Łukasz Pietrzyk

Simulation techniques in the anatomy curriculum: review of literature.

Modern medical education faces a problem of combining the latest technology, procedures and information with classic teaching methods. Simulation is a technique, which replaces or amplifies doctor-patient experiences in controlled conditions and therefore evokes or replicates substantial aspects of the real world in a fully interactive manner. The basic course of anatomy in medical education could be recognised as the best example of implementing new educational techniques such as simulation, into the traditional medical curriculum. The PubMed database was searched using specific key words. Finally 72 articles were accepted and were divided into 3 basic categories of teaching methods: Category 1 - cadaveric dissection, Category 2 - simulator based education and Category 3 - other. A state of the art anatomical curriculum offers numerous possibilities and solutions including the oldest like cadaveric dissection and newest like simulators. Different simulation techniques are used with different intensity; however cadaveric dissection is still the most popular method. The second most frequent method is simulation-based training, in which North America is the leading country. The identification of anatomical structures during virtual surgical procedures or laparoscopic robotic procedures can be integrated into the traditional anatomy course. New technologies are supportive and beneficial in anatomy teaching however each excitement of new technologies sometimes should be tempered and evaluated for its usefulness in making the learning process constructive for students and their future practice.

Evaluation of peritoneal tissue by means of differential scanning calorimetry (DSC)

Abdominal surgeries alter the integrity of the peritoneal layer and cause imbalances among immunological, inflammatory and angiogenic mechanisms within the tissue. During laparoscopic procedures a protective function of the peritoneal layer can be disturbed by the gas used to create a pneumoperitoneum. The aim of this study was to characterize peritoneal tissue by means of differential scanning calorimetry (DSC) as a reference for future investigations on the influence of surgical procedures on the physicochemical state of the peritoneum. Thirty-seven patients participated in the study. Patients were divided into three groups according to the type of surgery: group H - patients who underwent hernia repair; group Ch - patients who underwent laparoscopic cholecystectomy; and group C - patients operated due to rectal cancer. It was observed that onset temperature (T(o)), denaturation temperature (T(m)) and change of enthalpy (ΔH) during thermal denaturation of peritoneal collagen in were significantly different for these three groups of patients. The mean values of onset temperature (T(o)) and denaturation temperature (T(m)) in group H were significantly lower, while DH in this group was significantly higher than in the two other groups (Ch and C). This preliminary study does not answer whether the differences in collagen denaturation found in peritoneal tissue from different groups of patients resulted from a different inherent state of the tissue, or from surgical procedures. However, the results suggest that DSC is an appropriate method to study subtle changes in the physicochemical condition of the peritoneum using small samples obtained during surgical procedures.

Food properties and dietary habits in colorectal cancer prevention and development

ABSTRACT Colorectal cancer (CRC) is a very common and lethal disease worldwide. The etiology of the disease includes genetic and environmental factors. Among environmental factors, the dietary habits are considered to be easily changeable regarding preventing the CRC. Although there is still a long road to cover the gaps in knowledge on nutritional determinants and the dietary pattern on the CRC risk, several dietary suggestions and goals could be summarized. Diets high in energy, consumption of red meat or processed meat, food with a high glycemic index (carbohydrates, snack food, frying fast food, and sugar-sweetened drinks, sweets), exceed intake of salt (NaCl), low daily water intake (<4 cups per day) have been linked to an increased CRC risk. In contrast, consumption of white meat, as well as plant and fish oils with a high omega-3 PUFA to omega-6 PUFA ratio might even reduce the occurrence of CRC. A fiber-rich diet can lower the CRC risk up to 50%. Diet rich in vitamin B6, C, D, E, folic acid, selenium, and magnesium has also been considered to reduce the CRC risk. General unhealthy lifestyle which results in overweight and obesity-related syndromes (chronic inflammation, type 2 diabetes) can promote CRC. However, in many cases, the results are inconsistent and depend on multiple interdependent factors, i.e., ethnic, anthropometric, gender, age, hormones, and environment. In addition to dietary habits, all these agents are suggested to modify the risk of CRC.

Anatomical variations of the coeliac trunk in the homogeneous Polish population

BACKGROUND The abdominal vessels show a number of abnormalities and pathologies knowledge of which is important during open as well as laparoscopic surgeries. One of the most common vessels which pattern has many variations is the coeliac trunk. The present study was undertaken on homogeneous population to assess morphology of the coeliac trunk and to evaluate the possible variability of its branches. MATERIALS AND METHODS Standard abdominal multidetector computed tomography examinations were performed on a total of 1569 patients diagnosed by 2 radiologists independently; in case of doubts common assessment was performed. RESULTS The coeliac trunk followed the classic pattern in 92.7% of the cases (1455/1569 of patients). The gastrosplenic trunk was detected in 4.1% of cases (64/1569); the hepatosplenic trunk in 2.2% of cases (34/1569); the coeliac-mesenteric trunk was observed in 0.5% of cases (8/1569); the hepatogastric trunk in 0.2% of cases (4/1569); the splenomesenteric trunk was detected in 0.1% of cases (2/1569). In the next 0.1% the coeliac trunk was absent. The hepatosplenomesenteric and the coeliac-colic trunk were not observed in the study population. CONCLUSIONS Vascular anatomical abnormality is usually asymptomatic hovewer, its preoperative knowledge is helpful to reduce complications like vascular bleeding when dissecting the hapato-pancreatic region. The coeliac trunk and its branches can be fast and easy evaluated in computed tomography exams performed due to various symptoms from abdominal cavity.

An overview of Human Papillomavirus (HPV) as an etiological factor of the anal cancer

Human papillomavirus (HPV) is a DNA tumour virus that is the primary cause of sexually transmitted infections (STIs). The direct connection between HPV and cervical cancer was discovered in 1980, however, many physicians and the general public are still oblivious to the association of HPV and anal cancer; most individuals find out about this relationship after a confirmed diagnosis, and therefore, it is important to raise awareness about HPV as an etiological agent in anal cancer. There is a quadrivalent vaccine available, which prevents an individual from being infected with HPV, thus anal cancer is mainly a preventable cancer when caused by HPV, and ultimately, preventing cancer is better than curing cancer, especially when there is no definite cure.This article aims to review the microbiology, pathophysiology, epidemiology, clinical presentation, diagnostic evaluation, prophylaxis and treatment options for HPV as an etiology agent in anal cancers in light of recent literature.

TGF-β and inflammatory blood markers in prediction of intraperitoneal adhesions

PURPOSE Intraperitoneal adhesions (IA) develop as a consequence of the healing process in peritoneum injured during surgeries. IA might be formed after all types of surgical interventions regardless the surgical approach with a higher incidence in obese individuals. Here we determine the diagnostic power of TGF-β and blood inflammatory parameters in the prediction of IA in obese patients undergoing second surgical intervention. MATERIALS AND METHODS Eighty patients were divided into groups according to body mass index (BMI) values and presence of intraperitoneal adhesions (IA). Evaluation of peritoneal adhesion index (PAI), serum TGF-β and blood inflammatory parameters was performed. RESULTS Level of TGF-β, C-reactive protein (CRP), leukocytes, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio were significantly higher in obese patients while TGF-β, CRP, and leukocytes were higher in patients with IA. There was a significant correlation between PAI values and TGF-β concentration (p<0.001; r=0.869) in IA group. CONCLUSIONS The preoperative TGF-β concentration, BMI, CRP and NLR could be strong predictors of intraperitoneal adhesions in patients with the history of surgeries.

What Do We Know About Education in Colorectal Cancer Prevention?—Survey Among 1130 Medical Students

Colorectal cancer (CRC) is a global public health problem. The degree of knowledge on CRC among medical students, future physicians, brings essential implications for their patients. Therefore, to acquire information about students’ knowledge on CRC, a questionnaire survey was conducted in Medical University of Lublin, Poland, with a representative sample of 1130 medical students (basic vs. clinical 552 vs. 578; male vs. female 442 vs. 688). The questionnaire was anonymous and designed in a four-section scheme (CRC risk factors, CRC prevention, CRC symptoms, CRC screening methods). There was a significant difference in the percentage of correct answers between basic and clinical level groups (P = 0.034). In general, clinical students had higher scores for their knowledge regarding CRC. Gender impacted the students’ CRC knowledge to a lesser degree; however, if the difference was revealed, female students were more aware about CRC issues (P = 0.045). We found several important deficits in students’ knowledge on CRC. These findings should motivate the oncology education coordinator as well as our teachers to introduce innovations in education methods and training environments to enable students to gain necessary knowledge and acquire the skills and competencies that would help them to function as physicians.