Volume 125 (2015): Issue 1 (March 2015)

Introduction. Cataract surgery is one of the most important surgical procedures in ophthalmology.

Aim. The aim of this study is to compare cataract surgeries performed in 1994 and 2014.

Material and methods. A retrospective analysis of 100 cataract procedures in 1994, as well as a total of 100 cataract procedures performed in 2014. The authors considered the following factors: age, sex, vision acuity, cataract type, preoperative patient preparation, intra- and postoperative complications, and total hospitalization time.

Results. Back in 1994, extracapsular cataract extraction (ECCE) was the most common treatment technique. It caused more intraoperative complications (46) and postoperative complications (38) and longer total hospitalization time (9.25 days±3.25 SD). In 2014, all procedures were performed using phacoemulsification. As a result, the number of intraoperative (20) and postoperative (14) complications has dropped significantly. Total hospitalization time was also reduced (1.53 days±1.08 SD).

Conclusions. Phacoemulsification significantly improved cataract treatment. This method is much safer and more effective than ECCE.

The understanding of retinal disease has evolved rapidly with a growing number of clinical evidence supplied by ultrawidefield retinal imaging.

Optos 200Tx ultra-widefield retinal imaging system uses a scanning laser ophthalmoscope, as well as an ellipsoid mirror. This creates a possibility of making a virtual focal point inside the eye and, in turn, enables the system to simultaneously make a single capture of the central retina and periphery. This system offers multimodal ultra-widefield imaging, including color photographs, fundus autofluorescence images, red-free images and fluorescein angiography (FA), allowing visualization of the retinal circulation. For color photographs, green and red lasers are used simultaneously to allow visualization of retinal substructures from the sensory retina and retinal pigment epithelium to the choroid.

In our clinic ultra-widefield fluorescein angiography has became an elegant diagnostic imaging modality that has improved our ability to diagnose and plan treatment strategies.

In the future widefield imaging will probably be coupled with OCT (optical coherence tomography) option to better evaluate retinal pathologies in the periphery.

During the last 4 decades reflux disease (GERD) has evolved from being a rare clinical problem to a disease with high incidence. This automatically rises its social costs. First descriptions came from western countries only but nowadays there are many published papers from Asia and Middle East that can be found on the Internet. There is no clear explanation for this fact. Our understanding of GERD has changed over the time. At first GERD, hiatal hernia and oesophagitis were synonyms. Since the 1940s when the first manometrical studies were done it was concerned as lower oesophageal sphincter or peristaltic disfunction. The following years gave a definition of acid-peptic disorder. Nowadays all this concepts are mixed together and we are considering GERD as a heterogeneous clinical problem. In this paper we would like to present up-to-date knowledge about GERD.

Effective treatment of peritoneal surface neoplasms is possible through the simultaneous use of cytoreductive surgery with intraperitoneal chemotherapy in hyperthermia. It is successfully performed in patients with peritoneal pseudomyxoma, mesothelioma, as well as a limited and resectable peritoneal carcinomatosis in the course of colorectal cancer. It can also be used in patients with gastric or ovarian cancer but also metastatic colorectal cancer or metastases to the ovaries from gastric cancer. Aggressive surgical management of patients with primary or secondary neoplasms of the peritoneal surface was initiated by Sugarbaker’s research group.

I Chair and Department of Gynecological Oncology and Gynecology is a specialist research center providing help in diagnostics and treatment of gynecological malignancies. The research work is focused on the processes of angiogenesis and lymphangiogenesis. Development of blood and lymphatic vessels is subject to research in a wide range of malignancies, including ovarian cancer, endometrial cancer and uterine sarcomas. Angiogenesis in malignancies of the female genital tract is investigated by using some modern 3D sonography that uses high-definition blood flow imaging. Ovarian Tumors and Early Ovarian Cancer Detection unit was established in 2002 and since that time more than 3500 patients with difficult to diagnose tumors have been consulted and treated in the Department. Ovarian cancer immunology studies are the second leading research fiekld in the 1st Chair Department of Gynecological Oncology and Gynecology. The Department is well equipped with diagnostic devices as well as a scientific laboratory. This allows for studies in the fields of imaging of masses, their immunology, biochemistry and molecular biology. Understanding immunological response in patients with ovarian cancer is the key to develop new, effective therapies, including immunological vaccines. In this area we are cooperating with prominent international research centers: Department of Surgery, University of Michigan and Department of Microbiology and Immunology, University of Arkansas. Results of our research are published in both Polish and international journals specializing in fields of gynecology, oncology, immunology and basic science.

Introduction. Chromosomal abnormalities, one of the leading causes of pregnancy complications, attract attention of both researchers and clinicians. They use two approaches to identify chromosomal abnormalities, namely screening and diagnostic tests. Ultrasonography is a very reliable screening and diagnostic tool, but the only way to determine if there are any chromosomal defects in the fetus, is performing one of invasive diagnostics tests chorionic villus sampling (CVS), cordocentesis or amniocentesis. Unfortunately, these invasive diagnostic procedures carry a potentially high risk of complications. Using amniocentesis means a procedure-related miscarriage risk at a rate of about 0.5-1%.

Aim. The aim of this paper was to present our own experience, results in performing amniocentesis and a review of the literature.

Material and methods. During a 10-year period 237 mid-trimester, transabdominal amniocenteses were performed.

Results. The follow-up revealed one spontaneous abortion within seven days after the procedure. Premature delivery occurred in fourteen cases (two of them with chromosomal abnormalities). No neonatal deaths related to amniocentesis were noticed. Chromosomal abnormalities were detected in 33 patients.

Conclusions. In the group with chromosomal abnormalities the main indications to perform amniocentesis were: improper ultrasound scan and the first trimester biochemical, noninvasive screening tests. This is a proof that modern, non-invasive procedures like the first-trimester ultrasound scan and biochemical tests should be made available to every pregnant woman and not only to mothers’ aged >35 years or those with a poor obstetrics history.

In the last decades, substantial strides have been made in the diagnosis, treatment, and prevention of blood diseases. The new drugs to be used in combination with cytostatic therapy have been developed, based on increased understanding of the biology of neoplasia. The diagnosis of several diseases is based exclusively on cytogenetic and molecular analysis which has become a part of routine diagnostic management. Moreover, molecular definition has allowed the introduction of therapy targeted at molecular change characteristic for a given disease. The introduction of novel agents for the treatment of hematological disorders has resulted in a great improvement in response rate and median survival.

The aim of this study is to show advances and possible future directions in the treatment of chosen hematological malignancies during the recent decades.

A non-invasive, conservative treatment has been a standard in treating acute and chronic deep vein thrombosis. This treatment turned out to be ineffective, particularly in the hip area. Also, it was demonstrated that it does not influence the frequency of manifestations of post-thrombotic syndrome. Previous attempts to surgically reconstruct deep veins, unlike arteries reconstruction, yielded no positive results and also increased hemorrhagic and embolic complications. Currently, already in the period of the acute thrombosis of deep veins, the methods of early re-canalization, both with the application of targeted thrombolisis, as well as of pharmacomechanical methods, are applied.

Thanks to a wide array of image examination methods applied in pre-operational and intra-operational diagnostics optimum, it is possible to plan a revascularising treatment in the sick individuals suffering from the already developed manifestations of the post-thrombotic syndrome.

The development of endovascular methods, made possible thanks both to the surgeons’ experience in the re-canalization field, as well as constant improvements of stents dedicated to the venous system, allowed for effective use of these techniques in curing the occlusion of deep veins. It was the case with the arterial system and works here as well. Applying the hybrid proceeding, combining opened techniques and endovascular ones, works very well in selected cases.

The number of patients with type 2 diabetes increases along with civilizational development. Advanced treatment methods applied in diabetology and other branches of medicine increase the number of patients. The aim of this work is to present diagnostic and therapeutic problems in elderly people with diabetes. There isa a number of other diseases coexisting with diabetes. These are: hypertension, hyperlipidemia and obesity. The risk of diabetes increases with age and it is related to lowered insulin secretion, worsened absorption and insulin resistance. Diabetes symptoms in older patients differ from those of other age groups. An early diagnosis can minimize the risk of any cardiovascular events, ranked as one of the leading causes of death in elderly patients. The choice of treatment should be adjusted to the particular patient’s needs, avoid any sudden modifications of administered drugs and educating the patients. These are the most important elements of the therapy.

Motor organ injuries are one of the most common consequences of trauma, out of which comminuted fractures with a bone loss are the most challenging. Numerous methods are applied to treat these injuries; however, still in many cases we are unable to suggest successful medical treatment. Therefore, treating these injuries using elastic and surgically handleable bone replacement materials was started at Trauma Surgery and Emergency Medicine of Medical University of Lublin (provided for the experiments by Medical Inventi Lt). Preliminary assessment based on the results of treatment with bone replacement materials of two patients with comminuted fractures of femur was promising. Bone union was achieved without any adverse effects.

Face skeletal deformities have been confusing both doctors and patients for ages. The harmony of the face exerts huge influence not only on one’s psyche but also the behavior and the individual’s social and professional status. In this study we present a procedure of treating skeletal malocclusion. It was performed using various orthodontic methods, like the alteration of the growth of jaws and camouflage applied in appropriate age groups. We paid special attention to the close cooperation between the orthodontist and the surgeon, which hugely facilitates curing the most complex, multi-dimensional deformities. In this study, we present our own materials concerning the effects of cooperation between two departments of Medical University of Lublin, namely the Chair and Clinic of Maxillofacial Surgery and Department of Jaw Orthopedics.

Introduction. Capillaroscopy is a non-invasive imaging method that allows cutaneous microcirculation to be analyzed. During the last decades, a diagnostic and prognostic potential of nailfold capillaroscopy (NVC) has been gaining increasing appreciation. The main indications include Raynaud phenomenon and scleroderma spectrum diseases, however the usefulness of this technique is also suggested in a variety of non-rheumatic diseases.

Aim. To assess capillaroscopic patterns in systemic scleroderma (SSc), psoriasis (PV), psoriatic arthritis (PsA), alopecia areata (AA) and androgenetic alopecia. To evaluate serum levels of several endothelial and angiogenic markers, and their relation to capillaroscopic pattern.

Material and methods. There were evaluated 295 patients with systemic scleroderma (SSc), psoriasis (PV), psoriatic arthritis (PsA), alopecia areata (AA) and androgenetic alopecia, as well as age- and sex-matched controls, were examined. In each subject, NVC was performed and serum concentration levels of several angiogenic markers.

Results. In SSc three NVC patterns: early, active and late were distinguished. Angiopoietin-2 concentrations were higher and andothelial microparticles were lower in patients with late NVC pattern. We found several differences between the NVC pattern in PV and PsA. No correlations between NVC pattern and serum levels of angiogenic markers were revealed. In AA, we distinguished both normal and abnormal NVC patterns, although the normal patterns were more frequent. Branching capillaries and features of neoformation were often present in patients with the abnormal pattern. In androgenetic alopecia, the normal NVC pattern was most frequently present, however, we found several statistically significant capillarosopic alterations, like branching capillaries, features of neoformation and altered distribution of capillaries.

Discussion and Conclusions. Serum levels of Ang-2 and EMPs may reflect capillary damage in SSc. NVC pattern varies between PV and PsA patients. The presence of abnormal NVC patterns in alopecia patients might show the role of disturbances in microcirculation in the diseases. Further studies are required to confirm the hypothesis.

Introduction. Increased suicide rates, both among adults and adolescents, have been seen in Poland over recent years.

Aim. The aim of the study was to determine the prevalence of self-injury, suicide ideation, plans and attempts in adolescents aged 13 to 19 years.

Material and methods. The study encompassed the total number of 6883 individuals aged 13 to 19 years, 69% of them being girls and 31% - boys. All respondents lived in Lubelskie Province. The research was conducted using a questionnaire designed by the authors.

Results. In the group composed of 6883 adolescents living in Lublin Province, suicide ideation was reported by 47.65% of the respondents, suicide plans by 32.35%, suicide attempts were carried out by 10% of adolescents and self-injury by 24.91% of the respondents aged 13 to 19 years.

Conclusions. The greatest prevalence of suicide ideation, plans and attempts, as well as self-injuries, were recorded in the group of adolescents aged 17. The adolescents living in the urban areas are more likely to inflict self-injury than those living in rural areas. Furthermore, adolescents with suicidal tendencies, e.g. attempting suicide and self-injury, are more prone to alcohol and substance abuse. It needs emphasizing that many adolescents with suicidal tendencies, compared against those who did not carry them out, have past experience of psychological, physical and sexual violence in the family, have been raised by a single parent or in families, where one of the parents abused alcohol.