The results of high-position anal fistula treatment using the LIFT (ligation of intersphincteric fistula tract) procedure. A retrospective, single-center study.

Ligation of the intersphincteric fistula tract (LIFT) is an established method for the treatment of high- and lowposition anal fistulas. Numerous meta-analyses confirm the high healing success rate with simultaneous low risk of sphincter damage. The aim of the study was to evaluate the results of the treatment of patients with high-position and complex transsphincteric fistulas using the LIFT procedure. Twelve patients (M - 9, F - 3) aged between 28 and 69 years (median age 50) undergoing surgery for complex and high-position transsphincteric anal fistulas, either primary or recurrent, in the period of 2016 to 2020, were included in the study. The inclusion criterion consisted in the presence of a fistula encompassing more than 30% of the anal sphincter volume as confirmed by transrectal ultrasound. All patients were subjected to surgical treatment by means of the LIFT procedure. The follow-up period was between 6 and 51 months (average of 16 months). Follow-up visits were held at 1 and 4 weeks as well as 6 months after surgery. During the postoperative period, data were collected on the curative effect or recurrence of transsphincteric fistulas (the primary endpoint) and on the presence of postoperative complications (the secondary endpoint). A total of 10 patients (83.3%) were healed, with 2 patients (16.7%) experiencing complications as manifested by recurring intersphincteric fistula. Full recurrence of the disease was observed in 2 patients (16.7%). Slight disturbances of continence were observed in 2 out of 12 patients (16.7%).

Usefulness of the FOUR scale to assess the state of consciousness of the patients treated in the Intensive Care Unit.

The Glasgow Coma Scale (GCS) is a widely adopted clinical scale which fails to assess a verbal component in intensive care units (ICUs) patients who are ventilated mechanically. AIM: The aim of the study was to evaluate the validity of the FOUR scale (Full Outline of UnResponsivness) when applied by staff of an ICU. MATERIALS AND METHODS: This prospective cohort study included 65 consecutive intubated patients treated in the ICU with brain damage. The study design included the simultaneous assessment of the patients' consciousness by two scales - the FOUR scale and the GCS. All assessments were made under strict inclusion and exclusion criteria. The patients were assessed by a randomly selected staff pairs (neurointensivist/ nurse, neurointensivist/resident, neurointensivist/neurointensivists). The assessments made by experienced neurointensivists were regarded as basic examinations and by other members as control examinations. The study design allowed for the assessment of the interrater reliability. RESULTS: In 65 enrolled patients, a total of 763 double assessments were made using the FOUR score and by the GCS. It has been shown that in 751 out of 763 assessments the patients' consciousness was accurately assessed, representing 98.43 % accuracy of the FOUR scale. In contrast, the patients' consciousness was reliably assessed by the GCS in only 88 assessments, representing 11.5 % of accuracy. CONCLUSIONS: The study showed excellent interrater reliability among the groups of examiners for the FOUR scale as well as the GCS. The main advantage of the FOUR scale in intubated patients is excellent accuracy. The FOUR scale is easy to learn. It is functional and it has no limitations typical of verbal scales. It is a valuable and recommended clinical tool for the assessment of consciousness of the ICU patients.

Results of surgical treatment of pilonidal sinus in 50 patients operated using Bascom II procedure - prospective study.

INTRODUCTION: Treatment of the pilonidal sinus, due to various surgical methods, remains the current topic of discussion during surgeon meetings worldwide. The newest methods of treatment consist in the excision and simultaneous closure of the wound with cleft lift procedures. One of such methods is Bascom II procedure which has been widely used in the world but is less popular in Poland. AIM OF THE STUDY: To evaluate the results of treatment of pilonidal cysts using Bascom II procedure performed by one operator. MATERIAL AND METHOD: 50 patients (40 men, 10 women), Avg. 30.6 years of age. All patients treated with Bascom II procedure in one surgical ward by one operator (resident during specialisation training) with the use of uniform surgical care for all operational protocols. The following were assessed: BMI, average hospitalisation time, pain, post-operative complications, wound healing time, patient's quality of life, and the recurrences rate after surgery. The follow-up period ranged from 12 to 52 months. RESULTS: Average BMI 27.13 kg / m2. Avg. time of hospitalisation 2.95 days. Post-operative pain in the first 24 hours was on average 4.55 points. (+/- 2.24 points); on the 10th day on average 2.04 points (+/- 1.58 points); in the 30th day on average 0.76 points (+/- 1.1 points). Pain after healing 0.14 points (+/- 0.40 points). Post-oerative complications occurred in 28.57% of patients [partial wound dehiscence (16.32%), serum leak (10.2%), hematoma (6.12%), total wound dehiscence (0%), wound infection (0%)]. The average time of full healing was 2.94 weeks. Recurrence occurred in one patient (2.04%). CONCLUSIONS: Bascom II procedure is characterised by a low recurrence rate and short wound healing time. It is a a safe, effective and patient-accepted method of treatment. Statistically, it significantly improves the patient's quality of life one year after surgery in terms of both physical and mental health.

New porcine model of perineal tear and its utility in physicians' training on the reconstruction of 3rd and 4th degree perineal tear during vaginal delivery.

OBJECTIVES: One of the most serious complications of vaginal delivery is 3rd and 4th degree perineal tear and its incorrect management results in anal incontinence. Animal-based anatomical models of childbirth-induced perineal tear are an important element of the physicians' practical training [1]. The proposed new model, prepared using porcine tongue and intestine, closely mimics all the tissues and organs subjected to injury during complicated deliveries and constitutes an educational opportunity for the reconstruction of the injuries. The objective of this paper was to present a new porcine model of the perineum and to evaluate the utility of this model in the training of physicians on the reconstruction of the 3rd and 4th degree perineal tear during childbirth. MATERIAL AND METHODS: We presented a preparation method of the proposed model and a calculation of the amount of time and costs required for its preparation. The utility of the model was assessed using a questionnaire completed by the participants of a workshop conducted with the model. RESULTS: We found that 95% of the respondents had never practiced perineal reconstruction on any model. According to 85% of the respondents, our model was very similar to natural tissues. According to 95% of the respondents, the simulated model of the perineal tear satisfactorily mimicked the real-life situation. CONCLUSIONS: The presented model is cheap and easy to prepare. It satisfactorily mimics the tissues and tissue injuries caused by the tear, making it helpful in training physicians on the reconstruction of 3rd and 4th degree perineal tear.

Assessment of the Surgical Treatment Results in Patients with Colorectal Cancer in a District Hospital Versus Treatment Results in a Highly Specialized Center.

UNLABELLED: In Poland there there are about 15-16 thousand cases of colon cancer per year. The health care system allows the treatment of patients with colorectal cancer in highly specialized hospitals, oncology centers and district hospitals. The results of treatment within different reference level differ. The aim of the study was to evaluate the results of surgical treatment of patients with colorectal cancer at a district hospitals compared with the results of highly specialized center. MATERIAL AND METHODS: A retrospective study. The material consisted of 171 consecutively operated patients diagnosed with colorectal cancer treated in the Department of Surgery, District Hospital in Wolomin. The control group consisted of 200 patients treated surgically at the Department of General and Colorectal Surgery, University Hospital in Lódz. In both centers, the patients were operated on by surgeons with experience in operations on the large bowel. The demographic data, information on the type of indication (elective vs emergent), and the severity of the disease by AJCC / TNM scale were collected. In the district hospital there were patients with more advanced disease (p <0.001), older (p = 0.0001), and often operated under emergent indication (p = 0.0001). The telephone survey collected data on survival or the date of death of the patient and set the percentage of five-year survival. RESULTS: The proportion of five-year survival in the study group and control group was respectively 46% and 71% (p <0.0001). The percentage of five-year survival among patients undergoing elective procedure in both centers were respectively for Wolomin and Lódz 58% and 73% (p = 0.008). The proportion of 5-year survival among "younger" patients (<70) was respectively in Wolomin and Lódz 64% and 81% (p = 0.004) for "older" patients with (> 70) 50% and 60% (p = 0.6747) Conclusions. Overall results of surgical treatment of patients with colorectal cancer in the district hospital are inferior to treatment results in a highly specialized center. The population treated in the district hospital is statistically significantly different in comparison to patients treated in highly specialized center. The following differences were captured: severity of the disease, age and type of indication (elective vs emergent). The diffrences has an influence on the outcomes. The five years survival for patients > 70 years undergoing elective procedure is not statistically different between the district hospital and highly specialized center.

Neck sweat gland cancer hemorrhage. Case study.

BACKGROUND: This paper reports a case of an 87-year-old female patient who was admitted for an emergency operation due to massive hemorrhage of an ulceration localized on a huge neck tumor. Post-interventional diagnosis indicated hidradenocarcinoma. Hidradenocarcinoma is a rare skin neoplasm. It can coincide with adenoma, may develop through its malignant transformation or develop as a malignant tumor from the beginning. It may be found in all dermal localizations. It may develop metastases or appear in the diffuse form. MATERIAL AND METHODS: Surgical excision of the tumor was performed obtaining a surgical margin, completed with excision of local lymph nodes and multiple layer suturing. Due to lack of the patient's consent, she has not been qualified for adjuvant therapy. RESULTS: Control examination 6 and 12 months later showed no signs of local recurrence or lymph node metastasis. CONCLUSION: Surgical excision of apocrine hidradenocarcinoma with a surgical margin could present a good therapeutic effect in spite of lack of adjuvant therapy.