Biomedical subjects

S Cichoń

Publications and source records attributed to S Cichoń.

At least 19 recordsLinked to original sources

PubMed2001

[Should we operate goiter in the elderly?].

The aim of this study was to compare the elderly patients group to the group of others undergoing surgical treatment due to goitre regarding type of goitre, extent of surgical procedures and postoperative follow-up (including early postoperative complications). 5872 patients with various type of goitre (between 1984 and 1998) were surgically treated, among them were 5244 (89.3%) females and 628 (10.7%) males (sex ratio as 8.1:1). The mean age was 46.1 (10 to 95 years). 278 (4.7%) patients were above 70 years of age (235-84.5% females and 43-15.5% males), their mean age was 73.7 years. The increase of malignant goitre was evident among the elderly patients (19.9% vs 5.5%). The dominant types were anaplastic cancers and malignant non-Hodgkin lymphomas. Much more frequently a giant goitre was diagnosed (20% vs 6.1%). It was localised substernally (39.6%) or intrathoracic (4.7%). The elderly prepared properly underwent surgical treatment quite well. Among early postoperative complications in the elderly dominant were surgical ones (6.8%), most frequently the injuries of the recurrent laryngeal nerve (4.67% vs 1.14%). Perioperative mortality regarded mostly the elderly with disseminated anaplastic cancer (3.6% vs. 0.2%). Surgical treatment of goitre in the elderly is a safe and justified method. High incidence of malignant tumours especially anaplastic cancers among the elderly should encourage to operation as early as possible.

Adolescent↗

PubMed2001

[Acute appendicitis in Crakow population].

UNLABELLED: In spite of decreasing morbidity, acute appendicitis (AA) is still found the most frequent cause of so called acute abdomen. This study presents the retrospective estimation of 1515 patients treated surgically in ten years period, admitted to hospital with the initial diagnosis of AA. In 1339 patients the initial diagnosis was confirmed during surgery. This group was divided into three subgroups: 1. Without perforation, 2. With perforation or abscess presence, 3. With diffuse peritonitis. In our study 60% of patients were male, however in the group aged over 70 we found the majority were females. The mean age was 16.7 years and in half of the cases patients were under 20. The incidence for Cracow population was 61.6 new cases in group of 100,000 inhabitants per one year (74.7 for males and 49.7 for females). The risk of appendix perforation or diffuse peritonitis was higher in extreme age groups. Mortality rate we found as 0.9%, but the risk of death was significantly higher in patients with advanced AA, or in the group over 70. Percentage of missed diagnoses was found as 11.6, and there was an advantage of female (female 19.2%, male 5.7%). Wound infection was dominant with the frequency rising along with the progression of AA. CONCLUSIONS: 1. The morbidity of AA in Cracow population in years 1989-1998, was 61.6/100,000/year on average and showed decreasing trend. 2. General mortality in AA remains at a stable and does not exceed 1%. It is most frequent in patients over 70 irrespectively of the form of AA.

Adolescent↗

PubMed2000

[Diagnosis, treatment and prognosis in cases of renal clear cell carcinoma metastases into the thyroid gland].

The most common metastatic tumour of the thyroid gland which is clinically revealed is renal clear cell carcinoma (RCCC). Our clinical experience in cases of RCCC metastases into thyroid gland is reviewed in terms of the history of the disease, obligatory diagnostic procedures, surgical management and outcome prognosis. We believe that all the patients with even a remote RCCC history require systematic follow-up including thyroid gland as metachronic metastatic disease can occur many years after primary surgery. Clinical diagnosis and ultrasound of the thyroid gland is essential in selection for surgical treatment. Confirmation of malignancy in FNA (fine needle aspiration) in often difficult regarding concomitant multinodular goitre. Enlargement of a single thyroid nodule except L-thyroxin therapy for 3-6 months is a sufficient indication for surgical treatment, not depending on FNA result, particularly when a suspected nodule becomes bigger than 30 mm in diameter.

Adenocarcinoma, Clear Cell↗

PubMed2000

[Ultrasonographic evaluation of thyroid tissue perfusion in patients with Graves-Basedow disease as preparation for surgery].

The aim of this work was to asses the usefulness of a new colour Doppler ultrasonography technique, namely power Doppler (PD), in the management of thyroid tissue perfusion in patients with Graves' disease before surgery. Forty six patients with Graves' disease treated conventionally with Lugol's solution before the operation were examined with power-Doppler scanner. The distribution of the vascular patterns of both lobes was analysed by computer program. Results were compared with bleeding during surgery subjectively and objectively. The analysis of power-Doppler thyroid perfusion showed significantly higher values of blood flow in patients suffering from Graves disease when compared with control group. Pre-operative preparation with Lugol's iodine decreases parenchymal blood flow. Auscultation of vascular murmur over the gland fading after Lugol's treatment does not always reflect parenchymal high value of blood flow measured by density of microvessels.

Adolescent↗

PubMed1999

[Treatment approach for substernal and intrathoracic goiter. Personal experience].

The retrospective analysis of 489 cases of substernal and intrathoracic goiters among 4122 patients undergoing surgical treatment between 1984 and 1996 due to various thyroid gland diseases including clinical data, surgical technics and early postoperative complications was performed. The surgical procedures of substernal and intrathoracic goiter amounted to 11.9% of all thyroid gland surgery. In 468 (95.5%) patients goiter was situated substernally, in 22 (4.5%) intrathoracicaly. The mean age and time of goiter growth in that location exceeded over 10 years the location of goiter within the neck. In preoperative examination the X-ray of chest and trachea were essential. Routine ultrasonography and thyroid gland scyntigraphy were scarcely helpful as the retrosternal and mediastinal region were often omitted. The jugular access was dominant (98.6%), sternotomy was performed in 1.4% of cases due to big disproportion between size of the goiter and size of the upper inlet into the chest. The surgical complications, similarly as in goiter within the neck (no cases of pneumothorax were observed), included the single-side paresis of recurrent laryngeal nerve in 3.7% of patients, in 0.2% hypoparathyroidism, in 1% bleeding requiring reoperation and in 0.2% esophageal fistula (self-healed). The surgical treatment of retrosternal and intramediastineal goiter was safe and a total number of complications was comparable to that one in a group of patients under-going surgery due to goiter within the neck. Most of surgical procedures was possible to perform using the jugular access. In a small number of cases because of difficulties related to the anatomical conditions the access was reached through the oblong sternotomy.

Adolescent↗

PubMed1999

[Perioperative mortality for perforated duodenal and gastric ulcer--analysis of 226 patients].

Between 1988 and 1997 in 226 patients (169 males--75.2% and 57 females--24.8%) surgical treatment was performed due to duodenal ulcer perforation (205 cases--90.7%) or gastric ulcer perforation (21 cases--9.3%, including 3 cases of perforated gastric cancer). Mean age was 51.5 years (19-94 years). In perforated duodenal ulcer the main procedure was truncal vagotomy with pyloroplasty performed in 95.6%, and simple ulcer suture in 4.4%. In perforated gastric ulcer the main procedure was Billroth I (Rydygier) stomach resection performed in 76.18%, and simple ulcer suture in 23.82%. A group of patients who died in perioperative period (29 cases--12.8%) was selected and compared to a group of others regarding age, sex, smoking, alcohol abuse, time elapsing between first symptoms and surgical treatment, use of NSAIDs, location and size of perforation hole, type of surgical procedures. On that basis 4 risk factors of disease in perioperative period due to perforated ulcer surgery were appointed: 1. Age--mean age of patients who died was 67 years (vs. 48.9 years among successfully treated), perioperative mortality in patients over 60 years old was 35.4%, and in patients over 70 years old was 50%). 2. Presence of three or more coexisting diseases--54.54% risk of disease (vs. 2.5% in patients with less than three or without coexisting diseases). 3. Delay in surgical treatment over 24 hours--48.15% of diseases vs. 7.04% in patients undergoing surgery within the first 24 hours following perforation. 4. Septic shock--80% of diseases.

Aged↗

PubMed1999

[Acute mesenteric ischemia--current diagnostic and therapeutic problems].

The paper presents current views of the acute mesenteric ischemia pathophysiology. The etiology and pathogenesis with all clinical symptoms were discussed. There were presented up to date methods of diagnosis and treatment. Special attention was paid to the nonocclusive mesenteric ischemia and its prophylaxis. The diagnostic algorithm applied to all acute mesenteric ischemia was presented.

Algorithms↗

PubMed1999

[Retrosternal parathyroid gland cystic neoplasm as a cause of primary hyperparathyroidism].

Parathyroid carcinoma is a rare cause of primary hyperparathyroidism (1-2%). In this paper a case of parathyroid cancer of the right inferior parathyroid gland cyst (5 cm in diameter) localised mostly retrosternally is presented in a patient suffering from severe hypercalcaemia (Ca--3.7 mmol/l, Ca(++)--1.8 mmol/l), severe bone pains and weakness, huge osteoporosis with following L5 compression fracture and recurrent nephrolithiasis. PTH blood level before surgical treatment was 1243 pg/ml (Norm: 10-60 pg/ml). In the preoperative ultrasonography of the neck, a lesion was found, but it was considered to be a cyst in the inferior pole of the right thyroid lobe. In a fine-needle biopsy from the lesion-colloid mass without any cells was found. In a 99mTc-MIBI scintigraphy of the neck a suspicion of focus lesion in the right superior parathyroid gland was made, which was not confirmed intra-operatively. Parathyroid carcinoma was diagnosed intraoperatively in histological examination. 'En block' resection of the retrosternal parathyroid tumor and right thyroid lobe was performed from the jugular incision. Any enlarged jugular lymph nodes were not found. In a postoperative period a transient hypocalcaemia was present, which disappeared after pharmacological treatment. During 32 months of follow-up neither no features of local recurrence nor distant metastases were found. Calcium level in blood was normal, PTH 216.0 pg/ml, severity of bone pains and weakness lessened, osteoporosis in a course of pharmacological treatment--with no further progress.

Diagnosis, Differential↗

PubMed1998

[Metastasis of kidney clear cell carcinoma to the thyroid cell in patients on renal replacement therapy].

The paper presents 2 cases of metastases of clear cell carcinoma of kidney into thyroid gland in patients on renal replacement therapy. In one patient after bilateral nephrectomy due to renal clear cell carcinoma (in 15 years time interval) and in second patient after left-side nephrectomy performed 16 years earlier and terminal right kidney insufficiency due to nephropathy with nephrotic syndrome for a year. In diagnosis essentials were: physical signs--palpable single node within the thyroid gland, earlier neoplastic anamnesis, cold node in scintigraphy, hypoechogenic node in ultrasonography of the thyroid gland, particularly with a rich vascular net within the node in power-doppler examination and, at last cytology of material from ultrasound-guided fine needle biopsy of the node. The diagnosis had been confirmed in intraoperative histopathological examination before the total thyroidectomy was performed.

Adenocarcinoma, Clear Cell↗

PubMed1998

[Intrathoracic goiter as a cause of superior vena cava syndrome].

Between 1984 and 1997 year 4985 patients underwent surgical treatment due to various thyroid gland diseases, among them were 28 (0.6%) patients with intrathoracic goitre, but only in one case (0.002%) the signs of superior vena cava syndrome (SVCS) were observed: oedema and lividity of the face, enlargement of jugular veins and superior limbs' veins. In addition the patient manifested subsequently growing dyspnoea, dysphagia and hoarseness. In diagnose essential were X-ray examination of the chest (widening of mediastinal shadow), X-ray examination of the trachea (dislocation and compression of the trachea), X-ray of esophagus with contrast (compression from the outside), ultrasonography of thyroid gland. Intraoperatively, after it was confirmed that the SVCS was caused by compression of the intrathoracic right lobe of thyroid gland, the oblong sternotomy was performed to provide the proper surgical access for subtotal thyroidectomy. The weight of resected tissues of thyroid gland was 1036 g. In histopathological examination the diagnosis of multinodular toxic goitre was confirmed.

Aged↗

PubMed1998

[Chromosome aberrations in patients with papillary thyroid cancer and other neoplasms].

Cancer is essentially a genetic disease resulting from congenital or acquired alterations in some cells of the patient. Such changes may occur in particular oncogens and are responsible for the tumour phenotype of the affected population of cells. In contrast, unaltered tumour-suppressor genes are responsible for suppressing the neoplastic phenotype, and their inactivation by deletion or mutation permits cancerous development in the affected cells. The genetic model of carcinogenesis is based on the idea mutations at the DNA level, what creates a functional imbalance between the oncogenes and the tumour-suppressor genes, resulting in uncontrolled clonal proliferation. The ret/PTC oncogene is unique to papillary thyroid cancer. The paper presents a correlation analysis between chromosomal changes in papillary thyroid cancer and abnormalities of chromosomes in patients with breast cancer and chronic lymphocytic leukemia.

Breast Neoplasms↗

PubMed1997

[Mechanical ileus from material of the IIIrd Department of Surgery at the College of Medicine of the Jagiellonian University].

Retrospective analysis of 177 patients with mechanical ileus was performed. The mean age was 16 to 94 years with average of 66. There were more females-107 (60.5%). There was 74.2% of strangulation ileus and 25.2% of obturation ileus. The incarcerated hernia was the main cause of strangulation ileus (59%) and carcinoma of obturation ileus (93%). Within the large bowel carcinoma was the cause of ileus in all patients. Postoperatively 33 patients (18.6%) died. Mortality among the patients with strangulation ileus was 13.6% and with obturation ileus was 33.3%.

Adolescent↗

PubMed1997

[Wound dehiscence as a problem of the surgery department].

UNLABELLED: Eventration is still the great surgical problem. Although it is not very often, but may course serious complication leading to death. The aim of this study is the retrospective analysis of patients undergone surgery in the III Department of Surgery in 1982-1995 (14 years). During this period eventration was observed with 61 patients, constituting 1% of laparotomies performed in this period. Among the re-operated on, there were 40 males and 21 females. In 6 cases this complication occurred twice and in 1 case - three times. The age of patients ranged from 29 to 95, the average being 61.5. The usual time spent in the Hospital was 35.9 days. There were 51 patients (83.6%) admitted and operated in the surgical casualty. Among those there were cases of diffuse peritonitis, bowel obstruction, gastro-intestinal hemorrhage etc. In 40% of patients the eventration occurred in 5 days after surgery (the average time was 6.5 days). Eventration was not found after 2 weeks following the operation. Wound infection, the most common cause of dehiscence, was observed in 29 cases (47.5%). During the reoperation, in 10 patients we diagnosed bowel obstructions, in 6 - jejunal fistula and in other 6 - abdominal abscess. 24 (39.3%) patients died in the period following the operation because of septicemia, cardiovascular and respiratory deficiency. In 1/3 cases there were pulmonary complications. Authors draw attention to the prevention of wound dehiscence as well as to the additional suturing procedure which has been successfully used in their Department. CONCLUSION: Wound dehiscence is the surgical complication with the high risk of death.

Adult↗

PubMed1997

[Surgical treatment of secondary hyperparathyroidism in patients treated with renal replacement].

Between January 1990 and July 1997, in 15 maintenance dialyzed patients and in 3 patients after renal transplantation manifesting hyperparathyroidisms surgical treatment was performed. The diagnosis was based both on the estimation of serum PTH level, total and ionised calcium, phosphates, alkaline phosphatase and imaging procedures: ultrasonography and 99-mTc subtraction scintigraphy. Indications to surgical treatment included ailments like generalized prurigo, bone and joint pains and muscular weakness with no response to pharmacological treatment. The commonly used procedure was subtotal parathyroidectomy (94%), its extent, however, was in each case determined during surgery, depending on the quantity and size of parathyroid glands found. In all cases the immediate intraoperative histopathological examination of the resected tissues was performed. In 10 patients resection of the thyroid gland tissues was carried out because of goiter (56%), among them in 1 case occult papillar carcinoma was found in histopathological examination. In the postoperative period 4 patients (22%) manifested transient hypocalcemia with good response to pharmacological treatment. Good results of surgical treatment reflected by both ailment relief and normalization of serum PTH and phosphates were obtained in 16 patients (89%). In 2 patients (11%) the ailments subsided but did not completely disappear. Surgical treatment of secondary hyperparathyroidism by subtotal parathyroidectomy is efficacious and entails a low risk of complications.

Adolescent↗

PubMed1996

[Treatment of goiter in adolescents in surgical practice--personal observations].

Fifty one patients 12-19 years old were operated on because of different thyroid diseases (1.7% of total amount 3029 patients after surgical treatment). There was no post-operative complication (except of 2 cases of temporary vocal cord paresis). Late results of surgical treatment in adolescents were not significantly different then in other groups. Presence of the symptoms of clinical or subclinical hypothyreosis or rarely recurrence of thyrotoxicosis in patients with toxic nodular goitre after surgical treatment, however, makes the treatment worst, particularly important in this age group. Suppression therapy of thyroid hormones was administrated in all patients with simple nodular goitre and with thyroid cancer. All patients were followed up in our outpatient clinic. During the follow-up from 6 months to 10 years no recurrence of goitre or thyroid cancer was observed.

Adolescent↗

PubMed1996

[Acute intestinal ischemia in material of the III Clinic of General Surgery, Collegium Medicum at the Jagellonian University].

The research work below focuses on a retrospective analysis of a group of 28 patients who suffered from acute intestinal ischaemia caused by upper mesenteric artery embolism of thrombus. The analysis is based on Clinic's own data in the years 1991-1995. The above mentioned patients constituted 3.4% of the 828 patients suffering from acute diseases of the abdominal cavity, accepted and treated in our Clinic. Their age ranged from 38 to 89 and average age was 72.4 y. There were 18 women (64.3%). Mesenteric embolism was the cause of intestinal ischaemia with 21 patients, whereas mesenteric thrombus with 7. Twenty four patients were operated on, the remaining 4 patients were disqualified from the operative procedure, 27 patients died. A considerable progression of the necrotic lesions of the intestines was found in all the patients operated on.

Acute Disease↗

PubMed1995

[Wrong diagnoses of acute appendicitis in women].

In the years 1988 through 1992, 434 patients with acute appendicitis were operated at Third Department of Surgery, Medical Academy, in Kraków. The group included 201 females aged 14 to 90 years of life. In 159 women the diagnosis of acute appendicitis was confirmed, whereas 42 patients were subjected to surgical procedures due to other than appendicitis conditions located within the abdominal cavity. Surgeries prompted by symptoms suggesting appendicitis were most often performed in women with gynecological diseases. Only in several cases laparotomies were performed for other reasons. Wrong diagnoses were most often noted in women below 20 years of life and in the group between 40 and 60 years of life. The introduction of routine ultrasound examinations into the diagnostic management of acute peritonitis and diseases of the reproductive system might result in decrease of the number of diagnostic errors in acute appendicitis in women. An emergency procedure performed when the diagnosis is unclear is recommended rather than prolonged observation. The latter often results in delayed diagnosis of acute appendicitis when diffuse peritonitis develops.

Adolescent↗

PubMed1994

[Risk factors and surgical tactics in differentiated thyroid cancer].

Differentiated thyroid cancer presents various, frequently astonishing outcomes, not only to the patients but sometimes to physicians as well. The dynamics of progress of the neoplasm is calculating depending on the type of tumor, that is to say microscopic findings, ways of spreading and other prognostic factors, such as: age, sex, grade of histologic malignancy and the advancement of the disease. The authors of this paper try to assess the purposefulness of individual choice of surgical procedure, according to analysis of risk factors (AMES, AGES). Therefore, the surgeon should decide about the extent of the procedure depending on those factors.

Adenocarcinoma↗