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Open access

Joanna Żukowska and Marcin Budzyński

Road Safety System in Poland

The main objective of the paper is to present crucial for road safety improvement elements of the diagnosis of safety state and safety system in Poland, which could be the part of the activities of ZEUS Project. The estimation of the diagnosis was made by the comparison with the standards from those countries, which are regarded as leaders in safety.

Open access

Kazimierz Rembiasz, Marcin Bednarek, Piotr Budzyński, Marek Poźniczek and Andrzej Budzyński

Endoscopic-Ultrasound Guided Drainage of the Pancreatic Pseudocyst

The aim the study was the evaluation of the treatment results of the internal ultrasound and gastroscopy-guided pancreatic pseudocysts.

Material and methods. From 1994-2008 at the 2nd Department of General Surgery UJ CM there were 126 patients (incl. 45 female and 81 male) treated for pancreatic pseudocyst. Mean age of the women was 41.05 years (25-81) while men 48 years (19-79). Ultrasound and gastroscopy-guided drainage by the means of insertion of double pig tail drain was attempted in 46 patients (17 female and 29 male). Mean diameter of the cyst was 11.02 cm (from 2.5-20 cm).

Results. Out of 46 patients assigned to the internal ultrasound, gastroscopy guided drainage, the procedure was technically feasible in 39. Internal marsupialization was successful in 24 patients (52.17%). We did not observe serious complications mentioned in the literature incl. iatrogenic injuries of the intraabdominal organs or fistulas. Drain was removed after 5 month (1-9 month).

Conclusions. Endoscopic drainage consists an interesting minimally invasive approach in the management of pancreatic pseudocyst. More precise inclusion criteria could increase its efficacy.

Open access

Marcin Strzałka, Andrzej Budzyński, Andrzej Bobrzyński, Piotr Budzyński and Anna Gwóźdź

Analysis of Conversion Rates and Reasons in Minimally Invasive Surgery

Nowadays the number and range of laparoscopic procedures is quickly increasing and contraindications are limited. But laparoscopic operations cannot be performed in every case, what leads to conversion.

The aim of the study was to present the conversion rates and reasons in different types of laparoscopic procedures, both emergency and elective.

Material and methods. 7685 patients operated laparoscopically in the 2nd Department of General Surgery of the Jagiellonian University between 1993 and 2008 were included in the study. Minimally invasive approach was used at the beginning in 608 patients with acute appendicitis (average age = 28,4 years), in 101 patients with perforated peptic ulcer (average age = 46.4 years), in 236 patients who underwent splenectomy (average age = 41 years), in 166 patients who had adrenalectomy (average age = 53 years), in 117 patients who underwent Nissen fundoplication (average age = 44,4 years), in 834 individuals who had inguinal hernia repair (average age = 49.4 years), in 5311 who had cholecystectomy (average age = 52.1 years and in 212 patients who underwent other procedures.

Results. The conversion rates in the analyzed period were 2.88% in whole material, in case of appendectomy 3,95%, perforated ulcer operation 19,80%, splenectomy 2.12%, adrenalectomy 1.81%, Nissen fundoplication 1.71%, inguinal hernia repair 0.96% and cholecystectomy 2.92%. Emergency surgery was related to higher (4.98%) conversion rate than elective procedures (1.88%). Most frequently convestions were related to technical reasons (2,48%), than enforced by complications (0.41%).

Conclusion. Most conversions were caused by technical reasons, not complications. The change of the approach from laparoscopic to open one was more frequent in case of emergency procedures.

Open access

Marcin Budzyński, Kazimierz Jamroz and Wojciech Kustra

Abstract

In Poland, road inspections were implemented in June 2014 on all national roads. Previous traffic surveys mainly looked at the technical condition of roads, signs and markings; other safety issues were overlooked. The main problem of the inspections is that the qualitative assessment is subjective which affects the classification of the sources of hazard on the road. The paper presents an analysis of the variability of the qualitative assessments of road defects when they are assessed by different teams of inspectors. On this basis, guidelines were developed for the classification of risks based on the relationship between sources of road hazard and the personal and economic losses involved in road accidents. These relationships are quantified using mathematical models to simulate the effect of hazard variability on the consequences of selected road accident causes on sections of the road network.

Open access

Marcin Budzyński, Kazimierz Jamroz and Łukasz Jeliński

Abstract

Key to understanding the needs and tools of road infrastructure management is identifying the hazards and their sources involved in having no or faulty road restraint systems. Clarity is also needed on why the systems are wrongly designed, constructed, built and operated. To ensure that the problem is adequately understood, research and site observations were conducted and mathematical models were built to describe the level of roadside risk. To aid studies of road safety barrier and other road safety equipment functionality, it is vital to carry out field crash tests and crash test simulations. The main goal of the work is to develop a method for selecting optimal road restraint systems.

Open access

Marcin Strzałka, Maciej Matyja, Maciej Matłok, Marcin Migaczewski, Piotr Budzyński and Andrzej Budzyński

Laparoscopic single access technique is a next step in development of minimally invasive surgery.

The aim of the study was to present results of different laparoscopic single incision procedures and evaluate application of this technique.

Material and methods. 102 patients (15 males and 87 females) who underwent laparoscopic single incision procedure from 15th October 2009 to 31st December 2012 were included in the study.

Results. In the analyzed period we performed 72 cholecystectomies (70.6%), 8 left adrenalectomies (7.8%), 3 right adrenalectomies (2.9%), 7 splenectomies (6.9%), 5 spleen cysts unroofings (4.9%), 2 appendectomies (2%), 1 Nissen fundoplication procedure (1%), 1 removal of the adrenal cyst (1%) and 3 concomitant splenectomies and cholecystectomies (2.9%). There were 3 technical conversions to multiport laparoscopy, but no conversion to open technique. Complications were observed in 5 patients (4.9%). Average operation time was 79 min (SD=40), average hospitalization time 2.4 day (SD=1.4).

Conclusions. Laparoscopic single incision technique is a safe method and can be used as a reasonable alternative to multiport laparoscopy in different minimally invasive procedures especially in young patients to whom an excellent cosmetic effect is particularly important.

Open access

Andrzej Budzyński, Anna Gwóźdź, Jan Kulawik, Marcin Strzałka and Maciej Matłok

Laparoscopic Spleen Preserving Procedures

Laparoscopic splenectomy evolved into one of the principal operations of the spleen. High short- and long-term morbidity associated with asplenia has prompted surgeons to implement spleen preserving procedures.

The aim of the study was to evaluate laparoscopic spleen preserving procedures with regard to their feasibility and treatment results.

Material and methods. Prospective evaluation of treatment results in patients submitted to laparoscopic operations of the spleen in 2nd Department of General Surgery CM UJ in Cracow.

From August 1998 until May 2009 we performed 278 laparoscopic operations of the spleen. The group consisted of 164 females and 114 males, of which 256 (92.09%) patients were operated on electively and 22 (7.91%) in emergency settings. 235 patients (84.53%) were assigned to total splenectomy (most for ITP - 142 patients). In 43 patients (15.47%) the laparoscopic spleen preserving procedure was attempted. The indications included rupture of the spleen, cysts, tumors and abscess.

Results. Laparoscopic spleen preserving procedure was successfully performed in 23 out of 43 patients (53.49%). There were 9 excisions of the splenic cysts, 8 hemostases from ruptured spleen, 5 resections of the tumors and one drainage of the abscess. Postoperative complications were observed in 16 (7.66%) patients after total splenectomy, including 8 (3.4%) infectious. 3 patients (6.98%) after spleen preserving procedure were re-operated due to bleeding. There were no infectious complications in this group.

Conclusions. There is a limited number of indications for laparoscopic procedures preserving splenic parenchyma. Despite high failure rate attempts to perform laparoscopic spleen sparing operation are usually beneficial due to low risk of complications, particularly infections.

Open access

Marcin Budzyński, Dawid Ryś and Wojciech Kustra

Abstract

Port towns are strategic places from the point of view of transport systems. They form integration junctions for various transport branches , apart from the traditional - road and railway ones , also for water( sea) transport which is active there. Moreover, air transport comes also into consideration , whose efficient functioning must be connected with good accessibility, that concerns sea transport as well. Efficient and safe servicing the ports is crucial for their functioning. Problems associated with the overloading of lorries, which leads to degradation of road surface structure , observed in Gdynia, are discussed as an example in this paper. Problems of road traffic safety (RTS) are presented in this paper on the example of Gdańsk. The two issues: the road traffic safety and road surface degradation constitute only some transport problems of port towns , but they are very important, from the point of view of their specificity, for integration junctions of all the transport branches for people and goods. However, in discussing selected aspects of transport in port towns it is necessary to refer to the managing of integrated transport system with taking into account its traffic safety aspects.

Open access

Mateusz Rubinkiewicz, Marcin Migaczewski, Michał Pędziwiatr, Maciej Matłok, Marcin Dembiński and Andrzej Budzyński

Abstract

Laparoscopic surgery is becoming an approved technique in pancreatic surgery. It offers some advantages over an open approach due to shorter hospital stay and decreased complication rate. Regardless the technique the most significant problem of pancreatic surgery is postoperative pancreatic fistula. There are numerous methods attempted at reduction of its incidence. One of the possibilities is preoperative pancreatic duct stenting. It aims at decreasing the pressure in the pancreatic duct, which is supposed to facilitate pancreatic juice flow to the duodenum.

The aim of the study was to determine the role of preoperative pancreatic duct stenting in pancreatic surgery.

Material and methods. Nineteen patients undergoing laparoscopic pancreatic resection were enrolled into the study. Prior to the surgery, all of the patients were submitted for the Endoscopic Retrograde Choleangiopancreatography (ERCP) with pancreatic duct stenting. Following the subsequent laparoscopic pancreatic resection, all patients were monitored to detect the pancreatic fistula appearance. The pancreatic stent was removed 6‑8 weeks after the surgery.

Results. With an exception of two patients, all other patients underwent successful ERCP with pancreatic duct stenting before the surgery. In one case the placement of the prosthesis failed due to a tortuous pancreatic duct. Five patients had an episode of acute pancreatitis including two severe courses as a complication of preoperative ERCP. One of the patient died due to severe GI bleeding 2 weeks after stenting. Among the procedures there were 15 distal pancreatectomies, two enucleations of the tumor localized in the uncinate process and in the body of the pancreas and one central pancreatectomy. The median time of surgery duration was 186 minutes (90‑300; ±56). No conversions to an open approach were necessary. Likewise, there was neither any major complications reported in a postoperative course nor incidence of pancreatic fistula in any of the patients undergoing surgery.

Conclusions. Preoperative pancreatic duct stenting can decrease the incidence of pancreatic fistula. However, a number of serious complications exceed the potential benefit of this method.

Open access

Kazimierz Rembiasz, Andrzej Budzyński, Jan Kulawik, Maciej Matłok, Marcin Migaczewski, Alicja Hubalewska-Dydejczyk and Filip Gołkowski

Laparoscopic Transperitoneal Approach to Adrenal Gland Malignancies

Even though there is not enough good data, the use of laparoscopic approach in malignant disease is regarded by some controversial issue. On the other hand it seems that transperitoneal access to the adrenal gland allows for effective and safe oncological removal of adrenal gland neoplasms.

The aim of the study was to present our experience with the use of transperitoneal approach in patients with adrenal gland malignancies.

Material and methods. From March 2003 till May 2009 we performed 200 laparoscopic transperitoneal adrenalectomies. There were 82 hormonally silent tumors (1.5-14 cm in diameter) and 118 hormonally active (63 pheochromocytomas, 26 Conn's syndrome, 25 Cushing's syndrome and 4 virylizing tumors).

Results. 197 procedures were completed laparoscopically and 3 were converted (including one for inability to assess resectablility of the tumor). 14 tumors (7%) were overtly malignant; 7 arising form the adrenal (adrenal cortex - 3, pheochromocytoma - 3, lymphoma - 1) and 7 metastatic (squamous cell cancer of the lungs - 2, clear cell carcinoma of the kidney - 2, collecting duct carcinoma of the kindey - 1, hepatocellular cancer - 1, NET lung tumor - 1). Further 19 tumors (9.5%) were assessed histologically as potentially malignant (pheochromocytomas - 16, tumors of neural origin - 2, oncocytomas - 1). One malignant tumor was unresectable other were operated radically. Progression of the cancer was observed in 3 patients with metastatic tumors.

Conclusions. Laparoscopic transperitoneal adrenalectomy allows for safe and radical removal of adrenal gland malignancies. Longer follow-up and larger patients volume are needed for better evaluation of long-term results.