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Lateral and median cysts of the neck

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Buła G., Waler J., Niemiec A., Mucha R., Gawrychowski J.
Polish Journal of Surgery
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2012
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vol. 84
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issue 9
445-448
EN
The aim of the study was to present clinical picture, indications for surgery, immediate and remote results of surgical treatment for lateral and median cysts of the neck. Material and methods. A total of 17247 patients were operated between 1 January 1990 and 31 December 2011 for neck tumors. Results. Neck cysts were diagnosed in 34 (0.2%) patients, including lateral in 12 (35.3%) and median in 22 (64.7%). Lateral cyst once descended to the mediastinal. Nodular goitres were diagnosed in 17 (50%) of them - with the lateral cysts 4x and median cysts 13x. Guided fine-needle aspiration biopsy of the cyst-like lesions revealed the presence of protein masses in all patients. The lesions were found to have inflammatory character in 6 patients (17.6%) regarding median cysts (5x) or lateral cyst (1x). Out of them, 3 patients developed purulent inflammatory process. All patients were operated. The operation consisted of radical resection of the cyst only or plus partial resection of both thyroid lobes and total resection of pyramidal lobe if concomitant goitre was found. Two patients required one-stage resection of the enlarged lymph nodes in the neck. Suspected focus of thyroid papillary cancer was found by intra-operative examination in neck median cyst wall in one patient. However, paraffin tests did not confirm the suspicion. Another patient was found by histopathological examination to have active tuberculotic process within both lateral cyst and lymph nodes. The patient received intensive antituberculotic treatment postoperatively. Conclusions. 1. Median cysts of the neck are more often accompanied by thyroid tumor-like goitres than lateral cysts. 2. Radical resection of the cysts in operative treatment results in good long term patient condition and prevent in recurrence of the illness.
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Postoperative Acute Respiratory Failure In Patients Treated Surgically For Goiters

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Buła G., Mucha R., Paliga M., Truchanowski W., Gawrychowski J.
Polish Journal of Surgery
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2015
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vol. 87
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issue 7
331-335
EN
The aim of the study was to present a clinical picture, treatment and prognosis regarding patients who developed acute respiratory failure (ARF) while treated surgically for a goiter. Material and methods. A total of 3810 patients were treated for goiters between 2008 to 2013. Symptoms of postoperative ARF were recognized in 39 (1%) patients. Results. Symptoms of postoperative ARF were a postoperative hemorrhage in 31 (79.4%), lymphorrhagia in 1 (2.6%), bilateral paralysis of recurrent laryngeal nerves in 6 (15.4%) and acute circulatory – respiratory failure in 1 (2.6%). Postoperative hemorrhage appeared in 19 patients operated for nodular goiter, 4 with a retrosternal nodular goiter, 1x nontoxic recurrent retrosternal nodular goiter, 1x toxic recurrent retrosternal goiter nodular goiter, 2x Graves'goiter and 4x with malignant goiter. The cause of hemorrhage was parenchymal bleeding from the stumps and / or short neck muscles (29x), arterial bleeding (1x) and bleeding into the subcutaneous tissue (1x). Massive lymphorrhagia appeared as a result of damage to the thoracic duct after total thyroidectomy due to papillary thyroid carcinoma with cervical lymph node dissection on the left side. All patients who were diagnosed with bilateral paralysis of RLN, tracheostomy was performed. Of all 39 patients who underwent surgery two died – one in 6 days after surgery due to myocardial infarction, and another as a result of micropulmonary embolism and acute circulatory – respiratory failure in 18 hours after surgery. Conclusions. 1. The most frequent causes of acute respiratory failure in postoperative period are a hemorrhage from the operation site and bilateral paralysis of recurrent laryngeal nerves. 2. Acute postoperative respiratory failure is an indication for postoperative wound revision
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DNA Ploidy in the Treatment of Stomach Adenocarcinoma: A Follow-Up Study

86%
Gawrychowski J., Tyczyński A., Danik A., Lackowska B., Koziołek H., Mucha R.
Polish Journal of Surgery
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2007
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vol. 79
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issue 12
753-761
EN
The aim of the study was to determine unfavourable prognostic factors for patients with stomach adenocarcinoma after their surgical treatment through evaluation of prognostic indicators for cellular ploidy and proliferative activity.Material and methods. A group of 51 patients following surgical treatment due to stomach adenocarcinoma and discharged from our hospital between 1995-2000 were studied here. The material examined was encased in paraffin blocks. After histopathological verification, the tumour segments within these blocks were used for cytofluorometric analysis of DNA-ploidy according to Hedley's method.Results. In 41 (80.4%) stomach cancer patients (out of the total group of 51 patients), diploid tumours were found. No significant relationship between DNA ploidy and sex, age, symptoms, inherited susceptibility to a disease, tumour magnitude, grade of histological malignancy, or grade of clinical progression was observed. Generally, after the stomach cancer operation, the probability of five-year survival was 22.1% for patients with diploid tumours (DI=1.0), and 20% for the patients with aneuploid tumours (DI ± 1.0). The probability of 10-year survival was 19.2% for diploid tumours, and 10% for aneuploid tumours. These differences were not statistically significant (p=0.255).Conclusions. 1. Classical clinicopathologic factors are still the best prognostic criteria for the evaluation of long-term results of surgical treatment for stomach cancer patients. 2. Determination of DNA-ploidy and proliferative activity of stomach cancer did not decrease the gap between long-term results prognosis for surgical treatment and actual results.
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Non-Recurrent Laryngeal Nerve

86%
Buła G., Mucha R., Paliga M., Koziołek H., Niedzielski Z., Gawrychowski J.
Polish Journal of Surgery
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2015
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vol. 87
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issue 7
336-339
EN
The aim of the study was to assess the frequency of non-recurrent laryngeal nerves (Non-RLN). Material and methods. A total of 6110 patients were operated in our hospital between 1 January 2005 and 31 December 2013 for various goiters (5429) and various types of hyperparathyroidism (618). Laryngeal nerve was exposed during operation in 1700 patients from superior aperture of the chest to superior aperture of the larynx. Identification process of RLN was started with dissecting inferior thyroid artery (ITA) and its junction with the nerve. Then main trunk of the nerve was exposed backwards till the region of superior aperture of the chest together with the end portion till the nerve outlet to the larynx. Results. In the group of 1700 patients, RLN was exposed bilaterally in 1400 (82.4%) and unilaterally in 300 (17.6%). In the group of 3100 dissected RLNs the course of RLN was observed on the right side in 1710 patients and on the left in 1390. Irreversible nature RLN was shown in four cases (0.1%) – four women (02%) aged 42-55 (mean 49.3) – three operated for non-toxic nodular goiter and one for primary hyperparathyroidism. Each time the Non-RLN was seen on the right side. The other patients manifested recurrent character RLN. Moreover, interstitial course of RLN was found on the left side in one man. Conclusion. Non recurrent laryngeal nerve is a rare anatomical variation, occurring more frequently on the right side. Surgeon during surgery of the thyroid and parathyroid glands should be aware of its existence to avoid damage.
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DNA Ploidy in the Treatment of Large Bowel Adenocarcinoma: A Follow up Study

86%
Gawrychowski J., Tyczyński A., Danik A., Lackowska B., Mucha R., Koziołek H.
Polish Journal of Surgery
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2008
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vol. 80
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issue 1
6-13
EN
The aim of the study was to look for unfavourable prognostic features in colorectal cancer patients after their surgical treatment as well as to evaluate the prognostic value of cellular ploidy and proliferative activity.Material and methods. A group of 71 colorectal cancer patients discharged from the hospital after surgical treatment in the years 1995-2000 was studied. The examined material was acquired from paraffin blocks of tumour segments. After histopathological verification, the tumour segments recovered from paraffin blocks were used for cytofluorometric analysis of cellular ploidy according to the Hedley method.Results. Diploid tumours were found in 45 of 71 (63.4%) colorectal cancer patients. No significant relationship between DNA ploidy and sex, age, complications, inherited susceptibility to a disease, tumour magnitude, grade of histological malignancy, or grade of clinical progression was observed. After colorectal cancer surgery, the probability of five- and ten-year survival was 44.4% and 37.1%, respectively, for the patients with diploid tumours (DI=1.0), and 38.5% and 9%, respectively, for the patients with aneuploid tumours (DI≠1.0). These differences were not statistically significant (p=0.120).Conclusions. 1. Classical clinicopathologic factors are still the best prognostic criteria for the evaluation of the future results of colorectal cancer patients' surgical treatment. 2. Determination of cellular ploidy and proliferative activity of colonic adenocarcinoma cannot increase the ability to predict prognosis based on surgical treatment.
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