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1
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There is a controversial debate about whether early surgical treatment of elderly patients with hip fractures yields health benefits.Material and methods. In a prospective observational study of the care provided to hip fracture patients in Germany, the association between time-to-surgery and the frequency of postoperative complications and mortality was examined. The study was conducted between January 2002 and September 2003. We analyzed the data of patients aged 65 and older who underwent surgical treatment for isolated proximal femoral fractures (femoral neck fractures or pertrochanteric femoral fractures). The incidences of postoperative pneumonia, thrombosis or embolism, urinary tract infections, decubitus ulcers, and mortality (in-hospital mortality, one-year mortality) were compared in patients receiving early (≤ 24 h) and late (> 24 h) surgery.Results. Clinical data on 2325 hip patients was available for analysis. The mean age of the study participants was 83.2±7.4; 80.3% of the patients were women. Comparison between patients with early (n=631) and late (n=1694) surgery did not show any statistically significant differences in the frequency of postoperative pneumonia, thrombosis/embolism or urinary tract infections (≤ 24 h vs > 24 h; 2.5% vs 3.9%, p=0.11; 0.79% vs 0.89%, p=0.83; 7.8% vs 9%, p=0.33). However, we did observe that fewer patients undergoing early surgery developed postoperative decubitus ulcers than those undergoing late surgery (1.9% vs 0.6%, p=0.02). A significant relationship between time-to-surgery and in-hospital mortality and/or one-year mortality could not be demonstrated statistically (≤ 24 h vs > 24 h; 3.3% vs 3.5%, p=0.80; 12.5% vs 13.8%, p=0.41).Conclusions. In the present study, a statistically significant association between time-to-surgery and mortality could not be proven. Early surgical treatment, i.e. within 24 hours, significantly reduces the decubitus ulcer rate. This study confirms that elderly patients with femoral fractures in the hip region require surgical treatment within 24 hours.
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The aim of the study was to present evolution of the technique of minimally invasive video-assisted thyroidectomy, its advantages, limitations and possible complications related to the method.Material and methods. Minimally invasive video-assisted thyroidectomy (MIVAT) is characterized by a unique central incision of 1.5 cm, 2 cm above the sternal notch. The operative space is maintained by means of an external retraction: no gas insufflation is utilized. Potential complications of Minimally Invasive Video-assisted Thyroidectomy (MIVAT) are roughly the same as in open surgery.Results. Since June 1998 to March 2008 1524 patients underwent a minimally invasive video-assisted thyroidectomy. Complications were represented by transient monolateral recurrent nerve palsy in 38 cases (2.4%), definitive monolateral recurrent nerve palsy in 18 cases (1.1%), bilateral transient recurrent nerve palsy in 2 cases. Fifty five patients exhibited a hypoparathyroidism, which corresponds to 5.1% of the 1059 total thyroidectomies performed, but only 5 complained of a permanent hypocalcemia which necessitated a substitutive therapy, thus reducing the rate of permanent hypoparathyroidism to 0.4%. We registered in two cases of postoperative bleeding requiring re-operation; wound sepsis occurred in three cases.Conclusions. MIVAT unlike other minimally invasive endoscopic techniques proposed for thyroidectomy, reproduces the standard operation and does not introduce any modification of the traditional technique and in our series total complication rate resulted similar to that described in literature for standard thyroidectomy in large series. As long as these criteria are carefully respected one need not to be concerned that these techniques might increase the complication rate.
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Content available remote Orthodontic Treatment – Complications and Preventive Measures
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Orthodontic treatment aims at restoring correct occlusion and chewing function and improving the aesthetics of the dentition and facial esthetics of the patient. During treatment complications may occur. Most frequently observed complications have been described in the paper. There role of the orthodontist in the therapeutic process and the principles on which doctor- patient cooperation should be based in order to achieve a therapeutic success have been presented. Particular emphasis has been put to the importance of prevention of dental caries and periodontal diseases in orthodontic patients.
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Objective: A pure tone audiomety analysis of patients with extracranial complications of chronic suppurative otitis media (ECCSOM). Material and methods: We retrospectively analyzed audiometric data performed before treatment from 63 patients with ECCSOM (56 single, 7 multiple complications) including groups of frequencies. Results: The greatest levels of hearing loss were noted for 6 and 8 kHz (79.0 and 75.7 dBHL) and for the frequency groups high tone average (76.1 dBHL). As regards the severity of hearing impairment in pure tone average the prevalence of complications was as follows: labyrinthitis (77.8±33.6 dBHL), facial palsy (57.1±14.3 dBHL), perilymphatic fistula (53.9±19.9 dBHL) and mastoiditis (42.2±9.5 dBHL) (p=0.023). Conclusions: Hearing loss in ECCSOM is dominated by mixed, high-tone, moderate type of hearing loss, most profound in labyrinthitis. In 11% of patients the complication causes total deafness.
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The aim of the study multicenter analysis of risc factors during 74 000 cholecystectomies to establish age dependent morbidity and transfusion rate.Material and methods. Between 1th January 1993 and 31th December 1997, 74 049 patients overall in 178 surgical departments with the diagnoses of cholecystolithiasis or cholecystitis were included into a prospective database.Results. The most frequently used method of cholecystectomy was the laparoscopic technique in patients up to 70 years of age. With increasing age, the proportion of laparotomy to laparoscopy procedures inverts; in patients over 70 years of age, open cholecystectomy was the most common method used. In the group of patients older than 90 years, 67.6% of patients were operated by laparotomy and 21.9% laparoscopically (conversion rate 3%).In the age group of 41-50 years, less than 5% of cholecystectomies were performed as emergency cases. This proportion was increased with age continuously up to 46.2% in patients over 90 years of age. After elective cholecystectomy, the postoperative morbidity rate increased continuously from 5.3% to 21.7% in relationship to the patient age. In cases of emergency cholecystectomy, the morbidity rates were higher in all age groups ranging from 12.7% in patients between 31 and 40 years to 34.6% in patients over 90 years of age.Mortality rates also increased continuously from 0.1% to 3.5% after elective cholecystectomy and from 2.9% up to 12.5% after emergency cholecystectomy depending on the age of the patient. The transfusion rate was 0% to 16.6%, increased with age from 0.8 to 5.5% in the cases of elective operations and from 3.8% to 16.6% in the cases of emargancy operations in erderly patients.Conclusions. 1. The number of complication after elective cholecystectomies were low, increase it the case of emergency. 2. In the group of elderly patients laparotomy was done more frequently then laparoscopy. 3. The number of emergency operations increased in elderly patients. 4. The postoperative morbidity, mortality and transfusion rate increase in relationship to the patient age
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The aim of the study was to compare the extent of surgery in removal of thyroid tissue and serum calcium values postoperatively.Material and methods. Between January 1 and December 31, 2005, 987 patients were operated on at our department due to various thyroid disorders. Patients with anaplastic, medullary and high-stage highly-differentiated (TNM>T3, N0, M0) thyroid carcinomas, as well as reoperated individuals, were excluded from the investigation. The patients were divided into three groups, depending on their serum calcium values; thus, the authors distinguished groups with mild (2.0-2.19 mmol/l), moderate (1.8-1.99 mmol/l) and severe hypocalcemia (<1.8 mmol/l). Differences between the groups were assessed by statistical methods (the t-Student's test and the X2 test - the STATISTICA software). The value of p<0.05 was accepted as statistically significant.Results. Of 987 surgical patients, 63 (6.4%) were found to have symptomatic or asymptomatic hypocalcemia. The group included 61 females and two males, their mean age being 50.1±12 years. The intensity of clinical symptoms of hypoparathyroidism was positively correlated with serum calcium values and the said symptoms were most clearly seen in patients classified as belonging to group 3 (Ca<1.8 mmol/l). The most common surgically treated thyroid disease was non-toxic nodular goiter. Hypocalcemia was the most frequent finding in patients operated on due to thyroid carcinoma. In all patients with a mild form of hypocalcemia, the onset of clinical symptoms occurred on postoperative day 2. As it follows from the analysis, there were no statistically significant differences in hypocalcemia prevalence between patients subjected to bilateral exposure of the thyroid lobes and subtotal vs. total thyroidectomy (6 (6.1%) vs 24 (7.1%) patients). On the other hand, a statistically significant difference between the lower prevalence rate of hypocalcemia in unilateral procedures (p<0.001) as compared to bilateral neck explorations (4 (1.4%) vs 59 (8.4%) patients) seems to be logical and physiologically justified. In addition, an element that was found to affect the level of calcium deficit was the number of parathyroid glands identified "in situ". Hence, the prevalence of hypocalcemia increased with a decrease in the number of identified parathyroids (p<0.05). In hypocalcemic patients, hospitalization time ranged from 3 to 11 days, with a mean time of 5.3 days as compared to 3 days in patients without complications. Six months after the surgery and pharmacotherapy, no clinical and biochemical signs of hypocalcemia were noted in the above described group.Conclusions. The risk of hypocalcemia following thyroid surgery is higher in bilateral neck explorations. There are no statistically significant differences in postoperative hypocalcemia between patients subjected to bilateral subtotal vs. total thyroidectomies.
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Splenic abscess is a potential complication of many disease entities which involve infections. Diagnostics are based on imaging studies. Treatment involves splenectomy and antibiotic therapy. In the case the abscess is limited, and particularly in young patients, percutaneous abscess drainage may be performed. This paper presents a case of a 66-year old female patient following coronary artery bypass grafting (CABG) complicated with sternum infection and cholecystectomy due to gallbladder abscess complicated with surgical site infection, who underwent long-term treatment in the ICU due to respiratory failure and persistent septic condition. Splenic abscess is a rare complication of abdominal cavity diseases and systemic infections.
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Content available remote Pulmonary Sequestration - Analysis of Diagnostic and Therapeutic Difficulties
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The aim of the study was to review the clinical characteristics of operated patients with respect to pulmonary sequestration and analyze diagnostic and therapeutic problems connected with this anomaly.Material and methods. We performed a retrospective analysis of 23 patients operated on because of pulmonary sequestration between 1963 and 2004 in the Departments of Thoracic Surgery in Zakopane (10 patients) and Szczecin-Zdunowo (13 patients).Results. The study group comprised 8 men and 15 women and the mean age was 28 years. 15 patients (65.2%) presented with clinical symptoms such as coughing, fever and chest pain. Preoperatively, pulmonary sequestration was suspected in 5 patients. Amongst the remaining patients, the preoperative diagnosis was lung cancer (9 patients), metastasis from testicular neoplasms (n=1), emphysematous bullae (n=2), pulmonary cyst (n=4), bronchiectasis (n=1) and lung abscess (n=1). None of the patients were subjected to arteriography and 6 patients underwent contrast-enhanced computer tomography examination, although it did not lead to a proper diagnosis. We found 20 intralobar sequestrations and 3 extralobar sequestrations, which were situated above the diaphragm. There were 11 sequestrations on the right side and 12 on the left side. The operations performed included: lobectomy (14 patients), segmentectomy 1+2 (n=1), wedge resection (n=3), sequestrectomy (n=3), lower bilobectomy (n=1), and middle lobectomy (n=1). Blood supply from the thoracic aorta was found in 17 patients and the abdominal aorta in the remaining 6 patients. In 5 patients, the pulmonary sequestration was supplied by more than one artery. Complications included hemorrhage from supplying arteries in 8 patients and phrenic nerve palsy in one patient. One patient required mechanical ventilation after the operation. There was no further morbidity and mortality. Distant surgical results were good.Conclusions. 1. Pulmonary sequestration in adults is difficult to diagnose before the operation, even with a detailed computer tomography examination. 2. Intralobar sequestration is much more common (87%) than extralobar and is often situated in the basal segments with comparable incidence on the right and left sides. 3. The greatest danger during the operation is major bleeding from the supplying artery. 4. Prognosis after the operation is favorable.
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Introduction. Circumcision is one of the most performed surgical procedures in neonates. Aim. The aim of this study was to evaluate our experience with neonates who developed complications following the use of plastibell for circumcision. Material and methods. This was a retrospective study of male neonates who were managed for complications resulting from circumcision (performed with plastibell) over a 5-year period at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. Ethical approval was obtained from the ethics and research committee. Results. Out of the 1794 neonatal circumcisions (using plastibell) performed during the study period, 134 (7.5%) neonates had complications. Sixty percent (1074) of the circumcisions were performed in the teaching hospital while 40% were referred cases. The ages of the patients ranged from 7 to 27 days with a median of 10 days and their mean weight was 2.5 kilograms. Majority of the plastibell circumcisions that developed complications was performed by unregistered (auxiliary) nurses. Retained plastibell was the most common complication and its removal was the most performed procedure. No mortality was recorded. Conclusion. Complications following circumcision with plastibell vary widely. Retained plastibell was the most common in the present study. The most complications occurred when the circumcision was performed by auxiliary (unregistered) nurses.
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Introduction According to the WHO, an estimated 422 million people are suffering from diabetes worldwide. Among them, the incidence of cholelithiasis is higher than in the healthy population. The aim of this literature review was to summarize the available evidence about acute cholecystitis in patients with diabetes. Materials and methods This study adhered to the PRISMA guidelines. The course of hospitalization of patients with and without diabetes who underwent cholecystectomy due to acute cholecystitis was compared. Following information was abstracted from original studies: general study information, patient characteristics, complications, and recommendations for patients with diabetes Results Initial search provided 1632 results. After full text assessment, 40 studies met the inclusions criteria. Operative and postoperative complication rates were significantly higher among the diabetic patients. Diabetes is a risk factor for conversion from laparoscopic to open cholecystectomy method. The authors' opinions on elective surgery before the onset of acute cholecystitis symptoms are divided. Conclusions Diabetic patients are at greater risk of developing complications. An individualized screening and treatment approach, as well as proper preparation of the diabetic patient for an elective cholecystectomy could have a positive effect on the outcome. However, the low quality of the data from the systematic review does not allow for meta-analysis, which is why we cannot draw strong conclusions.
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Background. Pharyngocutaneous fistula following laryngectomy is a serious complication, and its incidence varies from 4% to 65%. The study’s objective was to determine the incidence of post laryngectomy fistulas in patients operated in our department to establish whether specific factors predispose to fistula formation. Methods. A retrospective study was performed in 573 patients who underwent laryngectomy. Results. Between 1989 and 1999, 835 cases of laryngeal carcinoma were diagnosed, 690 were treated surgically, 573 of them underwent laryngectomy in our department. Of these patients, 545 (95,1%) had total laryngectomy, while 28 (4,9%) partial laryngectomy. In 538 cases the laryngectomy was combined with radical or functional neck dissection. The presence of early postoperative fistula was established in 65 of the 573 patients (11,3%). Our study could not verify reports that any specific factors were significantly related to fistula formation, the only factors that did show statistical significance were the preoperative patient’s general health status and the kind of postoperative antibiotic therapy. Conclusions. On the base of literature review, the authors compare results obtained in the last decade of the 20 century with results obtained earlier. Although the incidence of post-laryngectomy pharyngocutaneous fistulas decreased in comparison with the fistula rate observed earlier, the problem is still unresolved, and the fistulae remain a serious complication of larynx oncology surgery.
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Familial adenomatous polyposis (FAP) is a colorectal cancer syndrome caused by a germline mutation inherited in an autosomal-dominant pattern with a 100% penetrance. Our detailed case report presents a history of a 55-year-old FAP female patient who had been under constant clinical observation for 30 years. The disease was diagnosed at the age of 22. The patient underwent restorative proctocolectomy with ileal pouch-anal anastomosis (PRC-IPAA). During our follow-up extra-colonic manifestations occurred such as a desmoidtumour, fundic gland polyps in the stomach and duodenal polyps also in the periampullary region. Apart from disease-related symptoms the patient manifested other complications such as small bowel adhesive obstruction, benign breast tumours, uterine myomas, cholelithiasisand thyroid nodules. Our analysis of the above case presents advantages of a long-term medical observation of a FAP patient carried out by a specialist surgical medical centre
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Iatrogenic bile duct injuries (BDI) are still a challenging diagnostic and therapeutic problem. With the introduction of the laparoscopic technique for the treatment of cholecystolithiasis, the incidence of iatrogenic BDI increased. The aim of the study was a retrospective analysis of 69 patients treated at the department due to iatrogenic BDI in the years 2004-2014. Material and methods. In this paper, we presented the results of a retrospective analysis of 69 patients treated at the Department due to iatrogenic BDI in the years 2004-2014. The data were analysed in terms of age, sex, type of biliary injury, clinical symptoms, the type of repair surgery, the time between the primary surgery and the BDI management, postoperative complications and duration of hospital stay. Results. 82.6% of BDI occurred during laparoscopic cholecystectomy, 8.7% occurred during open cholecystectomy, whereas 6 cases of BDI resulted from surgeries conducted for other indications. In order to assess the degree of BDI, Bismuth and Neuhaus classifications were used (for open and laparoscopic cholecystectomy respectively). 84.1% of patients with confirmed BDI, were transferred to the Department from other hospitals. The average time between the primary surgery and reoperation was 6.2 days (SD 4). The most common clinical symptom was biliary fistula observed in 78.3% of patients. In 28 patients, unsuccessful attempts to manage BDI were made prior to the admission to the Department in other centres. The repair procedure was mainly conducted by laparotomy (82.6%) and by the endoscopic approach (15.9%). Hepaticojejunostomy was the most common type of reconstruction following BDI (34.7%). Conclusions. The increase in the rate of iatrogenic bile duct injury remains a challenging surgical problem. The management of BDI should be multidisciplinary treatment. Referring patients with both suspected and confirmed iatrogenic BDI to tertiary centres allows more effective treatment to be implemented.
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Loop stoma allows reducing the percentage of anastomotic leak and re-operation caused bythis complication. Our department has performed the loop stoma on a skin bridge since 2011. The aim of the study was to evaluate the early results of treatment after the skin bridge loop stoma creation in comparison with the stoma made on a plastic rod. Both groups had 20 patients. Material and methods. The study involved 40 patients with ileostomy, operated 2010-2013. We evaluated 20 patients with a loop ileostomy on a plastic rod, compared to 20 other patients with a skinbridge ileostomy. The study included 24 men and 16 women. Median age was 68.3. All evaluated patients were previously operated due to rectal cancer. Results. It has been shown that the surgical site infection is more common in the group with a plastic rod (5 vs 1 patient). Inflammation of the skin around the stoma occurred in 18 patients (90%) in the first group, while no such complication was found in patients in the second group. The average number of exchanged ostomy wafers was 2,9 per weekin the first group of patients, and 1,1 in the second group (p 0,05). Conclusions. The creation of the skin bridge stoma allows for tight fit of the ostomy appliance immediately after surgery completion. The equipment has stable and long-lasting contact with the skin, no skin inflammatory changes occur. Also the surgical site infection rates are lower in this group of patients. As perioperative patient does not require an increased number of ostomy appliance, the cost of treatment can be considered as an important aspect.
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Content available remote Analysis of complications after blood components’ transfusions
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Complications after blood components still constitute an important clinical problem and serve as limitation of liberal-transfusion strategy. The aim of the study was to present the 5-year incidence of early blood transfusions complications and to assess their relation to the type of the transfused blood components. Material and methods. 58,505 transfusions of blood components performed in the years 2006-2010 were retrospectively analyzed. Data concerning the amount of the transfused blood components and the numbers of adverse transfusion reactions reported to the Regional Blood Donation and Treatment Center (RBDTC) was collected. Results. 95 adverse transfusion reactions were reportedto RBDTC 0.16% of alldonations (95/58 505) - 58 after PRBC transfusions, 28 after platelet concentrate transfusions and 9 after FFP transfusion. Febrile nonhemolytic and allergic reactions constitute respectively 36.8% and 30.5% of all complications. Conclusion. Nonhemolyticand allergic reactions are the most common complications of blood components transfusion and they are more common after platelet concentrate transfusions in comparison to PRBC and FFP donations.
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Content available Major vascular injury during laparoscopy
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Major Vascular injury during laparoscopy is most deadly complication of laparoscopy. This report is review major vascular injuries based on surgeon’s relation and literature. The incidence of MVI is 0,04–0,1%. Extremely important is to learn proper technique of insuflation. According to patient’s physique surgeon should consider best technique of insuflation, take caution against slim people, and induct implements with proper angle. We should avoid excesive force during trocar and Verres’s needle insertion, we also should avoid redundant movement after Verres needle is inserted in abdomen cavity. Elevation of the anterior abdominal wall at the time of Veress or primary trocar insertion is routinely recomended. Major vascular injury is seriously underestimated problem of laparoscopic operations.
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Ipilimumab, an anticancer drug, is an anti-CTLA4 monoclonal antibody. It is used in treatment of disseminated melanoma. Therapy is associated with high risk of complications. One of the most serious, although one of the rarest is perforation of gastrointestinal tract. In this case report we describe a 52-year old male, with disseminated melanoma with unknown starting point, treated with anti- CTLA4 monoclonal antibody. After 3rd dose of drug administration, bloody diarrhea and acute abdominal pain occurred as a symptom of gastrointestinal perforation. A single perforation was sutured during laparotomy. Symptoms of acute abdomen returned after 10 days. Pus-faecalperitonitis, symptoms of necro-hemorrhagic colitis and multilocal perforation of the colon were found during relaparotomy. Pancolectomy with end ileostomy was performed. Few hours since relaparotomy pacient died due to multiple organ failure. The purpose of this case report is to draw attention to a risk of multilocal colon perforation in patient treated with ipilumumab.
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Content available remote Laparoscopic Treatment of Abdominal Hernia – 5 Years of Experience
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Laparoscopic surgery has become a well approved method of abdominal hernias treatment in recent years. Due to the advancement of laparoscopy and the use of improved synthetic materials laparoscopic surgery is characterized not only by low complication but also by a short period of recovery after surgery. The aim of the study was a retrospective analysis of the results of laparoscopic abdominal hernia surgeries (IPOM). Material and methods. Between year 2007 and 2012, 65 patients aged between 29 to 76 underwent laproscopic abdominal hernia surgeries due to either primary or postoperative abdominal hernias. All patients were examined in perioperative period, after 12 and 24 months after surgery in search of complications, pain and reccurence. Recovery period was also estimated. Results. In most cases postoperative pain was estimated from 1 to 4 on VAS scale. The most frequent complications were seromas that occured in 3 patients. The other complications were pneumothorax, wound hematoma and wound infection that occured once each. One patient required reoperation due to wound hematoma. Chronic postoperative pain was diagnosed in 3 patients and 4 recurrences were stated. Conclusions. Laparoscopic therapy of abdominal hernias is a safe operative method characterized by low recurrence and complication rates as well as short hospital stay and quick recovery. This technique is restricted by high material costs and the lack of full refund for the procedure.
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Background. This study evaluates 15 years’ results of the implantation of autoclaved femoral and tibial prosthesis components together with a new same brand polyethylene insert which were used as a temporary articulating spacer in patients with periprosthetic infection of total knee arthroplasty (TKA) in a two-stage reimplantation procedure in 6 patients.  Material and methods. The femoral and tibial prostheses of 6 patients with deep chronic periprosthetic infection of TKA who underwent elective two-stage exchange arthroplasty were autoclaved and reinserted with a new polyethylene insert of the same brand and bone cement mixed with tecoplanin in 2004. Results. Four patients were followed for 15 years. They were all female and between 47-70 years old. The infectious agent was meticillin-resistant Staphylococcus aureus (MRSA) in 3 and coagulase negative Staphylococcus in one patient. Patients were invited for second stage reimplantation, but they refused to undergo the second stage. Three of them had their second stage reimplantation after 15, 13 and 10 years while one patient was reinfected after 5 years, in 2009, and arthrodesis was performed. They were all happy with the result and infection free at last follow-up.  Conclusions. 1. Regarding the results of our patients, reinsertion of autoclaved femoral and tibial prostheses together with a new same brand polyethylene insert with teicoplanin loaded bone cement can be used cautiously in the management of periprosthetic deep infection of TKA. 2. That is because patients might not want the second stage reimplantation. 3. We believe that the refusal of patients to undergo the surgery shows that the single-stage treatment is effective.
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Content available remote Surgical Treatment of Meckel's Diverticulum
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The aim of the study. Assessment of own research material associated with surgical treatment of Meckel's diverticulum (MD).Material and methods. Retrospective analysis of medical records of 27 patients managed in the Department of Endocrine and General Surgery of Medical University in Łódź between 1st October 2002 and 31st December 2009 due to incidentally found during surgery and not producing symptoms MD and also operated on for its complications.Results. After excision of MD causing symptoms surgical complications possibly directly associated with the removal of MD were not observed. After prophylactic excision of MD such complications occurred in 2 patients (11.11%). Moreover, in this group we found one death after the operation, but it was not attributable to performed diverticulectomy and was caused by multiple coexisting diseases. In 3 of 14 prophylactically removed and macroscopically normal Meckel's diverticula the presence of reactive inflammation was diagnosed on histopathology.Conclusions. Excision of MD, both producing symptoms and incidentally found, is associated with the low risk of complications. After the recognition of acute appendicitis all identified Meckel's diverticula should be removed, even macroscopically normal, because they can present with the reactive inflammatory process. The method of MD excision depends on intraoperative diagnosis. The risk of MD-related complications may increase with age.
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