Endoscopic changes in patients diagnosed with acute pancreatitis.

BACKGROUND: There have been long debates on the introduction of proton pump inhibitors into acute pancreatitis therapy as standard treatment. The aim of the study was to assess endoscopic lesions of the upper gastrointestinal tract in patients hospitalized for acute pancreatitis. METHODS: We carried out a prospective analysis of patients hospitalized in one surgical center who had an upper gastrointestinal tract endoscopic examination performed during the first 48 hours of hospitalization. We performed analysis of basic descriptive statistics along with the Shapiro-Wilk Test, logistic order regression analysis, One-Way Analysis of Variance, and Student's t-test for independent trials. RESULTS: From January 2016 to December 2019, 476 patients were hospitalized because of acute pancreatitis. The upper gastrointestinal tract endoscopic examination was performed in 85 patients (N.) in the first 48 hours. From the examined group 45 patients (52.94%) developed mild acute pancreatitis, 28 (32.94%) moderate pancreatitis, and 12 (14.12%) severe pancreatitis. Lesions in the endoscopic imaging were observed in 80 patients (94.12%). CONCLUSIONS: A very high percentage of patients hospitalized for acute pancreatitis present lesions in the endoscopic imaging of the upper gastrointestinal tract. The standard treatment of AP is the administration of non-steroidal anti-inflammatory drugs, which themselves can cause gastric and duodenal mucosal defects. All these factors indicate the need for standard use of proton pump inhibitors in patients hospitalized for acute pancreatitis.

Does neuromonitoring affect voice quality in patients subjected to a complete thyroidectomy ?

Voice dysfunction is the most common complication of thyroid surgery. The use of intraoperative neuromonitoring (IONM) is to protect the recurrent laryngeal nerves, the damage of which causes voice dysfunction. The aim of the study was to evaluate voice quality in patients who underwent complete thyroidectomy operated on with the application of IONM as well as a group of patients operated on with only macroscopic nerve visualization. In the analysis, clinical voice assessment was performed with particular focus on voice efficiency using the Voice Handicap Index (VHI), Vocal Tract Discomfort (VTD) and GRBAS scale. The study group consisted of 205 patients operated on with IONM. The control group consisted of 162 patients subjected to surgery only with macroscopic visualization of recurrent laryngeal nerves, without IONM. During the follow-up period from 2 to 10 years after surgery, checkups were performed. Each patient who came for a checkup was subjected to perceptual voice evaluation with the use of the GRBAS scale, indirect laryngoscopy procedure and voice selfevaluation with two questionnaires (VHI and VTD). The frequency of vocal fold palsy did not differ significantly statistically in the study group and the control group. Both in the study group and in the control group, patients with vocal fold paralysis had statistically significantly higher results in the VHI and VTD questionnaires as well as in the GRBAS study. Patients with recurrent laryngeal nerve injury show significant differences in the scope of voice handicap, both in the voice quality assessment with the use of the GRBAS scale, and self-evaluation questionnaires: VHI and VTD. All voice disorders evaluated with self-assessment are medium voice disability.

GERD-A Burning Problem after Sleeve Gastrectomy?

BACKGROUND: Surgical treatment is the most effective method of treatment for obesity; and laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric surgery. OBJECTIVE: The aim of the study was evaluation of the frequency of occurrence and the degree of progression of changes characteristic of GERD in patients who had undergone LSG in clinical; endoscopic; and microscopic images in the obtained bioptats; and an attempt to correlate the results obtained with the effectiveness of bariatric treatment. MATERIALS AND METHOD: The anonymized clinical data concerning 214 patients who had undergone LSG were collected from the database. Invitations for check-up examinations were distributed, to which 37 patients responded. Two patients were excluded from the study. In 35 patients after LSG check-up clinical examination, bariatric endoscopy (BE) and bariatric microscopy (BM) were performed on bioptats collected from the site of the gastro-esophageal junction; and 3 specimens collected at 2 cm intervals from the Z-line. The study was performed according to the standard protocol. RESULTS: In the analyzed group, clinical symptoms of GERD occurred in 12 patients (34.5%), including 10 females and 2 males. The symptom reported by all patients was retrosternal pain/burning (heartburn). In BE, foci of ectopic mucosa in the epicardial part of the esophagus were found in 16 patients (14 F and 2 M). No correlation was observed between the analyzed parameters and the occurrence of the above-mentioned changes. In BM, only in three patients were the changes described as normal esophageal mucosa; while in another three, as foci of intestinal metaplasia, Barrett's esophagus. In this group no foci of dysplasia were found. In eight patients, the changes were described as inflammatory. In ten patients from this group, microscopic changes occurred without clinical symptoms of the disease. CONCLUSIONS: GERD is an important clinical problem in patients after LSG; therefore; the problem of occurrence or exacerbation of symptoms of the disease should be discussed with the patient during qualification for bariatric surgery. The bariatric effectiveness of LSG does not correlate with the occurrence of the symptoms of GERD after the procedure. However; the lack of clinical symptoms of the disease does not mean the lack of its occurrence. Therefore; the endoscopic check-up after LSG should be routinely performed. During the qualification for LSG screening, histopathologic examinations of the esophagus may be useful for the assessment of the microscopic symptoms of GERD in oligosymptomatic patients; and exclusion of rare pathologies of the esophagus (e.g., eosinophilic esophagitis), which may complicate post-operative course.

Tumors of the right atrium and the inferior vena cava operated in deep hypothermic circulatory arrest.

<b>Introduction:</b> Tumors which most frequently metastasize to the heart include: malignant melanoma, lung cancer, breast cancer, ovarian cancer, kidney cancer, leukemia, lymphomas and esophageal cancer. <br><b>Purpose:</b> The purpose of this paper was clinical analysis of a group of patients operated in deep hypothermic circulatory arrest due to tumors of the right atrium and the inferior vena cava. <br><b>Material and method:</b> The study covered 7 patients operated at the Cardiac Surgery Clinic with a cardiac tumor diagnosed on the basis of an echocardiographic assessment in the years 2012-2019. Before qualifying for surgical treatment, each patient underwent: thorough interview and physical examination, 12-lead ECG, laboratory tests and echocardiography. Patients additionally underwent: computed tomography of the chest or abdomen, magnetic resonance imaging and coronary angiography on the basis of which patients with significant coronary artery changes underwent simultaneous coronary artery bypass graft. After preparation, the tumor was excised from the vena cava and right atrium with simultaneous removal of the primary tumor, most often kidney cancer. Early and distant results of treatment were analyzed in the examined group of patients to determine the following endpoints: hospital mortality and survival after surgery: after 3 months and 12 months. <br><b>Results:</b> Of all operated patients: 2 individuals died in the early postoperative period due to hemorrhagic complications (hospital mortality - 28.6%), and 5 patients (71.4%) were discharged from the Clinic in a good general condition. In total, 3-month survival was 71.4%, and 12-month survival amounted to 28.6%. <br><b>Conclusions:</b> Surgeries are very complex and challenging, and usually take on average 8-10 hours. It can improve the outcomes of palliative oncological treatment, better physical function (cardiovascular fitness) and extend life from several months to several years in more than ²/3 patients.

The Effect of Bariatric Surgery on Weight Loss and Metabolic Changes in Adults with Obesity.

Methods of treating obesity, such as changes in lifestyle, physical activity, restrictive diets, and psychotherapy, are not sufficient. Currently, it is considered that in the case of patients who meet the eligibility criteria for surgery, the treatment of choice should be bariatric surgery. The aim of this study was to assess the weight loss and metabolic changes in a group of adults with obesity undergoing bariatric surgery. The study involved 163 patients whose body mass index (BMI) exceeded 40 or 35 kg/m2, concurrent with at least one metabolic sequelae. In 120 of the cases (74%), sleeve gastrectomy was used; in 35 (21%), gastric bypass was used; and in 8 (5%), laparoscopic Roux-en-Y bypass was used. Metabolic parameters such as total cholesterol, LDL-cholesterol (low-density lipoprotein cholesterol), HDL-cholesterol (high-density lipoprotein cholesterol), triglycerides, and glucose were measured preoperatively and postoperatively, as well as the creatinine, creatine kinase (CK-MB), and leptin activity. In patients undergoing bariatric surgery, a significant decrease in excess weight (p < 0.001) was observed at all the analyzed time points, compared to the pre-surgery value. Weight loss after surgery was associated with a significant improvement in glycemia (109.6 ± 48.0 vs. 86.6 ± 7.9 mg/dL >24 months after surgery; p = 0.003), triglycerides (156.9 ± 79.6 vs. 112.7 ± 44.3 mg/dL >24 months after surgery; p = 0.043) and leptin (197.50 ± 257.3 vs. 75.98 ± 117.7 pg/mL 12 months after surgery; p = 0.0116) concentration. The results of the research confirm the thesis on the effectiveness of bariatric surgery in reducing excess body weight and improving metabolic parameters in patients with extreme obesity.

Can urea breath test (UBT) replace rapid urea test (RUT)?

BACKGROUND: Helicobacter pylori (Hp) is classified by the International Agency for Research on Cancer (IARC) as a Group 1 carcinogen. Its influence on the carcinogenesis of gastric cancer has been confirmed in many researches. The conclusion is obvious- early detection and eradication of Hp can prevent the development of the disease. METHODS: The objective of the study was to analyse the clinical and practical value of Carbon-13 urea breath test (UBT) in patients hospitalized due to pain complaints in the upper abdomen and dyspeptic symptoms. Fifty patients were enrolled in the study. Each patient underwent urea breath test according to the instruction included by the producer. Thereafter, each patient included in the study group was performed endoscopy of the upper gastrointestinal tract with the biopsy of the mucosa to determine the urease activity with rapid urease test (RUT). RESULTS: In the study group, 14 patients (28%) achieved a positive urease test result which was confirmed in RUT. Four (8%) patients, despite a positive breath test, did not have a positive result in urease activity from gastric mucosa. In 2 cases (4%) despite negative result of UBT there was urease actitvity confirmed in gastroscopic sections. The remaining 30 patients (60%) had a negative result in both studies. CONCLUSIONS: The limited availability of the gold standard for diagnostics of upper gastrointestinal tract diseases (gastroscopy) is the basis for the search for new methods for the detection of Helicobacter pylori infection. The urea breath test is a method of high sensitivity and specificity. The positive result of urea breath test may be the basis for the inclusion of eradication therapy.

Reoperations in bariatric surgery - indications and initial evaluation of postoperative complications.

UNLABELLED: Obesity, at present, seems to be a very serious health problem all over the world. The surgery is said to be the most successful treatment of obesity. With the increase in the quantity of conducted bariatric procedures, the number of revision treatments increases as well. The aim of the study was to analyze the indications, results and complications after repeated bariatric surgeries. MATERIAL AND METHODS: The repeated bariatric procedures performed in 2009-2015 have been retrospectively analyzed. The endpoint of the study was the evaluation of early surgical treatment results-up to 30th day after repeated surgery. RESULTS: Overall, amongs 103 obese patients with a BMI over 35 kg / m2, qualified for bariatric treatment 7 revision surgeries were conducted (6.8%). Two operations were carried out by laporotomy, other by laparoscopy. In the study group, neither any deaths were noted in perioperative period nor life-threatening complications. The frequency of complications-Surgical site infection and bleeding from the staple lines of stapler in the study group appeared to be 28.6%. CONCLUSIONS: Qualification for repeated bariatric surgeries should be based on a thorough analysis of the condition of the patient, previous outcome of the bariatric treatment: evaluation of weight loss as well as possible complications of the original surgery.