Biomedical subjects
Publications and source records attributed to J Dybicki.
The paper presents a case of hepatolithiasis. Final diagnosis was established due to computed tomography and endoscopic recurrent cholangiopancreatography many years after the first symptoms' occurrence. Left hemihepatectomy was performed with very good 5-year result.
The authors present their own experience in the treatment of 4 patients (3F, IM) with multiple pancreatic pseudocysts. The diagnosis was based on ultrasound and CT. In 4 patients 2, 2, 3, and 3 pseudocysts were found respectively. One patients was cured using two pig-tail catheters within 3-5 days. Two patients had internal drainage. One of them had 3 pseudocysts, two were anastomosed with the stomach (Jurasz operation) and the third one with jejuneum. The other patient had cystocystostomy and so created cyst was then anastomosed with the stomach applying Jurasz's method. In the 3rd patient with 3 pseudocysts pancreatectomy was done. This case was complicated by pancreatic fistula, but finally good result was achieved. In the follow up time (2, 3, 5 years and 5 months) there was no recurrence of the pseudocysts and the patient's condition was good.
Comparative susceptibility testing of 428 strains of obligate anaerobic bacteria belonging to genera Propionibacterium, Arachnia, Actinomyces, Bacteroides, Prevotella, Porphyromonas, Anaerorhabdus, Fibrobacter, Fusobacterium, Peptostreptococcus and Clostridium to metronidazole and tinidazole was performed. The study of the susceptibility of anaerobic bacteria was carried out by the method of serial dilution in Brucella agar according to Finegold and Sutter (1972). Strains of B. fragilis species, B. fragilis group, other Bacteroides spp.. Fusobacterium spp. and Clostridium spp. were susceptible to both chemotherapeutics in clinically attainable concentrations. Of particular significance is the greater susceptibility of these bacteria to tinidazole. Taking into account this activity, tinidazole is a superior agent in the treatment of anaerobic infections. Both chemotherapeutics were not active against, rarely isolated from severe infections. Gram-positive anaerobic rods from genera Propionibacterium. Actinomyces and Arachnia and were partially active against peptostreptococci.
For evaluation of usefulness of natural fluorescence of clinical materials in UV radiation as rapid diagnostic method of infections with anaerobes, 405 samples of pus, bloody-purulent fluids, blood, wound secretions, dressings and other materials were investigated. Occurrence of red-brick UV fluorescence of clinical materials was compared with results of culture aimed at isolation of non-sporeforming anaerobes from "B. melaninogenicus group (P. melaninogenica, P. intermedia and P. saccharolytics). Significant correlation red-brick fluorescence of clinical materials resulting from UV irradiation with presence in these materials of anaerobes such as P. melaninogenica, P. intermedia and P. asaccharolytics was detected. Investigation of clinical materials with application of fluorescence in UV radiation lasts only 1-2 minutes and together with preparation and microscopical inspection which is Gram-stained--only 15-20 min. Positive results of this test may constitute a basis for rapid, preliminary identification of the etiologic factor and for direction of chemotherapy in the early period of infection.
Studies were performed in the years 1986-1990 and dealing with 405 clinical materials originating from infections within the abdominal cavity, maxilla, reproductive organ, post-operative wounds as well as dressings, extremities, blood, bile and other types of material and usefulness of analysis by gas chromatography of presence of lower fatty acids in materials for rapid and preliminary diagnostics with strictly anaerobic bacteria was confirmed. Presence in chromatograms of isobutyric, butyric isovaleric, valeric, isocaproic and caproic acid, and partly of propionic acid, is a good indication of infection with strictly anaerobic bacteria. Moreover, presence of succinic acid may suggest presence of anaerobic infection, similarly as presence in chromatograms of three or more various lower fatty acids. Rapid, approximative diagnosis of anaerobic bacteria by application of gas chromatography is worth of broader application. Investigation of clinical material by this method lasts only 1-2 hours and obtained results my present a basis for preliminary diagnosis of the etiological factor and for direction of chemotherapy, which is very important in most early period of treatment of infections.
42 cases of hepatocellular carcinoma (CHC) in patients chronically infected with HBV are presented. These are 37 men and 5 women, aged 12 to 78 years. The underlying disease was liver cirrhosis in 38 cases and chronic active hepatitis in 4. HBV infection was confirmed by the detection of viral markers in serum or/and in liver tissue. 52 percent of patients were HBsAg positive and 92 HBcAg positive. In 64 percent of cases the course of HBV infection had been subclinical before the CHC was revealed. The first signs of neoplasm are not characteristic, as the concomitant liver cirrhosis may well justify them. In all patients the diagnosis of CHC was established with presence when manifest clinical symptoms were present according to advanced lesions in most of cases. For the estimation of the stage of disease, the OKUDA system was used. In 24 patients cytostatic treatment was applied. The liver artery embolisation was performed in two cases. The surgical treatment took place in 2 cases of monolobular tumours. The survival period of the non-treated and treated patients was: in the 1st group 2.5 and 7.7 mths, in the 2nd group 1.5 and 5.2 mths, in 3rd group 1.2 and 1.1 mths, and in the 4th group 1.0 and 2.5 mths, respectively. In the groups 1 and 2 improvement of live comfort, due to Zubrod scale, was obtained. The results presented are the argument for attempts of treatment in patients from the 1st and 2nd groups.
One-hundred patients treated for gallbladder carcinoma in the years 1970-1986 are described. They accounted for 2.63% of all patients treated surgically for diseases of the gallbladder and bile ducts. Coexistence of carcinoma and cholelithiasis was found in 76% of cases. In 64 cases only exploratory laparotomy was done and biopsy was done for histological examination, since the progression of the tumour precluded any radical operation. In 15 cases cholecystectomy was done and in the remaining 21 patients palliative procedures were done. In the perioperative period 17 patients died. Information on the length of survival time was obtained in 43 cases. It was longest in cases in which the degree of progression of the tumour was classified into stages I and II after Nevin. Six patients are alive 7 months to 8 years after the operation. The authors think that the methods for improvement of the results of surgical treatment should be sought in prevention of this carcinoma that is early surgical treatment of cholelithiasis.
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