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Open access

Monika Knakiewicz, Julia Rudno-Rudzińska and Wojciech Kielan

Liposarcoma of the Retroperitoneal Space - Case Report

Liposarcomas are rare neoplasms most often localized in the retroperitoneal space. Due to there localization, slow growth, and long latency period they often attain large sizes, infiltrating surrounding tissues and organs, before being diagnosed.

The study presented the case analysis, diagnostics, multistage surgical treatment and chemotherapy and recurrence rate, as a consequence of the primary tumors' properties. Surgery remains the main method of treatment considering patients' diagnosed with liposarcomas.

The role of chemotherapy in the management of the above-mentioned remains an unsolved issue.

Open access

Oskar Pelzer and Wojciech Kielan

Abstract

Due to recorded growth both in living standards and latest researches in medicine, proportion of people in old age has significantly improved all over the world. Although old age people are several percent of the entire society, number of surgeries within the group does not exceed 40%. Also risk of malignant neoplasms among old age people, significantly grows. Malignant neoplasm of colon appears to be most visible problem in group of people in age over 75 years old.

The aim of the study was a retrospective analysis of results in treatment of the sick over 75 years old, suffering from Malignant neoplasm of colon. Therapy was performed in the I Unit of General Surgery and Surgical Oncology in Provinical Hospital in Jelenia Góra.

Material and methods. Subject to analysis were 63 patients that went under operations in years from 2006 to 2010 due to the colorectal cancer, who have been divided now into two groups. First group included 49 patients treated as per schedule, and the second stood for 14, who required urgent treatment. Reference group has involved 20 younger patients, treated in urgent and scheduled courses, due to the colon cancer. There are no contradictions to emergencies and scheduled surgeries for patients in advanced years, suffering from colon cancer. Complications after colon cancer emergencies are far more frequent than in case of scheduled surgeries. Death rates among patients over 75 years old are far more frequent after emergencies than after scheduled surgeries. Concomitant diseases occur the same frequent during emergenices as during scheduled operations. During emergencies, it was left side of the colon that occured to be infected with cancer more frequent.

Conclusions. There is no significant diversity in hospitalization time frames after emergencies and scheduled surgeries. Dangerous surgical complications within group of older patients, those after emergencies and scheduled surgeries too, are far more frequent in comparison to the reference group.

Open access

Oskar Pelzer, Krzysztof Tobiasz, Piotr Berezowski, Rafał Nyc, Ewelina Frejlich and Wojciech Kielan

Abstract

It is extremely difficult to determine the limit at which the elderly age starts. According to the commonly accepted WHO definition, persons aged over 65 years are considered elderly. However, this is a very rough definition which does not take the social and economical diversity of a society into account. In addition, it seems important to consider the clinical status of a patient, namely a widely understood biological age as it determines the course of a disease and its treatment. Therefore the therapy of elderly people requires a through analysis and a special, interdisciplinary approach due to the concurrent or additional medical problems.

Open access

Piotr Żukrowski, Wojciech Kielan, Zygmunt Grzebieniak, Jerzy Rudnicki, Robert Tarnawa, Anil Agrawal, Tomasz Bąk and Monika Knakiewicz

Splenectomy in Patients with Hematological Disorders - Our Experience

The aim of the study. Retrospective analysis of indications for splenectomy in hematological diseases, positive effect of this operation and correlations between objective prognostic factors and good response to splenectomy in patients with different hematological indications for splenectomy.

Material and methods. 98 adult patients with hematological disorders, who were splenectomised in the years 1994 - 2004. We evaluated the effects of splenectomy in patients with hematological diseases as defined by patient documentation from the 2nd Department of General and Oncological Surgery, Department of Hematology and Hematological Ambulance and the questionnaires that patients completed by themselves.

Results. The beneficial effect of splenectomy was observed in the majority of cases of idiopathic thrombocytopenic purpura (41 of 53 patients), acquired hemolytic anemia (2 of 3 patients) and hereditary spherocytosis (8 of 9 patients). Surgery can provide a high frequency of durable response for adult patients with benign hematological disorders. In malignant hematological diseases, splenectomy eliminates consequences of hypersplenism or splenomegaly. Splenectomy in patients with malignant hematological disorders can improve their condition and relieve symptoms of hypersplenism and splenomegaly to improve their quality of life. There were early complications in 11 patients (11.3%). Mortality was 2%. Late complications appeared in 24 patients out of 96 patients, who survived the perioperative period. The most common late complication was moderate respiratory infections.

Conclusions. Splenectomy is the most common operation in patients with hematological disorders. Indications for splenectomy have been hindered by the lack of any objective prognostic factors of good postoperative response. Nevertheless, the effect of splenectomy is positive in many patients with benign and malignant hematological diseases.

Open access

Piotr Żukrowski, Wojciech Kielan, Zygmunt Grzebieniak, Jerzy Rudnicki, Robert Tarnawa, Anil Agrawal, Tomasz Bąk and Monika Knakiewicz

Analysis of Selected Clinical and Laboratory Parameters in Patients with Splenectomy Complications Due to Hematological Disorders

The aim of the study was to investigate the role of certain clinical characteristics and laboratory examination results as prognostic factors for complications after splenectomy in patients with hematological disorders.

Material and methods. Ninety-eight adult patients with hematological disorders who underwent splenectomy in our department between years of 1994 and 2004. A retrospective analysis of the medical records from patients who underwent splenectomy was conducted; we divided the patients into 6 groups with various postoperative complications; patients without complications after splenectomy were the control group (the seventh group). Then, we compared patients from groups 1 - 6 with patients from the control group (group 7) before and after splenectomy with regard to various parameters including age, sex, presence of splenomegaly or accessory spleen, the operation's duration, hemoglobin level, number of erythrocytes, leukocytes and plateletes, levels of protein and fibrinogen, activity of prothrombin, INR, APTT, TT, proteinogram and levels of IgG, IgM and IgA.

Results. We found that postoperative complications, especially early complications, were more common in groups with malignant hematological complications and in older patients. Infection complications appear more often in men than in women with benign hematological disorders. The sustained platelet level elevation after splenectomy is positively associated with a higher number of thrombotic complications. Also, a lower level of gamma globulin, IgG and IgM after splenectomy correlated with a higher number of infection complications.

Conclusions. Splenectomy in patients with hematological disorders is burdened with small risks of postoperative complications. Some clinical and laboratory parameters can be used to select the group of patients with higher risks of complications, but there remains a lack of objective prognostic factors which are sure in every clinical situation.

Open access

Łukasz Szpon, Aleksander Stal, Marcin Zawadzki, Anna Lis-Nawara, Wojciech Kielan and Zygmunt Grzebieniak

Abstract

Due to increased colorectal cancer incidence there is a necessity of seeking new both prognostic and prediction factors that will allow to evolve new diagnostic tests. K-ras gene seems to be such a factor and its mutations are considered to be an early marker of progression of colorectal cancer.

The aim of the study was to find a correlation between K-ras gene mutation in patients with diagnosed colorectal cancer and selected clinical parameters.

Material and methods. A total of 104 patients (41 women and 63 men) with diagnosed colorectal cancer were included in this study. The average age of male group was 68.3 and in female group − 65.9. Samples were taken from paraffine blocks with tissue from diagnosed patients and K-ras gene mutation were identified. Afterwards the statistical analysis was made seeking the correlation between K-ras gene mutation incidence and clinical TNM staging system, tumour localisation, histological type, sex, age.

Results. K-ras gene mutations were detected in 20.1% of all colorectal cancers. Significantly higher rate of K-ras gene mutations were diagnosed among patients classified at stage I (40%), stage IIC (50%) and stage IV (50%) according to the TNM classification.

Conclusions. The results of our study are compatible with other studies and indicate the correlation between K-ras gene mutation and colorectal cancer incidence. Identification of K-ras gene mutation may complement other diagnostic methods at early stage of colorectal cancer.

Open access

Andrzej Hap, Wojciech Kielan, Maciej Siewiński, Robert Tarnawa, Anil Agrawal, Julia Rudno-Rudzińska, Wojciech Hap and Zygmunt Grzebieniak

Inhibition of Selected Enzymes with Specific Inhibitors in the Tissue Homogenates from Patients with Colorectal Cancer

Large intestine malignancy is the second most common malignancy and second leading cause of cancer mortality in Poland. This is related to late detection of these lesions, e.g. due to lack of effective screening tests. Lesions found by a surgeon are clinically advanced, making the treatment often ineffective and sometimes even completely impossible. Discovery of a substance that would be able to stop key processes for the development of malignancy could change such situation. Activity of certain enzymes was found to increase in malignant cells and invasion of malignancy could be triggered by inadequate amount of endogenous inhibitors of these enzymes in the surrounding healthy tissues. Inhibitors identical with that produced in human cells were found in egg whites.

The aim of the study was to determine ability of cystatin isolated from egg whites to inhibit activity of cathepsin B and L.

Material and methods. Immunohistochemistry and histology of tissue specimen collected from malignant lesions resected from 60 patients diagnosed with large intestine adenocarcinoma, who underwent surgical treatment in 2nd Department of General and Oncological Surgery, Medical University of Wrocław between 2007 and 2009.

Results. Differences were fund between health tissues, margins and center of the malignant lesions with regard to amount and distribution of stained cathepsin B - cystatin complexes. The above mentioned inhibitors were able to inhibit 90% of primary activity of cathepsin B and L in malignant tissues.

Conclusions. Cystatins obtained from egg whites could be used as substances supporting anti-cancer therapy in the future.

Open access

Jan Kulig, Grzegorz Wallner, Michał Drews, Mariusz Frączek, Arkadiusz Jeziorski, Wojciech Kielan, Piotr Kołodziejczyk, Anna Nasierowska-Guttmejer, Teresa Starzyńska, Krzysztof Zinkiewicz and Marek Krawczyk

Open access

Marek Szczepkowski, Tomasz Banasiewicz, Piotr Krokowicz, Adam Dziki, Grzegorz Wallner, Michał Drews, Roman Herman, Zbigniew Lorenc, Piotr Richter, Krzysztof Bielecki, Wiesław Tarnowski, Jan Kruszewski, Józef Kładny, Stanisław Głuszek, Wojciech Zegarski, Wojciech Kielan, Krzysztof Paśnik, Marek Jackowski, Mariusz Wyleżoł, Zoran Stojcev and Alicja Przywózka