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Open access

Mariusz Frączek, Piotr Hevelke, Krzysztof Komorzycki, Marcin Kotulski, Piotr Kalinowski, Barbara Górnicka and Marek Krawczyk

Esophagogastric Junction Versus Gastric Carcinoma - Implications for Surgical Tactics on the Basis of Own Experience

The exact prevalence and results of treatment of the carcinoma of esophagogastric junction (gastric cardia) are difficult to assess, and the data concerning thereof, presented in different series of patients, are frequently inconsistent. This phenomenon may result from terminological mess, resulting in different comprehension of the sole term "esophagogastric junction". That can be why the results of treatment of patients with this type of cancer are dispersed in the literature and may be as well found under "esophageal", as well as "gastric cancer" headings.

The aim of the study was to present the current view of the pathogenesis, pathology and terminological issues concerning this tumor, interesting at least for its localization at the border of two viscera and two body cavities. On the basis of our own material, we also tried to delineate the implications of such a localization to surgical tactics.

Material and methods. The patients with esophagogastric junction and more peripherally located gastric cancer were analysed in two groups, according to the date of resectional surgery performed: From 1989 to 1998 (group I), and from 1999 to 2005 (group II). In each group the patients with esophagogastric junction and peripheral gastric cancer were investigated separately. The influence of more aggressive approach to cardial cancer (additional thoracotomy approach) in group II patients on the cancer free tissue margin, number of metastatic lymph nodes excised, as well as on survival rate during a 5-years follow-up was assessed.

Results. The results show, that the additional thoracotomy, despite the increase in postoperative complications rate (mainly affecting the respiratory system- 19 vs 4.3% at laparotomy alone), did not influence the perioperative motality in our patients (approximately 5% in all subgroups). Despite the additional thoracotomy approach, facilitating the safe lower esophageal resection, the cancer free margins of the excised specimens remained unsatisfactory (the target safe margin value of 7 cm), although some improvement can be noted as compared with group I patients. The interesting finding was, that the survival rates following gastrectomy for ‘peripheral’ gastric carcinoma has been remaining practically unchanged during the 20 years of this study. Survival rates following gastric cardia resection improved in group II patients, but the differences did not reach the statistically significant level. The difference in survival rate was increasing with time in favor of group II patients, its value being triple at 5 years from surgery (18 vs 6%) as compared with group I.

Conclusions. We see the need for the development of a method allowing to select the patients with good prognosis, in whom further radicalization of resectional procedures (and subsequent treatment) would be justified by long-term disease-free survival.

Open access

Marian Simka

Leg Ulceration Associated with Incompetence of the Gastrocnemius Vein - A Case Report

This paper presents a case of the patient with leg ulcers resulting from incompetence of the gastrocnemius vein with refluxing variety referred to as the "enigma of the gastrocnemius vein". The operation consisted of the selected ligature of incompetent perforator joining the gastrocnemius vein and the small saphenous vein. After the operation ulcers healed and reflux in the system of the gastrocnemius vein disappeared. Surgical tactics of operations for varicose veins accompanied by incompetence of the gastrocnemius vein is also discussed.

Open access

Astra Zviedre, Arnis Engelis, Mohit Kakar and Aigars Pētersons

Potential Role of Cytokines in Children with Acute Appendicitis and Acute Mesenteric Lymphadenitis

Although, AAP and AML have different etiological factors, clinical symptoms are very much similar but treatment tactics in both the disease differ a lot. In case of AML, treatment is more conservative and does not require hospitalization while in case of AAP immediate hospitalization and maybe further surgery can be mandatory. With the identification of group of cytokines serum inflammatory mediators IL-8, IL-10, IL-12[p70], IL-17, TNF-a and MCP-1, it is believed early and proper diagnosis of AAP in the near future. Research of cytokines-serum inflammatory mediators has opened new opportunities for an early detection and differentiation of these two diseases in children.

Open access

Edgars Zarembo, Arnis Engelis and Aigars Petersons

Diagnosis and Management of Blunt Pancreatic Trauma in Children

There are still diagnostics problems and variety of opinions about tactics in the treatment of blunt pancreatic injurys. The methods of surgery treatments are more and more replacing the methods of endoscopy and conservative therapy. There is a remarkable diference in the tactic of treatment between adults and children because of the anatomical physiological reasons. Delayed diagnosis of this wounding is connected with heightened morbidity and mortality.

Handlebars injury is the most frequent mechanism of the trauma. The most determinant role in the diagnostics has active examination tactic and arsenal of visual diagnostics methods. Therapy approach must be individualized depending from the hemodynamic status, seriosity of injury, existence of associated injuries and the experience in the institution. After traumatic pseudocysts can be successfully drained in US control or endoscopic to stomach. Children with such injuries must be concentrated if possible in the specialized centers.

Open access

Krzysztof Bartosz and Stanisław Głuszek

Need Assessment for Gastroscopy in Patients with Gall-Stones

Cholelithiasis (gall-stones) occurs in 13% of the Polish population. Patients affected with gall-stones notify non-specific symptoms caused by pathology of the upper segment of the digestive track which coexists with gall-stones.

The aim of the study was to analyze the risk of occurrence of pathological changes, within the part of the digestive track in patients affected with gall-stones, to assess the correlation between data of medical histories of patients and results of gastroscopy based diagnosis; to devise tactics of alterations to the planned measures in case a clinically significant disease has been diagnosed.

Material and methods. The study group comprised 615 patients, qualified for cholecystectomy, with symptomatic gall-stones, verified by an ultrasound diagnosis. After being interviewed and examined, all the patients were subjected to gastroscopy, and when necessary biopsy was performed. The statistical analysis was performed using an multifactorial analysis (Pearson's correlation coefficient for categorical variables).

Results. Among 615 patients, the subjects in the study, we found 183 ones (29.7%) with a normal upper digestive tract, we found pathology of the upper digestive system in 70.3% cases (432 patients). Serious pathology resulting in changing the planned treatment was found in 83 patients (13.5%): among those four ones had gastric carcinoma, sixty-three ones suffering from chronic peptic ulcer disease (gastric or/and duodenal), twelve patients were affected with hemorrhagic gastritis, four patients had GERD C and D. In a group of 83 patients cholocystectomy was postponed and the diagnosed disease was treated. Four patients were operated on because of gastric cancer, with intention of cure.

Conclusions. 1. Routine gastroscopy performed before cholecystectomy is justified. The percentage of abnormalities diagnosed during gastroscopy proved the above mentioned thesis. 2. Medical histories and an object examination do not allow to state explicitly that there is another disease of the upper part of the digestive system which coexists with gall-stones. In case of diagnosing the other pathology it is necessary to take into consideration an alteration of tactics of management: to delay an operation and treat the other disease which has been diagnosed.

Open access

Silvestris Zebolds, Valdis Goncars, Ints Zommers and Konstantins Kalnberzs

Summary

Introduction. Total knee replacement (TKR) is still a challenging procedure for severe gonarthrosis patients. Deformities of knee joint (varus, valgus - more than 30 degrees), insufficiency of collateral ligaments and extensive bone loss could be a difficult problem to solve with standard knee endoprosthesis. Also in cases of revision - TKR the restoration of bone loss and regaining of stability of the joint could be a problem.

Aim of the Study. The aim of our study was to analyse the results with Rotating - Hinge prosthesis after severe primary and revision TKR.

Materials and Methods. 34 patients (27 female, 7 male) were treated with Rotating - Hinge prosthesis during 12 years (first in 1997). Mean age of patients were 69 years. 17 operations were primary total knee arthroplasties and also 17 were revisions of the knee prosthesis. The Oxford Knee score was used for evaluation of patients satisfaction rate. The Knee Society Score was used to get objective functional results. For radiological analysis X-rays of knee joint in two projections were performed.

Results. 34 Oxford Knee score questionnaires were sent to patients, response we got from 27 patients (79%). Mean result from Oxford Knee score was 32 which is good. The same number of patients (34) were invited for examination using Knee Society score. The response were from 20 patients (59%). Mean result from Knee Society score was 83, which means excellent.

Conclusions. Rotating-Hinge prosthesis allows to achieve good and excellent functional results and high patients satisfaction rate after severe primary and revision TKR. The biological age, general health condition, insufficiency of ligaments and previous infection in patients history have to be considered for choosing the tactics for each case.

Open access

Michał Kisielewski, Michał Pędziwiatr, Magdalena Pisarska, Piotr Major, Mateusz Rubinkiewicz, Maciej Matłok, Marcin Migaczewski, Piotr Budzyński and Andrzej Budzyński

Abstract

The aim of the study was to assess safety of elective laparoscopic cholecystectomy (LC) performed by residents that are undergoing training in general surgery.

Material and methods. A retrospective analysis was conducted on 330 patients operated electively due to cholelithiasis. Patients with acute cholecystitis, choledocholithiasis, undergoing cholecystec-tomy as a part of more extensive operation and patients with gall-bladder cancer were excluded. Group 1 included patients operated by resident, group 2 – by specialist. Duration of operation, mean blood loss, number of major complications, number of conversions to the open technique and conversions of the operator, reoperations and length of hospital stay were analyzed.

Results. Mean operative time overall was 81 min (25 – 170, SD±28.6) and 71 min (30-210, SD±29.1) in groups 1 and 2 respectively (p=0.00009). Mean blood loss in group 1 was 45±68.2 ml and in group 2 – 41±73.4 ml (p=0.23). Six major complications has occurred (1.81%) – 2 (2%) in group 1 and 4 (1.7%) in group 2. 18 cases (15.5%) of conversion of the operator occurred in group 1, and 6 cases (2.6%) of conversion of the operator happened in group 2. Average LOS was 1.9 days in group 1 and 2.3 days in group 2 (p=0.03979).

Conlcusions. Elective LC performed by a supervised resident is a safe procedure. Tactics of “conversion of operator” allowed to prevent major complications. Longer LC by residents is natural during the learning curve. Modifications of residency program in the field of laparoscopy may increase its accessibility.

Open access

Janis Vilmanis, Arturs Ozolins and Janis Gardovskis

Summary

Introduction. The liver is a parenchimal abdominal organ with wide variety of primary benign or malignant tumors as well as metastatic tumors.

Aim of the study. Was to evaluate the informativity and usefulness of abdominal ultrasound (US) and computer tomography (CT) imaging results in diagnostics of focal liver lesions.

Material and methods. The study was conducted in Pauls Stradins Clinical University Hospital. Retrospective analysis of 126 patients with focal liver lesions was performed in the time period of 5 years (2009 till 2014). The medical records of patients with focal liver lesions were analyzed. Primary diagnosis detected by US or CT was evaluated and compared with final morphology after surgical operation or liver biopsy. The obtained results were expressed in percent and analyzed. Sensitivity and specificity of CT scan to detect malignant hepatic lesions was estimated and expressed as percentage with 95% confidence interval.

Results. A total of 126 patients with diagnosed liver lesions were included in the study. 96 patients were in the group with performed liver CT scans, with median age of 58.9 years. 30 patients were included in the group with liver US, with median age of 60.1 years. Liver biopsy under US control was performed for 95 patients, but surgical operations with liver resections for 31 patients. 86 patients had malignant liver lesions, but 40 had benign liver lesions. In the US group primary and final diagnosis agreement was in 26 (87%) cases, but diagnosis disagreement in 4 (13%) cases. Diagnosis disagreement was found in 26 (27.1%) cases in the CT group, but agreement was in 70 (72.9%) cases. Overall sensitivity of CT to detect malignant hepatic lesions was 95.2% (95%CI 86.7-98.3%) and specificity was 64.7% (95%CI 47.9-78.5%).

Conclusions. CT is a good imaging method for detection of focal liver lesions. In case of unclear diagnosis, percutaneous liver puncture biopsy is recommended. It is mandatory to develop a unified CT scan and US investigation protocol to improve the quality of investigation as well as further treatment tactics.

Open access

Jaime A. Teixeira da Silva

Abstract

Science is becoming more challenging, not only for scientists, but also for editors and publishers. Faced with limited funding within an expanding economic crisis, competition between scientists is increasing. The struggle for professional survival is leading some to revert to dishonest tactics to get ahead of the pack and cheating or fraud may be involved. Confronted with these new realities, which have become more debatable within the public arena, mainly as a result of an increase in blogs and social media, editors and publishers are reinforcing current publishing platforms in a bid to reduce the risks and to fortify their journals against future submission- and fraud-related problems. Ultimately, this places greater scrutiny — and stress — on the authorship, leading to an increase in militarization. At some point — which certain hints already indicate — the criminalization of science will begin as publishers fail to curtail fraud.