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Biomedical subjects

W Gacyk

Publications and source records attributed to W Gacyk.

At least 19 recordsLinked to original sources
PubMed1997

[Early and late evaluation of Jurasz's operation].

In the years 1971-1996, 102 patients were treated for pancreatic pseudocysts. In 42 cases pancreatocystogastrostomy modo Jurasz was done. 12 patients operated on in the years 1971-83 were included in group I--retrospective trial, other 30 patients treated in the years 1984-96 were included to group II (prospective trial). Postoperative course was uneventful in 38 patients, remaining 4 (9%) had the following complications: bleeding from gastric mucosa 2x, or from the cysts 1 x, mechanical ileus 1x. Hospital mortality was 7% (3 patients). The cause of the death was: sepsis, pulmonary oedema, cardiac arrest. Pancreatic enzymes monitoring in the postoperative period and controlled USG and endoscopic tests (group II) indicate that emptying of the cysts takes place mainly during first 3-4 days and it's closure is completed within two weeks. The follow up period is 1 month to 13 years (mean 5 years). Recurrence of the cyst was noted only in 1 patient 2%.

Adult↗
PubMed1997

[Diagnosis of pancreatic neoplasm--possibilities and limitations].

75 consecutive patients treated for pancreatic cancer were submitted to prospective trial. 1 to 12 weeks passed from the onset of symptoms before diagnosis was established. 61 (81%) patients were admitted due to symptoms and 14 (19%)--due to USG findings. Sensitivity and selectivity of imaging techniques was as follows: USG-87% and 73%, ERCP-72% and 72%, CT-100% and 82% respectively. Staging of the lesions estimated by CT (AJCC/TNM scale) 34 patients qualified as stage I, 15 as stage II, 14 as III and 12 as stage IV. Surgery was undertaken in 71 patients and resective procedures in 32 of them (43%). The final diagnosis was established by one biopsy in 21 patients, and in the further 8 cases 2-3 biopsies were necessary. In 3 cases cancer cells were found only during histological examination of the whole resected specimen. The follow up in resected group was 1-30 months. One year survival was 72%, actuarial survival is 38%.

Actuarial Analysis↗
PubMed1997

[Results of treating liver cysts].

In the years 1974-96, 27 patients aged 31-74 were treated for symptomatic pseudocysts. The duration of symptoms ranged from 3 months to 20 years. Patients were complaining for: pain in the upper abdomen (82%), feeling of fullness (59%), nausea and vomiting (41%), weight loss (23%). Diagnosis was confirmed by USG and CT except of two patients who were diagnosed during emergency surgery because of the cyst rupture. Multiple cysts were present in 4 patients others had single cysts. The treatment comprised: excision of the cyst in 13 patients, excision with partial right lobectomy in 4, fenestration in 5 (laparoscopically in two), marsupialisation of ruptured cyst in one and in remaining 4 puncturing or transcutaneous drainage. Good result of treatment was achieved in all cases. Histologic examination of the cysts revealed: serosal cyst in 18, echinococcal in 2, adenoma originating from bile ducts epithelium in the remaining. The follow up period is 3 months to 21 years. No recurrence of the cyst was noted.

Abdominal Pain↗
PubMed1997

[Results of reconstructive surgery for bile duct injury].

The results of the treatment of 51 patients operated on for iatrogenic bile duct injuries are presented. 65 reconstructive operations were performed. In 92% of the cases the injury was causes during cholecystectomy, in 8% - it happened during gastric resection. According to Bismuth's classification, 2 patient demonstrated type I injury, 13 - type II, 21 - type III, 10 - type IV, and 3 - type V. The choice of reconstructive method depended on the type of injury and the local situation. Consequently 37 hepatic-jejunostomies were performed (classic method - 17x, the mucosal-graft - 18x, Allen's method modified by Galperin - 1x, Hepp-Couinaud's - 1x), 8 hepatic-duodenostomies, 2 - Longmire-Sanford method, 4 choledocho-duodenostomies. Recurrence of structure in anastomosis place were noted after 11 procedures, but no one were observed after mucosal-graft reconstruction.

Adolescent↗
PubMed1997

[Repeated laparotomy for acute necrotizing pancreatitis].

In the period of 1984-1996, 569 patients were treated for acute pancreatitis and 37 of them (6.5%) developed infected pancreatic necrosis (IPN). All these patients were submitted to repeated laparotomies according to Bradley's procedure. The IPN was caused by: bile duct stones--in 11 cases, alcohol abuse-14, ERCP-6, trauma-1, in 6 cases the etiology was cryptogenic. The accuracy of imaging tests was: USG-62%, CT-100%. Sepsis was present in all cases, and multiorgan insufficiency-in 25 patients. Hospital mortality was 30% (11 patients). The most frequent reason of death was multiorgan insufficiency. The actuarial survival was 26 patients (70%).

Acute Disease↗
PubMed1997

[Prospective evaluation of treatment results while using surgical esophageal devascularization and transection for esophageal varices].

During the years 1979-1996 over 300 patients aged 2-71, with esophageal varices had been treated in our Clinic. In 104 cases extended gastroesophageal devascularization and esophageal transection combined with splenectomy was performed. According to Child-Pugh's classification 60 patients (58%) were qualified to group A and B, 44 (42%)-to group C. In 61 cases (59%) the operations were carried out electively, in 30 (29%)-as an emergency and in the remaining 13 (12%)-prophylacticly. In all cases the operation was successful in controlling preoperative variceal bleeding. Postoperative mortality amounted in 20 cases (19%): in Child's group A and B-10% and in group C-32%. The highest mortality rate was noted in group C patients operated emergently (38%). The main cause of death was developing hepatic failure (18 cases) and esophageal fistula in the remaining 2. Recurrence of esophageal varices was observed in 4 patients (4%) and the recurrence of variceal bleeding in 3 of them (3%). In other 3 cases recurrent bleeding was caused by acute mucosal lesions in the stomach. No cases of postoperative encephalopathy have been observed. Follow-up period ranged from 2 months to 15 years (mean 6.5 years) and actuarial survival-67 patients (64%). In our opinion esophageal transection with extended gastroesophageal devascularization is an effective method of controlling variceal hemorrhage, with very low recurrence rate and allows to avoid postoperative encephalopathy.

Adolescent↗
PubMed1997

[Changes in portal circulation after esophageal transection].

UNLABELLED: 104 patients with hepatic cirrhosis and esophageal varices were treated between 1979 and 1996 using the modified Sugiura (Hirashima) procedure. In 60 cases (18 F, 42 M) portal hemodynamics (portal blood velocity (PBV) and portal blood flow (PBF)) were investigated using Doppler-USG method. In 40 cases a prospective study before operation, 2 weeks, 3 months after operation and then in 6-month intervals was completed. In 20 patients the study was done 18 months to 7 years after operation only. The control group comprised 20 healthy volunteers. Mean PBV before operation was 17.5 +/- 1.2 cm/s, 2 weeks after surgery-14.2 +/- 1.0 and 3 months after operation 15.1 +/- 0.9 cm/s, mean PBF: 1211 +/- 124 ccm/min, 987 +/- 97 ccm/min and 1179 +/- 92 ccm/min respectively. The observed decrease of PBV and PBF was not significant. In the late postoperative period mean PBV was 14.0 +/- 1.2 cm/s and PBF 1077 +/- 99 ccm/min. We observed portal vein thrombosis in 4 cases before the operation and 7 new cases after operation. In 3 of them the recanalization of portal vein trunk was noted in further investigations. CONCLUSION: Extended gastroesophageal devascularization, splenectomy and esophageal transection (Hirashima procedure) does not result in significant decrease of portal blood velocity and portal blood flow. The hemodynamic effect of this operation is stabile in the observation period 1.5 to 7 years.

Adolescent↗
PubMed1997

[Treatment results for inguinal hernia repair with the mesh-plug method].

In the years 1992-1996 367 operations were performed in 350 patients aged 15-88. The type of the hernia was classified according to Gilbert's classification in Rutkow's modification. Type 2 and 3 was the most often (136 and 102 patients respectively). Recurrent hernia after classical operations were treated in 33 patients. Local, epidural or subarachnoid anesthesia was applied in 93% of patients In 75% of patients no analgetics were administered within first 24 hours after operation. In the remaining only traditional analgetics were given. Early complications were noted in 6 patients: wound infections, scrotal oedema, hydrocele. The time of operation was 35 minutes and the time of hospitalization was 2-5 days. Patients returned to their normal activity within 2 weeks. In the follow up period 1-5 years only 2 recurrences of hernia were noted (0.5%).

Adolescent↗
PubMed1997

[Mesh-plug operation for treating inguinal hernia. Randomized studies].

In the period from October 1996 to April 1997 a prospective randomized study of one hundred patients with inguinal hernia was performed. 50 patients underwent the Bassini procedure (group I) and others tension-free mesh-plug repair (Lichtenstein in Rutkow's modification) (group II). The type of hernia was classified according to Gilbert's classification in Rutkow's modification. We used t- Student test and Mann-Whitney's test to evaluate significant differences. There was no significant difference in patients' age, types of hernia or the type of anesthesia between to groups. The time of operation was significantly shorter in group II (median 51.8 min) than in group I (median 63 min). During the post operative period more patients from group I required narcotic analgetics (64% versus 22%). The rate of complications was similar (8% and 6% respectively). Hospital stay was significantly shorter in group II-median 4 days versus 6 days in group I. Rehabilitation to normal activity and return to work was also shorter in group II-median 2 weeks versus 3 weeks (not statistically significant). During the follow up period 1-17 months no recurrences were observed.

Adult↗
PubMed1995

[Development of renal transplantation in the Gdansk center].

The kidney transplantation is one of the renal replacement therapy methods, which prolongs live of the patients with the end stage renal disease for many years. Moreover, this method is well known, safe and not so expensive as dialysotherapy. Our purpose was to present the 15-year activity of the transplantation center in Gdańsk. The first renal transplantation took place on the 31st of March 1980 and there have been 137 renal transplantations in Gdańsk until now. We can divide the time between the 31st of March 1980 and the end of 1994 into two periods: I from 31.03.80 to 31.12.89 and II from 1991 to 1994. During the first were 46, and during the second were 91 renal transplantations performed. It means that since the second half of 1991 the activity of the center in Gdańsk has increased. The graft function was noted in 29 patients (63%) during the first period and in 75 (82%) during the second. The acute graft failure was observed in the most of the cases mentioned above. The 5-year living of the transplanted patients and the dialysed patients is comparable and amounts to 90%. Infections were the main reason of death during the first period, and cardiovascular complications during the second. The 5-year graft's functioning is 60%. Nowadays the results of the kidney transplantation center in Gdańsk are good and comparable with the results of other centers in Poland and Europe. Our center, as similar ones in Poland is prepared to extend the kidney transplantation activity. So it is necessary to intensify an effort to gain more organs for transplantations.

Cause of Death↗