Medikana - diagnostikos ir gydymo centras

Apie Pranas Šniuolis

Pranas Šniuolis Pranas Šniuolis Chirurgas

Pareigos: Chirurgas
Trumpa biografija:

1984 m. — Kauno Medicinos Universitetas (KMU)
1996 m. — Aukščiausia onkochirurgo kategorija
Stažuotės: Austrijoje, Izraelyje, Prancūzijoje, Škotijoje, Italijoje, Rusijoje.
Dirba Klaipėdos Universitetinėje ligoninėje vyresniuoju gydytoju onkologu-chirurgu. Turi chirurgo licenciją, onkoproktologo, krūtų onkologo licencijas.

Trumpas centre atliekamų procedūrų aprašymas:

  • Chirurgo - onkologo konsultacijos dėl krūtų, odos, žarnyno ir kitų ligų;

  • Ambulatorinės operacijos chirurginiu CO2 lazeriu;

  • Konsultacijos po operacijų;

  • Atlieka hemorojinių mazgų šalinimo procedūrą;

  • tiria bei gydo įvairius odos darinius;

  • atlieka įaugusių nagų chirurginį gydymą;

  • atlieka įvairių tiesiosios žarnos darinių šalinimą

  • atlieka daugelį kitų chirurginių procedūrų.

Susiję straipsniai

Hemorojus - liga, apie kurią pacientai garsiai nekalba

Pranas ŠNIUOLIS
Chirurgas onkologas

Hemorojumi serga daugiau nei pusė suaugusių žmonių, net ir XXI amžiuje liga laikoma gė­dinga, todėl pacientai ir toliau linkę kęsti jos nemalonumus, o ne kreiptis į gydytoją. Taip yra ir todėl, kad iki šiol hemorojus buvo gydomas senoviškai: pa­cientai operuojami ligoninėse, kelias savaites būna nedarbingi.

Kaip pasireiškia hemorojus? Dėl daugelio priežasčių išsiple­čia vadinamieji spongioziniai - į kempinę panašūs kraujagysli­niai dariniai išangėje, ir pacien­tas apčiuopia mazgus, kurie kar­tais iškrenta ir nebesugrįžta į išangę.

Pagal kai kuriuos aprašymus hemorojumi sirgo jau senovės Egipte, Babilone, jį tiksliai ap­rašė ir gydė garsusis Hipokratas 460-377 p.m.e.

Hemorojumi serga dažniau­siai tie žmonės, kurie dirba sun­kų stovimą fizinį darbą arba, at­virkščiai, sėdimą darbą, tai pa­plitusi vairuotojų ir vadovų liga. Pastebėta taip pat, kad su­serga tie žmonės, kuriems užkie­tėja viduriai, dėl to jie priversti ilgai stangintis, ypač pavojingas užsitęsęs vadinamasis dvimomentinis tuštinimasis. Pastebė­ta, kad šia liga suserga pacien­tės, turėjusios daug gimdymų, sirgusios uždegiminėmis ligo­mis. Svarbus ir paveldimumo faktorius - šia liga dažniau su­sirgs tie, kurių tėvai sirgo, turė­jo venų nepakankamumą.
Paprastai hemorojumi serga dažniau vyrai nei moterys, o ypač tie, kurie piktnaudžiauja alkoholiu, vartoja aštrų maistą.
Hemorojus gali būti ir labai pavojingos ligos - vėžio pasireiškimas. Net 20 proc. sirgusių bei besigydžiusių nuo hemorojaus vėliau buvo nustatytas tiesiosios žarnos vėžys.
Ar tai hemorojus, ar kita tie­siosios žarnos liga, o jų yra ke­liolika, gali nustatyti tik specia­listai.
Hemorojus buna vidinis ir iš­orinis, ūmus ir lėti­nis. Paprastai yra matomi trys penki stambūs mazgai, bet jų ga­li būti dešimt ir daugiau. Išori­niai hemoroidiniai mazgai dažniausiai būna pagal išangės kraštą ir gali būti išsidėstę ap­link. Paspaudus nekomplikuo­tus mazgus, jie ištuštėja. Papras­tai išoriniai hemoroidiniai maz­gai susisiekia su vidiniais, iš ku­rių dažnai kraujuoja.
Liga pasireiškia priklausomai nuo hemorojaus išplitimo laips­nio ir jos komplikacijų. Ilgą lai­ką pacientas gali nieko nejaus­ti, tik vėliau atsiranda nemalo­nių jutimų: kraujavimas, skaus­mas, tempimo jausmas, niežulys.
Paprastai minėtų nusiskundi­mų atsiranda, kai žmogus pavar­toja alkoholio, kelionėje, kai pa­sikeičia maisto pobūdis, užkie­tėja viduriai.
Pirmas pasireiškimas gali būti kraujavimas, kuris atsiranda tuštinantis, kraujas pastebimas ant tualetinio popieriaus, kloze­to, kartais kraujas laša ar net trykšta srove.
Kraujavimas pasirodo peri­odiškai, kraujas paprastai būna šviesiai raudonas, be gleivių, skirtingai nei sergant kitomis uždegiminėmis storųjų žarnų li­gomis ar net vėžiu.
Pacientas gali netekti nedide­lio kiekio kraujo, o kartais gali ir stipriai nukraujuoti, dėl ko gali iš­sivystyti mažakraujystė. Pacien­tams, sergantiems hemorojumi, dažnai išsivysto įvairios kompli­kacijos: hemoroidinių mazgų trombozė ar jų iškritimas, išangės įplėša, užsitęsęs niežulys, pūliniai, fistulės, dujų ir išmatų nelaikymas.
Iš pradžių pacientas jaučia stiprų skausmą, tempimą išan­gėje, ypač skauda vaikščiojant. Vėliau hemoroidiniai mazgai dar labiau paburksta, padidėja skausmas - labai intensyvus, ne­begalima išsituštinti.
Jei ir toliau pacientas nesigy­do, jo būklė pasidaro sunki, at­siranda hemoroidinė mazgų ne­krozė, pakyla temperatūra iki 39 laipsnių, gali išsivystyti anaero­binė gangrena ar net ištikti mirtis.
Hemorojus gali atsirasti ir sergant kepenų ciroze, širdies nepakankamumu, esant augliams dubenyje, t.y. vadinamasis antrasis hemorojus.
Pacientai, turintys įvairiausių nemalonių jutimų tarpvietėje ir išangėje, turėtų kreiptis į gydy­toją, nes šie pojūčiai gali atsirasti dėl vėžio, uodegikaulio arba kryžkaulio li­gų, kartais net dėl užkrečiamų venerinių ligų.
Pacientas neturėtų bijoti tyrimų: paprastai jie neskausmingi. Paprasčiausia išangės apžiūra padeda nustatyti ligą - ar tai he­morojus, ar tai išangės įplėšą, ar tai uždegiminės ligos. Tirdamas pirštu tiesiąją žarną, gydytojas įvertina tiesiosios žarnos rauko būklę, hemorojaus išplitimą, prostatos būklę. Specialiu apa­ratu - anoskopu detaliai įverti­namą tiesiosios žarnos gleivinė, o rektoskopu ištiriama ne tik tie­sioji, bet ir dalis riestinės žar­nos.
Tik atlikus tyrimus ir nusta­čius ligos priežastį paskiriamas gydymas.
Dažniausiai užtenka suregu­liuoti dietą: atsisakyti alkoholio, maistas neturi būti aštrus, ne­valgyti rūkytų produktų, valgyti daugiau daržovių, vaisių, sėle­nų, slyvų, burokėlių, gerti dau­giau skysčių, vartoti aliejų su maistu.
Labai svarbus fizinis aktyvu­mas, ypač dirbantiems sėdimą darbą: kas 2-3 nepertraukiamo darbo valandas patartina 5 min. pasimankštinti, pavaikščioti aukštai keliant kelius, atlikti pri­tūpimus. Išvengti hemorojaus ar jo progresavimo, taip pat ir pro­statos ligų padeda bėgiojimas. Yra įrodyta, kad bėgiojant yra masažuojama prostata, nes pa­gerėja veninio kraujo nutekėji­mas.
Pacientai, linkę į vidurių už­kietėjimą, jei nepadeda mitybos įpročių pakeitimas, turi vartoti vidurius liuosuojančius prepara­tus, ricinos aliejų ir kt., jei ne­padeda - daryti klizmas.
Esant paūmėjusiam hemorojui rekomenduojamos šiltos sė­dimos vonelės su dezinfekuo­jančiomis medžiagomis - kalio permanganatu, "Betadine" - pa­deda pašalinti išangės rauko spazmą, mažina uždegimą.
Gydytojai, priklausomai nuo hemorojaus komplikacijų pobū­džio, paprastai paskiria arba žvakučių arba tepalų ar tablečių ir kt. Šiuo metu efektyviai naudojamas gydymas lazeriu, koaguliacija infraraudonaisiais spinduliais, skleroterapija - kai hemoroidinį mazgą suleidžiama medikamentų, su­keliančių jo uždegimą, paraudi­mą ir pasveikimą. Pastaruoju metu Vakarų šalyse labai papli­tęs hemorojaus gydymo būdas - gumblikacija, mazgų užspaudi­mas elastiniais žiedais - Barrono operacija. Specialiu aparatu ant hemoroidinio mazgo kojytės už­maunamas guminis žiedelis, tuomet j jį nebepatenka kraujo, mazgas nekrotizuoja per 5-7 dienas ir išnyksta. Gydymas guminiais žiedais visiškai neskausmingas, atliekamas ambulatoriš­kai. Po šios operacijos dauguma pacientų yra darbingi ir tą pa­čią dieną grįžta į darbą.
Hemorojaus, kaip ir daugelio ligų profilaktika - tai sveikas gyvenimo būdas, fizinis aktyvu­mas, racionali mityba, alkoholio atsisakymas.

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Hemorrhoids - a disease that patients are silent about

Pranas ŠNIUOLIS
Surgeon oncologist

More than half of the adults are ill with haemorrhoids, even in the XXI century the disease is being considered shameful­, because patients further tend to suffer its unpleasantness, and not to contact the physician. This is because until now, the hemorrhoids was treated in the old-fashioned way: patients were operated in hospitals and were unable to work for several weeks.­

How do haemorrhoids manifest? Due to many reasons the so called spongiotic­ - sponge like blood vessel­ formations in the anus, and the patient feels the nodes ­ that sometimes­ prolapse and do not go back into the anus.

According to some descriptions, people were suffered from haemorrhoids in ancient Egypt, Babylon, it was accurately described and treated by the famous Hippocrates 460-377 B.C.­

Usually haemorrhoids plagues the people, who perform hard standing physical or, on the contrary, sedentary work, it is a common disease for drivers and managers.­­­­It was also noted that disease plagues those people­, who have constipation­, due to that they have to push for a long time, especially dangerous is prolonged so called two momentum bowel movements. It was noticed that this disease develops for the patients, who gave multiple births, or have a history of inflammatory diseases. ­­­Hereditary factor is important as well - those, whose parents had had venous insufficiency, will become ill with this disease more often.­­
Usually, haemorrhoids are more common among men than women, especially those, who abuse alcohol or consume spicy food.
Haemorrhoids can be a manifestation of a very dangerous disease - cancer. Even 20 percent of those, who suffered from haemorrhoid and treated it, subsequently were diagnosed with rectum cancer.
Only specialists can diagnose whether this is haemorrhoids or other rectal disease, of which there are more than a dozen.­­­
Haemorrhoids is internal and external, acute and chronic.­­Usually three to five large nodes are visible, but there can be ten or more of them.­External haemorrhoid knots are usually located along the edge of the anus and can be situated around.­­As the uncomplicated nodes are pressed, they become empty.­Typically, the external haemorrhoid nodes connect with the internal ones that often bleed.­­­
The disorder manifests depending on the degree of the haemorrhoid spreading and its complications.­For a long time the patient may feel nothing, but later the unpleasant sensations present: bleeding, pain, tension, itching.­­­­
Typically, the above-mentioned complaints arise when the person consumes the alcohol, on the road, when a nature of food changes, or in case of a constipation.­­­­
The first sign could be bleeding that presents during the bowel movements, the blood is noticed on the toilet paper, closet­, sometimes the blood drips or even flows.
The bleeding presents periodically­, the blood usually is light red, without mucus, unlike when being ill with other inflammatory diseases of the large intestines­ or even cancer.
The patient may lose a small amount of blood, and sometimes can bleed severely that may lead to the development of the anaemia.­­The patients­, who are ill with haemorrhoids, often develop various complications­: thrombosis of the haemorrhoids nodes or their prolapse, tearing of the anus, prolonged itching, abscesses, fistulas, gas or excrement incontinence.
Initially, the patient feels severe pain, tension in the anus, especially hurts when walking.­Later haemorrhoid nodes swell even more, the pain increases - very intense, can no longer defecate.­
If the patient continues to avoid treatment­, his condition becomes severe, the haemorrhoidal necrosis of the nodes­­ develops, the temperature increases to 39 degrees, anaerobic gangrene­ could develop or the patient can even die.
Haemorrhoids can occur in patients with the liver cirrhosis, heart failure, tumours in the bowl, i. e. the so-called the second haemorrhoids.
Patients with the various unpleasant sensations in the perineum and anus should contact the physician­, because these sensations can present due to the cancer, diseases of the coccyx or sacrum­, sometimes even due to the contagious venereal diseases.
The patient should not be afraid of tests: usually they are painless. The simplest anal examination helps to diagnose the disease - whether it's haemorrhoids or anal tearing, or whether it is inflammatory diseases.­During the examination of the rectum with a finger, the physician evaluates the condition of the rectal sphincter, spread of haemorrhoids and the prostate condition. A special machine - anoscope is used to perform the detailed assessment of the rectal mucosa and the rectoskope is used to examine not only the colon, but also a part of the sigmoid as well.­­­­
The treatment is prescribed only after the performance of tests and the identification of the cause of the disease.­
Mostly it is enough to adjust­ the diet: give up the alcohol, the food must not be spicy, do not eat the smoked­ products, eat more vegetables, fruits, bran­, plums, beetroots, drink more­ fluids, consume more oil with food.
Physical activity is very important­, especially for those, whose work is sedentary: it is advised to exercise for 5 minutes every 2-3 hours of continuous work, to walk around by lifting the knees high, perform squats­. Jogging helps to prevent the haemorrhoids or progression of a prostatic diseases.­There is evidence that prostate is massaged during the jogging because it improves the outflow of venous blood.­­
If the alteration of the nutritional habits is not helpful, the patients, who are prone to constipation­, must use the laxative preparations­, castor oil and other if that do not help­ - take enemas.
In case of flaring up of the haemorrhoids warm sedentary baths with disinfecting substances (potassium permanganate) are recommended­­, "Betadine" - helps­ to eliminate the spasm of the anus fold, reduces the inflammation.
Depending on the nature of the complications of haemorrhoids the physicians usually prescribe suppositories, lubricants or tablets etc.­Currently the laser treatment is being used effectively, coagulation with infra-red rays, sclerotherapy - medication that causes the inflammation, reddening and recovery are injected into the haemorrhoidal node­­. Currently very common haemorrhoid treatment in the Western countries is gumblication, nodes are tightened with elastic bands - Barron's operation.­­The special device is used to put on the rubber band on the foot of the haemorrhoid node­, after that the blood is not entering it any more, the necrosis of the node occurs and within 5-7 days it disappears. Treatment with rubber bands is completely painless, and performed in the outpatient department.­After this surgery, most patients are able-bodied and return to work on the same day.­
Prophylaxis for haemorrhoids, as for many diseases - a healthy lifestyle, physical activity, rational nutrition, refusal of alcohol.­

 

 

 

 

 

In our country, men's sexual health is given too little attention, therefore the morbidity of genital diseases is very high. For example, periodic medical examinations for female diseases is mandatory, while for male - voluntary. Given our level of awareness, it is unlikely that men themselves will make regular visits to physicians until they feel fairly well. Probably because of that every second woman is constantly visiting the gynaecologist, and no smaller number of men are constantly sick, but do not seek treatment, because they do not know and do not really want to know. Because men psychology is rather primitive: if the wife or mistress is satisfied, it means that everything is in order. Often women are the first to get concerned with the health of their husbands, especially when they themselves cannot recover from inflammations of their reproductive organs or cannot get pregnant for several years. In fact, male and female sexual problems are common and cannot be solved separately. These problems have a negative impact on personal life, family and society.

Diseases of the frontal gland (prostate) plague men during the whole life. Younger threatened with inflammation - prostatitis older - benign and malignant tumours. Prostatitis is the most common male genital disease. In Lithuania over 70% of men from 20 to 45 years of age are suffering from it. Such a high prevalence of prostatitis worldwide is associated with the abundance of the sexually transmitted diseases, and the weakening of the human immunity. After all the likelihood of disease and the possibility of recovery largely depends on the interaction of the infectious and immune factors.

Perhaps the circumstance that women themselves cannot become ill with prostatitis, because they do not have the prostate, confuses those, who think that prostatitis is not a transferable disease and appears somehow on its own. In fact, prostatitis is an acute or chronic inflammation of the prostate gland of infectious nature. It is caused by various bacteria that usually enter the prostate through the urine channel (the urethra). Only in up to 10% of the cases, prostatitis may develop if the bacteria are introduced non-sexualy, but through blood or lymph from other foci of infection in the body. Thus, infectious urethritis is the direct cause of prostatitis. From the epidemiological point of view, it is the most often occurring STD that men contract when having sex with a woman, who is ill with the inflammation of the reproduction organs, and there are approximately 50% of such women in Lithuania. It should also be noted that the oral sex is no less dangerous to man's health. Because in each person's mouth there are a lot of bacteria that can cause purulent inflammations: tonsillitis, prostatitis, adnexitis, etc.

After contracting the urethritis, in other words the inflammation of the urine channel or urethra, the signs of the disease may present themselves only after quite a long time, but after getting cold or consuming the alcohol, the slight itching may appear when urinating, thin secretion in the morning. Approximately within a month the inflammation goes into the prostate. However, many men do not feel that and continue to feel quite reasonably for a few more months or years, therefore do not seek medical attention. Only when the most unpleasant complications of prostatitis: potency disorders and infertility begin to emerge, a man starts to care about his illnesses.

Most men had read or heard somewhere that when becoming ill with prostatitis, there should be an immediate pain in some areas, an increase in body temperature, and an impairment of urination and potency. In fact, these symptoms are characteristic to the acute prostatitis, but it is very rare and its diagnostics and treatment do not cause any problems. In most cases the chronic progress is characteristic to the prostatitis, when all of the aforementioned symptoms are very indistinct or present only after few years in more neglected stages of the disease.

Since the results of treatment always directly depend on the stage of the disease, the early diagnosis of prostatitis has a great practical significance. It means the identification of prostatitis in the preclinical stage of the disease, when the functions of the body are not significantly impaired and there are no irreversible changes in the tissue of the prostate. Many men who care of their health, and some physicians believe that the earliest and the most accurate way to diagnose all diseases is the ultrasound examination. Actually the ultrasonography is a very useful auxiliary method for the confirmation of the late stages of prostatitis, but is completely usuitable for its early diagnostics, because ultrasound usually "does not show" the fresh prostatitis.

Press and television often reminds that a man, who reached the age of 45, should be examined by a urologist for prostate diseases every year. In fact, at this age benign prostate enlargement or cancer might be onset already, while the prostatitis is a disease of young or middle-aged men. Therefore, all men from 18 to 45 years of age are welcome to visit dermatovenereologist for a prophylactic check for STDs and prostatitis at least once a year.
A common misconception is prevalent among the patients that prostatitis is an incurable disease. In fact, the effectiveness of treatment very much depends on the duration of the disease, the professionalism of the physician and patience of the patient's. In every specific case the treatment should be individual, but in all cases complex, rationally combining the medication and non medication means, in order to ensure not only the clinical cure, but the total rehabilitation of the patient as well. True, after treatment a small defect of prostate tissue often remains, but it is quite possible to restore its functions even without "Viagra".

Prostatitis morbidity continues to grow, therefore it may seem that this is almost an incurable disease. Actually it is easy to protect oneself from prostatitis, because there is no need to do almost anything: do not get cold, do not overwork, do not be nervous, do not abuse the alcohol and sex, do not sit in the vehicle or chair for the whole day, and most importantly not to have any sexual contact without the condom, cure the uretritis and other foci of the infection on time. In addition, each accomplished man, like any self-respecting woman, undergo medical examinations at least once a year in order to diminish the need to care for illnesses. Only completely healthy men and women can create a strong family and ensure the future of the nation.

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