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1
Content available remote Exceptionally Late Reconstruction of the Esophagus for Congenital Atresia
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EN
In this case report, the treatment history of a woman with congenital esophageal atresia is presented. She underwent thoracotomy immediately after birth, but the distance between two atresic parts of the esophagus (7cm) did not allow for a primary anastomosis. Gastric and salivary fistulas were constructed. A salivary fistula was made in the cervical part of the esophagus. For 21 years, the patient received nutrition only by gastrostomy. Her physical and mental conditions were normal. She underwent esophageal reconstruction of the last segment of the ileum, coecum, and ascending colon and began oral feeding when she was 21 years old.
EN
New materials, techniques of tendon suture and methods of post-operative rehabilitation offer surgeons perspective of effective repair and excellent outcomes. Results of experimental studies show that multistrand tendon suture provides better mechanical properties than two-strand technique, however, clinical use in only 4 studies did not confirm its definitive superiority to traditional method of the repair.The aim of the study was the assessment of the outcomes of the treatment of flexor tendon repair by a modified, four-strand Stickland technique.Material and methods. Flexor tendons lacerations in 60 patients, all in Verdan's zone II, without associated bone fractures and impaired blood supply were repaired by a modified, four-strand Stickland technique. An active flexion and extension of the fingers in the range restricted by a splint was recommended immediately after operation. Early results were evaluated in 51 patients, 41 men and 10 women, in a mean age of 31 years, in whom 69 tendons were repaired in 69 digits. Follow-up at 2 and 6 weeks included examination of total active range of motion (AROM) of involved fingers, rupture rate and complications.Results. Failure of the repair occurred in 3 cases (6%), including one thumb, index and little finger, all between 2nd and 6th week after the operation. A mean AROM at 2 and 6 weeks was 38% and 58% of the normal value (270° for the finger and for 170° the thumb), respectively. In 13 digits (28%) AROM at 6 weeks was excellent, greater than 80%, but in 5 digits was poor, less than 20% of the normal value. The main cause of reduced AROM was incomplete extension of the digits, due to splint employment up to 6 weeks post-operatively.Conclusions. Early results obtained in the study fail to confirm greater endurance of four-strand repair over two-strand, what suggest rupture rate closed to given in the literature. An active range of motion achieved in the group was poorer than obtained after two-strand repair in other studies, but one can expect its improvement in the longer perspective.
PL
W pracy przedstawiono przegląd robotów mających zastosowanie w chirurgii. Scharakteryzowano zarówno ich zalety jak i najistotniejsze problemy związane z ich wdrażaniem i użytkowaniem. Zgodnie z zastosowaniem poszczególnych robotów dokonano podziału na kilka typów systemów chirurgicznych.
EN
This paper deals with robots used in surgical applications. The advantages, disadvantages and essential problems of development and using robots for surgery are discussed. There are presented and identified five broad types of robotic systems in accordance with their appliance.
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The authors present a case report of a 46-year-old man with a tumor of the posterior pharyngeal wall. Based on clinical examination and magnetic resonance imaging, the patient was qualified for surgical treatment. The patient underwent tumor resection under general anesthesia. Histopathological examination of resected tumor revealed the diagnosis of ancient schwannoma.
5
Content available remote Surgery for Inflammatory Bowel Disease in Children and Adolescents
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EN
Recent decades have seen a constant rise in the incidence of IBD in both adults and children. Despite considerable progress in the pharmacological treatment of this disease, surgery has become the more frequently used treatment modality in younger patients. In the presence of massive haemorrhage, free perforation, fulminate colitis or acute obstruction, only surgical intervention has a chance of saving the patient's life.The aim of the study was to present the results of surgical treatment of IBD in children and adolescents who were operated on in a department which copes with "adult surgery" in its everyday practice.Materials and methods. 235 patients were operated on for IBD in the years 1998-2005. There were 18 (7,66%) children in this group, 10 girls and 8 boys. 12 patients were diagnosed with ulcerative colitis (66.7 %) and (6) patients were diagnosed with Crohn's disease (33.3%). The age of the patients ranged from 12 to 17 years (mean 15.6). Among the 18 children, 10 (55.6%) were operated on for elective reasons and 8 (44.4%) of the interventions were emergencies (three perforations, two obstructions, one acute haemorrhage and one fulminate colitis). In all cases of ulcerative colitis, a two-step restorative proctocolectomy with J pouch anal anastomosis was performed. Patients with Crohn's disease were treated by limited (sparing)[it seems that either limited or sparing works here, pick one] bowel resection and/or strictureplasty.Results. There were no postoperative deaths in the study group. Postoperative complications were observed in 6 (33.3%) patients, the complications were ileus in 3 patients (1 patient demanded relaparotomy), pneumonia in 2 patients and wound suppuration with subsequent dehiscence in 1 patient. In one patient treated preoperatively with large doses of Imuran, the postoperative histology revealed a malignant lymphoma. Hospital stays ranged from 8 to 19 days (mean 12 days).Conclusions. Surgery for IBD in children and adolescents has become a widely accepted method, and it is often the only treatment modality that offers a chance of a cure. Restorative proctocolectomy should be considered earlier in many cases of younger patients with ulcerative colitis, prior to conservative treatment, as imunosupression and steroid therapy in particular produce undesired side effects. A consulting surgeon should be involved in the treatment of younger patients with IBD at a much earlier stage of therapy than is currently practiced.
EN
Summary: Lung cancer is the most common malignant tumor in the world, as well as one of the cancers with the most fatal prognosis. The acceptance of the disease is the most important element of the adaptive process. The better the illness acceptance, the lower the stress level and the higher the self-esteem, which facilitates the adaptation to the health status. Aim: The aim of this study was to assess the acceptance of the disease in patients before and after lung cancer surgery. Materials and methods: The study was conducted in 2016 at the Center of Oncology in Bydgoszcz and the Kuyavian and Pomeranian Pulmonology Center in Bydgoszcz. The study involved 87 patients who were assessed both before and after lung cancer surgery. The original questionnaire, as well as the Acceptance of Illness Scale, were used. Results: Men accounted for 75% of the probands, 65% of the study population were 50-69 years old. The highest number of patients – 25 (28.7%) had a 5-pack-year history, and the lowest amount of patients – 8 (9.2%) had a 2.5-pack-year history. The level of acceptance of illness before and after surgery differed in 58 persons. In 29, the level of acceptance remained the same, in 45, the level of acceptance decreased, and in 13 – it increased. Before surgery, the mean acceptance of illness score was 26.2 points, and after surgery – 20.89 points. The patients both after and before surgery had acceptance of illness scores regardless of their gender, age, education, place of residence or occupational activity. Conclusions: In more than a half of the patients, the acceptance of illness decreases after surgery and is at an average level. Male patients, patients aged 50-69 years, with primary, middle or vocational education, employed persons show a significantly worse illness acceptance, regardless of their place of residence, and occupational activity do not influence the acceptance of the disease.
EN
The 30-day mortality is one of the factors reflecting the quality of treatment. All these efforts focused on decreasing 30-day mortality will directly improve quality of care. The aim of the study was to identify risk factors of 30-day postoperative mortality in a cohort of patients operated on for colorectal cancer in one tertiary colorectal centre. Material and methods. Patients operated on due to colorectal cancer (CRC) between 2008 and 2014 were included in the study. 30-day mortality was assessed as an endpoint of the retrospective study. All records were collected from prospective database. Results. 1744 patients were operated on due to CRC. The 30-day mortality was noted in 65 patients (3.5%). In multivariable analyses we revealed that spread disease and poor general condition at admission were risk factors of 30-day mortality: OR 2.35; 2.01‑2.57 95%CI, p=0.03 and OR 2.18; 1.95‑2.41 95% CI; p=0.01, respectively. Emergency surgery significantly increased the risk of 30-day mortality: OR 2.64; 2.45‑2.87 95%CI; p=0.009. Low serum albumin concentration level and diabetes mellitus were additional risk factors for 30-day mortality, OR 1.65; 1.52‑1.78 95%CI; p=0.01 and OR 1.67; 1.41‑1.82 95%CI; p=0.03, respectively. Mortality was significantly higher after resection procedures than after only palliative operations: 4.21% vs 1.57%; p=0.002. Conclusions. Emergent patients, patients with advanced disease and in poor general state have to be assessed by multidisciplinary team to prepare them to operation. Additionally to reduce the risk of 30-day mortality decision of extend of surgery should be made by experienced surgeons.
EN
The article demonstrates the important problematic areas associated to the ergonomics of surgical instruments during their usage. For this purpose, an analysis of cholecystectomy surgery with the use of laparoscopic instruments was conducted. There was identified the individual operations performed by surgeon, as well as the particular laparoscopic instruments. The prepared in this way study material, allowed for evaluation of design features of tools used in laparoscopic surgery from functional and ergonomic point of view and developing special research procedure for ergonomic assessment. Particularly, the critical states within the selected body postures in the system were identified: an operator (surgeon) and a surgical tool, as well as the areas of ergonomics corrective intervention in the process of using laparoscopic instruments.
10
Content available Surgical treatment of pancreatic cystic tumors
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EN
The aim of this study was to assess short-term outcomes of surgical treatment of pancreatic cystic tumors (PCTs). Material and methods: We retrospectively reviewed medical records of 46 patients (31 women and 15 men) who had undergone surgery for pancreatic cystic tumors in our department. Results: Pancreatic cystic tumors were located within the pancreatic head (21), body (11), tail (13), and whole pancreas (1). The following surgical procedures were performed: pancreatoduodenectomy (20), central pancreatectomy (9), distal pancreatectomy (3), distal pancreatectomy with splenectomy (3), distal extended pancreatectomy with splenectomy (2), total pancreatectomy (1), duodenum preserving pancreatic head resection (1), local tumor resection (4), and other procedures (2). Histopathological tumor types were as follows: serous cystadenoma (14), intraductal papillary mucinous adenoma (5), intraductal papillary mucinous carcinoma (5), solid pseudopapillary tumor (5), mucinous cystadenoma (5), mucinous cystadenoma with border malignancy (1), mucinous cystadenocarcinoma (2), adenocarcinoma (4), and other tumors (5). Early postoperative complications were observed in 14 (30.43%) patients. Reoperations were performed in 9 (19.56%) patients. The perioperative mortality rate was 6.52%. Conclusions: Serous cystadenoma was the most common pancreatic cystic tumor in the analyzed group. PCTs were most frequently located within the pancreatic head. Pancreatic resection was possible in most patients, and pancreatoduodenectomy was the most common pancreatic resection type.
EN
Insulinomas are rare tumors, accounting for 1-2% of all neoplasms of the pancreas. Usually their treatment is not associated with any problems; however there is a small subset of problematic clinical cases. The authors present their own clinical experience with surgical treatment of insulinomas of the pancreas. The aim of the study was to conduct a retrospective analysis of patients with insulinomas of the pancreas who underwent surgical treatment at Department of General and Transplant Surgery Medical University in Łódź. Material and methods. The study included all patients who underwent surgical treatment at the Department between 2007 and 2013 for the tumor of the pancreas. Further retrospective analysis included all patients with tumors of the insulinoma type. The data was obtained from medical records, surgical protocols and histopathology reports. Results. The analysis included 530 patients who underwent surgical treatment for the tumor of the pancreas. Insulinoma was found in 10 (1.88%) patients (8 females, 2 males). An average age of patients who underwent surgical treatment was 47.5±13.8 years. An average size of the tumor was 1.6±0.5 cm. Six patients underwent extirpation of the insulinoma, while the other patients underwent distal resection of the pancreas. All patients underwent “an open surgical procedure”. The average duration of the surgical procedure was 55±45 minutes. Duration of the hospitalization in the analyzed group of patients was 7±5 days. Incidence of postoperative pancreatic fistulas was 10%. All insulinomas were benign. Conclusions. Insulinomas were rare among patients who underwent surgical treatment at the Department. They were benign and their treatment was unproblematic. However, there is a small group of cases that can be associated with problematic clinical situations. Thus treatment of patients with insulinomas should be conducted at specialist centers. Correct diagnostic and therapeutic management, involving close cooperation between multiple medical specialists, results in complete curing of majority of patients.
EN
In Polish society Stereotypes about the surgeons are deeply rooted, which could really affect their relationship with the patient and the entire treatment process. The aim of the study was to evaluate the results of an opinion survey on the image of the surgeon and operative treatment. Material and methods. Between 1 January and 30 October 2012, 1000 patients were examined by use of a original questionnaire containing 25 questions. Results were analyzed statistically by STATISTICA test. Differences between groups were tested using Chi-square test (X²) with Yates modification, adopting the significance level α = 0.05. Results. The study group consisted of 1000 patients, including 56% of women (n = 560) and 44% of men (n = 440). The media image of Polish surgeon was identified as positive by 78% of respondents. A majority of patients (74%) considered that the Polish surgeons had equal level of competence and skills as foreign specialists. The greatest trust of the respondents (n = 537) had surgeons in middle age (40‑60 years). For the majority of patients (n = 649) a sex of the surgeon had no significance. Respondents clearly stated that a surgeon performing the operation should not have additional financial rewards. Almost all respondents in medical emergencies without hesitation declared their agreement to surgery (n = 974). Conclusions. Present knowledge of Polish patients about surgeons and surgical treatment is high. The surgeon has a high social prestige, respect and appreciation, and his image in the opinion of the vast majority of respondents is positive.
EN
Background. Lateral compression (LC) accounts for a wide spectrum of pelvic ring injuries (PRIs). The primary aim of this study was to assess the health-related quality of life outcomes of surgically fixed LC crescent versus sacral fractures in patients less than 50 years old after high energy trauma. Material and methods. We retrospectively reviewed the database for PRIs treated surgically from December 2011 to January 2019 at our tertiary level trauma centre. The EuroQoL-5D (EQ5D5L) questionnaire was electronically sent to all patients. Multiple linear regression was conducted to determine the predictors of quality-adjusted life-years (QALYs). Results. The study included 37 patients. The mean age was 26 SD 9.46 years. The mean duration of follow-up was 3.78 (r:1-9) years. Twenty-one (56.8%) and 16 (43.2%) patients sustained sacral fractures and crescent fractures, respectively. Multi-regression analysis showed that any patient with LC injury without a sacral fracture is expected to have a utility value of QALY= 0.876. A reduction of 0.072 units in QALYs is expected in the presence of sacral fracture. About 71% of patients with sacral fractures were able to return to work and this probability increased by 40% among patients with crescent fractures (RR=1.4, p=.015). Conclusions. 1. Younger patients with crescent fractures tend to have better quality of life (higher EQ5D and QALYs) compared to those with LC sacral fractures. 2. Moreover, patients with LC sacral fractures have less chance to return to their pre-injury level of work compared to those with crescent fractures.
EN
Introduction: Recurrent thyroglossal duct cyst after surgery is not a rare condition and first-line treatment has not been established yet. Aim: Evaluation of outcomes and complications of OK-432 treatment in patients with recurrent thyroglossal duct cyst after surgery. Material and methods: This study is designed as a case series with planned data collection at Tohoku Medical and Pharmaceutical University and Fukase Clinic. Five patients with recurrent thyroglossal duct cyst after surgery received this therapy between January 2014 and February 2020 on an outpatient basis, without hospitalization. OK-432 solution was injected into the lesion using an 18- or 27-gauge needle, depending on the location and size of the lesion, as well as on possible complications. Results: Lesions showed marked reduction or total shrinkage in all patients, with no local scarring or deformity at the injection site. Side effects manifested as local pain at the site of injection and fever (37.5–38.5°C) observed in three patients, but the symptoms resolved within a few days. Conclusions: Since OK-432 therapy is simple, easy, safe and effective, it can be used as an alternative to surgery in the treatment of recurrent thyroglossal duct cyst after surgery.
EN
Introduction: There are different complications related to the submandibular gland resection, like damage to the mandibular branch of the facial nerve, lingual or hypoglossal nerve. Moreover, subjective complaints like dry mouth, altered sensation around the scar and taste alterations were described. Patients and methods: A prospective, non-randomized study was performed including 20 patients treated with submandibular gland resection. Results: The most common etiology was sialolithiasis affecting 9 (45%) patients. One (5%) patient presented a lingual nerve paresis, 2 (10%) patients presented a transient marginal mandibular branch paresis and no hypoglossal nerve alteration was observed. Factors like the size of the lithiasis (P = 0.293), size of the tumor (P = 0.445) or type of pathology (P = 0.694) were not related with neurological complications. Altered sensation in the skin around a scar was the most severely weighted problem (55% and 33.3%), and xerostomia was the second one (33% and 27.3%) at one month and at six months after surgery, respectively. Conclusion: The submandibular gland resection remains to be a safe technique with a low rate of surgical and neurological complications. However, patients should be informed about sequelae like xerostomia, altered sensation in the skin or pain around the scar, which may be discomforting. The cosmetic result can be satisfactory, but a surgical scar can be avoided with another approach. Although rare, the risk of MBFN, lingual and hypoglossal nerve damage should always be included in the preoperative information on surgical risks.
EN
Introduction: Congenital factor VIII deficiency is a rare hemorrhagic disorder inherited in an autosomal recessive pattern. Surgical treatment with insufficient diathesis correction is burdened with a high risk of bleeding complications. The aim of the study was to evaluate the surgical outcome in patients with congenital factor VII deficiency and assessment of the efficacy and safety of recombinant activated factor VII (rFVIIa) used for perioperative hemostatic coverage in our two schemas of substitutive therapy. Material and methods: In the years 2002-2017 a total of 22 patients with congenital factor VII deficiency were subjected to surgery. Substitution therapy relied on rFVIIa used in two schemas. One involved 15 patients with factor VII activity of <10% of normal value who were injected rFVIIa at a dose of 30 μg/kg b.w. every 12 hours on surgery day, 15 μg/kg b.w. every 12 hours on the first postoperative day and 15 μg/kg b.w. every 24 hours on the following days. The second schema involved 7 patients with factor VII activity of 10-25% of normal value who were given rFVIIa at a dose of 15 μg/kg b.w. every 12 hours on surgery day and the first postoperative day; then the same dose was administered every 24 hours on consecutive days. The treatment continued for 4-10 days. Results: In 22 patients a total of 26 surgeries were performed; 17 surgeries in 15 patients with factor VII <10% of normal and 9 in 7 patients with factor VII deficiency of 10-25% of normal. The surgeries included: 9 cholecystectomies (8 laparoscopic, 1 open), 7 thyroidectomy procedures, 2 exploratory laparotomies, 1 left hemicolectomy, 1 total proctocolectomy, 3 inguinal hernia repairs and 3 excisions of varicose veins. One patient with factor VII activity of 9% required an additional dose of rFVIIa in the intraoperative period due to diathesis bleeding. Intraoperative hemostasis was normal for all other patients; no postoperative hemorrhagic complications were reported. In patients with FVII activity <10% average daily dose of rFVIIa was 31.3 (range 20-56) μg/kg b.w., total daily dose 186 (136-303) µg/kg b.w., total dose of rFVIIa - 15.2 (12-112) mg. In patients with FVII activity 10-25% the doses were 21.2 (15-31), 117 (46-271) µg/kg b.w. and 9.1 (6-17) mg respectively.
EN
The purpose of this study was to evaluate the effect of physical exercise on limited locomotion in the hands of patients who underwent surgery to correct Dupuytren's contracture. We studied the hands of 84 patients with Dupuytren's contracture aged from 30 to 84 years. In all patients, the contracture was removed by performing a partial fasciectomy. Physical exercises were carried out a week prior to surgery and during the postoperative period. Patients were divided into group I, in which the exercise was carried out under the supervision of the authors of this study and group II, in which exercises were performed sporadically and without professional supervision. Measurements were performed on all patients one week before surgery (A), 1 week after surgery (B) and 6 weeks after (C). The range of movement of fingers was measured using a goniometer. The average total loss of finger extension was evaluated, taking due account of the extension loss in the MCP, PIP and DIP joints of all fingers of the treated hand. Rehabilitation treatment included active and passive exercises; in more severe cases the treatment of choice was massage and special equipment to help bear flexion contracture. Test results were statistically analyzed. In all patients, there was an increase in mobility of the fingers. Patients taking part in physical exercise had significantly greater range of finger movement.
EN
Cervical branchial cleft cysts are relatively common tumors of the neck that should be distinguished from an epidermoid cyst, hygroma, hemangioma, lymphangioma, lymphadenitis, and metastatic papillary carcinoma of the thyroid gland. Infected cysts might be misdiagnosed as a recurrent abscess. The aim of the study was to present current views concerning diagnosis and treatment of cervical branchial cleft cysts. Material and methods. Data and histopathological results obtained from 49 patients (18 women and 31 men) admitted to the Department of Cranio-Maxillofacial Surgery, due to lateral cervical cysts during the period between 2005 and 2009 were subject to retrospective analysis. Results. Most patients were in their third decade of life. The clinical examination showed a painless, slowly growing tumor on the lateral surface of the neck, more often on the right side, and in 30 cases with a concomitant infection. Initial diagnosis on the basis of the clinical examination, radiology and biopsy was confirmed in 48/49 cases (98%). All patients were subject to surgical treatment. During the 3 to 7 year follow-up period recurrence was not observed. Conclusions. Initial diagnosis of a cervical branchial cleft cyst on the basis of the clinical examination should always be confirmed by means of ultrasonography. In case of suspicion of a coexisting infection, fine-needle aspiration biopsy under ultrasound control is recommended. If there is concern that the lateral neck lesion is not a branchial cyst or its dimension is large, computed tomography of the neck or magnetic resonance should be performed. Complete excision of the tumor under general anesthesia is the treatment of choice, being associated with the low risk of local postoperative complications
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In patients with dyspeptic symptoms who have been treated for gastric cancer, other medical conditions apart from cancer recurrence should be considered. A long small-bowel loop left after esophagogastric anastomosis, flaccid diaphragmatic crura, and several external factors such as hard physical exertion can promote the development of postoperative hiatus hernia. The authors of this paper present a rare case of hiatus hernia considered a late complication of primary surgery performed due to gastric cancer. The 63-year-old patient had undergone total gastrectomy with double tract reconstruction (DTR) six years earlier. Gastrectomy was performed with extended lymphadenectomy (>D2). Histopathologic examination of tumor specimens showed mucinous adenocarcinoma with no lymph node metastasis and no distant metastases (pathologic staging: pT2, pN0, pM0). After six years, the patient was admitted to the 2nd Department of General and Gastroenterologic Surgery with abdominal pains, malaise, weight loss and feeling of fullness after small meals. Diagnostic procedures performed showed the presence of hiatus hernia, a very rare complication after this particular surgery, with no features of cancer recurrence. The patient was underwent surgery and the hernia was successfully repaired.
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