Association of Gem-associated protein 4 gene polymorphisms with the risk of colorectal cancer in the Polish population

Aim: Gem-associated protein 4 (GEMIN4), a member of the GEMIN gene family, is a key compound of the regulating factors responsible for miRNA biogenesis. Genetic variability within this gene can alter the risk for development of colorectal cancer (CRC) as was shown for other genes involved in miRNA biogenesis. Therefore, presented study was intended to identify genetic variants of three single nucleotide polymorphisms (SNPs) in the GEMIN4 gene (rs1062923, rs2740348 and rs910925) and their relationship with CRC. Methods: The study comprised 203 patients and 179 age and sex matched controls. Genotyping of GEMIN4 gene variants was done using Taqman® assay. The association of GEMIN4 variants with CRC was done by odds ratio analysis. Haplotype analysis was done to see the combined effect of studied variants on CRC. Results: Patients carrying all variant genotypes for GEMIN4 rs1062923 (odds ratio [OR]= 0.205; 95% confidence interval [CI]= 0.1034-0.4065 for CC variant and [OR] = 0.1436; [CI] = 0.0869-0.2373 for CT variant, respectively) and GEMIN4 rs2740348 (odds ratio [OR]= 0.4498; 95% confidence interval [CI]= 0.2342-0.8637for CC variant and [OR] = 0.3986; [CI] = 0.2043-0.7776 for CG variant, respectively) showed significant association in lower occurrence of cancer, whereas in case of GEMIN4 G/C rs910925 variant genotype, no significance correlation was found. Conclusions: Our study gives a substantive support for the association between the GEMIN4 gene variants/miRNA biogenesis and CRC risk.

Location of liver lacerations resulting from deceleration injuries and a proposal for their classification

Purpose: The aim of the study was to verify during forensic autopsies the occurrence of liver lacerations resulting from deceleration traumas in the locations reported in professional literature, and also to check whether they are located near the left coronary ligament and its extension, i.e. the left triangular liver ligament. Methods: The liver injuries were assessed on the base of cases of forensic autopsies, performed at the Department of Forensic Medicine of the Medical University of Lodz from 1 of September 2011 to 15 of April 2014. In order to analyze the collected data, descriptive methods and statistical inference methods were used. Results: Three types of liver rupture turned out to be characteristic and statistically significant: 1 – on the diaphragmatic surface of the right lobe between its two sectors; 2 – within the left lobe to the right (in segment IV) or to the left (in segment III) of the falciform ligament; 3 – located near the left coronary ligament (in segment II). Conclusions: Typical location of liver lacerations after deceleration trauma, i. e. the right triangular ligament and falciform ligament, are confirmed in the analysed autopsy material. The place not previously described in the literature, which should be regarded as a characteristic location of a liver rupture after deceleration trauma is the diaphragmatic surface of segment II of the left lobe.

Use of percutaneous cholecystostomy for complicated acute lithiasic cholecystitis: solving or deferring the problem?

Objective: Percutaneous cholecystostomies are not infrequently used as an adjunct in the treatment of severe lithiasic cholecystitis, particularly in unstable and comorbid patients. However, their out of proportion liberal use tends to substitute the performance of emergency cholecystectomy, which the definitive treatment. Our aim was to assess the short and long-term outcomes of patients who had percutaneous cholecystostomy insertion due to severe lithiasic cholecystitis, aiming to define areas for improvement of our institutional practice. Materials and Methods: Retrospective review of our institutional practice including all patients who had a percutaneous cholecystostomy for complex lithiasic cholecystitis, over a 5-year period, allowing for an additional 1-year follow up. Results: A total of 34 patients were included in our final analysis. Percutaneous cholecystostomy insertion enabled quick and efficient control of the source of biliary sepsis without major procedural complications in all cases. In 14 (41.2%) patients, cholecystostomy alone served as definitive treatment, while in 20 (58.9%) cases it was used as bridging strategy for delayed elective cholecystectomy. In the delayed cholecystectomy group of patients, we noted a high conversion rate from laparoscopic to open surgery rate of 70%, with an overall subtotal cholecystectomy rate of 60%. Conclusion: Percutaneous cholecystostomies should be reserved only for complex lithiasic cholecystitis patients who are unwilling and/or unfit for surgery. We advocate the performance of upfront emergency cholecystectomy in any other case with liberal use of operative bail-out strategies, as a delayed elective operation is anyway likely to be converted to open and/or subtotal cholecystectomy.

Laparoscopic treatment of rare median arcuate ligament syndrome – medium-term follow-up

The paper "Laparoscopic treatment of the rare median arcuate ligament syndrome - mid-term follow-up" is important because the results of treatment are based not only on the subjective feelings of patients, but also on objective imaging tests, which is not observed in the previously published works on this topic. SUMMARY Introduction Median arcuate ligament syndrome [MALS] is a rare cause of chronic epigastric pain. The presentation might be unclear and non-specific. Diagnosing the syndrome requires interdisciplinary methods and specialists. Treatments consist of celiac axis release performed laparoscopically or robotically, and intraluminal stenting. The aim of the study was to report the medium-term postoperative follow-up results for four patients with MALS. Material and methods We performed 5 laparoscopic celiac axis releases in patients with MALS in our department in 2018. We included 4 patients in this study and all patients were admitted 16-23 months after the surgery for computed tomography angiography. Results Patients constituted 4 women aged 28-63 years with a mean body mass index of 22.4 kg/m2. The diagnosis of MALS was confirmed by computed tomography angiography, which showed severe (> 70%) narrowing of the celiac axis. Patients underwent laparoscopic celiac axis release, and all patients were discharged on the first postoperative day with no postoperative complications. Patients improved quality of life and complete relief of symptoms. Follow-up computed tomography angiography confirmed full decompression of the celiac axis in all four patients, with no stenosis caused by scarification of the celiac axis. Conclusions Laparoscopy is a valuable and safe method to treat patients with MALS. Keywords: Dunbar syndrome, median arcuate ligament syndrome, laparoscopy, MALS, digestive surgery

Can BMI be a predictor of perioperative complications in Head and Neck cancer surgery?

Context: The effect of BMI on development of perioperative complications in head and neck cancer surgeries is not well-defined. Aims: This study aims to evaluate the effect of body mass index (BMI) on the development of surgical complications during the perioperative period in head & neck carcinoma (HNC) patients. Settings and Design: Retrospective analytical study Methods and Material: This study was conducted from 2019 to 2020. Electronic medical records of 210 patients undergoing major (clean-contaminated) surgeries were analysed. Statistical analysis used: Chi-square test or Fisher exact test for determining association in categorical data and independent T-test or Mann-Whitney U test for comparison between the presence of complication and relation with continuous clinical parameters were used. Results: The majority of patients were within normal-weight (68.57%). Only 12.85% patients had BMI under 18.5 kg/m2 and 18.57% patients had BMI equal to or more than 25 kg/m2. The coexisting comorbidities were present in 48.7% patients with BMI more than 25 kg/m2. In all patients, major and minor complications were present in 10.5% and 16.7% patients, respectively. Surgical site infections were present in 18.1% patients. There was no statistical difference in the rate of complication (major, minor and SSI) in underweight, normal weight and overweight categories. The complications was significantly associated with the extent of surgery (p=0.00413) and blood loss of more than 775 ml (p-value 0.005). Conclusions: In conclusion, the rate of surgical complication in head and neck onco-surgeries is not related to BMI of the patients. The perioperative management of these patients might require some modification due to co-existing comorbidities, but the overall impact on development on complication could not be proven in this study.

The quality of life in patients after laparoscopic cholecystectomy due to gallstone disease - evaluation of long-term postoperative results

Introduction: Currently, the standard treatment of gallstone disease is laparoscopic cholecystectomy. Considering its availability, reduction of postoperative pain and shortened stay in the hospital, a constant upward trend in the number of such procedures is observed. However, about one third of patients undergoing such treatment report pain and dyspeptic disorders following the surgery. The assessment of the quality of life of patients undergoing laparoscopic cholecystectomy, based on standardized questionnaires, should be one of the elements allowing for the assessment of the impact of the applied treatment on patients' lives. Aim: The aim of this retrospective study is to evaluate the impact of laparoscopic cholecystectomy on the quality of life of patients operated in one center. Material and methods: The study has been carried out retrospectively with the use of a GIQLI questionnaire completed online by the patients 6 months after undergoing laparoscopic cholecystectomy. The study included patients over 18 years of age who have not experienced any complications within the perioperative period and did not require open surgery. The study group has been divided into two subgroups depending on the presence of symptoms of acute gallstone disease in the pre-operative period. Results: The study group consisted of 205 patients (53 men, 152 women, aged 19 to 87, with an average of 54.3). The subgroup with an asymptomatic gallstone disease (dyspeptic disorders, without biliary colic) consisted of 47 patients (18 men, 29 women, aged 19-87). Symptomatic gallstone disease occurred in 158 people (35 men, 123 women aged 22 to 81). There have been certain statistically significant differences in the post-operative health condition between the group of patients with symptoms of gallstone disease and the asymptomatic patients. 94.3% of symptomatic patients concluded that their condition has improved and 5.7% that it remained unchanged. Among asymptomatic patients, only 53.2% of patients stated that they felt better post-surgery, 44.7% reported no changes (p <0.001). There have been no significant differences in the overall QIQLI scores between these subgroups, although symptomatic patients assessed their social functioning better (8.9 ± 1.5 vs 8.11 ± 2.08, p = 0.004). There have been certain differences between men and women in the assessment of the quality of life in the context of the presence of key symptoms (M: 28.87 ± 4.23, F: 26.77 ± 5.0, p = 0.007) Conclusions: The patients with a symptomatic gallstone disease report they feel better after laparoscopic cholecystectomy as compared to the group of asymptomatic patients. The overall QOL score measured by the GIQLI form does not depend on the presence of symptoms in the preoperative period. Men benefited more from surgery as regards key symptoms.

Health locus of control among patients operated on for colorectal cancer

<b>Introduction:</b> An important factor determining health-oriented behavior is the health locus of control (HLC). Patients with cancer differ in health practices and perception of the disease. <br/><b>Aim:</b> Assessment of the influence of demographic factors and somatic symptoms of the disease on HLC in patients treated for colorectal cancer. <br/><b>Materials and methods:</b> The study included 160 people divided into patients with colorectal cancer (CRC) and healthy people. The Multidimensional Health Locus of Control Scale was used in the adaptation of Z. Juczyński. The scale includes three dimensions of health perception, which depends on internal control, impact of others and random. <br/><b> Results:</b> The study group consisted of 80 patients with CRC (51.2% women), and the control group 80 healthy people (57.7% women). In our analysis, we found that people with CRC were significantly more dependent on their own health control on the influence of external factors, such as doctors and nurses, than healthy people (27.11±5.43 vs. 19.64±7.77; p=<0.001). Similarly, patients with CRC significantly more than healthy people considered random as a dimension responsible for HLC (23.05±5.95 vs 20.36±7.45; p=0.012). Men with CRC more than women conditioned HLC on random influence (24.21±5.94 vs. 21.95±5.91; p=0.044). People with secondary and higher education made the HLC more dependent on internal control (26.98±5.98 vs. 23.14±5.74; p=0.041). <br/><b>Conclusions:</b> Patients with CRC made their sense of health control dependent on external dimensions: influence of others and random. Men with CRC were more likely to condition their health control on random events than women. Secondary and higher education guaranteed greater autonomy in undertaking health behaviors.

The impact of telemedicine on the quality and satisfaction with the health care provided during the COVID-19 pandemic in the field of pediatrics with special reference to the surgical professions

The COVID-19 pandemic has forced healthcare systems around the world to adopt telemedicine at an unprecedented rate. Visits to telemedicine have increased to provide access and maintain continuity of care. Internet access has almost become a necessity, and new technologies allow for the easy flow of data from patient to doctor and vice versa. Doctors of all specialties were forced to adapt to the pandemic and emerging conditions. The provision of surgical services and the learning ability of surgeons are particularly disrupted, and the pediatric surgical community is not exempt. During the pandemic, telemedicine proved to be a viable and safe technique for providing health services. In an environment of a health system that is constantly facing a shortage of resources, effective telemedicine placement can come with a high benefit-cost ratio and quality of care, while ensuring patient satisfaction.

Volume of surgical interventions for benign colorectal tumors – an analysis of 3510 surgical and endoscopic resections in the single colorectal center in Poland

Introduction: Colorectal cancer is the most frequent neoplasm of the whole gastrointestinal track. Due to screening colonoscopy program, colorectal lesions are often diagnosed at early stage. The vast majority of them are possible to remove endoscopically. However, a substantial percentage of benign lesion in Western centers are still operated. The aim of this article was to determine the percentage of surgical resections due to benign adenomas in the reference center of endoscopic submucosal dissection (ESD) and colorectal surgery in Poland. Materials and Methods: Retrospective analysis of 3 510 patients operated from 2015 to 2019 in Center of Bowel Treatment in Brzeziny. Results: We have analyzed 3 510 endoscopic and surgical procedures performed in the colon: 601 ESDs; 1 002 endoscopic mucosal resections (EMRs); and 1,907 surgical resections. Out of 601 ESDs, 57 invaded the submucosa, of which 29 (4.8%) were non-therapeutic ESDs. In 5 patients, due to occurrence of post-ESD perforation, an additional surgical intervention was necessary. Out of the 1,002 EMRs, 22 cases (2.2%) were diagnosed with deeply infiltrating cancers, which required a surgery. The overall percentage of the need for surgery in the endoscopically treated patients (ESD + mucosectomy) was 3.5% (56/1 603). Among resection surgeries, 15 of them (0.8%) ended with the diagnosis of a benign lesion in the postoperative histopathological examination. Conclusions: Inclusion advanced endoscopic techniques such as ESD to routine clinical practice in colorectal centers gives clear benefits for the patients. Well defined and standardized process of qualifying for appropriate treatment allows to significantly reduce the percentage of abdominal approach surgery due to benign colorectal lesions.

Statement of the polish expert group on the current practice and prospects for the treatment of complex perianal fistulas in Crohn's disease. Update 2021

Perianal fistulas in Crohn’s disease (CD) are a major problem. In majority of patient, inflammation involves the rectum. Perianal fistulas in CD pose a diagnostic and therapeutic challenge due to severe symptoms and worse prognosis compared to cryptogenic fistulas. The accurate diagnosis is crucial for an effective treatment of CD-related perianal fistulas, and the following should be determined: anatomy of the fistula, possible strictures and inflammation of the alimentary tract, including the rectum and the anal canal. Treatment of fistulas might be challenging and requires cooperation between the colorectal surgeon and the gastroenterologist. The combination of surgical and pharmacological therapy is more effective than surgical or pharmacological therapy alone. In conservative treatment, aminosalicylates or steroids have little significance. In everyday practice, antibacterial chemotherapeutics, antibiotics and thiopurines are applied. The most effective are TNF-neutralizing antibodies, i.e. infliximab (IFX), adalimumab (ADA) and certolizumab (CER). Surgical management can be urgent including drainage. Elective procedures include dissection of the fistula (simple fistula) or more complex interventions such as mucosal flap or ligation of the intersphincteric portion of the fistula. Surgical interventions can be enhanced using the video-assisted anal fistula treatment (VAAFT) or negative-pressure therapy. In extreme cases, creation of a stoma may be necessary. Also, tissue glues or so-called plugs may be applied in managing perianal fistulas. The use of stem cells seems promising, i.e. application of multipotent non-hematopoietic stem cells around the fistula in order to induce immunomodulation and wound healing.