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1
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On Endocrine Surgery - From Tumor Surgery to Evidence Based Surgery

100%
Pomorski L.
Polish Journal of Surgery
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2010
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vol. 82
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issue 1
1-3
2
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Physician as an Infective Vector at a Department of Surgery

51%
Paduszyńska K., Rucińska L. G. M., Pomorski L.
Polish Journal of Surgery
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2015
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vol. 86
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issue 11
511-517
EN
This study was designed to assess the degree of risk of bacterial transmission from physician to patient through hands, equipment and enclosing surfaces (shoe soles). Material and methods. The study was conducted in the Clinical Department of General and Oncological Surgery UM in Łódź. In days 16.10.2013, 17.10.2013, 18.10.2013 there were done swabs from hands, stethoscopes and soles of shoes from the same group of physicians before and after doctor's rounds. The presence of alert-pathogens in swabs was regarded as positive result. Results. Isolates included mostly aerobic saprophytic bacilli and Staphylococcus species coagulase-negative. There were detected a singly cases of Acinetobacter Baumani and Escherichia coli. Alert-pathogens were found in 4 (16%) swabs taken from hand before doctor's rounds and in 7 (28%) swabs taken after rounds. Stetoscopes were contaminated by alert-pathogens in 3 (12%) cases before doctor's rounds and in 3 (12%) cases taken after doctor's rounds. Soles of shoes were contaminated by alert-pathogens in 14 (56%) cases taken before and 16 (65%) cases taken after doctor's rounds. Conclusions. 1. Physicians are important factor of bacterial transmission in hospital. 2. Hands, stetoscopes and particularly soles of shoes of medical staff is the source of infection.
3
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Patients Subject to Surgery due to Acute Abdominal Disorders during the Period between 2001-2004

51%
Paduszyńska K., Celnik A., Pomorski L.
Polish Journal of Surgery
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2012
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vol. 84
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issue 10
488-494
EN
was to evaluate the clinical spectrum of emergency surgery for acute abdominal disorders and their outcome. Material and methods. The study group comprised 1426 patients, aged between 10 and 92 years subject to emergency surgery, due to an acute abdomen during the period 2001-2004. Analysis comprised age, sex, concomitant diseases, ASA scale classification, postoperative diagnosis, type of surgery, complications, mortality and duration of hospitalization. Patients were divided into two age groups: <60 and ≥60 years. Results. Appendicitis was the most common diagnosis (52.9%) in patients under 60 years, while cholecystitis (32.5%) and ileus (30.9%) in patients over 60 years. Complications were observed in 14.8% patients, the most common being related with wound healing (5.6%). The mortality rate amounted to 5.7%. Mortality was most often associated with bowel obstruction (29.2%), surgery for acute bowel ischemia (25.5%), and bowel perforation (20.7%). The mean duration of hospitalization was 7.9 days. Conclusions. 1. In comparison to elective surgery, emergency abdominal operations, particularly in elderly patients are related with a higher mortality rate. 2. In elderly patients, the high mortality rate and substantial number of complications is associated with the advanced primary disease and severe coexisting comorbidities, which significantly reduce the overall health condition.
4
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Papillary Thyroid Microcarcinoma - Own Experience

51%
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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Evaluating the Prognostic Value of Selected Prognostic Scales in Patients Operated on Due to Peritonitis

45%
Paduszyńska K., Kaczka K., Dworzyńska A., Sieniawski K., Pomorski L.
Polish Journal of Surgery
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2015
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vol. 86
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issue 9
422-428
EN
The aim of the study was to assess the usefulness of prognostic scales: ASA (American Society of Anesthesiologist), MPI (Meinheim Peritonitis Index), MOFS (the Multiple Organ Failure Score) and SPI (the Simple Prognostic Index) in the prognosis of the course of disease in patients operated on for peritonitis. Material and methods. The study was conducted in the Clinical Department of General and Oncological Surgery of the Medical University in Łódź between January 2009 to December 2010. During this period 263 patients were operated on for peritonitis. Before surgery all patients were classifed into particular groups according to the above mentioned prognostic scales according to their criteria. Results. There were 29 (11%) deaths. ASA ≥4 (p<0.0001), MPI >30 (p<0.0001) MOFS ≥2 (p<0.0001), SPI II, III, IV (p<0.0001) were important risk factors of death. Conclusions. 1. ASA, MPI, MOFS and SPI scales are of high signifcance in predicting the outcome in patients operated on for peritonitis. 2. The ASA scale in spite and due to its simplicity is adequate enough to be used in everyday practice in patients operated on for peritonitis. 3. The MPI scale is most suitable in the scientifc aims and in comparing the outcomes of patients operated on for peritonitis.
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Acinetobacter Baumannii Nosocomial Infections

45%
Sieniawski K., Kaczka K., Rucińska M., Gagis L., Pomorski L.
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vol. 85
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issue 9
483-490
EN
Nosocomial infections caused by strains Acinetobacter baumannii strands are a growing clinical problem. The occurrence of multidrug-resistant strands is observed and that limits the ways of therapy considerably. The aim of the study was to determine the rate of infection and susceptibility spectrum of the species Acinetobacter baumannii isolated from patients treated at Maria Skłodowska-Curie Memorial Hospital in Zgierz with particular emphasis on surgical wards. Materials and methods. The material consisted of Acinetobacter baumannii isolates were obtained from samples of materials from patients treated at Maria Skłodowska-Curie Memorial Hospital in Zgierz from January to December 2011. Isolated bacterial strains were cultured at microbiological substrates. Isolates were identified to species using the VITEK 2 GN card (bioMérieux) and Vitek 2 automated system (bioMérieux). Susceptibility towards antibiotics of particular strains was determined by the means of AST NO 93 card. In the case of resistance towards carbapenem, the MIC was marked by E-test with Mueller Hinton substrate. The occurrence of MBL was verified by the means of disc system with Mueller Hinton substrate. Results. We have shown that total number of Acinetobacter baumannii infections at hospital was 140 (10,31% of total results of cultures). Percentage of Acinetobacter baumannii infections at wards: Intensive Care Unit 48%, Surgical Departments 20%, Internal Diseases Department 16%, Neurology 13%, other wards - 3%. The susceptibility percentage of Acinetobacter Baumannii against antibiotics: colistin 90%, imipenem 64%, meropenem 43%, ampicillin-sulbactam 28%, amikacin 27%, gentamicin 24%, cefepime 9%, ceftazidime 7%, ciprofloxacin 7% Conclusions. Acinetobacter baumannii infections are a significant proportion of nosocomial infections. Most relate to surgical wards and ICUs. Acinetobacter baumannii is resistant against most antibiotics. The highest percentage of sensitivity demonstrated for colistin and carbapenems
7
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Total Thyroidectomy for Nodular, Benign Thyroid Diseases in Terms of Larynx Function Examinations - Is it a New Treatment Standard?

45%
Kaczka K., Jankowski W., Kopczyński J., Kwiecień J., Pomorski L.
Polish Journal of Surgery
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2010
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vol. 82
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issue 1
4-11
EN
Aim of the study was the assessment of total thyroidectomy (TT) value as a treatment method of goiter with particular emphasis on the results of laryngological examination.Material and methods. From 15th April 2008 to 1st July 2009 there were 125 (72.7%) TTs, 12 (7%) TTs and appropriate lymphadenectomies, 9 (5.2%) near TTs, 14 (8.1%) lobectomies, 5 (2.9%) completion thyroidectomies and 6 (3.4%) other operations. Vocal cords function was assessed routinely one day before, two days after operation by an otolaryngologist. Voice quality was assessed by patients in VHI questionnaire theirselves.Results. Five patients had one-sided vocal cord paralysis before the operation. The one-sided transient recurrent laryngeal nerve injuries was observed in 16 other patients (9.3% among patients and 4.6% among nerves at risk) in the second day after the operation. There was no bilateral recurrent laryngeal nerve injury. From three to six months after the operation, 21 (among 23) patients with vocal cord movement disability were examined once again by the same otolaryngologist. The same vocal cord paralysis was observed in 4 sicks (one person died), which was found preoperatively. Seven (4%) other patients had permanent one vocal cord paresis. This represents 2% the nerves at risk. Three of them were recognized benign lesions and four thyroid cancer. Our percentage of early, postoperative hypoparathyroidism was 6.4% and persistent was 1.7%. VHI score in the group with paresis or paralysis of vocal cord gave the score of 4 to 90 points- an average of 49 points. In patients with proper vocal cord movement there were results from 0 to 6 points- an average of 2 points.Conclusions. 1. Total thyroidectomy in the treatment of bilateral goiter without malignancy features is radical and safe procedure. 2. It protects against goiter relapse and its consequences. 3. Complications rates after total thyroidectomy are at acceptable and comparable proportions to the other operation types.
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Adrenal Metastases

39%
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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Operations on Adrenal Gland Tumours in A Multicentre Study at the Łódź Medical University

39%
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

39%
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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