Nowa Medycyna最新文献

{"title":"Standards of anal fissure management in Europe and the United States","authors":"M. Kołodziejczak, P. Ciesielski, A. Kucharczyk","doi":"10.25121/nm.2021.28.2.80","DOIUrl":"https://doi.org/10.25121/nm.2021.28.2.80","url":null,"abstract":"Anal fissure is the second most common proctological disorder after haemorrhoids. The majority of researchers agree that conservative treatment should be the first stage of anal fissure management. The procedures used for the treatment of anal fissure are the biggest subject of disagreement. The aim of this article is to review and compare thedifferences in the methods of anal fissure management in certain European countries and in the United States. Anal fissure treatment varies between different countries. In many algorithms, fissurectomy combined with anal skin advancement flap reconstruction is listed as the first treatment option. Posterior sphincterotomy, which is frequently performed in Poland, is not included in any of the algorithms quoted in this paper; lateral sphincterotomy is preferred instead. No algorithm recommends manual anal dilation, which is consistent with our observations that this procedure is associated with uncontrolled tearing of sphincter muscle fibres and a high risk of incontinence. This article reviews and compares the differences in the methods of anal fissure treatment in certain European countries and in the United States.","PeriodicalId":311146,"journal":{"name":"Nowa Medycyna","volume":"294 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126959766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstetric anal sphincter injuries – management guidelines","authors":"M. Kołodziejczak, P. Ciesielski","doi":"10.25121/nm.2021.28.2.59","DOIUrl":"https://doi.org/10.25121/nm.2021.28.2.59","url":null,"abstract":"Gas and stool incontinence is a serious disability, which significantly impairs the patient’s quality of life in the personal, professional and social sphere. Although it is estimated that continence problems affect up to 15% of the adult population, the problem still seems to be epidemiologically underestimated. In women, obstetric trauma is the most common cause of incontinence, referred to as “the silent affliction” as the patients do not talk about it, and doctors do not actively ask patients about incontinence after delivery. Insufficient reimbursement of sphincter repair by the National Health Fund means that there is little interest in performing sphincter repair in surgical departments, while the difficulty of the surgery requiring extensive experience, as well as the risk of postoperative complications make these procedures unattractive for the private sector. Proper emergency treatment of postpartum sphincter damage prevents functional complications in the form of gas and faecal incontinence. Elective, distant reconstructions have a higher complication rate than emergency reconstructions, and therefore should be preceded by imaging and functional diagnosis. The paper discusses the problem of postpartum incontinence, presenting the diagnostic and therapeutic algorithms for emergency and elective sphincter repair.","PeriodicalId":311146,"journal":{"name":"Nowa Medycyna","volume":"298 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115862286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dr James Marion Sims – kontrowersyjny „ojciec ginekologii”","authors":"M. Ciesielska","doi":"10.25121/nm.2021.28.1.30","DOIUrl":"https://doi.org/10.25121/nm.2021.28.1.30","url":null,"abstract":"Vesico-vaginal fistula (VVF) was a a catastrophic and common complication of childbirth among American women. In the mid 1800s Dr. J. Marion Sims reported the successful repair of vesicovaginal fistulas with a technique he developed by performing multiple operations on on a group of young, enslaved, African American women who had this condition between 1846 and 1849. Numerous modern authors have attacked Sims’s medical ethics, arguing that he manipulated the institution of slavery to perform ethically unacceptable human experiments on powerless, unconsenting women. It is impossible to understand Sims’s operations within the clinical context of the 1840s. To avoid the problems of “presentism”, in which beliefs, attitudes, and practices of the 21st century are anachronistically projected backward into the early 19th century we have to judge Sims within the context of his time. This is the only way to understand that Sims’ first fistula operations were legal, that they were carried out with express therapeutic intent for the purpose of repairing these women’s injuries, that they conformed to the ethical requirements of his time, and that they were performed with the patients’ knowledge, cooperation, assent, and assistance. Though the legacy of Dr. Sims is for some authors controversial he still seems to be considered as “the father of gyncology” who developed the first consistently successful surgical technique for the vesico-vaginal fistula.","PeriodicalId":311146,"journal":{"name":"Nowa Medycyna","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125152107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Undifferentiated cancer with unknown primary location infiltrating the rectum – a case report","authors":"Paweł Dutkiewicz, R. Chmielewski, M. Chudzik, Jowita Grządkowska, P. Kluge","doi":"10.25121/nm.2021.28.1.17","DOIUrl":"https://doi.org/10.25121/nm.2021.28.1.17","url":null,"abstract":"Colorectal cancer (CRC) is the third leading malignancy in men after prostate and lung cancer. Adenocarcinomas account for about 90% of all colorectal cancer cases. Carcinomas of unknown primary site (CUPs) are usually found in patients > 60 years of age. They account for 3% of all malignancies in Poland. We describe a diagnostically challenging case of undifferentiated carcinoma of unknown primary site invading the rectum. Rectal specimens collected during endoscopy and open biopsy, as well as samples collected during laparotomy from the side of the peritoneal cavity did not confirm cancer despite progressing clinical symptoms of an ongoing neoplastic process. Histopathological diagnosis was obtained only with core-needle biopsy of the rectal infiltration and sphincter muscles. The histopathological confirmation of carcinoma invading the sigmoid colon, rectum, anus and the mesorectum described in PET-CT enabled patient qualification for further palliative treatment.","PeriodicalId":311146,"journal":{"name":"Nowa Medycyna","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127365240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstruction of anal sphincter muscles in post-traumatic sphincter damage with fecal incontinence – case report","authors":"R. Cylke, M. Kwapisz, A. Ostaszewska, M. Kołodziejczak","doi":"10.25121/nm.2021.28.1.23","DOIUrl":"https://doi.org/10.25121/nm.2021.28.1.23","url":null,"abstract":"Extra-obstetric injuries to the anal area are rare. The cause of isolated damage is most often accidents when working with utility machines or impalement injuries caused by sharp objects, as well as transport accidents. The authors present a rare case of a young man who, 8 years ago, suffered an extensive pelvic fracture injury, with rectal detachment, and extensive injuries to the thigh and buttock area with skin-fat lobe detachment in the course of a transport accident. At the pediatric surgery center, fracture stabilization was performed and colostomy was created, which was closed when patient completed 15 years of age. Due to persistent symptoms of fecal incontinence, the man was qualified for a late reconstruction of sphincters. Prior to the operation, detailed imaging diagnostics were performed. 6 months after the procedure, the patient declared significant improvements in quality of life and fecal retention (3/20 points on the Wexner Faecal Incontinence Quality of Life Scale). After complete healing of the wound, the patient was prescribed sphincter electrostimulation. The authors conclude that there are no clear guidelines for the management of patients with rectal and anal injuries. Treatment should be individualized on a case-by-case basis. In the situation of supplying the acute damage to the sphincter apparatus, it is crucial to verify that the injury does not also include the intraperitoneal organs, as this determines further proceedings and a possibility of primary definitive reconstructive surgery. For the successful functionality of sphincters, it is also important to implement muscle-strengthening exercises, “biofeedback” therapy and electrostimulation.","PeriodicalId":311146,"journal":{"name":"Nowa Medycyna","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132594839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the rationale for the use of preventive antibiotic (clindamycin) therapy in patients operated on for anal fistula based on authors’ own experience","authors":"Marzena Kesler, A. Koch, M. Rychlik, Jacek Bierca, M. Kołodziejczak","doi":"10.25121/nm.2021.28.1.5","DOIUrl":"https://doi.org/10.25121/nm.2021.28.1.5","url":null,"abstract":"Introduction. Bacterial infection of the anal glands has been considered the main cause of anal fistulae for many years. Other most common causes include Crohn’s disease, ulcerative colitis, any type of immunosuppression (e.g. HIV infection, immunosuppressants), foreign bodies, and injuries. Studies assessing the type of bacterial pathogen involved in the formation of an anal fistula are sparse. Furthermore, it seems that although surgery remains the primary treatment of the disease, the importance of treating cryptic infection and the use of antibiotic therapy based on culture findings seems underestimated. Aim. The aim of this study was to assess the rationale for the use of preventive antibiotic therapy in patients after proctological surgeries. Material and methods. In the period from January 1 to December 31, 2019, 46 patients (40 men, 6 women) aged 28 to 71 years (mean age 49 years) were operated on at the Department of General Surgery of the County Hospital in Ostrów Mazowiecka for anal fistulae. All patients were operated on by the same surgeon experienced in proctological surgery. Bacterial cultures were collected intraoperatively and preventive antibiotic therapy in the form of IV clindamycin 2 × 600 mg was used in all patients. Results. A large number of Bacteroides spp. showed high resistance (88%) to clindamycin. Anaerobic bacteria showed 60% resistance to clindamycin. Conclusions. 1. Clindamycin should not be used in preventive antimicrobial treatment in patients undergoing surgical treatment for anal fistula in the Department of General Surgery of the County Hospital in Ostrów Mazowiecka. 2. The variable sensitivity of bacteria to antimicrobials should be considered and antibiotic prophylaxis should be changed depending on the resistance developed to the subsequent antibiotics used.","PeriodicalId":311146,"journal":{"name":"Nowa Medycyna","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122708429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of treatment of haemorrhoidal disease with KLS Martin maXium marClamp® CUT IQ thermal tissue fusion instrument based on offset electrode technology compared to the Milligan-Morgan procedure with bipolar coagulation for the excision of grade III and IV haemorrhoids","authors":"G. Ćwiertnia, M. Dyaczyński, M. Lesiecka, M. Dróżdż, Michał Glogasa, K. Buczkowski, D. Gajda, L. Wylężek, Jarosław Łach","doi":"10.25121/nm.2021.28.1.12","DOIUrl":"https://doi.org/10.25121/nm.2021.28.1.12","url":null,"abstract":"Introduction. The study compared the effects of surgical treatment of grade III and IV haemorrhoids achieved with a conventional operative technique and by using a thermal tissue fusion instrument based on offset electrode technology. A total of 60 patients with grade III and IV haemorrhoids were operated on in the Department of General and Oncologic Surgery, Municipal Hospital in Siemianowice Śląskie, and in the On-Clinic Medical Centre in Chorzów, between October 2011 and September 2015. Aim. The aim of the study was to compare the outcomes of treatment of haemorrhoidal disease using KLS Martin maXium marClamp® CUT IQ thermal tissue fusion instrument based on offset electrode technology and the Milligan-Morgan surgical procedure with bipolar coagulation for the excision of grade III and IV haemorrhoids. Material and methods. The patients were divided into two groups: Group 1 – patients operated on using KLS Martin maXium marClamp® CUT IQ thermal tissue fusion instrument based on offset electrode technology. Group 2 – patients operated on using the conventional Milligan-Morgan technique with electrocoagulation. The evaluated parameters included the length of hospital stay after surgery, duration of the surgical procedure, level of pain on the postoperative days 1 and 2 rated on a 10-point VAS scale, and postoperative wound healing time. Results. A reduction in postoperative pain, shorter procedure duration and hospital stay, and more rapid postoperative wound healing were observed in Group 1 compared to Group 2. Conclusions. In our study material, the application of a thermal tissue fusion instrument using offset electrode technology in surgeries to remove grade III and IV haemorrhoids, compared to the conventional Milligan-Morgan procedure with electrocoagulation, brought the following results: – less postoperative pain, – shorter duration of surgical procedure, – reduced length of hospital stay, – faster healing of postoperative wound.","PeriodicalId":311146,"journal":{"name":"Nowa Medycyna","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127723712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amina Okujewa (1983-2017) – chirurżka na wojnie XXI wieku. In memoriam","authors":"M. Ciesielska","doi":"10.25121/nm.2020.27.4.162","DOIUrl":"https://doi.org/10.25121/nm.2020.27.4.162","url":null,"abstract":"Amina Viktorivna Okueva (Ukrainian: ????? ?????????? ??????); was a Ukrainian doctor of Chechen descent, During the Euromaidan she worked as a medic in the Kyiv-2 battalion and saw combat in the city of Debaltseve after it was taken over by Russian-aligned rebels in 2015. She was killed in an ambush by unknown attackers on 30 October 2017. Her husband Adam Osmaev, a leader of the Dzhokhar Dudayev Battalion. Okueva was killed in a military-style ambush on 30 October 2017 near the village of Hlevakha, Kyiv Oblast. Unidentified attackers opened fire on the car containing her and her husband while it slowed by a railroad crossing, firing five rounds into her including two fatal rounds into her head. Adam Osmaev was injured in the ambush but survived.","PeriodicalId":311146,"journal":{"name":"Nowa Medycyna","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116809735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proctogyneacology – who should treat? A proposed treatment algorithm","authors":"M. Kołodziejczak, P. Ciesielski, Maja Gorajska-Sieńko","doi":"10.25121/nm.2020.27.4.143","DOIUrl":"https://doi.org/10.25121/nm.2020.27.4.143","url":null,"abstract":"Proctogyneacology deals with conditions involving the anal canal, anal sphincter muscles, rectum, rectovaginal septum, and the female reproductive tract. They may be due to sagging of the pelvic floor and the rectovaginal septum (rectal, vaginal or uterine prolapse, enterocele and rectocele), perinatal injury, including sphincter damage, rectovaginal fistulas, endometriosis with anal sphincter and rectovaginal septum involvement, proctological inflammatory diseases in pregnancy, as well as radiation-induced rectal damage after gynaecological cancer treatment. There are no set guidelines defining which specialist should operate on these patients. We attempted to systematise this issue in the form of an algorithm. An interdisciplinary dialogue allowing for our professional development and, most of all, therapeutic success and reduced risk of postoperative complications, seems to be crucial.","PeriodicalId":311146,"journal":{"name":"Nowa Medycyna","volume":"1994 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130346655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"My first appendectomy: on both sides of the table. A surgeon’s personality","authors":"K. Bielecki","doi":"10.25121/nm.2020.27.4.156","DOIUrl":"https://doi.org/10.25121/nm.2020.27.4.156","url":null,"abstract":"","PeriodicalId":311146,"journal":{"name":"Nowa Medycyna","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123811420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}