Łukasz Krokowicz

Microencapsulated sodium butyrate reduces the frequency of abdominal pain in patients with irritable bowel syndrome

Aim  Abdominal pain, defaecation disorder and change of bowel habit are the commonest symptoms of irritable bowel syndrome (IBS). The effect of microencapsulated sodium butyrate (MSB) was assessed on the severity of symptoms in patients with IBS.

Comparison of the effectiveness of the treatment using standard methods and negative pressure wound therapy (NPWT) in patients treated with open abdomen technique.

UNLABELLED Open abdomen technique is a surgical treatment in which the fascia and skin are left open in order to reduce the value of the intra-abdominal pressure. According to the World Society of the Abdominal Compartment Syndrome (WSACS) normal values of the intra-abdominal pressure are between 5 and 7 mm Hg. Intra-abdominal hypertension occurs when the pressure value is equal to or exceeds 12 mm Hg. The aim of the study was to compare the results of the open abdomen treatment using standard methods and negative pressure wound therapy. MATERIAL AND METHODS The study was in the form of a retrospective analysis of the documentation of the patients treated with open abdomen technique. The study included 37 patients treated in the Department of General and Endocrine Surgery and Gastroenterological Oncology and in the Department of Anesthesiology and Intensive Care of the Medical Sciences since 2009-2012. Patients were divided into two groups: group 1 (n = 20) was treated with standard surgical procedures (laparostomy, repeated peritoneal cavity lavage) and group 2 (n =17) was treated using negative pressure wound therapy (NPWT). The analysed clinical data included the period of hospitalization and clinical outcome (survival vs death), the occurrence of enteroatmospheric fistulae, cyclical determination of the quantitative C-reactive protein levels. RESULTS The number of deaths during hospitalization in the group treated with NPWT was lower than in the group treated with standard methods (3 vs 9). The number of fistulae during hospitalization in the group treated with NPWT dropped as compared to the group treated using standard procedures (18% vs 70%). The decrease in the CRP levels was recorded in the group treated with NPWT and its increase - in the group treated with standard methods. CONCLUSIONS The use of NPWT in patients requiring open abdomen treatment is reasonable due to the positive results with respect to survival rates and the decrease in the number of gastrointestinal fistulae. It is necessary to train the physicians in using this type of therapy in the form of workshops and in the clinical setting.

Long-term follow up of the effects of extracorporeal shockwave therapy (ESWT) on microcirculation in a denervated muscle flap

UNLABELLED Extracorporeal Shock Wave Therapy (ESWT) is a golden standard for treatment of kidney and urinary calculi. It is also widely used in a number of orthopedic pathologies and other fields of medicine. Although clinical success the exact mechanism of shock wave technology is not well established. Cremaster muscle model used in our experiment is structurally and functionally similar to other skeletal muscles (striated muscle). The aim of the study was to evaluate influence of ESWT treatment on microcirculation and leukocyte-endothelial interactions after longer time period post ESWT application. MATERIAL AND METHODS In experiment we used 34 Lewis rats weighting 125-160 grams. Animals were divided into 4 groups--Group 1 (n = 10) control, without ESWT application, group 2 (n = 8), in which measurements were performed 3 days after application of 500 impulses of ESWT; group 3 (n = 8) in which measurements were performed 7 days after application of 500 impulses of ESWT; group 4 (n = 8), in which measurements were performed 21 days after application of 500 impulses of ESWT. RESULTS The experiment showed a decrease in functional capillaries activity, we also observed the reduction in leukocyte rolling over the endothelium and an increase in flow velocity in V1 venules. CONCLUSIONS ESWT therapy after 3, 7 and 21 days decreases inflammatory process in the muscle, the other of its effect is weakened. This confirms that the treatment had a positive effect if ESWT is applied repeatedly, because only in this case a wave maintains its beneficial effects.

Surgical methods of treatment of intestinal passage disturbances with the characteristics of constipation in patients with intestinal stoma based on own experience.

UNLABELLED Stoma is an intestinal fistula created in emergency or by elective indications, and it is done to drain out the digestive tract content. In some patients there is a disturbance passage of gastric contents through the stoma, which may take the form of chronic constipation or even periodic subileus that will sooner or later require surgical treatment. The aim of the study was the assessment of the causes and method of treatment of constipation in patients with intestinal stoma. MATERIAL AND METHODS A total of 331 patients with stoma followed by Ostomy and Proctology Outpatient Clinic were included in the study in the years 2011-2014. The study included 146 women and 185 men and the average age was 61.3 ± 12.7 years. Within the entire froup, 273 patients had the end stoma performed whereas in 58 patients the loop stoma was created. The highest percentage of patients were the ones with diverticulosis and colorectal cancer, i.e. 132 and 114 patients respectively. A stoma was created in 35 patients due to inflammatory bowel disease (IBD), in 23 patients because of cancer, in 14 as a result of injuries and in 13 due to rectovaginal fistula. RESULTS Out of the entire group subject to study (331 patients) 93 patients (28.1%) suffered from constipation. 50 patients with constipation required surgical intervention. The most common indication for surgical treatment was the parastomal hernia (36 patients, 72%), other indications were the narrowing of the stoma (5 patients, 10%), its collapse (6 patients, 12%) or prolapse (3 patients, 6%). Parastomal hernia was responsible for 84% of constipation within the stoma and 86.1% were treated with laparotomy (31 out of 36 patients). Other causes of constipation were the stomal stenoses (5 patients), collapse of the stoma (6 patients) and stomal prolapse (3 patients). All patients were treated surgically with a good final result. CONCLUSIONS Constipation associated with dysfunction of the stoma in most cases should be treated surgically. Parastomal hernia is the most common cause of constipation in the stoma. Treatment should be performed in due time because of the possibility of developing complications, especially dangerous one is a strangulated parastomal hernia and ischemia of stoma.

Usefulness of magnetic resonance imaging in diagnosis and monitoring of treatment of perianal fistulas.

A fistula-in-ano (also referred to as anal fistula, rectal fistula, perianal fistula or anorectal fistula) is an abnormal tract or cavity communicating with the rectum or the anal canal by an identifiable internal opening (1). The problem is still up-to-date and remains a difficultone to handle, with an overall incidence of 8.6:100,000 annually, affecting patients with a mean age of 38.3 years. The problem is much more common in men, with a female to male ratio of 2:15. There is a wide spectrum of potential causes of fistulas, but it appears that the majority of fistulas result from infection (abscess) in the anal glands extending from the intersphincteric plane to various anorectal spaces (2). The fistula-in-ano significantly decreases the quality of life, most patients experience recurrent perianal drainage, fever, perianal pain, itching and/or recurrent abscesses (3). Although anal fistulas were known to Hippocrates and have been described throughout the centuries, they began to receive special attention in the 19th century. In 1835, Frederick Salmon founded the Benevolent Dispensary for the Relief of the Poor Afflicted with Fistula, Piles, and Other Diseases of the Rectum and Lower Intestines, he now world famous St Mark’s Hospital in London. Much of our understanding of perianal fistulas comes from the work of surgeons at St Mark’s Hospital: Salmon, who operated on Charles Dickens; Goodsall, who described the course of fistulous tracks from the skin to the anus (4); and Parks, whose classification of fistulas in relation to anal anatomy is widely used in surgical practice (5). In this article we will discuss the anatomy of the perirectal area, the causes of anal fistulas and MRI protocols useful to assess the position of the fistula duct. Also, we will present classification types (gradation) of fistulas in surgery based on MR imaging.

Conservative Measures for Managing Constipation in Patients Living With a Colostomy

PURPOSE: The purpose of this study was to determine the effect of a conservative regimen for the treatment of constipation in persons living with a colostomy. DESIGN: Prospective, noncontrolled, single-center study. SUBJECTS AND SETTING: The study sample comprised 35 patients with a colostomy who were diagnosed with constipation. Subjects with morphologic changes causing constipation such as stomal stenosis and neoplastic and inflammatory changes were excluded. The study was conducted in the Proctology and Stoma Outpatient Clinic at Poznan University of Medical Sciences. METHODS: Patients at our Stoma Outpatient Clinic underwent baseline evaluation, and those with symptoms of constipation (prolonged periods between bowel movements, passage of pasty or hardened fecal effluent, and associated symptoms such as abdominal discomfort or bloating, flatulence, and pain with passage of effluent into the stoma) received individualized dietary recommendations that typically included an increase in dietary fiber and fluid intake, along with increased fluid intake. The outcomes of dietary changes were evaluated during a follow-up visit 3 months later. If dietary changes alone did not improve constipation symptoms, we prescribed a psyllium-based bulk-forming agent, an osmotic stool softener, and a probiotic, with or without a prokinetic agent such as metoclopramide taken 3 times daily. RESULTS: Dietary interventions alone were deemed successful in 60% of study subjects (n = 21); the remaining 14 patients required additional treatment. CONCLUSIONS: Dietary modifications alone relieved constipation in more than half of a group of 35 patients with constipation. We therefore recommend a trial of dietary modifications prior to the initiation of pharmacotherapy in patients with a colostomy.

A giant non-functioning pancreatic neuroendocrine carcinoma founded as an incidentaloma successfully treated with pancreatoduodenectomy

Pancreatic neuroendocrine tumours (PTENs) are a heterogeneous group of tumours that develop from neuroendocrine cells of the pancreas [1]. Pancreatic neuroendocrine tumours comprise a rare group of pancreatic tumours and represent about 1–2% of all tumours developing within this organ [2]. The potential of neuroendocrine cells to produce and secrete peptides and/or biogenic amines affecting the clinical presentation of the disease thus determines their division into functioning and non-functioning pancreatic neuroendocrine tumours (functioning, F-PTEN and non-functioning, NF-PTEN). General accessibility of cross-sectional imaging of the abdomen has caused a significantly increasing rate of incidentally revealed non-functioning pancreatic neuroendocrine tumours in recent years. The group of NF-PTEN represents the majority of neuroendocrine tumours of the pancreas and is estimated at 60–90% [3]. An asymptomatic pattern of the disease associated with a lack of the peptide and/or biogenic amine productions means that these tumours may present with considerable size at the time of clinical diagnosis.

Late Band Migration After SAGB. Case Report

Obesity, a major public health issue of the 21st century, is increasingly common in adults and children. No good results of pharmacological treatment of obesity results in rapid development of bariatric surgery, which treats obesity and comorbidities associated. There are many surgical options for treating obesity. Options for surgical management of morbid obesity include restrictive (adjustable gastric banding, vertical band gastroplasty), restrictive/resective (sleeve gastrectomy), restrictive/malabsorptive (Rouxen-Y gastric by-pass, biliopancreatic diversion with duodenal switch) and purely malabsorptive procedures (duodenal switch). Among them, swedish adjustable gastric banding (SAGB) or laparoscopic adjustable gastric banding (LAGB) have been more frequently performed. SAGB is considered to be safe and effective method of weight loss and elimination of diseases associated with obesity. Laparoscopic gastric banding offers the advantages of minimally invasive surgery, adjustability, and reversibility. Despite fewer number of complications than other bariatric operations, patients after SAGB may have unique complications that are characteristic of the SAGB and require special management and treatment. This paper presents a rare case of complete migration of the band into the gastric lumen.

A case of late breast cancer metastases to both suprarenal glands 28 years after mastectomy.

We present an extremely rare case of late metastases of breast cancer to both suprarenal glands 28 years after mastectomy. The patient originally underwent Patey’s radical mastectomy of the left breast. In the follow-up, metastases were detected in the skin of the thorax and labia majora and were subsequently resected. During the most recent hospitalization metastases to both adrenal glands were detected (PET-CT, MRI) and removed. In genetic examination the entire coding sequences of BRCA1 and BRCA2 gene were screened for mutation by direct PCR product sequencing as described before by Gorski et al. No BRCA1 and BRCA2 gene mutations were found. Histological examination revealed breast cancer metastasis to the adrenal glands. In our opinion our case can be the latest described metastases of breast cancer. The described case was an early stage of primary cancer (T1N0M0). Patients after breast cancer resection should still be followed up for late metastases. Late metastases including atypical sites should always be suspected regardless of time from initial presentation. The correlations between mutation and metastases of breast cancer needs to be discussed.

Analysis of the Efficacy of Screening Tests in Colorectal Cancer by Faecal Occult Blood Test - Own Experience

UNLABELLED Screening of the colon cancer seems to be important to improve the results of the surgical treatment. There are different screening programs, the most common use the fecal occult blood (FOB) tests or colonoscopy. THE AIM OF THE STUDY was to evaluate the results of the colon cancer screening based on the FOB test and perform the algorhytm improving the effectiveness of the screening. MATERIAL AND METHODS 941 patients with the positive results of the FOB (immunochromatographic method) test were investigated. In all cases the rectosigmoidoscopy for the detection of the lower GI tract pathology was done. 312 patients were qualified to colonoscopy. RESULTS Adenomatous polyps and adenocarcinomas were detected in 116 patients. There was no correlation between clinical symptoms and the colorectal cancer. The colorectal cancer was recognized statistically more common at the patients with previous detected neoplasia, in the colon and other organs, with hereditary nonpolyposis colorectal cancer and with inflammatory bowel diseases. CONCLUSIONS The colorectal cancer screening based on the FOB can be effective in the early recognition of the bowel malignancy. The previous questionnaire can eliminate from the FOB screening the patients without indications (previously done colonoscopy or barium enema) or with directly indications for colonoscopy.