Medical sciences

Folia Medica Cracoviensia


Folia Medica Cracoviensia | 2018 | vol. 58 | No 3 |


A personal data referring to the scaphoid skull housed in the Department of Anatomy of the Jagiellonian University, Medical College was established thanks to reviewing 19th century literature performed by Dr. Sofi caru. We received information that the skull had belonged to an adult man who was a carpenter, born at Cracow. Th e original anthropometrical study of this skull was performed by prof. Kopernicki 19th century.

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Background: Recoarctation (reCoA) of the aorta is a common complication after the Norwood procedure. Untreated, it can lead to failure of the systemic ventricle and death. The main goal of the study is to defi ne risk factors of reCoA after the Norwood procedure in hypoplastic left heart syndrome (HLHS).

Methods: We retrospectively analyzed the pre-, intra- and postoperative data of 96 successive patients who underwent the Norwood procedure between 2007 and 2011. In case of reCoA balloon angioplasty was performed. We analyzed and compared the data of the patients with reCoA and without reCoA using the StatSoft STATISTICA™ 10 soft ware.

Results: ReCoA was noted in 23 patients (33.3%). Th is complication was diagnosed 95.1 days (49–156 days) on the average aft er the Norwood procedure. Balloon angioplasty successfully allowed for decreasing the mean gradient across the site of the narrowing from the average 27.5 mmHg to the average 9.7 mmHg (p = 0.008) and enlarged the neo-isthmus by the average of 2 mm (p <0.05). Th e risks factors seemed to be the diameter of the ascending aorta OR = 7.82 (p = 0.001), atresia of the mitral valve OR = 7.00 (p = 0.003) and atresia of the aortic valve — OR = 6.22 (p = 0.002).

Conclusion: Balloon angioplasty seems to be an eff ective intervention in case of reCoA. A low diameter of the native ascending aorta (≤3mm) and the presence of atresia of the mitral and/or aortic valve should intensify the vigilance of a cardiologist in the search for signs of reCoA of the aorta.

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Introduction: The prolongation of the life of men results in the growing number of people suffering from benign prostatic hyperplasia (BPH). In 2010, BPH concerned more than 200 million men in the whole world, which at that time made up 6% of the population of men at large. Currently, the population of men in the world amounts about three billion six hundred million. The modern surgical treatment of BPH consists of minimally invasive techniques, including laser systems.

Aim: Evaluation of the eff ectiveness of photoselective vaporization of the prostate (PVP) on the basis of subjective parameters assessed by patients using IPSS and QoL questionnaires as well as objective parameters obtained from results of urodynamic tests.

Material and Methods: Between 2012 and 2015, 120 patients with benign prostatic hyperplasia were included in the study and underwent PVP. Finally, 77 patients were included in the study. In all patients, IPSS and QoL sheets were carried out 1, 6 and 12 months, and urodynamic tests 12 months after the surgical treatment.

Results: The statistically signifi cant change in the value of each parameter assessed: decrease in the IPSS, QoL, PVR, Pmax, Pop, the degree of obstruction according to Schäfer and ICS nomogram, and an increase in the values of Qmax and Qave.

Conclusions: Photoselective vaporization of the prostate is an eff ective method of therapy in patients with benign prostatic hyperplasia.

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Introduction: The history of using performance-enhancing substances (PES) is long and it goes back to ancient times. At present, PES are employed at all levels of sport competition, starting from Olympic level contestants to individuals recreationally involved in various sports disciplines.

Purpose: The objective of the study was examining the views on doping in sports in a group of physicians, together with evaluating the frequency of their contacts with this phenomenon, in their professional activities.

Methods: The investigation was carried out using a validated questionnaire developed by the authors. Questionnaire included 34 questions divided into 6 sections. In total, 257 individuals participated in the study. The percentage of answers was 75.81%.

Results: Among the responders, 96.50% believed that using PES by sports competitors represented unethical behavior. 42% participants declared that they met doping problem during their professional career. Almost one-third of the physicians (28.79%) declared that during their work, they consulted patient suffering from adverse side eff ects resulting from using PES.

Conclusions: In Poland, physicians regard using PES as unethical behavior. They believe that a health care system professional should participate in counteracting doping in sports. Physicians — regardless of their specialty — are also exposed to PES-related problems in their professional work. In view of the above facts and the consistently increasing popularity of PES, extending the knowledge in this field among physicians seems to be of importance to allow for their offering better medical services to their patients.

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Background: The older population is very heterogeneous with regard to the co-morbidity and the physical reserve. This can result in unacceptably high postoperative complications rates. Th erefore, the aim of the study was to review the literature regarding the outcomes of older patients treated for pancreatic cancer, including the usage of minimal invasive techniques.

Methodology: A review of the literature was carried out including studies on pancreatic cancer in older patients published between 2011 and 2016.

Results: Seventeen retrospective studies were included. The total number of patients was 9981 with the age range of 65 years and more. Studies on surgical treatment alone (1.4%), neoadjuvant/adjuvant treatment with or without surgery (89.4%) and palliative therapy (9.2%) were assessed separately. Appropriate comparison was diffi cult due to the retrospective character and heterogeneity of the study population. Mortality was low, yet there was a great diff erence in morbidity ranging from some percent to even 100% of the study population. Long-term results were poor.

Conclusions: The functional status, not the chronological age alone, is the factor limiting therapeutic options in older patients with pancreatic cancer.

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Purpose: The purpose of this research is to defi ne the total number of septa and the total number of antra in the sphenoid sinuses (created as a result of the presence of additional septa), as well as the relation between the number of the septa and their location in the adult population.

Materials and Methods: The study was conducted as a retrospective analysis of the computed tomography (CT) scans of the paranasal sinuses of 296 patients (147 females and 149 males), who did not present any pathology in the sphenoid sinuses. The CT scans of the paranasal sinuses were done with the spiral CT scanner (Siemens Somatom Sensation 16) by using a standard procedure, in the option Siemens CARE Dose 4D, without using any contrast medium. After obtaining the transverse planes, the frontal and sagittal planes were created using secondary reconstruction tool (multiplans reconstruction — MPR).

Results: The analysis of the obtained images in the transverse plane and secondary CT reconstructions has shown the presence of only one sphenoid septum (main septum — MS) in 21.96% of the patients, which divided the sphenoid sinus into two sphenoid antra. In 78.04% of the patients, there were more than one sphenoid septa present in the posterior part of the sphenoid sinuses, hence there were additional septa (AS) present. One AS was present in 22.97% of the patients. The most common variant — two AS — was found in 32.09% of the cases. The presence of more than two AS was found in the following number of patients: three AS in 9.8%, four AS in 7.09%, five AS in 1.69%, six AS in 3.04% and seven AS in 1.01%. Th e rarest variant was the presence of more than seven AS: eight AS in 0.34% and nine AS also in 0.34%. Th ere were no sphenoid sinuses that would have more than nine AS in the researched material.

Conclusions: Due to the high incidence of the anatomical variants of the paranasal sinuses, a CT scan is recommended in all patients before a planned surgery in order to avoid the potential complications that might arise as a result of the complicated structure of the paranasal sinuses.

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Meckel’s diverticulum represents a remnant of the proximal end of the omphalomesenteric duct, which constitutes a connection between the middle intestine and the vitelline vesicle. It is the most common congenital anomaly of the gastrointestinal tract and is found in approximately 0.3–2% of the general population. Complications such as hemorrhage, bowel obstruction, infl ammation, perforation, intussusception, volvulus and malignant transformation develop in only 4–4.8% of all patients, with most cases presenting in childhood, while relative risk decreases during life. The aim of the present study is to present our experience in managing a 15-year old male patient with Meckel’s diverticulum covered perforation. It was a case of disguised perforation of the Meckel’s diverticulum, with development of adhesions to the anterior surface of the right third of the transverse colon, which was successfully treated on the basis of emergency. Diagnosis was made intraoperatively and was documented by histological examination of the excised diverticulum.

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Introduction: Uterine leiomyoma is the most widespread benign tumor affecting women of childbearing age. There are still gaps in the understanding of its pathogenesiss. Telocytes are unique cells described in greater than 50 different locations inside the human body. The functional relationship of cells could clarify the pathogenesis of leiomyomata. In the current study, we focused on the identification of telocytes in all regions of the human uterus to explain their involvement in leiomyoma development.

Materials and Methods: Tissue samples from a healthy and myomatous uterus were stained for c-kit, tryptase, CD34 and PDGFRα to identify telocytes. Routine histology was performed to analyze tissue morphology and collagen deposits.

Results: Telocytes were detected in the cervix, corpus of the uterus and leiomyoma. The density of telocytes in fibroid foci was reduced compared with normal myometrium.

Conclusions: Our results demonstrated the existence of telocytes in all parts of the human body affected and unaff ected by leiomyoma of the uterus. In addition, telocytes were also present in leiomyoma foci. Our results suggest that the reduced density of telocytes is important for the pathomechanisms of myometrial growth, demonstrating its value as a main component of the myomatous architecture.

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Inguinal hernia repairs are one of the most common procedures performed in general surgical departments. Approximately 20 million hernia repairs are performed annually all over the world. According to the EHS guidelines, the recommended treatment methods of the inguinal hernia are tension–free techniques: the Lichtenstein open hernia repair and the laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) methods. The TEP hernia repair, first performed by Duluq in 1992, is one of the three current leading techniques in the inguinal hernia repair. The most important advantage of this technique is minimal invasive access without the need to open the peritoneum, which carries a lower risk of abdominal organs injury. Additionally, the TEP method facilitates shorter recovery time, less postoperative pain and an earlier discharge form hospital. The aim of the article is to present the TEP method by comparing it with the other inguinal hernia repair techniques, on the basis of the available literature.

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Background: Anorexia nervosa is a widely prevalent eating disorder that often leads to life-threatening complications. Since it mostly concerns females, many authors have focused on studying the reproductive system in anorexic women. Recently discovered telocytes may give a new insight into the pathophysiology of gynecological complications in these patients.

Material and Methods: We adopted an animal model of anorexia nervosa induced by voluntary physical activity. Sixteen female Wistar rats were divided into two groups: control and activity-based anorexia. When the weight loss of activity-based anorexia (ABA) rats reached 25% animals were euthanized. Size and weight measurements as well as histopathological analysis of the reproductive organs were performed. Additionally, we used immunohistochemical staining for detection of telocytes.

Results: Telocytes were identified in uteri of anorectic rats but no diff erences were observed when compared to the control group. Nevertheless, in the ABA group the weight of the uteri and the number of follicles in the ovaries decreased significantly.

Conclusions: Our rat model of anorexia nervosa mimics the effects of this eating disorder that occur in the female reproductive system since we reported ovarian dysfunction and uterine involution in the experimental animals. It supports its potential role in the further studies of anorexia pathophysiology and treatment possibilities.

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Editorial office


Redaktor Naczelny
Dr hab. Krzysztof Gil, prof. UJ

Zastępca Redaktora Naczelnego
Prof. Andrzej Surdacki

Sekretarz Redakcji
Prof. Beata Kuśnierz – Cabala

Prof. Benjamin Chain (London, UK),
Prof. Paul Enck (Tübingen, Germany),
Prof. Tomasz Grodzicki (Kraków, Poland),
Prof. Kalina Kawecka-Jaszcz (Kraków, Poland)
Prof. Maciej Małecki (Kraków, Poland),
Prof. Janusz Marcinkiewicz (Kraków, Poland),
Prof. Franz H. Messerli (New York, USA),
Prof. Jacek Musiał (Kraków, Poland),
Prof. Wiesław Pawlik (Kraków, Poland),
Prof. Jacek J. Pietrzyk (Kraków, Poland)
Prof. Władysław Sułowicz (Kraków, Poland)
Prof. Piotr Thor (Kraków, Poland)
Prof. Jerzy A. Walocha (Kraków, Poland)

Redaktor techniczny
Danuta Ambrożewicz


Adres redakcji
ul. Czysta 18
31-121 Kraków

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