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Danuta Neuman and Zygmunt Grzebieniak

Abstract

Surgical site infection is a common complication in surgery, which increases treatment cost, extends hospitalization time and can lead to septic complications. The aim of the study was analysis of postoperative infections in own material and finding significant risk factors with preserving the obligatory procedures in the clinic. Material and methods. Prospective analysis of 270 consecutively operated patients aged from 18 to 101 was performed with observation of early infection until 7th day postoperatively. Factors judged included: age, sex, BMI, operation type: elective or urgent, physical preparation for surgery, antibiotic prophylaxis, length and type of surgery. Wound observation card was used. Data were analysed statistically (t-Student’s test, chi2 test, U Mann Whitney test and logistic regression analysis). Results. Wound infection was observed in 33 patients (12.22% of the entire group). In 24 (8.88%) it was a superficial infection and in 9 (3.33%) deep infection. Statistically significant risk factors were age, presence of diabetes, operation time and operations on large bowel. The average age of patients with present infection was 61.2. In the group without infection there were 6,3% patients with diabetes and 20.8% in the group with infection. In our study diabetes increased the risk of infection four times. The longer the operation time the higher was the risk of deep infection (without complications 76.2 minutes, superficial 94.9 minutes, deep 148.9 minutes). Operations on large bowel were performed in 11.9%of all study patients. In the group of 33 patients with surgical wound infection, 39.4% had colon surgery, 39.4% of all deep infections and 29.2% of all superficial infections. Conclusions. In own study material significant risk factors of surgical wound infection were: age, presence of diabetes, length of operation, large bowel surgery. In preoperative course risk factors should be identified to perform certain prophylactic procedures to lower the risk of infectious complications.

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

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

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

Aleksander Stal, Agnieszka Stembalska, Robert Śmigiel, Radosław Tarkowski, Zygmunt Grzebieniak and Maria Sąsiadek

Hereditary Nonpolyposis Colorectal Cancer in Lower Silesia

The aim of the study was to assess the frequency of hereditary nonpolyposus colorectal cancer in the Lower Silesia area.

Material and methods. The study population consists of 318 patients hospitalized between 2001-2002 on 14 surgical wards in the Lower Silesia area. Patients formed four groups: hereditary nonpolyposis colorectal cancer (HNPCC), suspected HNPCC (S-HNPCC), familial colorectal cancer (FCC) and cancer familial aggregation (CFA). The epidemiological data were analyzed (age on onset, gender, localization, extracolonic tumors in family).

Results. 3.77% of all patients with colorectal cancer (CRC) were diagnosed with HNPCC and 6.92% with S-HNPCC. The mean age of CRC onset in HNPCC group was 53.07; in the S-HNPCC group, 62.2. Seven male and 5 female patients were diagnosed with HNPCC; for S-HNPCC, 14 males and 8 females were diagnosed. In the HNPCC group, 55.55% of CRC were situated in the right colon and in 44.55%, the left colon. In the S-HNPCC group, 28.57% CRC was in the right colon and in 71.43%, the left colon. In the HNPCC and S-HNPCC groups, there were 4 patients diagnosed with synchronous sigmoid and rectal adenomas. Two of them were diagnosed during intraoperative colonoscopy. One patient was diagnosed with 3 metachronous lesions. In the families of 6 patients with HNPCC extracolonic tumors were identified.

Conclusions. 1. Knowledge of HNPCC criteria ensures proper treatment of the patient and their family. 2. During colonoscopy, the whole colon should be inspected. 3. Patients suspected of HNPCC should undergo intraoperative colonoscopy.

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.