tunnel syndrome. J Clin Neurophysiol 2012; 29(3): 260-62. 8. Dale AM, Descatha A, Coomes J et al.: Physical examination has a low yield in screening for carpal tunnel syndrome. Am J Ind Med 2011; 54(1): 1-9. 9. Wiącek R, Pielka S, Rutkowski R i wsp.: Ocena dynamiki poprawy czucia w ręce po operacyjnym leczeniu zespołu kanału nadgarstka. Neurol i N eurochir Pol 2007; 41,6: 517-24 10. Elfar JC, Yaseen Z, Stern PJ et al.: Individual finger sensibility in carpal tunnel syndrome. J Hand Surg Am 2010; 35(11): 1807
Marcin Nowak and Bartłomiej Noszczyk
Grzegorz Wallner, Michał Solecki, Jacek Huk, Andrzej Dąbrowski, Marek Majewski and Aleksander Dombroskyy
References Tutuian R, Vela MF, Shay S et al.: Multichannel Intraluminal Impedance in Esophageal Function Testing and Gastroesophageal Reflux Monitoring. J Clin Gastr 2003; 37(3): 206-15. Sifrim D, Castell D, Dent J et al.: Gastroesophageal reflux monitoring: rewievs and consensus report on detections and definitions of acid, nonacid, and gas refluks. GUT 2004; 53: 1024-31. Shay S, Tutuian R, Sifrim D et al.: Twentyfour hour ambulatory simultaneous impedance and pH monitoring
Sylwia Niemyjska, Anna Ukleja and Michał Ławiński
school male students in Al Jouf Province, North of Saudi Arabia. JPMA 61/11: 1111-15. 21. Johannesson E, Simren M, Strid H: Physical Activity Improves Symptoms in Irritable Bowel SyndromeL: A Randomized Controlled Trial. Amer J of Gastroenterol 2011; 106: 915-22. 22. Ziółkowski BA, Pacholec A, Kudlicka M: Prevalence of abdominal symptoms in the Polish population. Przegl Gastroenterol 2012; 7/1: 20-25. 23. Krajewska-Kułak E, Ortman E, Moczydłowska A: Radzenie sobie z dolegliwościami w drodze samoleczenia w popukacji studentów Uniwersytetu
Maria Wieloch, Kamila Bazylińska and Piotr Ziemniak
Spontaneous, idiopathic urinary bladder rupture is a very rare disease entity, which may face the problem of proper preoperative diagnosis. In many cases the medical history, physical examination, and additional tests raise false suspicion of gastrointestinal perforation. The study presented a case of a female patient with spontaneous urinary bladder perforation, paying particular attention to the diagnostic difficulties associated with the above-mentioned pathology. The aim of the study was to analyse the presence of symptoms and imaging and laboratory results observed in case of spontaneous urinary bladder rupture, as well as differentiate the above-mentioned pathology with gastrointestinal perforation. Whenever diagnosing a patient with acute peritonitis symptoms, in whom the predominating symptoms include sudden abdominal pain, peritoneal cavity fluid presence, hematuria, oliguria, and coexisting increased urea, creatinine, and potassium levels, one should consider the possibility of urinary bladder rupture.
Danuta Neuman and Zygmunt Grzebieniak
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.
Maria Jeleńska and Łukasz Romanowski
Wiele R: Studies of the coagulation and fibrinolytic system in hyperstymulation syndrome after administration of human gonadotrophins. J Reprod Med 1975; 14: 138-43. Di Nisio M, Van Sluis GL, Bossuyt PMM et al.: Accuracy of diagnostic tests for clinical suspected upper extremity deep vein thrombosis: a systematic review. J Thromb Haemost 2010; 8: 684-92. Kearon C, Kahn SR, Agnelli G et al.: Therapy for venous thromboembolic disease: American College of Chest Physicians evidence-based clinical practice
Angelika Bara, Piotr Pluta and Arkadiusz Jeziorski
Cancer of Unknown Primary Origin (CUPO) is defined by the presence of metastatic lesions, diagnosed by means of cytological or pathological evaluation, for which no primary site can be detected during a thorough examination. The clinical investigation, directed at locating the site of the neoplastic lesion, is determined by the results of laboratory tests, imaging procedures, and pathological examinations. It is also essential to conduct a complete medical history and thorough physical examination. The detection of the primary site allowed to introduce specific therapy, which can offer clinical benefits, considering a favorable prognosis.
The aim of the study was to assess the range of diagnostic procedures performed in patients with CUPO and efficacy in identifying the primary lesion.
Material and methods. Retrospective analysis comprised a group of 29 patients with CUPO, operated between January, 2002 and December, 2011, at the Department of Surgical Oncology, Medical University in Łódź. The study group comprised 16 male and 13 female patients; median age at presentation was 58.3 years (ranging between 30-79 years).
Results. Detailed diagnostic management depending on the location of metastatic lesions and their histological type was performed in 20 of the 29 study patients (69%). Considering the remaining 9 (31%) patients detailed diagnostics was not performed, due to the patients' poor general condition. In 55% (11/20) of patients subject to detailed diagnostics, the primary neoplastic lesion was determined.
Conclusions. Considering the study group, most patients with cancer of unknown primary origin were characterized by a favorable prognosis, which justified thorough diagnostics, in order to establish the primary neoplastic lesion. The introduction of diagnostic examinations enabled to identify the primary site of the tumor in more than 50% of patients. With the development of imaging methods one can expect improvement of unsatisfactory results, considering the detection of primary neoplastic foci.
Jacek Huk, Witold Wiktor, Tomasz Pedowski, Wioletta Masiak and Grzegorz Wallner
Gastroenterol Hepatol 2004; 16: 837-45. Numans ME, Lau L, de Wit NJ. et al. : Short-term treatment with proton-pump inhibitors as a test for gastroesophageal reflux disease: a metaanalysis of diagnostic test characteristic. Ann Intern Med 2004; 140: 518-27. Kahrilas PJ, Shaheen NS, Vaezi MF: American Gastroenterological Associacion Institute Technical Review on the Management of gastroesophageal reflux disease. Gastroenterology 2008; 135: 1392-13. Boparai V, Rajagopalan J, Triadafilopoulos G
Martin Bach Jensen, Charlotte Buchard Nørager, Thorbjorn Sommer, Mogens R. Madsen and Soren Laurberg
References 1. Christensen T, Kehlet H: Postoperative fatigue.World J Surg 1993; 17: 220-25. 2. Jensen MB, Houborg KB, Norager CB et al.: Postoperative changes in fatigue, physical function and body composition: an analysis of the amalgamated data from five randomized trials on patients undergoing colorectal surgery. Colorectal Dis 2011; 13: 588-93. 3. Christensen T, Bendix T, Kehlet H: Fatigue and cardiorespiratory function following abdominal surgery. Br J Surg 1982; 69: 417-19. 4. Edwards H
Jerzy Gosk, Roman Rutowski, Roman Wiâcek, Maciej Urban, Witold Wnukiewicz and Pawel Reichert
of suprascapular nerve neurotization after nerve graft or transfer in the treatment of brachial plexus traction lesions. J Neurosurg 2004; 101: 377-89. Haerle M, Gilbert A: Management of complete obstetric brachial plexus lesions. J Pediatr Orthop 2004: 24: 194-200. Al-Qattan MM: Assessment of the motor power in older children with obstetric brachial plexus palsy. J Hand Surg 2003; 28B: 46-49. Dellon AL: The moving two-point discrimination test: clinical evaluation of the quickly