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Open access

Witold Woźniak, Krzysztof Mlosek, Tomasz Miłek, Marcin Kowalski and Piotr Ciostek

The Association of Surgery and Sclerotherapy in the Treatment of Severe Chronic Venous Insufficiency

The aim of the study was to evaluate the efficacy of surgery in combination with sclerotherapy in the treatment of severe chronic venous insufficiency.

Material and methods. During the period between 2007 and 2009, 38 patients with symptoms of advanced chronic venous insufficiency - C4, C5 and C6, according to the CEAP classification- were subject to surgery in combination with sclerotherapy. The study group comprised 24 (63%) female and 14 (37%) male patients, aged between 42 and 95 years. Twenty-three patients were diagnosed with saphenous vein insufficiency, 14 with small saphenous vein insufficiency, and one with femoro-popliteal venous insufficiency. Based on the VCSS scale, disease symptoms were evaluated before the operation and six months after the surgical intervention. In cases of saphenous or small saphenous vein insufficiency, the patients underwent crossectomy, followed by ligation of the saphenous-femoral and small saphenous-popliteal ostia. The distal segment of the vein was obliterated using a 3% polidocanol foam solution. Control ultrasonography was performed 1, 3, 6 and 12 months after the procedure. Patients with crural ulcerations that did not heal by three months postoperatively were subject to additional epidermal grafts.

Results. Statistical analysis of the VSCC point scale before and after the operation demonstrated a significant reduction in the following parameters: pain, presence of varices, edema, ulcerations, and use of compression therapy. Analysis showed an effective elimination of the main venous trunks. Among patients with venous ulcerations, spontaneous healing was observed during the nine months after the procedure was observed in 17 (94%) patients. In one patient, the ulceration was reduced by 30-40%. Neurological, ophthalmological and thromboembolic complications of the deep venous system were not observed.

Conclusions. 1. The combination of surgery and sclerotherapy in the treatment of advanced chronic venous insufficiency is a method worthy of recommendation. 2. The method is effective with a low risk of complications, thus significantly shortening hospitalization and absence from work. 3. An evaluation of the disease stage based on the VCSS scale, before and after the operation, demonstrated a significant improvement.

Open access

Eliza Pleban, Piotr Szopiński, Grzegorz Górski, Jacek Michalak, Bartłomiej Noszczyk and Piotr Ciostek

The Use of Liposomal Heparin Spray-Gel in the Treatment of Superficial Thrombophlebitis: A Multicenter Clinical Investigation Analysis

The aim of the study was to evaluate the efficacy and safety of liposomal heparin spray-gel in the treatment of superficial thrombophlebitis.

Material and methods. The presented study is an analysis of two clinical investigations performed during the period between March 1999 and May 2002, which evaluate the efficacy and safety of liposomal heparin spray-gel (Lipohep) in the treatment of superficial thrombophlebitis, as well as a comparison with results obtained following subcutaneous enoxaparin injections. The study group comprised 88 patients, including 43 on Lipohep treatment and 45 on low molecular weight heparin.

Results. Two patients withdrew from the investigation before the control visit. After seven days, therapy was stopped in the case of 16 Lipohep patients and 18 low molecular weight heparin patients. After 14 days, therapy was stopped in 21 and 25 patients, respectively. One low molecular weight heparin and five Lipohep patients did not finish the investigation. This was connected with a lack of clinical improvement and development of side-effects. A statistically significant reduction of pain and the appearance of erythema was observed in both patient groups during the initial seven days of treatment. One patient on low molecular weight heparin was diagnosed with superficial thrombophlebitis recurrence. Ten patients developed complications, with deep venous thrombosis being most significant (two patients were treated with Lipohep and one with enoxaparin). One patient on Lipohep treatment developed superficial thrombophlebitis of the upper extremity.

Conclusions. Liposomal heparin spray-gel is safe and effective in the treatment of local superficial thrombophlebitis symptoms. The initial results considering the use of Lipohep are promising and should be confirmed in a larger group of patients.

Open access

Tomasz Miłek, Piotr Ciostek, Witold Woźniak, Andrzej Lewczuk, Robert Petryka, Jakub Słowik and Mirosław Jarosz

Preliminary Results of the use of Self-Expanding Nitinol Stents in Inoperable Gastrointestinal Cancers

The aim of the study was to present preliminary results of the palliative treatment of strictures and obstruction of the gastrointestinal tract in stage IV cancers with the use of self-expanding stents.

Material and methods. Within a one-year period, from October 2007 to September 2009, stent implantation in the gastrointestinal tract was performed in 32 patients. Eligibility for palliative treatment was determined on the basis of a clinical examination and diagnostic tests to assess cancer stage. Each patient was assessed on the Karnofsky performance scale. The condition for eligibility, except for emergent circumstances, was performance status below 70. Endoscopy to collect biopsy samples for histopathologic examination and abdomen and chest CT scans were performed. Local advancement of cancer with infiltration of other tissues, such as metastases to the liver, distant lymph nodes or other organs, determined the choice of palliative treatment. Moreover, the presence and severity of coexisting disorders were also thoroughly examined. The procedures were performed using a c-arm X-ray system and endoscope. Following the introduction of the endoscope to the area of cancerous narrowing, a guide tube was inserted through the stricture under fluoroscopic control. Under combined endoscopic and radiological control, after contrast administration above the narrowing, a stent to expand the stricture was placed and released. The result of stent placement was documented by radiologic photographs, and a subsequent X-ray check was performed 48 hours after stent implantation.

Results. A total of 33 stents were implanted in 32 patients. Problems with stent placement occurred in one patient. During implantation into a stricture secondary to sigmoid colon cancer, the stent slipped down and incompletely filled the tumor lumen. In this case, a short supplementary stent was added, which yielded a satisfactory result of the procedure. In another case, the stent migrated and adhered to the gastric wall, which further impaired passage through the patient's gastrointestinal tract. A feeding jejunostomy was performed in this patient, which was considered the best course due to the patient's extremely poor general condition.

Conclusions. 1. Stent implantation in the gastrointestinal tract lumen in the setting of inoperable carcinomas under endoscopic and X-ray control is effective and safe. 2. In the case of gastrointestinal tract sub-obstruction in patients with left colon cancers and in poor general condition, this procedure should be considered prior to pursuing surgical operations.

Open access

Marek Hara, Karol Forysiński, Edyta Teodorowicz-Struś and Piotr Ciostek

Abstract

The report presents the case of a patient treated surgically for perforated gastroenterocolic fistula with a concomitant abscess in abdominal integuments and symptoms of the digestive tract blockage. Many months before this surgery the patient had undergone gastric resection and hepaticoenterostomy (Roux-Y) due to inflammatory tumor causing pyrolostenosis and including the peripheral part of the common bile duct. After the surgery, the patient suffered from recurrent abdominal pain which resulted in many hospitalizations. After one of the episodes of complaints, the patient with symptoms of the digestive tract blockage was admitted again to our ward, prepared to the surgery and qualified for the surgical intervention. En bloc resection of the stomach, hepaticoenterostomy and partial resection of the transverse colon were performed. The continuity of the digestive tract was restored by gastroenterostomy with the isolated jejunal loop, anastomosis between the hepatic loop and side of the afferent loop and end-to-end anastomosis of the transverse colon. There were no postoperative complications.

The authors point out circumstances affected on decision to postpone the surgery by the patient despite frequent recurrent complaints after primary surgery and numerous previous hospitalizations.