Marian Brocki

Serum MMP 2 and TIMP 2 in patients with inguinal hernias

Eur J Clin Invest 2011; 41 (6): 584–588

Gastric perforation as a complication after BioEnterics intragastric balloon bariatric treatment in obese patients--synergy of endoscopy and videosurgery.

The BioEnterics intragastric balloon (BIB) is one of the most common bariatric procedures in obese patients in Europe. Associated gastric perforation is a rare, yet very dangerous, complication. We report a case of such a complication after BioEnterics intragastric balloon insertion in a 60-year-old female patient and subsequent cooperation between an endoscopist and bariatric videosurgeon in her treatment.

Biochemical and functional indices of malnutrition in patients with operable, non-microcelullar lung cancer

INTRODUCTION The aim of this study was to assess non-microcellular lung cancer patients´ nutritional status impact on psychomotor performance, muscle strength and functional activity. MATERIAL AND METHODS The study involved 60 consecutive patients admitted to the clinic for surgical treatment due to histologically verified non-microcellular lung cancer. The patients were divided, depending on the stage of weight loss, into two groups: relatively well-nourished--29 patients and those with malnutrition--31 patients. History, physical examination, anthropometric data, biochemical parameters as well as functional tests were carefully noted. RESULTS Patients qualified for particular groups differed significantly in age, p<0.002. Mean values of albumin, transferrin and total protein for the well nourished patients ranged within proper values. In the malnourished patients they were respectively: 34.05±0.27 g/l, 1.764±0.27 g/l, 68.90±6.39 g/l and the differences were statistically significant. Total loss of urea nitrogen was significantly higher in malnourished patients 13.32±2.92 g/l (p<0.005). The average percentage weight loss in both groups differed significantly 0.111±0.044 vs. 0.031±0.028 at p<0.0005. In the group of malnourished patients the right hand average strength was 26.52±8.06 kg and the left one amounted to 25.35±6.04 kg, The values were significantly lower than the results recorded in well nourished patients: 34.93±11.27 kg, 32,37±11.72 kg, p<0.001. The tapping test average time of the right hand was 19.24±4.04 vs. 16.72±3.06 and of the left one 19.69±3.59 kg vs. 17.48±2.79 kg and were significantly longer in patients suffering from malnutrition (p<0.01). Simple reaction times for dominating hand were longer in the group of patients with malnutrition, for the visual stimulus 0.50±0.08 s vs. 0.45±0.087 s, (p<0.05) and for auditory one 0.43±0.08 vs. 0.39±0.08 s (non significant). CONCLUSIONS Malnutrition in the course of non-microcellular lung cancer significantly reduces psychomotor function assessed by reaction time to visual and acoustic stimuli as well as efficiency of the functional tests evaluated by tapping test and muscle strength measurement.

Efficacy assessment of the drainage with permanent airflow measurement in the treatment of pneumothorax with air leak.

AIM The aim of this study was to compare the efficacy of the treatment of patients with spontaneous pneumothorax with air leak (AL) using two different chest drainage systems. METHODS Patients were randomized into two groups: group A included 30 patients (23 males and 7 females, mean age 41.1 ± 16.29 y, range 17-71 y) in which digital drainage system was used, group B with 30 patients (22 males and 8 females, mean age 40.3 ± 15.74 y, range 18-72 y) in which traditional suction drainage system was applied.The following variables were evaluated: intensity of AL, duration of the chest tube drainage, delay in surgery, length of stay, and the overall hospitalization costs. RESULTS In group A the mean drainage duration was 47.63 hours, the hospitalization time was about 5.10 days, and the cost of hospitalization was €1,495. In group B the mean drainage duration was 84.93 hours, the hospitalization time was 6.97 days, and the hospitalization cost was €1,925. CONCLUSION The digital drainage system applied in the treatment of AL in patients with pneumothoraces reduced the duration of the drainage, the length of hospital stay, and overall hospitalization costs.

Assessment of quality of life in patients with non-operated pancreatic cancer after videothoracoscopic splanchnicectomy

Introduction Pancreatic tumours are a crucial medical issue. The majority of patients report sick in the late stage of carcinoma clinical advancement, which considerably limits the possibility of surgical treatment. Pancreatic cancer patients with no other alternative but palliative treatment constitute a large group. Aim To assess pain intensity levels and quality of life of pancreatic cancer patients after videothoracoscopic splanchnicectomy. Material and methods Between 2001 January and 2010 November in the Department of Thorax, General Surgery and Oncology of the Medical University of Lodz 262 patients with pancreatic tumours were hospitalized. In 121 cases grade 3 and grade 4 tumours were observed. Hundred and twenty-one videothoracoscopic procedures of sympathetic trunk and ganglion excision were performed in 89 patients. Results Before the procedure the pain intensity level according to VAS was 5.66 (3.9-7.2; SD 1.24) in the trial group and 5.46 (4.1-7.1; SD 1.15) in the control group. The quality of life average assessment in both groups did not differ statistically (p = 1.07) and was 46.3 (32-66; SD 0.92) in patients before the operation and in the control group 50.3 (41-63; SD 0.75). On the 7th postoperative day the pain intensity on average was 2.33 (1.2-3.9; SD 0.78) and 4.57 (3.6-5.5; SD 0.69) respectively. One week after the procedure the quality of patients’ life was estimated at 64.1 (39-83; SD 1.38) and in the control group at 52.2 (42-65; SD 0.71); the differences are significant (p < 0.05). Thirty days after the procedure 12 patients did not take any painkillers (13.5%), and in the others a considerable decrease of the taken drugs was observed. On average, the pain intensity was estimated at 1.78 (0.6-3.6; SD 0.68). The quality of life, on the other hand, improved considerably in relation to the state prior to the procedure, but increased insignificantly in relation to the state on the 7th postoperative day to 70.9 (52-88; SD 1.14). Conclusions Splanchnicectomy is a safe method of cancer pain treatment in patients with advanced pancreatic tumours. Videothoracoscopic excision of visceral nerve thoracic section contributes to the statistically significant decrease of cancer pain intensity and considerably improves the quality of patients’ lives.

Assessment of adhesion formation after laparoscopic intraperitoneal implantation of Dynamesh IPOM mesh

Introduction Formation of adhesions after laparoscopic hernia repair using the intra-peritoneal onlay mesh (IPOM) procedure can lead to intestinal obstruction or mesh erosion into intestinal lumen. The aims of this study included: measurement of adhesion formation with Dynamesh IPOM after laparoscopic intraperitoneal implantation, and assessment of the occurrence of isolated adhesions at the fastening sites of slowly absorbable sutures. Material and methods Twelve healthy pigs underwent laparoscopic implantation of 2 Dynamesh IPOM mesh fragments each, one was fastened with PDSII, and the other with Maxon sutures. An assessment of adhesion formation was carried out after 6 weeks and included an evaluation of surface area, hardness according to the Zhulke scale, and index values. The occurrence of isolated adhesions at slowly absorbable suture fixation points was also analyzed. Results Adhesions were noted in 83.3% of Dynamesh IPOM meshes. Adhesions covered on average 37.7% of the mesh surface with mean hardness 1.46 and index value 78.8. In groups fixed with PDS in comparison to Maxon sutures adhesions covered mean 31.6% vs. 42.5% (p = 0.62) of the mesh surface, mean hardness was 1.67 vs.1.25 (p = 0.34) and index 85.42 vs. 72.02 (p = 0.95). Conclusions The Dynamesh IPOM mesh, in spite of its anti-adhesive layer of PVDF, does not prevent the formation of adhesions. Adhesion hardness, surface area, and index values of the Dynamesh IPOM mesh are close to the mean values of these parameters for other commercially available 2-layer meshes. Slowly absorbable sutures used for fastening did not increase the risk of adhesion formation.

The estimation of metaloproteinases and their inhibitors blood levels in patients with pancreatic tumors

BackgroundThe aim of the study was to evaluate the concentration of proteolytic enzymes, MMP-2 and MMP-9, and their tissue inhibitors, TIMP-1 and TIMP-2, in the blood of patients with benign and malignant pancreatic tumors.MethodsMMP-2, MMP-9, TIMP-1, and TIMP-2 were evaluated in the patients with benign and malignant pancreatic tumors before surgery and in the 30-day follow-up. The study covered 134 patients aged 54 to 76 years, who were divided into groups by TNM staging.ResultsBefore the operation, the highest mean concentration of MMP-2 was found in patients with unresectable cancer, whereas the highest level of MMP-9 was in patients with resectable cancer. The highest level of TIMP-1 was noted in patients with inflammatory tumors. In 1 month following the operation, the highest level of MMP-2 was also in patients with unresectable cancer and the highest level of TIMP-2 in patients with inflammatory tumors.ConclusionsThe evaluation of the level of the studied cytokines in the pancreatic tumor patients can be diagnostically significant in the differentiation of benign and malignant changes. The changes in the levels of the studied enzymes and their inhibitors can have a prognostic value in the clinical severity of pancreatic cancer.

Comparison of effectiveness of electrocautery and phenol application in partial matricectomy after partial nail extraction in the treatment of ingrown nails

UNLABELLED Ingrowing nail also known as onychocryptosis is a common health problem. This disease mostly affects young people, often carrying a considerable amount of socio-economic implications. Its foot problem that usually manifests as inflammation of tissue along the side of a toenail. The aim of the study was to asses and to compare effectiveness of electrocautery and phenol application in partial matrixectomy after partial nail extraction in the treatment of ingrown toenails. MATERIAL AND METHODS The group of 60 patients with ingrowing toenail which was randomized into two groups underwent partial matrixectomy in surgical outpatient clinic between 2009-2013. This group of patients was under surgical observation for 100 days in outpatient clinic. RESULTS In all operated patients we obtained surgical success however we had 13 recurrences during the follow up period, 5 in the phenolization group and 8 in the electrocoagulation group. CONCLUSIONS There was statistically significant difference between these two techniques, which indicated that matrix phenolization is connected with shortened healing time vs the matrix electrocoagulation.

Evaluation of prognostic value of selected biochemical markers in surgically treated patients with acute mediastinitis

Summary Background Monitoring of biochemical markers of inflammation in acute mediastinitis (AM) can be useful in the modification of treatment. This study was a retrospective evaluation of selected biochemical parameters with negative impact on the prognosis in surgically treated patients. Material/Methods There were 44 consecutive patients treated surgically due to AM of differentiated etiology. Selected biochemical markers (WBC, RBC, HGB, HCT, PLT, CRP, PCT, ionogram, protein and albumins) were assessed before surgery and on the 3rd day after surgery. ANOVA was applied to find factors influencing observations. Numerical data [laboratory parameters] were compared by means of medians. Results The overall hospital mortality rate was 31.82%. In the group of dead patients, there were observed statistically significant lower mean preoperative values of RBC [p=0.0090], HGB [p=0.0286], HCT [p=0.0354], protein [p= 0.0037], albumins [p=0.0003] and sodium [p<0.0001] and elevated values of CRP [P=0.0107] and PCT p<0.0001]. High level of inflammatory markers on day 3 after surgery was found to increase the risk of death – for WBC (by 67%), for CRP (by 88%) and for PCT (by 100%). Conclusions Poor prognosis was more frequent in patients with preoperative high levels of CRP, PCT, anemia, hypoproteinemia and hyponatremia. The risk of death increases significantly if in the immediate postoperative period no distinct decrease in WBC count and of the CRP and PCT level is observed. In such a situation the patients should be qualified earlier for broadened diagnostic workup and for reoperation.

Giant mesentery fibromatosis presenting as acute abdomen - case report

Mesentery fibromatosis, also called abdominal desmoid, is a rare clinical entity. It is part of the clinical-pathologic spectrum of so-called deep fibromatoses. The deep fibromatoses encompass a group of benign fibroproliferative processes that are locally aggressive; they may infiltrate the adjacent organs or recur, but do not create distant metastatic lesions. The small bowel mesentery is the most common site of intraabdominal fibromatosis. However, the omentum, ileocolic mesentery, transverse or sigmoid mesocolon, or ligamentum teres may be the site of origin for intraabdominal fibromatosis. Mesenteric fibromatosis occurs in a wide age range of patients, and has no gender or race predilection. Most cases of abdominal fibromatosis occur sporadically. In this article we would like to present a case report of a patient who was admitted to the clinic due to severe abdominal pain with clinically advanced peritoneal signs. The intraoperative findings were astonishing; we found a giant desmoid which originated in the mesentery. The tumor oppressed the ileum, leading to its obstruction.