Witold Woźniak and Tomasz Miłek
Paweł Rambuszek and Tomasz Miłek
The study presented a case of a 32-year old female patient admitted to the department of surgery with symptoms of abdominal pain and retention of gas and stool. The abdominal X-ray examination showed signs of intestinal obstruction. Abdominal CT suggested the possibility of a cancerous lesion located in the colon. The patient was qualified for surgical intervention. An anterior rectal resection was performed. The histopathological examination revealed the presence of colorectal endometriosis. After two months the patient was subject to gastrointestinal continuity restoration. Endometriosis is a rare cause of intestinal obstruction, considering patients hospitalized in the department of general surgery.
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.
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.