Karolina Dorobisz

Incidental gallbladder cancer after cholecystectomy: 1990 to 2014

Introduction Cancer of the gallbladder is a serious diagnostic and therapeutic problem. According to the literature, 30% of cases are not confirmed before surgery. Other cases are detected incidentally by histopathology. Clinical trials and meta-analyses show that incidental gallbladder cancer (iGBC) occurs in 0.19%–2.8% of patients after cholecystectomy. The aim of this study was to analyze the incidence and severity of iGBC in cholecystectomy procedures performed in the surgical department at the 4th Military Teaching Hospital in Wroclaw during the years 1990–2014. Patients and methods In the years 1990–2014, a total of 7,314 cholecystectomies were performed in the surgical department because of cholecystolithiasis: 6,145 were performed using the laparoscopic approach (84.02%), 867 were performed as open surgery (11.8%), and 302 cases required conversion (5.1%). In this group, 5,214 of the patients were females (71.3%) and 2,100 were males (28.7%), with an average age of 54.7 years. Results We found 64 iGBC cases which were confirmed by histopathology. This represented 0.87% of all cases. In this group, 50 patients were females (78.1%) and 14 were males (21.8%), with an average age of 67.1 years. Of this group, 40 patients underwent a classic cholecystectomy, while 24 underwent laparoscopic procedures, out of which 13 cases ultimately required traditional surgery. The histopathology showed 15 carcinomas that were classified as G1 (23.4%), 28 were G2 (43.75%), and 21 were G3 (32.8%). Conclusion iGBC detected after a cholecystectomy due to cholecystolithiasis is a rare disease. We found iGBC in 0.87% of cases, which is on a comparable scale to the world literature. In the case of cancer, we frequently found it necessary to convert to an open surgical procedure. This cancer is more common in females and in people over 60 years of age.

An evaluation of the diagnostic efficacy of fine needle aspiration biopsy in patients operated for a thyroid nodular goiter

Background Thyroid cancer (TC) comprises 1% of all carcinomas and is the most common malignancy of the endocrine system. The disease is more common in women, with its peak morbidity observed in 40–50-year-old patients. The main risk factors include radiation, iodine deficiency, hereditary background, and genetic mutations. Among all diagnosed thyroid nodules, 5%–30% will evolve into cancer. The gold-standard procedure in the preoperative evaluation of a nodular goiter, apart from ultrasonography, is fine needle aspiration (FNA) biopsy. The FNA biopsy is favored for its simplicity, safety, and high specificity and sensitivity rates. Aim The aim of our study was to evaluate the clinical efficacy of FNA based on the patients’ register. Materials and methods In the Department of Surgery at the 4th Military Teaching Hospital in Wroclaw, 2,133 patients underwent thyroid surgery for thyroid goiter between 1996 and 2015. One hundred and eight cases of TC were diagnosed and of these, 66 patients had a preoperative FNA. Results Fourteen FNA biopsies (21%) revealed cancer, all of which were confirmed in the postoperative histopathology, although six cases of FNA-diagnosed cancer revealed a different histological type postoperatively. Eighteen FNA biopsies (27%) were suspected of being malignant. A disturbingly high rate of “benign” FNA biopsies (32 cases; 48%) revealed TC after surgery. Conclusion It is of great importance that the quality and quantity of FNA biopsies that are performed have been improved, especially due to the wide adoption of the Bethesda cytological evaluation system. FNA biopsy remains an obligatory and valuable diagnostic tool in thyroid nodules, but it is still insufficient as a standard procedure. A preoperative biopsy should always be related to all the available clinical data in order to provide the best treatment option for each patient individually.

Ex vivo pyelotomy, nephroscopy and holmium laser lithotripsy of a staghorn stone in a donor kidney prior to renal transplant

This case report presents the diagnostic and treatment procedures of stone removal from the kidney of a 67-year-old donor, the transplantation of the kidney to a 65-year-old recipient, and the postoperative course until the end of hospitalization. Computed tomography performed before collecting the organ showed a staghorn stone in the renal pelvis and lower calyces in the right donor kidney. The stones were removed ex-vivo using a rigid ureteroscope and a holmium laser prior to transplantation. Then the organ was transplanted to the left iliac fossa of a 65-year-old man with end-stage renal failure. The authors think there is a possibility of increasing the kidney pool, by using organs containing large calculi. In such cases stones should be removed before the operation and the patient should be monitored regularly, especially in the first months after the transplant.

The cytokines within the carotid plaque in symptomatic patients with internal carotid artery stenosis

The aim of the study was the evaluation of the inflammatory cytokines within atheromatic carotid plaque.Materials and methodsThe experiment was carried out on 100 symptomatic patients with internal carotid artery stenosis that underwent carotid endarterectomy. Every patient had the wall of the carotid artery resected during organ harvesting surgery in order to evaluate some cytokines (TGF-β, VEGF, FGF, TNF-α) and to perform the immunohistochemistry (IHC). An immunoreactive score (IRS) was calculated based on the staining intensity and the number of cells stained. Over a 3-year period, 7 patients died, and 2 patients were lost to follow-up. The study group consisted of 91 patients. The control group comprised 20 young organ donors with confirmed death brain, who had their normal carotid artery sampled.ResultsIn all healthy donors (control group) with normal carotid arteries the three cytokines (TGF-β, VEGF, TNF-α) were not discovered. The presence of FGF was confirmed in 25% of healthy donors, probably due to an intima fibroblasts activity, responsible for the synthesis of elastin and collagen to the extracellular matrix (ECM). Only three cytokines (TGF-β, FGF, TNF-α) were found within atheromatous plaques (study group).ConclusionsOur research confirmed that these factors may accelerate the development of atheromatic plaque and its destabilisation.

Carotid artery stenting versus endarterectomy for the treatmentof both symptomatic and asymptomatic patientswith carotid artery stenosis: 2 years’ experience in a high-volume center

BACKGROUND Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the 2 current standard treatments for carotid artery stenosis. There is still no well-defined consensus with regard to their superiority. However, the minimally invasive nature of endovascular treatment makes CAS increasingly popular among vascular surgeons. OBJECTIVES The aim of the study is to compare the safety and efficacy of CEA and CAS in patients with symptomatic and asymptomatic carotid artery stenosis. MATERIAL AND METHODS A single-center, retrospective analysis of patients who were treated for carotid artery stenosis using CAS or CEA between January 2014 and December 2015 was carried out. There were 471 patients (266 CEA and 205 CAS) who were eligible for inclusion. The vast majority of the patients had significant (>70%) stenosis of the internal carotid artery (92.1% of CEA and 87.8% of CAS). The occlusion of the contralateral carotid artery was observed in 9.8% of all cases (2.6% of CEA vs 17.7% of CAS). RESULTS The occurrence of complications, such as stroke, myocardial infarction (MI) and death, did not vary statistically between the groups. There were 9 events of stroke in the CEA group (3.4%) and 8 in the CAS group (3.9%), 3 of which were fatal. There were no significant differences between the 2 groups (χ2 = 0.76; p > 0.05). There was no higher risk of mortality in any group (Fishers exact test; p = 0.08). Symptomatic patients had a higher incidence of stroke than asymptomatic patients across both groups (χ2 = 6.36; p < 0.05; hazard ratio 3.03 (1.26-7.33)). CONCLUSIONS Carotid endarterectomy is equally effective as CAS in stroke prevention, but is associated with a higher incidence of cranial nerve palsy, access site hematoma and other non-stroke complications. Symptomatic patients had a higher incidence of stroke, regardless of the treatment method.

Evaluating the Hearing of Patients with Pseudoexfoliation Syndrome.

BACKGROUND It is estimated that pseudoexfoliation syndrome (PEX) occurs in 10-20% of the general population over 60 years of age, and its morbidity increases with age. Some research indicates that PEX may be a systemic disease. Some experts state that it can also lead to ear dysfunction. OBJECTIVES The aim of the study was to evaluate the incidence and type of hearing disorders in patients with PEX. MATERIAL AND METHODS The study included 51 patients (102 eyes) hospitalized in Wroclaw Medical University Hospitals Department of Ophthalmology and scheduled for cataract surgery in 2012-2014. Among these patients (whose age ranged from 55 to 92), 28 had PEX and 23 served as a control group. Both groups underwent ophtalmic examinations as well as ENT inspection and audiological tests (tonal audiometry, impedance audiometry, distortion product otoacoustic emission tests [DPOAE] and auditory brainstem response tests [ABR]). RESULTS A statistically significant increase in the threshold of hearing in pure-tone audiometry was observed in PEX group for 2 kHz. In impedance audiometry tests, the stapedius reflex was identified in a greater proportion of patients in the PEX group than in the control group in all frequency ranges. There was no difference between the PEX groups and the control group in the results of the DPOAE and ABR tests. CONCLUSIONS PEX can be a systemic disease that affects the functioning of the inner ear causing sensorineural hearing impairment. The increased hearing threshold in pure-tone audiometry of the patients with PEX affects the speech range (mainly the frequency of 2 kHz). Impedance audiometry and pure-tone audiometry appeared useful in audiological diagnostics of patients with PEX.

The Use of Radioisotopic Tests for Diagnosing Lower Limb Venous Thrombosis – Own Research

UNLABELLED Inflammatory mediators play an important role in thrombosis etiopathology. Diagnostic radioisotopic tests can be used to assess the activity of thrombo-inflammatory process. The aim of the study was to assess the suitability of Tc-99m HMPAO labelled leukocyte scintigraphy in the diagnostics of deep vein thrombosis. MATERIAL AND METHODS The study covered 45 patients with lower limb deep vein thrombosis treated in 2009 at the Department of Vascular, General and Transplantological Surgery of the Wrocław Medical University. Scintigraphic test were performed during the first few days after the onset of symptoms and 8 weeks later. RESULTS All patients with active deep vein thrombosis had higher levels of TC-99m-HMPAO markers in sick limbs. After 8 weeks, 93% of patients still had elevated levels of radioisotope in limbs with an active thrombosis process. However, the levels of markers were clearly lower than in the acute phase of thrombosis. CONCLUSIONS 1. In the chronic phase of thrombosis, 93% of patients still have higher levels of radioisotopic markers, which indicates an active inflammatory process. 2. Tc-99m HMPAO labelled leukocyte scintigraphy demonstrates high sensitivity in the diagnostics of deep vein thrombosis.