Relationships between CD34-, CD105- and bcl-2-Expression Levels and Contrast-Enhanced Ultrasound-Based Differential Diagnosis of Adnexal Tumours.

The relationships between CEUS parameters of adnexal tumours and postoperative immunohistochemical assessments of CD34, CD105 and bcl-2 were analysed. This study aimed to investigate whether contrast-enhanced ultrasonography (CEUS) parameters depend on the microvascular density of the tumour lesion found after surgery. Fifty-one patients with a diagnosis of adnexal tumours were included in this single-centre, prospective study. Participants underwent preoperative CEUS (contrast-enhanced ultrasound). Colour Doppler enhancement characterisation parameters (Ystart, Ymax and S) were determined. Immunohistochemical examination of histological specimens of the adnexal lesions was then carried out to determine the expression levels of the CD34, CD105 and bcl-2 proteins. Relationships between the aforementioned parameters were investigated. No significant statistical correlations were observed between CD34, CD105 and bcl2 expression levels and CEUS parameters, independently of whether the operated lesion was malignant or benign. Transvaginal CEUS is diagnostic for the detection of pathological neoplastic vascularisation of an adnexal lesion independent of the density of microcapillaries found postoperatively.

Assessment of patients' quality of life after haemorrhoidectomy using the LigaSure device.

INTRODUCTION: Haemorrhoids are small anatomical structures within the anal canal that are involved in the proper functioning of the lower gastrointestinal tract. Factors favouring the development of haemorrhoidal disease are insufficient physical activity, prolonged sitting and hence a shortage of physical activity, as well as poor diet which lacks adequate amounts of fibre. The main symptom of this disease is bleeding with bright red blood just after defecation. Haemorrhoidal disease occurs when the ligamentous apparatus comes loose and the internal haemorrhoidal plexus translocates down, whereas haemorrhoids enlarge and move out of the anal canal. Haemorrhoidal disease treatment includes conservative, instrumental and surgical therapy. AIM: To assess treatment and satisfaction in particular life domains after haemorrhoidectomy. MATERIAL AND METHODS: The research was undertaken in the General, Thoracic and Vascular Surgery Clinic of the 10(th) Military Clinical Hospital with Polyclinic in Bydgoszcz among 50 patients treated due to haemorrhoids and operated on in the period 2007-2008. The study evaluated quality of patients' life after haemorrhoidectomy by Ferguson's method using a LigaSure appliance. RESULTS: The study investigated whether patients perceived a difference before and after surgery. The research proved that patients can describe disease symptoms and know the risk factors for haemorrhoids. In the studied group patients are able to describe characteristic signs of haemorrhoidal disease and also indicate differences in everyday life before and after the surgery. They can also describe and classify the pain before and 1 year after the haemorrhoidectomy, which was statistically significantly lower already 3 months after the operation. CONCLUSIONS: Conducted examinations showed that sick people in the precise way were able to determine manifestations and know risk factors of the prevalence of disease hemorrhoidal. Operated sick people indicated the difference in quality of the life both before, as well as after the undergone treatment. After the operation of the haemorrhoids with method of Ferguson using LigaSure apparatus operated sick persons could distinguish and classify pain before the treatment as well as in a year after which was statistically characteristically lower already after three months from treatment.

Analysis of factors influencing patient satisfaction with hospital treatment at the surgical department.

UNLABELLED: THE AIM OF THE STUDY was to determine factors responsible for patient satisfaction after treatment at the surgical department. MATERIAL AND METHODS: The study was conducted in six health care units, which were divided into two groups: Group I: 3 hospitals with the number of beds exceeding 400, and Group II: 3 hospitals with the number of beds below 400. The study group comprised 180 patients, 30 from each of the hospitals. The authors' used the Servqual method and questionnaire with 30 questions relating to five areas characteristic of medical service. Apart from the above-mentioned we also took into consideration hospital personnel: their qualifications and salary, hospital equipment, patient hospitalization costs, and indicated by the patient--the reason for his/her satisfaction or dissatisfaction with hospitalization. Results were subject to statistical analysis. RESULTS: The results indicated that the factors pertaining to costs, especially those related to living conditions and also those related to empathy, personnel competence, and their communication with the patient had very significant influence on patient satisfaction with his/her hospitalization. Fulfilling the patient's needs considering the functional quality increases the patient's comfort, and as a consequence translates into satisfaction with the hospitalization. CONCLUSIONS: Considering both groups of hospitals the surgical departments did not entirely fulfill the patient's expectations, and there is a need for improvement in this area. The main reason for the negative feelings of patients included worse than expected living conditions, sporadic contact with physicians and lack of information concerning the course of therapy.

Cornelia de Lange syndrome - characteristics and laparoscopic treatment modalities of reflux based on own material.

Cornelia de Lange syndrome (typus degenerativus amstelodamensis, CdLS, Brachmann syndrome) is a complex, congenital, multi-gene anomaly characterized by mental retardation. Its features include growth inhibition, hirsutism, structural anomalies of the limbs and abnormal development of osseous structures of the face. Independent of the phenotype of the disease, 85% of patients are assumed to have symptoms of gastroesophageal reflux disease (GERD). Aspiration pneumonia is one of the complications of GERD and a main cause of death in these patients. Patients not responding to medical treatment qualify for surgery. Until recently, anti-reflux procedures for GERD in CdLS patients were performed solely via laparotomy. The contemporary gold standard is a procedure performed laparoscopically. There are a few case reports of patients with CdLS operated on for GERD with laparoscopy available in the literature. The goal of this paper is to present two cases of Cornelia de Lange syndrome treated with laparoscopic antireflux procedures. We have performed two such procedures in 14 and 16 year-old girls with typical symptoms of the syndrome, i.e. developmental and mental retardation, hirsutism, structural limb anomalies and abnormal face development. The main indications for surgery in both cases were ineffective medical treatment and persistent aspiration pneumonia and its complications as a result of the gastroesophageal reflux. Oesophageal hiatus hernia and reflux were confirmed with accessory tests in both cases. During 36 months of follow-up, according to Barents, no episode of oesophageal reflux with acidic gastric content was noted. The treated children slept well during the night and did not need hospitalization for aspiration pneumonia. Neither of them required proton pump inhibitors. It should be concluded that laparoscopic Nissen fundoplication is a safe and effective method of GERD treatment in children with CdLS.

[Influence of low-molecular-weight heparin on the life quality of patients after intravascular medical procedures in comparison to patients who were treated with oral anticoagulants]. / Wplyw stosowanych heparyn drobnoczasteczkowych i doustnych antykoagulantów na jakosc zycia chorych po przebytych zabiegach wewnatrznaczyniowych.

UNLABELLED: Atherosclerosis is the illness of arteries which causes changes in vessels leading to their narrowing and then to their closure. Men are mainly attacked by illnesses of arteries. There are several factors which can intensify these illnesses such as: diabetes, smoking cigarettes, diet rich in cholesterol, arterial hypertension. Chronic ischemia of lower extremities is the most frequent illness with which patients notify. Patients with long-standing atherosclerotic process are usually afflicted with thrombotic ischemia. The life quality is the term that can have many meanings. It can be treated objectively or subjectively. In the first case we deal with the quality of life and in the second one with the feeling of life quality. Considering the problem we can base on the level of fulfilling the norm or on riches of obtained experience. The term life quality is significantly connected with the process of cognitive assessment of the individual. The quality of life of patients who were subjected to intravascular medical procedures considerably changes. The continuation of surgical treatment is pharmacotherapy which is connected with administering to patients low-molecular-weight heparin or oral antithrombotic medicine. The aim of the study was an evaluation of quality of life of patient after intravascular medical procedures, at which continued treatment was low-molecular-weight heparin and comparison of received results with subjective feeling of quality of life among ill across passing, treated oral anticoagulants medicines. MATERIAL AND METHODS: A number of 50 patients participated in the research. The most numerous group was made up of people aged 51-60 (20 people, 40%), 15 patients (30%) were over 61 years old, 7 ill (14%) were aged 41-50, 5 people (10%) were aged 31-40 and 3 patients (6%) were aged 20-30. Tested patients were selected randomly. The largest number of people (54%) came from the cities with more than 50 thousand inhabitants. People living in the towns with less than 50 thousand inhabitants made up a bit smaller group (30%). A questionnaire of pain assessment according to the NRS scale was used in the research (from 1 to 10; 1 means: "I do not feel pain", 10: "unbearable pain") as well as EuroQol 4D--a questionnaire of health state and quality of life assessment. The questionnaire consisted of 20 questions and was filled in voluntarily. RESULTS: Conducted research has shown that the life quality of patients who were treated with low-molecular-weight heparin changed for better in higher degree than patients who were treated with oral antithrombotic medicine.

[Long-term results of rectal tumors treatment by transanal endoscopic microsurgery (TEM)]. / Odlegle wyniki leczenia guzów odbytnicy sposobem przezodbytniczej mikrochirurgii endoskopowej (TEM).

UNLABELLED: Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for excision of selected benign and malignant rectal neoplasmas. The aim of this study was to assess the long-term results after benign and malignant rectal lesions excision using TEM. MATERIAL AND METHODS: Between December 1998 and October 2005 37 patients were operated on using TEM. Median follow-up was 3.5 years (range 1-5 years). There were 9 (33.3%) women and 18 (66.7%) men with a median patient age of 75 years (range 38-83 years). 27 patients were included into this study. RESULTS: One patient has still incontinent. There have been two local recurrences and liver metastasis in one patient. Two patients have had stricture of the rectum. One patient died because of heart attack. 21 (77.7%) of patients were satisfied with treatment. CONCLUSION: TEM is a safe, effective treatment for selected cases of benign lesions and some cases of early stage rectal cancer. Long-term results and a prospective randomized trial are needed.

[Bilateral posterior thoracoscopic splanchnicectomy in a face-down position in the management of chronic pancreatic pain]. / Obustronna tylna torakoskopowa splanchnicektomia w uloieniu brzusznym w leczeniu przewleklego bólu trzustkowego.

UNLABELLED: Abdominal pain is the primary symptom in most patients with chronic pancreatic diseases. Many authors have reported that thoracoscopic splanchnicectomy is a effective and recognize method for relief of chronic pain due to pancreatic cancer and chronic pancreatitis. Time ago only few authors used bilateral toracoscopic splanchnicectomy in one session because they observed side effects as transient orthostatic hypotension and/or diarrhea. The aim of this study was retrospective analysis of two methods of the bilateral thoracoscopy splanchnicectomy at one session. We comparsion operation's time, intraoperative and postoperative complication, hospitalization and evaluate pain intensity in patients with intractable pain due to advanced pancreatic cancer and chronic pancreatitis. MATERIAL AND METHODS: The study group comprised 94 patients, aged 26-69 years operated with bilateral thoracosopic splanchnicectomy at one session approach between years 1997-2006. There were two groups. First (I group) for operated patients in thoracotomy position with changed the position of patients at the same procedure and second (II group) for posterior thoracoscopic approach with the patient in a face-down position. In all patients evaluated operation's time, intraoperative and postoperative complication and pain intensity before and for 6 months after the thoracoscopic splanchnicectomy. RESULTS: The mean operating time in the I group was 58.3 min. and the II group was 43.5 min. (p < 0.05). There were no intraoperative and postoperative complications, only 16 patients I group and 3 patients II group had intercostal neuralgia after operation. The mean hospitalization's time in all patients were 1.3 day. In all patients pain was reduced significantly after the operation and during postoperative follow-up. CONCLUSION: Posterior thoracoscopic splanchnicectomy approach with the patient in a face-down position is a save, minimally invasive and reduce operation time procedure.

[Late complication of endoscopic sphincterotomy]. / Odlegle powiklanie endoskopowej sfinkterotomii.

Endoscopic sphincterotomy and stone extraction has become method of choice in the treatment of residual lithiasis after cholecystectomy. Then safe endeavour and effective, yet despite many advantages possible complications are. The paper presents a rare case endoscopic sphincterotomy under form of gigantic abscess of extraperitoneal space from consequent sepsis and death of patient.