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Surgical Treatment of Rectovaginal Fistulas

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EN
Rectovaginal fistulas account for less than 5% of all anorectal fistulas. They may occur as a result of obstetrical injuries, inflammatory bowel diseases, or pelvic cancer irradiation.The aim of the study was to describe the results of different methods of surgical treatment according to the etiology and localization of rectovaginal fistulas.Material and methods. The study included 23 female patients who underwent operations for rectovaginal fistulas within the period of 1995 to 2006. The age of patients ranged from 18 to 64 years, with an average age of 41 years.14 patients received radical treatment according to the etiology and localization of the fistulas: four were treated with abdominal approach, six with a local excision of the rectovaginal fistula involving layer closure of rectal and vaginal openings and interposition of musculomucosal flaps, and four with a simple fistulectomy involving the removal of inflamed tissue and the reconstruction of the perineal body, anal sphincters, and all layers of the rectal and vaginal walls.In nine cases, patients received a palliative surgical treatment to address extensive tissue destruction resulting from radiotherapy for uterine cervix cancer or advanced rectal cancer.Results. Complete recovery occurred in patients who underwent laparotomy for rectovaginal fistulas following inflammatory bowel disease or complicating anterior resection of the rectum. Patients operated on using rectal and vaginal approaches displayed positive results, as did those who underwent. fistulectomy with perineal body and anal sphincter reconstruction.Conclusions. Various surgical techniques are available for the management of rectovaginal fistulas depending on their etiology, size, and location. The best results of low rectovaginal fistula treatment occurred using fistulectomy with layer closure and both-sided covering of the tissue defect with advancement vaginal and rectal flaps.
EN
Introduction: The aim of the study was to attempt to analyze the most common causes leading to dizziness, vertigo and balance disorders according to gender and age. Material and methods: Analysis of medical records and evaluation of VNG tests were performed on 608 patients of the private ENT practice “VERTIGO” in Opole between 2011 and 2017, including 404 women and 204 men. The patients’ age was in the range from 18 to 85 years, average age 49.88 years. The following parameters were taken into account in the analysis: the result of the subjective examination and the basic ENT and otoneurological examination, videonystagmographic examination, hearing assessment (tonal and impedance audiometry) and imaging tests (head MRI/CT and cervical spine x-ray), assessment of doppler ultrasound examination of vertebral arteries flow. Results: In examinations patients dizziness and vertigo were more common in women (66.45%) than men (33.55%), the most numerous was group of patients over 60 years, i.e. 30, 76%, systemic ver-tigo predominated (61.02%). Hypertension was the most common chronic disease in the entire popu-lation of patients with dizziness, vertigo and balance disorder and its frequency increases with age, which translates into an increase in the frequency of non-systemic and mixed dizziness reported by patients. The frequency of lipid metabolism disorders increases statistically significantly with age, while thyroid dysfunction as well as migraines and frequent headaches are significantly more com-mon in women reporting dizziness, vertigo and balance disorder than in men. In doppler ultrasound examination, while with age the frequency of bilateral disorders in vertebral artery flow increases significantly. The percentage of individual diagnoses in the examined patients was as follows: ves-tibular disorder (35.86%), benign paroxysmal positional vertigo (18.9%), mixed vertigo (16.12%), cervical vertigo (5.42%), Méniére's disease and its suspicion (5.1%), vertigo and dizziness of central origin (3.78%), vascular vertigo (2.8%), vestibular neuritis (2.3%), post-traumatic dizziness (1.32%) and the cerebellopontine angle tumors (0.16%). In the VNG study: in visual-oculomotor tests an in-crease in the percentage of pathology with age between 51 and 60 years old. Conclusions: The structure of diagnoses made in private practice differs from public health care. This results from the fact that the patient with acute symptoms first goes or is transported to the hospital emergency department. The second reason is the cost of diagnostics in the private sector which is not affordable to every patient.
EN
Introduction: The aim of the study was to attempt to analyze the most common causes leading to dizziness, vertigo and balance disorders according to gender and age. Material and methods: Analysis of medical records and evaluation of VNG tests were performed on 608 patients of the private ENT practice “VERTIGO” in Opole between 2011 and 2017, including 404 women and 204 men. The patients’ age was in the range from 18 to 85 years, average age 49.88 years. The following parameters were taken into account in the analysis: the result of the subjective examination and the basic ENT and otoneurological examination, videonystagmographic examination, hearing assessment (tonal and impedance audiometry) and imaging tests (head MRI/CT and cervical spine x-ray), assessment of doppler ultrasound examination of vertebral arteries flow. Results: In examinations patients dizziness and vertigo were more common in women (66.45%) than men (33.55%), the most numerous was group of patients over 60 years, i.e. 30, 76%, systemic ver-tigo predominated (61.02%). Hypertension was the most common chronic disease in the entire popu-lation of patients with dizziness, vertigo and balance disorder and its frequency increases with age, which translates into an increase in the frequency of non-systemic and mixed dizziness reported by patients. The frequency of lipid metabolism disorders increases statistically significantly with age, while thyroid dysfunction as well as migraines and frequent headaches are significantly more com-mon in women reporting dizziness, vertigo and balance disorder than in men. In doppler ultrasound examination, while with age the frequency of bilateral disorders in vertebral artery flow increases significantly. The percentage of individual diagnoses in the examined patients was as follows: ves-tibular disorder (35.86%), benign paroxysmal positional vertigo (18.9%), mixed vertigo (16.12%), cervical vertigo (5.42%), Méniére's disease and its suspicion (5.1%), vertigo and dizziness of central origin (3.78%), vascular vertigo (2.8%), vestibular neuritis (2.3%), post-traumatic dizziness (1.32%) and the cerebellopontine angle tumors (0.16%). In the VNG study: in visual-oculomotor tests an in-crease in the percentage of pathology with age between 51 and 60 years old. Conclusions: The structure of diagnoses made in private practice differs from public health care. This results from the fact that the patient with acute symptoms first goes or is transported to the hospital emergency department. The second reason is the cost of diagnostics in the private sector which is not affordable to every patient.
EN
Coccygodynia is a problem with a small percentage (1%) of the population suffering from musculoskeletal disorders. This pain is often associated with trauma, falling on the tailbone, long cycling, or by women after childbirth. The reason for the described problem can be the actual morphological changes. Idiopathic coccygodynia causes therapeutic difficulties to specialists of many fields. Unsatisfactory treatment, including coccygectomy tends to seek new solutions. They belong to them techniques exploited in the manual therapy which in their spectrum hold: direct techniques - per rectum as well as indirect techniques taking into account distant structures of the motor organ, remaining in dense interactions with the coccygeal part. Idiopathic coccygodynia is a result perhaps from exaggerated tension the muscle of the levator ani, coccygeus and gluteus maximus as well as from irritating soft tissue structures surrounding the coccyx: of sacrococcygeum, sacrospinale, and sacrotuberale ligament. Unfortunately we can’t see them in objective examinations so as: the RTG, MR or TK, therefore constitute the both diagnostic and therapeutic problem. For describing the problem a writing of the object was used both from the field of the surgery and of manual therapy. Detailed and multifaceted knowledge about causes of the described problem allows more accurately to categorize the patient to the appropriate group and helps to select the best procedure of treatment.
EN
INTRODUCTION: Despite the extreme levels of care given to pregnant women and newborns, there is a high risk of infant mortality during the first weeks post-delivery. Understanding the causes might be fruitful for gynaecologists and neonatologists in reducing the risk factors involved. This could be achieved by targeting perinatal and postnatal care. The aim of this research project was to analyse the causes of preterm and full term infant deaths during the period of 2010 to 2015. MATERIAL AND METHODS: The analysis was performed in accordance with the autopsy protocols provided by the Chair and Department of Pathomorphology, Zabrze. The data contains 103 protocols which involved infants within the age range 0–1 years. The obtained information collected in Microsoft Office Excel 2010. Further analysis of the data was conducted using the software StatSoft, Inc. Statistica 12.0. RESULTS: The highest mortality rate was observed in the neonatal period – 55 (75%) premature babies and 24 (80%) full-term babies. There was statistical significance in the frequency of both pulmonary diseases (p = 0.0094) – full-term (17%) and pre-term (42%) babies – and in congenital defects (p = 0.0012) – full-term (50%) and pre-term (18%) babies. CONCLUSIONS: The research showed that the main cause of death in 38% of pre-term babies was due to multi-organ failure, whereas those in the case of full-term babies (14%) was due to sudden cardiac arrest.
PL
WSTĘP: Pomimo wysokich standardów opieki nad kobietą ciężarną i noworodkiem, pierwsze tygodnie po porodzie stanowią szczególny okres życia o podwyższonym ryzyku zgonu. Przeprowadzenie analizy zgonów może zrodzić cenne sugestie, służące zarówno ginekologom, jak i neonatologom, pozwalające zmniejszyć umieralność w obu grupach. CEL:Celem pracy była analiza przyczyn zgonów wcześniaków i noworodków urodzonych o czasie w latach 2010– –2015. MATERIAŁ I METODY: Dane opracowano na podstawie protokołów sekcyjnych z lat 2010–2015 zgromadzonych w Katedrze i Zakładzie Patomorfologii SUM w Zabrzu. Przeanalizowano 103 protokoły sekcyjne. Uzyskane informacje zebrano w programie Microsoft Office Excel 2010. Analizę statystyczną przeprowadzono z wykorzystaniem programu StatSoft, Inc. Statistica version 12.0. WYNIKI: Okres noworodkowy obarczony jest wysoką śmiertelnością. W tym czasie zmarła większość poddanych badniu dzieci, w tym aż 55 wcześniaków (75%) i 24 dzieci urodzonych o czasie (80%). Choroby układu oddechowego występowały znamiennie częściej w grupie wcześniaków niż u dzieci urodzonych o czasie (42% i 17%; p = 0,0094). Odmienną tendencję stwierdzono w przypadku wad wrodzonych, które zdecydowanie częściej pojawiały się u dzieci urodzonych o czasie (p = 0,0012). Odnotowano je u 50% noworodków, podczas gdy w grupie wcześniaków wystąpiły jedynie u 18% badanych. WNIOSKI: Główną przyczyną śmierci wcześniaków była niewydolność wielonarządowa, która wystąpiła u 38% badanej grupy. Wśród noworodków urodzonych o czasie zasadniczą przyczyną zgonu było nagłe zatrzymanie krążenia.
EN
Resistant hypertension is defined as a clinical situation characterised by a failure to achieve lower systolic and diastolic blood pressure levels below 140 mm Hg and 90 mm Hg, respectively, despite the use of the principles of lifestyle modification as well as pharmacological treatment, including a diuretic as well as two other antihypertensives belonging to different groups, administered at adequate doses (mineralocorticoid receptor may not be included in the regimen). Previous studies suggest that the prevalence of resistant hypertension in the population of patients receiving antihypertensive treatment is 13%. According to a Polish nationwide survey NATPOL 2011, 13% of patients treated due to hypertension suffer from resistant hypertension. It was noted that factors predisposing and/or related to the development of resistant hypertension primarily include: advanced age, high/increased baseline blood pressure (systolic pressure in particular), obesity, excessive salt intake, chronic renal disease and diabetes. There is a consistent view that apart from non-compliance with lifestyle modification, an inadequate antihypertensive regimen and/or non-compliance with therapeutic indications are among the most common causes of treatment-resistant hypertension. Current recommendations for the management of patients with resistant hypertension also stress the importance of identifying the causes of secondary hypertension. This represents a very important element in the management of resistant hypertension and may facilitate pharmacological treatment. In the case of failure to achieve blood pressure target values, it is recommended to include a drug belonging to aldosterone receptor antagonists. If both, non-pharmacological and pharmacological therapies prove inefficient, surgical treatment of resistant hypertension may be considered in selected cases.
PL
Oporne nadciśnienie tętnicze definiowane jest jako sytuacja kliniczna, kiedy wykorzystując zasady modyfikacji stylu życia oraz leczenie farmakologiczne – obejmujące diuretyk i dwa inne leki hipotensyjne z rożnych grup w adekwatnych dawkach (schemat nie musi uwzględniać antagonisty receptora mineralokortykoidowego) – nie udaje się obniżyć ciśnienia tętniczego skurczowego i rozkurczowego odpowiednio poniżej 140 mm Hg i 90 mm Hg. Dotychczasowe badania wskazują na sięgający blisko 13% odsetek występowania opornego nadciśnienia tętniczego w populacji leczonej hipotensyjnie. Z ogolnopolskiego badania NATPOL 2011 wynika, że częstość występowania opornego nadciśnienia tętniczego sięga 13% chorych leczonych na nadciśnienie tętnicze. Zwrocono uwagę, że do czynnikow predysponujących do rozwoju opornego nadciśnienia tętniczego lub/i związanyc hz nim należą zwłaszcza: bardziej zaawansowany wiek, wysokie/wyższe wyjściowe ciśnienia tętnicze (przede wszystkim skurczowe), otyłość, nadmierne spożycie soli kuchennej, przewlekła choroba nerek czy cukrzyca. Panuje zgodny pogląd, że obok nieprzestrzegania zasad modyfikacji stylu życia jedną z najczęstszych przyczyn opornego nadciśnienia tętniczego jest niewłaściwy schemat leczenia hipotensyjnego lub/i niestosowanie się do zaleceń terapeutycznych. We wspołczesnych zaleceniach dotyczących postępowania z chorym na oporne nadciśnienie podkreśla się rownież znaczenie wykrycia przyczyny rozwoju nadciśnienia wtornego. Zajmuje to bardzo ważne miejsce w schemacie postępowania z chorym na oporne nadciśnienie tętnicze i może ułatwić prowadzenie leczenia farmakologicznego. W przypadku nieosiągnięcia docelowych wartości ciśnienia tętniczego zaleca się dołączenie leku z grupy antagonistow receptora aldosteronu. W sytuacji nieskuteczności terapii niefarmakologicznej i farmakologicznej w wybranych przypadkach do rozważenia pozostaje leczenie zabiegowe nadciśnienia opornego.
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