Autogenous transplants of adrenal fragments in an animal model.

Introduction Adrenal insufficiency is a typical complication after surgical treatment of adrenal tumors, especially after the removal of both adrenal glands. Human beings are not able to survive without adrenal glands and without proper hormonal substitution. Autotransplantation of a fragment of the adrenal gland may prevent this complication. This can be done by transplanting the entire adrenal glands or its fragment, such as the adrenal cortex cells. In the case of adrenal tumors, the entire adrenal gland can not be transplanted. However, it is possible to transplant cells from the tumor-free part. Succesful adrenal autografts may result in a new treatment of adrenal insufficiency. MATERIALS AND METHODS: Autograft transplantation was performed on 3 groups of Sprague Dawley rats. In the first group, physiological corticosterone concentrations were determined. These animals were not operated. In the second group, both adrenal glands were removed. Corticosterone concentrations were determined after bilateral adrenalectomy. The third group was divided into two parts. In the first subgroup, bilateral adrenalectomy was performed simultaneosly with adrenal transplant into the omentum. In the second subgroup, right adrenalectomy was performed simultaneosly with and adrenal transplant into the omentum followed a month later by left adrenalectomy. During the experiment, corticosterone concentrations were measured at 4 time points. RESULTS: The statistical difference between corticosterone concentrations in rats after two timed adrenalectomies and rats after bilateral adrenalectomy was statistically different, but these results were far from physiological concentrations.

Early Predictors of Post - Thyroidectomy Hypoparathyroidism.

Thyroid surgery is the most commonly performed procedure in the field of endocrine surgery. Studies are still ongoing on the development of a single algorithm for diagnosis and care of patients at risk of postoperative hypoparathyroidism. The aim of the study was to determine the biochemical marker that would allow the most accurate diagnosis of patient groups at risk of developing hypoparathyroidism and to identify risk factors for this disorder. MATERIAL AND METHODS: The prospective study included 142 consecutive patients undergoing total thyroidectomy for benign goiter from January 1st 2014 to December 31st 2015. Serum intact parathyroid hormone (iPTH), total calcium (Ca), phosphate (P), and magnesium (Mg) levels have been measured preoperatively and at 1, 6, 24, and 48 h postoperatively. RESULTS: Clinical symptoms of hypoparathyroidism developed in 25 (17.6%) of 142 patients. The best diagnostic accuracy for hypoparathyroidism based on ROC curves was obtained for iPTH at 6h (AUC 0.942; 95% CI: 0.866-1.000, p<0.001) and its percentage change from baseline ΔiPTH at 6h (AUC 0.930; 95% CI: 0.858-1.000, p<0.001). In an multivariate analysis, the preoperative Ca level higher by 0.1 mmol/l, and iPTH level higher by 0.1 pmol/l were associated with a lower risk of hypoparathyroidism, by 68% (p=0.012) and 61% (p=0.007), respectively. A 1% decline in iPTH from baseline increased the risk of hypoparathyroidism by 15% (p<0.001). CONCLUSIONS: The most reliable markers indicating a high risk of postoperative hypoparathyroidism are the decline in ΔiPTH at 6h by > 65% or iPTH level at 6h <1.57 pmol /l. A postoperative decline in iPTH levels is an independent risk factor for the development of hypoparathyroidism. Preoperative higher concentrations of Ca and iPTH are protective factors for the development of this disorder.

Physician as an infective vector at a department of surgery.

UNLABELLED: This study was designed to assess the degree of risk of bacterial transmission from physician to patient through hands, equipment and enclosing surfaces (shoe soles). MATERIAL AND METHODS: The study was conducted in the Clinical Department of General and Oncological Surgery UM in Lódz. In days 16.10.2013, 17.10.2013, 18.10.2013 there were done swabs from hands, stethoscopes and soles of shoes from the same group of physicians before and after doctor's rounds. The presence of alert-pathogens in swabs was regarded as positive result. RESULTS: Isolates included mostly aerobic saprophytic bacilli and Staphylococcus species coagulase-negative. There were detected a singly cases of Acinetobacter Baumani and Escherichia coli. Alert-pathogens were found in 4 (16%) swabs taken from hand before doctor's rounds and in 7 (28%) swabs taken after rounds. Stetoscopes were contaminated by alert-pathogens in 3 (12%) cases before doctor's rounds and in 3 (12%) cases taken after doctor's rounds. Soles of shoes were contaminated by alert-pathogens in 14 (56%) cases taken before and 16 (65%) cases taken after doctor's rounds. CONCLUSIONS: 1. Physicians are important factor of bacterial transmission in hospital. 2. Hands, stetoscopes and particularly soles of shoes of medical staff is the source of infection.

One-step nucleic acid amplification testing in medullary thyroid cancer lymph nodes: a case series.

INTRODUCTION: Locoregional relapse in medullary thyroid cancer (MTC) may be caused by nodal micrometastases. Medullary thyroid cancer lymph nodes have not yet been evaluated by one-step nucleic acid amplification (OSNA). Therefore, the aim of this study was to detect MTC cells by OSNA in cervical lymph nodes and compare the obtained outcomes with conventional histopathology. MATERIAL AND METHODS: Twenty-one randomized, unenlarged lymph nodes from 5 patients with MTC were examined by histopathology and OSNA. Lymph nodes were divided into four representative blocks by a sterile, single use, special cutting device in the same way as in the clinical protocol study performed by Tsujimoto et al. Two blocks were used for histopathology and immunohistochemistry, 2 for OSNA. RESULTS: Positive results of histopathology and OSNA were revealed in 4 patients. The outcomes of OSNA and histopathology were corresponding in 3 patients. Positive histopathology results of 2 lymph nodes from 2 patients were confirmed by OSNA. In 1 patient there were only negative results of both examinations. One-step nucleic acid amplification failed to detect metastasis in 1 lymph node in 2 patients although it did not change the TNM status in these patients. There were no false positive results in the OSNA test. CONCLUSIONS: One-step nucleic acid amplification may be an alternative method to histopathology in detecting nodal involvement in MTC. Further studies should evaluate the sensitivity and specificity of OSNA and the impact on staging in MTC.

Health risk to medical personnel of surgical smoke produced during laparoscopic surgery.

OBJECTIVES: During laparoscopic cholecystectomy, the removal of the gall bladder, pyrolysis occurs in the peritoneal cavity. Chemical substances which are formed during this process escape into the operating room through trocars in the form of surgical smoke. The aim of this study was to identify and quantitatively measure a number of selected chemical substances found in surgical smoke and to assess the risk they carry to medical personnel. MATERIAL AND METHODS: The study was performed at the Maria Sklodowska-Curie Memorial Provincial Specialist Hospital in Zgierz between 2011 and 2013. Air samples were collected in the operating room during laparoscopic cholecystectomy. RESULTS: A complete qualitative and quantitative analysis of the air samples showed a number of chemical substances present, such as aldehydes, benzene, toluene, ethylbenzene, xylene, ozone, dioxins and others. CONCLUSIONS: The concentrations of these substances were much lower than the hygienic standards allowed by the European Union Maximum Acceptable Concentration (MAC). The calculated risk of developing cancer as a result of exposure to surgical smoke during laparoscopic cholecystectomy is negligible. Yet it should be kept in mind that repeated exposure to a cocktail of these substances increases the possibility of developing adverse effects. Many of these compounds are toxic, and may possibly be carcinogenic, mutagenic or genotoxic. Therefore, it is necessary to remove surgical smoke from the operating room in order to protect medical personnel.

Evaluating the prognostic value of selected prognostic scales in patients operated on due to peritonitis.

UNLABELLED: The aim of the study was to assess the usefulness of prognostic scales: ASA (American Society of Anesthesiologist), MPI (Meinheim Peritonitis Index), MOFS (the Multiple Organ Failure Score) and SPI (the Simple Prognostic Index) in the prognosis of the course of disease in patients operated on for peritonitis. MATERIAL AND METHODS: The study was conducted in the Clinical Department of General and Oncological Surgery of the Medical University in Lódz between January 2009 to December 2010. During this period 263 patients were operated on for peritonitis. Before surgery all patients were classified into particular groups according to the above mentioned prognostic scales according to their criteria. RESULTS: There were 29 (11%) deaths. ASA ≥4 (p<0.0001), MPI >30 (p<0.0001) MOFS ≥2 (p<0.0001), SPI II, III, IV (p<0.0001) were important risk factors of death. CONCLUSIONS: 1. ASA, MPI, MOFS and SPI scales are of high significance in predicting the outcome in patients operated on for peritonitis. 2. The ASA scale in spite and due to its simplicity is adequate enough to be used in everyday practice in patients operated on for peritonitis. 3. The MPI scale is most suitable in the scientific aims and in comparing the outcomes of patients operated on for peritonitis.

Patients subject to surgery due to acute abdominal disorders during the period between 2001-2004.

UNLABELLED: The aim of the study was to evaluate the clinical spectrum of emergency surgery for acute abdominal disorders and their outcome. MATERIAL AND METHODS: The study group comprised 1426 patients, aged between 10 and 92 years subject to emergency surgery, due to an acute abdomen during the period 2001-2004. Analysis comprised age, sex, concomitant diseases, ASA scale classification, postoperative diagnosis, type of surgery, complications, mortality and duration of hospitalization. Patients were divided into two age groups: <60 and ≥60 years. RESULTS: Appendicitis was the most common diagnosis (52.9%) in patients under 60 years, while cholecystitis (32.5%) and ileus (30.9%) in patients over 60 years. Complications were observed in 14.8% patients, the most common being related with wound healing (5.6%). The mortality rate amounted to 5.7%. Mortality was most often associated with bowel obstruction (29.2%), surgery for acute bowel ischemia (25.5%), and bowel perforation (20.7%). The mean duration of hospitalization was 7.9 days. CONCLUSIONS: 1. In comparison to elective surgery, emergency abdominal operations, particularly in elderly patients are related with a higher mortality rate. 2. In elderly patients, the high mortality rate and substantial number of complications is associated with the advanced primary disease and severe coexisting comorbidities, which significantly reduce the overall health condition.