76 research outputs found
Endoskopinis ūminės storosios žarnos obstrukcijos gydymas
No full textKęstutis Adamonis, Dainius Pavalkis, Žilvinas Saladžinskas, Algimantas Tamelis
KMU Gastroenterologijos klinika, KMU Chirurgijos klinika
Šiuolaikis virškinimo trakto piktybinės obstrukcijos gydymas vis labiau tampa minimaliai invazinis. Ligoniai, sergantys storosios žarnos vėžiu, komplikuotu obstrukcija, į gydymo įstaigas patenka skubos tvarka, neretai sunkios būklės, ir nėra idealūs kandidatai chirurginei operacijai. Šiuolaikinėje medicinos literatūroje gausėja mokslinių straipsnių apie sėkmingą ir saugų endoskopiniu būdu įkišamų savaime išsiplečiančių metalinių stentų naudojimą proktologijoje. Nors stentai ir yra brangūs, tačiau proktologinis stentavimas yra rentabili procedūra, leidžianti ligoniams, sergantiems storosios žarnos vėžiu, komplikuotu ūminė storosios žarnos obstrukcija, išvengti neatidėliotinos operacijos, o esant nerezektabiliam vėžiui, – kolostomos. Straipsnyje aprašomas KMU Chirurgijos klinikoje atliktas pirmasis Lietuvoje sėkmingas endoskopinis ūminės žarnų obstrukcijos gydymas stentuojant žarnyną.
Prasminiai žodžiai: žarnyno obstrukcija, kolorektinis vėžys, endoskopija, stentavimas.
Acute colonic obstruction: endoscopical management
Kęstutis Adamonis, Dainius Pavalkis, Žilvinas Saladžinskas, Algimantas Tamelis
Management of malignant gastrointestinal obstruction presents a significant challenge. Most patients are in a profoundly decompensated state due to underlying malignancy and are not ideal candidates for invasive surgical procedures. In recent years, self-expandable metal stents have emerged as an effective and safe, less invasive alternative for the treatment of malignant intestinal obstruction. Although stents are expensive, the procedure appears to be cost-effective, since emergency surgery can be avoided in patients with acute bowel obstruction, and in those with advanced disease no resection of the colon is necessary. Here we report a retrospective analysis of a first self-expandable metal stent placed for colorectal obstruction at Kaunas Medical University Hospital, as well as review the literature published on self-expandable metal stent placement. Our first data confirm self-expandable metal stent efficacy in palliation of malignant intestinal obstruction.
Keywords: intestinal obstruction, colorectal cancer, endoscopy, endoluminal stenting
Nudegusių ligonių ir jų žaizdų patogenų analizė
No full textRokas Bagdonas, Algimantas Tamelis, Rytis Rimdeika, Mindaugas Kiudelis
Įvadas / tikslas
Didžiausia nudegimų chirurgijos problema yra infekcija, nuo kurios miršta daugiau kaip 50% visų nudegusių pacientų. Nudegimų žaizda greitai infekuojasi, kadangi žaizdos aplinka yra ideali mikroorganizmams atsirasti ir daugintis. Studijoje, patvirtintoje Universiteto etikos komiteto, analizuojami nudegę pacientai ir iš nudegimo žaizdų išskirti patogenai.
Pacientai ir metodai
Mes analizavome 2246 nudegusius pacientus (amžiaus vidurkis – 27 metai), gydytus KMU Chirurgijos klinikose 1997–2002 metais. Nudegimo sunkumas buvo vertintas pagal Amerikos nudegimų asociacijos (ABA) schemą. 2462 nudegimo žaizdos pasėliai (2246 pacientų) buvo paimti steriliu tamponu ir pasėti 5% kraujo ir MacConkey terpėse.
Rezultatai
Iš nudegusių pacientų 1447 (74%) buvo vyrai ir 799 (26%) – moterys (p < 0,001). Pacientų amžius – nuo 2 iki 47 metų. 1261 (56%, p < 0,05) pacientai patyrė lengvą, 522 – vidutinį ir 463 – sunkų kūno nudegimą. 2130 pasėliai (86,5%), paimti iš 2462 nudegimo žaizdų, buvo teigiami. Iš 2130 teigiamų pasėlių Staphylococcus aureus išskirtas 1110 (52,1%) pasėliuose, iš jų MRSA – 498 (23,4%).
Išvados
Jauni vyrai dažniausiai patiria lengvus kūno nudegimus. Nudegimo žaizda dažniausiai infekuojasi S. aureus mikroorganizmais. MRSA yra pagrindinis ligoninės patogenas, infekuojantis nudegimo žaizdą.
Prasminiai žodžiai: nudegimo sunkumas, nudegimo žaizdos patogenai, išskirti sukėlėjai
Analysis of burn patients and the isolated pathogens
Rokas Bagdonas, Algimantas Tamelis, Rytis Rimdeika, Mindaugas Kiudelis
Kaunas Medical University, Clinic of Surgery,
Eivenių str. 2, LT-50009, Kaunas, Lithuania
E-mail: [email protected]
Background / objective
The major challenge for a burn team is infection, which is known to cause over 50% of burn deaths. Burns become infected, because the environment at the site of the wound is ideal for the proliferation of infecting organisms. This study, approved by the regional Ethics Committee, analyzes the features of burned patients and the rates of pathogens isolated from burn wounds.
Patients and methods
We studied 2246 burn patients (mean age 27 years) admitted to the tertiary academic hospital in 1997–2002. The differentiation of the severity of burn injury was based on the scheme of the American Burn Association (ABA). 2462 surface swabs for microbiological analysis were taken from all 2246 patients. The wound area was swabbed with an alginate swab and cultured in 5% blood and MacConkey agar.
Results
There were 1447 (74%) men and 799 (26%) women (p < 0.001), age range 2–47 years. There were 1261 patients (56%, p < 0.05) with minor, 522 with moderate and 463 with major burn injuries. 2130 swabs (86.5%) out of 2462 burn wound surface swabs were positive. Out of 2130 isolates positive for pathogenic bacterial culture, there were 1110 (52.1%) isolates positive for Staphylococcus aureus infection. The rate of MRSA was 23.4% (498 isolates).
Conclusions
Young male patients mostly have a minor burn injury. Burn wounds are most commonly infected with S. aureus. MRSA is still the main hospital pathogen in burns.
Keywords: severity of the burn injury, burn swabs, isolated pathogen
Short-term Results of Colostomy Formation and Reversal in Hartmann's Type Procedure
No full textAIM: To find and evaluate factors that influenced the occurrence of complications. Research tasks: To evaluate short-term Hartmann procedure treatment outcomes. To determine whether age, sex, BMI, ASA class, comorbidities, main disease parameters influenced the selection of patients for colostomy reversal surgery and the occurrence of short-term postoperative complications. To find the most common complications after colostomy removal surgery. Methods: A retrospective data analysis of patients who underwent Hartmann-type surgery between 2015 and 2018 and afterwards had a colostomy reversal surgery. The surgeries were performed at LUHS KK unit of surgery in Surgery Department. Results: A total of 106 Hartmann procedure sampled patients were taken for the analysis. The patients were older (67.81±13.76) with tumor-induced intestinal disease (χ²=23.58, p=0.00001) and higher ASA grades (p=3.562), and those with more comorbidities (χ²=58.81, p=0.00001) when the risk to make the primary connection was too risky. While assessing postoperative complications it cannot be said that some of the mentioned postoperative complications were more common than others. Reason is that no statistically significant difference was found between the groups (p>0.05). The most common complications were urinary tract infection, intestinal junction leakage and postoperative wound infection. The intestinal integrity was restored to 19.1% of subjects who had Hartmann procedure. Comparing subjects who underwent Hartmann procedure and colostomy reversal, patients were younger (p=0.017) with a mean age of 59.16±14.46. They also had fewer comorbidities (p=0.0025) however ASA class III-IV remained high. Colostomy reversal was performed statistically significantly (p=0.009) for subjects whose underlying disease was not of tumor origin. The incidence of postoperative complications was 20%. The most common being postoperative wound infection (60%). Conclusions: Postoperative proximal complication of Hartmann procedure developed in 18% of subjects. Complications were more common (p=0.05021) in emergency surgeries and grade IIIb (p=0.001) prevailed according to the Clavein-Dindo classification. Subjects with restored intestinal integrity after Hartmann procedure were younger (p=0.017), had fewer comorbidities (p=0.0025) but nevertheless had high ASA class III-IV. The most common short-term postoperative complications were postoperative wound infection 60%, intestinal junction leakage and intra-abdominal abscesses 20% (p > 0.05)
Results analysis of anorectal fistula treatment
No full textSeverija Pažemeckaitė Results analysis of anorectal fistula treatment Aim of study. To evaluate the treatment results of anorectal fistulas with more than 5 years after the surgery. Objectives. Find out the frequency of sphincter function disorders and their impact on quality of life after the surgery. Find after surgery relapse rate. To find and evaluate factors that are important for disabling the sphincter function and relapse. Materials and methods. Analytical and retrospective analysis of the history of anorectal fistula surgery and the comparison of the data of patients who have had anorectic fistula surgery in 2010- 2013 in the Department of Surgery, Lithuanian University of Health Science Kaunas Clinics. Life quality analysis was performed by interviewing patients. Results. Out of 204 patients selected, 91 (44.83%) patient had fistulotomy, 41 (20.20%) of them had fistulectomy according to Gabriel, 23 (11.33%) – tight seton, 41 (20.20%) – lose seton, 7 (3.45%) – anus plastic by sewing the inner hole. The most common type of fistula was intersphincteric with 83 (41.71%) patients having it, low transphincteric fistula canal observed in 67 patients (33.67%), suprasphincteric – in 32 (16.08%), and extrasphincteric – in 17 (8.54%). Moreover, 5-8 years after the surgery, 14 (8%) patients were observed spotting the clothes, and no such complications were observed for 161 (92%) patient. Fecal incontinence as a complication was reported by 23 patients (13.14%), 11 (6.29%) of which did not keep the gas, 8 (4.57%) had liquid fecal and 4 (2.29%) had hard stools. Using a Wexner scale, 174 patients received an average score of 1.58 ± 3.42 points (0 to 19 points). The extrasphincteric canal is usually associated with a 3.3-point Wexner scale score (p = 0.0013) compared to the intrasphincteric of the fistula canal. The suprasphincteric fistula canal was associated with a 1.75-point higher estimate on the Wexner scale (p = 0.0318). The lose seton was also associated with an average of 1,234 higher Wexner scale scores compared to fistulotomy, however, statistical reliability was not obtained (p = 0.087) Conclusion. After AF surgery, frequency of sphincter function disorders is 8% and for fecal incontinence - 13.14% (of which 6.29% of gas, 4.57% of liquid fecal and 2.29% of stools). The extrasphincter fistula canal is associated with a 3.3-point higher Wexner scale score (p = 0.0013) compared to the intrasphincter fistula canal. The relapse frequency is 22.9%. Age had the greatest influence on fecal incontinence - with each year the odds ratio of not keeping the stools increased by 6% (p = 0.026)
The Outcomes of Conservative Treatment of Acute Colon Diverticulitis
No full textTo evaluate the outcomes of conservative treatment of acute colon diverticulitis and to determine the most favorable treatment method. Research tasks: 1. Discuss the reasons for choosing conservative treatment. 2. Assess the frequency and duration of disease recurrence. 3. To find the factors influencing the recurrence of the disease. Methods: A systematic analysis of the literature was performed using the PRISMA references. A search of the PubMed, Cochrane and ScienceDirect databases was conducted. Articles discussing the conservative methods for the treatment of acute colon diverticulitis and the prevailing solutions have been searched. English queries "diverticulitis outcomes", "diverticulitis conservative treatment" “diverticulitis treatment” “diverticulitis recurrence” were used for the search. A filter was also used: language "english", articles not older than "5 years". Results: A systematic search included 10 full-text scientific articles in the analysis. The whole study sample was 203 978 patients older than 18 years. Articles from Germany, Sweden, Norway, Finland, Denmark, the Netherlands, Israel and Canada were included in the systematic analysis. The researchers analyzed the outcomes of conservative treatment methods in comparison with surgical treatment, the frequency of relapses and the factors determining it. Conclusion: 1.Reasons for choosing conservative treatment: treatment effectiveness, lower incidence of complications, lower need for surgical treatment. In all studies analyzed, conservative treatment was successful in more than 80% of patients. The incidence of complications ranged from 9 to 30 percent. No surgical treatment was required in the two studies analyzed, with the remaining need for surgical treatment reaching up to 10%. 2. Recurrences are more common in the first year after diagnosis and treatment. The figures range from 12.5 to 38 percent. The analyzed studies show that after 10 years 79 percent of patients do not experience relapses of diverticulitis. 3. Factors influencing disease recurrence include: alcohol consumption, previous complicated diverticulitis, lymphoma, chronic lung disease, arterial hypertension, and diabetes mellitus. With alcohol, the odds ratio ranges from 1.13 to 3.30, with complicated diverticulitis ranging from 0.72 to 2.06. Lymphoma from 1.52 to 1.57, chronic lung disease from 1.09 to 1.58, hypertension from 0.65 (complicated AH), 0.82 (uncomplicated AH) to 1.05. Diabetes - from 0.82 to 1.53
Comparison of Early Postoperative Complications in Patients with and without Antibiotic Therapy after Colorectal Surgery
No full textPurpose: To evaluate the significance of postoperative antibiotics in prevalence of early postoperative complications after colorectal surgery. Research tasks: To find out reasons of choice to administer antibiotics after colorectal surgery; To compare early postoperative complications in patients with or without postoperative antibiotic therapy Methods: This was a retrospective study. Data were collected from case histories of 376 consecutive patients, who have undergone colorectal surgery in Department of Surgery at Hospital of Lithuanian University of Health Sciences Kaunas Clinics between 2017 and 2018. There were two groups in this study – patients who received antibiotics after colorectal surgery and those who did not. Postoperative complications were rated with Clavien Dindo classification. Statistical analysis was processed using MS Excel 2010 and IBM SPSS 25.0. Data were analyzed using chi (χ2) square criterion, Mann Whitney’s U, Kruskal-Wallis tests and descriptive statistics. Data were considered statistically significant at p 70 years (p=0.038); which BMI greater than 25 kg/m2 (p=0.009); ASA III – IV class (p = 0.003). Mean duration of postoperative antibiotic therapy was 6.027 (SD 2.239) days. 303 patients had no postoperative complications . 39 (10.37%) patients receiving antibiotic therapy and respectively 34 (9.04%) without antibiotc therapy were diagnosed with early postoperative complications. The most common short - term postoperative complications were abdominal wall infection - 18 (4.79 %), peritoneal cavity abscess - 19 (5.05 %) and ileus -14 (3.72 %). Patients with postoperative complications were ranked by Clavien Dindo classification in these groups: I grade - 4 (1.06 %) patients; II grade -33 (8.8 %); III grade - 29 (7.7%); IV grade - 5 (1.3%); V grade - 2 (0.5%). However, there was no statistically significant difference between patients who received antibiotics after surgery and those who did not (p > 0,05). Conclusions: Reasons of surgeon‘s choice to use antibiotics after surgery were determined by the patient-related risk factors for postoperative complications. Postoperative antibiotics after colorectal surgery do not prevent early postoperative complications
Analysis of the effect of endophytic bacteria on the carbonylation of tobacco (nicotiana tabacum) cell proteins
No full textNors yra daug informacijos apie endofitinius mikroorganizmus, žinios apie augalų ir endofitų molekulinės sąveikos mechanizmus ir procesus vykstančius pradiniame augalo audinių kolonizacijos etape yra nepakankamai išsamios. Todėl tyrimo tikslas in vitro modelinėje sistemoje ištirti ankstyvosios kolonizacijos etape vykstančius procesus ir endofitinių bakterijų poveikį augalui.
Darbe aprašomi tyrimai buvo atliekami naudojant paprastojo tabako Nicotiana tabacum L. ląstelių kultūrą ir šešis skirtingus endofitinių bakterijų kamienus. Tyrimo metu buvo ištirtas endofitinių bakterijų poveikis paprastojo tabako Nicotiana tabacum L. ląstelių kultūros gebėjimui kaupti aktyviuosius deguonies junginius. Šis tyrimas buvo atliktas naudojant dichlorofloresceino diacetato fluorescencijos metodą, o viena . Gauti rezultatai rodo, jog viena iš tirtų bakterijų statistiškai mažino ADJ kaupimą. Dėl teigiamo poveikio aktyvių deguonies junginių kaupimui, tolimesniems tyrimams buvo pasirinkta Bacillus Simplex NT21. bakterija.
Sekančio tyrimo metu buvo atliktas skirtingų fluorescuojančių dažų stabilumo vertinimas skirtingose temperatūrose ir pasirinkti stabiliausi ir labiausiai tinkami dažai. Atlikus dažų stabilumo vertinimą, buvo pasirinkta dvikryptės elektroforezės metodui naudoti CF647DI dažus.
Pasirinkus tinkamiausią endofitinės bakterijos kamieną ir fluorescuojančių dažų tipą, buvo atliktas šių bakterijų inokuliacijos poveikio tabako ląstelių baltymų kaupimui ir oksidacinei modifikacijai tyrimas, naudojant dvikryptės elektroforezės metodą. Gauti rezultatai rodo, jog ištirtas endofitinės bakterijos kamieno aktyvinamas ADJ kaupimas tabako ląstelėse sukelia streso atsako, branduolio rūgščių sintezės ir metabolizmo procesuose dalyvaujančių baltymų karbonilinimo pokyčius.The studies described in this paper were carried out using a cell culture of Nicotiana tabacum L. and six different strains of endophytic bacteria. Knowledge of the molecular mechanisms of plant-endophyte interactions and the processes involved in the initial stages of colonisation of plant tissues is incomplete and lacking. Therefore, the aim of this study was to investigate in an in vitro model system the processes involved in the early colonisation phase and the effects of endophytic bacteria on the plant.
The study investigated the effect of endophytic bacteria on the cell culture of N. tabacum L. cells abilities to accumulate reactive oxygen species. This study was carried out using the dichloroflorescein diacetate fluorescence method. The results show that one of the six bacteria tested showed a statistically significant increase in the accumulation of ROS and one other strain showed an inhibition.
In the following experiment, the stability of different fluorescent dyes at different temperatures was evaluated and the most stable and suitable dyes were selected. After the stability assessment, the CF647DI dye was chosen for the bidirectional electrophoresis method.
After selecting the most suitable endophytic bacterial strain and type of fluorescent dye, the effect of inoculation of these bacteria on the accumulation and oxidative modification of tobacco cell proteins was investigated by means of bidirectional electrophoresis. The results show that this endophytic bacterial strain activated by the accumulation of reactive oxygen species in tobacco cells induces changes in the stress response, the synthesis of nuclear acids, and in the carbonylation of proteins involved in metabolic processes.Gamtos mokslų fakultetas / Faculty of Natural SciencesVytauto Didžiojo universitetas / Vytautas Magnus UniversityBiologijos katedra / Department of Biolog
Comparison of postoperative outcomes and complications rates after anterior rectal resection, obstructive resection and abdominoperineal resection
No full textObjective. We aimed to compare the outcomes and postoperative complications rates between the anterior rectal resection (AR), obstructive resection (OR) and abdominoperineal resection (APR). Research tasks. To determine the impact of preoperative variables on the choice of the surgery, to compare the complications occurence rates between AR, OR and APR, and to identify and evaluate the factors, that influenced the treatment outcomes. Methods. A retrospective analysis of case histories of patiens, who were treated in Lithuanian University of Health Sciences Hospital Kaunas Clinics‘, Department of Surgery in 2012-2014, and underwent either PR, OR or APR, was carried out. Results. Of 267 patients selected for the survey, 164 (61.4%) underwent AR, 47 (17.6%) – OR, and 56 (21%) - APR. Patients, who had ASA III-IV score, were 57.3% in AR group, 85.1% in OR group and 66.1% in APR group (p = 0.002). There were 71.2%, 93.5% and 66.7% patients who had T3-4 cancer (p = 0.001) in those groups. Cases of N1-4 stage cancer rates were 49.4%, 67.4% and 38.2%, respectively (p = 0.048). Complicated cancer rates were 4.3% in AR, 48.9% in OR and 12.5% in APR groups (p = 0.001), recurrent - 1.2%, 8.5% and 7.1%, respectively (p = 0.001). Neoadjuvant chemoradiation therapy was applied in 30.3% of patients in PR, 23.5% in OR and 47.3% ir APR group (p = 0.033). Erithrocyte mass (EM) trasfusion rates were 5.5%, 19.1% and 12.5% respectively (p = 0.012). Intraoperative perforation rates were 4.3% in OR and 1.8% in APR group (p = 0.044), pelvic abscess - 6.4% and 8.9% respectively (p = 0.001). Lenght of stay after surgery were 9.02 ± 4.64 (5-43) in AR, 10.36 ± 4.83 (5-26) in HR, and 10.25 ± 5.99 (4-42) in APR groups, (p < 0.05). There were no other significant differences in other variables. Binary logistic regression showed that the probability of developing postoperative complications increases with older age (OR-1.13; p = 0.046), higher ASA Score (OR-1.56; p = 0.011) and EM transfusions (OR-3.38; p = 0.01). Conclusions. With impaired general condition of the patient, advanced and complicated cancer, OR is chosen. APR is preferred when the cancer is low in the rectum. Complications, that require treatment in ICU and prolong the lenght of stay, occur more often if OR is performed, and after APR, there are higher chances to develop pelvic abscess. Postoperative complications rates increase with age, higher ASA score and blood transfusions
Staphylococcus aureus infekcija nudegimų chirurgijoje
No full textS. aureus causative agent is relatively pathogenic to humans and is found on the skin and mucosa of up to 40% of all population. Burn injuries are infected with S. aureus in 30% of cases; however, in many cases the injuries heal without the antibiotic therapy, solely by applying dressing with antiseptic solutions, early removal of necrotic masses and covering the injury with a skin graft. In 2000, in the Division of Plastic Surgery and Burns of our institution, the frequency of S. aureus infection among patients with burns was 47%, of which methicillin-resistant S. aureus – 45%. The study included 100 patients who had S. aureus grown in the samples of their injuries. The article compares the severity of the trauma and the results of treatment in groups of patients with methicillin-resistant S. aureus and methicillin-sensitive S. aureus
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