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Laparoscopic Adrenalectomy - Assessing the Learning Curve

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Fiszer P., Toutounchi S., Pogorzelski R., Krajewska E., Cieśla W., Skórski M.
Polish Journal of Surgery
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2012
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vol. 84
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issue 6
293-297
EN
Laparoscopic adrenalectomy (LA) has become the "gold standard" for treatment of most of adrenal tumors in last few years. It has many benefits comparing to open surgery, but still is considered as complicated procedure requiring experienced surgical team.The aim of the study was to assess the learning curve of laparoscopic adrenalectomy and the outcome of the first consecutive 154 LA.Material and methods. 154 consecutive patients undergoing LA between 2007 and 2010 were reviewed. Collected data included: patients demographics, clinical and histological diagnosis, side and length of operation, conversions to open surgery, complications and hospitalization time. Learning curve was evaluated by dividing all patients into three groups (group I - first 50 patients, group II - second 50 patients and group III last 54 patients). Differences between the groups were analyzed.Results. There were 154 LAs performed. Indications for LA were hormonally inactive adrenal adenoma(n=57), Conn's syndrome (n=30), Cushing's syndrome (n=28), pheochromocytoma (n=27), adrenal cyst (n=8), and others (n=4). Mean tumor size was 45.28 mm. There were 79 left-sided and 75 right-sided procedures and the average time of hospitalization was 4.64 days. Mean operative time was statistically different between the groups (216.2 min. - 164.6 min. - 131.9 min.; p<0.01) as well as the number of conversions to open surgery (18% - 4% - 3.7%; p=0.013). There was not any significant difference in the number of complications between analyzed groups (2% - 2% -3.7%).Conclusion. To improve the outcome of LA it is necessary to perform approximately 40 to 50 procedures.
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The local spread of pheochromocytoma after adrenalectomy with a rupture of the tumor capsule at the time of the surgery

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Pogorzelski R., Toutounchi S., Fiszer P., Krajewska E., Łoń I., Zapała Ł., Skórski M.
Open Medicine
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2014
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vol. 10
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issue 1
EN
Introduction: We present a case of a 29-year-old patient treated due to fully symptomatic pheochromocytoma of the right adrenal gland. Case presentation: Patient was operated on and an open right-sided adrenalectomy was performed. At the time of the surgery, a rupture of the tumor capsule occurred. Five years post-operatively, a recurrence of the symptoms of chromaffin-cell tumor was noted. After the exact localization of the multiple recurrences, the patient was reoperated on. Conclusion: The case of pheochromocytoma is presented due to the possibility of chromaffin-cell seeding into the peritoneum, with no signs of distal metastases so far.
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Anastomotic aneurysms after arterial reconstructive operations – literature review

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Pogorzelski R., Fiszer P., Toutounchi S., Szostek M. M., Krajewska E., Jakuczun W., Tworus R., Skórski M.
Polish Journal of Surgery
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2015
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vol. 86
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issue 1
48-56
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Location and Incidence Rate of Anastomotic Aneurysms – own Clinical Material and Literature Review

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Pogorzelski R., Toutounchi S., Fiszer P., Krajewska E., Tworus R., Szostek M. M., Jakuczun W., Skórski M.
Polish Journal of Surgery
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2015
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vol. 86
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issue 4
181-188
EN
Anastomotic aneurysms occurs at various levels of arterial system. Determining their location and incidence rate required investigation of large patient clinical material. Material and methods. In the years 1989-2010 in local centre 230 anastomotic aneurysms were operated in 180 patients. Results. For 187 (81.3%) patients anastomotic aneurysms were localised in the groin, while for remaining 43 (18.7%) they occurred in other localisations. In aortic arch branch they occurred four times (1.7), in descending aorta - three times (1.3%), in abdominal aorta - 14 (6.1%) and in iliac arteries - 6 (2.6%). While for anastomosis with popliteal artery they were diagnosed in 16 (7%) patients. Own clinical material was compared with literature data. Conclusions. Anastomotic aneurysms in over 80% of cases occur in the groin, remaining percentage corresponds to other localisations.
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Surgical Treatment for Thoracic Injuries - One Clinic's Experience

84%
Pogorzelski R., Szostek M., Wołoszko T., Jakuczun W., Toutounchi S., Macioch W., Szostek M., Skórski M.
Polish Journal of Surgery
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2007
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vol. 79
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issue 10
643-648
EN
The aim of the study was to present one clinic's experience in the treatment of thoracic injuries. Particular attention was paid to the methods for treatment of patients after thoracic injuries.Material and methods. During the years 1996-2006, 273 patients with thoracic injuries were hospitalized in the clinic; 0.9% of all patients treated during this time. There were 66 women (24.2%) and 207 men (75.8%), aged 17 to 85 years (average: 34.9).Results. Among all of the thoracic injuries analyzed, the most common was traffic accidents, which made up 111 (40.7%) cases. Next, accidents of violence made up 87 (31.9%) cases, and accidental falls and falls from heights 62 (22.7%) cases. Rare were self-mutilations, crash traumas and gunshot traumas. Isolated injury was observed in 107 cases, and 166 (60.8%) patients had multifocal trauma and multi-organ injuries. 50 patients (18.3%) had acute, penetrating injuries, and 223 patients (81.7%) had blunt thoracic injuries. During hospitalization, other traumas were diagnosed: rib fractures in 107 cases (39.2%), pleurohematoma in 37 cases (13.6%), pneumothorax in 36 cases (13.2%), pneumohemothorax in 26 cases (9.5%), lung contusion in 43 cases (15.8%), posttraumatic aorta aneurysm in 31 cases (11.4%), and contusion of the heart or great vessels in 8 cases (2.9%).The applied treatment was: pleural cavity drainage in 86 cases (27.8%), immediate thoracotomy in 24 cases (8.8%), laparotomy in 23 cases (8.4%), stent-graft implantation in posttraumatic aneurysms in 30 cases (11%), and other specialized operations in 46 cases (16.9%). Qualified surgical treatment was performed in 176 cases (64.5%) out of 273. Multispecialized treatment was used in 46 cases (16.8%). 16 patients died (5.9%), most directly after admission to the hospital.Conclusions. 1. Over 30% of patients need no surgical treatment after thoracic trauma. 2. The most common coexisting injuries with thoracic trauma are cranio-cerebral injuries and bone fractures. 3. The main cause of death is oligovolemic shock due to heart and great vessels contusion.
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Anastomotic aneurysms- 20-years of experience from one center

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Pogorzelski R., Fiszer P., Toutounchi S., Krajewska E., Szostek M. M., Tworus R., Jakuczun W., Skórski M.
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vol. 85
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issue 4
181-191
EN
Anastomotic aneurysms may develop after any type of vascular surgery, in different areas of the arterial system, and require reoperation. The frequency of occurrence of the above-mentioned is estimated at 1-5%. Material and methods. During the period between 1989 and 2010, 180 patients with 230 anastomotic aneurysms were subject to surgical intervention at the Department of General and Thoracic Surgery, Warsaw Medical University. The study group comprised 21 (11.7%) female and 159 (88.3%) male patients, aged between 30 and 87 years (mean age - 62.8 years). In relation to the number of anastomoses aneurysms were diagnosed in 2.1% of cases. Twenty-four (10.4%) patients were diagnosed with recurrent aneurysms. Results. Surgical procedures performed were as follows: artificial prosthesis implantation (119), reanastomosis (40), patch plasty (25), graftectomy (19), prosthesis replacement (9), and stent-graft (7) implantation. 195 (84.8%) aneurysms were subject to planned surgery, while 35 (15.2%) required emergency intervention. 77.8% of patients were diagnosed with aseptic aneurysms, while the remaining 22.2% with infected perioperative aneurysms. Good treatment results were obtained in 149 (82.8%) patients. Limb amputations were performed in 19 (10.5%) cases. Twelve (6.7%) patients died as a consequence of infection and general complications. Conclusions. Vascular reoperations are a difficult clinical problem and are burdened with a high rate of complications. The above-mentioned often require complex treatment, in order to improve therapeutic results.
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One-Centre Study Investigating a need for an immediate vascular surgery in patients over 80 years of age - comparison analysis of the results

84%
Pogorzelski R., Wołoszko T., Małek A., Szostek M., Jakuczun W., Toutounchi S., Macioch W., Leszczyński J., Skórski M.
Polish Journal of Surgery
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2010
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vol. 82
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issue 5
267-271
EN
According to the observation made by the study authors, every year there is an increasing number of patients advanced in years who require surgical management of their vascular disease. They constitute more than 4% of all patients. The similar situation is our medical centre, where the number of the hospitalisations of octogenarians increases with every subsequent year. In spite of many concomitant diseases we propose them immediate operation. Then it seems to be important a comparison two ways of treatment: immediate and elective ones.The aim of the study was evaluation of the results obtained in the treatment of vascular diseases requiring an immediate surgical intervention.Material and methods. In the years 2005-2007, there were 150 patients treated for arterial diseases. The group consisted of 87 men (58%) and 63 women (42%), with a mean age of 83.6. All the patients were divided into two groups: patients undergoing an elective surgery (n = 113), and those operated on immediately (n = 37). For both these groups was performed the comparison analysis, concerning the most important concomitant disorders, having an unquestionable influence on the final results of the operative treatmentResults. The comparison analysis of deaths, amputations, and hospitalisation period in the elective and immediate surgeries revealed the following: 5.3% vs 21.6% (p = 0.006), 7.9% vs 13.5% (p = 0.33), and 15.8 vs 9.8, respectively.Conclusions. Immediate vascular surgery is especially needed by older women. Culture and customs are the reasons for treatment delay in Poland, with its direct effects on the treatment results.
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Results of General Surgical Treatment of Patients Over 80 Years of Age in Single-Site Experience

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Fiszer P., Pogorzelski R., Toutounchi S., Szostek M., Krajewska E., Jakuczun W., Tworus R., Skórski M.
Polish Journal of Surgery
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2012
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vol. 84
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issue 4
173-176
EN
The aim of the study was to evaluate the results of general surgical treatment of patients over 80 years of age.Material and methods. Three hundred and four patients aged 80 to 105 years with general surgical disorders, treated in 2005-2009, were retrospectively included in the study. The collected information included demographic data, coexisting diseases, the mode of admission, the diagnosis, the method and result of treatment, and also potential complications and 30-day mortality. The data were subjected to statistical analysis.Results. The study group included 186 women and 118 men. Two hundred patients (65.8%) were admitted in an emergency setting. The most common causes of immediate hospitalisation were: mechanical ileus (26.5%), gastrointestinal bleeding (22%), trauma (16%), and gall-bladder disorders (8.5%). The remaining 104 (34.2%) patients were operated upon on an elective basis. An emergency operation was required by 121 (60%) of the patients admitted in an emergency setting; the remaining ones were treated conservatively. Hernia plasties (27.5%), cholecystectomies (15.3%), colorectal resections (13.2%), strumectomies (11.2%) and endoscopies (6.1%) predominated among elective surgeries.The total number of complications and mortality were 19.4% and 14.5%, respectively. The number of complications and mortality were significantly higher in the group of patients admitted in an emergency setting (25.5% and 20.5%, respectively) than in patients admitted on an elective basis (8.7% and 2.9%, respectively), p<0.01.The mean duration of hospitalisation was 9.7 days (1 to 60 days), with a small difference between the groups of patients treated on an elective and emergency basis (8.5 and 10.4 days), p=0.181.Conclusions. The results of surgical treatment of elderly patients do not significantly differ from the results of treatment of the general population. Much worse results, coupled with a significant increase in mortality, are observed in patients admitted and treated on an emergency basis.
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Adrenal Tumors - Diagnostics and the Factual Situation

84%
Krajewska E., Toutounchi S., Fiszer P., Cieśla W., Pogorzelski R., Bednarczuk T., Cieszanowski A., Łoń I., Skórski M.
Polish Journal of Surgery
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2012
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vol. 84
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issue 4
208-213
EN
The study presented three cases of patients diagnosed with adrenal tumors subject to surgical intervention during the past 6 months in our Department. The patients presented with radiological diagnostic difficulties, as to the character and location of the primary tumor.The aim of the study was to demonstrate differences between radiological examination results and the factual situation observed during the adrenalectomy. In all the presented cases patients' were subject to laparoscopic intervention. In two cases conversion to open surgery was necessary. The histopathological results of the surgically removed samples were as follows: leiomyoma, myoperycytoma and pheochromocytoma. In selected cases imaging examinations might be of limited value, especially when determining the character and location of the primary lesion of the adrenal gland.
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Regressive changes in phaeochromocytomas and paroxysmal hypertension

68%
Pogorzelski R., Toutounchi S., Fiszer P., Krajewska E., Górnicka B., Zapała Ł., Szostek M., Jakuczun W., Tworus R., Wołoszko T., Skórski M.
Open Medicine
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2014
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vol. 9
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issue 5
663-666
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