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1
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Obraz kliniczny i wyniki leczenia operacyjnego tłuszczaków kończyny górnej

100%
Żyluk A.
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vol. 23(6)
393-400
EN
Background. Lipomas are benign neoplasms arising from fat tissue, with an incidence in the upper extremity of 1%-3,8%. There is scarce literature on the outcomes of the treatment of lipomas in this region. The objective of this study was to assess clinical manifestations and outcomes of surgery for upper extremity lipomas. Material and methods. The sample comprised 40 patients, including 26 women (65%) and 14 men (35%), at a mean age of 37 years, with lipomas located in the upper limbs. Treatment outcomes were assessed at a mean of 4.2 years after surgery in 27 patients from this group. Results. Most of the tumours (29 cases, 73%) were located in the forearm and arm, with 11 patients (27%) presenting with lipomas of the metacarpus and wrist. In 35 patients (87%), lesions were located superficially, within subcutaneous tissue, whereas in 5 (13%) they were located more deeply, in the metacarpus and in the forearm muscles. The follow-up assessment was conducted as telephone interviews in 27 patients. No recurrence was noted. Seven patients (26%) complained of mild tenderness of the postoperative scar. Conclusions. 1. Lipomas are moderately frequent benign lesions occurring in the upper limb. 2. Surgical treatment is effective and the recurrence rate is very low.
PL
Wstęp. Tłuszczaki są łagodnymi nowotworami powstającymi z tkanki tłuszczowej, o częstości występowania na kończynach górnych wynoszącej od 1% do 3,8%. W piśmiennictwie nie ma wielu artykułów na temat wyników leczenia tłuszczaków o tej lokalizacji. Celem pracy była ocena manifestacji klinicznej i wyników leczenia tłuszczaków w obrębie kończyny górnej. Materia i metoda. Materiał kliniczny stanowiła grupa 40 pacjentów, 26 kobiet (65%) i 14 mężczyzn (35%), w wieku śr. 37 lat, z tłuszczakami umiejscowionymi na kończynach górnych. Wyniki leczenia po okresie śr. 4,2 lat od operacji oceniono u 27 pacjentów z tej grupy. Wyniki. Większość guzów - 29 przypadków (73%) była zlokalizowana na przedramieniu i ramieniu, a u 11 pacjentów (27%) na śródręczu i nadgarstku. U 35 pacjentów (87%) guzy były umiejscowione powierzchownie w tkance podskórnej, a u 5 (13%) były położone głęboko wewnątrz śródręcza i w mięśniach przedramienia. Badanie kontrolne w formie wywiadu telefonicznego przeprowadzono u 27 pacjentów. Nie zanotowano żadnego nawrotu choroby. Siedmiu pacjentów (26%) skarżyło się na niewielkie dolegliwości w okolicy blizny pooperacyjnej. Wnioski. 1. Tłuszczaki są umiarkowanie częstymi guzami łagodnymi spotykanymi w obrębie kończyny górnej. 2. Leczenie operacyjne jest skuteczne, a nawroty bardzo rzadkie.
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Wyniki leczenia operacyjnego chrzęstniaków w obrębie ręki

100%
Żyluk A.
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vol. 23(5)
325-334
EN
Background. Enchondromas are the most common benign bone tumours found in the hand. They are usually accidentally diagnosed on an X-ray, because they grow asymptomatically. In some cases, a pathological fracture of the involved phalanx may be the first sign. The objective of this study was to assess the results of operative treatment of enchondromas involving hand phalanges and metacarpals. Material and methods. The study group consisted of 24 patients, 16 women (67%) and 8 men, (33%), aged a mean of 31 years, who were operated on at our centre. The surgery consisted in curettage, and - in most cases - filling the bone defect with either a bone graft or a bone substitute. Follow-up assessment was performed over the telephone in 17 patients (79% of the group) at a mean of 2 years after surgery. Results. Half of the patients were asymptomatic and fully recovered functionally, whereas the other half complained of some not troublesome symptoms such as scar discomfort, limitation of finger movement or cold sensitivity. No differences were observed with regard to the material used for filling of the bone defect following curettage. Two cases of recurrence were noted after surgery: one in the bone substitute group and one in the bone graft group. Conclusions. 1. Enchondromas are the most common benign bone tumours encountered in bones of the hand. 2. The first line treatment in these lesions is curettage and filling of the bone defect with a bone substitute or cancellous bone graft. 3. Both the results of the present study and literature data show that the approach to managing the tumour cavity after curettage has no significant effect on outcomes, which are essentially satisfactory.
PL
Wstęp. Chrzęstniaki są najczęstszymi guzami łagodnymi spotykanymi w kościach ręki. Zwykle są rozpoznawane przypadkowo na zdjęciu rtg, ponieważ rozwijają się bezobjawowo. W części przypadków pierwszym objawem jest złamanie patologiczne paliczka zajętego przez guz. Celem pracy była ocena wyników leczenia operacyjnego chrzestniaków zlokalizowanych w obrębie kości śródręcza i palców ręki. Materiał i metoda. Materiał badawczy stanowiło 24 pacjentów, 16 kobiet (67%) i 8 mężczyzn (33%), w wieku śr. 31 lat, którzy byli operowani w ośrodku autorów. Operacja polegała na wyłyżeczkowaniu zawartości guza i – w większości przypadków - wypełnieniu jamy substytutem lub przeszczepem kości. Badanie kontrolne przeprowadzono u 19 osób (79% pierwotnej grupy) po śr. 2 latach od operacji, w formie wywiadu telefonicznego. Wyniki. Połowa chorych nie miało żadnych dolegliwości i osiągnęła pełną funkcje operowanych palców, a połowa zgłaszała nieuciążliwe objawy takie jak: dyskomfort blizny pooperacyjnej, ograniczenie ruchomości palca lub nadwrażliwość na niską temperaturę. Nie zanotowano różnic w wynikach leczenia w zależności od materiału, którym wypełniano jamę po wyłyżeczkowaniu chrzęstniaka. Zanotowano 2 przypadki wznowy, po operacji z zastosowaniem substytutu kości i przeszczepu kości. Wnioski. 1. Chrzęstniaki są najczęstszymi, łagodnymi zmianami spotykanymi w kościach ręki. 2. Podstawową metodą leczenia jest ich wyłyżeczkowanie i wypełnienie jamy substytutem kości lub przeszczepem kości gąbczastej. 3. Zarówno wyniki pracy, jak i dane z piśmiennictwa wskazują, że sposób postępowania z jamą po chrzęstniaku nie ma istotnego wpływu na wyniki leczenia, które są zasadniczo dobre.
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Przedłużona profilaktyka przeciwzakrzepowa u pacjentów poddanych dużym operacjom w obrębie jamy brzusznej zmniejsza ryzyko wystąpienia żylnej choroby zakrzepowo-zatorowej Komentarz do artykułu: Rasmussen MS, Jorgensen LN, Wille-Jørgensen P, Nielsen JD, Horn A, Mohn AC, Sømod L, Olsen B; FAME Investigators: Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major abdominal surgery: a multicenter randomized open-label study. J Thromb Haemost 2006; 4: 2384–2390.

100%
Żyluk A.
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EN
Patients undergoing major abdominal surgery carry a risk of complications associated with their underlying conditions and the surgery itself as well as venous thromboembolism (VTE), also called deep vein thrombosis (DVT). VTE consists in the formation of blood clots in the deep venous system, usually of the lower extremities or the pelvis minor. Additionally, 50% of patients develop more or less severe pulmonary embolism.
PL
Pacjenci wymagający tzw. dużych operacji brzusznych narażeni są oprócz innych powikłań, właściwych dla rodzaju schorzenia i wykonywanej operacji, także na powikłania zakrzepowo-zatorowe, czyli zakrzepicę żył głębokich (ZŻG), zwaną również żylną chorobą zakrzepowo-zatorową (ŻChZZ). W ŻChZZ dochodzi do powstawania zakrzepów w układzie żył głębokich, najczęściej w kończynach dolnych lub miednicy mniejszej, a u 50% chorych do mniejszej lub większej zatorowości płucnej.
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Diagnosing of Acute Appendicitis - A Review

64%
Żyluk A., Ostrowski P.
Polish Journal of Surgery
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2010
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vol. 82
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issue 5
297-306
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Results of the Treatment of Trigger Finger - A Review

64%
Żyluk A., Jagielski G.
Polish Journal of Surgery
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2009
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vol. 81
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issue 5
265-271
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Results of the Treatment of Major, Complex Hand Injuries

64%
Żyluk A., Janowski P.
Polish Journal of Surgery
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2011
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vol. 83
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issue 2
87-94
EN
Complex hand injuries are associated with serious consequences including long period off-work, permanent disability, inability to return to original profession or to work at all. As these injuries are common, they create considerable economical consequences and, therefore, it is desirable their treatment would be as perfect as possible to reduce potential loss of function.The aim of the study was analysis of the structure of complex, multi-structural hand injuries and evaluation of the outcomes of the treatment of these injuries in both medical (recovery of function) and economical (period of inability to work and costs of medical care) aspects.Material and methods. The study presents the results of treatment of 78 patients suffered from severe, major hand injuries, involving damage of at least two of four anatomical structures within the hand or wrist (bones, tendons, arteries or nerves) as well as severe injury involving at least two digits. Functional results were assessed at a mean of 10 months after the accident. Tendons were repaired in all 42 patients, bones were fixed in 29 (69%), nerves were repaired in 21 (50%), arteries in 14 (33%) and in two patients skin defect was covered by the flap (one local and one groin flap).Results. Total active motion of affected digits amounted 2/3 of normative active motion of the healthy digits and total grip strength approximated half of the grip strength of the unaffected hand. In patients with nerve injuries, a satisfactory recovery of sensation in the affected digits was obtained. Dexterity of the hand in daily activity was scored 30 points in DASH scale. Injury-related duration of sick leave in 31 patients worked at the time of the accident amounted 4.4 months in average (range 1-12). A total of 27 subjects (87% of worked) returned to work: 24 to their previous profession and three had to qualify for a new job. Total hospital costs of the treatment in the analysed group amounted a mean of 2600 PLN.Conclusion. The outcomes of the treatment of major hand injuries achieved in our institution over the period of the one year were satisfactory, considering their severity and complexity. These results, in our mind, show clearly advantages coming from an existence of qualified service for hand injuries.
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An Uncommon Course Of Acute Appendicitis With Sepsis – A Case Report

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Żyluk A., Jagielski W.
Polish Journal of Surgery
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2015
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vol. 87
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issue 5
272-276
EN
Authors report a case of 54-years-old patient, who presented to the hospital due to three-day history of weakness, abdominal pain and diarrhea. His general shape was severe, abdomen was tender at palpation in hypogastrium, peritoneal signs were positive, and blood tests showed highly elevated markers of inflammation, including procalcitonin, what suggested the sepsis. Despite unclear clinical picture, the presence sepsis was an argument to give the patient surgery. Intraoperatively, perforated appendix was found, being in mass with the omentum and small bowel. An appendectomy was performed. Postoperative course was complicated by the wound infection, but recovery progressed quickly and patient was dismissed at 5 days after operation. In the discussion the authors referred to the similar cases reported in the literature, concluding that acute appendicitis can be a life threating event for – to date – healthy adult person. Although a tendency to treat conservatively an uncomplicated acute appendicitis and to delay operations is supported by scientific evidence, the cases may occur in which only prompt surgical intervention protects the patient from serious complications.
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Traumatic Rupture of Massively Enlarged Spleen in Patient with Malignant Lymphoma and Thrombocytopenia - A Case Report

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Żyluk A., Walaszek I.
Polish Journal of Surgery
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2009
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vol. 81
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issue 5
246-250
EN
Traumatic ruptures of enlarged spleen in the course of haematological conditions are very rare. A case of 51-years old male suffering from a low-grade malignancy non-Hodgin lymphoma, who sustained a rupture of his massively enlarged spleen as a result of blunt trauma of the left side of abdomen and chest is reported. The patient attended to the hospital three days after trauma because of abdominal pain and weakness. Investigations revealed parenchymal laceration of massively enlarged spleen, heamoperitoneum, moderate anaemia and thrombocytopenia 48 G/l. Laparotomy was performed the next day after admission, after preparing packed red blood cells and packed platelets. Massively enlarged, 2.6 kg weight, ruptured spleen was removed and post-operative course was uneventful. Authors consider a reasonable the decision on delayed operation, when no signs of active intra-abdominal bleeding were observed. It allowed to prepare optimal conditions for potentially difficult splenectomy.
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Conservative vs Operative (Fixation with K-wires) Treatment of Isolated Fractures of Metacarpal Bones - Results of the Prospective, Randomized Study

64%
Żyluk A., Budzyński T.
Polish Journal of Surgery
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2009
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vol. 81
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issue 5
217-224
EN
Hand fractures (phalanges and metacarpals) are very common and they constitute a cause of considerable ambulatory and surgical departments workload. Isolated, undisplaced and displaced but stable fractures are usually treated non-operatively, and classical indication to surgery are unstable, oblique, spiral, intra-articular, open and complex fractures. Results of some studies suggest that oblique, spiral and apparently unstable fractures can be successfully treated conservatively, questioning afore-mentioned indications to surgeryThe aim of this prospective and randomized study was to compare the results of conservative versus operative (by fixation with K-wires) treatment of isolated, displaced and extra-articular metacarpal fractures.Material and methods. Forty-seven patients, 36 male (77%) and 11 female (23%) with a mean age of 34 years (range 16-75), with isolated metacarpal fractures, were randomly allocated to operative, by intramedullary fixation with K-wires (24 patients), or conservative, by reduction and immobilization (23 patients) treatment. Patients were followed-up at 2 and 6 months, and the assessments included measurements of active range of motion of fingers, total grip and pinch strengths, angular deformity on X-rays and subjective hand function with DASH questionnaire.Results. In one patient (4%) treated conservatively, an unacceptable secondary displacement occurred, and he was withdrawn from the study. and given surgical treatment. All fractures consolidated. At 2 months assessment, no statistically significant differences between the variables in the operative and conservative treatment groups were noted, except of the angular deformity on X-rays, which was significantly greater after conservative than operative treatment (median 31° vs 9°). At 6 months assessment, an active range of motion of involved fingers was statistically significantly greater in operative, than in conservative treatment group (median 269° vs 250°) and the angular deformity was significantly lesser after operative than conservative treatment (median 24° vs 12°). There were no statistically significant differences between the groups with regard other analysed parameters. None healing disturbances and malrotations were noted.Conclusions. The results of this study indicate the equal effectiveness of both the operative by K-wiring, and conservative treatment of fractures of the metacarpals. The better anatomical outcomes in terms of the degree of angular deformity did not translate directly into the better function of the hand.
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Treatment of Mallet Finger - A Review

64%
Żyluk A., Piotuch B.
Polish Journal of Surgery
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2010
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vol. 82
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issue 4
243-250
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An Analysis of Factors Influencing Accuracy of the Diagnosis of Acute Appendicitis

64%
Żyluk A., Ostrowski P.
Polish Journal of Surgery
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2011
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vol. 83
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issue 3
135-143
EN
The aim of the study was to "refresh" the knowledge about the course of acute appendicitis, to confront the classical clinical picture with the practice, analyze its fluctuations and identify factors influencing these.Material and methods. All patients admitted to the Department of General Surgery in Grudziądz District Hospital with the suspicion of acute appendicitis, who underwent appendectomy and in whom the appendicitis was confirmed in pathologic examination were included in the study. There were 85 patients, 49 men (58%) and 36 women (42%) in a mean age of 30 years (range 10-75). Symptoms, signs and results of biochemical tests (leukocyte rate and CRP) were considered in the analysis.Results. The commonest constellation of symptoms and signs, occurring in at least of 3/4 patients consisted of pain and tenderness localized in right lower quadrant (100%), which exacerbates at movements (98%), felling unwell (93%), loss of appetite (88%), and rebound tenderness in right lower quadrant (74%).Conclusions. No particular fluctuation of clinical features in relation to gender, age, duration of symptoms, biochemical parameters and morphological severity of the inflammation was observed. Relevant findings included relatively fast development (<12 hrs) of advanced appendicitis in 18% of adult patients and more than a half patients with normal body temperature, regardless true appendicitis.
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An Assessment of the Usefulness of Patient Evaluation Measure Questionnaire as an Outcome Measure after Carpal Tunnel Surgery

64%
Piotuch B., Żyluk A.
Polish Journal of Surgery
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2010
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vol. 82
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issue 6
347-353
EN
Outcome assessment of carpal tunnel release has relied upon objective measurements including grip strength and sensory testing as well as subjective parameters such as relief from pain and improvement of hand function. The latter can be obtained by the use of standardized questionnaires.The aim of the study was to assess the usefulness of Patient Evaluation Measure (PEM) questionnaire as an outcome measure after carpal tunnel surgery.Material and methods. Fifty patients, 43 women and 7 men with an average age of 55 years with carpal tunnel syndrome received mini-invasive carpal tunnel release. Patients were examined before the operation, and at 1 and 6 months after, according the same protocol. They had measured a total grip and key-pinch strengths and sensation by the filament test. They completed also the PEM questionnaire. The following parameters of the questionnaire were determined: responsiveness, concurrent validity and internal consistency.Results. Over a half-year follow-up, the sensation improved statistically significantly during the first month after operation. Power of the hand decreased initially comparing to baseline values, following by further gradual increasing throughout the follow-up. PEM scores showed continuous improvement of the hand status at each assessment. The PEM questionnaire showed excellent responsiveness to change of considered parameters, comparing to baseline values. The PEM showed also high concurrent validity with total grip and pinch strengths, as well as with Sensory Index, but only at 6 months assessment. However, the PEM showed a discordance with total grip and key-pinch strength at 1 month assessment. The instrument showed excellent internal consistency.Conclusion. The PEM questionnaire is, with some exceptions, a good and useful instrument for outcome measurement after carpal tunnel treatment surgery.
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Results of Scaphoid Nonunion Treatment with Vascularised Bone Grafting from the Distal Radius

64%
Żyluk A., Walaszek I.
Polish Journal of Surgery
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2008
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vol. 80
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issue 1
26-34
EN
Misdiagnosis or failed treatment of scaphoid fractures are frequently (25-45%) followed by disrupted healing and nonunion. This may reduce the wrist's capacity for occupational and daily use and, over time, lead to wrist arthrosis. Therefore, surgery is recommended even in asymptomatic nonunions of the scaphoid; the goal of this treatment is to achieve bone union and stability of the wrist.The aim of the study was to evaluate the results of operative management of scaphoid nonunion by vascularized bone grafting from the distal radius.Material and methods. Eleven patients, nine men and two women of a mean age of 29 (range 19-45 years) with scaphoid nonunion lasting a mean of 10 months (range 8-20) were recruited. The nonunion was localized in the waist of the scaphoid in seven patients and in proximal 1/3 in four patients. Operations were performed using cancellous bone grafts taken from the distal radius and supplied by the intercompartmental branch of the radial artery. Fracture fixation was accomplished with K-wires or headless canullated screws. The follow-up assessment at a mean of 10 months included measurements of wrist range of motion, grip strength and Mayo wrist score.Results. All patients achieved bone union. The mean Mayo wrist score increased from 25 points preoperatively to 75 points at the final assessment, which suggested significant improvement of the hand functions. In a qualitative evaluation, two patients had an excellent result, four had a good result, four had a fair result and one had a poor result. Surgery resulted in significant pain relief and increase in hand strength, but failed to improve wrist range of motion. The modest clinical outcomes do not allow a definitive conclusion to be reached, but the fact that bone union was achieved in all patients with no complications justifies continued use of this technique for the management of scaphoid nonunion.
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Reconstruction of the Distal Radio-Ulnar Joint with a Prosthesis of the Distal Ulna in the Treatment of a Recurrent Giant Cell Tumour

52%
Kotrych D., Żyluk A., Walaszek I., Bohatryrewicz A.
Polish Journal of Surgery
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2011
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vol. 83
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issue 9
518-522
EN
We present a case of 35-year old left-handed woman with recurrent giant-cell tumour affecting 1/4 of the distal part of the left ulna, with associated ulnar nerve involvement. After resection of the tumour and 1 cm of the ulnar nerve, the distal ulna was reconstructed with an individually designed and matched prosthesis, followed by ulnar nerve reconstruction. At 12 months follow-up the patients was free of pain, had excellent recovery of ulnar nerve function, satisfactory wrist range of motion and moderately impaired function of the left hand (DASH score 42). She returned to her original work in the office. We believe that restoration of the anatomy of the distal forearm after en block resection of the distal ulna is desirable in young, active patients, and that the prosthesis we used provides a good anatomical framework for the recovery of the function of the wrist.
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Hand injuries in polytrauma patients

52%
Żyluk A., Fliciński F., Pakulski C.
Polish Journal of Surgery
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2021
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vol. 93
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issue 4
21-27
EN
Hand and forearm injuries are relatively rare in polytrauma patients; their incidence is estimated at 2–5%. Hand and forearm injuries are usually not life threatening, and, therefore are considered of secondary importance, replaced by serious injuries of other body parts. However, they should be treated immediately after stabilization of the general condition of patients, as their delayed management may result in serious dysfunction of the hand. The aim of this study was to determine the incidence, distribution and methods of treatment of hand and forearm injuries in patients treated at the Polytrauma Centre of the SPSK 1 in Szczecin over the period of 4 years. Medical records of 16 patients, 11 men (65%) and 5 women (35%) with a mean age of 34 years (range 19–62) who were treated at the Polytrauma Centre and sustained an additional injury to the hand and/or forearm were analyzed. Medical records of 16 patients, 11 men (65%) and 5 women (35%) at the mean age of 34 years (range 19–62) who were treated in Polytrauma Centre and sustained an additional injury to the hand and/or forearm were analysed. The most common component of polytrauma with associated hand injury was major bone fractures (spine, pelvis and extremities) – 12 cases (70%), followed by chest – 11 (65%), maxillofacial – 9 (53%), brain – 8 (47%) and abdominal injuries – 5 (29%). The most common injury of the distal upper limb was fracture of the distal radius – 9 patients (53%). Two patients sustained excessive crush-degloving injuries which were the primary cause of their admission to the Polytrauma Centre. Nine patients required surgery, predominantly fixation of the distal radius with a plate. All patients survived. The importance of the correct management of hand injuries performed promptly after stabilization of the general condition of polytraumatized patients was emphasized.
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Analysis of the reliability of clinical examination in predicting traumatic cerebral lesions and skull fractures in patients with mild and moderate head trauma

52%
Żyluk A., Mazur A., Piotuch B., Safranow K.
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vol. 85
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issue 12
699-705
EN
The aim of the study was to assess the reliability of neurological examination and other factors in predicting traumatic cerebral lesions and skull fractures in patients with mild and moderate head trauma (GCS 10-15). Material and methods. Over a one-year period, 227 patients: 145 male and 82 female, aged a mean of 51 years who sustained mild or moderate head trauma (GSC 10-15) were examined neurologically and had performed head CT scans. The neurological examination as a whole and each finding of the neurological examination were tested as predictors of the presence of traumatic abnormalities in the head CT scan. Results. Post-traumatic lesions in head CT scan were found in 109 patients (48%): skull fractures in 66 of these and brain injuries in 94; fifty-eight patients had skull fracture combined with brain injury. Seventeen patients required neurosurgical intervention (hematoma evacuation). Abnormal neurological examination showed the highest reliability in identifying patients with brain injuries in CT (sensitivity 87%, specificity 79%). Of single findings, gait abnormalities and consciousness disturbances, present in sober patients, were the strongest predictors of cerebral lesions. Likewise, abnormal neurological examination was the best indicator of skull fractures (sensitivity 77%, specificity 63%). Gait abnormalities and “racoon eyes” present in alcohol intoxicated patients were the strongest individual predictors of skull fractures. Conclusion. Results of our study show neurological abnormalities as the most reliable (although not 100% accurate) in identifying patients who are likely to have brain injuries and/or skull fracture following head trauma. Use of clinical decision rules may reduce the number of head CT scans performed “just in a case”.
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A Comparison of the Efficacy of a Local Vs Brachial Plexus Block Anaesthesia in the Carpal Tunnel Release: The Results of a Prospective and Randomised Trial

52%
Żyluk A., Puchalski P., Walaszek I., Janowski P.
Polish Journal of Surgery
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2008
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vol. 80
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issue 11
615-620
EN
Carpal tunnel release can be performed in local anaesthesia, peripheral nerves blocks (either proximally or distally), intravenous regional (Bier block) and general anaesthesia. To our knowledge, in Poland operations of carpal tunnel syndrome are routinely performed under brachial plexus block anaesthesia.The aim of the study was to compare the effectiveness of local versus brachial plexus block anaesthesia for carpal tunnel decompression.Material and methods. One hundred and fifty-five patients diagnosed with carpal tunnel syndrome were randomly allocated to the local anaesthesia or brachial plexus block. Operations were done with two minimally invasive techniques: one and two small incisions. Questionnaires received from 135 patients, 115 women (85%) and 20 men (15%) in a mean age of 57 years (range 31-87) were analyzed. Sixty-six patients (49%) received local infiltration with 2% Lignocaine, and 69 (51%) received brachial plexus block with a mixture of 2% Lignocaine and 0.5% Bupivacaine. Pre- intra- and post-operative patients' complaints were assessed in visual analogue scale, as well as duration of anaesthesia, operation and surgeon subjective satisfaction were noted.Results. Except tourniquet pain, there were no significant differences between the groups in the pain scores associated with disease or operation. Although tourniquet pain was significantly lower favoring brachial plexus block, but the difference was slight (VAS 1.9) and most the patients well tolerated short-time inflation of the tourniquet. No significant difference was observed in duration of the operation, whereas duration of performing anaesthesia was significantly longer in brachial plexus blocks, but the difference of the mean values was as low as 1 minute. Operation under brachial plexus block provided greater surgeon's comfort.Conclusions. The results of this study show similar effectiveness of local and brachial plexus block anaesthesiae for carpal tunnel release, and confirm advantages of the former technique as simpler, cheaper and easier available. It seems that, according to European trends, local anaesthesia should be considered a method of choice in this operation and that fear associated with its use are not justified.
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Neglected, Traumatic Duodenal Rupture - Case Report

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Żyluk A., Jagielski W., Puchalski P.
Polish Journal of Surgery
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2011
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vol. 83
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issue 12
672-676
EN
A case of neglected, double-site, post-traumatic duodenal rupture, which was overlooked at the emergency laparotomy due to intra-abdominal bleeding is presented. For nine days the excessive laceration remained asymptomatic, probably because of visceral adhesions. Both tears of the duodenum were eventually repaired, but symptoms and signs of high mechanical obstruction had developed afterwards, requiring repeated surgery (gastric decompression). Endoscopy performed 2 weeks after duodenal repair showed both, repair site and gastro-jejunal anastomosis permeable. All symptoms quickly with-drawn and the patient recovered. Possible causes of the atypical clinical course in this case were discussed.
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Urazy ręki u pacjentów z obrażeniami wielonarządowymi

52%
Żyluk A., Fliciński F., Pakulski C.
Polish Journal of Surgery
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2021
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vol. 93
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issue 4
21-27
PL
Urazy ręki i przedramienia są stosunkowo rzadkie u pacjentów z obrażeniami wielonarządowymi; ich częstotliwość jest szacowana na ok. 2–5%. Zwykle nie stanowią zagrożenia życia i dlatego są traktowane jako drugorzędne, ustępując miejsca poważniejszym obrażeniom innych okolic ciała. Jednak powinny one być leczone niezwłocznie po ustabilizowaniu stanu pacjentów, ponieważ zbyt późne ich zaopatrzenie może skutkować poważną dysfunkcją ręki. Celem pracy była analiza częstotliwości występowania, spektrum i metod leczenia urazów przedramienia i ręki wśród pacjentów Centrum Leczenia Urazów Wielonarządowych (CLUW) SPSK 1 w Szczecinie przez 4 lata. Materiał badawczy stanowiły dane medyczne 17 chorych, 11 mężczyzn (65%) i 6 kobiet (35%), w wieku śr. 34 lat (zakres 19–62) leczonych w CLUW, którzy dodatkowo mieli uraz ręki i/lub przedramienia. Najczęstszą składową urazu wielonarządowego, któremu towarzyszył uraz ręki, były: złamania dużych kości (kręgosłup, miednica i kończyny) – 12 przypadków (70%), urazy klatki piersiowej – 11 (65%), twarzoczaszki – 9 (53%), czaszkowo-mózgowe – 8 (47%) i brzucha – 4 (29%). Najczęstszym urazem kończyny górnej było złamanie dalszego końca kości promieniowej – 9 chorych (53%). Dwie chore doznały rozległego zmiażdżenia z oskalpowaniem kończyny górnej, który to uraz był głównym powodem przyjęcia do CLUW. Dziewięciu chorych wymagało leczenia operacyjnego, najczęściej zespolenia kości promieniowej płytką. Wszyscy pacjenci przeżyli. W pracy podkreślono zasadność prawidłowego zaopatrzenia urazów ręki niezwłocznie po ustabilizowaniu stanu chorego z obrażeniem wielonarządowym.
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Three-Year Activity Report of the Replantation Service for Amputation of the Hand in Poland

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Żyluk A., Jabłecki J., Romanowski L., Mazur A.
Polish Journal of Surgery
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2012
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vol. 84
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issue 11
574-581
EN
A permanent on-call service for hand amputation (Replantation Service) was established in 2010 as the initiative of the Council of Polish Society for Surgery of the Hand. It is run by three qualified hand centres in Trzebnica, Poznań and Szczecin. The aim of the study was to present a summary of the almost three-year activity of this service. Material and methods. Over this period, a total of 435 cases of total amputations, subtotal amputations and other severe injuries to the hand were referred. Of these, 290 referrals (67%) were accepted and 141 (33%) rejected. Among accepted, there were 100 total (34%) and 113 subtotal (39%) amputations; 81 patients had other, severe hand injuries, such as crush, degloving and extensive wounds involving all tissues. Results. Young and middle-age males constituted the majority of patients with the mean age of 42 years (range 2-82). The most common injury was amputation of several digits (including thumbs) in one patient - 141 cases (48%), followed by amputations from the metacarpal- to the proximal forearm level -115 (39%) and elbow/arm level - 9 cases (3%). Niniteen patients (6%) had multi-level amputation or injury of the involved extremity. Replantation of the completely amputated extremity was performed in 83 patients (28%), revascularization in 95 (32%) and in 59 (20%) primary repair of the complex injuries. In 23 cases, the repair of tissue defects was performed with flaps, mostly with greater omentum. Survival rate was of 84% for replantations and 88% for revascularizations. Conclusion. Establishing of the Replantation Service constituted a significant progress in organization of the management of the most severest upper limb injuries.
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