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    Wyświetlanie 1-7 z 7
    Tytuł:
    An Umbilical/Paraumbilical Hernia as a Sign of an Intraabdominal Malignancy in the Elderly
    Autorzy:
    Kenig, Jakub
    Richter, Piotr
    Barczyński, Marcin
    Powiązania:
    https://bibliotekanauki.pl/articles/1395767.pdf
    Data publikacji:
    2014-04-01
    Wydawca:
    Index Copernicus International
    Tematy:
    umbilical hernia
    paraumbilical hernia
    intraabdominal malignancy
    surgery
    elderly
    Opis:
    The umbilical area can present with a variety of signs associated with an intra abdominal malignancy. An umbilical/paraumbilical hernia might itself be a sign of an internal malignancy. The correlation between the presence of an umbilical/paraumbilical hernia and an intra abdominal malignancy has been previously based only on case reports. The aim of the study was to evaluate the significance of an umbilical/paraumbilical hernia as a symptom of an intraabdominal malignancy. Material and methods. A retrospective analysis was performed; review of the medical records of 145 patients (113 female and 32 male; mean age 66.4±11.9) with an umbilical/paraumbilical hernia treated during the period of 2005-2013. Twenty-three patients (15.9%) were diagnosed with an intra abdominal malignancy; 34% were in the age group over 75 years of age. Results. The most common malignancies were: colorectal cancer, followed by pancreatic cancer, and cancers of the adnexa and kidneys. The patients with a concomitant malignancy identified were significantly older than those without a malignancy. In 65% of patients, the diagnosis was made postoperatively. Logistic regression analysis demonstrated that age, the presence of preoperative symptoms, anemia, and weight loss were independent risk factors for concomitant abdominal cancer. Conclusion. The findings of this study support intensive preoperative diagnostic evaluation of elderly patients that are qualified for surgery for an umbilical/paraumbilical hernia. This is particularly important because most of these patients had a small/medium hernia orifice, which did not allow for accurate manual abdominal exploration. Currently, the routine preoperative diagnostic evaluation is often insufficient for an accurate diagnosis
    Źródło:
    Polish Journal of Surgery; 2014, 86, 4; 189-193
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Vulnerable Elderly Survey 13 as a Screening Method for Frailty in Polish Elderly Surgical Patient - Prospective Study
    Autorzy:
    Kenig, Jakub
    Richter, Piotr
    Żychiewicz, Beata
    Olszewska, Urszula
    Powiązania:
    https://bibliotekanauki.pl/articles/1395722.pdf
    Data publikacji:
    2014-03-01
    Wydawca:
    Index Copernicus International
    Tematy:
    Vulnerable Elders Survey
    VES-13
    comprehensive geriatric assessment
    surgery in the elderly
    Opis:
    The Vulnerable Elders Survey (VES-13) is a simple function based frailty screening tool that can be also administered by the nonclinical personnel within 5 minutes and has been validated in the out- and in patient clinic and acute medical care settings. The aim of the study was to validate theaccuracy of the VES-13 screening method for predicting the frailty syndrome based on a CGA in polish surgical patients. Material and methods. We included prospectively 106 consecutive patients ≥65, that qualify for abdominal surgery (both due to oncological and benign reasons), at the tertiary referral hospital.We evaluated the diagnostic performance of VES-13 score comparing to the results from the CGA, accepted as the gold standard for identifying at risk frail elderly patients. Results. The prevalence of frailty as diagnosed by CGA was 59.4%. There was significantly higher number of frail patients in the oncological group (78% vs. 31%; p<0.01). According to the frailty screening methods, the frailty prevalence was 45.3%. The VES-13 score had a 60% sensitivity and 78% specificity in detecting frailty syndrome. The positive and negative predictive value was 81% and 57%, respectively. The overall predictive capacity was intermediate (AUC=0.69) Conclusions. At present, the VES-13 screening tool for older patients cannot replace the comprehensive geriatric assessment; this is due to the insufficient discriminative power to select patients for further assessment. It might be helpful in a busy clinical practice and in facilities that do not have trained personal for geriatric assessment.
    Źródło:
    Polish Journal of Surgery; 2014, 86, 3; 126-131
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    The Prognostic Role of Comorbidities in Older Patients Qualified for Emergency Abdominal Surgery
    Autorzy:
    Kenig, Jakub
    Richter, Piotr
    Olszewska, Urszula
    Żychiewicz, Beata
    Powiązania:
    https://bibliotekanauki.pl/articles/1395995.pdf
    Data publikacji:
    2015-03-01
    Wydawca:
    Index Copernicus International
    Tematy:
    emergency surgery
    comorbidities
    older patients
    Opis:
    Until now, the literature about the influence of specific comorbid conditions on outcome of emergency abdominal surgery in polish elderly patients is scars. The aim of the study was to determine the prognostic role of comorbidities in patients qualified for emergency abdominal surgery. Material and methods. One hundred and eighty four consecutive patients(98 female and 86 male). 65 years of age were prospectively enrolled. The mean age was 76.9±5.8 (range 65-100) years old. Results. Only 16% of patients did not have any preoperative comorbidity. The 30-day mortality was 24.5% (45 patients). The 30-day morbidity was experienced by the 58.7% (108 patients), including 40 patients (21.7%) with minor complications and 68 patients (37%) with major complications, according to the Clavien-Dindo complications scale. The dysrhythmia (odds ratio 1.6, 95% CI 1.2-2.6, p=0.02), vascular disease (odds ratio 2.1, 95% CI 1.4- 3.1, p=0.02) and renal disease (odds ratio 1.4, 95% CI 1.2-2.8, p=0.01) were independent risk factors of 30-day morbidity. The vascular disease was also the independent risk factor of 30-day postoperative death in the multivariate regression analysis (odds ratio 1.9, 95% CI 1.3-2.8, p=0.001). Conclusions. Preoperative comorbidities are common among elderly patients qualified for emergency abdominal surgery. However, only some of them (the dysrhythmia, the vascular disease and the renal disease) are independent risk factors of postoperative adverse outcomes. Therefore, number of comorbidies alone should not be the reason for a limited treatment.
    Źródło:
    Polish Journal of Surgery; 2014, 86, 12; 569-575
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Low-Anterior-Resection Syndrome. How Does Neoadjuvant Radiotherapy and Low Resection of the Rectum Influence the Function of Anal Sphincters in Patients with Rectal Cancer? Preliminary Results of a Functional Assessment Study
    Autorzy:
    Romaniszyn, Michał
    Richter, Piotr
    Walega, Piotr
    Kenig, Jakub
    Nowak, Marcin
    Nowak, Wojciech
    Powiązania:
    https://bibliotekanauki.pl/articles/1396730.pdf
    Data publikacji:
    2012-04-01
    Wydawca:
    Index Copernicus International
    Tematy:
    rectal cancer
    low anterior resection
    neoadjuvant radiotherapy
    anal sphincter function
    Opis:
    The aim of the study was to assess the influence of neoadjuvant radiotherapy and resection of the rectum on the functional parameters of anal sphincters.Material and methods. 20 patients with rectal cancer, qualified for low anterior rectal resection with neoadjuvant radiotherapy were enrolled in the study group. The study protocol included an anorectal manometry, electromyography and fecal incontinence questionnaire (FISI) before radiotherapy, after radiotherapy, and after the operation.Results. Of the 20 patients 12 were included in the final analysis, because 8 patients were re-qualified to abdomino-perineal resection of the rectum after neoadjuvant treatment. There were no significant changes in anal pressures assessed 5 to 8 days after radiotherapy. In 3 cases (25%) pathological changes in RAIR reflex were found in the manometric examination. After low anterior resection mean basal anal pressures were significantly lower, whereas squeeze anal pressures did not change significantly. In 7 patients (58%) the RAIR reflex was pathological or even absent after low anterior resection. Changes in manometric parameters correlated with FISI incontinence assessment after the operation. In electromyographic examination action potentials of motoric units of the external anal sphincter were still present both after radiotherapy, and after operation.Conclusions. Fecal incontinence after low anterior resection of the rectum seems to be caused mostly by changes in autonomic functionality of anal sphincters and lack of compliance of the neorectum, since the influence of neoadjuvant radiotherapy and the operation itself on the somatic innervation of anal sphincters seems to be minimal.
    Źródło:
    Polish Journal of Surgery; 2012, 84, 4; 177-183
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Risk Factors for Wound Dehiscence after Laparotomy – Clinical Control Trial
    Autorzy:
    Kenig, Jakub
    Richter, Piotr
    Żurawska, Sabina
    Lasek, Anna
    Zbierska, Katarzyna
    Nowak, W.
    Powiązania:
    https://bibliotekanauki.pl/articles/1396927.pdf
    Data publikacji:
    2012-12-01
    Wydawca:
    Index Copernicus International
    Tematy:
    dehiscence
    risk factors
    Opis:
    Described in the literature dehiscence rate in the adult population is 0.3-3.5%, and in the elderly group as much as 10%. In about 20-45% evisceration becomes a significant risk factor of death in the perioperative period. The aim of the study was to identify the main risk factors for abdominal wound dehiscence in the adult population. Material and methods. The study included patients treated in the 3rd Department of General Surgery, Jagiellonian University Collegium Medicum in Cracow in the period from January 2008 to December 2011, in which at that time laparotomy was performed and was complicated by wound dehiscence in the postoperative period. For each person in a research group, 3-4 control patient were selected. Selection criteria were corresponding age (± 2-3 years), gender, underlying disease and type of surgery performed. Results. In 56 patients (2.9%) dehiscence occurred in the postoperative period with 25% mortality. The group consisted of 37 men and 19 women with the mean age of 66.8 ± 12.6 years. Univariate analysis showed that chronic steroids use, surgical site infection, anastomotic dehiscence/fistula in the postoperative period and damage to the gastrointestinal tract are statistically significant risk factors for dehiscence. Two first of these factors occurred to be independent risk factors in the multivariate analysis. In addition, due to the selection criteria, a group of risk factors should also include male gender, emergency operation, midline laparotomy, colorectal syrgery and elderly age (> 65 years). Logistic regression analysis did not show that a particular surgeon, time of surgery or a particular month (including holiday months) were statistically significant risk factor for dehiscence. Conclusions. Wound dehiscence is a serious complication with relatively small incidence but also high mortality. Preoperative identification of risk factors allows for a more informed consent before patient’s treatment and to take measures to prevent or minimize the consequences of complication associated with it.
    Źródło:
    Polish Journal of Surgery; 2012, 84, 11; 565-573
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
      Wyświetlanie 1-7 z 7

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