent and fast result. The article discusses clinical peculiarities, treatment modalities and other aspects of paediatric CRPS. Poor awareness of the condition in the paediatric community is also emphasized.

Treatment of neglected, severely displaced, open malunion of the distal radius and ulna in an elderly person with Alzheimer's disease - a case report.

The case of a patient suffering from Alzheimer's disease who sustained epiphyseal, severely dislocated fractures of the distal radius and ulna is reported. As the patient was incapacitated and attempts to contact her curator failed, the decision was made on a conservative treatment of the fractures. This treatment eventually failed and resulted in malunion with exposure of bone fragments above the skin. After obtaining informed consent from her curator, a corrective osteotomy was performed using an original method, followed by fixation of bone fragments in almost anatomical position by intramedullary K wires. At a 6-month follow-up, the patient was using her hand in daily life and did not complain of any pain. An X-ray showed consolidation of the bones in the distal forearm in an acceptable position.

An assessment of quality of the surgical curriculum in Pomeranian Medical University in years 2015-2017.

The objective of this study was assessment of quality of the surgical curriculum in Pomeranian Medical University in years 2015-2017. MATERIAL AND METHODS: A questionnaire-survey has been conducted in a group of 100 of Polish students from the Medical Faculty just before the final test-exam in subject surgery. Main topics of the questionnaire items concerned students' opinion on the expected usefulness of acquired surgical knowledge for future medical practice, acquired manual skills, range of knowledge learned in particular academic years and on understanding the term "skill/competency-oriented teaching" surgery. RESULTS: Knowledge from general and oncologic surgery was scored by students the highest as potentially most useful for future medical practice. Learning manual skills (mostly put stiches on a pig trotter) was considered the most valuable portion of surgical curriculum. Acquiring of manual skills was also believed as the closest of meaning the term "skill/competency-oriented teaching" surgery. Sixth (last) year of studying was considered the most effective in acquiring surgical knowledge. Most responders considered time assigned for teaching surgery in the university curriculum adequate, but not optimally employed. A critical discussion of the results was done in a light of the results of earlier studies and the literature. CONCLUSIONS: Outcomes of this study showed the students' expectations in teaching surgery in the medical university curriculum and what was a grade of its performance. Awareness of this may have effect on modification of the curriculum and methods of undergraduate teaching surgery.

Pain control in chronic, refractory CRPS by continuous brachial plexus analgesia.

We report on the outcomes of treatment for severe pain associated with long-standing, refractory CRPS in 10 female patients by continuous brachial plexus analgesia. The duration of the disease prior to treatment was 3.5 years on average, and mean baseline pain intensity was 8.3 on a numeric analogue scale (NRS). All patients met the Budapest criteria for the diagnosis of CRPS. A spinal catheter was implanted into the brachial plexus via an open axillary approach. RESULTS: Each patient underwent a mean of 4.4 (range 2-8) spinal catheter implantations. A rapid and strong analgesic effect was observed immediately after the injection of bupivacaine solution was started: Pain decreased from a mean of 8.3 to 1.6. The duration of maintaining the catheter in the brachial plexus and achieving effective analgesia was 5.3 months (range 2-12). After the removal of the catheter, the pain returned to baseline. No patient achieved a permanent, or at least partial, reduction of pain after completing this therapy.

Effectiveness of complex regional pain syndrome treatment: A systematic review.

Complex regional pain syndrome (CRPS) is a descriptive term for a complex of symptoms and signs typically occurring following trauma of the extremity. Typical symptomatology includes severe pain, swelling, vasomotor instability and functional impairment of the affected limb. At present there is no one, effective method of treatment of the condition. A large number of treatments have been investigated but major multicentre randomized controlled trials are lacking. This study presents the results of a systematic review of the evidence on effectiveness of treatment methods in CRPS. It is a follow-up to earlier reviews of randomized controlled trials on CRPS treatment published between 1966 and 2016. RESULTS: The review of randomized controlled trials showed that only bisphosphonates were found to give uniformly positive effects, statistically significantly better than placebo. Improvement has been reported with topical dimethyl sulfoxide, systemic steroids, spinal cord stimulation and graded motor imagery/mirror therapy programmes. The available evidence does not support the use of other treatments in CRPS, however they are frequently used in clinical practice. CONCLUSION: Available evidence, although numerous, does not necessarily reflect what is truly effective and what is sham in the management of CRPS.

Factors involved in the clinical profile of carpal tunnel syndrome.

Clinical presentation of carpal tunnel syndrome may differ in relation to certain factors like sex, age, duration of symptoms and severity of compression. The objective of this study was an investigation into the hypothesis that several distinct factors are predictive of the clinical profile for the condition. The records of 1,117 patients: 909 women (81 %) and 208 men (19 %) with a mean age of 63 years, were analysed. The whole group was divided into subgroups, depending on the variables analysed: sex, age, duration of the condition, severity of symptoms, severity of electrophysiological abnormalities and occurrence or lack of comorbidities. RESULTS: Of all the considered variables, the Levine symptom scores had the greatest impact on the condition's clinical profile: the higher scores the more severe pain, poorer sensation, weaker grip and worse hand function. Also, ages greater than 80 years had a significant negative effect on most of the considered parameters. None of the remaining analysed variables had a substantial impact on the clinical profile of the condition.

A comparison of outcomes of carpal tunnel release for carpal tunnel syndrome in patients diagnosed with and without electrophysiological studies.

Records were analysed from the institutional database, including 943 patients (1089 hands) with CTS who were operated on in the authors' department over a period of four years (2012 to 2015). The diagnosis of CTS was made solely on the basis of clinical findings in 551 patients (58 %); 392 patients (42 %) also had electrodiagnostic tests performed, for various reasons. Patients were followed-up at 1 and 6 months with assessments that included the Levine scores, filament tests, grip and pinch strength. No significant differences in Levine scores were found at the 1 and 6 month assessments. Statistically significant differences were noted in 3-point pinch strength and sensation: however, these were not clinically meaningful. The results of the study show that the results of carpal tunnel release in patients with typical symptoms are no better after electrodiagnostic tests.

[Excessive left retroperitoneal abscess of an unknown aetiology perforating into the peritoneal cavity: a case report].

Retroperitoneal abscesses present a relatively uncommon complication of diseases of various abdominal organs, although most commonly they are related to acute appendicitis of retrocoecal location. The paper presents the case of a healthy patient in whom an excessive left retroperitoneal abscess developed, perforated into the peritoneal cavity, and almost perforated through the skin in XIIth intercostal space. The patient had no abdominal symptoms or signs, but complained from slight pain in the left lumbar area. The diagnosis was established based on abdominal computed tomography scanning and an operative treatment by laparotomy. The evacuation and drainage of the abscess was effective and the patient recovered. Bacteriological examination of the pus from the abdominal cavity revealed single colonies of anaerobic Fusobacterium species. The cause of the occurrence of the abscess remained unknown.

[Giant splenic cyst: a case report].

The case of a giant, nonparasitic splenic cyst, accidentally diagnosed in a young woman, is reported. The cyst was poorly-symptomatic, with only a discrete change of abdominal contour. The diagnosis was confirmed by USG and abdominal computed tomography scanning. The patient was operated on, and the cyst, containing 2.5 L of serosal fluid, was successfully excised, sparing almost the whole spleen. The postoperative course was uneventful, and histological examination showed the epidermoid character of the cyst.

Hand disorders associated with diabetes: a review.

The diabetes may cause damage many structures and organs of a human body and predispose to secondary disorders, including involvement of the hand. Carpal tunnel syndrome, trigger finger or Dupuytren's disease occur more frequently in diabetic patients as well as other, poorer recognized conditions such as limited joint mobility, or hand weakness. The paper presents these disorders, emphasizes differences in clinical presentation, methods and outcomes of treatment, comparing to the non-diabetic patients. Although there are not call complications, some evidence suggests that they may be, as their prevalence is related to the duration of the diabetes, poor metabolic control and occurrence of other disorders such as retino- and nephropathy.

The usefulness of the surgical knowledge and skills acquired via the university curriculum for doctors' medical practice several years after graduation.

BACKGROUND: Teaching surgery during university curriculum comprises transferring theoretical knowledge traditionally and simultaneously acquiring manual skills, i.e., suturing, stitch removal, limb immobilization, catheterization, and assisting operations. Observations of doctors several years after graduation led to the reflection that teachers' ideas about surgical knowledge and skills that are useful in daily practice frequently fail to meet the facts of the case. The objective of this study was to determine which part of the surgical knowledge and skills taught via the university surgical curriculum proved to be useful in the daily practice of young doctors. MATERIAL AND METHODS: A custom-made questionnaire was designed and mailed to 200 randomly chosen doctors who had graduated from the medical faculty at the authors' university 5 to 6 years previously. The questionnaire comprised 9 items concerning the knowledge and skills that proved to be the most useful in participants' daily practice, regardless of their specialty. RESULTS: A total of 64 completed questionnaires were returned (32% of 200 sent) and were the subject of analysis. The most useful knowledge in daily practice was that acquired from general surgery, followed by oncological and vascular surgery. The most useful was knowledge about the rational interpretation of clinical symptoms and signs acquired from examination of the patient, followed by arriving at an accurate diagnosis through logical analysis, and next developing "oncological sensitivity" to diagnosing neoplasms. The most effective teaching model was specialized outpatient clinic rounds, followed by training manual skills on a model and classical ward-round teaching. The most frequently learned (acquired) manual skills were removal of stitches, rectal examination, and examination of the abdomen. Of these skills, the most useful in daily practice appeared to be removal of stitches, catheterization of the urinary bladder, and wound suturing. Learning and practicing manual skills followed by classical ward-round teaching was considered "skill-/competency-oriented teaching" surgery by all respondents. CONCLUSION: The results of this study show some discrepancy between the knowledge and skills taught during university surgical curriculum and their actual usefulness in the daily practice of graduates. Awareness of this should have an effect on modification of the curriculum and methods for undergraduate surgery teaching.