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Jarosław Gołaś, Wojciech Kustrzycki and Jerzy Rudnicki

Simultaneous Coronary Artery By-pass Grafting (OPCAB) and Biliary Tract Drainage Using Kehr's Method

The study presents a case of a 66-year old male patient with coronary heart disease and a history of inferior wall myocardial infarction. During hospitalization the patient suddenly demonstrated symptoms of obstructive jaundice. The increasing intensity of these symptoms augmented the pre-existent coronary insufficiency, which was classified as stage 3 on the CCS scale. We encountered some circumstances, which rendered use of minimally invasive procedures impossible. Therefore, the patient was treated with combined therapy involving coronary artery bypass grafting on a beating heart, and evacuation of biliary stones followed by drainage of the biliary tract with the use of the T-drain (Kehr's method).

Open access

Maciej Sebastian, Jarosław Wierzbicki and Jerzy Rudnicki

ERCP with Removal of Concrements Through Choledocho-Duodenal Fistula - A Case Report

Spontaneous choledocho-duodenal fistula is mostly associated with choledocholithiasis. Symptoms of fistula are non-specific therefore its diagnosis is usually made incidentally during diagnosis of other bile duct diseases. ERCP is a method which plays the basic role in diagnosis and treatment of fistula between common bile duct and duodenum.

Open access

Piotr Żukrowski, Wojciech Kielan, Zygmunt Grzebieniak, Jerzy Rudnicki, Robert Tarnawa, Anil Agrawal, Tomasz Bąk and Monika Knakiewicz

Splenectomy in Patients with Hematological Disorders - Our Experience

The aim of the study. Retrospective analysis of indications for splenectomy in hematological diseases, positive effect of this operation and correlations between objective prognostic factors and good response to splenectomy in patients with different hematological indications for splenectomy.

Material and methods. 98 adult patients with hematological disorders, who were splenectomised in the years 1994 - 2004. We evaluated the effects of splenectomy in patients with hematological diseases as defined by patient documentation from the 2nd Department of General and Oncological Surgery, Department of Hematology and Hematological Ambulance and the questionnaires that patients completed by themselves.

Results. The beneficial effect of splenectomy was observed in the majority of cases of idiopathic thrombocytopenic purpura (41 of 53 patients), acquired hemolytic anemia (2 of 3 patients) and hereditary spherocytosis (8 of 9 patients). Surgery can provide a high frequency of durable response for adult patients with benign hematological disorders. In malignant hematological diseases, splenectomy eliminates consequences of hypersplenism or splenomegaly. Splenectomy in patients with malignant hematological disorders can improve their condition and relieve symptoms of hypersplenism and splenomegaly to improve their quality of life. There were early complications in 11 patients (11.3%). Mortality was 2%. Late complications appeared in 24 patients out of 96 patients, who survived the perioperative period. The most common late complication was moderate respiratory infections.

Conclusions. Splenectomy is the most common operation in patients with hematological disorders. Indications for splenectomy have been hindered by the lack of any objective prognostic factors of good postoperative response. Nevertheless, the effect of splenectomy is positive in many patients with benign and malignant hematological diseases.

Open access

Piotr Żukrowski, Wojciech Kielan, Zygmunt Grzebieniak, Jerzy Rudnicki, Robert Tarnawa, Anil Agrawal, Tomasz Bąk and Monika Knakiewicz

Analysis of Selected Clinical and Laboratory Parameters in Patients with Splenectomy Complications Due to Hematological Disorders

The aim of the study was to investigate the role of certain clinical characteristics and laboratory examination results as prognostic factors for complications after splenectomy in patients with hematological disorders.

Material and methods. Ninety-eight adult patients with hematological disorders who underwent splenectomy in our department between years of 1994 and 2004. A retrospective analysis of the medical records from patients who underwent splenectomy was conducted; we divided the patients into 6 groups with various postoperative complications; patients without complications after splenectomy were the control group (the seventh group). Then, we compared patients from groups 1 - 6 with patients from the control group (group 7) before and after splenectomy with regard to various parameters including age, sex, presence of splenomegaly or accessory spleen, the operation's duration, hemoglobin level, number of erythrocytes, leukocytes and plateletes, levels of protein and fibrinogen, activity of prothrombin, INR, APTT, TT, proteinogram and levels of IgG, IgM and IgA.

Results. We found that postoperative complications, especially early complications, were more common in groups with malignant hematological complications and in older patients. Infection complications appear more often in men than in women with benign hematological disorders. The sustained platelet level elevation after splenectomy is positively associated with a higher number of thrombotic complications. Also, a lower level of gamma globulin, IgG and IgM after splenectomy correlated with a higher number of infection complications.

Conclusions. Splenectomy in patients with hematological disorders is burdened with small risks of postoperative complications. Some clinical and laboratory parameters can be used to select the group of patients with higher risks of complications, but there remains a lack of objective prognostic factors which are sure in every clinical situation.

Open access

Piotr Rudnicki, Ireneusz Mazur, Konstanty Ślusarczyk, Jerzy Piecuch, Piotr Łopata, Janusz Jopek and Henryk Grzybek

Morphological Changes in the Stomach Mucosa of Rats Caused by Endogenous Bile Acids

"Bile reflux" is a common term to denote a process of placing duodenal contents in the stomach and/or lower oesophagus. It is most often associated with functional or organic failure of the pylorus and is a not uncommon postoperative condition after pyloric section, resection or by-passing.

Gastrotoxicity of the replaced small intestinal mixture leading to lesions in gastric mucosal barrier, is caused by an increased ability to reabsorb hydrogen ions along with migration of blood proteins and electrolytes towards lumen of the stomach. Consequently, histamine secretion becomes increased, leading to inflammatory and haemorrhagic changes or ulcer niches.

The aim of the study was to demonstrate histological and microscopic changes in the gastric mucosa following reflux and to determine if long-term exposure to refluxed duodenal contents will produce tumorous changes in the organs tested.

Material and methods. The study consisted of 25 mature female Wistar rats weighing 180-200 g. Bile reflux to the stomach was produced experimentally by surgical drainage. Final evaluation was performed after 55 weeks.

Results. Findings were as follows: gastric changes were noted in basal and parietal cells, no tumorous foci were found in histological samples. Slight morphological changes can be caused by short periods of gastric mucosa exposure to the gastrotoxic small intestinal mixture.

Conclusions. Endogenous bile acids cause morphological changes in the stomach mucosa of rats. In particular, these changes affect the ultrastructure of basal and parietal cells. No neoplastic foci were found in the examined organs.