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Z Puchalski

Publications and source records attributed to Z Puchalski.

At least 19 recordsLinked to original sources
PubMed1999

[Surgical treatment of thyroid disease in adolescents].

Surgical treatment of goitre in children and teenagers under 18 is relatively rare and undertaken for strict therapeutic indications. It still arouses much controversy among surgeons, being loaded with a high percentage of complications, usually distant ones. The aim of the study was to analyse the surgical treatment of various goitre types under the age of 18 basing on 65 operations performed in the years 1994-1998. Operations for non-toxic and hyperactive nodular goitre, including Graves-Basedow disease, were predominant. Five cases of thyroid carcinoma were found. No serious complications were observed during and after the surgery. Our own material and the 5-year observation reveal that surgical treatment of thyroid diseases in children and adolescents carried out for definite indications by an experienced operating team is successful and causes only few complications.

Adolescent↗
PubMed1999

[Diagnosis and surgical treatment of pancreatic carcinoma].

The aim of the study was presentation of our experiences in the diagnostics and treatment of pancreatic carcinoma in confrontation with current opinions. Between 1983 and April 1998 308 patients (198 males and 110 females with mean age 61 years) were treated at our department. In 211 cases tumor was primarily localized in the head and in 97 cases (31.5%) in the body or tail of pancreas. The diagnosis was determined on the basis of clinical symptoms and laboratory investigations. Diagnostic accuracy of performed investigations was as following. Ultrasonography-86%, CT-scan-95%, and ERCP-94%. Ultrasonography or CT guided biopsy and serodiagnostics improved detectability of resectionable carcinoma in the last past years. Among 308 patients, 292 underwent surgery. Since 1997 an intraoperative ultrasonography and cholangioscopy of common bile duct and Virsung were performed as a routine. The procedures depended on the localization and the grade of advance of the tumors. UICC classification of pancreatic tumors, pTNM (4th edition 1987) it was used. Only in 25 patients (8%) (tumors pT1a-bN0M0) it was possible to perform radical operation (resection of the pancreas). However in 172 patients (56%) only palliative procedures were done (pT2N1M0). In 95 patients (31%) only laparotomy and biopsy were performed (tumors pT2N1M1). The study shows that although diagnostic methods are improved, the tumors of the pancreas are diagnosed in stages making unable the radical procedures. Only about 10% of carcinomas are resectable. It is caused by with non-characteristic picture of the disease in its early stage.

Adult↗
PubMed1999

[Surgical management in the non-neoplastic and neoplastic thyroid goiter with Hürthla cells].

The routine preoperative cytological evaluation of pathological changes of the thyroid more and more frequently reveals single or multiple Hürthl cells in the material obtained by the method of fine-needle aspiration biopsy (FNA). Hürthl cells are a degenerative form of epithelial follicular cells of the thyroid and cytological examination is insufficient for unequivocal differentiation between adenoma and carcinoma. Management of patients with FNA-diagnosed Hürthl cells arouses a number of controversies. Therefore, the authors of the present study subjected the thyroids of patients with cytologically diagnosed Hürthl cells to postoperative histopathological analysis. Appropriate surgical management was indicated.

Adenoma, Oxyphilic↗
PubMed1998

[Local activation of blood coagulation in pancreatic tissue in chronic pancreatitis].

Thromboembolic events may complicate clinical course of chronic pancreatitis. It is accepted that trypsin plays a role in the pathogenesis of these abnormalities. However there is a lack of information about local activation of blood coagulation in pancreatic tissue in chronic inflammation and contribution of tissue factor (TF) to this process. Immunohistochemistry was applied to AMeX-fixed sections of tissues of ten cases of chronic pancreatitis to explore the presence and distribution of components of the coagulation system in situ. TF antigen was present in cells of ductules. Fibrinogen and fibrin were detected in the inflammatory infiltrates of the pancreatic tissue. The data suggest that there is local activation of blood coagulation in pancreatic tissue in chronic inflammation that depends on tissue factor.

Antibodies, Monoclonal↗
PubMed1998

[Use of Tienam in treatment of severe acute pancreatitis].

Therapeutic results obtained in the management of severe acute pancreatitis (AP) complications are still unsatisfactory, and mortality rate is about 40%. An improvement in treatment effectiveness can be related to successful control of infections and prevention of uncontrollable sepsis. The aim of the study was evaluation of effectiveness of Tienam in the management of severe acute pancreatitis complications. The clinical material included 24 patients, treated for AP between 1994 and 1996. All of the patients were operated on and 19 of them required at least one reoperation. During primary surgery we performed necrosectomy and continuous peritoneal lavage. The analysis of cultures obtained from infected necrotic tissue, pancreatic abscesses and whole blood showed that the infections were caused mainly by Gram-negative bacteria. The highest efficiency in infections control was observed in the case of Tienam (15% resistant strains). The authors emphasize also the increasing role of Staphylococcus aureus and Candida albicans in secondary infections.

Adult↗
PubMed1997

[The influence of hydrocortisone and dopamine on the behavior of fibrils and values of some sympathetic mediators in kidneys of experimental endotoxic shock].

The aim of the study was to evaluate the influence of hydrocortisone (H) and dopamine (DA) on behaviour of tissue content of DA, NA and homovanillic acid (HVA) as well as adrenergic fibers (AF) in canine kidney during endotoxic shock (ES). Above changes were considered on the background of hemodynamic, biochemical and morphologic alterations. Investigations were carried out on 5 groups of animals: I-control, II-dogs in ES without treatment, III-dogs in ES treated with H, IV-ES treated with DA, V-animals treated with H and DA. It was shown that the amount of catecholamines add AF in group II was lower than in group I. In groups of animal treated we observed bigger of well preserved AF and catecholamines, and the image similar to the one observed in control group-I was observed in group V. It appears from the study conducted that AF show active role to the course of ES, and beneficial effect of the treatment applied can be results of its influence on the function of DA, NA and AF.

Adrenergic Fibers↗
PubMed1997

[The effect of some drugs on the levels of selected cytokines in experimental septic shock].

The production of tumor necrosis factor (TNF-alpha), and interleukin 1 beta (IL-1 beta), IL-6, sTNFR-p55, sTNFR-p75 and their pharmacomodulation were evaluated in a model of septic shock induced in CD-1 mice by cecal ligation and puncture (CLP). This model of sepsis, which resembles the clinical situation of bowel perforation and peritonitis with subsequent septic shock was compared with that induced by administration of pure endotoxin (LPS). TNF-alpha was detectable in serum, liver, spleen and lungs during the first 4 h, with a peak 2 h after CLP. IL-1 beta was measurable in serum after 24 h, and levels increased significantly in spleen and liver 4 and 8 h after CLP. IL-6 levels increased significantly in serum throughout the first 16 h after CLP. sTNFR-p55 and p75 increased in both models of shock but with different kinetics. Cytokines were also detectable after LPS injection, with kinetics similar to those after CLP but a significantly higher level. Pretreatment with dexamethasone (DEX) and ibuprofen (IBU), significantly reduced survival, while TNF did not affect it. Only pentoxifylline (PTX) significantly increased survival in mice with CLP. However DEX protected the mice from LPS mortality. In conclusion, by inhibiting TNF-alpha with DEX and PTX survival was reduced or unchanged respectively, suggesting that the modulation of this cytokine does not play significant role in sepsis and septic shock induced by CLP, unlike treatment with LPS. The negative effects of IBU suggests a protective role by prostaglandins in sepsis induced by LPS.

Animals↗
PubMed1997

[Complications after surgical resection of liver parenchyma].

The number of liver resection in Poland has recently increased. Most frequent indications are benign tumors of the liver, metastatic changes and primary hepatic carcinoma. The aim of work is to discuss incidence of complications which appeared after liver resections at our Department. Among 56 patients aged 19-76, 32 anatomical and 24 nonanatomical resections of hepatic tissue were performed. In the early postoperation period, 8 patients had peritoneal fluid collections and 3 laparotomies with drainage were necessary, while in 5 cases fluid was aspirated under usg guidance. The outflow of bile and blood contents from subhepatic space was prolonged to 9 days in 3 patients, gastric or duodenal 3 stress ulcerations complicated with bleeding were observed as well as transitory hemobilia in 3 and jaundice in 6 cases. Early hemorrhage from excision line of hepatic tissue was observed in 2 patients which needed additional surgical intervention. Atelectasis and inflammatory changes of the right lung appeared in majority of patients operated on. The postoperative mortality of 16% (9 patients of total 56) was mainly dependent on hepatorenal or cardiorespiratory failure, however myocardial infarction and DIC syndrome were also noticed. In spite of progress of surgical technique and intensive perioperative care, resection procedures of the liver are still accompanied with large percentage of serious complications.

Adolescent↗
PubMed1997

[Polymorphism of collagen in duodenal mucosa of ulcers].

Determinations of collagen in specimens of duodenal mucosa taken from 15 patients operated on because of duodenal ulcer with pyloric stenosis were performed. In the ulcer and surrounding tissue, total collagen values were significantly increased when compared with the results in unchanged wall of the duodenum. Collagen polymorphism study showed considerably higher percentage of type I and decreased type III in the ulceration than in control duodenal mucosa. In conclusion, extracellular components of connective tissue may play a role in the formation and course of duodenal ulcer disease.

Adult↗
PubMed1997

[Results of surgical treatment for adrenal gland diseases].

The authors present their own experience in diagnosing and surgical treatment of adrenal tumors. The group consisted of 52 patients with adrenal tumors treated surgically in our Department in 1980-1996. There were 37 women (71%) and 15 men (29%); 22 with Cushing syndrome, 14 with pheochromocytoma, 4 with Conn's syndrome, 1 with virilizing tumor, 1 with adenocarcinoma, 1 with adrenocortical carcinoma, 1 with ganglioneuroblastoma 2 with adenomas, 6 with adrenal cyst. Diagnosis pre- and intraoperative was verified with histological examination. We suggest that the ultrasonography and computed tomography are the most useful methods in determining of tumor localisation. The authors prefer intraperitoneal approach, enabling evaluation of the contralateral adrenal gland and possible localisation of extraadrenal foci. Good results were obtained in 51 patients (98%).

Adrenal Gland Diseases↗
PubMed1997

Hyperthyroid goitre treated surgically.

The aim of the study was the comparative analysis of the degree of intensity of male and female hyperthyroidism treated surgically in the years 1990 to 1996. In this period 295 females and 42 males underwent operation for hyperthyroid goitre. Female predominance was noted in hyperthyroidism (ratio 7:1), in Graves' disease (7.4:1) and in toxic nodular goitre (6.3:1). The clinical findings in pre- and postoperative patients, including laboratory, visual diagnosis, and intra- and postoperative complications were evaluated. In the preoperative period, the incidence of the thyreocardiac syndrome was greater in the male. Male hyperthyroidic goitres were more frequently located retrosternally and caused trachea compression. No significant sexual differences were found in routine laboratory tests. Operations for hyperthyroidic male goitres usually caused more intraoperative problems and were connected with greater blood loss. Estimation of cardio-vascular parameters in the early postoperative period showed higher intensification of hyperkinetic circulation and higher mean body temperature in men. Signs of psychosis developed postoperatively in two men. The analysis of patients with hyperthyroidic goitre treated surgically revealed more severe course of male thyreotoxicosis in the perioperative period.

Adult↗
PubMed1997

Colour doppler sonography guided percutaneous fine-needle biopsy of the liver.

Between 1992 and 1997, every year, approximately 30,000 examinations of the liver and bile ducts were done. Addition of colour Doppler imaging improves safety of procedures and allowed to perform ultrasound guided biopsy in 73 patients. On the basis of our experience we state that colour Doppler sonography guided percutaneous fine needle biopsy of the liver is useful, sufficient and safety diagnostic method of abscesses, cysts and malignant tumours of the liver.

Bile Ducts↗
PubMed1997

Intermediate cells in chronic pancreatitis--ultrastructural observations.

Ultrastructural evaluation of the pancreas resected due to advanced chronic pancreatitis revealed the presence of numerous intermediate cells exhibiting both the morphologic features of the exocrine-acinar cell and those of the endocrine cell of Langerhans'islets in 3 out of 5 cases examined. The analysis of ultrastructural pictures showed a predominance of acinar-alpha, beta cells, although acinar-alpha and acinar-beta cells were also found. The role of an increases in the number of intermediate cells in chronic pancreatitis is not clear and requires further investigations.

Adolescent↗
PubMed1996

Diagnosis and surgical treatment of pancreatic carcinoma.

The aim of study was presentation of our experiences in diagnosis and treatment in pancreatic carcinoma in confrontation with current opinions. Between 1984-1995 at our Department was treated 211 patients with carcinoma of exocrine part of the pancreas. It were 137 male and 74 female with mean age 58.9 years. In 151 cases (70.5%) primary seat of tumour was located in the head and in 60 cases (29.5.1%) in the body or tail of pancreas. The diagnosis was determined on the basis of clinical symptoms and laboratory investigation Diagnostic accuracy of X-ray investigations was as follow: Ultrasonography-86%, CT-scan-91%, ERCP-94%. Ultrasonography or CT guided biopsy and serodiagnosis improved detectability of resectionable carcinomas in the last past years. Among 211 patients, 199 underwent surgery. The procedures depended on the localisation and grade of advance of the tumours. UICC classification of pancreatic tumours, pTNM (4th edition 1987) was used. Only in 21 patients (9.9%) (tumours pT1a-b N0M0) was possible to perform radical operation (resection of the pancreas). However in 107 patients (50.7%) were done only paliative procedures (pT2N1M0). In 83 patients (39.3%) only laparotomy and biopsy were performed (tumours pT2N1M1). The study shows that although improvement of the diagnostic methods tumors of the pancreas are diagnosed in stages making unable the radical procedures and only about 10% of carcinomas are resectable. It is relevant with non-characteristic picture of the diseases in its early stages.

Adult↗
PubMed1996

Chronic advanced pancreatitis--diagnosis, biochemical and ultrastructural changes and surgical procedures.

On the basis of 162 cases of chronic advanced pancreatitis seen at our Department during the last 15 years the diagnosis, indications and surgical procedures are described in this paper. Quantitative and qualitative changes of pancreatic collagen in chronic inflammation were also analysed. Results of these investigations were compared with histological and ultrastructural pictures of pancreatic tissue. Amongst 162 patients, 142 (88%) were operated upon. 71 underwent pancreatectomy or pancreatoduodenectomy, 14 anastomotic procedures and rest of them various operation of the bile ducts. Overall, 18 (13%) patients experienced significant complications after resectional procedures and 6 (4%) died as well after anastomotic procedures.

Basement Membrane↗
PubMed1995

Evaluation of the results of endotoxic shock (ES) treatment with dopamine (DA) and hydrocortisone (H).

The aim of this report is to present complex evaluation of the applied treatment with dopamine (DA) and hydrocortisone (H) in experimental endotoxic shock (ES). An evaluation is based on long-term experiences of the author's Clinic. The studies were performed in dogs. ES was evoked by intravenous E. coli endotoxin administration in a dose of 2 mg/kg. An appearance and progress of ES was evaluated by determination of many hemodynamic and biochemical parameters. In the treatment DA and H were used. Besides of mentioned above parameters also morphological, histochemical and ultrastructural investigations of the lung and liver were done. DA and H applied together were the most effective treatment in the course of ES. It could be a theoretical ground for combined ES treatment in people.

Animals↗