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Traumatic Rupture of Massively Enlarged Spleen in Patient with Malignant Lymphoma and Thrombocytopenia - A Case Report

100%
Żyluk A., Walaszek I.
Polish Journal of Surgery
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2009
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vol. 81
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issue 5
246-250
EN
Traumatic ruptures of enlarged spleen in the course of haematological conditions are very rare. A case of 51-years old male suffering from a low-grade malignancy non-Hodgin lymphoma, who sustained a rupture of his massively enlarged spleen as a result of blunt trauma of the left side of abdomen and chest is reported. The patient attended to the hospital three days after trauma because of abdominal pain and weakness. Investigations revealed parenchymal laceration of massively enlarged spleen, heamoperitoneum, moderate anaemia and thrombocytopenia 48 G/l. Laparotomy was performed the next day after admission, after preparing packed red blood cells and packed platelets. Massively enlarged, 2.6 kg weight, ruptured spleen was removed and post-operative course was uneventful. Authors consider a reasonable the decision on delayed operation, when no signs of active intra-abdominal bleeding were observed. It allowed to prepare optimal conditions for potentially difficult splenectomy.
2
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Results of Scaphoid Nonunion Treatment with Vascularised Bone Grafting from the Distal Radius

100%
Żyluk A., Walaszek I.
Polish Journal of Surgery
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2008
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vol. 80
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issue 1
26-34
EN
Misdiagnosis or failed treatment of scaphoid fractures are frequently (25-45%) followed by disrupted healing and nonunion. This may reduce the wrist's capacity for occupational and daily use and, over time, lead to wrist arthrosis. Therefore, surgery is recommended even in asymptomatic nonunions of the scaphoid; the goal of this treatment is to achieve bone union and stability of the wrist.The aim of the study was to evaluate the results of operative management of scaphoid nonunion by vascularized bone grafting from the distal radius.Material and methods. Eleven patients, nine men and two women of a mean age of 29 (range 19-45 years) with scaphoid nonunion lasting a mean of 10 months (range 8-20) were recruited. The nonunion was localized in the waist of the scaphoid in seven patients and in proximal 1/3 in four patients. Operations were performed using cancellous bone grafts taken from the distal radius and supplied by the intercompartmental branch of the radial artery. Fracture fixation was accomplished with K-wires or headless canullated screws. The follow-up assessment at a mean of 10 months included measurements of wrist range of motion, grip strength and Mayo wrist score.Results. All patients achieved bone union. The mean Mayo wrist score increased from 25 points preoperatively to 75 points at the final assessment, which suggested significant improvement of the hand functions. In a qualitative evaluation, two patients had an excellent result, four had a good result, four had a fair result and one had a poor result. Surgery resulted in significant pain relief and increase in hand strength, but failed to improve wrist range of motion. The modest clinical outcomes do not allow a definitive conclusion to be reached, but the fact that bone union was achieved in all patients with no complications justifies continued use of this technique for the management of scaphoid nonunion.
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Reconstruction of the Distal Radio-Ulnar Joint with a Prosthesis of the Distal Ulna in the Treatment of a Recurrent Giant Cell Tumour

81%
Kotrych D., Żyluk A., Walaszek I., Bohatryrewicz A.
Polish Journal of Surgery
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2011
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vol. 83
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issue 9
518-522
EN
We present a case of 35-year old left-handed woman with recurrent giant-cell tumour affecting 1/4 of the distal part of the left ulna, with associated ulnar nerve involvement. After resection of the tumour and 1 cm of the ulnar nerve, the distal ulna was reconstructed with an individually designed and matched prosthesis, followed by ulnar nerve reconstruction. At 12 months follow-up the patients was free of pain, had excellent recovery of ulnar nerve function, satisfactory wrist range of motion and moderately impaired function of the left hand (DASH score 42). She returned to her original work in the office. We believe that restoration of the anatomy of the distal forearm after en block resection of the distal ulna is desirable in young, active patients, and that the prosthesis we used provides a good anatomical framework for the recovery of the function of the wrist.
4
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A Comparison of the Efficacy of a Local Vs Brachial Plexus Block Anaesthesia in the Carpal Tunnel Release: The Results of a Prospective and Randomised Trial

81%
Żyluk A., Puchalski P., Walaszek I., Janowski P.
Polish Journal of Surgery
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2008
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vol. 80
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issue 11
615-620
EN
Carpal tunnel release can be performed in local anaesthesia, peripheral nerves blocks (either proximally or distally), intravenous regional (Bier block) and general anaesthesia. To our knowledge, in Poland operations of carpal tunnel syndrome are routinely performed under brachial plexus block anaesthesia.The aim of the study was to compare the effectiveness of local versus brachial plexus block anaesthesia for carpal tunnel decompression.Material and methods. One hundred and fifty-five patients diagnosed with carpal tunnel syndrome were randomly allocated to the local anaesthesia or brachial plexus block. Operations were done with two minimally invasive techniques: one and two small incisions. Questionnaires received from 135 patients, 115 women (85%) and 20 men (15%) in a mean age of 57 years (range 31-87) were analyzed. Sixty-six patients (49%) received local infiltration with 2% Lignocaine, and 69 (51%) received brachial plexus block with a mixture of 2% Lignocaine and 0.5% Bupivacaine. Pre- intra- and post-operative patients' complaints were assessed in visual analogue scale, as well as duration of anaesthesia, operation and surgeon subjective satisfaction were noted.Results. Except tourniquet pain, there were no significant differences between the groups in the pain scores associated with disease or operation. Although tourniquet pain was significantly lower favoring brachial plexus block, but the difference was slight (VAS 1.9) and most the patients well tolerated short-time inflation of the tourniquet. No significant difference was observed in duration of the operation, whereas duration of performing anaesthesia was significantly longer in brachial plexus blocks, but the difference of the mean values was as low as 1 minute. Operation under brachial plexus block provided greater surgeon's comfort.Conclusions. The results of this study show similar effectiveness of local and brachial plexus block anaesthesiae for carpal tunnel release, and confirm advantages of the former technique as simpler, cheaper and easier available. It seems that, according to European trends, local anaesthesia should be considered a method of choice in this operation and that fear associated with its use are not justified.
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Early Results of Flexor Tendon Repair in Zone II With Modified, Four-Strand Strickland Technique

81%
Walaszek I., Żyluk A., Piotuch B.
Polish Journal of Surgery
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2008
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vol. 80
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issue 12
645-652
EN
New materials, techniques of tendon suture and methods of post-operative rehabilitation offer surgeons perspective of effective repair and excellent outcomes. Results of experimental studies show that multistrand tendon suture provides better mechanical properties than two-strand technique, however, clinical use in only 4 studies did not confirm its definitive superiority to traditional method of the repair.The aim of the study was the assessment of the outcomes of the treatment of flexor tendon repair by a modified, four-strand Stickland technique.Material and methods. Flexor tendons lacerations in 60 patients, all in Verdan's zone II, without associated bone fractures and impaired blood supply were repaired by a modified, four-strand Stickland technique. An active flexion and extension of the fingers in the range restricted by a splint was recommended immediately after operation. Early results were evaluated in 51 patients, 41 men and 10 women, in a mean age of 31 years, in whom 69 tendons were repaired in 69 digits. Follow-up at 2 and 6 weeks included examination of total active range of motion (AROM) of involved fingers, rupture rate and complications.Results. Failure of the repair occurred in 3 cases (6%), including one thumb, index and little finger, all between 2nd and 6th week after the operation. A mean AROM at 2 and 6 weeks was 38% and 58% of the normal value (270° for the finger and for 170° the thumb), respectively. In 13 digits (28%) AROM at 6 weeks was excellent, greater than 80%, but in 5 digits was poor, less than 20% of the normal value. The main cause of reduced AROM was incomplete extension of the digits, due to splint employment up to 6 weeks post-operatively.Conclusions. Early results obtained in the study fail to confirm greater endurance of four-strand repair over two-strand, what suggest rupture rate closed to given in the literature. An active range of motion achieved in the group was poorer than obtained after two-strand repair in other studies, but one can expect its improvement in the longer perspective.
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