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Efficacy of Estimated Glomerular Filtration Rate in Prediction of the Early Complication After Peripheral Artery Reconstruction

100%
Kazimierczak A., Cnotliwy M., Gutowski P.
Polish Journal of Surgery
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2009
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vol. 81
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issue 11
512-517
EN
Glomerular Filtration Rate impairment is an important risk factor of complication after operation. The recognition of Chronic Kidney Disease prior to surgery assists in reducing postoperative complications. This is especially important for arteriosclerotic patients with kidney function impairment, which quite often persist unrecognized. Estimation of the eGFR identify patients with CKD and assist in the planning and modification of treatment.The aim of the study was evaluation of the number of patients with impaired kidney function (eGFR 15-60 ml/min/1.73 m2) from those referred for artery reconstruction. The analysis of early complications related to the impaired GFR.Material and methods. Prospective not-randomized trial of a group of 828 patients who had undergone surgical or endovascular procedures. On admission eGFR was assessed according to the Cockroft-Gault formula. Comparison in frequency and type of early complication was performed between two groups (eGFR ≤ 60 ml/min/1.73 m2 - 536 patients and eGFR 15-60 ml/min/1.73 m2 - 292 patients).Results. Impaired Kidney Function with eGFR in the range between 15- 60 ml/min/1,73 m2, was recognized in 35% of patients. In the impaired eGFR group gastrointestinal bleeding (p<0.0005), acute renal insufficiency (p<0.0005), pneumonia (p<0.05), diabetes decompensation (p<0.005) and myocardial infarct occurred more often (p<0.05) compared to the normal kidney group. Only a few general and local complications were noticed after the aortic arch arteries operations and endovascular procedures. No statistically insignificant differences were observed between both groups.Conclusions. Glomerular Filtration Rate assessment prior to surgery is useful in predicting severe complications after vascular surgery and should be performed on a regular basis.
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The Operation of Symptomatic Aneurysm of the Left Subclavian Artery with Supraclavicular Access

100%
Markiel Z., Gul T., Tomalski W.
Polish Journal of Surgery
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2007
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vol. 79
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issue 5
389-391
EN
The study presented a case of a 64-year-old woman with symptomatic aneurysm of the left subclavian artery. Because of comorbid diseases, the thoracic operation was associated with a high risk of complications. CT analyses enabled the surgeons to appropriately plan and perform a supraclavicular access operation, avoid possible complications, and shorten the length of hospitalization.
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Outcomes of Iatrogenic Femoral Artery Lesions - Treatment Results Valuation

100%
Łukasiewicz A., Hryncewicz W., Rychter M., Molski S.
Polish Journal of Surgery
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2009
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vol. 81
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issue 4
172-179
EN
Percutaneous cardiac interventions are nowadays the most common cause of the femoral artery injury. In these cases, surgical intervention was for many years considered the treatment of choice. Satisfactory results of conservative and minimally invasive treatment has changed the state of art.The aim of the study was the analysis of treatment results in patients with iatrogenic femoral aneurysm.Material and methods. In the period of 3 years between 2004 and 2006 in 66 patients an iatrogenic, spure femoral artery aneurysm was recognized. There were 36 women and 30 men in this group. The mean age was 68.8 years. All patients were included prospectively in the study. According to aneurysm morphology, compression pliability and patient choice 45 individuals were assigned to OT group, remaining 21 were treated conservatively: US-guided compression in all patients and thrombin injection if compression failed.Results. There was one death in OT group due to underlying coronary disease and in our opinion unrelated to surgical treatment. Other major adverse events were one postoperative stroke in OT group and superficial femoral artery thrombosis in NT group. 8 patients experienced minor events and they all were operative wound complications. No other complications were observed in NT group. Post procedural stay was longer for the OT group (8.7 vs 3.8 days, p<0.05). Length of hospital stay was also significantly correlated with presence of complications (5.5 days for patients without complications and 16.9 days for the complicated cases, p<0.001). The procedure was successful in 95.2% and 100% in the groups of NT and OT respectively.Conclusions. Utilized criteria of patients' assignment to conservative and operative treatment allowed plausible treatment results. OT and complications significantly increase the length of hospitalization. It is mandatory to remember of possible thrombotic complications related to thrombin injections.
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Career in vascular surgery – the medical student’s perspective

88%
Grobelna M. K., Stępak H., Kołodziejczak B., Dzieciuchowicz Ł., Oszkinis G.
Polish Journal of Surgery
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2017
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vol. 89(1)
33-41
EN
Aim: Under the supervision of the Department of General and Vascular Surgery of Poznan University of Medical Sciences, a questionnaire was distributed online or as a paper version to medical students (MSs) in order to better understand the attitudes towards surgery as a specialty and to determine the reasons why students do and do not choose vascular surgery as their career path. Materials and methods: The questionnaire was distributed online or as a paper version to MSs in the 3rd, 5th, and 6th year of the PUMS 6-year M.D. program. It provided the data on the year of study, grade point average (GPA), sex, age, respondent’s specialty choice, 33 questions with responses on a 1-5 Likert scale (1 was the least important reason and 5 was the most important reason), and 2 questions with socres between 0 and 4. A total of 136 Polish MSs of PUMS completed the survey. Results: For MSs who choose vascular surgery as their career path, “endovascular capabilities of vascular surgery” and “higher income possibilities than a general surgeon” were the most important reasons. The “poor availability of work in other places than the vascular surgery department of your choice, few such clinics in the region” was the most important reason not to choose vascular surgery. A role of gender was also noted - 13% of male MSs classified gender as an “important factor”, in contrast to 60% of female MSs. Conclusions: The findings of this study might help to develop better strategies to attract future trainees to surgical specialties, particularly vascular surgery, and improve work environment.
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Screening test for extracranial carotid lesions’ detection in patients of an outpatient vascular clinic

88%
Każmierski P., Pająk M., Kruś-Hadała J., Jęckowski M., Bogusiak K.
Polish Journal of Surgery
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2019
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vol. 91(5)
5-11
EN
Purpose The objective of the study was to evaluate the frequency and severity of atherosclerotic lesions in extracranial sections of carotid arteries and to determine the level of the correlation between these lesions and symptoms of cerebral ischemia. Secondly, to identify the most common risk factors of ischaemic stroke occurrence in population of patients of vascular outpatient clinic. Material and Methods Prospective study was conducted on a group of 1,000 people (217 women and 783 men), aged 50 to 86 years, the average age was 62 years (± 9.95). Results Atherosclerotic lesions of carotid arteries were observed in 670 examined people (67%). In 63 cases (6.3%) carotid artery occlusion was revealed. Patients with symptomatic carotid artery stenosis more frequently were addicted to cigarettes and suffered from hypertension in comparison to asymptomatic group. A statistically significant correlation between the TIA or ischemic stroke and smoking were noticed, as well as between TIA/ischemic stroke and hypertension Conclusions Among patients with atherosclerosis of peripheral arteries atherosclerotic lesions in the extracranial carotid sections occur with a high frequency. Statistically significant differences in the incidence and severity of atherosclerotic lesions in the carotid arteries were observed in this group. A statistically significant correlation was revealed between the prevalence and severity of atherosclerosis in the carotid arteries in symptomatic patients and smoking and hypertension. Performing screening in patients with atherosclerosis of the abdominal aorta and/or lower limb arteries may detect significant carotid artery stenosis, requiring surgical intervention.
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REPRINTED WITH PERMISSION OF EDITOR-IN-CHIEF OF ANNALS OF SURGERY: Annals of Surgery: Vol. 266, nr 5, November 2017; 703 - 705: Modern Surgeons: Still Masters of Their Trade or Just Operators of Medical Equipment?

75%
Krawczyk M.
Polish Journal of Surgery
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2018
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vol. 90(2)
1-4
EN
My surgical education began at a time when Poland formed part of the communist bloc and was isolated from the world, or in today’s Terms – it remained behind the Iron Curtain. This was true of all areas of life, including medicine. When after 40 years of work, I look back at my professional career; I wonder whether I owe my proficiency in surgery to my experience and dexterity or, like many others, to technological progress. Two of the great Polish surgeons were my mentors and teachers. Professor Zdzisław Łapiński was the one I met first. He was a manual genius and an unusual operational strategist. Granted, he had one character defect, but nobody’s perfect after all. In 1975, I defended my dissertation. I was convinced that I should continue my education at a center abroad, preferably within a postdoctoral scholarship. Professor Łapiński wanted me to learn everything about surgery from him. I decided otherwise, and in 1978 with his tacit agreement, I obtained a Humboldt Fellowship and went to Heidelberg, to the department headed by none other than Professor Fritz Linder.1 I started my research for the habilitation thesis at the Experimentelle Chirurgie Abteilung of his Department.
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Perioperative Antibiotic Prophylaxis in Clinical

75%
Jawień M., Bulanda M.
Polish Journal of Surgery
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2010
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vol. 82
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issue 4
219-225
EN
The aim of the study was to determine the efficiency of perioperative antibiotic prophylaxis in surgical patients.Material and methods. During the period between January and December, 2005, eight surgical Departments were subject to investigation, considering surgical wound infections following selected procedures: 3 orthopedic departments, 3 general surgery departments, and two vascular surgery departments. Based on obtained results the following parameters concerning perioperative antibiotic prophylaxis were evaluated: was the procedure performed with antibiotic prophylaxis?; type of chemotherapeutic agent used, and duration of prophylaxis.Results. Inguinal hernia repair procedures were most often performed without antibiotic (33% of procedures). The statistically significant higher incidence index of surgical wound infections was confirmed in case of cholecystectomy without (18.8 vs 2%). In case of vascular procedures cefuroxime was used in 8 doses. In case of hip or knee joint endoprosthesis surgery cefazolin was administered in five doses. In 70% of cholecystectomy and hernial repair procedures one dose of cefazolin was used. Considering colorectal operations the following antibiotics were used: 6 doses of cefazolin in 36% of cases, and 8 doses of amoxicillin with clavulanic acid. Twenty-five percent of colorectal procedures required the administration of amoxicillin with clavulanic acid and metronidazolConclusions. Analysis demonstrated that in spite of the many guidelines elaborated by scientific associations concerning perioperative antibiotic prophylaxis, the above-mentioned are rarely administered according to clinical practice.
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