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Treatment of Vascular Prosthesis Infections - 15 Years of Experience

100%
Kielar M., Lewczuk A., Tur W.
Polish Journal of Surgery
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2010
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vol. 82
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issue 3
130-139
EN
The aim of the study was to present the results of treatment for vascular prosthesis infections.Material and methods. From January 1993 until January 2008, 47 patients were treated at Department of General and Vascular Surgery Bródnowski Hospital due to symptomatic, late vascular graft infections. The most common local symptoms were groin abscesses, often with bleeding complications. All patients with diagnosed vascular prosthesis infections were treated operatively.Results. Fifty-three operations were performed, resulting in the regression of infection symptoms in 17 cases (63%), with 37% of cases leading to amputation. Mortality in the patients examined amounted to 37%; 46.4% of cases displayed recurrent infection. The period of hospital treatment oscillated between 12 to 221 days (av. 74 days).Conclusions. 1. Aggressive operative treatment of vascular prosthesis infections is burdened by high percentages of recurrence and amputation. 2. Less radical operative treatment techniques yield similar results. 3. A uniform protocol for diagnosed vascular prosthesis infection is currently lacking.
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Nasal Carriage of MRSA Strains Among Hospital Employees in a Surgical Department

88%
Tur W., Kielar M., Kłaczkowska A., Teodorowicz E., Lewczuk A.
Polish Journal of Surgery
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2010
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vol. 82
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issue 3
166-169
EN
The aim of the study was to estimate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strain carriage among hospital employees who have contact with patients treated at the General and Vascular Surgery Teaching Hospital of the Capital Bródnowski Hospital. Comparison of the findings with results from similar studies performed in various medical centers around the world.Material and methods. Using microbial cultures, we screened for nasal carriage of MRSA strains in hospital employees who have contact with patients at the General and Vascular Surgery Teaching Hospital. The medical and custodial staff of the Faculty of General and Vascular Surgery, Anesthesiology and Operating Suite were studied. If MRSA strains were present on bacterial cultures, identification of the strain was further confirmed using molecular methods, including reverse transcription polymerase chain reaction (RT-PCR). Examinations were performed in collaboration with the Department of Epidemiology and Clinical Microbiology of the National Medicines Institute.Results. The carriage rate confirmed by molecular techniques was 4.5%. Confirmed cases of MRSA carriage in hospital staff underwent eradication with a five-day treatment scheme of intranasal 2% mupirocin ointment. Control results confirmed its effectiveness.Conclusions. The prevalence of nasal carriage of MRSA among the medical and custodial staff screened was 4.5%. This prevalence of carriage among medical employees is similar to the rate of carriage in the general population. This finding suggests a low rate of bacterial transmission between the faculty, staff, and patients. Eradication of MRSA with the use of a five-day course of 2% intranasal mupirocin ointment is an effective method of controlling carriage among medical staff as well as among the general public.
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Evaluation of Telangiectasia Treatment Results Using an Electro-Optical Synergy Method

88%
Kielar M., Noszczyk M., Waligóra J., Lewczuk A., Tur W.
Polish Journal of Surgery
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2010
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vol. 82
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issue 3
170-175
EN
ELOS technology uses a simultaneous activity of a semi-conductor laser light and bipolar current of high radiofrequency (RF). The laser energy is absorbed by hemoglobin in the dilated vessels through a selective photothermolysis. Energy of the radiofrequency current, conducted through the skin, heats the vessel up until it reaches the temperature which destroys it. This technology is the basis of safe and effective ablation of small vascular lesions up to 4 mm in diameter.The aim of the study was evaluation of treatment results with application of a combined percutaneous technique using synergistic RF frequency activity and a diode laser.Material and methods. One -hundred and fifty women ages 23 to 68 years (mean=41.1) qualified for the treatment. None of the patients had a history of deep venous insufficiency. Electro-optical synergy (ELOS) technology was used as a treatment approach. The time for the procedure ranged from 10 to 30 minutes (average=18 min.). Treatment results were evaluated after 30 days using both a four-point medical evaluation scale and a four-point subjective assessment-of-satisfaction scale. The degree of pain accompanying the procedure was also determined.Results. In a medical evaluation, after all procedures were complete, 102 very good results were obtained (68%) and we did not succeed in 48 cases (32%). In a subjective evaluation, 120 (80%) very good or good and 25 (16.6%) unsatisfactory assessments were obtained. The results of the treatment were assessed as satisfactory by 5 patients (3.4%).Conclusions. 1. The ELOS technique is an efficient and safe method of telangiectasia treatment. 2, The ELOS technique gives a high percentage of good and very good treatment results, both in medical evaluations and patients' subjective assessments.
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Preliminary Results of the use of Self-Expanding Nitinol Stents in Inoperable Gastrointestinal Cancers

76%
Miłek T., Ciostek P., Woźniak W., Lewczuk A., Petryka R., Słowik J., Jarosz M.
Polish Journal of Surgery
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2010
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vol. 82
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issue 5
283-288
EN
The aim of the study was to present preliminary results of the palliative treatment of strictures and obstruction of the gastrointestinal tract in stage IV cancers with the use of self-expanding stents.Material and methods. Within a one-year period, from October 2007 to September 2009, stent implantation in the gastrointestinal tract was performed in 32 patients. Eligibility for palliative treatment was determined on the basis of a clinical examination and diagnostic tests to assess cancer stage. Each patient was assessed on the Karnofsky performance scale. The condition for eligibility, except for emergent circumstances, was performance status below 70. Endoscopy to collect biopsy samples for histopathologic examination and abdomen and chest CT scans were performed. Local advancement of cancer with infiltration of other tissues, such as metastases to the liver, distant lymph nodes or other organs, determined the choice of palliative treatment. Moreover, the presence and severity of coexisting disorders were also thoroughly examined. The procedures were performed using a c-arm X-ray system and endoscope. Following the introduction of the endoscope to the area of cancerous narrowing, a guide tube was inserted through the stricture under fluoroscopic control. Under combined endoscopic and radiological control, after contrast administration above the narrowing, a stent to expand the stricture was placed and released. The result of stent placement was documented by radiologic photographs, and a subsequent X-ray check was performed 48 hours after stent implantation.Results. A total of 33 stents were implanted in 32 patients. Problems with stent placement occurred in one patient. During implantation into a stricture secondary to sigmoid colon cancer, the stent slipped down and incompletely filled the tumor lumen. In this case, a short supplementary stent was added, which yielded a satisfactory result of the procedure. In another case, the stent migrated and adhered to the gastric wall, which further impaired passage through the patient's gastrointestinal tract. A feeding jejunostomy was performed in this patient, which was considered the best course due to the patient's extremely poor general condition.Conclusions. 1. Stent implantation in the gastrointestinal tract lumen in the setting of inoperable carcinomas under endoscopic and X-ray control is effective and safe. 2. In the case of gastrointestinal tract sub-obstruction in patients with left colon cancers and in poor general condition, this procedure should be considered prior to pursuing surgical operations.
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Low Invasive Treatment of Breast Abscess in Lactating Women

76%
Kielar M., Raczek-Pakuła K., Waligóra J., Lewczuk A., Woźniak W., Taranta I.
Polish Journal of Surgery
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2009
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vol. 81
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issue 5
225-229
EN
The aim of the study was to present our own results of low-invasive treatment of breast abscess in lactating women.Material and methods. 72 lactating women with severe mastitis were treated. In 22 cases abscess formations were observed, accompanied by local pain, tenderness, breast asymmetry and skin reddening. Ultrasonographic examinations confirmed the presence of typical image of an abscess, from 3.3 to 8.2 cm in diameter.The proposed procedure consisted in abscess aspiration biopsy guided by ultrasonography. A soft 1.5mm latex catheter was inserted into the abscess, and antiseptic lavage was made to evacuate puss. Medical control was performed on the second, fourth and seventh days after the procedure. The drain was usually removed after four or seven days.Results. In 21 cases the abscesses were healed without complications. During the treatment women fed their babies with the breast under treatment. No milk retention was noted, and there were no problems with breast-feeding.All the women highly appreciated aesthetic effect of the treatment - three months later no visible scars or breast deformations were noted.This treatment failed in one case, then we had to perform more aggressive surgical treatment: an incision and drainage performed under general anesthesia with farmacological suppression of lactation.Conclusions. 1. Low invasive treatment of breast abscess in lactating women can lead to successful treatment without drug-induced blockade of lactation. 2. The results of treatment and visual effects are very good. 3. This method are comfortable for the patients, the suckling babies (there no significant problems during twelve days cure), and can reduce the cost of treatment
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