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Open access

Marek Winiarski, Mariusz Urbański and Riffat Faizan

Abstract

Project management is general planning, coordination and inspection of the project, from the initial stage all the way to final phase, its purpose is an accomplishment of the accepted task and creation of the functional final effect, without exceeding established costs, time-frames and fulfillment of required standards of the quality. The present article was devoted to the issue of the project management in the construction sector in order to reduce the business risk. The study is based on literature examinations with an own methodological solution for project management in the construction industry. After introducing a set of definitions of the project and describing the concept of project management, a characterization of the project management in the construction industry and its effects in the economic space were described

Open access

Piotr Major, Michał Pędziwiatr, Maciej Matłok, Mateusz Ostachowski, Marek Winiarski, Kazimierz Rembiasz and Andrzej Budzyński

Cystic Adrenal Lesions - Analysis of Indications and Results of Treatment

Cysts are a rare pathology of adrenal glands. As the development of new diagnostic techniques takes place, the occurrence of adrenal cystic lesions has been rapidly increasing. The majority of them are solid adrenal lesions, but localized fluid collections are also more frequently diagnosed. In case of solid adrenal lesions, there are straight indications for surgery, but on the other hand there are no clear guidelines and recommendations in case of adrenal cysts.

The aim of the study was to analyze surgical methods and evaluate treatment effects in patients who were qualified for laparoscopic adrenalectomy due to adrenal cystic lesions.

Metarial and methods. Identical criteria were used to qualify patients with solid and cystic lesions of the adrenal gland for surgery. Out of the whole number of 345 patients who underwent laparoscopic surgery for adrenal tumors, 28 had adrenal cysts. 16 of them (57%) were women and 12 (43%) men. The average age of the studied group was 46.4 years (25-62 years). The average cyst diameter in CT was 5.32 cm (1.1-10 cm). Most of the lesions were hormonally inactive (22 patients), but in 6 cases increased level of adrenal hormones was observed.

Results. Pathological analysis revealed 4 (14%) pheochromocytomas and 2 (7%) dermoid cysts. In case of 22 (79%) patients, the postoperative material was profiled by pathologists as insignificant according to potential neoplasmatic transformation risk: 5 (17.5%) - endothelial vascular cysts, 3 (11%) endothelial lymphatic cysts, 7 (25.5%) pseudocysts, 3 (11%) simple cysts, 2 (7%) bronchogenic cysts, 1 (3.5%) - cortical adenoma and 1 (3.5%) cyst was of myelolipoma type.

Conclusions. Based on the performed research and previous experience in treating patients with adrenal lesions we can conclude that application of the same evaluating algorithm for both cystic and solid lesions is valid.

Open access

Marek Winiarski, Maciej Matłok, Zbigniew Biesiada, Leszek Bolt, Magdalena Woźniak and Anna Merak

Gastrointestinal Bleeding in Patients with Acute Surgical Diseases

The aim of the study was to analyse patients in whom upper gastroinentestinal bleeding appeared during hospitalization in the surgical clinic.

Material and methods. The study group consisted on 61 patients. 35 were women and 26 were men. The mean age of women was 76 and men 64.8 years. The mean age of the whole group was 72.3 years. 30 patients (49%) were hospitalized in general surgery ward, 16 (26%) in trauma unit and 15 patients (25%) in intensive care unit.

Results. The reasons of hospitalisation in general surgery ward were: acute cholecystitis, acute pancrtatitis, peritonitis, lower extremity ischemia with foot necrosis, large bowel cancer and cancer of the gall-bladder. Patients were admitted to trauma unit because of hip and pelvic fractures. Patients were hospitalized in intensive care unit because of polytrauma, diffuse peritonitis, isolated head trauma and necrotising pancreatitis. The main source of bleeding were duodenal and gastric ulcers. It appeared in 28 (45.9%) and 18 (29.5%) patients respectively. The other reasons of bleeding were: erosive gastritis (9 patients) and Mallory-Weiss syndrome (6 patients). Bleeding recurrence was found in 21 patients (34.4%). This group of patients was characterised by high mortality rate 43%. The highest was among patients in intensive care unit. It reached 60%.

Conclusions. Based on the performed analysis we come to the following conclusions: 1. Upper gastrointestinal bleeding is serious complication during hospitalisation in surgical clinic; 2. Usually it affects older patients; 3. This complication is associated with high rate of rebleeding and high mortality rate.

Open access

Maciej Matłok, Piotr Major, Michał Pędziwiatr, Marek Winiarski, Piotr Budzyński, Piotr Małczak, Leif Hynnekleiv and Andrzej Budzyński

Abstract

Currently, laparoscopic sleeve gastrectomy is one of bariatric surgeries most commonly performed in the world. The most frequent complications of surgeries of this type, with the highest mortality rate, include bleeding into the GI tract and peritoneal cavity, and sleeve staple line leaks. These severe complications prolong the hospital stay, and often are a cause of patient’s death. While in a case of bleeding the procedure appears to be obvious, so far no uniform and standard guidelines have been established for the group of patients with staple line leaks.

The aim of the study was to report results of treatment for staple line leaks following laparoscopic sleeve gastrectomy with a laparoscopic procedure and simultaneous endoscopic insertion of a self-expandable stent.

Material and methods. 152 laparoscopic sleeve gastrectomies were performed from April 2009 to December 2014. The BMI median was 46.9, and the age median was 42 years. Staple line leaks developed in 3 out of 152 people (1.97%). All patients who developed this complication were included in the study. The treatment involved laparoscopic revision surgery with simultaneous endoscopic insertion of a self-expandable stent (Boston Scientific, Wallflex Easophageal Stent, 150×23 mm) into the gastric stump during gastroscopy.

Results. Leaks following laparoscopic sleeve gastrectomy were diagnosed on day 5 after the procedure, on average. Intervention consisting of laparoscopy and endoscopic insertion of a self-expandable stent was initiated within 14 hours of diagnosing the leak, on average. The mean time for which the stent was kept was 5 weeks (4–6 weeks). Stenting proved to be fully effective in all patients, where after discharging home, a cutaneous fistula, periodically (every 2-3 weeks) discharging several millilitres of matter, persisted in one patient. The mean time for the leak healing in 2 patients, in whom the described method was successful in treatment of this complication, was 37 days. No patient died in the perioperative or follow-up period.

Conclusions. The proposed method for treatment of staple line leaks following laparoscopic sleeve gastrectomy by combined laparoscopic rinsing and draining of the peritoneal cavity and endoscopic insertion of a self-expandable stent is an interesting and worth recommending method for treatment of this complication.

Open access

Piotr Budzyński, Michał Pędziwiatr, Jakub Kenig, Anna Lasek, Marek Winiarski, Piotr Major, Piotr Wałęga, Michał Natkaniec, Mateusz Rubinkiewicz, Joanna Rogala and Andrzej Budzyński

Abstract

Bowel obstruction is a common condition in acute surgery. Among the patients, those with a history of cancer consist a particular group. Difficulties in preoperative diagnosis – whether obstruction is benign or malignant and limited treatment options in patients with reoccurrence or dissemination of the cancer are typical for this group.

The aim of the study was to analyze causes of bowel obstruction in patients with history of radical treatment due to malignancy.

Material and methods. Patients with symptoms of bowel obstruction and history of radical treatment for malignancy who were operated in 2nd and 3rd Department of General Surgery JUCM between 2000 and 2014 were included into the study. The patients were divided into 2 groups based on type of mechanical bowel obstruction (group 1 – adhesions, group 2 – malignant process).

Results. 128 patients were included into the study – group 1: 67 (52.3%) and group 2: 61 (47.7%). In the second group bowel obstruction was caused by reoccurrence in 25 patients (40.98%) and dissemination in 36 (59.02%). The mean time between onset of the symptoms of bowel obstruction and the end of treatment for the cancer was 3.7 and 4.4 years, respectively in group 1 and 2 (p>0.05). Median time between onset of the symptoms and admission to Emergency Department was significantly longer in patients with malignant bowel obstruction compared to those with adhesions (11.6 ±17.8 days vs 5.1 ± 6.9 days, p=0.01). Considering type of surgery due to bowel obstruction, in first group in most patients (69.2%) bowel resection was not necessary and in the second group creation of jejuno-, ileo- or colostomy was the most common procedure. Morbidity was significantly higher in second group (45.9% vs 28.26%, p<0.05) but there was no difference in mortality (26% vs 24%, p>0.05). In both groups the most common localization of primary malignancy was colon.

Conclusions. In analyzed group of patients frequency of bowel obstruction caused by adhesions and malignancy was similar. However, in patients with bowel obstruction caused by malignancy morbidity was significantly higher and duration of symptoms was longer. There was no diagnostic procedure which would allow to differentiate the cause of bowel obstruction preoperatively and the diagnosis was made during the operation.

Open access

Piotr Major, Marcin Dembiński, Marek Winiarski, Michał Pędziwiatr, Mateusz Rubinkiewicz, Maciej Stanek, Jadwiga Dworak, Magdalena Pisarska, Kazimierz Rembiasz and Andrzej Budzyński

Abstract

The reported prevalence of periampullary duodenal diverticula varies between 9 and 32.8%.

The aim of the study was to evaluate the prevalence of periampullary diverticula in the studied population and establish whether their presence influence the risk of choledocholithiasis and the risk of Endoscopic Retrograde Cholangio Pancreatography (ERCP) related complications.

Material and methods. The study group of 3788 patients who underwent ERCP between 1996 and 2016 at the 2nd Department of General Surgery Jagiellonian University Medical College in Kraków were analyzed. The group comprised of 2464 women (mean age 61.7 years) and 1324 men (mean age 61.8 years). The patients were divided into two groups. Group A included patients in whom there were no periampullary diverticula detected. Group B included patients in whom the opening of the bile duct was in the vicinity of a duodenal diverticulum.

Results. There were 3332 patients included in group A (2154 women and 1178 men) and 456 patients in group B (310 women and 146 men). The prevalence of periampullary duodenal diverticula in the analyzed group was 12.8%. The presence of stones or biliary sludge was diagnosed in 1542 patients (47.6%) in group A and 290 patients (68.1%) in group B. Recurrence of choledocholithiasis occurred in 4.5% of patients (70/1542) in group A and 10.3% of patients (30/290) in group B. Complications occurred in a total of 76 patients in group A (2.3%) and 22 patients in group B (4.8%).

Conclusions. The presence of choledocholithiasis and the risk of ERCP related complications are significantly higher in the group with duodenal diverticula.