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1

Neuroendocrine tumours of the chest area

100%

Jabłoński S. , Brocki M.

Polish Journal of Surgery

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2010

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tom 82

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nr 2

101-111

2

Comparison of Early Results of Surgical Treatment in Patients with Pancreatic Cancer

80%

Śmigielski J. , Piskorz Ł. , Kutwin L. , Brocki M.

Polish Journal of Surgery

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2012

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tom 84

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nr 1

1-5

EN

Pancreatic tumours are a serious medical and social issue. Patients come to the doctor too late, when the disease is well advanced. The most frequently applied method of surgical treatment is pancreatoduodenectomy (Whipple procedure). The most frequently used technique of pancreatoduodenectomy is the Child-Waugh method. The procedure can be performed in a classic way or as modified by Traverso (with preservation of the pylorus).Material and methods. Between August 2008 and June 2011, in the Department of Thoracic, General and Oncologic Surgery of Medical University in Łódź, a total of 79 patients with pancreatic tumours were hospitalized. In 61, pancreatoduodenectomy was performed. The patients were divided into two groups, depending on the diagnosis and the procedures performed: group 1 comprised patients in whom the pylorus was resected (n = 43); group 2 comprised patients in whom the pylorus was preserved (Traverso-Longmire procedure; n = 18).Results. Mean duration of surgery was about 3 hours and 50 minutes in both groups. Mean duration of hospitalization after the procedure was 15.6 days in group 1 and 12.2 days in group 2 (p < 0.05). Early complications (within 30 days of the procedure) were observed in 33.2% of patients in both groups. Blood transfusion was necessary in 21% of patients in group 1 and 28% of patients in group 2 (p>0.05).Conclusions. There are specific indications for each method of surgical treatment, however, it seems that both techniques of pancreatic resection can be recommended as standard surgical treatment, and the number of complications after both procedures is similar.

3

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

70%

Misiak P. , Terlecki A. , Rzepkowska -Misiak B. , Wcisło S. , Brocki M.

Polish Journal of Surgery

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2015

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tom 86

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nr 2

89-93

EN

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. It’s 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.

4

Intrathoracic Thyroid Goiters

70%

Jabłoński S. , Wawrzycki M. , Brocki M. , Filgus M. , Kordiak J.

Polish Journal of Surgery

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2010

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tom 82

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nr 2

69-76

EN

In this article, the difficulties in treatment of 18 patients with intrathoracic thyroid goiters were discussed.The aim of the study were: defining the etiology and symptomology of goiters within the chest in the own material, conducting the analysis of the diagnostic efficiency, the evaluation of the early results of surgery and postoperative complications.Material and methods. The research material included 18 patients with intarhoracic thyroid goiters after surgical treatment (mediastinal goiters, ectopic goiters). The cases of retrosternal goiters were not analyzed. There was carried out the retrospective analysis of the medical documentation of goiters etiology, the frequency of dominating clinical symptoms, value of diagnostic methods, early effects of surgical treatment and postoperative complications.Results. In the years 2004-2008, operations were performed on 14 women and 4 men with intrathoracic goiters, aged from 34 to 82. The average age of patients was 51.1. The etiology of intrathoracic thyroid goiters were as follows: thyroid goiters (struma nodosa) - 55%, adenoma and thyroid goiters - 17%, thyroid cancer (ca papillare) and thyroid goiters - 11%, ectopic thyroid gland - 11%, thyroid goiters and thyroid inflammation - 6%. The majority of the material were cases of a cervico-mediastinal thyroid gland, only 2 patients were diagnosed with an ectopic thyroid gland located in the mediastinum with no connection with the cervical thyroid. The local symptoms of compression on intrathoracic organs were mostly observed in the clinical picture, 22% of patients were asymptomatic. The diagnostic process included the estimation of the hormonal state and the radiology localised methods among which helical computer tomography was the most valuable. In order to estimate endotracheal intubation conditions 11 patients (61%) underwent brochofiberoscopy. The following accesses were used in the treatment: cervical - 3 cases, partial sternotomy - 11, longitudinal sternotomy - 2, thoracotomy - 1, combined thoracotomy with cervicotomy - 1. Good treatment results were obtained in all cases. The following complications were noted: a permanent paralysis of the laryngeal nerve - 1 case (6%), hypoparathyroidism - 1 (6%).Conclusions. Thyroid goiters situated inside the chest are a rarely met pathology which may cause serious difficulties in surgical treatment. Patients with this illness require a thorough preparation for the treatment including balancing hormonal perturbations, preventing intubation difficulties and access to the necessary quality of a diagnostics wit purpose of planning the most optimal surgical access and avoiding serious perioperative complications.

5

Adrenal Metastases

61%

Pomorski L. , Kołomecki K. , Brocki M. , Pasieka Z. , Kaczka K. , Kuzdak K.

Polish Journal of Surgery

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2010

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tom 82

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nr 2

95-100

EN

The aim of the study was an retrospective assessment of adrenal metastases based on the analysis of patients operated on in three surgical institutions between 2001 and 2005.Material and methods. Between 2001 and 2005 169 patients (106 females and 63 males) were treated due to adrenal tumors. The age of patients ranged between 25 and 82 years (mean 55.4± 11.8 years). All patients were routinely diagnosed by means of ultrasound, computed tomography or magnetic resonance imaging and hormonal tests such as cortisol, chromogranine A, aldosterone and natrium, potassium concentrations. Patients were surgically managed after preparation dependent on general status, tumor type and concomitant diseases. Operations were carried out using classic techniques via lumbar approach in 146 cases (86.4%) or videoscopic techniques via retroperitoneal or transperitoneal approaches (13.6%).Results. In 143 cases (84.6%) benign tumors and in 26 (15.4%)-malignant lesions were diagnosed. 16 (9.5% of all cases and 61.5% of malignant tumors) were secondary- metastases form various cancers treated previously. Adrenal metastases occurred most often in the 7th decade (43.7%), and primary site was clear cell carcinoma of the kidney (9 cases - 56.25%) and non-small cell lung cancer (4 - 25%), melanoma (2 cases - 12.5%) and rectal cancer (1 - 6.25%). During the follow-up of 1-5 years (mean 3.1 years) 12 patients died of metastatic tumors - 6 with multiple metastases and 6 with solitary adrenal metastasis. 4 patients are still alive with metastatic deposits in the adrenal glands (at the moment of adrenalectomy) - 3 with metastatic renal cancer (currently 2 without other metastases) and 1 with disseminated lung cancer.Conclusions. 1. Adrenal metastases are the most frequent malignant tumors of these glands. 2. Metastatic tumors occur most often during the 6th and 7th decades. 3. Results of treatment are not satisfactory and dependent on the extent of spread.

6

Operations on Adrenal Gland Tumours in A Multicentre Study at the Łódź Medical University

61%

Pomorski L. , Brocki M. , Kołomecki K. , Andrzejewska E. , Kobos J. , Kuzdak K.

Polish Journal of Surgery

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2008

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tom 80

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nr 7

364-370

EN

The aim of the study was to determine the prevalence of adrenal tumours and their types based on the analysis of material from university surgical centres participating in a 5-year study between the years 2001 and 2005.Material and methods. A total of 178 patients, 169 (94.9%) adults and 9 (5.1%) children, with adrenal tumours were treated during the study period. Amongst the operated upon patients, there were 111 (62.4%) females (106 adults and 5 girls) and 67 (37.6%) males (63 adults and 4 boys). The age of patients ranged from 7 months to 82 years (mean 55.4 ± 11.8 years). For children, ages ranged from 7 months to 17 years, while for adults ages ranged from 24 to 82 years.Results. Incidentalomas were detected in 36 (21.3%) of 169 adults, and seven (19.4%) of them were found to be hormonally active in biochemical tests.The patients underwent surgery after the preparation depending on the general state, type of tumour, its functioning, and concomitant diseases. Adrenalectomy was performed using a classical open technique through the lumbal access in 146 (86.4%) adults, and a laparoscopic technique through the retro- or transperitoneal access in 23 (13.6%) adults. In the videolaparoscopic operations, retroperitoneal access was preferred. All children were operated upon by means of the classical technique with trans-abdominal access.Adrenal tumours were most frequent in the 6th decade of life (33.2% of all tumours). In the adult group, 143 (84.6%) cases of histologically diagnosed benign tumours and 26 (15.4%) cases of malignant neoplasms were found. Sixteen (9.5% of all tumours and 61.5% of malignancies) of them appeared to be secondary metastatic tumours. Moreover, six (66.7%) children had primary malignant adrenal tumours.In three adult patients whose tumours were up to 3 cm in size in the remaining adrenal gland (after previous adrenalectomy on the other side), enucleation was carried out in one patient and partial resection of the only adrenal gland in two patients. The follow-up cortisol levels in the blood sera of these patients appeared to be normal.Conclusions. 1. Adrenal tumours most commonly occur in the 6th and 7th decades of patients' lives; an increase in the incidence rate is affected by the percentage of metastases to adrenal glands. 2. Adrenal incidentalomas reveal subclinical hormonal activity in a significant percentage of patients and require adequate preparation prior to surgery. 3. Operations preserving the cortex of the only adrenal gland allow the patients to avoid hormonal substitution therapy. 4. Tumours in children are a separate phenomenon with specific tumour characteristics and origin.