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Solid Pseudopapillary Tumor of the Pancreas in a Young Woman - Case Report

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Arkuszewski P., Pasieka Z., Srebrzyński A., Kuzdak K.
Polish Journal of Surgery
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2011
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vol. 83
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issue 7
389-391
EN
We report a case of pancreatic solid pseudopapillary tumor that was diagnosed in a 36-year-old female patient. This neoplasm usually occurs in young women. Solid and cystic areas form a characteristic appearance of this tumor. Surgical resection is the mainstay of treatment and is possible in the majority of cases. Neoplasm is associated with a low-grade malignancy and a very good outlook.
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True and Pseudocysts of the Spleen - A Diagnostic and Therapeutic Problem

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Arkuszewski P., Srebrzyński A., Niedziałek L., Kuzdak K.
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EN
Splenic cysts are rarely diagnosed lesions. This also includes splenic pseudocysts, which usually develop as a result of a blunt abdominal cavity injury. Splenic cysts are usually diagnosed on the basis of imaging examinations, performed in case of symptomatic patients or those subject to a blunt abdominal cavity injury.Material and methods. The study group comprised six patients with a positive history of blunt abdominal cavity trauma, verified by means of histopathological examinations, which were subject to surgical intervention at the Department of General and Endocrinological Surgery, Medical University in Łódź, during the period between 01.01.2006 and 31.12.2010. Before or during the surgical procedure cystic lesions were diagnosed. The efficacy of the surgical intervention was determined.Results. Splenic pseudocysts were diagnosed in only two of the patients, although in all there was a reasonable suspicion of the above-mentioned lesion. One patient required three operations, due to recurrence of the lesion, which proved to be a primary epithelial cyst. Two of the patients required early explorative relaparotomy. Apart from the above-mentioned, treatment proved uneventful.Conclusions. The diagnosis of a splenic pseudocyst is established in case of suspicion of the above-mentioned lesion. This is evidence that in some patients focal lesions of a different nature are present, being detected by means of diagnostic imaging examinations performed after abdominal cavity injuries.
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Accesory Spleen - Incidence, Localization and Clinical Significance

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Arkuszewski P., Srebrzyński A., Niedziałek L., Kuzdak K.
Polish Journal of Surgery
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2010
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vol. 82
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issue 9
510-514
EN
The aim of the study. Assesment of prevalence, localization and clinical significance of an accessory spleen in own research material.Material and methods. Retrospective analysis of medical records of 8 patients managed in the Department of Endocrine and General Surgery of Medical University of Łódź between 1st January 2006 and 31st December 2009 with an accessory spleen recognized in the perioperative period. 7 splenectomies were performed (5 due to hematological indications) while one patient was operated on due to the recurrence of hematological disorders after previous splenectomy 3 years earlier.Results. In the early postoperative period complications requiring surgical reintervention occured in 2 patients. 5 patients underwent splenectomy for hematological indications and in 4 of them parameters of complete blood count improved. In one female patient operated on due to idiopathic thrombocytopenic purpura postoperative thrombocytopenia occured after splenectomy and excision of an accessory spleen.Conclusions. An accessory spleen is identified during 10% of splenectomies. This anomaly is most often localized in the area of vascular splenic hilum and is usually single. Complications after excision of the accessory spleen are attributable to splenectomy and typical for this procedure. The presence of the accessory spleen is significant only when excision of entire splenic tissue is necessary due to hematological indications.
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Analysis of the Analgesic Effect of Metamizole Sodium in Patients Operated on for Goitre

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Srebrzyński A., Ziółkowski R., Płużańska K., Kaczka K., Kuzdak K., Pomorski L.
Polish Journal of Surgery
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2008
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vol. 80
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issue 5
263-270
EN
The aim of the study was to evaluate the analgesic effect of metamizole sodium administered intravenously during the day after surgery in patients operated on for nodular goitre - using the 11-point NAS scale (Numeric Analog Scale).Material and methods. The study was comprised of 114 patients who had undergone surgery for nontoxic: 84 (73.7%) or toxic: 30 (26.3%) nodular goitre. The goitre size, according to the WHO classification ranged between III and I° (2). I° goitre was found in 31 (27%) patients, II° goitre - in 46 (40.4%) patients and III° goitre - in 37 (32.4%) patients. The age of patients ranged between 22 and 75 years (median 53, IQR 43-61). The goitre was localized in the neck in 103 (90.4%) patients and it partially reached the superior aperture of the thorax with its lower poles in 11 (9.6%) patients. Patients with coexisting diseases such as diabetes mellitus or peripheral neuropathy were excluded from the study. Patients were randomly assigned to 4 groups. Group I included 38 subjects in whom metamizole sodium was applied at a dose of 1 g intravenously every 6 hours for a day after surgery; the first dose was administered at the moment of surgical wound closure. Group II included 37 patients in whom metamizole sodium was applied according to the above-mentioned regimen and, additionally the surgical wound was injected with 10 ml of bupivacaine 0.25%. Group III consisted of 36 patients in whom 1 g of metamizole was first administered intravenously thirty minutes before surgery and the subsequent doses were systematically repeated at time intervals of 6 hours (preemptive analgesia), avoiding buvacaine wound infiltration. Group IV included 40 patients in whom ketoprophen was administered intravenously at a dose of 0.1 g every 6 hours for a day after the procedure. Surgical wounds were not injected with buvacaine in these patients, similarly as in groups III and I. In case of severe pain patients could additionally receive morphine 1 mg on-demand.Results. Pain intensity was analyzed every 6 hours on NAS scale and pain scores ranged from 1 to 5.5. At all time points, the highest pain intensity scores were found in patients who received metamizole as monotherapy (group I) or ketoprofen (group IV), while the lowest were found in the groups where surgical wound was additionally injected with bupivacaine solution (group II) or additional metamizole dose was used before the procedure (group III). Patients from group II rated their pain intensity as slightly higher or similar to that in group III (statistically insiginficant). Similarly patients from group I had pain scores slightly higher or similar to scores reported in group IV (statistically insiginficant).Conclusions. 1. The most intense pain was observed during the first 12 hours after thyroid surgery. 2. Administration of metamizole sodium according to the regimen that was applied in groups II and III provided sufficient analgesia. 3. Infiltration of the surgical wound with buvacaine or administration of an additional dose of metamizole sodium prior to the surgery (preemptive analgesia) results in postoperative pain relief and allows avoiding demand for opioid analgetics.
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