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Open access

Tadeusz Peterlejtner, Tomasz Szewczyk, Piotr Firkowski and Michał Zdrojewski

Endoscopic Treatment of the Choledocholithiasis - Effectiveness, Safety and Limitations of the Method

Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is accepted referred method of treatment of the choledocholithiasis

The aim of the study. Evaluation of efficacy and safety of the endoscopic treatment of the biliary tract stones.

Material and methods. Results of 3309 Endoscopic Retrograde Cholangio-Pancreatography (ERCP) carried out in Division of Endoscopy of the General Surgery Department in the period 2000 - 2010. The retrospective analysis of the indications, process, findings and final results of 1698 ERCP and Endoscopic Sphincterotomy (ES) was performed with intention to treat of the biliary tract stones.

Results. The 883 (52%)patients with coexisted gall-bladder and biliary tract stones were the principal group. The second group included 580 (34.2%) patients with residual choledocholithiasis after cholecystectomy and biliary tract surgery. Moreover ERCP, ES and endoscopic evacuation of biliary stones have been urgently carried out in 159 (9.4%) cases with acute biliary pancreatitis. Lastly ERCP with re-sphincterotomy and removal of the stones was performed in 75 (4.4%) patients with recurrent choledocholithiasis. The procedure was effective in 1561 (92%) patients. When removal of the stones was not possible, decompression of the biliary tract by implantation of the plastic stent was done in 63 (3.7%) cases. Ineffective procedure was noted in 74 (4.3%) patients. The most commonly observed complication was acute pancreatitis. Because of: post ES bleeding, acute haemmorhagic and necrotic pancreatitis, impacted Dormia basket and peripapillary duodenal perforation 10 patients (0.5%) had to be operated. Two patients (0.1%) died.

Conclusions. 1. Endoscopic treatment of choledocholithiasis is highly effective but risk factors of complications with urgency an intensive conservative management and surgical intervention have to be considered. 2. After ES, if surgical evacuation of the stones have to be carry out, post operative biliary tract drainage (by T tube) is not necessary.

Open access

Ewelina Gaszyńska, Paweł Ratajczyk, Andrzej Wieczorek, Tomasz Szewczyk and Tomasz Gaszyński

Abstract

Tracheal secretion leakage might lead to ventilator-associated pneumonia. Standard tracheal tube cuffs are cylindrical in shape. Bronchial tree aspiration is observed in the presence of leakage past tracheal tube cuffs. The new TaperGuard tracheal tube has a cuff in the shape of a cone, preventing from the development of microtubules and microaspiration.

The aim of the study was to compare standard tracheal tube cuffs with TaperGuard tubes, in terms of protection from microaspiration under general anesthesia. Material and methods.

The observational study evaluated incidents of leakage during general anesthesia with intubation and mechanical ventilation in patients with significant obesity. The study group comprised 20 patients with the BMI >40 kg/m2 subjected to elective surgery under general anesthesia with intubation and mechanical ventilation, randomly divided into two subgroups: standard tracheal tube and TaperGuard tube.

Results. In 4 of 10 patients with standard tracheal tubes we observed leakage around the cuff. In case of TaperGuard tubes no such leakage was observed. Conclusion. TaperGuard tubes protect against microaspirations, while standard tracheal tubes have no such properties.

Open access

Piotr Oramus, Tomasz Chmielewski, Tomasz Kuczek, Wojciech Piasecki and Marcin Szewczyk

Abstract

Electric arc is a complex phenomenon occurring during the current interruption process in the power system. Therefore performing digital simulations is often necessary to analyse transient conditions in power system during switching operations. This paper deals with the electric arc modelling and its implementation in simulation software for transient analyses during switching conditions in power system. Cassie, Cassie-Mayr as well as Schwarz-Avdonin equations describing the behaviour of the electric arc during the current interruption process have been implemented in EMTP-ATP simulation software and presented in this paper. The models developed have been used for transient simulations to analyse impact of the particular model and its parameters on Transient Recovery Voltage in different switching scenarios: during shunt reactor switching-off as well as during capacitor bank current switching-off. The selected simulation cases represent typical practical scenarios for inductive and capacitive currents breaking, respectively.

Open access

Tomasz Klimczak, Tomasz Szewczyk, Przemysław Janczak and Piotr Jurałowicz

Abstract

Laparoscopic adjustible gastric binding (LAGB) is one of most common surgical methods of treating obesity. Gastric band migration (erosion) is a typical LAGB complication, with a frequency of about 1-4%.

The aim of the study was to present the possibilities of endoscopic diagnosis and treatment of this complication.

Material and methods. The study was carried out in the Department of Gastroenterological, Oncological and General Surgery in Łódź. Between 2008 and 2015, 450 gastric bands were implanted using the laparoscopic technique in 318 (71%) women and 132 (29%) men. In this period 7 cases of band migration were diagnosed – 3 cases in men (2.3%) and 4 cases in women (1.3%), what presents 1.56% of general number of complications. Five out of 7 eroded bands were qualified for endoscopic removal. Four out of 5 qualified eroded bands were removed using the gastric band cutting technique. In one case we used the musculo-mucosal incision technique. In order to diagnose early perforations all patients underwent control passage examinations with oral contrast (gastrografin) 3-6 hours after the procedure.

Results. All 5 out of 5 qualified eroded gastric bands were successfully removed with the endoscopic method, which gives 100% success rate in own material. Two endoscopic methods were used: 1) endoscopic gastric band cutting, 2) endoscopic musculo-mucosal incision.

Conclusions. Endoscopy gives a possibility of instant diagnosis of gastric band migration and early minimally invasive treatment. One of our endoscopic methods of removing the bands by making several incisions of the musculo-mucosal plicae has not yet been described in professional medical literature.

Open access

Aldona Adamska-Szewczyk, Kazimierz Glowniak and Tomasz Baj

Abstract

Over the past five years, phytochemical and pharmacological studies have been conducted on material extracted from members of the Rutaceae family. In such work, new furochinoline-structured alkaloids were isolated from Ruta sp. and Dictamnus sp. Beyond the aforementioned, other substances with promising activity were isolated from the less-known species of Zanthoxylum, Evodia, Lonchocarpus, Myrthopsis and Teclea. Currently used forms of extraction, as well as methods of isolation and detection, allow the obtaining of pure, biologically active compounds. Many of these have antifungal, anti-bacterial and anti-plasmodial properties. Others are still being researched as potential drugs, which, in future, may be used in treating those afflicted with HIV and cancer. This article is designed to give the readers a thorough review of the active natural products from the Rutaceae family.

Open access

Tadeusz Peterlejtner, Tomasz Szewczyk, Elżbieta Buczyńska, Michał Zdrojewski, Piotr Firkowski, Radosław Kwiasowski and Łukasz Wojtowicz

Colonoscopic Polypectomy - Evaluation of the Effectiveness and Safety (Single Center Experience)

Colonoscopy is currently accepted as the golden standard in the detection of pre-malignant lesions, and reduction of the incidence of colorectal cancer in patients with adenomatous polyps.

The aim of the study was to determine the diagnostic value of colonoscopy in case of patients with clinical symptoms suggesting the possibility of colorectal pathology, as well as evaluate the technical aspects and results of colonoscopic polypectomies, considering the efficacy and safety of the above-mentioned procedures.

Material and methods. Retrospective analysis of the course and results of the polypectomies performed during 3638 colonoscopies was undertaken, considering patients with suspicion of colorectal pathology.

Results. Complete colonoscopy with cecal intubation was performed in 3310 (91%) cases. Colonoscopic polypectomies were performed during 806 (22.1%) examinations. Single polyps were detected in 459 (56.9%) cases, while multiple lesions in 347 (43.1%) cases. The total number of removed polyps amounted to 1184. There were 882 (74.6%) adenomas of which 225 (25.5%) were considered as an advanced pathology. Moreover, the pathologist detected 4 malignant polyps with features of adenocar-carcinoma. In case of 30 examinations, adenomas coexisted with colorectal cancer and were removed preoperatively. Post-polypectomy bleeding was observed after 15 (1.7%) polypectomies, although only two patients required surgery. Moreover, amongst the 343 rectal polyps, 19 (6%) non-pedunculated lesions were surgically removed (18 of them by means of the trans-anal approach).

Conclusions. The method proved effective and the polyps were detected and removed in more than 22% of the colonoscopic examinations. In two (0.28%) cases surgical intervention was required, in order to stop post- polypectomy bleeding from the polyp's peduncle. Some of the rectal polyps (6%) had to be surgically removed. Preoperative endoscopic "clearance" of large bowel polyps, facilitated the adjustment of the resection margin in subsequent colorectal cancer surgery.

Open access

Jan Bodziarczyk, Tomasz Zwijacz-Kozica, Anna Gazda, Janusz Szewczyk, Magdalena Frączek, Antoni Zięba and Jerzy Szwagrzyk

Abstract

Effects of ungulate pressure on the development of young generation of trees is one of the most important issues in ecology and forestry. Ungulate pressure influence on the development of natural regeneration has been also reported from several national parks. Our study on the effects of ungulate browsing on the young generation of trees was conducted on more than 500 sample plots controlled during one growing season.

The overall browsing pressure ranged from 7.6% in seedlings to 20.3% in low saplings. The pressure of ungulates on the regeneration of Picea abies, the dominant species in the Tatra National Park, was by and large below 1%. Broadleaved species were browsed more frequently. The relationship between the plot altitudes and browsing intensity was statistically significant for seedlings and low saplings; at the higher altitudes, the browsing pressure was greater. There was also observed a statistically significant relationship between the type of former management and the browsing degree in seedlings; in the areas subjected to “landscape protection”, the intensity of browsing was higher when compared to strictly protected areas. Pressure exerted by ungulates on tree regeneration was very unevenly distributed, i.e. some plots were heavily browsed and many others - not browsed at all. The most affected tree species were Salix caprea and Sorbus aucuparia, although the percentage of browsed individuals rarely exceeded 50%. Other species favored by ungulates was Acer pseudoplatanus; despite the high browsing pressure, this species was present among seedlings and tall saplings, suggesting that it would be able to recruit to the tree layer. Abies alba was browsed less frequently than the deciduous trees; however, among the tall saplings it was the third most browsed species.