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1
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Therapeutic Management of Stoma Complications in Selected Patients

100%
Trzciński R., Kresińska-Kaba T., Dziki A.
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vol. 85
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issue 9
496-504
EN
Stoma complications occur in 21-75% of patients, and 30% of them require redo surgery within 10 years after previous surgical treatment. Medical treatment is successful in most cases with no need for surgery. However, severe stoma complications are the real challenge for medical team and require an individual approach to each patient. The aim of the study was to report stoma patients with severe complications of both ileo- and/or colostomy and present different options of medical treatment. Material and methods. Between March 2005 and April 2007 we treated 8 patients with severe stoma complications at the Department of General and Colorectal Surgery, Medical University of Łódź. There were 4 patients with colostomy, 3 patients with ileostomy and one patient with both ileo- and colostomy. The mean age of patients was 56,7 years (range 30-68 years). Results. In all patients we achieved either complete stoma-related wound healing or we observed substantial progress of wound healing with medical treatment. No patient required surgery for stoma complications. Conclusions. Stoma complications still occur in spite of adherence to rules of stoma care and surgical technique. Most of them can be treated conservatively. Much emphasis is put on close team work comprising doctors and nurses in the treatment of severe stoma complications.
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The Antioxidative Barier in Patients with Colorectal Cancer

76%
Murlikiewicz Ł., Trzciński R., Sygut A., Rutkowski M., Grzegorczyk K., Dziki A.
Polish Journal of Surgery
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2010
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vol. 82
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issue 6
341-346
EN
Colorectal cancer is still a major medical, economical and public health problem. Pathogenesis of colorectal cancer remains unknown. It is thought both genetic and environmental factors contribute to the etiology and progression of the disease. Reactive oxygen species are known to play a dual role in biological systems they can be either harmful or beneficial. Oxygen-free radicals are important mediators of damage to cell structures, including lipids, proteins and nucleic acids. Radical-related damage to cell structures has been proposed to play a key role in the development of many diseases including cancer.Humans have evolved complex antioxidant strategies to protect cells from oxidation.Total antioxidant capacity (TAC) considers the cumulative action of all the antioxidants present in plasma or other body fluids.The aim of the study was to investigate antioxidant status in patients with colorectal cancer measuring plasma TAC as a tool.Material and methods. The study group comprised 102 patients in different clinical stages operated on for colorectal cancer. To evaluate plasma total antioxidant capacity we used "Total Antioxidant Status Kit" - RandoxResults. Statistical evaluation of results demonstrated significantly lower serum total antioxidant capacity in patients with colorectal cancer, as compared to the healthy control group. We observed increase mean plasma total antioxidant capacity correlating with decrease of clinical disease stage.Conclusions. Colorectal patient have impairment antioxidant barrier. The deterioration of its functioning corresponds with the stage of the disease.
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A/G Polymorphism of the MMP-7 Gene Promoter Region in Colorectal Cancer

76%
Dziki Ł., Przybyłowska K., Majsterek I., Trzciński R., Mik M., Sygut A.
Polish Journal of Surgery
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2011
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vol. 83
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issue 11
622-626
EN
In gastrointestinal malignancies increased expression of matrilysin - MMP-7 - is often observed. Its high level positively correlates with clinical stage of malignancy and is a negative prognostic factor. This suggests a possible relationship between functional polymorphisms of the MMP-7 gene and susceptibility to development of colorectal cancer and an aggressive course of the disease.The aim of the study was to assess the effects of A/G functional polymorphism at -181 site of the MMP-7 gene promoter region on development and progression of colorectal cancer.Material and methods. In total, 184 patients treated surgically for colorectal cancer at the Department of General and Colorectal Surgery of the Medical University in Łódź in the years 2006-2009 and a control group of 205 cancer-free individuals with a negative family history for malignancy have been investigated. Polymorphic variants of the MMP-7 gene promoter region have been analysed using the RFLP-PCR method.Results. A statistically significant difference in distribution of genotypes has been found between the investigated group and the control group, and the OR analysis confirmed a relationship between the A/G [1.67 (1.03-2.72); p= 0.038] and G/G [2.12 (1.34-3.38); p = 0.018] genotypes and an increased risk of colorectal cancer. The risk of lymph node involvement was more than twice higher for the G/G genotype (OR = 2.83 (1.18-6.79); P = 0.017). In addition, the analysis of genotype distribution in patients divided into groups according to the T parameter of the TNM classification revealed a relationship between the G/G genotype and advanced tumour infiltration. No relationship between the investigated A/G polymorphism and the presence of distant metastases has been found.Conclusions. Obtained results indicate a possible relationship between -181 A/G polymorphism of the MMP-7 gene and malignant transformation of colorectal epithelial cells and progression of colorectal cancer. This suggests applicability of this polymorphism as a predisposing factor for the disease and a prognostic factor, which in the future may be useful in the management algorithm for colorectal cancer.
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Anterior overlapping sphincteroplasty – who benefits from the surgery?

76%
Mik M., Rośniak K., Narbutt P., Dziki Ł., Tchórzewski M., Trzciński R., Dziki A.
Polish Journal of Surgery
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2015
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vol. 86
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issue 1
33-38
EN
The aim of the study was to identify clinical factors which could influence the results of overlapping sphincteroplasty. Material and methods. Between 2003-2009 the group of 78 incontinent patients (59 women, mean age of 61±13 years), was operated on with anterior overlapping anal sphincteroplasty. Only patients with severe incontinence (>16 pts in Wexner scale) were included. Before surgery and in follow-up period anorectal ultrasound, manometry and incontinence assessment were performed and in follow-up period patients additionally fulfilled survey. The study was prospective. Follow up period was more than 36 months. Results. In survey the excellent results related to 52 patients (66.7%), good in 15 (19.2%) and poor in 11 (14.1%). The squeeze pressure improved more significantly in men 33±11 cm H2O vs. 22±14 cm H2O; p=0.039. In patients <50 year squeeze pressure was significantly larger 32±10 cm H2O vs. 25±12 cm H2O; p=0.045. If the width of a defect within sphincter was less than 60°飀 the improvement in squeeze pressure was higher 33±9 cm H2O vs. 22±15 cm H2O; p=0.031. In Wexner scale male patients better responded to surgery than females 6.94±1.8 vs. 5.12±2.2, p=0.048; as well as patients with smaller scar <60° 6.51±1.4 vs. 4.28±2.3; p=0.042. Conclusions. To succeed in sphincteroplasty the proper qualification to the procedure should be crucial. Clinical assessment prior to surgery with the use of all available non-surgical methods in patients suffer from severe symptoms can help to select optimal group who will benefit from surgery. Male patients may have to obtain better outcome and patients with smaller sphincter defect could likely have also better results from surgery.
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Colorectal Cancer in Young and Elderly Patients

76%
Berut M., Mik M., Kędzia-Berut R., Kujawski R., Trzciński R., Dziki Ł., Dziki A.
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vol. 85
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issue 8
446-451
EN
The aim of the study was to answer the question whether there are differences in the progression of the disease and its morphology, dependent of the patient’s age, as well as show colorectal cancer differences between young and elderly patients. Material and methods. During the period between 2009 and 2011, 747 patients with rectal carcinoma, and 478 with colon cancer underwent surgery at the Department of General and Colorectal Surgery. The study group comprised patients under the age of 40 years (56 patients) and >80 years (90 patients). The following were subject to analysis: gender, tumor location, percentage of radical and palliative procedures, clinical and histopathological staging, as well the differences in the morphology of the tumor. The χ2 test and Yates’ correction were used for statistical analysis. p<0.05 was considered as statistically significant. Results. A higher incidence of rectal carcinoma was observed in younger patients (p=0.004). Amongst the younger patients 30.3% were diagnosed with stage III cancer, while 35.7% with stage IV. In case of elderly patients 30.6% were diagnosed with stage III cancer, while 30.7% with stage IV. In 53.3% of young patients, local lymph node metastases were observed, while in the elderly 41.8%. No statistically significant difference was observed, considering the total number of lymph nodes metastases. However, in case of stage N2, results were unfavorable for young patients 31.8% vs 17% in case of the elderly. Mucogenic adenocarcinoma incidence was similar in both groups. In case of patients< 40 years we observed a higher incidence of poorly differentiated tumors, as compared to the elderly patients (>80 years). Conclusions. 1. It is necessary to create appropriate prevention programs for young community, and improvement of public awareness in this age group. 2. Colorectal cancer (CRC) in young patients is often recognized in advanced stage. 3. A high percentage of unresectable tumors in group of elderly patients shows that CRC is still diagnosed too late in Poland.
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Treatment of Perianal Fistulas in Poland

76%
Dziki Ł., Mik M., Trzciński R., Włodarczyk M., Skoneczny M., Dziki A.
Polish Journal of Surgery
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2015
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vol. 87
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issue 12
614-619
EN
A perianal fistula is a pathological canal covered by granulation tissue connecting the anal canal and perianal area epidermis. The above-mentioned problem is the reason for the patient to visit the surgeonproctologist. Unfortunately, the disease is characterized by a high recurrence rate, even despite proper management. The aim of the study was to determine the current condition of perianal fistula treatment methods in everyday surgical practice, considering members of the Society of Polish Surgeons. Material and methods. 1523 members of the Society of Polish Surgeons received an anonymous questionnaire comprising 15 questions regarding perianal fistula treatment in everyday practice. Results. Results were obtained from 807 (53%) members. After receiving answers, questionnaire results were collected, analysed, and presented in a descriptive form. Conclusions. Study results showed that most Polish surgeons choose the fistulectomy/fistulotomy method. Considering treatment of perianal fistulas the most important issue is to find the correct, primary fistula canal. Further methods should be individually selected for each patient. One should also remember that every fistula is different. Surgical departments that operate a small number of perianal fistulas should direct such patients to reference centers.
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Association of -1112 C/T Promoter Region Polymorphism of the Interleukin 13 Gene with Occurrence of Colorectal Cancer

76%
Walczak A., Przybyłowska K., Trzciński R., Sygut A., Dziki Ł., Dziki A., Majsterek I.
Polish Journal of Surgery
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2011
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vol. 83
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issue 1
27-31
EN
Colorectal carcinoma is one of the leading causes of death from cancer amongst adults. Considering its molecular background, cytokines are the key component of the inflammatory microenvironment of these tumors. Investigations that enable better understanding of colorectal cancer concerning the molecular level, may provide important tools for genetic screening of disease high-risk groups, as well as molecular diagnostics for the non-invasive detection of cancer in its early stages.The aim of the study was to evaluate the association between colorectal cancer and the -1112 C/T single nucleotide polymorphism (SNP) of the interleukin-13 gene.Material and methods. The study group comprised 150 cancer patients and 170 healthy subject genotypes from the Polish population. Analysis was performed by PCR-restriction fragment length polymorphism (PCR-RFLP).Results. We showed that the CT genotype is connected with a higher risk of colon cancer occurrence (OR 2.51; 95% CI 1.57-4.02; p < 0.0001). We also correlated the polymorphic variants of the IL-13 gene with the clinical characteristics of colorectal cancer patients. We observed no association between the investigated polymorphism and colorectal cancer progression, evaluated by tumor stage, as well as lymph node metastasis.Conclusions. The presented study suggested the possibility of a connection between the IL-13 gene polymorphism (-1112 C/T) and colorectal cancer risk in the Polish population.
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Oxidative protein damage in patients with colorectal cancer

76%
Murlikiewicz Ł., Sygut A., Trzciński R., Grzegorczyk K., Rutkowski M., Dziki A.
Polish Journal of Surgery
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2010
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vol. 82
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issue 8
454-458
EN
Colorectal cancer is a major public health concern particularly in developed countries. Despite decades of advances in the treatment and prevention of colorectal cancer, it remains the second most common cause of cancer death. There now exists convincing evidence that reactive oxygen species play an important role in the etiology and progression of a number of human diseases including colorectal cancer. Reactive oxygen species may damage all types of biological molecules. However, proteins are possibly the most immediate vehicle for inflicting oxidative damage on cells since they are often catalysts rather than stoichiometric mediators, hence, the effect of damage to one molecule is greater than stoi-chiometric.The aim of the study was to investigate oxidative protein damage in patients with colorectal cancer and its correlation with the clinical stage of the disease.Material and methods. The study group comprised 102 patients operated on for colorectal cancer in different clinical stages of the disease. Plasma carbonyl levels were determined using Levin's method.Results. Patients in all tumor groups showed significantly higher levels of plasma carbonyls when compared to healthy people. We observed an increase in mean plasma carbonyl levels correlating with an increase in the degree of disease advancement.Conclusions. This study demonstrates that reactive oxygen species may have a role in pathogenesis of colorectal cancer. The outcomes of this research seem to confirm that antioxidants may play a role in chemoprevention of colorectal cancer.
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Evaluation of the Early Results of a Loop Stoma with a Plastic Rod in Comparison to a Loop Stoma Made with a Skin Bridge

64%
Dziki Ł., Mik M., Trzciński R., Buczyński J., Darnikowska J., Spychalski M., Wierzbicka A., Dziki A.
Polish Journal of Surgery
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2015
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vol. 87
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issue 1
31-34
EN
Loop stoma allows reducing the percentage of anastomotic leak and re-operation caused bythis complication. Our department has performed the loop stoma on a skin bridge since 2011. The aim of the study was to evaluate the early results of treatment after the skin bridge loop stoma creation in comparison with the stoma made on a plastic rod. Both groups had 20 patients. Material and methods. The study involved 40 patients with ileostomy, operated 2010-2013. We evaluated 20 patients with a loop ileostomy on a plastic rod, compared to 20 other patients with a skinbridge ileostomy. The study included 24 men and 16 women. Median age was 68.3. All evaluated patients were previously operated due to rectal cancer. Results. It has been shown that the surgical site infection is more common in the group with a plastic rod (5 vs 1 patient). Inflammation of the skin around the stoma occurred in 18 patients (90%) in the first group, while no such complication was found in patients in the second group. The average number of exchanged ostomy wafers was 2,9 per weekin the first group of patients, and 1,1 in the second group (p 0,05). Conclusions. The creation of the skin bridge stoma allows for tight fit of the ostomy appliance immediately after surgery completion. The equipment has stable and long-lasting contact with the skin, no skin inflammatory changes occur. Also the surgical site infection rates are lower in this group of patients. As perioperative patient does not require an increased number of ostomy appliance, the cost of treatment can be considered as an important aspect.
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Expression of the PLS3 Gene in Circulating Cells in Patients with Colorectal Cancer

64%
Kujawski R., Przybyłowska-Sygut K., Mik M., Lewandowski M., Trzciński R., Berut M., Dziki Ł., Majsterek I., Dziki A.
Polish Journal of Surgery
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2015
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vol. 87
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issue 2
59-64
EN
Circulating tumor cells (CTC) are cells in circulating blood that have the antigen and gene features of tumor cells of a specific type. Since they can be potentially used in diagnostics and monitoring of treatment of many tumors, they have been attracting attention of researchers worldwide. Plastin-3 (PL S3) is one of such markers of CTC. The aim of the study was to assess expression of PL S3 in CTC in patients with colorectal cancer, to conduct a statistical analysis and to demonstrate a link between expression of PL S3 and progress of the disease, level of CEA and Ca19-9 markers, gender and age of the patients. Material and methods. A group of 85 patients of the Department of General and Colorectal Surgery of the Medical University in Łódź were enrolled in this study. Circulating tumor cells were isolated from whole blood of patients with colorectal cancer and an analysis of PL S3 gene expression in CTC was conducted. The next step was to conduct a statistical analysis and to demonstrate a link between expression of PL S3 in patients’ CTC and progress of the disease, level of CEA and Ca19-9 markers, gender and age of the patients. Results. PL S3 is a marker which can be potentially used in prediction and monitoring of colorectal cancer. A link between expression of PL S3 in CTC of patients with colorectal cancer and metastasis to lymph nodes has been demonstrated. It may be of key importance how PL S3 could impact the qualification to supplementary cancer treatment in patients with stage II colorectal cancer. A link between expression of PL S3 gene in CTC and gender requires further in-depth studies. It is beyond doubt that PL S3 must be further investigated to determine its role in diagnostics, prediction, treatment and monitoring of treatment of colorectal cancer
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Large Colorectal Polyps - Endoscopic Polypectomy as an Alternative to Surgery

64%
Spychalski M., Buczyński J., Cywiński J., Dziki Ł., Langner E., Sygut A., Trzciński R., Dziki A.
Polish Journal of Surgery
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2011
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vol. 83
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issue 10
531-536
EN
Endoscopic polypectomy of colorectal polyps is a common procedure. However, endoscopic treatment of large polyps (those with a diameter exceeding 2 cm) remains questionable. There is a serious risk of colorectal carcinoma presence inside these lesions, which eventually would require surgical intervention. Apart from this fact endoscopic polypectomy of large polyps is connected with substantial risk of complications, such as perforation and bleeding. Many patients with large colorectal polyps are qualified for surgical intervention.The aim of the study was to determine the efficacy and safety of polypectomy of large colorectal polyps.Material and methods. The study presented results of endoscopic treatment in case of patients with large colorectal polyps at the Department of General and Colorectal Surgery, Medical University in Łódź. Patients were admitted to the hospital during the period between January, 2008 and January, 2010. The following parameters were analysed: location of polyps, percentage of high grade dysplasia, complete excision rate, and complications connected with polypectomy procedures.Results. During the analyzed period of time 488 endoscopic polypectomies were performed. Forty-three large colorectal polyps were removed (8.8%). Seven (16.3%) of them were classified as flat polyps. Out of 488 removed polyps, 39 were classified as adenomas with high grade dysplasia (7.9%), while 16 were large-exceeding 2 cm (37.2%). Considering the group of large polyps no invasive carcinoma case was detected. The radical excision rate for large pedunculated polyps was obtained in 88.8% (32/36) of cases. In case of flat adenomas the above-mentioned parameter was lower - 57.1% (4/7). During polypectomy of large colorectal polyps one perforation was observed during the excision of a flat cecal polyp. In two cases immediate bleeding occurred (2/43). In both cases endoscopic treatment of bleeding proved sufficient.Conclusions. Endoscopic polypectomy of large pedunculated polyps is a safe and efficient method, which makes it a rationale alternative for surgery. Polypectomy of flat adenomas is connected with a lower radical excision rate and higher risk of perforation.
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Recommendations for the Management of Trauma or Surgery-Related Massive Blood Loss

40%
Paluszkiewicz P., Mayzner-Zawadzka E., Baranowski W., Bręborowicz G., Brzeziński M., Durek G., Dziki A., Czupryńska M., Lipińska-Gediga M., Łętowska M., Mital A., Nowacka E., Pychyńska-Pokorska M., Ratajczak J., Rogowski J., Rybicki Z., Sobieszczyk S., Trzciński R., Wawrzynowicz-Syczewska M., Windyga J., Wujtewicz M.
Polish Journal of Surgery
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2011
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vol. 83
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issue 8
465-476
EN
Exsanguination is an underestimated cause of treatment failures in patients with severe trauma or undergoing surgery. In some patients the primary dysfunction of blood clot formation is a direct cause of a massive blood loss. Patients without previous coagulation disorders are at risk of coagulopathy following intraoperative or post-traumatic bleeding, where the local haemostasis does not warrant bleeding cessation.The aim of the study was to assess the therapeutic value of various components of a complex interdisciplinary approach, based on the opinion of the experts treating patients with massive bleeding.Material and methods. The study was conducted by anonymous questionnaire, using the analogue representation of the argument strength. The results were analyzed based on the techniques of descriptive statistics. The argument was considered a key parameter, when the median value of strength was located in the highest quartile.Results. It was found that the arguments of the highest strength for the risk of developing the posthaemorrhagic coagulation disorders are: loss of more than one third of blood volume, fluid therapy in an amount greater than 35 ml / kg, administration of more than 5 units of packed red blood cells, insufficient supply of fresh frozen plasma and platelets in proportion to packed red blood cells, severe acidosis and hypothermia. The most important tests for post-haemorrhage coagulopathy are: anatomically non-localized bleed, abnormal values of the standard coagulation parameters and fibrinogen level below 1 g / L. In the treatment of post-haemorrhagic coagulopathy the team of experts pointed out the benefits of antifibrinolytic drugs, concentrates of prothrombin complex and recombinant activated coagulation factor VII.Conclusions. Multidisciplinary therapeutic management of bleeding patients is associated with employment of appropriate treatment methods to achieve the best possible outcome. Factors influencing the development of coagulopathy, the methods of diagnosis and proposed techniques of treatment may facilitate therapeutic decisions in bleeding patients requiring massive transfusion of blood components.
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