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1
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The Limberg Flap Procedure in the Treatment of Pilonidal Cyst Disease of the Sacrum – Initial Report

100%
Spychała A., Murawa D.
Polish Journal of Surgery
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2015
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vol. 86
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issue 6
257-262
EN
Pilonidal cyst disease mainly concerns young people, aged between 16 and 25 years. The disease causes significant pain, considerable discomfort and impairs daily functioning, often resulting in an inability to work and study. Many techniques have been introduced in the treatment of pilonidal cysts, but till today no gold standard has been established. The aim of the study was to present initial results considering the treatment of pilonidal cyst disease with the use of a skin flap by means of Limberg’s method. Material and methods. During the period between January, 2012 and March, 2013, 10 patients were operated due to pilonidal cysts using the Limberg flap procedure. All patients presented with the chronic form of the disease and were after previous surgical incisions. Pain considering patients was evaluated using the visual pain scale (VAS), one and 10 days after the operation. Patients reported for control 10 days, one month, and 6 months after the surgical procedure. Results. The planned procedure was safely performed in all cases. There were no complications during the procedure, nor late postoperative complications. We observed no wound infection or dehiscence in all operated patients. The mean follow-up time of the presented group was 13.32 months (ranging between 7.53‑21.57). During the follow-up period there was no episode of recurrence. Conclusions. The use of the skin flap by means of Limberg’s method after excision of the pilonidal cyst in the sacrum area is a good method, which provides a very low percentage of recurrences and complications. Fast return to daily activities, no significant pain in patients, and an acceptable cosmetic result are strong reasons in favor of the above-mentioned method. Preliminary observations and experience enable to recommend this method for the treatment of pilonidal cysts in the vicinity of the sacrum
2
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Melanoma of Unknown Primary as a Cause of Intestinal Obstruction - a Case Description

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Murawa D., Spychała A.
Polish Journal of Surgery
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2012
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vol. 84
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issue 8
415-419
EN
Melanoma of unknown primary applies to 1-8% of all diagnosed melanomas, whereas primary melanoma of the small intestine is a extremely rare case. One of the melanoma characteristics is its capability of forming metastases in the small intestine which very often are diagnosed during autopsy.We present a case report of diagnosed melanoma of unknown primary, whose first symptom was intestinal obstruction. Before admission to the hospital cause of intestinal obstruction, the patient didn't present any signs and symptoms. All typical localizations of primary melanoma were excluded during diagnostic procedure. Palliative right hemicolectomy and segmental small intestine resection were performed. There were no complications in the postoperative course. On the ninth day the patient was discharged from hospital.Quick identification and radical resection of melanoma metastases in the alimentary tract may improve the survival rate in this group of patients. Resection, even if it is palliative by assumption, is not only the best method of elimination of persistent symptoms but it also gives hope for longer survival.
3
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Giant Post-Inflammatory Pancreatic Cyst Associated with Giant Abdominal Hernia - a Case Report

81%
Murawa D., Nowaczyk P., Adamczyk B.
Polish Journal of Surgery
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2008
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vol. 80
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issue 7
389-394
EN
The case of a patient who developed a giant post-inflammatory pancreatic cyst, which resulted in the development of a giant abdominal hernia, is presented. The cyst developed as a consequence of earlier shortcomings in the diagnostic and therapeutic process; cyst development was also due to the patient's irresponsible approach to the problem. The patient did not present any typical symptoms of pancreatic pseudocyst. He reported to the Surgical Outpatient Clinic in the Wielkopolska Cancer Centre because of a reduced quality of life caused by a giant abdominal hernia. Basic laboratory tests and an abdominal CT were conducted, and a decision was reached regarding laparotomy. The pseudocyst was anastomosed with the intestinal wall on Roux-en-Y loop. A prolene net was applied simultaneously, due to the extensive defects in the abdominal integuments. In this case, treatment should have been implemented at a much earlier stage, without exposing the patient to the consequences of basic disease and the presence of a foreign body (net) in the abdominal integuments.
4
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Marjolin's Ulcers as a Consequence of Chronic Venous Ulcers and Chronic Skin Injury - Case Reports

81%
Ciesielczyk B., Murawa D., Nowaczyk P.
Polish Journal of Surgery
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2007
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vol. 79
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issue 10
667-671
EN
In the literature, Marjolin's ulcers are defined as skin cancers that develop secondarily in areas susceptible to an injury, seized by a chronic inflammation or covered by scar tissue.This paper presents three clinical cases of spinocellular carcinoma, which occurred around long-standing venous ulcers or chronic traumatic skin injury within the lower limbs. All the patients had their limbs amputated. No clinical or radiological qualities of lymphadenopathy were diagnosed. The latest checkups indicated the patients' good condition without traits of the neoplastic disease.Managing patients with chronic ulcers, regardless of their aetiology, requires that the doctor should have increased oncological alertness. In this case, one of the most important elements of diagnostics is a regular histopathological assessment of the lesion. Only this procedure enables the early and efficacious surgical treatment of potential secondary neoplastic lesions and possible saving of the limb.
5
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Brain metastasis as the first symptom of gastric cancer – case report and literature review

81%
Murawa D., Nowaczyk P., Szymkowiak M., Karaszewska B.
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vol. 85
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issue 7
401-406
EN
The study presented a patient with asymptomatic gastric cancer, in whom the first symptom was metastasis to the brain. The patient was initially diagnosed by a neurologist and subject to surgical intervention in the area of residence, where he underwent craniotomy with the excision of the metastatic lesions located in the occipital lobe. The histopathological examination revealed the presence of adenocarcinoma metastases. Following complex diagnostics the patient was diagnosed with cardial carcinoma, being subject to cerebral radiotherapy and chemotherapy. The patient was then referred to surgery at the Wielkopolska Cancer Center in Poznań. After final exclusion of disease dissemination (by means of PET-CT) the patient underwent total gastrectomy with D2 lymphadenectomy, and gastrointestinal tract reconstruction by means of the Roux-en-Y method. The histopathological examination result was as follows: tubular-papillary G2 adenocarcinoma (intestinal type), pT2 pN0 (23 evaluated lymph nodes without cancer metastasis), vascular neoplastic emboli, and positive HER2 protein expression. After surgery the patient was subject to adjuvant chemotherapy. Control brain CT examinations revealed the presence of 4 recurrent metastatic lesions-the patient was disqualified from stereotactic radiation therapy and was subject to palliative chemotherapy. The discussion presented the problem of treating patients with stage IV gastric cancer, including current management guidelines, as well as literature review concerning the treatment of patients with diagnosed gastric cancer and brain metastases.
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Myositis Ossificans of the Quadriceps Femoris Mimicking Sarcoma as a Diagnostic and Therapeutic Problem – Case Report and Literature Review

81%
Nowaczyk P., Murawa D., Żmudzińska M., Wasiewicz J.
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vol. 85
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issue 9
520-526
EN
Myositis ossificans (MO) may be included in the group of lesions described as pseudosarcomas. Its clinical and histological picture frequently mimics a malignant neoplasm and therefore, ultimate diagnosis and implementation of adequate treatment requires the cooperation of interdisciplinary team of physicians. The paper presents the case of 20-year old female patient suffering from severe pain in the right thigh. The patient was initially diagnosed with the lower limb overload. Rest and administration of non-steroidal anti-inflammatory drugs (NSAID) were recommended. Due to the lack of the efficacy of the recommended conservative treatment and detection of tumorous mass on ultrasound examination, the patient was referred to the cancer centre. The diagnostic procedures were extended and an open biopsy of the lesion was performed which revealed the presence of MO. The patient underwent a surgical procedure during which the pathological mass was entirely removed. Follow up examinations conducted upon the conclusion of the rehabilitation indicate no pathologies in the operated area.
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A Second Relapse of a Solid Pseudopapillary Tumor of the Pancreas: Case Description

81%
Murawa D., Zasadowski Z., Kruszyna Ł.
Polish Journal of Surgery
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2008
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vol. 80
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issue 1
46-50
EN
Solid pseudopapillary tumor (SPT) is a rare pancreatic neoplasm of unspecified origin that occurs most frequently in young women. In most patients, it has a benign character.In study presented a description of the case of a 36-year-old patient operated due to SPT in 2004. The patient had an atypical clinical course of the disease with a double relapse of the neoplastic process, which was operated on in 2006 and 2007.The symptoms and clinical course of SPT are characterized by very high interpersonal variation. Therefore, it is necessary to deepen the knowledge of the histogenesis and biology of the tumor. Additionally, the patients who receive surgery due to the tumor must be observed for many years.
8
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Splenic Site Abscess as a Symptom of Colorectal Carcinoma - Case Report

81%
Murawa D., Nowaczyk P., Murawa P.
Polish Journal of Surgery
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2007
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vol. 79
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issue 12
779-784
EN
Splenic abscess occurs only rarely. However, in recent years its frequency has been growing, which is related not only to the improvement in diagnostics but also to the increasingly common problem of immunosuppression caused by multiple factors and the occurrence of diabetes in the population. This paper presents a case of splenic flexure carcinoma, which was manifested clinically by a splenic site abscess and earlier probably by splenic abscess. Its aetiology was not specified after splenectomy had been carried out at the local hospital; only symptomatic treatment was applied. Due to the low occurrence of splenic abscess and non-specific clinical symptoms, doctors must show a great deal of prudence and alertness to make the right diagnosis. Furthermore, knowing that the presence of such lesions in the spleen is a consequence of other local or distant pathogenic processes, appropriate management and treatment of such patients requires investigating the cause and specifying the aetiology of the abscess. Failure to do so exposes the patient to the danger of serious consequences, frequently making early and successful treatment of many diseases, including neoplasms in the abdominal cavity, impossible.
9
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Sentinel Lymph Node Biopsy in Cutaneous Melanoma - Analysis of 227 Cases

71%
Spychała A., Murawa D., Połom K., Gracz A., Murawa P.
Polish Journal of Surgery
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2008
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vol. 80
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issue 5
241-247
EN
The aim of the study was to evaluate the experience of the centre in carrying out and assessing the use of sentinel node biopsy in skin melanoma.Material and methods. From 2000 to 2004, a sentinel node biopsy was carried out on 227 patients being treated for skin melanoma. In all the patients, the sentinel node was subjected to a standard histological evaluation with the application of H+E staining. If no melanoma cells were visualised within the sentinel node, the material was subjected to an immunohistochemical investigation. The patients whose sentinel node included metastases found in the H+E examination or micrometastases identified by means of the immunohistochemical investigation were subjected to a supplementary lymphadenectomy.Results. The sentinel node was identified in all the patients. In a group of 28 patients (12.3%), the presence of metastases within the sentinel node was visualised by means of H+E examination. A group of 199 patients (87.66%) with a metastases-negative sentinel node (H+E staining) was subjected to immunohistochemical evaluation, which revealed the presence of micrometastases in 45 patients (19.82%). Supplementary lymphadenectomy was carried out in patients who screened positive, and metastases were identified in other regional lymph nodes in 11 (4.8%) patients.Conclusions. 1. After finishing the learning curve, the sentinel node biopsy is a simple and effective method, enabling precise assessment of the lymphatic system in patients with skin melanoma. 2. The application of immunohistochemical investigation enabled the identification of micrometastases in 19.8% of the patients, where these were not found in the H+E examination. 3. The application of sentinel node biopsy allowed lymphadenectomy to be avoided in 154 (67.8%) patients.
10
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Zastosowanie sródoperacyjnej radioterapii u chorych na wczesnego raka piersi – ocena efektywnosci i toksycznosci leczenia

52%
Urbański B., Roszak A., Bratos K., Wareńczak-Florczak Ż., Włodarczyk H., Milecki P., Karczewska-Dzionk A., Murawa D., Wierzchosławska E.
Current Gynecologic Oncology
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2012
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vol. 10
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issue 4
286-295
EN
Introduction: Breast-conserving therapy (BCT) with adjuvant radiotherapy in the management of patients with breast cancer is an effective alternative for mastectomy. A standard adjunct to BCT is irradiation of the entire breast for 5-7 weeks. Aim of paper: Evaluation of treatment effectiveness, analysis of early and delayed radiation- induced reactions, cosmetic effect and quality of life. Material and methods: Analysis encompassed 150 patients undergoing BCT, intraoperative radiotherapy (IORT) and external beam radiotherapy (EBRT) followed up for at least one year. Follow-up examination 1 month, 6 months, 12 months and 24 months after completion of treat- ment included: physical examination, breast photography, analysis of early and delayed post-radiation reactions. Nuclear magnetic resonance mammography and sonography of the breasts was obtained after 6 months of observation. Results: No cases of local recurrence have been noticed. Acute radiation-induced reaction of the skin (grade 1 and 2) developed in 21.2% patients. No cases of grade 3 and 4 reactions have been noticed. Very good and good cosmetic effect was obtained in 81.5% of the patients. Breast pain has been reported by 20.6% of the patients, and skin hyperesthesia – by 17% of them. Breast edema was seen in 81.3% of the patients 1 month, in 63.4% 6 months, in 54.9% 12 months and in 56% 2 years after completion of radiotherapy. Altered skin pigmen- tation was noticed in 67.8% of the patients 1 month, in 44.1% 6 months, in 37.8% 1 year and in 31% 2 years after completion of radiotherapy. Conclusion: No cases of local recurrence or severe (high-grade) radiation-induced reactions were noticed during follow-up. Intraoperative radiotherapy reduced duration of treatment by one week, enabling inclusion the entire planning target volume (PTV) by a homogenous radiation dose and reduced the risk of geographic error.
PL
Wstęp: Oszczędzające leczenie chorych na raka piersi (breast-conserving therapy, BCT) z uzupełniającą radiotera- pią stworzyło skuteczną alternatywę dla mastektomii. Standardowym postępowaniem po BCT jest napromienianie całego gruczołu piersiowego przez 5-7 tygodni. Cel pracy: Ocena skuteczności leczenia, analiza wczesnych i póź- nych odczynów popromiennych, efektu kosmetycznego oraz jakości życia. Materiał i metody: Przeanalizowano 150 pacjentek po BCT, śródoperacyjnej radioterapii (intraoperative radiation therapy, IORT) oraz napromienianiu z pól zewnętrznych (external beam radiotherapy, EBRT) z minimalnym okresem obserwacji 1 roku. Obserwacja w 1., 6., 12., 24. miesiącu od zakończenia leczenia obejmowała: badanie kliniczne, zdjęcie gruczołów piersiowych, analizę odczynów wczesnych i późnych. Po 6 miesiącach wykonano MMR i USG gruczołów piersiowych. Wyniki: Nie stwierdzono wznowy miejscowej. Ostra reakcja popromienna (w stopniach 1. i 2.) w obrębie skóry wystąpiła u 21,2% chorych (brak odczynów w stopniach 3. i 4.), bardzo dobry i dobry efekt kosmetyczny leczenia odnoto- wano u 81,5% badanych. Ból w obrębie gruczołu piersiowego zgłaszało 20,6%, a zwiększoną wrażliwość skóry – 17% pacjentek. Obrzęk gruczołu piersiowego stwierdzono u 81,3% chorych po 1 miesiącu, 63,4% po 6 miesiącach, 54,9% po 12 miesiącach i u 56% po 2 latach od zakończenia radioterapii. Zmianę zabarwienia skóry odnotowano u 67,8% chorych po 1 miesiącu, 44,1% po 6 miesiącach, 37,8% po 12 miesiącach i u 31% po 2 latach od zakończe- nia teleradioterapii. Omówienie: W trakcie obserwacji chorych nie stwierdzono wznowy miejscowej oraz odczynów w stopniu ciężkim. Śródoperacyjna radioterapia skróciła czas leczenia o tydzień, umożliwiła objęcie jednorodną dawką PTV i zmniejszyła ryzyko błędu geograficznego.
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