TGC is efficacious in the treatment of patients with cIAIs and TGC met per the protocol-specified statistical criteria for noninferiority to the comparator, IMI/CIS.

Background and objective: Rectus sheath haematoma (RSH) is an uncommon condition that may vary from contained haematoma to life-threatening bleeding. Timely diagnosis and treatment is crucial in this patient population. The aim of the current study was to investigate the results of the different RSH treatment strategies among patients admitted to a surgery department. Materials and methods: A retrospective analysis of 29 patients treated for RSH in surgery departments of two medical centres from 1 January 2007 to 30 September 2017 was conducted. The patient’s age, sex, ASA (American Society of Anesthesiologists; physical status classification system), use of anticoagulants, cause of haematoma, radiological data, vital signs, blood investigations, and type of treatment were extracted. The results were analysed according to the type of treatment. Results: The patients’ mean age was 67.6 ± 14.3 years, and the mean duration of in-hospital stay was 10.7 ± 6.7 days. All patients were on anticoagulant treatment, and 82.8% of them had spontaneous haematoma. Nine patients (31%) needed transfusion of packed red blood cells with an average of 2.6 units (range: 1–4). Five patients (17.2%) presented with symptoms and signs of hypovolemic shock, and four of them underwent embolisation. Embolisation was successful in all cases. Open surgery was performed in 6 patients, 8 patients underwent percutaneous drainage, and 10 patients were treated conservatively. Two patients (6.7%) died in our series. Both of these patients had type III RSH. Patients in the conservatively treated group had the shortest hospital stay. There were no readmissions due to repeated haematoma or infection. Conclusions: Embolisation of epigastric arteries is a useful tool to stop bleeding into RSH in patients with unstable haemodynamics. Conservative treatment is comparable to ultrasound (US) drainage of RSH but results in a shorter hospital stay. Type III RSH is associated with a higher death rate.

Total incidence of large bowel full-thickness injury in Lithuanian hospitals is 0.07 %. Incidence of this complication after diagnostic and therapeutic colonoscopies is 0.056 and 0.169 %, respectively. The most common site of perforation is sigmoid colon and rectosigmoid junction, at 70 %. Risk rises when colonoscopy is performed in low-volume practice centers. Urgent surgical management resulted in overall mortality rate of 15.0 % and morbidity of 37.5 %.

BackgroundRecent data shows that patients with severe acute pancreatic might benefit from early intensive therapy, enteral nutrition and timely transfer to specialized centers. The early prophylactic use of antibiotics in AP remains controversial. The role and need for new markers in stratification of acute pancreatitis is also uncertain. This study aims to evaluate the prognostic usefulness of adipokines in prediction of the severity and outcome of acute pancreatitis (AP).MethodsProspective study was conducted in four clinical centers. The diagnosis and severity assessment of AP was established according to the revised 2012 Atlanta classification. Adipokines, IL-6 and CRP levels were measured at admission and on 3rd day of hospital stay and compared with the control group. The predictive accuracy of each marker was measured by area under the receiver operating curve.ResultsForty healthy controls and 102 patients were enrolled in to the study. Twenty seven (26.5 %) patients had mild, 55 (53.9 %) - moderate and 20 (19.6 %) - severe AP. Only resistin (cut-off value 13.7 ng/ml) and IL-6 (cut-off value 473.4 pg/ml) were reliable early markers of SAP. IL-6 with cut-off value of 157.0 pg/ml was a predictor of necrosis. The peripancreatic necrosis volume of 112.5 ml was a marker of SAP and 433.0 ml cut-off value could be used to predict the need of interventions.ConclusionsThe prognostic value of adipokines in AP is limited. Only admission resistin levels could serve as an early predictor for SAP.The Lithuanian Regional Ethics Committee approved the study protocol (permission No. L-12-02/1/2/3/4) and all the patients and the control group provided written informed consent.

Introduction. Both mesenteric cysts and cystic lymphangiomas are scarce and clinically and radiologically almost identical derivatives, but their histological structure is fundamentally different. Case Presentation. A 52-year-old woman was consulted by a surgeon for a derivative felt in her abdomen. The patient said she felt a growing derivative in the abdomen about a month ago. After consulting and testing, a sigmoid colon mesenteric cyst ( 13   cm × 11   cm × 10   cm ) was found. Complete excision of the cyst within healthy tissues was performed through laparotomy. The surgery had no complications. The initial pathological answer was a simple mesothelial cyst (a rare histological finding). However, immunohistochemical tests were performed that showed that diagnosis was mesenteric cystic lymphangioma (ML). Cystic lymphangiomas that have a link to the mesentery have been described less than 200 times. Conclusions. Final differential diagnosis between different cystic derivatives is possible only based on histopathological examinations. Mesenteric lymphangioma is most common at a very young age, but in rare cases, it also occurs in adults. All clinicians should increase their awareness of the disease.

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We present a case of a 59-year-old male who was admitted to the emergency department with urinary retention, with a history of lower urinary tract symptoms, with the value of serum prostate specific antigen level of 100 ng/mL and an estimated prostate size of 800 mL, according to magnetic resonance imaging. A prostate biopsy showed benign prostatic hyperplasia. Transvesical prostatectomy was performed, following additional procedure of transurethral resection of the prostate. To the best of our knowledge, this is the fourth highest prostate volume reported in medical literature. In this paper, we examine the factors that may have influenced the development of giant prostate hyperplasia.

Vilius Petrėtis1, Jonas Činčikas1, Audrius Gradauskas21 Vilniaus miesto universitetinės ligoninės Chirurgijos klinikaAntakalnio g. 57, LT-2040 Vilnius2 Vilniaus universiteto Medicinos fakultetoBendrosios medicinos praktikos ir slaugos katedraVilniaus miesto universitetinės ligoninės Chirurgijos klinikaAntakalnio g. 57, Vilnius, LT-2040 VilniusEl paštas: wiliux@vlk.lt Įvadas / tikslai Daugiau nei 60% kojų amputacijų priežastis – cukrinis diabetas. Mirštamumas po amputacijų Lietuvos ligoninėse svyruoja nuo 5 iki 37%. Pagrindinė invalidumo ir mirštamumo priežastis – pėdos infekcija, gangrena, sepsis, širdies ir plaučių komplikacijos. Periferinės neuropatijos, neuroischemijos ir infekcijos derinys skatina diabetinių opų raidą, o uždelsus padidėja gangrenos ir amputacijos tikimybė. Vis dėlto dažnai pėdos opų ir apatinės galūnės amputacijos būtų galima išvengti. Diabetinės pėdos profilaktika turėtų būti pradėta iškart diagnozavus cukrinį diabetą. Klinikiniais tyrimais įrodyta, kad įvairių specialistų gebėjimas kartu gydyti diabetinės pėdos sindromą yra viena svarbiausių sąlygų sumažinti apatinių galūnių amputacijų skaičių. Kompleksinė daugiaprofilinė pagalba yra veiksmingas diabetinės opos gydymo metodas. Todėl pacientams, kuriems labiau nei kitiems gresia diabetinės pėdos sindromas, būtinos kraujagyslių chirurgų, endokrinologų, bendrosios chirurgijos bei diabetinės pėdos specialistų konsultacijos ir nuolatinė kontrolė. Mes šią problemą norime panagrinėti bendrosios chirurgijos aspektu. Tyrimo tikslas: panagrinėti diabetinės pėdos gydymo taktiką, veiksnius, skatinančius apatinės galūnės gangreną esant diabetinei pėdai, vyraujančius mikroorganizmus ir jų jautrumą antibiotikams. Metodai 1992–2002 metais Vilniaus miesto universitetinės ligoninės (VMUL) bendrosios chirurgijos skyriuose buvo hospitalizuotas 441 ligonis, sergantis diabetinės pėdos sindromu. Duomenys rinkti pildant specialiai sudarytas anketas. Rezultatai Pagrindinis diabetinės pėdos sindromo gydymo tikslas – išsaugoti galūnę, o išplitus infekcijai – išgelbėti ligonio gyvybę. Dėl diabetinės pėdos sindromo hospitalizuotų ligonių gydymas galėtų būti skirstomas į bendrąjį ir vietinį. Bendrajam diabetinės pėdos sindromo gydymui priskirtina visų pirma glikemijos kontrolė, o prisidėjus infekcijai – antibakterinis gydymas. Esant išplitusiai infekcijai, sepsiui, gelbstint ligonio gyvybę atliekama radikali chirurginė operacija – galūnės amputacija. Vietiniam diabetinės pėdos sindromo gydymui priskirtume pėdos chirurgiją ir infekuotos diabetinės pėdos drenavimą, plovimą, negyvybingų audinių šalinimą. Bendrosios chirurgijos skyriuose taikomos ir kitos, pagalbinės, gydymo priemonės, pavyzdžiui, hiperbarinė oksigenoterapija. Nustatėme, kad VMUL bendrosios chirurgijos skyriuose iš 441 hospitalizuoto ligonio 71,7% buvo operuoti. Vidutiniškai vienam dėl diabetinės pėdos sindromo hospitalizuotam ligoniui tenka 1,07 operacijos, arba vienam nuo diabetinės pėdos sindromo operuotam pacientui tenka 1,5 operacijos. Nagrinėjant mikroorganizmų paplitimą diabetinės pėdos žaizdose paaiškėjo, kad tik iš 46% diabetinių žaizdų buvo imtas pasėlis mikroorganizmams nustatyti. Iš viso išaugintos 323 mikroorganizmų kolonijos. Vienas sukėlėjas nustatytas 54,5% pasėlių, du mikroorganizmai – 29,6%, trys – 11,1%, keturi ir daugiau – 4,8% pasėlių. Vyrauja gramteigiami aerobai, sudarantys 61,9% visų pasėlių. Iš jų dažniausiai pasitaiko Staphylococcus aureus (36,2%), o 12% atvejų išauginti meticilinui atsparūs stafilokokai (MRSA). Nustatyta, kad vidutiniškai iki 31,1% ligonių anksčiau buvo hospitalizuoti dėl diabetinės pėdos sindromo komplikacijų. VMUL bendrosios chirurgijos skyriuose 7,7% hospitalizuotų ligonių atlikta amputacija virš kelio, 23,4% – žemiau kelio sąnario. 59,6% ligonių išgydyti. Hospitalizavimo metu mirė 9,3% ligonių. Trys pagrindinės mirties priežastys: sepsis ir septicemija, miokardo infarktas, širdies veiklos nepakankamumas. Kitos mirties priežastys: plaučių arterijos trombembolija, terminalinis inkstų funkcijos nepakankamumas, hipoglikeminė koma, prakiurusi dvylikapirštės žarnos opa. Vidutinis mirusių pacientų amžius – 68,4 metų. Paaiškėjo, kad diabetinės pėdos sindromo baigtis nepriklauso nuo cukrinio diabeto tipo. Išvados Kasmet vidutiniškai 0,5% pacientų hospitalizuojama dėl diabetinės pėdos sindromo VMUL bendrosios chirurgijos skyriuose. Apie 60% šių pacientų pavyksta išgydyti, tačiau nemaža dalis netenka galūnės (7,7%) aukščiau kelio sąnario ar miršta (9,3%) hospitalizavimo metu. Vienuolikos pacientų mirties priežastys buvo tiesiogiai susijusios su diabetinės pėdos sindromu (sepsis, septicemija), vieno – su pačiu diabetu (hipoglikeminė koma). Kitų pacientų mirties priežastys – gretutinės ligos. Tik glaudus ir darnus endokrinologų, kraujagyslių ir bendrosios chirurgijos specialistų darbas galėtų sumažinti amputacijų ir mirčių nuo diabetinės pėdos sindromo skaičių. Diabetinės pėdos opose vyrauja polimikrobinė flora. Dažniausias infekcijos sukėlėjas – St.aureus, kuris buvo jautriausias oksacilinui, gentamicinui, eritromicinui, cefazolinui. Meticilinui atsparus stafilokokas nustatytas 12% atvejų. Prasminai žodžiai: cukrinis diabetas, diabetinė pėda, gydymo patirtis, baigtys Experience of treatment of diabetic foot at Vilnius City University Hospital departments of general surgery Vilius Petrėtis1, Jonas Činčikas1, Audrius Gradauskas2 Background / objective More than 60% of lower extremity amputations are due to diabetes mellitus. In Lithuania, in-hospital mortality after amputations varies from 5 to 37%. The main causes of invalidity and mortality are foot infection or gangrene, sepsis and complications of the heart and lungs. A combination of peripheral neuropathy, ischemic vascular disease and infection facilitate diabetic ulcer development, which can lead to gangrene and amputation. However, in many cases foot ulcers and amputation can be prevented. The work of prevention begins with the initial diagnosis of diabetes. Attempts to reduce the incidence of lower extremity amputations have shown that multi-disciplinary team management is one of the more effective means of accomplishing this goal. A complex multi-disciplinary team, including vascular surgeon, endocrinologist, general surgeon, podiatrist consultations and continuous control are vital for patients with diabetic foot syndrome. The topics were analyzed from general surgeon's point of view. The objective of this analysis was to find the experience of treatment of diabetic foot syndrome, factors inducing gangrene of lower extremity, dominant microorganisms and their susceptibility to antibiotics in diabetic foot wounds. Methods At Vilnius City University Hospital departments of general surgery, from 1992 to 2002 441 patients with diabetic foot syndrome were hospitalized. The data were collected by filling in a questionnaire. Results The main goal in the treatment of diabetic foot syndrome is to save the extremity or in the case of life-threatening infection to save the patient's life. Treatment of diabetic foot syndrome could be categorized into general and local. For the general treatment of diabetic foot we resort first of all to glycemic control and in the case of infection to antibiotic therapy. If a life-threatening infection, sepsis occurs, radical surgical intervention – amputation of lower extremity – is performed. For the local treatment of diabetic foot we resort to foot surgery including dreinage, lavage and debridement. Also other therapies such as adjuvant means of treatment, e.g., hyperbaric oxygen therapy, are applied at Vilnius City University Hospital departments of general surgery. Of all the patients hospitalized for diabetic foot syndrome 71.7% were operated on. We analyzed the prevalence of microorganisms in diabetic foot wounds. Microbiological tests were taken only from 46% of all diabetic wounds. In total, 323 pathogens were isolated. One pathogen was found in 54.5%, two in 29.6%, three in 11.1%, four and more in 4.8% of all swabs. According to the data, in almost half of all swabs two or more pathogens were found. The most common species were Staphylococcus, Proteus, Streptococcus and Enterococcus. The predominant pathogenic organisms were Gram-positive aerobes found in 61.9% of swabs. Of the Gram-positive aerobes, St. aureus was found most frequently (36.2% of all swabs), and 12% were MRSA. We analyzed the outcomes of diabetic foot syndrome. Of all hospitalized patients, 31.1% had been ill with diabetic foot complications before hospitalization. At the departments of general surgery, 7.7% of hospitalized patients' extremities were amputated above the knee and 23.4% below the knee; 59.6% of patients were cured. We found that 9.3% of patients died during hospitalization; their mean age was 68.4 years. Three main causes of the lethal outcome were sepsis and septicemia, myocardial infarction and heart failure. Other causes were lung artery embolism, terminal insufficiency of renal function, hypoglycemic coma, perforated ulcer of the duodenum. Conclusions Approximately 0.5% of all patients of Vilnius City University Hospital departments of general surgery are hospitalized with diabetic foot syndrome every year. About 60% of patients were cured, but some patients were not: their extremities were amputated above the knee in 7.7% and 9.3% of patients died during hospitalization. Eleven cases of lethal outcome were directly associated with diabetic foot syndrome (sepsis, septicemia), one case with diabetes mellitus (hypoglycemic coma), and the other cases with concomitant and conterminous diseases. Only a multi-disciplinary team (including endocrinologists, vascular and general surgeons) applying a combined management of diabetic foot syndrome can reduce the prevalence of amputations and mortality in diabetic foot patients. In diabetic foot wounds polymicrobic flora was dominant. St.aureus was the sole pathogen most sensitive to oxaciline, gentamycine, erythromycine, cefazoline and 12% were MRSA. Keywords: diabetes mellitus, diabetic foot, experience of treatment, outcomes