Ileal pouch morphology and microbiology in ulcerative colitis patients.

BACKGROUND: Ideal pouch created during restorative proctocolectomy is a new gastrointestinal organ--"neorectum". Although it is made from the ileum, it takes over function of the removed rectum. This new function results in significant morphological changes in pouch's mucous membrane, which becomes similar to the large bowel mucosa. The most common pathology of the ileal pouch is its inflammation--pouchitis. One of the suspected causes of pouchitis is bacterial flora disturbance. OBJECTIVES: The aim of the study was to analyze the morphological and microbiological changes in ileal pouches in different time periods after ileostomy closure and to evaluate the influence of certain bacterial strains on the degree of inflammation. MATERIAL AND METHODS: The study involved 47 patients who had been treated surgically; they were investigated before and at different stages after ileostomy closure. They underwent repeated rectoscopies with biopsies of pouch mucosa and swabs for microbiological examination. In total 89 rectoscopies were performed, which provided 70 histopathological results according to the Heidelberg Pouchitis Activity Score and 87 microbiological test results. RESULTS: The assessment of the morphology of intestinal pouches showed increased signs of chronic inflammation as the length of time after the closure of a protective ileostomy increased. There was no correlation between the signs of acute inflammation and the length of time after surgery; there were more signs of acute inflammation in cases of pouchitis. The composition of the bacterial flora of intestinal pouches changed as the length of time after ileostomy closure increased, with significant increases in the number of enterobacteriaceae species. The presence of Staphylococcus aureus significantly correlates with a higher degree of chronic inflammation; this bacterium may be a potential infectious factor in pouchitis. CONCLUSIONS: Microbiological analysis of intestinal pouch lumen is a useful tool that can be used in routine follow-up assessment of intestinal pouches as well as in diagnosing pouchitis.

[Haemorrhagic shock complicating acute pancreatitis]. / Wstrzas krwotoczny w przebiegu powilanego zapalenia trzustki.

BACKGROUND: Acute pancreatitis may be accompanied by a number of complications. They include diffuse peritonitis, intra-abdominal and retroperitoneal abscesses, and severe haemorrhage. These complications are the cause of approximately 50% of all deaths in acute pancreatitis. CASE REPORT: A 33-year-old man was admitted to ITU with septic shock, due to acute pancreatitis and necrosis after multiple surgeries. On the fifth day after admission, his condition deteriorated due to respiratory distress and massive bleeding from the splenic region requiring surgical packing. On the next day, the bleeding became critical. More than 2000 mL of blood was evacuated from the peritoneal cavity, the bleeding site was re-packed, and the patient was transfused with RBCs, FFP and 0.04 mg kg(-1) of recombinant factor VIIa concentrate. This resulted in haemostasis, however the subsequent clinical course was complicated by septic shock, perforation of the transverse colon and peritonitis. The patient eventually recovered and was discharged home after 105 days in hospital. CONCLUSION: Multifactorial management of acute pancreatitis is essential; in cases of severe haemorrhage, surgical packing and administration of recombinant factor VIIa concentrate are key components of successful treatment.

Retroperitoneal tumours--analysis of own clinical material--a six-year retrospective study.

BACKGROUND/AIMS: Primary retroperitoneal tumours and retroperitoneal organs' tumours represent a variety of lesions that require different treatments and have various prognoses. The aim of this study was to present the author's observations of the histological tumors types occurrence and their surgical treatment. METHODOLOGY: One hundred twenty-three cases of retroperitoneal tumours were studied retrospectively in a 6-year period. All cases were investigated for haematological and biochemical parameters. Abdominal ultrasonography, computed tomography or magnetic resonance imaging of abdominal cavity and pelvis were done in the all cases. All cases were subjected to laparotomy with an aim to resect the tumour completely. RESULTS: In the present study we observed primary retroperitoneal tumours like malignant neuroblastoma, paraganglioma, primitive neuroectodermal tumour, cavernous haemangioma and mucinous cystadenoma. Among retroperitoneal organs' tumours pancreatic lesions present the majority of them. There were 6 cases of neuroendocrine pancreatic tumours. We had two cases of retroperitoneal fibrosis in patients with ulcerative colitis. In adrenal glands we observed benign and malignant lesions like pheochromocytoma and fibrosarcoma. All primary retroperitoneal tumours, except two cases of retroperitoneal fibrosis, were an bloc removed. CONCLUSIONS: Primary retroperitoneal tumours in contrast to retroperitoneal organs' tumours occur very rare. Their anatomical location makes early detection difficult and as a result they are usually quite extensive when first detected. The clinical manifestations of all retroperitoneal tumours are not specific, so it causes a lot of difficulties in early diagnosis. This is the main reason that contributes to treatment failure.

Analysis of results of surgical treatment in Crohn's disease.

BACKGROUND/AIMS: Crohn's disease is a non-specific, chronic inflammatory disorder affecting any part of alimentary tract. Patients receiving proper medication require surgery in 70-90% of cases. Analysis of results of surgical treatment in Crohn's disease in patients treated at the Medical University of Wroclaw and an attempt to elaborate the optimal surgical strategy in Crohn's disease was the aim of the study. METHODOLOGY: The medical documentation of 52 patients with confirmed diagnosis of Crohn's disease was analysed, focusing on the course of the disease before surgery linked with its localization, duration and medical treatment. Then indications for surgery, type of surgical procedure performed and perioperative morbidity and mortality were discussed. RESULTS: Thirteen patients had urgent surgery. Thirty-nine patients had planned surgery. The most common procedure was ileocecal resection or right hemicolectomy. In 36 cases the postoperative course was uncomplicated. The most common surgical complication was wound infection. Pneumonia was the most common general complication. Fatal cases occured in elderly patients with long-term and severely complicated disease. CONCLUSIONS: The optimal timing of surgery is extremely difficult and remains non-standardized. Key decisions are often established intraoperatively and they require considerable surgeon experience, patient's awareness and close cooperation of surgeons and gastroenterologists.

[Preliminary approach towards construction of peptide libraries as potential tools for diagnosis of malignant thyroid tumors]. / Wstepne próby knostrukcji bibliotek peptydowych jako narzedzia w diagnostyce nowotworéw zlosliwych tarczycy.

INTRODUCTION: Cancer of thyroid gland is the most common malignancy of the endocrine system. The treatment improvement could be achieved by early diagnosis. The aim of the study was to identify cancer specific antigenes with use of peptide libraries. MATERIAL AND METHODS: The material from 6 patients with thyroid cancer (4 with papillary cancer, 1 with follicular cancer and 1 with oxyphilic tumor) were analyzed. It was performed with use of lipophylic peptide libraries by direct comparison of staining of specimens prepared from normal and malignant tissue. RESULTS: Preliminary results confirm practical value of peptide libraries in early diagnostics of thyroid cancer. CONCLUSIONS: It is important to optimize construction of peptide libraries by using different staining agents hydrolyzed by proteases.

[Clinical significance of oxidation and acetylation genetic polymorphism in patients with hyperthyreosis]. / Kliniczne znaczenie fenotypu oksydacji i fenotypu acetylacji u chorych na nadczynnosc tarczycy.

INTRODUCTION: The relationship between genetically determined polymorphic oxidation and acetylation and susceptibility to some disease was aroused much interest. The aim of our study was to evaluate whether patients with hyperthyreosis differ from healthy persons in their ability to oxidize sparteine and acetylate sulphadimidine as model drugs. Oxidation and acetylation were estimated in 48 patients with hiperthyreosis. MATERIAL AND METHODS: The control group consisted of 160 healthy volunteers for comparison of oxidation phenotype and 60 healthy volunteers for comparison of acetylation phenotype. The phenotyping of oxidation revealed two distinct populations among 40 patients with hyperthyreosis: 38 persons (95%) were extensive metabolizers (EM) of sparteine and 2 persons (5%) was poor metabolizers (PM). In 160 healthy persons (91.2%) were EM and 14 persons (8.8%) were PM. The difference between frequency distribution of PM and EM in healthy persons and in patients with hyperthyreosis was not statistically significant. RESULTS: The phenotyping of acetylation showed among 48 patients with hyperthyreosis 8 persons (13%) were rapid acetylators (RA) and 40 persons (87%) were slow acetylators (SA). In 60 healthy volunteers the phenotype of rapid acetylation was observed in 31 persons (51%) and slow acetylation in 29 persons (49%). Relative risk (odds ratio) of development of thyroid diseases was 5.34 times higher for SA in comparison to RA. The prevalence of SA among patients with hyperthyreosis in comparison to healthy volunteers was statistically significant (p < 0.0002). CONCLUSIONS: The results of our study may suggest that slow acetylation phenotype is associated with increased risk of the development of hyperthyreosis.

Ileal-pouch-anal anastomosis after restorative proctocolectomy in patients with ulcerative colitis or familial adenomatous polyposis.

BACKGROUND/AIMS: Restorative proctocolectomy is the "golden standard" in surgical treatment of ulcerative colitis and familial adenomatous polyposis. The two alternative techniques of ileal-pouch-anal anastomosis include hand-made suture and double line stapled suture. The aim of the study was the analysis of postoperative complications and functional results of the two types of anastomosis. METHODOLOGY: Analyzed group consisted of 71 patients operated between 1994 and 2003 for ulcerative colitis (n=62) or familial adenomatous polyposis (n=9). Stapled anastomosis was performed in 56 (79%) cases whereas hand-made suture was performed in 15 (21%) cases. RESULTS: No significant differences between the two anastomosis techniques were found in terms of postoperative complications as well as late functional results. CONCLUSIONS: The low rate of complications and well accepted functional outcome prove that restorative proctocolectomy is a safe surgical procedure which may be offered to patients with ulcerative colitis of familial adenomatous polyposis. Double line stapled suture should be the preferred method of ileal-pouch-anal anastomosis, however hand-made suture remains its valuable alternative and may be considered in selected cases.

[Cavernous hemangiomas of the adrenal glands--rare incidentaloma type tumors]. / Naczyniaki jamiste nadnerczy--rzadkie guzy z grupy incidentaloma.

Cavernous hemangiomas of the adrenal glands are extremely rare benign lesions and most are incidental findings. The increasing frequency of the adrenal masses detection is due to the widespread use of the contemporary imaging techniques. We review incidence, pathology, clinical features, diagnostic and therapeutic treatment of the adrenal cavernous hemangiomas.

[Ludwik Rydygier--homo creator. The 150th anniversary of the birth of Ludwik Rydygier]. / Ludwik Rydygier--homo creator. W 150 rocznice urodzin prof. Ludwika Rydygiera.

The authors present biography of Ludwik Rydygier, the great Polish surgeon, with special emphasis on his medical and scientific activity as well as his role in the foundation of Polish surgical school.

The influence of chronic pancreatitis on carcinogenesis: an experimental study in rats.

BACKGROUND: The literature contains many controversial or unclearly defined opinions about the risk of development of carcinoma of the exocrine part of the pancreas in patients with chronic pancreatitis. This and our own clinical observations based on analysis of patients with chronic pancreatitis treated surgically (anastomotic and resectional procedures) formed the background to an experimental study to define the risk of carcinogenesis in the course of chronic pancreatitis in rats. EXPERIMENTAL FINDINGS: In Wistar rats with chronic pancreatitis induced by etionine and then exposed to carcinogenic action of azaserine, proliferation, adenomas and acinic cell carcinomas of the exocrine part of the pancreas were diagnosed; the carcinomas were transplantable. In rats treated with azaserine only, benign proliferative lesions and adenomas were found. The presence of the p53 mutation protein was observed in carcinomatous pancreatic cells in malignant lesions of the pancreas in primary and transplantable cancers, but was not detected in benign proliferative lesions and adenomas. Chronic pancreatitis in Wistar rats predisposes the exocrine part of pancreas to malignant transformation. Growth of cancers of the exocrine part of the pancreas in male rats, but not in female rats, suggests hormonal determination of experimental pancreatic cancer. CONCLUSIONS: Results demonstrate that chronic pancreatitis in rats predisposes to malignant proliferative lesions, including acinic cell carcinoma. Expression of the protein product of p53 gene mutations correlated with neoplastic transformation of pancreas preceded by chronic pancreatitis, and was also detected in transplantable tumours.