Biomedical subjects
Publications and source records attributed to M Zaniewski.
We described a case of abdominal aortic aneurysm ruptured into duodenum. It was diagnosed successfully before laparotomy using duodenoscopy. We think that gastrointestinal endoscopy allows to make a correct diagnosis.
Eventration is a serious complication in the abdominal surgery. Despite the surgical suture technique improvement the frequency of this complication is still increasing. In the paper the cases of the patients operated for the diseases requiring laparotomy from November 1991 to December 1997 were retrospectively analysed. There were 4030 laparotomies done because of vascular or other surgical diseases. In 23 cases eventrations were postoperatively observed (0.57%). Mean age was 58.7 years. 11 patients were qualified for the emergency surgery (6 patients with acute abdominal diseases and 5 with vascular diseases). 12 patients were operated electively (6 patients--general surgery, 5--vascular reasons). Among 23 patients with eventrations--16 patients were qualified for the relaparotomy with abdominal cavity suture. In 7 cases because of bad general condition of the patient only the skin suture above the eventration in the intensive care station was performed and abdomen was wrapped with the bandage. There were 8 deaths: 2 patients (8.7%) after skin suture and 6 patients (26.1%) after reoperation. Respiratory or respiratory and circulatory insufficiency was observed in 13 patients (56.5%). In 60.8% of cases (14 patients) wound infection was recognized and in 3 cases sepsis occurred in the postoperative period. The disease that was the reason for the surgery did not play a significant part in the eventration occurrence frequency. The condition of the patient before the surgery was the most important prognostic factor of the eventration. In patients with bad condition it is more convenient to perform the suture of the skin above the abdominal viscera first and later the reoperation.
The occurrence of the postcholecystectomy syndrome is very often connected with inappropriate preoperative diagnostics. One of the reasons might be the presence of gastric or duodenal ulcer, what can be connected with peri- and late postoperative complications. The prospective analysis of 250 patients admitted to the Department because of cholelithiasis was performed. In 28.8% of cases endoscopical changes in the upper alimentary tract were recognized. That is why, in patients qualified for cholecystectomy the upper alimentary tract endoscopy should be performed.
The purpose of the study was to estimate which factors could have effect on successful outcome of surgery in patients operated on for ruptured abdominal aortic aneurysm (RAAA). The analysis referred to 66 patients operated upon from 1992 to 1995. The specification of all factors which could bring the influence on the successful result of the surgical treatment, was done. The statistical analysis was taken using the Yule-Kendall test and according to it for each factor the risk coefficient Q (from 0.8 to 1.0) was suggested. The group of factors conditioning in each case the failure of surgical procedure was noticed. There were differences in mortality after surgical treatment of RAAA -from 41.2% to 83.3%, mean 63.6%. The mortality of 100% was ascertained in patients with Q above 3.5. The correlation between number of patients with expected risk factors and increasing mortality rate was done. This method is useful for explaining divergences in results of surgical treatment in patients with RAAA and may be helpful for qualification of patients for surgical procedure.
The paper presents authors experience and indications for an elective relaparotomy performed as the second-look laparotomy after primary operation. 12 patients with vascular or surgical diseases were operated on for: abdominal neoplastic tumors (2 patients), elective abdominal aneurysm (2 patients), ruptured abdominal aneurysm (2), abdominal aneurysm ruptured into the inferior caval vein (1), ruptured aneurysm of the iliac artery (1), abdominal aortic coarctation with visceral arteries abnormality (1), thrombosis of the superior mesenteric artery (1) and peritonitis because of intestinal ischaemia and necrosis (2 patients). In all cases an elective relaparotomy was done on the 1st or 2nd postoperative day. 5 patients died, in 4 cases complications found during second look relaparotomy required surgical treatment (2 of this patients died, two other were successfully treated). The authors discuss indications and advantages of elective second-look laparotomy in abdominal surgery according to the anticipated risk factors and patients condition.
Pregnancy and puerperal period are favorable factors for appearance of or deterioration of peripheral vessels diseases and simultaneously limits ability of treatment. In the case of varicose veins the compressing therapy is the method of choice. The appearance of thromboemboli is the indication to the long time heparin treatment and according to other authors even to the surgery. In some cases implantation of the special filter to the inferior vena cava is necessary to prevent the pulmonary embolism. The worst form of thrombosis-phlegmasia cerulea dolens is the absolute indication to surgery. Pregnancy at patients with previous reconstructions in the aorto-iliac segment needs frequent examination of fetus and blood flow in the graft to avoid many dangerous complications. At pregnant women with peripheral vessels diseases examination using color ultrasonic doppler is method of choice. In some cases pregnancy should be treated as a high risk pregnancy and should remain under obstetrician and vascular surgeon care.
In patients with hypercalcemia with abdominal symptoms, gastrin concentration is often measured to exclude the Zollinger-Ellison syndrome. We found that interpretation of such measurements is clouded by a contradictory literature. We therefore measured serum gastrin concentrations in 78 patients with primary hyperparathyroidism, 36 with nonparathyroid hypercalcemia, 13 with hypocalcemia, and 33 normocalcemic controls. Gastrin values above normal occurred in 22% of those with primary hyperparathyroidism and 28% of those with nonparathyroid hypercalcemia. Values above 250 pg/mL occurred only in those with hypochlorhydria or multiple endocrine neoplasia, type 1 (MEN 1). After parathyroidectomy, gastrin levels fell significantly, but elevated values tended to recur in those with MEN 1 if hypercalcemia recurred. Thus, chronic hypercalcemia of either parathyroid or nonparathyroid origin may elevate serum gastrin concentrations, but marked elevations suggest either achlorhydria or MEN 1.
A 35-year-old woman who had bone pain in the extremities was found to have Cushing's syndrome, for which she had adrenalectomy. Pathologic examination revealed a solitary black adenoma. Bone scan and roentgenograms showed regional osteoporosis of the extremities and avascular necrosis of the hip. Her cushingoid manifestations and bone pain resolved after adrenalectomy and vitamin D therapy.
The popliteal artery entrapment syndrome is observed in about 0.5% of patients suffering from intermittent claudication, most often in young fit people. Significant diagnostic problems are the reason of frequent underestimation of the patients complaints. The development of the disease may further lead to lower leg arteries thrombosis or popliteal artery aneurysm. The latter condition is caused by abnormal course of the popliteal artery. Preliminary diagnostic procedures may comprise the examination with most simple Doppler apparatus. The diagnostic should be confirmed with the use of colour-Doppler ultrasonography or computed tomography (with contrast). The treatment of choice is an operation restoring normal anatomy within the popliteal space.