Should the Histological Examination Be Used in the Diagnosis of Aneurysms of the Dorsalis Pedis Artery? A Case Report and Review of the Literature.

Aneurysms of the dorsalis pedis artery are rare, and they are not commonly examined histologically. In general, pseudoaneurysms are thought to be more common than true aneurysms of the dorsalis pedis artery. We present a patient with a true aneurysm of the dorsalis pedis artery, which was initially diagnosed as a pseudoaneurysm that had developed because of a blunt trauma of the ankle. However, the intraoperative appearance and histological examination both confirmed a true aneurysm. Our experiences seem to confirm that postoperative histological examination is needed to distinguish pseudoaneurysms from true aneurysms of the dorsalis pedis artery. The treatment of aneurysms of the dorsalis pedis artery is simple and includes resection, which completely relieves the symptoms; few patients need vascular reconstructions.

The employee's productivity in the health care sector in Poland and their impact on the treatment process of patients undergoing elective laparoscopic cholecystectomy.

BACKGROUND: Increasing the engagement of employees in the treatment process of patients may benefit a hospital and employee productivity and may result in better patient care and satisfaction with medical services. Given this, the first step in improving the quality of patient care is better availability of doctors for patients in a hospital ward. METHODS: The research for this paper was conducted in six health care units in the Kuyavian-Pomeranian province in Poland. The research assessed how the elements relating to employees' behavior and things characteristic to medical service influence patients' willingness to recommend a hospital. RESULTS: Patients' perception of services is linked with the behavior of medical employees and their engagement in the treatment process. CONCLUSION: Our research indicates that individual employee recognition and collective recognition of hospital employees as a whole were identified as the most important factors in employee engagement in the treatment process (employee productivity) and patients' satisfaction with medical service.

Health behaviors of patients diagnosed with type 2 diabetes mellitus and their influence on the patients' satisfaction with life.

BACKGROUND: The diagnosis of type 2 diabetes mellitus (T2DM) carries with it a number of changes to the patient's lifestyle. A healthy lifestyle, health and preventive behaviors, as well as healthy nutrition habits play a key role in treating T2DM as well as limiting its complications. MATERIALS AND METHODS: The aim of this study was the analysis of the correlation of T2DM patients' health behaviors and their influence on the patients' quality of life. The study was performed on a group of 50 patients from the Kuyavian-Pomeranian Voivodeship. In this study, the Health Behavior Inventory and the Satisfaction with Life Scale were used. The results were statistically analyzed. The study was approved by the ethics committee. RESULTS: The intensity of severity of health behavior and satisfaction with life of T2DM patients depends on the gender of the patient (P<0.05). The analysis of the patients' behaviors in four categories, proper eating habits (consuming vegetables, fruit, whole meal bread), health practices (daily physical activity, recreation, sleeping habits), preventive behaviors (including keeping to health recommendations), and positive mental attitude, showed substantial correlation of the Health Behavior Inventory and the Satisfaction with Life Scale (P<0.05). CONCLUSION: The categorization of the prohealth behaviors shown by diabetics allowed us to measure the connection between the individual categories of satisfaction with life. Males with T2DM showed a higher satisfaction with life score than females with the same diagnosis. The analysis showed that patients with a higher intensity of health behaviors also had superior health behaviors. The resulting correlations prove a notable relationship.

The risk factors and prevention of cardiovascular disease: the importance of electrocardiogram in the diagnosis and treatment of acute coronary syndrome.

Acute coronary syndrome is a leading cause of emergency medical treatment and hospitalization in Poland. High-speed electrocardiogram (ECG) has shown good accuracy of the initial diagnosis and of the final diagnosis in treated cardiac patients. Initial diagnosis and definitive diagnosis were analyzed statistically (P<0.0001). Although much is said about the prevention of sudden death in heart failure, the elimination of risk factors health care in Poland does not pay due attention to the need for early diagnosis and ECG analysis (at the stage of prevention). This article presents the inclusion of ECG in the prevention process and shows that it allows for early detection of cardiovascular diseases. In Poland, ST-segment elevation myocardial infarction patients are identified in the ambulance that reduces time to door-to-balloon.

Occupational HIV risk for health care workers: risk factor and the risk of infection in the course of professional activities.

Virtually created panic among health care workers about pandemic acquired immune deficiency syndrome prompted us to review the scientific literature to investigate the risk of human immunodeficiency virus (HIV) transmission in the daily works of health care workers, especially surgeons and anesthesiologists. In this review, we report worldwide valuations of the number of HIV infections that may occur from unsafe daily work in health care. We also present how to minimize the risk of infection by taking precautions and how to utilize postexposure prophylaxis in accordance with the latest reports of the Centers for Disease Control and Prevention. HIV-infected patients will be aging, and most of them will become the candidates for procedures such as major vascular reconstruction and artery bypass grafting, where the risks of blood contact and staff injury are high. For these reasons, all health care workers need to know how to prevent, and fight following the accidental exposure to HIV.

Rare Case of Hepatic Artery Pseudoaneurysm.

Hepatic artery aneurysms are rare, but potentially life-threatening vascular pathologies. They are usually discovered incidentally during imaging diagnostics of different pathologies. The study presented a rare case of hepatic artery pseudoaneurym with a fistula to the left branch of the portal vein.

Evaluation of Stress Intensity and Anxiety Level in Preoperative Period of Cardiac Patients.

INTRODUCTION: The stress related to patient's stay in a hospital increases when it is necessary to perform a surgery. Therefore, the study of the phenomenon of stress intensity in hospitalized patients has become an important issue for public health. MATERIAL AND METHOD: The study was conducted in University Hospital No. 1 in the cardiosurgery clinic. The study involved 58 patients who were admitted as planned to the hospital. The study used a standardized questionnaire measuring intensity of the stress and also deepened interviews with patients about stress and anxiety felt before the surgery. RESULTS: The greater the patient's anxiety resulting from his state of health, the greater the intensity of stress in the preoperative period. This relationship is linear. The results of the study also made it possible to see intrapersonal factors (pain, illness, and suffering) and extrapersonal factors (anesthesia, surgery, and complications after surgery), which are causes of anxiety before surgery. CONCLUSION: The research showed high (negative) results of anxiety and stress associated with the disease, surgery, and complications after cardiac surgery. Active involvement in hospitalization elements, such as patient education before surgery, psychological support, and medical care organization taking into account patient's preferences, reduces the impact of stressors.

Chronic Stress and Suicidal Thinking Among Medical Students.

INTRODUCTION: The subject of chronic stress and ways of dealing with it are very broad. The aim of this study was to analyze stress and anxiety and their influence on suicidal thinking among medical students. MATERIALS AND METHODS: The study was conducted in the years 2014 to 2015 in Poland, at the Medical University-Nicolaus Copernicus University, Collegium Medicum. The objective of this study was to assess chronic stress and suicidal thinking among students and how students cope with this huge problem. Descriptive statistics and chi-square analyses were conducted to detect differences. RESULTS: Analyses showed that students' life is full of stressors. Students toward the end of their education cope better with stress than students starting their university studies. Chronic stress has a strong impact on mental health and suicidal thinking among students. CONCLUSIONS: The results of the study confirmed that chronic stress and anxiety have a negative influence on mental health and also confirm a relation to suicidal thinking in medical students. Students cope with stress by listening to music, talking to relatives or people close to them, resting or engaging in sports, with cycling, running and swimming being the most common methods used to affect suicidal thinking.

Effect of Television on Obesity and Excess of Weight and Consequences of Health.

The epidemic nature of obesity in industrialized countries is a serious health and social concern. The number of obese people has significantly increased in the past 20 years. In Poland excess weight and obesity are a serious epidemiological concern. In terms of the number of overweight people, Poland is a leader in Europe. Therefore, indicating many serious health concerns that are the natural consequences of this phenomenon has become important from the point of view of public health. This work identifies numerous diseases which are a direct consequence of obesity due to bad eating habits and lack of physical exercise among Poles. It discusses the negative effect of television and food commercials contributing to an increase in obesity, not only among adults but also among children. This is an overview forming grounds for further studies into ways of preventing the development of diseases due to obesity, both in Poland and in the world.

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.

A comparison of direct and two-stage transportation of patients to hospital in Poland.

BACKGROUND: The rapid international expansion of telemedicine reflects the growth of technological innovations. This technological advancement is transforming the way in which patients can receive health care. MATERIALS AND METHODS: The study was conducted in Poland, at the Department of Cardiology of the Regional Hospital of Louis Rydygier in Torun. The researchers analyzed the delay in the treatment of patients with acute coronary syndrome. The study was conducted as a survey and examined 67 consecutively admitted patients treated invasively in a two-stage transport system. Data were analyzed statistically. RESULTS: Two-stage transportation does not meet the timeframe guidelines for the treatment of patients with acute myocardial infarction. Intervals for the analyzed group of patients were statistically significant (p < 0.0001). CONCLUSIONS: Direct transportation of the patient to a reference center with interventional cardiology laboratory has a significant impact on reducing in-hospital delay in case of patients with acute coronary syndrome. PERSPECTIVES: This article presents the results of two-stage transportation of the patient with acute coronary syndrome. This measure could help clinicians who seek to assess time needed for intervention. It also shows how time from the beginning of pain in chest is important and may contribute to patient disability, death or well-being.

Technology advances in hospital practices: robotics in treatment of patients.

Laparoscopic cholecystectomy is widely considered as the treatment of choice for acute cholecystitis. The safety of the procedure and its minimal invasiveness made it a valid treatment option for a patient not responding to antibiotic therapy. Our research shows that patients positively assess this treatment method, but the world's tendency is to turn to a more sophisticated method utilizing robot-assisted surgery as a gold standard. Providing patient with minimally invasive surgical procedures that utilize the state-of-the-art equipment like the da Vinci Robotic Surgical System underscores the commitment to high-quality patient care while enhancing patient safety. The advantages include minimal invasive scarring, less pain and bleeding, faster recovery time, and shorter hospital stay. The move toward less invasive and less morbid procedures and a need to re-create the true open surgical experience have paved the way for the development and application of robotic and computer-assisted systems in surgery in Poland as well as the rest of the world.

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.

Computed tomographic colonography in preoperative evaluation of colorectal tumors: a prospective study.

BACKGROUND: This study aimed to assess the usefulness of computed tomographic colonography (CTC) in preoperative evaluation of colorectal tumors and the entire bowel including endoscopically inaccessible regions. METHODS: Colonoscopy and CTC were performed for 49 patients. The tumor and the entire colon were assessed, and the results were compared with colonoscopy. The extraluminal findings of CTC were compared with contrast-enhanced computed tomography (CT) of the abdomen and the pelvis in 33 patients. All these patients had undergone surgery. A comparison of results for tumor node metastasis classification between CTC, CT, and histopathology was performed. RESULTS: Exploration of the entire colon was possible for 89.8% of the patients using CTC and 49.0% of the patients using colonoscopy. Bowel cleansing was assessed as worse with CTC. In the evaluation of tumor location and morphologic type, CTC was congruent with colonoscopy. Colonoscopy enabled approximate tumor size and volume to be evaluated for only 59.2% (29/49) and 30.6% (15/49) of patients, respectively, whereas CTC enabled evaluation of all 48 (100.0%) visualized tumors. Wall thickening, outer contour, and suspected infiltration of surrounding tissues and organs are impossible to determine with colonoscopy but can be determined with CTC. Using CTC, two additional tumors were found proximate to occlusive masses in endoscopically inaccessible regions. CONCLUSION: Computed tomographic colonography is a useful method for diagnosing colorectal tumors. It allows the clinician to diagnose tumor, determine local tumor progression, and detect synchronous lesions in the large bowel including endoscopically inaccessible regions.

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.

Bispectral index and cerebral oximetry in low-flow and high-flow rate anaesthesia during laparoscopic cholecystectomy - a randomized controlled trial.

INTRODUCTION: The need to reduce pollution emissions in the operating room and to reduce treatment costs motivates more frequent use of general anaesthesia with a small or minimal fresh gas flow rate. Nevertheless, the reduction of the delivery of fresh gases should not influence the quality and safety of the anaesthesia. MATERIAL AND METHODS: A total of 105 elective laparoscopic cholecystectomy patients were included in the study. There were 72 female (68.6%) and 33 male (31.4%) patients. Patients were randomized by a 'closed envelope' method into two groups. Group I included patients with low-flow anaesthesia and group II included patients with high-flow anaesthesia. In all patients the cerebral oximetry was measured separately for each cerebral hemisphere; the bispectral index (BIS), heart rate, blood pressure, end-tidal carbon dioxide concentration and haemoglobin oxygen saturation were monitored. RESULTS: Heart rate, blood pressure, end-tidal carbon dioxide concentration and saturation were similar in both groups and the differences between them were statistically insignificant. The BIS values were similar in both groups and indicated that patients who underwent low-flow anaesthesia were not exposed to a higher risk of awakening during the procedure than the high-flow anaesthesia patients. The changes in brain oximetry values were similar in both low-flow and high-flow anaesthesia. CONCLUSIONS: Use of both low-flow and high-flow rate general anaesthesia provided patients undergoing laparoscopic cholecystectomy proper oxygenation of the central nervous system, adequate sleep depth and haemodynamic stability.

[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.

Computed tomography colonography - reasons for different and false results.

Computed tomography colonography (CT colonography) is one of the latest radiological methods of colorectal diagnostic imaging. Many studies confirmed a high efficacy of CT colonography in diagnosing colorectal polyps and tumors. However, this imaging method is not devoid of false diagnoses. Our paper presented the main causes of false results, causes of heterogeneity of the results among centres, as well as ways of avoiding them.

[Early results of surgical treatment of haemorrhoids at use of harmonic scalpel]. / Wczesne wyniki operacji zylaków odbytu przy uzyciu noza harmonicznego.

AIM OF THE STUDY: To estimate the usefulness of harmonic scalpel during operation of haemorrhoids. MATERIAL AND METHODS: It presented material 37 patients, 23 women and 14 men, in average from 28 for 76 year, middling 53 year. Operated by harmonic scalpel in haemorrhoids dissease. During the study was evaluate pain scale (NRS), hospitalization time, consumption of analgesics, postoperation complications, time needed to resume regular professional activity. RESULTS: At the 1st, 2st, 1th postoperative mean intensity of pain was respectively: 2.3, 1.2, 1.0 Mean consumption of metamizole during the 1st postoperative day was 2.7 g/24, but to II day 1.1 g/24. Mean consumption of pethidine on the 1st postoperative day was 70.9 mg/24, but to II day 37.8 mg. Time of procedure evaluated from 10 for 44 minutes (median 26,9 minutes). Seven patients was bleeding from operation field. Postoperation complications has been appeared in 10 patient, including: bleeding (6 patients), leak from anal canal at 3 patients and anoderm mucosal oedema at one patient. CONCLUSIONS: Using of harmonic scalpel in hemoroidectomy procedure is technically simple and safe procedure.

[Comparison of two methods of pre-emptive infiltration anaesthesia for inguinal hernia repair]. / Ocena porównawcza dwòch metod znieczulenia nasiekowego z wyprzedzeniem u chorych operowanych z powodu przepukliny pachwinowej.

BACKGROUND: Intraarticular injection of neostigmine has been reported to create long-lasting analgesia due to the blockade of muscarinic receptors and neuronociceptive transmitters. The aim of the study was to determine if similar effects could be achieved after adding neostigmine to bupivacaine during infiltration of the surgical area before inguinal hernia surgery. METHODS: Ninety patients (82 males and 8 females), aged 20-88 (mean 54.8) years, scheduled for Lichtenstein hernia surgery under spinal anaesthesia, were randomly allocated to three groups. The surgical area was infiltrated with 10 mL of 0.5% bupivacaine in group 1, or 10 mL of 0.5% bupivacaine with 0.5 mg neostigmine in group 2. Patients in the control group did not receive local infiltration. Postoperative pain was assessed using a numerical rating scale (NRS), and adjective rating scale (ARS) and the need for rescue analgesia (ketoprofen or pethidine) was recorded. RESULTS: The patients of group 1 required rescue analgesia significantly later, compared to the other two groups. Intense pain occurred less frequently in group 1 and the most frequently in group 3. The need for rescue analgesia was also least in group 1 and greatest in group 3. CONCLUSIONS: Neostigmine added to bupivacaine had no effect on analgesia after pre-emptive local wound infiltration.