The correlation of protein peroxidation with morphological changes in experimental oestradiol-induced carcinogenesis.

Oestradiol-induced male Syrian hamster carcinogenesis is a well-known experimental model of human cancer of the breast, ovary and uterus. The pathomechanism postulated in this model is 4-hydroxylation of oestradiol and further free radical formation. The same process is suspected in human breast cancer. Dynamic changes in protein peroxidation were reported during the tumour induction. In this paper we try to correlate the protein peroxidation markers with the histopathological progression of the changes. The biochemical and histopathological evaluations were performed after 1, 3, 6 and 9 months of the hormone exposition. Significant protein peroxidation was observed as soon as after 1 month and increased further until the 6th month. After 9 months however, it was not significantly different from the control. The discrete histopathological changes after 1 month, progressed into tubular and interstitial hyperplasias after 3 and 6 months. After 9 months several dysplastic areas, sometimes with features of carcinoma in situ, were observed. The severe 9-month histopathological changes did not correlate with the protein peroxidation.

[Endoscopic dilatation of benign gastrointestinal anastomotic stenosis with hydraulic balloon]. / Endoskopowe leczenie lagodnych pooperacyjnych zwezen przewodu pokarmowego przy uzyciu balonu hydraulicznego.

Incidence of postoperative anastomotic stenosis range from 5 to 30 percent though most of them are not clinically relevant. Strictures of gastrointestinal tract (GI) within reach of the endoscope may be treated successfully with dilatation. The aim of the study was to evaluate the technique of endoscopic balloon dilatation in the treatment of GI anastomotic strictures. The procedure of endoscopic dilatation was performed in 17 patients with obstruction due to the postoperative stricture of anastomosis. In 11 patients stenoses were localized in the lower and in 6 patients in the upper digestive tract. In all cases the stricture was caused by scar tissue and had benign character (confirmed by computed tomography and biopsy). Endoscopic hydraulic balloon dilatation was performed using a pressure of 2 atm. All dilatations of the upper digestive tract strictures were successful with immediate relieve of symptoms. In 4 patients with high grade stenoses after low anterior resection of the rectum anastomotic strictures did not dilate after endoscopic treatment. No complications of endoscopic dilatations were observed. Endoscopic balloon dilatation is useful in the treatment of symptomatic gastrointestinal anastomotic stenosis, but good results are expected only in low grade strictures.

New comprehensive surgical curriculum of pre-graduate surgical education.

INTRODUCTION: Surgical education has become one of the most important directions in modern surgery evolution. To meet growing need for appropriate training in laparoscopic and, even more importantly, classic surgical skills, a curriculum involving contemporary tuition methods is needed. Advanced, structuralised training, which includes advanced technologies like virtual reality training, video coaching and motivative aspects of competition, seems to be important for an adequate education programme. MATERIAL AND METHODS: In academic years 2009/2010 and 2010/2011 the Department of General, Endocrine and Transplant Surgery of the Medical University of Gdansk together with the Pomeranian Foundation for Progress in Surgery organized 4480 h of training in that area of classic (2744) and laparoscopic (1736) skills. Both groups were involved in the programme of training in which the two most important aspects were reliable evaluation of the results and effective motivation to work. Skill evaluation at different stages of the programme were based on completion time and quality measurements. Apart from that, at the end of the course, the participants completed a questionnaire on their subjective perspective on this innovative curriculum, the quality and stability of the skills they obtained. RESULTS: In both arms of the programme (laparoscopic and classic) a statistically significant improvement was obtained as early as after the second and third sessions in half of the exercises. The acquired skills were stable over time, as proved by the plateau of completion time achieved in 11 out of 12 exercises. The results of the post-training questionnaire revealed that the participants were very satisfied with the structuralised form of training and appreciated the motivational role of competition. CONCLUSIONS: Contemporary surgical training should be organized as a systematic, well-evaluated and goal-oriented programme similar to the one proposed by our team. The use of contemporary training aids should be utilized in training of every surgical skill, not only laparoscopy. This form of training, associated with the component of competition, enables good and stable results to be achieved, as well as high satisfaction of trainees.

Single incision laparoscopic surgery - is it time for laboratory skills training?

INTRODUCTION: With the introduction of new surgical equipment, there is always the need for new, more advanced training. The authors try to answer whether the use of the newest generation tools has an impact on achieving better results in single incision laparoscopic surgery (SILS) technique during the exercises in the surgical skills laboratory. MATERIAL AND METHODS: There were 51 participants in the study: 44 'novices' and 7 'experts'. All subjects performed the 'advanced grasping' exercise according to the FLS programme manual using four types of laparoscopic approach including two SILS ports and SILS-dedicated instruments. The outcome measures involved task completion time and the number of errors. RESULTS: Tasks using straight laparoscopic instruments set together with classic three-port access as well as SILS access ports were finished significantly faster when compared with SILS-dedicated instruments (p < 0.05). There were no significant differences in performance times between the two setups with straight instruments (p < 0.05) and both setups with SILS-dedicated instruments, irrespective of the use of curved or dynamic articulated tools. Students with no previous laparoscopic experience had significantly worse task completion times in all tasks in comparison to students with laparoscopic laboratory training and the 'experts' group. CONCLUSIONS: The use of the straight instruments in the SILS technique remain similar to its performance in full triangulation. SILS-dedicated instruments paradoxically increase the task completion time irrespective of possessed skills. The study showed the necessity of a SILS-dedicated tools training programme.

Structuralized box-trainer laparoscopic training significantly improves performance in complex virtual reality laparoscopic tasks.

INTRODUCTION: In the era of flowering minimally invasive surgical techniques there is a need for new methods of teaching surgery and supervision of progress in skills and expertise. Virtual and physical box-trainers seem especially fit for this purpose, and allow for improvement of proficiency required in laparoscopic surgery. MATERIAL AND METHODS: The study included 34 students who completed the authors' laparoscopic training on physical train-boxes. Progress was monitored by accomplishment of 3 exercises: moving pellets from one place to another, excising and clipping. Analysed parameters included time needed to complete the exercise and right and left hand movement tracks. Students were asked to do assigned tasks prior to, in the middle and after the training. RESULTS: The duration of the course was 28 h in total. Significant shortening of the time to perform each exercise and reduction of the left hand track were achieved. The right hand track was shortened only in exercise number 1. CONCLUSIONS: Exercises in the laboratory setting should be regarded as an important element of the process of skills acquisition by a young surgeon. Virtual reality laparoscopic training seems to be a new, interesting educational tool, and at the same time allows for reliable control and assessment of progress.

Biliary versus alcohol-related infected pancreatic necrosis: similarities and differences in the follow-up.

OBJECTIVES: Infected pancreatic necrosis (IPN) is a serious complication of acute pancreatitis. Data concerning survivors' quality of life and pancreatic functions are scarce. Follow-up of the patients with alcohol and biliary etiology of IPN treated with open necrosectomy was performed. METHODS: Twenty-eight survivors after operative treatment (Bradley procedure) of IPN were followed up 24 to 96 months after discharge from the hospital (10 biliary and 18 alcohol patients). Their exocrine and endocrine pancreatic functions and quality of life (Functional Assessment of Chronic Illness Therapy scale) were evaluated. Pancreatic tissue remaining after necrosectomy was visualized by use of contrast-enhanced computed tomography (CT). RESULTS: In 44.4% of alcohol-induced IPN patients, the presence of the whole pancreas was shown on the follow-up CT, contrary to the biliary group, where the partial lack of the pancreas was observed in all cases. Pancreatic tissue calcifications were present on CT in 8 patients of alcohol-induced acute pancreatitis group only. Median stool elastase 1 concentrations were 318.1 U/mL in the biliary group and 238.3 U/mL in the alcohol-induced group (not significant). The Functional Assessment of Chronic Illness Therapy scale showed significantly higher social/family and emotional well-being in patients with biliary acute necrotizing pancreatitis. CONCLUSIONS: Patients after alcohol-induced IPN had lower quality of life compared with biliary etiology. Biliary and alcohol-induced IPN patients after surgical treatment have nonsignificant differences of endocrine and exocrine pancreatic functions.

New prognostic scales LAST-1 and LAST-2: supporting prediction and staging of thyroid cancer.

INTRODUCTION: Epidemiologically, thyroid gland tumors are lesions of the highest importance among endocrine tumors in humans. Although the results of surgical treatment of the highly differentiated (follicular and papillary) tumors seem to be satisfactory, treatment of the poorly differentiated (medullary and anaplastic) tumor still demands clinical and basic investigations. In this study the authors sought to evaluate clinical and molecular factors that could contribute to preoperative detection of more advanced thyroid cancers (i.e., those that exhibit extrathyroid spread and lymph node invasion). METHODS: A total of 27 patients operated on for thyroid cancer were evaluated according to age, sex, time from the onset of the disease, cytogenetic changes, and loss of heterozygosity (LOH) in 14 microsatellite markers. The output variables were defined according to postoperative findings and the TNM 2002 score. The T1-2 N0 M0 cases were defined as local malignancy (LM); and T3-4 any N any M, any T N1 any M, or any T any N M1 were considered advanced malignancy (AM). The control groups consisted of 25 patients with multinodular goiter (MNG) and 32 patients with follicular adenoma (FA). In all cases, clinical and molecular data similar to those listed above were collected, excluding staging and follow-up information. RESULTS: There was no predominant specific type of chromosomal aberration observed and no marker lost in more than five patients (18%). The logistic regression identified three input variables as contributing significantly to the dichotomized outcome measure (LM vs. AM): LOH in any of the examined loci, age of the patient at the presentation, and the sex of the patient. Furthermore, discriminant analysis revealed four input variables differentiating among TC, FA, and MNG patients. Based on the multivariate analysis results, two numeric prognostic scales were fashioned: LAST-1, a scale applicable to differentiation of thyroid cancers at different degrees of clinical advancement; and LAST-2, a scale applicable to differentiation of any thyroid lumps. CONCLUSIONS: It was concluded that LOH and the age and sex of the patients can provide sufficient data to predict thyroid cancer with a high degree of clinical advancement. LAST-1 scale is a reliable tool for identifying these patients. The LAST-2 scale gives supportive information about the character of thyroid lumps, distinguishing TC from MNG and FA.

Pancreatitis following heart transplantation: report of a case.

Serious complications involving the alimentary tract following cardiac transplantations are commonly reported, and may be associated with significant morbidity and mortality. One of the most serious gastrointestinal complications in such patients is acute pancreatitis. There is still little known concerning its pathogenesis, early diagnosis, and the most appropriate treatment for this clinical condition. Many authors have reported a high mortality caused by difficulties in making an accurate diagnosis resulting in the use of inappropriate therapy for so called crypto-symptomatic acute pancreatitis. The factor suspected to be responsible for the increased frequency of the gastroenterological diseases and for their masked onset seems to be immunosuppression, especially by corticosteroids. The case of a 46-year-old male patient with cardiac transplant, who, 3 years after the transplantation, developed mild acute pancreatitis, is presented. The immunosuppressive regimen he followed was based on cyclosporine. The acute pancreatitis was treated conservatively with a satisfactory outcome. In the course of the illness the patient developed a pancreatic pseudocyst that was managed successfully by percutaneous drainage. The patient is currently being followed up, and both his medical ailments and health-related quality of life are being monitored, while he continues to show mild symptoms of chronic pancreatitis.

Quality of life improvement after videothoracoscopic splanchnicectomy in chronic pancreatitis patients: case control study.

The authors report on the effectiveness of videothoracoscopic splanchnicectomy (VSPL) as a method of pain treatment in patients with chronic pancreatitis (CP). A minimally invasive technique, VSPL is used in CP as an alternative method of pain treatment. The aim of the investigation was to evaluate by a prospective, semirandomized case-control study the influence of VSPL on the quality of life and the level of pain suffered by patients with CP. The study groups consisted of 32 patients who underwent VSPL between March 2000 and January 2001 and a control group of 32 CP patients who received conservative treatment. The effect of the therapy on subjective pain measures and multiparametric quality of life was measured before VSPL and throughout the first year thereafter. In the follow-up period there was a significant decrease in intensity of pain and an improvement in the quality of life of the patients-most significantly concerning emotional well-being and functioning in everyday life. We conclude that the VSPL is a safe, effective, and minimally invasive procedure and recommend that it be used in such cases.