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Vegetables Enriched Diet and Oesophageal Cancer Risk. Systematic Review and Meta-Analysis of Case-Control Studies

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Smolińska K., Dębińska I., Paluszkiewicz P.
Polish Journal of Surgery
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2010
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vol. 82
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issue 12
639-644
EN
Oesophagus is common primary localization of digestive system cancer. Recent analyses suggest the role of vegetarian food in reduction of cancer risk. The role of vegetables intake in oesophageal cancer prevention still needs to be proved.Objective. The estimation of the role of vegetables intake in oesophageal cancer risk based on published case-control studies using meta-analysis methods.Methods. The selected literature published till 2009 from MEDLINE, PubMed, Scopus, Embase, CancerLit, Google Scholar and Cochrane Library databases were included into meta-analysis. The following search terms, key words and text phrases were used: esophageal cancer, cancer risk, oesophageal cancer risk, oesophageal neoplasm; oesophageal neoplasm risk, diet, dietary habits, vegetables and life style. Articles investigating vegetables intake were reviewed and selected for further analysis.Results. Twelve studies have fulfilled the established criteria. The meta-analysis has confirmed the protective effect of vegetables against oesophageal cancer development. The vegetables intake, more frequent than once per week, reduce oesophageal cancer risk (relative risk 0.52; 95% CI 0.38-0.71). The declared intake more frequent than once daily was connected with reduction of cancer development about of 57% (relative risk 0.43; 95% CI 0.32-0.58). The dose-dependent manner of vegetables intake was observed against oesophageal cancer development.Conclusion. The vegetables intake is associated with reduced risk of developing an oesophageal cancer. The total reduction of oesophageal cancer risk is associated with frequency of vegetables intake in the diet.
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The Possum Scoring System and Complete Blood Count in the Prediction of Complications After Pancreato-Duodenal Area Resections

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Dębińska I., Smolińska K., Osiniak J., Paluszkiewicz P.
Polish Journal of Surgery
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2011
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vol. 83
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issue 1
10-18
EN
The introduction of markers which help in the identification of patients prone to suffer from postoperative complications enables to recognize them more easily and thus, treat them more effectively.The aim of the study was to evaluate complete blood count indicators, as well as preoperative results obtained on the basis of the POSSUM and P-POSSUM scoring systems, considering the prediction of complications after surgical resections in the pancreato-duodenal area.Material and methods. A prospective 30-day non-interventional clinical study was conducted on a group of 65 patients who underwent scheduled surgery, due to pancreatic head cancer or chronic pancreatitis. Total pancreatoduodenectomy was performed in 24.1% of patients, while the remaining were subject to hemi-pancreatoduodenectomy. The authors evaluated the preoperative complete blood count parameters, as well as the risk of complications and mortality using the audit POSSUM and P-POSSUM scoring systems.Results. Postoperative complications were observed in 32.4% of patients. The white blood cell count and platelet count in the preoperative period were statistically lower in the group of patients with postoperative complications, in comparison to patients without diagnosed complications. Higher severity scores obtained by means of the P-POSSUM scoring system, as well as higher mortality during the perioperative period can be ascribed to patients who suffered postoperative complications. However, no correlation was found between the occurrence of complications and gender, age, type of resection, preoperative hemoglobin level, absolute lymphocyte count, or numerical value representing the patient's general condition (POSSUM) and predicted postoperative morbidity.Conclusions. The absolute white blood cell count and total platelet count during the preoperative period may be considered as an indicator of the higher risk of complications during pancreato-duodenal area resections. The usefulness of the POSSUM and P-POSSUM scoring systems is limited. However, the surgical severity index and calculated mortality coefficient risk can facilitate the identification of patients threatened with postoperative complications.
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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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