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Epidemiological Characteristic of Acute Pancreatitis in Trzebnica District

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Bogdan J., Elsaftawy A., Kaczmarzyk J., Jabłecki J.
Polish Journal of Surgery
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2012
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vol. 84
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issue 2
70-75
EN
Acute pancreatitis is one of the most common surgical disease, and thus cause of hospitalization. Incidence and etiology of this condition demonstrates large regional differences. This situation is a substantial financial burden forhospital district, and changes in organization structure and funding medical service should be taken under consideration.The aim of the study was to record the epidemiology with etiology, diagnosis and treatment of acute pancreatitis in large district (77 000 inhabitants).Material and methods. A meta-analysis study of all 298 patients admitted to Hospital St Hedwig in Trzebnica, in the six-year period from 2005 to 2010, with acute pancreatitis was performed.Results. Acute pancreatitis was diagnosed in 298 patients in the six - year period, giving an estimated incidence of 64.4 per 100 000. Among the group of 441 admissions for acute pancreatitis in 298 patients was confirmed. Severe acute pancreatitis developed in 22.5% (67/298) of patients, more often in males 56/208 (27%) than in females 11/90 (12%). Gallstones were found as an etiological factor in 27% (80/298), and alcohol intake in 49% of patients. 211/298 (70%) patients had only one attack, whereas 29% (87/298) were readmitted with 230 relapses. The risk of recurrent pancreatitis was 48% in alcohol induced and 6,25% in gallstone induced pancreatitis. 53/298 patients (17%) were operated, ERCP procedures were performed in 24.Performed operations: necrosectomy in 25/53 (47%), elective cholecystectomy in 16/53 (30%), open drainage of abdominal abscess in 5/53 (9%), open drainage of cysts in 5/53 (9%), Jurasz's operation in 2/53 (3%). Majority surgical treatment was carried out in 68% cases with severe acute pancreatitis. Mortality due to acute pancreatitis was 3% (10/298); 15% in severe pancreatitis.Conclusions. 1. Acute pancreatitis continues to be an important clinical problem. 2. Severe, necrotic acute pancreatitis is associated with high mortality rates. 3. The ethanol-intake-related episodes of acute pancreatitits are much more prevalent than the gall-stone-related ones. 4. After the exclusion of ethanol- and gall-stones-related etiologies, the subsequent diagnostic process should aim at excluding neoplastic process of the head of pancreas.
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Early Results of Open Fasciotomy as a Treatment of Dupuytren's Disease in Elderly Patients

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Jabłecki J., Kaczmarzyk L., Domanasiewicz A., Kaczmarzyk J.
Polish Journal of Surgery
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2007
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vol. 79
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issue 12
746-752
EN
The demand for treatment of Dupuytren's disease by a procedure of limited invasiveness and quick recovery is increasing in accordance with aging of the Polish population. Such a demand is fulfilled by different types of fasciotomy (open, percutaneous needle fasciotomy).The aim of the study was to asses the early results of the open fasciotomy in elderly patients.Material and methods. We treated 38 patients (61 fingers) whose mean age was 72 (SD 12) by open fasciotomy; 43 fingers presented stage III Tubiana contracture, 18 stage IV. The pre-operative total passive extension deficit was 123° (78° for stage III group, 111° for stage IV group). All the procedures were performed in outpatient setting. Patients used splint for 5 days, then performed finger - extension exercises and were encouraged to use their hands normally after 1 week.Results. The evaluation of the results was performed 4 weeks post-op. The greatest improvement in both of the groups was noted in MCP joint - 80% and in PIP joint - 48%, this difference is statistically significant. The general improvement ratio was 76%, greater in stage III group - 82% whereas in stage IV group 69%, but this difference was not statistically significant. All of the wounds healed up to 3 weeks, no complications were observed.Conclusion. The open fasciotomy is a recommendable short term treatment in patients of advanced age, suffering from stage III and stage IV of Dupuytren's disease.
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Surgical treatment of hemangiomas and arteriovenous malformations in upper extermity

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Jabłecki J., Elsaftawy A., Kaczmarzyk J., Kaczmarzyk L.
Polish Journal of Surgery
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2013
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vol. 85
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issue 3
107-113
EN
Hemangiomas belong to one of the most common type of tumors occurring in childhood. They are benign and often do not require any treatment, with the tendency to. frequently disappearing spontaneously at the age of 5-7 years. The tumors usually develop in the head and neck area, whereas vascular malformations (AVMs) are rare congenital anomalies, which may occur anywhere. In upper limb, they may amount to 30-60% of cases. It is common for these changes not to require any surgical treatment. In case they do, the main indications for such treatment of upper limb AVMs may be as follows: signs of compression of the peripheral nerves, limited mobility of the fingers because of the tumor, which entails difficulties in the functioning of the whole arm, pain and aesthetic considerations. Aim of the study was to present the results of surgical treatment of vascular tumors (hemangiomas and AVMs) in the upper limb that was applied in our department, as well as a broader discussion on epidemiology, diagnosis, and treatment of these changes. Material and methods. In 2003-2011 period we treated 11 patients aged 24-39, suffering from vascular tumors (hemangiomas / vascular malformations) in the upper limb; the group included 3 men and 8 women. In this group we diagnosed 2 cases with arm hemangiomas, 2 cases of intramuscular hemangiomas of the forearm, 2 cases of hemangiomas in metacarpal area, 2 cases of AVMs of the finger and metacarpal area, and 4 cases of isolated vascular malformations (mainly arteriovenous malformations) of the fingers. All preparations were examined histologically. Results. No complications or recurrence were found in 7 cases, recurrences of AVMs were observed in 4 patients with finger changes. In one patient with AVMs of the index finger, we observed a treble recurrence, which severely impaired functioning of his hand. We eventually suggested to him the finger amputation, to which the patient agreed Conclusions. Upper extremity is a rare location of hemangiomas and other vascular malformations requiring surgery. hemangiomas are more common in women, and the occurrence of AVMs in both males and females is similar. Surgical treatment of hemangiomas and AVMs of the upper extremities is doubtlessly an arduous task, which calls for great microsurgical skills.
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Hand Replantation in 83 Year Old Man - Case Report

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Kaczmarzyk L., Jabłecki J., Kaczmarzyk J.
Polish Journal of Surgery
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2009
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vol. 81
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issue 5
242-245
EN
Indications for hand replantation need to take into account the patients general condition and the severity of the trauma. The advanced age of the patient is generally considered as a limiting factor of the replantation but does not absolutely disqualify a patient.The case of a right - handed man, 83 years of age is presented, who had a circular- saw wrist level amputation of his dominant hand. As the general condition of the patient was satisfactory, the wound was clean, and the ischemia time was only 3 hrs the replantation of the hand was decided. The procedure was performed in a standardized way, the revascularization took place 7 hrs after injury. In the early post-operative period within the replanted part skin and soft tissue necrosis developed. It was treated with hyperbaric oxygen therapy, pediculed skin flap, and after its failure omental flap. The early functional result was poor (Chen's IV°). Patient died 27 weeks after replantation due to complications of coronaroplasty. The problems involved in replantation of hands of senile patients are discussed.
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Problems Associated with Forearm Reimplantation

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Jabłecki J., Kaczmarzyk J., Kaczmarzyk L., Domanasiewicz A., Kocięba R.
Polish Journal of Surgery
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2007
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vol. 79
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issue 2
70-77
EN
The aim of the study was to present the technical and qualification problems associated with forearm reimplantation.Material and methods. The analysed group included 29 patients, 25 male and 4 female, who had in the period of 10 years (between January 1994 and December 2003) undergone 10 reimplantations and 19 revascularisations (partial amputation) of the forearm. The age of the patients ranged from 19 to 63 years. Due to massive limb destruction, 8 patients only underwent wound revision. The number of operations performed within the 4 distinct zones of the forearm was as follows: I - 8 patients, II - 17, III - 3, IV - 1; 20 (69%) of cases were the result of crush-avulsion injuries. The bones were stabilised by means of intramedullary nails, muscle bellies were sutured with mattress sutures, and the torn-off tendons were reinserted to the bellies by Chen's method. We attempted anastomosis of two main forearm arteries and the greatest possible number of veins, and a vein graft was applied in 2 cases. The operative wound was closed with skin graft in 4 patients.Results. There were 5 failures (17.2%). Nine patients required secondary reconstructive procedures for bone issues, 4 patients for nerves, and 3 for tendons. The operations were performed between 20 to 29 months after the reimplantation. The functional results were assessed according to Chen's scheme. 2 patients achieved grade I, 9 grade II, 13 grade III, and 5 grade IV. Two patients, the farmers, regained their previous profession. All of the patients were satisfied with regaining the limb.Conclusions. Problems encountered in forearm reimplantation are due to unfavorable mechanisms of trauma. The technical aspects of such surgeries require a highly qualified surgical team. The prognosis for survival and functional recovery is lower in proximal as compared to distal injuries.
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Treatment possibilities of reverse-flow sural flap in covering the defects of lower extremities

76%
Elsaftawy A., Jabłecki J., Domanasiewicz A., Paruzel M., Kaczmarzyk J., Kaczmarzyk L.
Polish Journal of Surgery
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2013
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vol. 85
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issue 4
192-197
EN
Soft tissue defects of the lower extremity pose an important surgical challenge, often because of inviability of primary covering. Therapeutic modalities of choice comprise of local perforator flaps, as well as of free flaps created with the use of microsurgical skills. However, these methods cannot be applied in patients with important comorbidities, and it is in such cases where the reverse sural flap proves to be the best solution. The aim of the study was to present the results of treating lower extremity defects with various modifications of the reverse sural flap. Material and methods. Sixteen patients, males aged 17-56 years, were operated on from 2007 to 2013. Diabetes with multiple complications, disseminated atheromatosis, and extensive soft tissue trauma involving the arteries crucial for microsurgica anastomoses were the most common reason disqualifying from the free and perforator-based flap techniques. Results. All of the patients achieved very good results; in two cases distal and marginal flap necrosis was observed which, once exiced, covered with granulation, and was successfully covered with a partialthickness skin graft. Conclusions. The reverse sural flap, technically easy, offers a viable, low-risk alternative to free and perforator-based flaps.
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First Polish Hand Allograft - 6-Month Report

76%
Jabłecki J., Kaczmarzyk L., Patrzałek D., Domanasiewicz A., Paruzel M., Chełmoński A., Kaczmarzyk J.
Polish Journal of Surgery
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2007
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vol. 79
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issue 3
232-238
EN
The transplant recipient is a 32 year-old man who lost his right, dominant upper limb on the level of the midpoint of his forearm in an accident 14 years ago. After a comprehensive pretransplantation evaluation and informed consent process he received a transplant of the right forearm, matched for size and skin tone, of a brain-dead man aged 47. The donor's limb was amputated at the elbow and irrigated with UW solution. We dissected the donor and recepient limbs simultaneously. Appropriate lengths of anatomical structures were matched. Bone fixation was performed with Rush pins, without bony transplants; the muscles were anastomosed in layers and the skin wound was closed without a skin transplant. The cold ischemia time was 10.5 hours. Immunosuppresion included simulect, tacrolimus, mycophenolic acid, and prednisone. Maintanance therapy included tacrolimus (15 ng/ml), mycophenolic acid, and encorton.There were no intraoperative or early postoperative complications. No episodes of rejection were observed. Immunosupression was well tolerated. The intensive physiotherapy led to satisfactory progress of motor function recovery. Reinnervation was excellent, and after 6 months, Tinel's sign was present over 40% of the respective lengths of the median and ulnar nerves. Follow-up included routine post-transplant laboratory tests, skin biopsies, bacteriological tests, and physiotherapy.
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