Dorota Kozieł

Prevalence and progression of acute pancreatitis in the Świętokrzyskie Voivodeship population.

UNLABELLED Acute pancreatitis (AP) is a significant clinical problem. There have been no prospective epidemiological data on AP in Poland. The aim of this study is to estimate prevalence, etiology and severity of acute pancreatitis in the Świętokrzyskie Voivodeship population, involving risk factors of this disease. MATERIAL AND METHODS In 2011 prospective observation was conducted in all departments of surgery of the Świętokrzyskie Voivodeship. The inclusion criterion of the study, a definite diagnosis of AP, was met in 1044 hospitalized patients. According to our assumption that repeated hospitalization is considered as a new case if occurred more than 60 days after the previous one, 1004 patients were included in the further analysis. RESULTS The incidence rate was 99.96/100,000. Incidence rate among woman was 72/100,000 and incidence among men was 130.24/100,000 (p < 0.05). Median age of AP patients was 53 years. Median age among woman (65 years) was significantly (p < 0.005) higher than among man (47 years). Incidence rate for the first episode was 79.7/100,000 citizens. Main causes of AP included cholelithiasis (30.1%), alcohol (24.1%), coexisting cholelithiasis and alcohol abuse (2.9%), pancreatic cancer (1%), AP after ERCP (0.7%). Basing on modified Atlanta criteria, severe AP was diagnosed in 7%, moderate in 12.3%, and mild in 80.7% of patients. Mean duration of hospitalization of patients with severe AP was 14.8, moderate - 16,7, mild - 7.1 days. Mortality rate for AP was 3.9%. Mean age of deceased women was 74 years and was significantly higher than in the group of men (61 years). Mortality rate in severe AP was 52.9% and was significantly (p < 0.05) higher than mortality in moderate (no deaths) or mild AP (0.2%). CONCLUSIONS Incidence rate of AP in the Świętokrzyskie Voivodeship population is among the highest in Poland. Our study indicates that new Atlanta classification, that differentiates between moderate and severe AP, needs to be implemented to the clinical practice, since the latter carries high mortality in severe cases.

Prevalence of metabolic syndrome in normal weight individuals

INTRODUCTION AND OBJECTIVE The prevalence of metabolic syndrome and overweight in individuals with normal body weight is connected with higher exposure to type 2 diabetes and cardiovascular diseases. The aim of the study was to evaluate the risk and frequency of occurrence of metabolic syndrome and each of its components among individuals with normal weight. MATERIALS AND METHOD Data were obtained by structured interview, and by measurements of anthropometric factors and blood analyses among 13,172 individuals aged 37-66. The risk of occurrence of metabolic syndrome was analysed in tertiles within the normal range of BMI (18.5-24.9 kg/m2 ). RESULTS Metabolic syndrome was diagnosed in 17.27% of individuals with normal weight. A significant increase in the risk of occurrence of metabolic syndrome in females was observed within the second (OR = 2.22; 95% CI: 1.63-3.05) and the third (OR = 3.97; 95% CI: 2.97-5.36) tertiles of normal BMI values. In males, a significantly higher risk of occurrence of metabolic syndrome was noted only in the highest BMI tertile (OR = 2.16; 95% CI: 1.26-3.83), compared to the reference level. CONCLUSIONS A high frequency of occurrence of metabolic syndrome risk factors was observed among individuals with BMI close to the upper cut-off point of the normal range. In order to early diagnose metabolically obese individuals with normal weight it is necessary to check the waist circumference when BMI ≥ 22.5 kg/m2 in females, and BMI ≥ 23.8 kg/m2 in males, where abnormal values should be a signal that further examinations should be performed to determine other risk factors of metabolic syndrome.

Retrospective analysis of clinical problems concerning acute pancreatitis in one treatment center

Introduction Severe acute pancreatitis is still a difficult clinical problem, it is a challenge for medical teams, which should include the strategy of personalized medicine. In clinical observations, among patients with the fulminating course of acute pancreatitis developed during the first hours leading to irreversible multiorgan failure and death. Aim To evaluate the frequency of occurrence and analyze the progression and treatment of severe acute pancreatitis (AP) in patients hospitalized during the years 2004–2010 at the Clinical Surgery Ward. Material and methods One thousand and fifty patients treated for AP were included in the study; 97 patients with severe AP were subjected to a detailed clinical analysis. Results The average age of the patients was 52.8 years. Relapses occurred in 14.9% of patients. The severe form of acute pancreatitis was diagnosed in 97 patients, which accounts for 9.2% of all the illnesses, and occurred significantly more often in male patients (p < 0.01). The most frequent etiological factors were cholelithiasis (46.4%), and idiopathic pancreatitis (27.8%); alcohol consumption was responsible for 22.7% of the cases; the occurrence of both a bile-derivative and alcoholic factor was found in 3.1% of the cases. A worsening clinical state resulted in laparotomy in 26 patients (26.8%), and re-laparotomy in 5 patients. Necrosectomy was performed on 15 patients, of whom 33.3% died due to complications. The total mortality in severe AP was 38.1%. The average age of the deceased was 66.5. Early deaths within 14 days were noted in 78.4% of patients (n = 29) who died due to severe AP. Conclusions Severe AP in spite of implementing modern diagnosis and treatment methods is still associated with a high risk of death. Constant clinical observation and use of available prognostic scales are essential in improving AP prognoses.

Percutaneous Fine Needle Biopsy in Pancreatic Tumors: A Study of 42 Cases

The technological progress within the range of methods of pancreas imaging and their more common accessibility selects a group of patients requiring a microscopic diagnosis. Percutaneous fine needle aspiration biopsy under the control of ultrasonography (PCFNA/USG) is the method commonly used in determining the character of a focal pancreatic lesion. Aim of the Work. An assessment of the accessibility of PCFNA biopsy in the assessment of solid and cystic changes in a pancreas and the correlation of the results of imaging examination, cytological smear and concentration of a serous marker CA19-9. Material and Methodology. In our material we analysed 43 cases of tumors of the pancreas among the patients who were at the average age of 59 ± 10.4 (14 women, 28 men) diagnosed by PCFNA biopsy. Results. In a group we are 23 cases of cancer, 12 cases of inflammation and 7 cases of cellular atypia for which 2 cases of IPMN were included. The sensitivity of the method was 92.5% but specificity was 68%. In our opinion PCFNA/USG is a method of the comparable sensitivity and specificity with fine needle aspiration biopsy with EUS control and its efficiency depends to a considerable degree on experience and interdisciplinary collaboration.

Coffee consumption and the occurrence and intensity of metabolic syndrome: a cross-sectional study

Abstract The objective of the study was to investigate associations between coffee consumption and the occurrence of metabolic syndrome (MetS) and its components in individuals with a normal BMI, as well in those who are overweight and obese. The analysis was based on the data of 10,367 participants. The studies included a questionnaire interview, anthropometric measurements, blood pressure measurements and analyses of collected fasting-blood samples. In the overweight and obese participants, lower coffee consumption, compared with higher consumption was correlated with a significantly higher risk of abdominal obesity, hypertension, an abnormal glucose concentration, HDL cholesterol, triglycerides and MetS (p < .05). In the participants with a normal BMI, lower coffee consumption was related to the abdominal obesity, HDL cholesterol and MetS (p < .05). Individuals with a normal BMI may react slightly differently to nutritional factors modifying metabolism such as coffee, compared with those with excessive body mass.

Iatrogenic bile duct injuries – clinical problems

UNLABELLED Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures in surgical wards. Iatrogenic bile duct injuries (IBDI) incurred during the procedures are among postoperative complications that are most difficult to treat. The risk of bile duct injury is 0.2-0.4%, and their consequences are unpleasant both for the surgeon and for the patient. The aim of the study was analysis of iatrogenic bile duct injuries and methods of their repair, taking into consideration the circumstances, under which the injuries occur. MATERIAL AND METHODS The study group consisted of 16 patients who had suffered IBDI during surgery. The analysed parameters included sex, age, indications for surgery, the setting of the surgical procedure and the type of bile duct injury. Additionally, the time of injury diagnosis, type of repair and treatment outcome were assessed. The IBDI analysis used the EAES classification of injuries. The time of IBDI repair was defined as immediate, early or late,depending on the time that had passed from the injury. The analysis included complications seen after bile duct repair. RESULTS The study group consisted of 10 women and 6 men, aged 29-84. Patients underwent 6 classic cholecystectomies, 8 laparoscopic cholecystectomies, one gastrotomy to remove oesophageal prosthesis and one laparotomy due to peptic ulcer. IBDI was diagnosed intraoperatively in 4 patients. In 12 patients IBDI was diagnosed within 1-7 days. The diagnosis was based on endoscopic retrograde cholangiopancreatography and the results of biochemistry tests. According to the EAES classification, the injuries were of type 1 (4 patients), type 2 (8 patients), type 5 (3 patients) and type 6 (1 patients). Reconstruction procedures were performed during the same anaesthesia session in 3 patients, and in the early period in 13 patients. The main procedure was Roux-en-Y anastomosis (12 patients), with the remaining including bile-duct suturing over a T-tube (3 patients) and underpinning of an accessory bile duct in the pocket left after gallbladder removal (1 patient). The most common reconstruction complications included bile leak (3 patients), recurrent cholangitis (3 patients) and bile duct stricture (2 patients). Mortality in the study group was 12.5%. CONCLUSIONS The procedures of laparoscopic and classic cholecystectomy are associated with a risk of IBDI, especially in the presence of inflammatory state of the gall-bladder. IBDI is a complex complication: its treatment poses a challenge for the operating surgeon, and even the most careful treatment adversely affects the patients lifedue to complications.

Factors Associated with Adiposity, Lipid Profile Disorders and the Metabolic Syndrome Occurrence in Premenopausal and Postmenopausal Women.

The aim of the study was the assessment of the dependencies between a woman’s menopausal status and adiposity, lipid profile and metabolic syndrome occurrence, as well as finding out whether the correlations between the socio-demographic profile and lifestyle elements and adiposity, lipid profile and the risk of MetS are the same before and after menopause. A cross-sectional study was carried out on 3636 women, aged between 40–59, which involved a questionnaire interview, anthropometric measurements and fasting blood samples, on the basis of which the concentration of triglycerides, cholesterol and glucose was estimated. Before menopause, a greater adiposity (BMIβ = 0.08; %BFβ = 0.07; WCβ = 0.06) was characteristic for women living in a stable relationship than for single women. Women who smoked in the past were characterized by a higher BMI (β = 0.09) and WC (β = 0.06) in comparison with women who have never smoked, while after menopause a greater adiposity (%BFβ = 0.12) and a worse lipid profile (TCβ = 0.08; LDLβ = 0.07; HDLβ = -0.05; TGβ = 0.14) were present in women currently smoking, in comparison to women who have never smoked. After menopause, in women who had two or more children, a greater adiposity (BMIβ = 0.07 and 0.09; %BFβ = 0.05 and 0.07) and a higher risk of MetS (OR = 1.22, 95%CI: 1.03–1.44) was observed compared to nulliparous women, than before menopause. In women with a higher level of education, the risk of MetS after menopause was significantly lower compared with women with a lower level of education (OR = 0.74, 95%CI: 0.61–0.90). Physical activity after menopause had a higher influence on the decrease in the women’s adiposity (BMIβ = -0.11 v. -0.06; %BFβ = -0.11 v. -0.06; WCβ = -0.14 v. -0.08), than before menopause. In women not undergoing hormone replacement therapy, some of the socio-demographic factors and lifestyle elements affected adiposity, lipid profile and the risk of MetS differently before and after menopause, which requires verification through long-term research.

The Risk of Surgical Treatment in Patients Aged 85+, with Special Consideration of Colorectal Cancer

UNLABELLED The increase in prevalence of chronic diseases in old age is concomitant with increasing risk of neoplasms requiring surgical treatment. The aim of the study was to assess the indications, treatment outcomes, complications and mortality associated with surgical treatment of patients aged 85 or more, with special consideration of colorectal cancer. MATERIAL AND METHODS The retrospective analysis involved a group of 94 patents (x = 88.9) aged 85 or more and treated surgically in the years 2006-2011. The results were compared with a randomly selected control group of 91 patients aged 45-75 (x = 56,4) and treated surgically in the same period. RESULTS Neoplastic diseases in the study group (85 ≥), compared with the control group (< 75), were a significantly more frequent indication for surgical treatment (p < 0.01). In the group of patients aged 85 or more, the most frequent indications for elective surgery were neoplasms of the skin and subcutaneous tissue (26.4%) and gastrointestinal neoplasms, mainly colorectal cancer (23.5%). Postoperative complications were significantly more frequent (p < 0.01) among patients aged 85 or more (n = 27; 34.8%) than in the younger group (n = 17; 18.7%). Postoperative mortality among patients undergoing emergency surgery was significantly higher (p < 0.05) in the senior group than in the group of younger patients. CONCLUSIONS Surgical procedures in patients aged 85 or more are most frequently performed in the emergency setting, and their most common cause are neoplastic diseases. Emergency surgical treatment in patients aged 85 or more is associated with a significantly higher risk, compared with younger age groups, of developing multi-organ postoperative complications, usually leading to death. Elective surgical treatment in patients aged 85+ after appropriate preoperative preparation and in the group of younger patients shows similar early outcomes.

CTRC gene polymorphism (p.G60=; c.180 C > T) in acute pancreatitis

BackgroundThe aim of the study was to determine the relationship between the presence of p.G60 = polymorphism (c.180C > T; rs497078) CTRC and the incidence together with the clinical course of acute pancreatitis (AP).MethodsTwo hundred ninety-nine people suffering from AP and 417 healthy volunteers were subjected to the study. DNA was isolated from blood samples.ResultsCTRC p.G60 = polymorphism (c.180C > T) occurred more frequently in the AP group (p = 0.015). The CT and TT genotype was found in 27.8% of the AP patients and in 19.9% of the healthy subjects (p = 0.017). No significant correlation was found between having the CT and TT genotype and the severity of the AP clinical course. In 6 patients (2%) with the CT genotype, a SPINK1 gene mutation was found, while in the control group it was found in 3 patients (0.7%), (p > 0.05). All patients with the present SPINK1 mutation with the CT genotype had a moderate or a severe course of the disease (p = 0.0007).ConclusionsCTRC polymorphism Hetero p.G60=; c.180C > T increases the risk of an AP occurrence and together with the SPINK 1 mutation, may be responsible for a more severe course of the disease.

CD63 and GLUT-1 Overexpression Could Predict a Poor Clinical Outcome in GIST: A Study of 54 Cases with Follow-Up

Background and Goals. In light of current knowledge, it seems that alternations underlying GISTs are well explained, although all that is enhanced by various aspects on a daily basis. More recently, attention has been pointed towards exosomes as important particles able to modify healthy and also diseased tissues including cancer. The goal of the present study was an analysis of CD9, CD63, and GLUT-1 as a marker of hypoxia status within 54 cases of GIST and evaluation of their predictive value. Methods. 54 cases of patients suffering from GIST were enrolled into the study, predominantly in the gastric location. All operated cases had no Imatinib and other chemotherapies up to the day of operation. Expression of targeted proteins was performed by immunohistochemistry and, after that, the results with tabulated clinical data were compared by Kaplan-Meier method and multivariate Cox proportional hazard model of statistical analysis. Results. Our results presented a marked dependence of worsening clinical outcome with high expression CD63 (p = 0.008) as well as with GLUT-1 (p = 0.014). We noted a strict correlation of GLUT-1 expression with CD63 expression (p = 0.03), which could confirm the thesis about the contribution of exosomes in intratumoural hypoxia status. The collected material did not confirm CD9 contribution. Conclusions. As presented here, CD63 and GLUT-1 have a prognostic value in GIST cases. The results confirm the other studies in this scope and can be used in future as an additional prognostic factor.