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1
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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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Navigation with Use of Intra-Operative Ultrasound in Search for Neoplastic Lesions of Endocrine Glands

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Sopiński J., Kuzdak K.
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vol. 85
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issue 5
262-270
EN
was to evaluate the effectiveness of intraoperative ultrasonography (IOUS) during operations of endocrine glands tumors. Material and methods. The study was conducted in patients who underwent endocrine operation in Department of Endocrine, General and Vascular Surgery, Medical University in Łódź in 2008-2011. Results. Patients with thyroid cancer recurrences:in study group we managed shorter lesion access time (10 ± 4.47 min vs 16.78 ± 8.9 min; p=0.04). Time of surgery was also shorter in study group (75 ± 30.17 minvs 85,71 ± 38.92 min), but it was not significant (p=0.46). The use of IOUS did not affect the hospitalization time (2.91 ± 1.64 days vs 3 ± 1.66 days; p=0.820), intraoperative blood loss (45.45 ± 105.96 ml vs 40 ± 82.89 ml; p=0.972) and the rate of intraoperative complications (1/11 - 9.09% vs 2/14 - 14.29%; p=1). Patients with primary hyperparathyroidism: the time of surgery (58± 22.74 min vs 65 ± 19.6 min; p=0.336) and the lesion access time (13.33 ± 7,94 min vs 17.25 ± 8.19 min; p=0.169) were shorter in study group. Hospitalization time was longer in study group (6.13 ± 5.3 days vs 4.45 ± 4.58 days; p=0.079). The rate of intraoperative complications was higher in study group (3/15 - 20% vs 2/20 - 10%; p=0.631). None of this results were statistically significant (p≤0.05). Patients who underwent open adrenalectomy: in study group we managed significantly shorter time of surgery (70 ± 44.35 min vs 80.12 ± 29.60 min; p=0.033) and shorter lesion access time (12 ± 8.88 min vs 17.37 ± 7.42 min; p=0.045). The use of IOUS did not affect the hospitalization time (5.6 ± 1.65 days vs 6.35 ± 2.38 days; p=0.429), intraoperative blood loss (110 ± 164.65 ml vs 172.5 ± 226.35 ml; p=0.442) and rate of intraoperative complications (0/10 vs 1/40; p=1). Patients who underwent videoscopicadrenalectomy: in study group we managed to get shortertime of surgery (89.44 ± 27.11 min vs 109.12 ± 33.88 min; p=0.034) and shorter lesion access time (28.61 ± 14.93 min vs 45.98 ± 20.44 min; p=0.002). Intraoperative blood loss was also significantly lower in study group (86.11 ± 157 ml vs 169.27 ± 201.04 ml; p=0.037). The use of IOUS did not affect the hospitalization time (4.39 ± 3.27 days vs 3.83 ± 3.67 days; p=0.227), the rate of intraoperative complications (0/18 vs. 2/41; p=1) and the conversion rate (2/20-10% vs. 5/46- 10.87%; p=1). Conclusions. 1.During adrenalectomies this technique facilitates finding the pathological lesion shortening the time of access to the tumor and procedure duration. 2. IOUS is useful for determining the tumor relationship with the surrounding anatomical structures. 3. IOUS isa useful technique in the assessment of adrenal tumor infiltration of vena cava. 4. The use of IOUS allows the surgeon to assess anatomical relationships in the real time, after incision and retraction of tissues. 5. During operations of thyroid cancer recurrences using this technique makes easier to find a lesion in the operated area and it is possible to asses radical of surgery. 6. The use of IOUS allows to find pathological parathyroid glands inside thyroid gland. 7. IOUS is useful in the detection of thyroid pathology during parathyroidectomy.
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Navigation with the Use of Intraoperative Ultrasonography in Videoscopic Adrenal Surgery

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Sopiński J., Kuzdak K.
Polish Journal of Surgery
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2012
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vol. 84
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issue 8
399-405
EN
The aim of the study was to assess the efficacy of intraoperative ultrasonography during videoscopic adrenalectomy.Material and methods. The study was conducted in patients undergoing extraperitoneal videoscopic adrenalectomy for adrenal tumours in the Department of Endocrine, General and Vascular Surgery of the Medical University in Łódź in 2008-2011.Results. The active group consisted of 20 patients in whom navigation with the use of intraoperative ultrasonography (IOUS) was used in the course of surgery. The comparison group consisted of 46 patients operated without the use of IOUS. In the active group, we managed to obtain a shorter time of surgery by almost 20 min (89.44 ± 27.11 min vs 109.12 ± 33.88 min; p=0.034) and a shorter lesion access time by more than 15 min (28.61 ± 14.93 min vs 45.98 ± 20.44 min; p=0.002). Intraoperative blood loss was also significantly lower in the active group (86.11 ± 157 ml vs 169.27 ± 201.04 ml; p=0.037). In contrast, the use of IOUS did not affect the hospitalisation time (4.39 ± 3.27 days vs 3.83 ± 3.67 days; p=0.227), the rate of intraoperative complications (0/18 vs 2/41; p=1) and the conversion rate (2/20 - 10% vs 5/46 - 10.87%; p=1).Conclusions. 1. Intraoperative ultrasonography is useful for determining the tumour relationship with the surrounding anatomical structures. 2. Intraoperative ultrasonography is a useful technique in the assessment of adrenal tumour infiltration of the surrounding tissues. 3. This technique facilitates finding the pathological lesion, shortening the time of access to the tumour and procedure duration (thus reducing the burden for the patient). 4. Reduced blood loss was also obtained owing to the use of IOUS.
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Bleeding Liver Tumor in a Patient on Anticoagulation Therapy – Case Report

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Migdalski Ł., Kuzdak K.
Polish Journal of Surgery
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2015
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vol. 87
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issue 12
641-643
EN
Intraabdominal bleeding is a serious surgical problem, particularly in elderly patients following an anticoagulant therapy. It occurs, that abdominal haemorrhage is the first symptom of hepatocellular carcinoma, mostly in Asians and Africans, occasionally in Europeans. The article's author shows a case of an elderly man, treated by Acenocumarolum, in a haemorrhagic shock. During an operation a bleeding liver tumor was revealed. The surgical team performed an effectual tumor resection and stoped the bleeding.
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Intraoperative Parathyroid Hormone Level as a Predictor of Post-Thyroidectomy Hyproparathyrodism

81%
Lewandowicz M., Kuzdak K., Pasieka Z.
Polish Journal of Surgery
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2009
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vol. 81
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issue 8
340-347
EN
Hypoparathyroidism is the most common complication of thyroid surgery. Accurate treatment of this condition requires early diagnosis of patients at risk of hypocalcemia.The aim of the study was to evaluate the predictive value of intraoperative parathyroid hormone assessment in identification of affected subjects.Material and methods. Sixty five subjects participated in the prospective study. They underwent bilateral neck exploration with subtotal or total thyroidectomy. Parathormone (PTH) and calcium levels were assessed prior to surgery, intraoperatively and at different time-points following the operation.Results. In respect of the results, patients were allocated into 3 groups: (A) subjects with asymptomatic course; (B) subjects with perioperative symptomatic hypocalcemia; (C) subjects with prolonged symptomatic hypocalcemia. No differences between these groups were observed in the intraoperative calcium levels. Intraoperative parathormone (ioPTH) level was significantly lower in group C and at value minor of the reference range identified group C subjects with sensitivity and specificity of 100 and 91.5%, respectively. Mean intraoperative PTH level decrease (ΔioPTH) of 22.5% was observed. ΔioPTH rate was significantly higher (81.4%) in group C. This parameter presented sensitivity of 66.7% and specificity of 93.2% in identification of group C patients.Conclusions. Single intraoperative PTH level assessment identifies subjects at risk of postoperative hypoparathyroidism. Intraoperative drop of PTH (ΔioPTH) proves less sensitive. Intraoperative calcium levels cannot be regarded as a predictor of this complication.
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Papillary Thyroid Microcarcinoma - Own Experience

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Pomorski L., Pasieka Z., Kuzdak K.
Polish Journal of Surgery
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2008
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vol. 80
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issue 11
604-608
EN
Papillary thyroid microcarcinoma is a particular form of cancer of the thyroid gland. This term, according to the WHO classification, is applied to papillary tumors no larger than 1.0 cm in diameter, which are incidentally detected during the postoperative histopathological examination. In clinical practice, the term pertains to all papillary tumors of the size smaller than or equal to 1 cm.The aim of the study was to determine the prevalence of papillary thyroid microcarcinoma and its selected histopathological characteristics among patients with malignant cancer of the thyroid gland identified in our own material in the years 2000-2007.Material and methods. The study included 523 patients treated for thyroid carcinoma: 401 (76.7%) women and 122 (23.3%) men aged 12-83 years (mean 49.8 years). Surgeries were carried out according to the Polish Group for Endocrine Carcinomas recommendations, in compliance with the European consensus.Results. Papillary thyroid carcinoma was identified in the postoperative histopathological examination in 391 (74.8%) patients; 285 (72.9%) women and 106 (27.1%) men. Their age ranged from 14 to 75 years (mean 49.3 years).Among 391 cases, tumor progression classified according to the WHO criteria (3) was as follows: T1 in 260 (66.5%), T2 in 59 (15.1%), T3 in 53 (13.5%) and T4 in 19 (4.8%) patients.In 150 cases (38.4% of papillary tumors), the tumor fulfilled the morphological criteria for microcarcinoma (4) and was detected in 118 (78.7%) women and 32 (21.3%) men. Carcinoma was identified in the neutral goiter in 138 cases, and in 12 patients in hyperactive, including 9 in nodular and 3 in Graves' goiters. The disease was suspected or diagnosed preoperatively or at surgery in 112 patients. Postoperative diagnosis was performed in 38 (25.3%) individuals with micrcarcinoma. Twenty-four (38%) of 63 patients with multifocal tumors were subjected to adjunctive surgery as their cancer diagnosis was made only postoperatively in the histopathological examination. The subcapsular location of microcarcinoma was found in 78 (49.4%) cases including capsular infiltration and extracapsular invasion in 14 patients. The exact histopathological examination showed multifocality in 63 (42%) cases and involvement of the local lymph nodes in 29 (19.3%) patients. In 21 cases, the central compartment lymph nodes were involved. The presence of metastases in the central and lateral lymph node compartment was observed in 5 cases; in 3 patients skip metastases were detected in the lateral compartment on the tumor side omitting the central compartment. No patient with microcarcinoma diagnosed between the years 2000 and 2007 revealed distant metastases.Conclusions. Due to contemporary diagnostics, papillary thyroid microcarcinomas - tumors up to 1 cm - are most commonly identified cancers of the thyroid gland. High accuracy of US-guided fine-needle aspiration biopsy of high resolution permits to diagnose the majority of these tumors prior to surgery.
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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

81%
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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One-Day Thyroid Surgery – Is it Safe?

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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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Adrenal Metastases

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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

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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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Analysis of the Analgesic Effect of Metamizole Sodium in Patients Operated on for Goitre

62%
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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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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