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Synchronous occurrence of multiple focal nodular hyperplasia and huge hepatic Perivascular epithelioid cells tumor (PEComa) in young woman after oral contraceptive use – is there a common pathogenesis?

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Durczyński A., Hogendorf P., Szymański D., Sporny S., Strzelczyk J.
Polish Journal of Surgery
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2012
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vol. 84
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issue 9
457-460
EN
The association of focal nodular hyperplasia (FNH) and various neoplasms was described, but coincidence of multiple FNH and hepatic perivascular epithelioid cells tumor (PEComa) has not been reported. The clinical debate of oral contraceptive (OC) influence on FNH growth is ongoing, but no evidence exists about association of hepatic PEComa with OC use. Herein, we report a case of two FNH lesions and huge (150x100x80 mm) left hepatic lobe PEComa that occurred simultaneously in 18-year-old female with previous two year history of OC use, who underwent left hemihepatectomy and right hepatic FNH enucleation. Up to date, the patient has been followed-up for 65 months and remained disease-free. FNH and PEComa have a common vascular cytogenetic denominator. Our case raising a question of a causal relationship of FNH and PEComa with OC use that might be attributed to vascular changes. Future researches of larger sample sizes should further address this issue.
2
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Insulinoma - Rare, But Important Clinical Problem. Analysis of a Series of 530 Patients Who Underwent Surgical Treatment for the Pancreatic Tumor

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Durczyński A., Hogendorf P., Szymański D., Izdebski W., Kaczka A., Durko Ł., Strzelczyk J.
Polish Journal of Surgery
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2015
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vol. 86
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issue 11
505-510
EN
Insulinomas are rare tumors, accounting for 1-2% of all neoplasms of the pancreas. Usually their treatment is not associated with any problems; however there is a small subset of problematic clinical cases. The authors present their own clinical experience with surgical treatment of insulinomas of the pancreas. The aim of the study was to conduct a retrospective analysis of patients with insulinomas of the pancreas who underwent surgical treatment at Department of General and Transplant Surgery Medical University in Łódź. Material and methods. The study included all patients who underwent surgical treatment at the Department between 2007 and 2013 for the tumor of the pancreas. Further retrospective analysis included all patients with tumors of the insulinoma type. The data was obtained from medical records, surgical protocols and histopathology reports. Results. The analysis included 530 patients who underwent surgical treatment for the tumor of the pancreas. Insulinoma was found in 10 (1.88%) patients (8 females, 2 males). An average age of patients who underwent surgical treatment was 47.5±13.8 years. An average size of the tumor was 1.6±0.5 cm. Six patients underwent extirpation of the insulinoma, while the other patients underwent distal resection of the pancreas. All patients underwent “an open surgical procedure”. The average duration of the surgical procedure was 55±45 minutes. Duration of the hospitalization in the analyzed group of patients was 7±5 days. Incidence of postoperative pancreatic fistulas was 10%. All insulinomas were benign. Conclusions. Insulinomas were rare among patients who underwent surgical treatment at the Department. They were benign and their treatment was unproblematic. However, there is a small group of cases that can be associated with problematic clinical situations. Thus treatment of patients with insulinomas should be conducted at specialist centers. Correct diagnostic and therapeutic management, involving close cooperation between multiple medical specialists, results in complete curing of majority of patients.
3
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Very High Concentration of D-Dimers in Portal Blood in Patients with Pancreatic Cancer

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Durczyński A., Szymański D., Nowicki M., Hogendorf P., Poznańska G., Strzelczyk J.
Polish Journal of Surgery
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2012
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vol. 84
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issue 10
521-525
EN
Nowadays, increasing attention has been focused on relation between increased D-dimer levels and cancer among patients without detectable thrombosis. was to measure plasma D-dimer levels in portal and peripheral blood in pancreatic cancer patients with absence of venous thromboembolism. Material and methods. Fifteen consecutive patients hospitalized in the Department of General and Transplant Surgery of Medical University in Łódź, from January to March 2012 who underwent surgery due to a pancreatic cancer were enrolled. At laparotomy, portal and peripheral blood were sampled concurrently. D-dimer and fibrinogen levels were measured. Moreover, to investigate overall coagulation function prothrombin time (PT), prothrombin index (PI), international normalized ratio (INR), thrombin time (TT), activated partial thromboplastin time (APTT), TT and APTT index were evaluated. Results. Peripheral plasma D-dimmer levels above normal range were found in 10/15 patients (66,67%), whereas D-dimer above normal values were confirmed in all portal blood samples. Mean D-dimer values were higher in portal than in peripheral blood (3279.37 vs 824.64, by 297%, p=0,025). These discrepancies were accompanied by normal limits of portal and peripheral levels of fibrinogen and comparable coagulation function indexes. Conclusion. Our preliminary study showed the close relation between activation of hemostasis, reflected by elevated D-dimers in portal blood and presence of pancreatic cancer. These data suggest that measurement of portal blood D-dimer levels may be a potentially useful technique for screening the pancreatic cancer.
4
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Clinical Experience in Surgical Treatment of Gastrointestinal Neuroendocrine Tumors

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Durczyński A., Sporny S., Szymański D., Nowicki M., Hogendorf P., Strzelczyk J.
Polish Journal of Surgery
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2010
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vol. 82
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issue 4
212-218
EN
Gastroenteropancreatic neuroendocrine tumors (GEP NET) represent heterogenous group of very rare neoplasms. Nevertheless, these tumors have been increasingly diagnosed recently. Authors present own experience with surgical treatment of gastrointestinal neuroendocrine tumors.The aim of the study was to analyse retrospectively own material of patients with gastrointestinal neuroendocrine tumors treated surgically in the Department of General and Transplant Surgery of Medical University in Łódź.Material and methods. The analysis included all patients with neuroendocrine tumors surgically treated from January 2007 to June 2009 in the Department of General and Transplant Surgery of Medical University in Łódź. The clinical patients data were obtained from medical histories, operative protocols and outcomes of final histopathological examinations. Analyzed data were as follows: age, gender, type and localization of tumor, clinical signs, results of preoperative tests and type of surgical procedure.Results. Analysis revealed that 17 patients were operated on for gastrointestinal neuroendocrine tumors between years 2007-2009 in the Department of General and Transplant Surgery. Foregut tumors (5 gastric neuroendocrine tumors and 4 pancreatic insulinomas), midgut tumors (1 neuroendocrine cancer of ascending colon, 3 hepatic neuroendocrine cancers metastases, 2 primary hepatic neuroendocrine cancers, 1 gall bladder neuroendocrine cancer) and hindgut tumors (neuroendocrine cancer of rectum) were diagnosed in nine cases (53%), in seven cases (41%) and in one case (5%), respectively. Wide range of surgeries were performed in the Department, as follows: in 2 cases right hemihepatectomy, in 3 cases extended right hemihepatectomy, in 1 case left hemihepatectomy, in 4 cases pancreatic tumor enucleation, in 2 cases gastric resection, in 3 cases gastrectomy, in 1 case right hemicolectomy and in 1 case anterior resection of the rectum. The vast majority (11/17 patients; 64%) of tumors were poorly-differentiated neuroencorine carcinomas with high grade of histological malignancy. In one case coincidence of insulinoma and nesidioblastosis was confirmed. One patient suffered from signs of neuroglycopenia with loss of consciousness and convulsion preoperatively, incorrectly diagnosed as epilepsy.Conclusions. Treatment of patients with gastrointestinal tumors is complex process and most commonly require close cooperation of various proffesional clinicians. Since asymptomatic course of disease and late stage of tumor advancement at diagnosis, technically difficult operations are often essential. Thus, surgeon who perform operations of patients with neuroendocrine tumors should be well experienced in carring out extensive surgical procedures.
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