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1
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Assessment of Pharmacological Prophylaxis for Acute Pancreatitis Following ERCP in Patients with Choledoholithiasis

100%
Łubowska-Pająk E., Kołomecki K.
Polish Journal of Surgery
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2015
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vol. 87
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issue 12
620-625
EN
Endoscopic retrograde cholangiopancreatography (ERCP) is an effective tool in the diagnostics and treatment of bile duct diseases. Although minimally invasive, the procedure is associated with a risk of complications, with acute pancreatitis being the most serious. In recent years, high hopes have been placed on pharmacological prevention of acute pancreatitis after ERCP. The aim of the study was assessment of the efficacy of low-molecular-weight heparin and somatostatin in combination with diclofenac in the prevention of acute pancreatitis after ERCP. Material and methods. The study enrolled three groups of 30 patients diagnosed with cholelithiasis; group I: patients who received low-molecular-weight heparin prior to ERCP, group II: patients who received somatostatin and diclofenac, group III: control group. The study assessed the incidence of acute pancreatitis, hyperamylasemia and increased CRP levels. Results. Acute pancreatitis was observed in 13.3% of group I patients, 10% of group II patients and 16.7% of group III patients (no statistical significance). Hyperamylasemia was observed in 16.7% of group I patients, 16.7% of group II patients and 43.3% of group III patients. These differences were statistically significant. No significant differences were found in the occurrence of increased CRP levels among the study groups. Conclusions. No significant reduction in the occurrence of acute pancreatitis after ERCP was observed in patients who received pharmacological prophylaxis. A significant reduction in the occurrence of hyperamylasemia was found in drug-treated patients.
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One-Day Thyroid Surgery – Is it Safe?

71%
Wieloch M., Koza P., Kuzdak K., Ziemniak P., Kołomecki K.
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vol. 85
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issue 6
317-322
EN
was to evaluate the safety of one-day thyroid surgery based on the assessment of the incidence of early postoperative complications. Material and methods. The study comprised 726 patients who underwent total thyroidectomy during the period between January, 2012 and February, 2013. The study considered the three most common thyroidectomy complications. Results. In the group of 726 patients, recurrent laryngeal nerve paralysis was observed in 22 cases, accounting for 3.07% of all patients. Postoperative bleeding was observed in 12 cases (1.65%). In 8 cases, bleeding occurred during the first 8 hours after surgery, while in the remaining four cases- 9, 12, 18, and 26 hours after surgery. The study group was divided into three subgroups, in which the concentrations of calcium and parathyroid hormone, 6 hours and 20 hours after surgery, were determined. In the first group (223 patients), only the parathyroid hormone level was determined. The decreased PTH level was associated with the appearance of tetany symptoms in 15% of cases. Amongst patients in whom the parathyroid hormone level was normal, tetany symptoms were observed in 0.5% of cases. In the second group (256 patients), only the serum calcium level was determined. Amongst patients with normal serum calcium levels, 1% of cases presented with tetany symptoms. In patients where the serum calcium level was reduced, tetany symptoms appeared in 35% of cases. In the third group (247 patients), both serum calcium and parathyroid hormone levels were determined. In the group of patients with normal, both serum calcium and parathyroid hormone levels, tetany symptoms were not observed. Amongst patients with normal serum calcium levels and decreased PTH levels on the day of surgery, tetany symptoms were observed in 25% of cases, while during the first postoperative day-37% of cases. Conclusion. One-day thyroid surgery, due to the appearance of complications cannot be regarded as a completely safe procedure.
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Preparation of Patients Submitted to Thyroidectomy with Oral Glucose Solutions

71%
Libiszewski M., Drozda R., Śmigielski J., Kuzdak K., Kołomecki K.
Polish Journal of Surgery
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2012
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vol. 84
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issue 5
253-257
EN
The aim of the study was to determine postoperative insulin-resistance in patients subject to total thyroidectomy, the prevalence of subjective feelings of hunger immediately before surgery, and the incidence of nausea/vomiting after surgery in patients prepared for elective operations by means of oral glucose solutions.Material and methods. The study group comprised 115 patients, including 71 patients prepared for surgery by means of oral glucose solutions (12.5% glucose) administered 12 and 3 hours before the procedure, at a dose of 800 and 400 ml. The control group comprised 44 patients prepared for surgery by means of the traditional manner- the last meal was served before 2pm the day before the surgical procedure, while fluids before 10pm. Considering both groups, we evaluated glucose and insulin levels three times, as well as determined the insulin-resistance ratio (HOMA-IR) 24 before, and 12 hours and 7 days after surgery. The incidence of nausea and vomiting after surgery, and the subjective feeling of hunger before surgery were also evaluated.Results. Statistically significant differences considering insulin level and HOMA-IR values were observed during the II and III measurements. The glucose and insulin values, and the HOMA-IR insulin-resistance ratio, showed no statistically significant differences during measurement I. No statistically significant glucose level differences were observed during measurements II and III. A significantly greater subjective feeling of hunger before surgery and nausea/vomiting afterwards were observed in the control group.Conclusions. The preparation of patients with oral glucose solutions decreases the incidence of postoperative (thyroidectomy) insulin-resistance, and occurrence of nausea/vomiting during the postoperative period.
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Influence of the Classic and Laparoscopic Bariatric Operations For the Ventilation Lung Activity

62%
Świαtkowska M., Cywiński J., Hedayati M., Drozda R., Wieloch M., Kołomecki K.
Polish Journal of Surgery
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2008
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vol. 80
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issue 12
659-663
EN
The obese patient constitute the group with high perioperative risk due to more respiratory and cardiovascular disorders. The respiratory disorders deepen during postoperative period.The aim of the study was an assessment of changes in ventilation lung activity after classic and laparoscopic bariatric operations.Material and methods. For the lung activity assessment the measurement of pick expiratory flow was used before operation, in the first and third twenty-four hours after operation. Moreover, before and in the first twenty-four hours after operation a spirometry was performed. The forced vital capacity (FVC), 1 second forced expiratory volume (FEV1) and Tiffenau index (FEV1/FVC) were estimated in the study. 54 persons were included in batriatric operations. The first group was formed by the patients after vertical banded gastroplasty (VBG), the second after laparoscopic vertical banded gastroplasty (LVBG), the third one after laparoscopic adjustable gastric banding (LABG).Results. The following average results were gained: first group-PEF before operation 399 liter per minute, in the first twenty-four hours after operation 195 liter per minute and in the third twenty-four hours 282 liter per minute. FEV1 before operation 2.6 liter, in the first twenty-four hours 1.5 liter, FVC before 3.5 liter and after operation 2liter. Tiffenau index before 86%, after 85%. The second group PEF before operation 446 liter per minute, in the first twenty-four hours 326 liter per minute in the third twenty-four hours 409 liter per minute, FEV1 before 3.6 liter, after 2.6 liter, FVC before 3.9 liter, after 2.7 liter, Tiffenau index before 92%, after 96%. The third group PEF before 460 liter per minute, in the first twenty-four hours 340 liter per minute, in the third twenty-four hours 430 liter per minute, FEV1 before 3.2 liter, after 3.1 liter, FVC before 4.5 liter, after 3.6 liter, Tiffenau index before 90%, after 90%.Conclusions. The bariatric operations reduce ventilation lung activity. After classic bariatric surgery respiratory disorders are longer and become more intense. Independently of bariatric operation's method all respiratory disorders have a restrict type.
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Adrenal Metastases

62%
Pomorski L., Kołomecki K., Brocki M., Pasieka Z., Kaczka K., Kuzdak K.
Polish Journal of Surgery
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2010
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vol. 82
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issue 2
95-100
EN
The aim of the study was an retrospective assessment of adrenal metastases based on the analysis of patients operated on in three surgical institutions between 2001 and 2005.Material and methods. Between 2001 and 2005 169 patients (106 females and 63 males) were treated due to adrenal tumors. The age of patients ranged between 25 and 82 years (mean 55.4± 11.8 years). All patients were routinely diagnosed by means of ultrasound, computed tomography or magnetic resonance imaging and hormonal tests such as cortisol, chromogranine A, aldosterone and natrium, potassium concentrations. Patients were surgically managed after preparation dependent on general status, tumor type and concomitant diseases. Operations were carried out using classic techniques via lumbar approach in 146 cases (86.4%) or videoscopic techniques via retroperitoneal or transperitoneal approaches (13.6%).Results. In 143 cases (84.6%) benign tumors and in 26 (15.4%)-malignant lesions were diagnosed. 16 (9.5% of all cases and 61.5% of malignant tumors) were secondary- metastases form various cancers treated previously. Adrenal metastases occurred most often in the 7th decade (43.7%), and primary site was clear cell carcinoma of the kidney (9 cases - 56.25%) and non-small cell lung cancer (4 - 25%), melanoma (2 cases - 12.5%) and rectal cancer (1 - 6.25%). During the follow-up of 1-5 years (mean 3.1 years) 12 patients died of metastatic tumors - 6 with multiple metastases and 6 with solitary adrenal metastasis. 4 patients are still alive with metastatic deposits in the adrenal glands (at the moment of adrenalectomy) - 3 with metastatic renal cancer (currently 2 without other metastases) and 1 with disseminated lung cancer.Conclusions. 1. Adrenal metastases are the most frequent malignant tumors of these glands. 2. Metastatic tumors occur most often during the 6th and 7th decades. 3. Results of treatment are not satisfactory and dependent on the extent of spread.
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Assesment of Inflammatory Response Intensity in Early Postoperative Period in Patients After Hernioplasty Operated on with Classic Stoppa Method and Videoscopic TEP Method

62%
Libiszewski M., Drozda R., Białecki J., Wieloch M., Hedayati M., Kuzdak K., Kołomecki K.
Polish Journal of Surgery
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2011
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vol. 83
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issue 9
497-501
EN
The aim of the study was comparison of inflammatory response intensity through estimation of CRP, IL-6 and WBC concentration in blood serum in patients before and after inguinal hernia operations with Stoppa and TEP method.Material and methods. The study involoved 117 patients operated on inguinal hernia between 2006-2008. The patients were divided into two groups. In the first group (group I - 56) Stopp'a method was used, in the second (group II - 61) TEP method. The patients selection was coincidental. All examined patients were men between 25-75 years old (mean age 54.3). Moreover, the operation's time, state of postoperative wound, the average hospitalization time and intensity of pain were estimated. The observations were directed over two weeks after operation.Results. The inflammatory response estimated with CRP, IL-6 concentration in blood serum was considerably higher in patients operated with Stoppa method. There wasn't observed a relevant difference in increase of white blood cells' concentration in both groups. Moreover, the patients operated on with TEP method experienced lower pain. In group, operated on with Stoppa method, 3 cases of wound healing complications were observed. The operation's time was considerably shorter in the first group. The hospitalization time, was considerably shorter in patients operated on with videoscopic method.Conclusions. The operation of inguinal hernia with TEP technique in comparison with Stopp'a method is connected with considerably lower inflammatory response of organism, what directly involve with postoperative pain abridgment and reduction of hospitalization time. Moreover it may have influence on frequency of postoperative complications related with wound healing.
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Evaluation of Selected Indicators of Apoptosis in Patients with Thyroid Tumors

62%
Kołomecki K., Maciaszczyk P., Stępień H., Cywiński J., Cielecka J., Stępień T., Kuzdak K.
Polish Journal of Surgery
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2007
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vol. 79
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issue 2
85-91
EN
The aim of the study. Estimatation of p53 protein and soluble FasL ligand level concentration in serum of patients with benign and malignant primary follicular thyroid tumors as indicators of apoptosis and evaluation of their usefulness for early diagnosis of thyroid tumors.Material and methods. 42 patients were qualified for the study. 28 patients were diagnosed with follicular neoplasm (NF) in preoperative fine-needle biopsy. The final verification was postoperative histopathology. Control group consisted of 14 patients with euthyroid goiter, with no cancerous cells detected in cytologic examination. All patients underwent surgical procedures. Levels of p53 and sFasL were marked on the day of admission, before surgery. Destinationes were made in the serum using the ELISA immunoenzymatic method. Obtained data underwent computer statistical analysis.Results. The analysis revealed significantly higher sFasL and p53 concentration in blood of patients with follicular thyroid cancer in comparison with the control group. Similarly, p53 serum level was significantly higher in case of patients with benign thyroid adenoma than in the control group. Comparison between p53 and sFasL serum level in cases of patients with follicular cancer and follicular adenoma showed statistically higher sFasL blood concentration in cases of patients with follicular cancer; there was no statistically significant connection in case of p53 concentration.Conclusions. 1. sFasL and p53 serum concentration are significantly higher in patients with follicular thyroid cancer than in the control group. 2.The p53 serum concentration is significantly higher in cases of all patients with benign thyroid adenoma than in the control group. There was no such correlation for sFasL concentration. 3. sFasL serum concentration is significantly higher in cases of patients with follicular thyroid cancer than in patients with benign thyroid adenoma. There was no such correlation with serum levels of p53.
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Operations on Adrenal Gland Tumours in A Multicentre Study at the Łódź Medical University

62%
Pomorski L., Brocki M., Kołomecki K., Andrzejewska E., Kobos J., Kuzdak K.
Polish Journal of Surgery
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2008
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vol. 80
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issue 7
364-370
EN
The aim of the study was to determine the prevalence of adrenal tumours and their types based on the analysis of material from university surgical centres participating in a 5-year study between the years 2001 and 2005.Material and methods. A total of 178 patients, 169 (94.9%) adults and 9 (5.1%) children, with adrenal tumours were treated during the study period. Amongst the operated upon patients, there were 111 (62.4%) females (106 adults and 5 girls) and 67 (37.6%) males (63 adults and 4 boys). The age of patients ranged from 7 months to 82 years (mean 55.4 ± 11.8 years). For children, ages ranged from 7 months to 17 years, while for adults ages ranged from 24 to 82 years.Results. Incidentalomas were detected in 36 (21.3%) of 169 adults, and seven (19.4%) of them were found to be hormonally active in biochemical tests.The patients underwent surgery after the preparation depending on the general state, type of tumour, its functioning, and concomitant diseases. Adrenalectomy was performed using a classical open technique through the lumbal access in 146 (86.4%) adults, and a laparoscopic technique through the retro- or transperitoneal access in 23 (13.6%) adults. In the videolaparoscopic operations, retroperitoneal access was preferred. All children were operated upon by means of the classical technique with trans-abdominal access.Adrenal tumours were most frequent in the 6th decade of life (33.2% of all tumours). In the adult group, 143 (84.6%) cases of histologically diagnosed benign tumours and 26 (15.4%) cases of malignant neoplasms were found. Sixteen (9.5% of all tumours and 61.5% of malignancies) of them appeared to be secondary metastatic tumours. Moreover, six (66.7%) children had primary malignant adrenal tumours.In three adult patients whose tumours were up to 3 cm in size in the remaining adrenal gland (after previous adrenalectomy on the other side), enucleation was carried out in one patient and partial resection of the only adrenal gland in two patients. The follow-up cortisol levels in the blood sera of these patients appeared to be normal.Conclusions. 1. Adrenal tumours most commonly occur in the 6th and 7th decades of patients' lives; an increase in the incidence rate is affected by the percentage of metastases to adrenal glands. 2. Adrenal incidentalomas reveal subclinical hormonal activity in a significant percentage of patients and require adequate preparation prior to surgery. 3. Operations preserving the cortex of the only adrenal gland allow the patients to avoid hormonal substitution therapy. 4. Tumours in children are a separate phenomenon with specific tumour characteristics and origin.
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The relationship between features of metabolic syndrome and blood adipocytokine concentrations in the morbid obese patients during dynamic weight loss

62%
Jankiewicz-Wika J., Kołomecki K., Cywiński J., Piestrzeniewicz K., Stępień H., Komorowski J.
Open Medicine
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2006
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vol. 1
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issue 2
136-147
EN
Bariatric surgery is the most effective method to achieve weight loss in obese subjects. The aim of this study was to evaluate some adipocytokines and insulin, as well as parameters of metabolic syndrome of the obese patients, for three and six months after vertical banded gastroplasty, in the time of dynamic weight loss. Seven males and two females aged 28 to 49 years, with long lasting simple obesity and the presence of metabolic syndrome, were studied. After surgical treatment the values of the body mass index, waist circumference, systolic and diastolic blood pressure, total cholesterol, LDL cholesterol, triglycerides, and blood concentrations of leptin decreased significantly. Before surgical operation of all obese patients no statistically significant correlations between studied parameters were noted. Three and six months later a lot of correlations between studied parameters appeared. In conclusion, (a) vertical-banded gastroplasty is a valuable method in treatment of obese subjects, leading to a significant decrease in body weight and improvement in some parameters of metabolic syndrome in a few months after surgery, (b) adipocytokines, together with an unknown gastric factor, may be key factors in the control of some features of the metabolic syndrome.
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Videoscopic Extraperitoneal Operations of Suprarenal Glandules

52%
Kołomecki K., Hedayati M., Cywiñski J., Drozda R., Libiszewski M., Wieloch M., Kalupa J., Kuzdak K.
Polish Journal of Surgery
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2008
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vol. 80
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issue 7
371-376
EN
An adrenal tumors are a clinical problem encountered by all health care providers go into endocrinological surgery. Nowadays the videoscopic adrenalectomy gains mounting acceptance. In the adrenal operations two kinds of operative access are used: an itraperitoneal and an extraperitoneal.The aim of the study was to analyse its own material and literature in purpose to find the answer if extraperitoneal access may be acknowledged as widely used method in adrenal tumor operations.Material and methods. 68 videoscopic adrenalectomy with extraperitoneal access were made in the Surgery Department of MSWiA Hospital in Łódź, between 2005 to 2007. The time of the operation, the time of the hospitalization, intraoperative blod loose, probability of complications, number and reasons of the conversies were taken into account.Results. In all the patients was performed complete tumor resection with adrenal gland. The diameter of removed tumors was between 4-14 cm. In 23 cases (33.8%), intraoperatively, during tumor preparation, the continuity of the peritoneum was broken however it didn't have any influence for the operation's proceedings and postoperative condition of the patients. Three conversions were made (4.4%). The average time of hospitalization was about 3.1 days. There weren't observed, in the postoperative period any wound suppurations or postoperative hernias.Conclusions. The own observations in confrontation with literature let find an extraperitoneal videoscopy as method with wide application in various size and origination in adrenal tumor operations.
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