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  • Author: Andrzej Pogorzelski x
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Open access

Jarosław Prusak, Waldemar Tomalak, Artur Leżański and Andrzej Pogorzelski

Streszczenie

Wstęp: Przeszczepienie płuc jest obecnie coraz powszechniejszą metodą terapeutyczną u chorych na mukowiscydozę. Celem badań było zastosowanie testu 6-minutowego chodu w ocenie tolerancji wysiłku u chorych na mukowiscydozę, kwalifikowanych do przeszczepienia płuc.

Materiał i metody: W badaniach wzięło udział 49 badanych (27 płci żeńskiej i 22 męskiej). Średni wiek badanych wyniosł 24,6 ± 9,4 lat w przedziale 9 - 45 lat. Test 6- minutowego chodu ukończyło 47 badanych i ich wyniki stanowiły podstawę analizy badawczej.

Wyniki: Średnia wartość dystansu uzyskanego w teście 6- minutowego chodu wyniosła 493,4 ± 101,0 metrow. Wartość wskaźnika SaO2 mierzona przed rozpoczęciem testu wyniosła 90,1 ± 4,9% i spadła w momencie zakończenia testu do wartości 74,5 ± 10,5%. Z wskaźnikow spirometrycznych w analizie uwzględniono: FEV1 ktory wyniosł 0,71 ± 0,2 4 (22,1 % nal.) oraz FVC wynoszący 1,34 ± 0,54 (35,7 % nal.). Wartości wskaźnikow FVC, FEV1 oraz wyjściowych SaO2 i HR korelowały nieznacznie z uzyskanym w teście dystansem.

Wnioski: Test 6- minutowego chodu jest przydatnym narzędziem w ocenie możliwości wysiłkowych chorych na mukowiscydozę u ktorych rozważana jest kwalifikacja do przeszczepienia płuc.

Open access

Ryszard Pogorzelski, Tomasz Wołoszko, Małgorzata Szostek, Waldemar Macioch, Jerzy Leszczyński, Wawrzyniec Jakuczun, Andrzej Małek, Maciej Skórski and Mieczysław Szostek

Anastomotic Aneurysms in the Groin - Results of Surgical Treatment

The aim of the study. The authors introduce single-center results of surgical treatment of 84 aneurysms in 79 patients. Anastomotic aneurysms belong to group of pseudoaneurysms which appear in places after vascular anastomosis.

The most common location of this kind of pseudoaneurysm is the groin (85%). The next most common location is the proximal anastomotic place with the aorta or iliac common artery (12%), which constitutes from 1 to 5% of all vascular abnormalities. Usually, these need to be surgically treated.

Material and methods. The authors present surgical treatment results of 79 patients with 84 pseudoaneurysms: 10 women (12.7%) and 69 men (87.3%) ranging in age from 44 to 81 years old, with an average age of 64.7 years old.

The frequency of this pathology in all patients with vascular diseases treated in our Department was 1.6% and 7.7% in patients after surgical anastomosis in the groin. Eleven patients (13.9%) with aneurysm rupture and four (5.1%) with thrombosis and acute ischemia of the lower limb needed an emergency operation. The remaining 64 patients (81%) were operated on according to the plan.

The most common operations were: vascular by - pass, secondary suture of anastomosis, and covering the lost part of the anastomosis with a patch. This treatment was used in 66 cases (84.5%), and 18 patients (22.8%) needed early secondary operation. 18 patients (22.8%) had a vascular prosthesis infection.

Results. A good treatment result of anastomotic aneurysms was observed in 64 patients (81%).

In 10 cases (12.7%), amputation was needed due to lack of blood recirculation in the limbs.

Five patients died because of MODS due to vascular prosthesis infection.

Conclusions. 1. The most important complication resulting in surgical treatment failure is vascular prosthesis infection and the progress of peripheral arteriosclerosis. 2. Distant vascular anastomosis dehiscence may show that the anastomosis was done using too much tension or that there were dakron physicochemical changes due to the aging process.

Open access

Ryszard Pogorzelski, Tomasz Wołoszko, Andrzej Małek, Małgorzata Szostek, Wawrzyniec Jakuczun, Sadegh Toutounchi, Waldemar Macioch, Jerzy Leszczyński and Maciej Skórski

One-Centre Study Investigating a need for an immediate vascular surgery in patients over 80 years of age - comparison analysis of the results

According to the observation made by the study authors, every year there is an increasing number of patients advanced in years who require surgical management of their vascular disease. They constitute more than 4% of all patients. The similar situation is our medical centre, where the number of the hospitalisations of octogenarians increases with every subsequent year. In spite of many concomitant diseases we propose them immediate operation. Then it seems to be important a comparison two ways of treatment: immediate and elective ones.

The aim of the study was evaluation of the results obtained in the treatment of vascular diseases requiring an immediate surgical intervention.

Material and methods. In the years 2005-2007, there were 150 patients treated for arterial diseases. The group consisted of 87 men (58%) and 63 women (42%), with a mean age of 83.6. All the patients were divided into two groups: patients undergoing an elective surgery (n = 113), and those operated on immediately (n = 37). For both these groups was performed the comparison analysis, concerning the most important concomitant disorders, having an unquestionable influence on the final results of the operative treatment

Results. The comparison analysis of deaths, amputations, and hospitalisation period in the elective and immediate surgeries revealed the following: 5.3% vs 21.6% (p = 0.006), 7.9% vs 13.5% (p = 0.33), and 15.8 vs 9.8, respectively.

Conclusions. Immediate vascular surgery is especially needed by older women. Culture and customs are the reasons for treatment delay in Poland, with its direct effects on the treatment results.

Open access

Ewa Krajewska, Sadegh Toutounchi, Patryk Fiszer, Witold Cieśla, Ryszard Pogorzelski, Tomasz Bednarczuk, Andrzej Cieszanowski, Izabela Łoń and Maciej Skórski

Adrenal Tumors - Diagnostics and the Factual Situation

The study presented three cases of patients diagnosed with adrenal tumors subject to surgical intervention during the past 6 months in our Department. The patients presented with radiological diagnostic difficulties, as to the character and location of the primary tumor.

The aim of the study was to demonstrate differences between radiological examination results and the factual situation observed during the adrenalectomy. In all the presented cases patients' were subject to laparoscopic intervention. In two cases conversion to open surgery was necessary. The histopathological results of the surgically removed samples were as follows: leiomyoma, myoperycytoma and pheochromocytoma. In selected cases imaging examinations might be of limited value, especially when determining the character and location of the primary lesion of the adrenal gland.