Tomasz Miłek

The removal of post-sclerotherapy pigmentation following sclerotherapy alone or in combination with crossectomy.

BACKGROUND Sclerotherapy is a widely used method for the obliteration of blood vessels. Hyperpigmentation is a frequent complication that results from haemosiderin (FeO) accumulation. Hyperpigmentation and changes in the skin can be observed with ultrasound. OBJECTIVE The aim of this study was to evaluate the efficacy of hyperpigmentation elimination using an intense pulse light generator (IPL) equipped with radio waves (RF) under ultrasonography (US) control. METHODS Twenty-one women with permanent hyperpigmentation (after sclerotherapy or crossectomy combined with sclerotherapy) underwent a hyperpigmentation eliminating therapy with the use of IPL + RF and were monitored by using US. The thicknesses of the dermis and the subcutaneous tissue as well as the echogenicities of each layer were assessed. RESULTS As a result of the therapy, a complete regression of hyperpigmentation was achieved in 90.48% of the women, and in 9.52% of the women, the therapy led to a reduction in hyperpigmentation but did not cause its complete disappearance. An increase in dermal echogenicity and a decrease in subcutaneous tissue echogenicity were observed, but there was no change in their thicknesses. After the therapy, the ultrasound images of areas of previous hyperpigmentation corresponded with images that were characteristic of healthy skin. CONCLUSION IPL + RF therapy is effective for eliminating permanent skin hyperpigmentation after sclerotherapy. US is also useful in this therapeutic method.

Implantation of a new enteral stent in obstructive colorectal cancer using interventional radiology in patients over 70 years of age.

Introduction Colorectal cancer is the second leading cause of death due to cancer in Poland. The traditional approach to treat patients included a surgical procedure. Irrespective of the surgical method being used, surgical treatment of malignant colorectal obstruction is associated with prolonged hospitalisation, and the postoperative mortality rate is approximately 5–11%. Due to these problems, more interest has been shown in less invasive methods. Prosthesis implantation is a leading endoscopic method used currently in palliative or preoperative treatment. Aim To compare the results of implantation of traditional stents with the results of implantation of an own stent using minimally invasive methods. Material and methods Left-sided colon obstruction due to cancer was an indication for transplantation. All patients were aged over 70 years and had serious concomitant diseases. The control group included 50 patients with colorectal cancer who received traditional stents in the period 2009–2011. Our stent covers only the internal length of a tumour. It is not equipped with anti-migration flares. To minimize the risk of migration it has a system of hooks that are responsible for permanent anchorage of the stent within the tumour mass. Results Implantation technical and clinical success defined as effective decompression of intestinal obstruction was 100% in both groups. There were 2 cases of stent migration in the control group. Conclusions It is possible to achieve a secure surgical anastomosis after intestinal decompression. Stent implantation is fast and safe thanks to the positioning system that was used. The use of labelled hooks is a secure anti-migration solution.

Role of plasma growth factor in the healing of chronic ulcers of the lower legs and foot due to ischaemia in diabetic patients

Introduction It has been demonstrated that plasma growth factor (PGF) responsible for proliferation of smooth muscle cells and fibroblasts significantly shortens treatment duration. Aim To determine the role of human growth factor in the healing of ulcers due to ischaemic diabetic foot syndrome (DFS) following previous angioplasty of the blood vessels of the lower leg and foot. Material and methods The study group included 50 patients with ischaemic diabetic foot complicated by lower leg ulcers in which angioplasty of the stenotic arteries in the distal lower leg and foot was performed. It has been assumed that the area of the ulcer cannot exceed 5 cm2. Following surgical debridement, each patient received platelet-rich plasma in the form of dressings applied on an ulcer, followed by hydrocolloid dressings. Each dressing was replaced after 10 days, and this procedure was repeated after 20 and 30 days of treatment. The control group included 50 patients with ischaemic diabetic foot complicated by an ulcer up to 5 cm2. Angioplasty of the lower leg arteries was also performed in this group. However, after surgical debridement, wounds were covered with hydrocolloid dressings. Results After 3 months of combined treatment, all wounds in the study group healed whereas in the control group, only wounds of the smallest size healed. Conclusions Combined treatment of ulcers due to ischaemic DFS with endovascular procedures to re-establish blood flow to the vessels and dressings with autologous platelet-rich plasma significantly shortens the healing time.

Multiple orifices are better than single in the endoscopic treatment of pancreatic pseudocysts

BACKGROUND/AIMS The aim of this study was to compare the surgical drainage of large, symptomatic pancreatic cysts (>5 cm) with single- and multi-channel endoscopic drainage. MATERIALS AND METHODS In the period 2005-2010, we treated 112 patients with post-inflammatory pancreatic cysts. Thirty-six patients underwent surgical internal drainage. The remaining group of patients was treated endoscopically. In 28 of them, drainage was performed by anastomosing the cyst to the gastrointestinal tract using a single pig tail drain and then widening the channel to a diameter of 15 mm. Forty-eight patients underwent multi-channel cystic drainage. It consisted of connecting the cyst to the stomach and/or duodenum using at least 3 drains. Each connection was widened to a minimum diameter of 15 mm to ensure free drainage of the morphotic elements of the cyst. Each procedure was preceded by abdominal computed tomography to determine the exact location of the cyst in relation to the gastrointestinal tract and a Doppler ultrasound scan to determine the location of the blood vessels modeling on its surface. RESULTS In 48 patients with multi-channel drainage, there was no obstruction of the anastomosis, and cysts closed within 4 months. The drains were removed after about 3 months. The created channels were patent for about 3-4 weeks, which was enough to completely close the cyst. CONCLUSION Multi-channel endoscopic anastomosis of pancreatic cyst to the gastrointestinal tract is a very effective method for drainage of large post-inflammatory pancreatic cysts, comparable in terms of effectiveness with the surgical method but less invasive.

Using our own developed stent in the palliative treatment of obstruction in the left half of the colon due to ovarian cancer

OBJECTIVES An assessment of implantation efficacy and safety of self-developed self-expanding stent in patients with an ovarian cancer induced by intestinal obstruction. MATERIAL AND METHODS The study of the stenting efficacy and safety was realized prospectively. The group consisted of 13 patients with left half colon obstruction due to an inoperable metastatic ovarian carcinoma. All the patients had a histopathologically diagnosed ovarian carcinoma and were treated in the past both surgically and systemically. Stenting was preceded by a Computed Tomography (CT) scan confirming and locating the obstruction. Patients with a multilevel intestinal obstruction were disqualified. RESULTS Nine stents were implanted in the rectosigmoid; 4 stents were implanted in an externally compressed rectum. One migration of implanted stent was observed. In one case 2 stents were implanted due to an insufficient coverage of the stricture. The decompression of the obstruction of the gastrointestinal tract was achieved in 11 patients (85%). CONCLUSIONS 1) The implantation of our own developed, self-expanding stent is effective and safe. 2) The implantation of the stent in patients with an inoperable ovarian cancer causing an obstruction of the gastrointestinal tract is an effective procedure limiting postoperative complications and improving life comfort by avoiding stoma.

The Use of Interventional Radiology Techniques in the Treatment of Pancreatic Fistula.

One of the complications of pancreatic disease is the formation of pancreatic fistulae. The presence of fistula leads to body wasting and cachexia. The standard treatment is intubation of the Wirsung duct and in cases where there are no improvements the next proposed form of treatment is surgery. The aim of the study was to evaluate the efficacy of pancreatic fistula closure using interventional radiology techniques. In 2009 to 2014, 46 patients diagnosed with pancreatic fistula were treated with interventional radiology techniques. Treatment consisted of vascular coil implanted at the entry of the fistula and then sealed with tissue glue adhesive during endoscopic procedure. Technical success of vascular coil implantation and the use of tissue glue adhesive were reported in all patients. Pancreatic fistula recurred in 7 patients (15.2%). The latter group of patients underwent statistical analysis to determine what the risk factors in recurring pancreatic fistulas were. The results indicate a significant relationship between etiology of the fistula and treatment effect. In conclusion: (1) the use of interventional radiology methods in the closure of pancreatic fistula is an effective and safe procedure; and (2) the recurrence of fistula is dependent on the etiology and often occurs after surgery or trauma.

Results of Endoscopic and Surgical Fistula Treatment in Esophagointestinal Anastomosis After Gastrectomy.

Introduction: Intestinal fistulas occur in 4% to 8% of cases of upper gastrointestinal tract surgery. Until now, this type of surgery has been the standard for treating fistulas in esophagointestinal anastomosis. The use of stents and hemoclips is still controversial, but an increasing number of publications have been presenting good results with this type of treatment. Objective: The objective of the study was to investigate the outcome of endoscopic and surgical treatment of fistulas in esophagointestinal anastomosis after gastrectomy. Materials and Methods: Fistulas in esophagointestinal anastomoses were observed in 23 patients (4.8%) over an 18-year period. The indications for endoscopic treatment were small (<50 mL/d) and large (>50 mL/d) fistulas in patients with no symptoms of peritonitis or abscess, who were treated with implantation of a covered stent. Surgical intervention was carried out for large fistulas that resulted in peritonitis and complicated gangrene of margins and/or abscesses. Results: Four subjects were treated endoscopically with hemoclips, resulting in 50% technical and clinical success. We implanted stents in 12 patients. Technical success was achieved in all patients; yet, permanent closure of the fistula was reported in 8 subjects (66%). Thirty-three percent of patients were operated upon for fistulas. We reported 4 deaths in this group. Conclusions: The use of hemoclips in the treatment of small fistulas and of self-expandable covered stents in the treatment of medium and large fistulas is an effective method that shortens the hospitalization period and accelerates the introduction of oral nutrition while reducing the number of fatal complications.

The Effect of Local Platelet Rich Plasma Therapy on the Composition of Bacterial Flora in Chronic Venous Leg Ulcer

Microbial colonisation of chronic venous ulcers and synergism between bacterial species slow down the healing process. The study aimed at performing qualitative analysis of microbial flora in venous leg ulcers treated with platelet rich plasma (PRP). Twenty two women and twelve men aged 47-90 years were treated with PRP at our department between 2012 and 2015. Ulcer cultures collected before and after PRP therapy yielded 83 and 110 microbial isolates, respectively, of Gram positive, Gram negative bacteria and candida. Pseudomonas aueruginosa and Staphylococcus aureus were the most common pre- and post-treatment isolates. PRP therapy and increased the variety of microbial flora.

Levels of interleukin-2 in patients with colon cancer and diabetes type 2

Introduction and objectives. The risk of development colon cancer (CC) is increased significantly among patients with the type 2 diabetes (T2DM). A mechanism responsible for the higher prevalence of CC among diabetic patients may be associated with the immunity system. The aim of this study is to point out the differences in the immunity state in terms of interleukin 2 level among patients with T2DM suffering from CC, and patients without these diseases. Materials and methods. 79 patients were included the tests, divided into 4 groups: Group 1–23 people with T2DM, Group 2–23 people with large intestine CC, Group 3–10 people with large CC and T2DM, and Group 4–23 people without T2DM or CC. Each patient had a colonoscopy and those with cancer were confirmed in a histopathological examination. Laboratory measurements included fasting glucose, insulin, C-peptide. The concentration of interleukin-2 in serum was determined with the immunoenzymatic (ELISA) method. Results. The results obtained showed that in patients with T2DM and CC the concentration of interleukin-2 was statistically higher than in the other groups.(4.21±1.61 pg/ml vs. Group 1 -1.64±0.44 pg/ml, Group 2–1.54±0.21 pg/ml, and Group 4–1.70±0.36 pg/ml; p<0.05). Insulin levels, C-peptide and HOMA-IR did not differ significantly between groups, but a tendency was observed to higher values of HOMA-IR and insulin levels in the groups with T2DM alone and T2DM with concomitant

Results of endoscopic and surgical fistula treatment in oesophagointestinal anastomosis after gastrectomy

Introduction Intestinal fistulas occur in 4–8% of cases of upper gastrointestinal tract surgery. Until now, surgery has been the standard of treating fistulas in oesophagointestinal anastomosis. The use of stents and haemoclips still causes much controversy, but more and more publications present good results with this type of treatment. Aim To present results of endoscopic and surgical treatment of fistulas in oesophagointestinal anastomosis after gastrectomy. Material and methods A fistula in the oesophagointestinal anastomosis was observed in 23 (4.8%) patients within an 18-year period. The indications for endoscopic treatment were small fistulas (< 50 ml/day), and large (> 50 ml/day) fistulas in subjects with no symptoms of peritonitis or abscess were treated with implantation a of covered stent. Surgical treatment was performed with a large fistula leading to peritonitis and complicated gangrene of margins and/or the presence of abscess. Results Four subjects were treated endoscopically with the use of haemoclips, resulting in 50% technical and clinical success. We implanted stents in 12 patients. Technical success was achieved in all the patients, yet permanent closure of the fistula was reported for 8 (66%) subjects. The percentage of patients operated on for fistula was 33%. We recorded 4 deaths in this group. Conclusions The use of haemoclips in treatment of small fistulas, and self-expandable, covered stents in treatment of medium and large fistulas, is an effective method that shortens the hospitalisation period and accelerates introduction of oral nutrition while reducing the number of fatal complications.