[Acute mesenteric ischemia--current diagnostic and therapeutic problems]. / Ostre niedokrwienie jelit--wspólczesne problemy diagnostyczne i lecznicze.

The paper presents current views of the acute mesenteric ischemia pathophysiology. The etiology and pathogenesis with all clinical symptoms were discussed. There were presented up to date methods of diagnosis and treatment. Special attention was paid to the nonocclusive mesenteric ischemia and its prophylaxis. The diagnostic algorithm applied to all acute mesenteric ischemia was presented.

[Treatment approach for substernal and intrathoracic goiter. Personal experience]. / Taktyka postepowania w wolu zamostkowym i sródpiersiowym. Doswiadczenia wlasne.

The retrospective analysis of 489 cases of substernal and intrathoracic goiters among 4122 patients undergoing surgical treatment between 1984 and 1996 due to various thyroid gland diseases including clinical data, surgical technics and early postoperative complications was performed. The surgical procedures of substernal and intrathoracic goiter amounted to 11.9% of all thyroid gland surgery. In 468 (95.5%) patients goiter was situated substernally, in 22 (4.5%) intrathoracicaly. The mean age and time of goiter growth in that location exceeded over 10 years the location of goiter within the neck. In preoperative examination the X-ray of chest and trachea were essential. Routine ultrasonography and thyroid gland scyntigraphy were scarcely helpful as the retrosternal and mediastinal region were often omitted. The jugular access was dominant (98.6%), sternotomy was performed in 1.4% of cases due to big disproportion between size of the goiter and size of the upper inlet into the chest. The surgical complications, similarly as in goiter within the neck (no cases of pneumothorax were observed), included the single-side paresis of recurrent laryngeal nerve in 3.7% of patients, in 0.2% hypoparathyroidism, in 1% bleeding requiring reoperation and in 0.2% esophageal fistula (self-healed). The surgical treatment of retrosternal and intramediastineal goiter was safe and a total number of complications was comparable to that one in a group of patients under-going surgery due to goiter within the neck. Most of surgical procedures was possible to perform using the jugular access. In a small number of cases because of difficulties related to the anatomical conditions the access was reached through the oblong sternotomy.

[Chromosome aberrations in patients with papillary thyroid cancer and other neoplasms]. / Aberracje chromosomalne u chorych z rakiem brodawkowatym tarczycy i innymi nowotworami.

Cancer is essentially a genetic disease resulting from congenital or acquired alterations in some cells of the patient. Such changes may occur in particular oncogens and are responsible for the tumour phenotype of the affected population of cells. In contrast, unaltered tumour-suppressor genes are responsible for suppressing the neoplastic phenotype, and their inactivation by deletion or mutation permits cancerous development in the affected cells. The genetic model of carcinogenesis is based on the idea mutations at the DNA level, what creates a functional imbalance between the oncogenes and the tumour-suppressor genes, resulting in uncontrolled clonal proliferation. The ret/PTC oncogene is unique to papillary thyroid cancer. The paper presents a correlation analysis between chromosomal changes in papillary thyroid cancer and abnormalities of chromosomes in patients with breast cancer and chronic lymphocytic leukemia.

[Acute intestinal ischemia in material of the III Clinic of General Surgery, Collegium Medicum at the Jagellonian University]. / Ostre niedokrwienie jelita cienkiego w materiale III Kliniki Chirurgii Ogólnej CM UJ.

The research work below focuses on a retrospective analysis of a group of 28 patients who suffered from acute intestinal ischaemia caused by upper mesenteric artery embolism of thrombus. The analysis is based on Clinic's own data in the years 1991-1995. The above mentioned patients constituted 3.4% of the 828 patients suffering from acute diseases of the abdominal cavity, accepted and treated in our Clinic. Their age ranged from 38 to 89 and average age was 72.4 y. There were 18 women (64.3%). Mesenteric embolism was the cause of intestinal ischaemia with 21 patients, whereas mesenteric thrombus with 7. Twenty four patients were operated on, the remaining 4 patients were disqualified from the operative procedure, 27 patients died. A considerable progression of the necrotic lesions of the intestines was found in all the patients operated on.