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Left-hemihepatectomy as a method of treatment of locally limited Caroli disease

100%
Badura J., Król R., Kurek A., Hartleb M., Cierpka L.
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vol. 85
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issue 11
663-665
EN
The study introduces a case of a 51-year old patient with Caroli’s disease of left liver lobe. In 2011 the patient was admitted to Clinic of General, Vascular and Transplantation Surgery. She was after first in her life incident of an acute pancreatitis and subsequent ERCP procedure with left hepatic biliary tract drainage. The lady was qualified to left-hemihepatoctomy, which was successfully conducted in our clinic. The only complication of the procedure was surgical site infection which was properly treated with typical antibiotics. One-year observation occurred no other complications and liver function was fine.
2
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Decrease of Arterial Hypertension After Adrenalectomy in Patients Without Confirmation of Adrenal Tumour Hyperfunction

86%
Ziaja J., Chudek J., Król R., Cierniak T., Adamczak M., Więcek A., Cierpka L.
Polish Journal of Surgery
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2007
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vol. 79
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issue 4
273-279
EN
Adrenal tumours incidentally found in patients with arterial hypertension pose a severe clinical problem when no endocrine hyperactivity is confirmed and their features in diagnostic imaging do not suggest malignancy.The aim of the study was to evaluate the clinical consequences of unilateral adrenalectomy in a long term follow up period for patients that have adrenal tumours without confirmed endocrine hyperactivity.Material and methods. We evaluated the clinical consequences of unilateral adrenalectomy in a long term follow up of 48 hypertensive patients with a unilateral adrenal tumour lacking biochemical confirmation of adrenal hyperactivity. The mean duration of hypertension was 87 months; observation time ranged from 6 to 62 months.Results. Normalisation of blood pressure was observed in 8.3% of patients. In addition, better blood pressure control was documented in 35.4% of patients. There were no significant differences between group of patients with normalization or improvement of blood pressure control and those with no improvement with respect to age, BMI, duration of hypertension, tumour size, renin activity, aldosterone to plasma renin activity ratio, or the preoperative plasma concentration of potassium, aldosterone, or cortisol. The maximum values of systolic, but not diastolic, blood pressure before surgery were lower in patients with normalization or improvement of blood pressure control.Conclusions. Improvement of blood pressure control after unilateral adrenalectomy in 43.7% of patients may suggest tumour endocrine hyperactivity which remains unconfirmed by laboratory tests. It is not possible to predict improvement of blood pressure control after adrenalectomy in this group of patients according to tumour size and routine biochemical examination.
3
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Expression of Genes Encoding Aldosterone Synthesis Pathway Enzymatic Proteins in Adrenocortical Adenomas in Patients With Conn Syndrome

73%
Ziaja J., Cholewa K., Chudek J., Król R., Kajor M., Więcek A., Mazurek U., Cierpka L.
Polish Journal of Surgery
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2010
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vol. 82
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issue 1
47-52
EN
One of the possibilities of explanation of persistent hypertension after adrenocortical adenoma excision in patients with Conn syndrome could be analysis of transcriptional activity of genes encoding aldosterone synthesis pathway enzymatic proteins within these tumours.The aim of the study was to analyze the expression of mentioned genes in adrenocortical adenomas in patients with primary hiperaldosteronism and to analyse correlations between their expression and results of hormonal tests of blood serum before surgery as well as maximal values of blood pressure before surgery and their decrease after operation.Material and methods. Thirteen patients with Conn syndrome subjected to surgical excision of adrenocortical tumour were analyzed. Expression of CYP 11A1, CYP 21A2, CYP 11B2 and HSD 3B2 genes in tissue of removed tumours was analyzed using RT real-time PCR method. GAPDH was used as reference gene. The results analysis was based on amplification threshold values CT. Analysis of clinical consequences of adrenalectomy was performed after a period of minimum 12 months after surgery.Results. Expression of mRNA, presented as 2-ΔΔCT, of CYP 11A1 gene was 1.58 (1.01-2.48), CYP 21A2-2.74 (1.78-4.24), CYP 11B2- 19.15 (11.28-32.50) and HSD 3B2-2.57 (1.47-4.50). Correlation analysis revealed only negative correlation between CYP 11A1 gene expression and plasma renin activity in upright position (r=-0.604; p=0.049) and positive correlation between HSD 3B2 gene expression and decrease of maximal values of systolic blood pressure in long term follow up (r=0.763; p=0.010).Conclusions. High expression of genes encoding aldosterone synthesis pathway enzymatic proteins is observed in adrenocortical adenomas in patients with Conn syndrome. The transcriptional activity of the genes does not correlate with results of preoperative hormonal tests and is not a prognostic factor of persistent hypertension after adrenal tumour excision.
4
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Introduction of Liver Transplant Programme in Upper Silesia

52%
Król R., Jaworska K., Karkoszka H., Chudek J., Ziaja J., Badura J., Pawlicki J., Oczkowicz G., Caban A., Marcinkowski W., Sekta S., Wilk J., Gabriel A., Gonciarz Z., Kunsdorf-Wnuk A., Kokot F., Więcek A., Cierpka L.
Polish Journal of Surgery
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2007
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vol. 79
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issue 10
656-662
EN
Liver transplantation is the only method of treatment of patients with end stage liver insufficiency. Inadequate number of transplantations in Poland in relation to demands causes a need of new liver transplantation centres formation.The aim of the study was to present process of introduction of liver transplantation programme and results of the first 12 transplantations.Material and methods. Preparations to transplantation were based on training of surgical, anaesthetics and nephrological teams in transplant centres in Paris, Birmingham and Warsaw. Own protocols of organ harvesting, recipients' qualification, transplantation and postoperative treatment were worked out; they were a result of experience acquired in teaching centres. From October 16, 2005 to October 2006, 12 liver transplantations were performed in patients with end stage liver insufficiency of different origin. Patients' age varied from 21 to 67 years. The stage of liver failure according to Child-Pough was 8.6±2.8, and MELD 18.6±7.2. All elective operations were performed using Piggyback technique. Immunosuppression regimen was uniform and consisted of tacrolimus and prednisolone.Results. One patient died due to post reperfusion syndrome with no respond to catecholamine treatment. In 1 patient developed primary lack of the liver graft function that required re-transplantation, which was successfully performed on 2nd postoperative day. Among 10 patients who were discharged from the hospital on mean 31 postoperative day all are alive, and 7 of them returned to full live activity.Conclusion. Training in famous liver transplant centres and own experience in kidney and pancreas transplantation allowed for successful introduction of liver transplantation programme.
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