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The Levine questionnaire is commonly used to assess the treatment outcomes of carpal tunnel syndrome (CTS). However, specific items in this questionnaire do not address symptoms or impairment in each hand separately. One concern is that patients with unilateral disease would experience greater improvement as a result of surgery than those with bilateral who have only one hand treated. The objective of this study was to compare the early outcomes of surgery for unilateral and bilateral CTS, after operation on only one hand, in order to determine if the disease in the untreated hand affects the subjective perception of treatment outcomes. A total of 372 patients, 186 with unilateral and 186 with bilateral CTS underwent minimally invasive carpal tunnel release under local anesthesia. None of the patients with bilateral CTS had the other hand operated on before the follow-up examination. The pre- and post-operative (at 3 months) measurements included subjective pain intensity in numeric rating scale and the Levine questionnaire. No statistically significant differences in declared pain intensity, as well as in the Levine symptom and function scores in patients with unilateral or bilateral CTS were noted. This suggests that subjective perception of the improvement experienced by patients as a result of surgery was independent of involvement of one or both of the patients' hands.

Introduction: Modifications to teaching medicine introduced 5 years ago consisted of abolishing the internship, changing the surgical curriculum in the last year of studies by introduction of a so called “practical year”. The objective of this study was investigating how the practical year was undertaken at the Pomeranian Medical University in Szczecin in the academic year 2017/2018. Materials and methods: A study was carried in a group of 154 students of the 6th year of Faculty of Medicine, just before the final test-exam in surgery. The questionnaire used in the study consisted of 11 closed questions concerning the organization, course, and accomplishment of the provided program. Results: The questionnaire results show that the assumed aim of the curriculum, which was a skill/competency-oriented teaching of surgery, was half executed. Students were insufficiently engaged in typical doctor’s activities. One-half of them considered their practical-year as no different from classes practiced in the previous years. Ward-round teaching and the performance of manual skills was considered the most valuable portion of the surgical curriculum. Seminars were scored the lowest, as the least useful. Organization of the classes and the engagement of tutors were evaluated positively by the majority of students. The results of this survey show the grade of accomplishment of the assumed educative aims in teaching surgery in the practical year, and have revealed some drawbacks, which should translate into an improvement of teaching in the forthcoming years.

Introduction: The objective of this study was assessment of the course, quality and accomplishment of 4th year surgical curriculum in Pomeranian Medical University in Szczecin (in Poland) for the academic year 2016/2017. Materials and methods: A questionnaire-survey was carried out in a group of 97 Polish students in the 5th year of the Medical Faculty just before the seminar-block of surgery. Main topics of the questionnaire items concerned students’ opinion on the expected usefulness of the acquired surgical knowledge for future medical practice, acquired manual skills, classes conducted in the operative theatre and overall organization of classes. Results: Knowledge from general surgery was scored by students the highest as potentially most useful for future medical practice. Assisting in operations and learning manual skills (mostly inserting stitches on a pig trotter) was considered the most valuable portion of surgical curriculum. These skills were also believed to be the closest to the meaning of the term “skill/competency-oriented teaching” surgery. Theatre classes were considered valuable only for students assisting in operations, but for most of the passive observers it was a waste of time. Less than a half the students took history and examined patients with common urological and surgical disorders. Most (96%) responders considered an inadequate amount of time assigned for manual skills and ward-round teaching the greatest drawback of the 4th year surgical curriculum. Conclusions: Outcomes of this study showed the students’ expectations in surgery lessons in 4th year of university curriculum and what a grade of its performance was. Awareness of this may have an effect on modification of the curriculum and methods of undergraduate teaching surgery.

Two cases of paediatric radial and ulnar nerve injuries occurring at operative treatment of distal humeral epiphyseal fractures. In one case, the nerve laceration was associated with a defect, requiring reconstruction by nerve grafting. In a 2nd case, the nerve was compressed and partially damaged by implanting, followed by entrapment in the scar; release of the nerve from the scar resulted in recovery of its function. The importance of being familiar with the nerves’ course at the distal end of the humerus, as well as proper and prompt reaction to symptoms of nerve dysfunction occurring immediately after the operation was emphasised.

Phlegmon is a purulent infection which spreads in loose connective tissue. It occurs most commonly in the limbs as a complication of other local infections. Untreated or inadequately treated infections in the skin of the fingers or hands are susceptible to phlegmon. In most cases, the infecting organism is Staphylococcus aureus. This article reports 7 cases of phlegmon involving upper limbs, caused by the Streptococcus pyogenes organism. The course of these types of infection are more serious, and the range of tissue damage greater, than those caused by staphylococci. This article presents the causes of the phlegmon, the methods and course of management, and the results of these. The principles of surgical management include wide incisions in the skin and an evacuation of pus and necrotic tissue debris. The skin is then sealed with stitches or a skin graft once the wound is clean. Of the 7 treated patients, 1 died in the intensive care unit due to sepsis and mutli-organ failure and 1 patient lost his all fingers due to necrosis. The authors believe that it is desirable that doctors working in emergency units and surgical admission rooms should be familiar with the basic rules of diagnosing and managing these potentially life-threatening or hand crippling disease

Thyroid neoplasms (tumors) are the most common pathology of the endocrine system that requires surgery, and in most cases changes are benign. The surgical treatment of thyroid neoplasms consists in total, subtotal, or one lobe excision. Our study aimed to assess the concentration of vitamin D and its metabolites in patients before thyroidectomy. The study included 167 patients with thyroid pathology. Before the thyroidectomy procedure calcidiol (25-OHD), calcitriol (1,25-(OH)2D), and vitamin D binding protein (VDBP), as well as basic biochemical parameters, were measured using an enzyme-linked immunosorbent assay kit. Data analysis showed that the cohort of patients has a significant 25-OHD deficiency and proper concentration of 1,25-(OH)2D. Before the surgery, more than 80% of patients have extreme vitamin D deficiency (

Microsurgical training is organised almost exclusively in a post-graduate setting, usually for residents of various surgical specialities. The aim of this study was to present an undergraduate microsurgical training model directed toward medicine students of clinical years. Curriculum design and results. Two six-participant groups of students interested in training were recruited. The programme consisted of 15 three-hour classes (2 hours' work under the microscope) and divided into basic and advanced training parts. The simulation model used in this course was a chicken thigh. The basic training programme consisted of placing sutures on a latex glove followed by preparation of a chicken thigh neurovascular bundle and performing femoral nerve and artery anastomoses. The advanced part of the training consisted of practising the acquired skills and the introduction of new techniques such as end-to-side arterial anastomosis, artery and nerve repair with vein conduit. A "6-stitches test" was used as an outcome measure of the acquired microsurgical skills. After 15 weeks and 30 hours of training and performing 31 anastomoses the undergraduate microsurgical course was completed. CONCLUSION: The results of this study show that the undergraduate, facultative microsurgical training is effective in acquiring microsurgical skills, competence and confidence for participating students.Die Ausbildung in der Mikrochirurgie wird beinah ausschließlich im Rahmen eines weiterführenden Studiums durchgeführt – normalerweise für Assistenzärzte in unterschiedlichen chirurgischen Fachgebieten. Diese Studie sollte ein Modell für die Ausbildung von Studenten in der Mikrochirurgie vorstellen, insbesondere für Medizinstudenten in den klinischen Jahrgängen. Design des Lehrplans und Ergebnisse: Wir rekrutierten zwei Teilnehmergruppen von je sechs Studenten, die sich für diese Ausbildung interessierten. Das Programm bestand aus 15 dreistündigen Klassen (je 2 Stunden Arbeit mit dem Mikroskop), die zwischen einführenden und fortgeschrittenen Ausbildungsabschnitten geteilt wurden. In diesem Kurs stellte der Hühnerschenkel das Simulierungsmodell dar. Das einführende Ausbildungsprogramm bestand aus drei Teilen: Nähte auf einen Latexhandschuh einzuführen, die Vorbereitung eines neurovaskulären Bündels aus dem Hühnerschenkel und die Vorbereitung von Anastomosen im femoralen Nerv und in der femoralen Arterie. Im fortgeschrittenen Teil mussten die angeworbenen Techniken geübt werden. Darüber hinaus lernten die Teilnehmer neue Techniken, zum Beispiel Ende-an-Seite Anastomose sowie Wiederherstellung von Arterien und Nerven mit einem venösen Abfluss. Ein 6-Stich Test wurde als Maß des Erwerbs der neuen mikrochirurgischen Fertigkeiten eingesetzt. Nach 15 Wochen, 30 Ausbildungsstunden und der Fertigstellung von 31 Anastomosen war der Studentenkurs in der Mikrochirurgie abgeschlossen. SCHLUSSFOLGERUNG: Die Ergebnisse belegen, dass die fakultative Ausbildung in der Mikrochirurgie einen wirksamen Ansatz für die Studenten darstellt, um mikrochirurgische Fertigkeiten, Können und Vertrauen zu erwerben.

Local infiltration anaesthesia with a bloodless operation field (WALANT) allows for performing hand surgery without a tourniquet. This effect is obtained through an injection of greater than standard volume of the anaesthetic solution composed of lignocaine and adrenaline. The addition of adrenaline induces spasm of small arteries within the infiltration area, which inhibits bleeding and allows visualization of most of the subtle but important structures in the hand and fingers. This article presents a method of preparation of the anaesthetic solution and the technique of anaesthesia for several common procedures in hand surgery. In 2019, our centre performed 340 operations under WALANT anaesthesia, with no serious complications observed. Data from the literature are presented showing that this technique is attracting increasing popularity worldwide. Our centre was the first in Poland to introduce the WALANT method to hand surgery.

Outcomes of surgery for carpal tunnel syndrome may differ in relation to certain factors like age, duration of symptoms, clinical and electrophysiological severity. The objective of this study was an investigation into the hypothesis that several factors are predictive of results of surgical treatment of the condition. The pre- and postoperative records of 1,117 patients: 909 women (81 %) and 208 men (19 %) with a mean age of 63 years were analysed. Outcomes recorded in the sensory and functional severity scores of the Levine questionnaire were dichotomized into achieving or not-achieving a minimally clinically important difference. The effect of selected variables: sex, age, duration of symptoms, clinical and electrophysiological severity of and presence of comorbidities on outcomes of surgery at 6 months was investigated. Univariate and multivariate analysis of covariates based on sex, age, duration of the disease and its clinical severity showed female gender and worse baseline symptom severity scores to be significant predictors for an improvement following carpal tunnel syndrome surgery. It showed also younger age, shorter duration of symptoms and higher baseline symptom severity scores to be predictive of a greater improvement of total grip strength, and younger age to be predictive of a greater pain cessation following surgery. Of all considered patient's and disease related factors, the baseline clinical severity expressed in the Levine symptom severity scores had appeared to be the strongest predictor of better outcomes of surgery for carpal tunnel syndrome.ZIEL: Das Ergebnis nach Operation eines Karpaltunnelsyndroms (KTS) mag abhängig vom Alter des Patienten, der Dauer der Beschwerden sowie dem klinischen und elektrophysiologischen Schweregrad unterschiedlich ausfallen. Die vorliegende Studie untersucht die Hypothese, dass mehrere Faktoren eine Vorhersage des zu erwartenden Ergebnisses nach KTS-Operation erlauben. Die Krankenakten von 1.117 Patienten (999 Frauen = 81 % und 208 Männern = 19 % mit einem Durchschnittsalter von 63 Jahren) wurden ausgewertet. Untersuchte Faktoren waren Geschlecht, Alter, Dauer der Beschwerden, klinischer und elektrophysiologischer Schweregrad und das Vorhandensein von Begleiterkrankungen. Als Kriterium, ob ein Faktor als vorhersagerelevant eingestuft wurde oder nicht, diente das Erreichen bzw. Nicht-Erreichen eines minimal klinisch bedeutenden Unterschiedes im sensiblen und funktionellen Livine questionair 6 Monate postoperativ. Weibliches Geschlecht und schlechte Ausgangsdaten konnten als aussagekräftige Vorhersageparameter puncto Verbesserung nach KTS-Operation identifiziert werden. Jüngeres Alter, kürzere Beschwerdedauer und schlechtere Ausgangsdaten lassen eine stärkere Zunahme der Griffkraft erwarten; jüngeres Alter auch eine stärkere Schmerzreduktion. Von allen untersuchten patienten- und krankheitsbezogenen Parametern scheint der klinische Schweregrad, ermittelt durch den Levine symptom severity score, der aussagekräftigste Vorhersageparameter bzgl. einer Verbesserung nach KTS-Operation.

Records were analysed from the institutional database, including 943 patients (1089 hands) with CTS who were operated on in the authors' department over a period of four years (2012 to 2015). The diagnosis of CTS was made solely on the basis of clinical findings in 551 patients (58 %); 392 patients (42 %) also had electrodiagnostic tests performed, for various reasons. Patients were followed-up at 1 and 6 months with assessments that included the Levine scores, filament tests, grip and pinch strength. No significant differences in Levine scores were found at the 1 and 6 month assessments. Statistically significant differences were noted in 3-point pinch strength and sensation: however, these were not clinically meaningful. The results of the study show that the results of carpal tunnel release in patients with typical symptoms are no better after electrodiagnostic tests.Die Akten von 943 Patienten (1089 Händen), die 2012 bis 2015 im Institut des Autors aufgrund eines Karpaltunnelsyndrom (KTS) operiert wurden, wurden retrospektiv ausgewertet. Alle Patienten wiesen die typische Anamnese und klinische Symptomatik eines KTS auf. Die Diagnose KTS wurde bei 551 Patienten ausschließlich basierend auf den klinischen Befunden gestellt, bei 392 war zusätzlich aus unterschiedlichen Gründen eine elektrophysiologische Untersuchung erfolgt. 1 und 6 Monate postoperativ erfolgten Nachuntersuchungen mit Erfassung des Levine Scores, des Monofilamentests, der Grob- und Spitzgriffkraft. Signifikante Unterschiede bzgl. des Levine Scores fanden sich weder nach 1, noch nach 6 Monaten. Statistisch signifikanter Unterschiede fanden sich bei der 3-Punkt-Griffkraft und der Sensibilität, ohne dass die Unterschiede klinisch wesentlich waren. Zusammenfassend zeigt diese Untersuchung, dass die Ergebnisse nach Operation eines Karpaltunnelsyndroms bei Patienten mit typischer Karpaltunnelsymptomatik nicht besser sind, wenn präoperativ eine elektrophysiologische Untersuchung erfolgt, als wenn die Diagnose ausschließlich aufgrund der Klinik gestellt wird.

Degloving injury consists in tearing out the soft-tissue integument from skeleton of the hand, with accompanied nerves and vessels. The whole hand degloving has bad reputation and one of worst prognosis, even worse than total hand amputation. The range of possible salvage procedures in these cases is limited and their outcomes are unsatisfactory. One of the suitable methods is wrapping the skinned hand with pedicled or free greater omentum flap, retrieved from the abdominal cavity. The article reports outcomes of the treatment of 5 patients at a mean of 8 years after total degloving of their hands and coverage with omental flaps. All flaps healed uneventfully, but in none of the patients the whole length of the fingers was preserved. Division of stumps of 3 fingers was possible in one patient, two others had three-digital hands and remaining two had only separated thumb. Dexterity of injured hands was limited with a mean of score DASH questionnaire of 43 points. Quality of life as measured by SF-36 questionnaire was fair (58 and 53 points in physical and mental domain, respectively). Regardless this, all patients were satisfied with achieved outcomes and all returned to work, which was a confirmation of the effectiveness of the method used in their treatment.

The objective of the study was a comparison of outcomes of K-wire vs plate fixation for distal radial fractures with regard to patients' quality of life. One hundred and two patients, 79 women and 23 men with displaced distal radial fractures, were non-randomly allocated for either K-wire (n=72) or palmar plate (n=30) fixation. In general, simpler fractures were fixed by pins, while plates were used for those that were more severe. No statistically significant differences were seen at 3- and 6-month follow-up assessment in any of the analyzed variables: wrist range of motion, total grip and key-pinch strength, and the DASH and SF-36 scores. We conclude that being guided by the postulated algorithm in treatment-choice of distal radial fractures is a reasonable balance between clinical- and cost-effectiveness. We also failed to find any advantage in health-related quality of life as an outcome measure in distal radial fractures compared to standard measures.

The objective of this study was to investigate the incidence of familial carpal tunnel syndrome in patients admitted to the authors' institution for carpal tunnel release. Questionnaires completed by 120 patients: 92 women (77%) and 28 men (23%) at a mean age of 56 years at their baseline clinical examination were reviewed. Familial occurrence of the disease was noted in 21 patients (17%): 16 women and five men. Three family members were affected in three patients, two relatives in eight patients, and one relative in 10 patients, giving a total of 35 affected relatives. The patients' sisters (n = 16) were the most commonly involved, followed by mothers (n = 12), daughters (n = 2), brothers (n = 2), grandmothers (n = 2) and an aunt (n = 1). Bilateral manifestation of the disease was noted in 19 patients (90%) and in 31 (88%) of their affected relatives. The results suggest that carpal tunnel syndrome shows a moderate tendency to familial occurrence and, if so, it usually manifests bilaterally.

The objective of the study was a comparison of the outcomes of K-wire vs plate fixation for distal radial fractures used according to the proposed institutional algorithm. Fracture configurations A2, A3, B1, B2, C1 and some C2 were operated on with K-wire pinning, whereas B3 and some B2, C3 and some C2 were with locking palmar-plate fixation.Four hundred and sixty-seven patients were non-randomly allocated for either K-wire (n = 363) or palmarplate (n = 104) fixation. The results were assessed at 3 and 12 months by the same outcome measures.At the 3-month assessment, statistically significant differences in grip strength and the DASH scores were noted in favour of the plate-fixation group. At the 12-month assessment, statistically significant differences were observed in the wrist palmar and dorsal flexion, favouring the plate-fixation group. Statistically significant differences were noted in radiological measures of the palmar tilt and the ulnar variance, both favouring the plate-fixation method. Meaningful secondary dislocations were noted in ten patients, all in the K-wire-fixation group.We conclude that palmar locking plate fixation in even more severe fractures leads to better radiological and clinical outcomes than K-wire fixation in less severe fractures.Die Studie überprüft die institutseigene Therapierichtlinie zur Behandlung distaler Radiusfrakturen anhand der Behandlungsergebnisse. Gemäß unserer Therapierichtlinie wurden A2-, A3-, B1-, B2-C1- und einige C2-Frakturen nach der AO-Klassifikationen mittels K-Draht-Osteosynthese versorgt, B3- und einige B2- sowie C3- und einige C2-Frakturen mittels palmarer winkelstabiler Plattenosteosynthese.Von 467 Patienten erhielten entsprechend 363 eine K-Draht-Osteosynthese und 104 eine palmare Plattenosteosynthese. Klinische und radiologische Ergebnisse wurden nach 3 und 12 Monaten überprüft.Bei der Untersuchung 3 Monate postoperativ zeigten Patienten mit einer palmaren Plattenosteosynthese statistisch signifikant bessere Ergebnisse punkto grober Kraft und DASH-Score, nach 12 Monaten statistisch signifikant bessere Ergebnisse bei der Handgelenksstreckung- und –beugung. Statistisch signifikant bessere Ergebnisse bei palmaren Plattenosteosynthesen wurden auch für die Palmar- und Ulnarinklination der Radiusgelenkfläche festgestellt. Das klinische Ergebnis beeinflussende sekundäre Dislokationen wurden bei 10 Patienten registriert, alle 10 waren mittels K-Draht-Osteosynthese versorgt worden.Die winkelstabile palmare Plattenosteosynthese führt selbst bei komplexeren distalen Radiusfrakturen zu besseren klinischen und radiologischen Ergebnissen als die K-Draht-Osteosynthese bei einfachen distalen Radiusfrakturen.

The objective of this study was assessment of quality of the surgical curriculum in Pomeranian Medical University in years 2015-2017. Material and methods. A questionnaire-survey has been conducted in a group of 100 of Polish students from the Medical Faculty just before the final test-exam in subject surgery. Main topics of the questionnaire items concerned students’ opinion on the expected usefulness of acquired surgical knowledge for future medical practice, acquired manual skills, range of knowledge learned in particular academic years and on understanding the term “skill/competency-oriented teaching” surgery. Results. Knowledge from general and oncologic surgery was scored by students the highest as potentially most useful for future medical practice. Learning manual skills (mostly put stiches on a pig trotter) was considered the most valuable portion of surgical curriculum. Acquiring of manual skills was also believed as the closest of meaning the term “skill/competency-oriented teaching” surgery. Sixth (last) year of studying was considered the most effective in acquiring surgical knowledge. Most responders considered time assigned for teaching surgery in the university curriculum adequate, but not optimally employed. A critical discussion of the results was done in a light of the results of earlier studies and the literature. Conclusions. Outcomes of this study showed the students’ expectations in teaching surgery in the medical university curriculum and what was a grade of its performance. Awareness of this may have effect on modification of the curriculum and methods of undergraduate teaching surgery.

TOpisano przypadek martwiczego zapalenia tkanek miękkich okołoodbytowych imitującego ropień okołoodbytowy, którego rozległość i przebieg kliniczny mogły odpowiadać łagodnej formie zgorzeli Fourniera. U nieobciążonej dodatkowymi chorobami 65-letniej pacjentki choroba rozwinęła się w ciągu 5 dni, powodując martwicę okołoodbytowych tkanek miękkich i uogólnione zakażenie. Miejscowy wygląd zmian przypominał ropień umiejscowiony po obu stronach odbytu. Leczenie operacyjne przez rozległe nacięcie zmienionej zapalnie okolicy, ewakuację tkanek martwiczych i antybiotykoterapię było skuteczne, ale musiało być powtarzane, a zamknięcie ubytku skóry na pośladku w okolicy odbytu wymagało plastyki płatowej.

Clinical presentation of carpal tunnel syndrome may differ in relation to certain factors like sex, age, duration of symptoms and severity of compression. The objective of this study was an investigation into the hypothesis that several distinct factors are predictive of the clinical profile for the condition. The records of 1,117 patients: 909 women (81 %) and 208 men (19 %) with a mean age of 63 years, were analysed. The whole group was divided into subgroups, depending on the variables analysed: sex, age, duration of the condition, severity of symptoms, severity of electrophysiological abnormalities and occurrence or lack of comorbidities.Of all the considered variables, the Levine symptom scores had the greatest impact on the condition's clinical profile: the higher scores the more severe pain, poorer sensation, weaker grip and worse hand function. Also, ages greater than 80 years had a significant negative effect on most of the considered parameters. None of the remaining analysed variables had a substantial impact on the clinical profile of the condition.Das klinische Erscheinungsbild des Karpaltunnelsyndroms wird von diversen Faktoren beeinflusst, wie dem Geschlecht und Alter des Patienten, der Dauer der Beschwerden und der Schwere der Kompression des N. medianus. Ziel dieser Untersuchung war es zu ermitteln, welcher Faktor mit dem Erscheinungsbild am stärksten korreliert.Die Akten von 1117 Patienten, 909 Frauen (81%) und 208 Männern (19%), mit einem Durchschnittsalter von 63 Jahren wurden abhängig von Geschlecht und Alter der Patienten, Dauer und Schwere der Beschwerden sowie der elektrophysiologischen Veränderungen und bestehender Begleiterkrankungen ausgewertet.Von allen untersuchten Parametern korrelierte der Levine Score am stärksten mit dem klinischen Erscheinungsbild. Je höher der Score desto stärker die Schmerzen, schlechter die Sensibilität, schwächer die Griffkraft und schlechter die Handfunktion. Auch ein Alter über 80 Jahre wirkte sich auf die meisten untersuchten Parameter negativ aus. Wohingegen keiner der anderen untersuchten Faktoren substantiellen Einfluss auf das klinische Erscheinungsbilder des Karpaltunnelsyndroms hatte.

Introduction : Metastases of malignant neoplasms to the hand and wrist are rare. The lung, breast and kidneys are more common sites of primary lesions that metastasize in the hand. Phalanges are more commonly involved than the metacarpal and wrist. Case report : We report the case of a metastatic tumour involving the distal phalanx of the little finger originating from lung cancer in a patient with a history of advanced neoplastic disease (stage III B). Lung cancer was diagnosed approximately 10 months prior to the occurrence of metastasis. The tumour in the finger grew slowly, causing enlargement of the distal phalanx, causing no pain and not interfering with the hand function. The diagnosis was made based on X-ray performed due to occasional trauma of the involved finger. Treatment of the metastatic tumour consisted in amputation of the finger. After healing of the stump the patient was referred to further palliative, oncologic care.

Wstep : Ropnie przestrzeni zaotrzewnowej stanowią stosunkowo rzadkie powiklanie schorzen roznych narządow jamy brzusznej, m.in. ostrego zapalenia wyrostka robaczkowego, szczegolnie polozonego zakątniczo, i choroby Leśniowskiego–Crohna. Opis przypadku : W pracy przedstawiono przypadek 37-letniego pacjenta chorującego na chorobe Leśniowskiego–Crohna, u ktorego rozwinąl sie rozlegly ropien w prawej przestrzeni zaotrzewnowej, wywolal ucisk na prawy moczowod i przebil sie do prawego stawu biodrowego. Pacjent zglosil sie do szpitala, bedąc w ciezkim stanie ogolnym, z rozpoczynającą sie posocznicą. Rozpoznanie ustalono na podstawie tomografii komputerowej jamy brzusznej. Pacjent byl operowany w trybie pilnym, a leczenie polegalo na resekcji cześci zmienionego jelita czczego i kątnicy, ewakuacji i drenazu ropnia zaotrzewnowego. Przebieg pooperacyjny byl powiklany wystąpieniem niedrozności o charakterze mechaniczno-porazennym i nieszczelnością zespolenia jelit. W czasie drugiej operacji wyloniono jejunostomie petlową, co przynioslo poprawe stanu i opanowanie choroby brzusznej. Niestety, nieewakuowany w pore ropien stawu biodrowego spowodowal jego zniszczenie, co wymagalo trzeciej operacji (ortopedycznej) – wyciecia glowy kości udowej. Ostatecznie pacjent wyzdrowial z powiklania, ale zostal okaleczony i bedzie wymagal alloplastyki stawu biodrowego.

Multitraumatic injuries are common in an era of widespread motoring. Abdominal trauma is linked with 30–40% of these injuries. Intraabdominal bleeding caused by ruptured abdominal viscera : liver, spleen or small bowel mesentery is potentially life-threatening and, in most cases, requires immediate surgical intervention. The paper reports the case of a patient following multitrauma, who was operated on in an emergency due to abdominal haemorrhage. During the laparotomy, apart from lesions causing bleeding (laceration of the mesentery and small bowel perforation), two unexpected, uncommon lesions were found : a healthy Meckel diverticulum and haematoma in the mesentery of the appendix. The rules of diagnostics and management in typical abdominal injuries are discussed, with special attention to some rare and atypical pathologies found during the operation.

Background The objective of the study was to assess the time of exposure of the surgeon's hands to radiation and calculate of the equivalent dose absorbed during surgery of hand and wrist fractures with C-arm fluoroscope guidance. Material and methods The necessary data specified by the objective of the study were acquired from operations of 287 patients with fractures of fingers, metacarpals, wrist bones and distal radius. 218 operations (78%) were percutaneous procedures and 60 (22%) were performed by open method. Data on the time of exposure and dose of radiation were acquired from the display of the fluoroscope, where they were automatically generated. These data were assigned to the individual patient, type of fracture, method of surgery and the operating surgeon. Results Fixations of distal radial fractures required longer times of radiation exposure (mean 61 sec.) than fractures of the wrist/metacarpals and fingers (38 and 32 sec., respectively), which was associated with absorption of significantly higher equivalent doses. Fixations of distal radial fractures by open method were associated with statistically significantly higher equivalent doses (0.41 mSv) than percutaneous procedures (0.3 mSv). Fixations of wrist and metacarpal bone fractures by open method were associated with lower equivalent doses (0.34 mSv) than percutaneous procedures (0.37 mSv),but the difference was not significant. Fixations of finger fractures by open method were associated with lower equivalent doses (0.13 mSv) than percutaneous procedures (0.24 mSv), the difference being statistically non-significant. Statistically significant differences in exposure time and equivalent doses were noted between 4 surgeons participating in the study, but no definitive relationship was found between these parameters and surgeons' employment time. Conclusions 1. Hand surgery procedures under fluoroscopic guidance are associated with mild exposure of the surgeons' hands to radiation. 2. The equivalent dose was related to the type of fracture, operative technique and - to some degree - to the time of employment of the surgeon.

A prospective study was carried out to investigate any correlation between electrophysiological and sonographic findings in patients with a clinical diagnosis of carpal tunnel syndrome. A total of 113 patients (113 wrists) in 90 women and 23 men, with a mean age of 60 years, underwent sonographic and electrophysiological examination. Fifty-five patients (48%) had mild, 43 (38%) moderate and 12 (11%) had severe conduction disturbances and three patients had normal conduction. Sonographic measurements showed a cross-sectional area of the median nerve of 9.9 mm2 at the forearm and 17.8 mm2 at the tunnel inlet. The mean anteroposterior diameter (height) of the nerve at the tunnel inlet was 2.7 mm, and the lowest height inside the tunnel was 1.8 mm. No correlation was found between sonographic and electrophysiological parameters.

Non-traumatic perforation of the digestive tract occurs most often in the duodenum and stomach (peptic ulcer), as well as the colon (diverticulitis, cancer or ischemic lesions). Perforation of the small bowel is very rare. The Authors of the study presented a case of proximal jejunum perforation, which occurred in a patient with a history of duodenal peptic ulcer disease. Diagnosis posed no difficulties, and treatment included the excision of the ulceration and suturing of the bowel. The patient recovered without complications and the histological examination failed to reveal the nature of the ulcer. However, based on the medical history, one may suppose that it might be of peptic etiology, which makes this case exceptional.

We compared the results of carpal tunnel release in patients with the diagnosis of carpal tunnel syndrome based on only clinical grounds and those diagnosed on clinical and electrophysiological grounds. Ninety-three patients, 83 women (89%) and ten men (11%), meeting the criteria of ‘typical’ carpal tunnel syndrome, were randomly assigned to receive carpal tunnel release with ( n = 45, 48%) or without ( n = 48, 52%) nerve conduction studies. Patients were followed-up at 1 and 6 months, by assessments that included the Levine scores, filament tests, grip and pinch strength. No significant differences in Levine scores were found at the 1 and 6 months assessments. Statistically significant differences were noted in three-point pinch strength and sensation; however, they were not of clinical importance. The results of the study show that the results of carpal tunnel release in patients with typical symptoms are no better after nerve conduction studies and, therefore, nerve conduction studies can be omitted.

We present the case of an 82-year-old patient who had successfully replanted 2 of his 4 amputated fingers in the left, non-dominant hand. Amputation was caused by a circular saw and the patient was delivered to the hospital 3 h after injury with amputated part of the hand appropriately stored. The patient’s general health status was good, with no serious systemic diseases. He also did not smoke. Post-operative course was uneventful for the replanted fingers, but after his return home the patient developed left-sided pneumonia, treated successfully with i.v. antibiotics. 8 months after replantation the patient presented with slight movement in the replanted fingers (AROM 45°), a total grip strength 8 Kg and the qDASH score 24; however, he could firmly grasp objects due to having an intact, well-functioning thumb.

Background Teaching surgery during university curriculum comprises transferring theoretical knowledge traditionally and simultaneously acquiring manual skills, i.e., suturing, stitch removal, limb immobilization, catheterization, and assisting operations. Observations of doctors several years after graduation led to the reflection that teachers’ ideas about surgical knowledge and skills that are useful in daily practice frequently fail to meet the facts of the case. The objective of this study was to determine which part of the surgical knowledge and skills taught via the university surgical curriculum proved to be useful in the daily practice of young doctors. Material and Methods A custom-made questionnaire was designed and mailed to 200 randomly chosen doctors who had graduated from the medical faculty at the authors’ university 5 to 6 years previously. The questionnaire comprised 9 items concerning the knowledge and skills that proved to be the most useful in participants’ daily practice, regardless of their specialty. Results A total of 64 completed questionnaires were returned (32% of 200 sent) and were the subject of analysis. The most useful knowledge in daily practice was that acquired from general surgery, followed by oncological and vascular surgery. The most useful was knowledge about the rational interpretation of clinical symptoms and signs acquired from examination of the patient, followed by arriving at an accurate diagnosis through logical analysis, and next developing “oncological sensitivity” to diagnosing neoplasms. The most effective teaching model was specialized outpatient clinic rounds, followed by training manual skills on a model and classical ward-round teaching. The most frequently learned (acquired) manual skills were removal of stitches, rectal examination, and examination of the abdomen. Of these skills, the most useful in daily practice appeared to be removal of stitches, catheterization of the urinary bladder, and wound suturing. Learning and practicing manual skills followed by classical ward-round teaching was considered “skill-/competency-oriented teaching” surgery by all respondents. Conclusion The results of this study show some discrepancy between the knowledge and skills taught during university surgical curriculum and their actual usefulness in the daily practice of graduates. Awareness of this should have an effect on modification of the curriculum and methods for undergraduate surgery teaching.

Background Recent studies have demonstrated ultrasonography as a valuable tool for confirming the diagnosis of carpal tunnel syndrome. The objective of this study was to investigate sonographic parameters of the median nerve in patients diagnosed clinically with carpal tunnel syndrome. Patients and methods 185 wrists in 185 patients, 149 women (81%) and 36 men (19%), with a mean age of 59 years, with the clinical diagnosis of carpal tunnel syndrome were examined sonographically. We measured cross-sectional area (CSA) of the median nerve at the forearm and at the carpal tunnel inlet, as well as the height (a-p dimension) of the nerve at the tunnel inlet and in the narrowest site in the carpal tunnel. Moreover, in all patients the severity of the disease was assessed by the Levine questionnaire. Results A significant variability of sonographic data characterizing the median nerve was found: the mean CSA at the tunnel inlet was 17.6 mm2 (range: 7-36) and height of the nerve at the tunnel inlet was a mean of 2.7 mm (range: 1.3-4.5). No correlation was found between sonographic data and severity of the syndrome as expressed by the Levine scores. Conclusion Sonography of the median nerve contributes little to the diagnosis of a clinically relevant carpal tunnel syndrome and its routine use is not justified.

An observation of patients suffering from carpal tunnel syndrome shows distinct overweight, short stature and relatively thick hands in majority of them. Objective of this study was evaluation of the relationship of anthropometric and anatomical factors related to the hand with incidence of the syndrome.The anthropometric measurements of body weight and height, as well as anatomical of wrist girth, hand length and volume were performed in 105 patients, 84 women (80%) and 21 men (20%), aged a mean of 59 years, with idiopathic carpal tunnel syndrome. The same examinations were made in a control group consisting of 105 healthy individuals, age and gender matched.Statistically significant differences (t-Student or U Mann-Whitney test, p0,05) were noted in all considered variables: patients with carpal tunnel syndrome were heavier (of a mean of 6%), shorter (of 1,5%) and had of a mean of 9% greater body mass index. They had also statistically significantly greater hand volume (of 13%), hand length (of 2%) and wrist girth (of 5%). Although all variables were statistically significantly greater in a study group, the clinically meaningful were considered only differences of hand volume, wrist girth, body weight and body mass index.Individuals with overweight and with thicker than average hands and wrists are more predisposed to carpal tunnel syndrome.

Most the of doctors, including surgeons, who deal with diagnosing and treatment of carpal tunnel syndrome believe that median nerve conduction studies are obligatory for accurate diagnosis of the syndrome, providing various arguments to support this opinion. Based on available, current literature, a critical analysis of such an attitude was conducted. There is no definitive scientific evidence supporting a greater diagnostic importance of abnormal conduction in median nerve, than classical symptoms and signs of carpal tunnel syndrome. There is no enough evidence that electrophysiological studies are necessary for differential diagnosis, because clinical features of other pathologies are sufficiently different from classical carpal tunnel syndrome to avoid a false diagnosis. Relief of the symptoms and signs, but not normalisation of the conduction in median nerve is enough substantial as an evidence of effective therapy. The available evidence suggests the need of treatment of patients with typical symptoms of carpal tunnel syndrome associated with normal conduction studies, and non-treatment of those, with abnormal conduction but asymptomatic. Electrophysiological studies are thus not really a gold standard for carpal tunnel diagnosis and doing them in all patients presenting with typical history is not justified. Presence of classical features is enough convincing to make a diagnosis and qualify to the treatment. Nerve conduction studies may be helpful in cases with atypical history, when more than one site of compression is suspected, in failures and complications of surgery. The presented approach is associated with undoubted advantages of reducing time from referral to operation, costs and workload of neurophysiologists. There is no account for fear that meeting these rules may deteriorate results of the treatment of carpal tunnel syndrome.