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Surgical Treatment of Meckel's Diverticulum

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Arkuszewski P., Kuzdak K.
Polish Journal of Surgery
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2010
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vol. 82
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issue 6
329-336
EN
The aim of the study. Assessment of own research material associated with surgical treatment of Meckel's diverticulum (MD).Material and methods. Retrospective analysis of medical records of 27 patients managed in the Department of Endocrine and General Surgery of Medical University in Łódź between 1st October 2002 and 31st December 2009 due to incidentally found during surgery and not producing symptoms MD and also operated on for its complications.Results. After excision of MD causing symptoms surgical complications possibly directly associated with the removal of MD were not observed. After prophylactic excision of MD such complications occurred in 2 patients (11.11%). Moreover, in this group we found one death after the operation, but it was not attributable to performed diverticulectomy and was caused by multiple coexisting diseases. In 3 of 14 prophylactically removed and macroscopically normal Meckel's diverticula the presence of reactive inflammation was diagnosed on histopathology.Conclusions. Excision of MD, both producing symptoms and incidentally found, is associated with the low risk of complications. After the recognition of acute appendicitis all identified Meckel's diverticula should be removed, even macroscopically normal, because they can present with the reactive inflammatory process. The method of MD excision depends on intraoperative diagnosis. The risk of MD-related complications may increase with age.
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Surgical Management of Injuries of the Hepatic Veins and Retrohepatic Inferior Vena Cava

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Arkuszewski P., Krawczyk M.
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issue 11
564-568
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Surgical Management of Liver Trauma

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Krawczyk M., Arkuszewski P.
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issue 11
554-563
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Pathological Fractures of the Mandible in the Department of Cranio-Maxillofacial Surgery Medical University in Łódź

81%
Tyndorf M., Manowska B., Arkuszewski P., Gaszyńska E.
Polish Journal of Surgery
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2010
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vol. 82
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issue 11
615-620
EN
Pathological fractures of the mandible are rare, comprising 1-2% of this injuries.The aim of the study was to analyse demographic data, etiology, site and treatment procedures of pathological mandible fractures.Material and methods. The retrospective study comprised 17 patients (10 males and 7 females) with pathological mandible fracture. Upon the basis of the medical documentation, demographic data, such as age and sex, were recorded, and so were clinical data: mechanism of the fracture, its cause (pathology, causing lowering the mechanical resistibility of the mandible), location and manner of the treatment.Results. Most common cause of the fracture was presence of odontogenic cyst and mandibular atrophy. Most common mechanism of injury were chewing and falls. Regardless of the causes, the majority of the fractures occurred in the body of mandible.Conclusion. Treatment of the mandibular pathological fractures differs according to etiology.
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Head and Neck Lymphomas - Diagnostic Difficulties

81%
Neskoromna-Jędrzejczak A., Tyndorf M., Arkuszewski P., Kobos J.
Polish Journal of Surgery
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2012
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vol. 84
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issue 3
113-118
EN
Malignant lymphomas represent approximately 5% of all malignant neoplasm of the head and neck and may involve nodal or extranodal sites. The head and neck region is the second most frequent anatomical site of extranodal lymphomas (after the gastrointestinal tract). Most are non-Hodgkin lymphomas (NHL) of B-cell lineage. Hodgkin's lymphoma (HL) rarely occurs in extranodal site.The aim of the study was to evaluate head and neck manifestation of lymphoma (both HL and NHL) and emphasize diagnostic difficulties of these pathologies.Material and methods. Retrospective review of medical records of patients diagnosed for lymphomas in our department was performed. Authors analyzed demographic data as well as clinical manifestation and diagnostic trials.Results. 9 patients were included to the study. 7 of them suffered from extranodal NHL and 2 of them from HL (one patient - extranodal and one nodal manifestation). There were diagnostic complications in all cases and final diagnosis was made after surgical material analysis.Conclusions. This data demonstrate low sensivity of fine needle aspiration for identification of lymphoma as well as clinical picture is non characteristic.
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Clinical Aspects of Diagnosis and Treatment of Elongated Styloid Proces Syndrome

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Arkuszewski P., Przygoński A., Tyndorf M.
Polish Journal of Surgery
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2010
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vol. 82
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issue 11
626-630
EN
Eagle's syndrome is a rare cause of chronic cervical and throat pain connected with styloid process elongation. The etiology of this disorder remains unclear. The authors presented four cases of symptomatic, one-sided and both-sided elongation of the styloid process. Moreover, the study presented aspects of diagnosis and treatment of Eagle's syndrome. The Authors especially focused on surgical techniques.
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Solid Pseudopapillary Tumor of the Pancreas in a Young Woman - Case Report

81%
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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Methicillin Resistant Staphylococcus Aureus Infections of Soft Issues of the Oral Cavity, Face and Neck in Patients Hospitalized at the Cranio-maxillofacial Surgery Department

81%
Gaszyńska E., Tyndorf M., Manowska B., Arkuszewski P.
Polish Journal of Surgery
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2011
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vol. 83
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issue 4
212-215
EN
The aim of the study was to identify a group of patients at high risk of methicillin resistant Staphylococcus aureus (MRSA) infection following surgical procedures involving oral cavity, head and neck.Material and methods. A retrospective analysis of demographic, clinical and laboratory data was performed. A manual search of laboratory records for a five years period (2005-2009) was performed for specimens submitted to the diagnostic microbiology laboratory from patients admitted to the Cranio-Maxillofacial and Oncologic Surgery Department.Results. Methicillin resistant Staphylococcus aureus was identified in 26 cases. Most commonly it was isolated from tongue swabs in patients following extensive oncological surgical procedures involving oral cavity. Most common risk factors were: age above 65 years, neoplasms, multisite trauma with loss of consciousness, cigarette smoking, alcohol abuse, tobacco addiction, antibiotic therapy immediately before hospitalization. More than half of patients with MRSA infection required surgical treatment except for pharmacological treatment.Conclusions. Monitoring of postoperative wounds is of great importance with regard to he risk of MRSA infection.
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Blindness After Midface Injuries - Data From the Department of Cranio-Maxillofacial and Oncological Surgery, Medical University in Łódź

81%
Gaszyńska E., Krawczyk M., Tyndorf M., Arkuszewski P.
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EN
One of the most serious consequences of eye globe injury is loss of vision. Direct trauma to the eyeball is extremely rare, in comparison to the incidence of orbital fractures.The aim of the study was to determine the frequency and characteristics of post-traumatic amaurosis in patients subject to midfacial injuries.Material and methods. Retrospective analysis comprised 6677 records of patients admitted to the Department of Cranio-Maxillofacial and Oncological Surgery, Medical University in Łódź during the period between 2004 and 2009.Results. Post-traumatic amaurosis was diagnosed in seven patients. The most common cause of post-traumatic blindness was attributed to fighting and road traffic accidents. All patients with midface fractures were thoroughly examined by an ophthalmologist. Six patients were subject to pharmacological therapy, while two were qualified towards surgical treatment (optic nerve decompression).Conclusions. It is necessary to conduct an accurate examination of the visual organ in all patients after midfacial trauma, in order to confirm or exclude organ of vision injuries. Pharmacological and surgical treatment should be immediately initiated, as a consequence of optic nerve neuropathy.
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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

81%
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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Bile Duct Cysts

81%
Krawczyk M., Arkuszewski P., Zieniewicz K., Grąt M.
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EN
Aim of the study was analysis of methods of surgical treatment of patients with bile duct cysts.Material and methods. Retrospective analysis of data from 30 patients who underwent surgical treatment for bile duct cysts in Clinic of General, Transplantation and Liver Surgery, Warsaw Medical University, between 1 October 2001 and 31 December 2009.Results. Bile duct cysts are more common in females; female to male ration is 4:1. Most of the treated patients had bile duct cysts belonging to type I according to Todani classification - 13 patients (43.3%). Six patients (20%) had type IV cysts, 8 patients (26.7%) had type V cysts according to Todani classification. Three patients (10%) with isolated intrahepatic bile duct cysts were not classified to any group according to Todani classification. The most common type of surgical treatment was complete resection of intrahepatic bile duct with choledocho-intestinal Roux-en-Y anastomosis that was performed in 17 patients (56.7%). The other patients generally underwent various types of resections of the liver and bile ducts or only of the liver. Five patients (16.7%) required liver transplantation. Nine patients (30%) developed complications. One patient (3.3%) who underwent liver transplantation and retransplantation, died from progressive multiorgan failure and renal failure.Conclusions. First line treatment of patients with bile duct cysts involves their resection, sometimes with requirement of resection of liver parenchyma. Most of these patients underwent reconstruction of bile duct through choledocho-intestinal Roux-en-Y anastomosis. Some patients undergo liver transplantation. Surgical treatment of patients with bile duct cysts is demanding from the technical point of view and should be undertaken in centers that specialize in hepatobiliary surgery.
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Diagnosis and Treatment of Cervical Branchial Cleft Cysts Based on the Material from the Department of Cranio-Maxillofacial Surgery, Medical University in Łódź and Literature Review

81%
Gaszyńska E., Gaszyński T., Arkuszewski P.
Polish Journal of Surgery
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2012
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vol. 84
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issue 11
547-550
EN
Cervical branchial cleft cysts are relatively common tumors of the neck that should be distinguished from an epidermoid cyst, hygroma, hemangioma, lymphangioma, lymphadenitis, and metastatic papillary carcinoma of the thyroid gland. Infected cysts might be misdiagnosed as a recurrent abscess. The aim of the study was to present current views concerning diagnosis and treatment of cervical branchial cleft cysts. Material and methods. Data and histopathological results obtained from 49 patients (18 women and 31 men) admitted to the Department of Cranio-Maxillofacial Surgery, due to lateral cervical cysts during the period between 2005 and 2009 were subject to retrospective analysis. Results. Most patients were in their third decade of life. The clinical examination showed a painless, slowly growing tumor on the lateral surface of the neck, more often on the right side, and in 30 cases with a concomitant infection. Initial diagnosis on the basis of the clinical examination, radiology and biopsy was confirmed in 48/49 cases (98%). All patients were subject to surgical treatment. During the 3 to 7 year follow-up period recurrence was not observed. Conclusions. Initial diagnosis of a cervical branchial cleft cyst on the basis of the clinical examination should always be confirmed by means of ultrasonography. In case of suspicion of a coexisting infection, fine-needle aspiration biopsy under ultrasound control is recommended. If there is concern that the lateral neck lesion is not a branchial cyst or its dimension is large, computed tomography of the neck or magnetic resonance should be performed. Complete excision of the tumor under general anesthesia is the treatment of choice, being associated with the low risk of local postoperative complications
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Damage of Facial Soft Tissues as a Result of Being Bitten by a Dog

62%
Zielińska-Kaźmierska B., Wieczerzak L., Kozioł A., Majkowska K., Arkuszewski P., Manowska B.
Polish Journal of Surgery
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2015
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vol. 86
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issue 8
364-369
EN
Being bitten by a dog can have serious health effects. That is why, never underestimate even the smallest soft tissue injuries inflicted by aggressive animals. This incident may have an impact on the further condition of a patient. From our first aid will also depend the aesthetic and functional effect of the scar on the face. We should pay attention to the use of antibiotic prophylaxis. The aim of the study was to perform the analysis of the soft tissue bitten injuries made by dogs in patients treated in the years 2004‑2009 in the Clinic of Cranio-Maxillo-Facial and Oncological Surgery in Łódź. The most frequent attacked areas were analyzed in the cases of single and multiple face wounds. The dependence of the dog attacks and the alcohol consumption by the victims. The use of an early antibiotic prophylaxis and the number of the infectious complications. Material and methods. The material studied is a group of 26 patients, including 17 women and 9 men. In the majority patients were older than 20 years old. Results. The analysis of our data shows that most of the victims were aged 19-30 and 51-60 years. 14 patients have been mutilated on one area of the face, the remaining patients at least two areas. Most injuries underwent upper or lower lip. In all cases, the initial supply has been applied to the wounds. Antibiotic prophylaxis was used in 23 patients. In one of the other three cases, patient who have not been applied to the prevention of complications in the form of phlegmon face. Half of the attack dogs have been known to the victims. All patients had implemented prevention of tetanus, or held-to-date vaccinations. In eight cases, patients reported that at the time of the event they were under the influence of alcohol. Conclusions. Primary supply of bitten wounds of face at the moment seems to be the standard. In our study, in cases where patients has been treated with an antibiotic, there was no case of infection in the wound. Late complication in the form of phlegmon occurred in one patient who had not used prophylaxis. As the most of the authors note lower lip is the most vulnerable for the bite in the case of adult people. Analysis of our data is consistent with these reports. It has also been found that people under the influence of alcohol are often attacked by unknown dogs.
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