Rare oesophageal tumours: experience of one centre.

AIM OF STUDY: The aim of this study is to compare demographic and clinical data as well as applied treatment methods in patients with rare benign and malignant tumours of the oesophagus. METHODS: Eight hundred and thirty patients with oesophageal cancer were treated in the Department of Surgical Oncology in 1960-2005. In 15 cases (1.8 %), rare benign (n = 11) or malignant (n = 4) types of tumours were diagnosed. Patients with rare oesophageal tumours were included in the study, excluding those with squamous cell carcinoma or adenocarcinoma of the oesophagus. Demographic and clinical data were analysed from each patient qualified for the study. Oesophageal X-rays with contrast medium, gastroscopies and, as of 1991, computed tomographies (CTs) were performed as preoperative diagnostic procedures. RESULTS: In the postoperative histopathological examinations, all benign tumours proved to be oesophageal leiomyomas. Four different malignant tumours-a sarcoma, a neuroendocrine carcinoma, a lymphoma, and a squamous cell carcinoma in a patient with Crohn's disease, were diagnosed in the other four patients. In a group of 15 patients with rare oesophageal tumours there were ten (66.7 %) males and five (33.3 %) females. In patients with benign and malignant tumours, the mean age for the benign group reached 44 years (range: 26-75 years old) and 54.7 years (range: 47-59 years old) for the malignant group. In the preoperative period, symptoms such as swallowing disturbances, retrosternal pains, and epigastric pains were observed. Dysphagia was the leading symptom in patients with benign and malignant oesophageal tumours. Out of 15 patients, surgical procedure was carried out in 13 cases with rare oesophageal tumours. In the group of 11 patients, with benign tumours, ten (90.2 %) warranted surgical treatment. Three patients (75 %) with malignant oesophageal tumours underwent an extensive Akiyama procedure of oesophageal resection. Chemo- and radiotherapy alone were performed on one (25 %) patient with oesophageal lymphoma. Postoperative complications were observed in only four (26.6 %) patients; pneumonia in the postoperative period was diagnosed in two patients who underwent surgery; infections of the postoperative wounds were diagnosed in the other two patients. CONCLUSIONS: Benign oesophageal tumours are characterised by similar clinical symptoms to malignant tumours of this organ. It is more complicated to obtain biopsy specimens for a histopathological examination in cases of benign tumours in comparison to malignant tumours. Treatment methods should be adjusted individually for each patient with a rare oesophageal tumour. For rare benign oesophageal tumours, the results of treatment are very good; however, for malignant tumours the prognosis depends on their histopathological type.

Heart retrieval for cardiac homograft.

BACKGROUND: The use of homograft tissue instead of various artificial materials in contemporary cardiovascular surgery, although limited by the constant shortage of donor organs, has become the clinically preferable procedure. The proper technique of heart retrieval, with strict donor qualification criteria and sterility procedures, is one of the key points in the successful preparation of allografts to be used later in a selected group of patients undergoing cardiac surgery, especially in the repair of pediatric congenital heart defects. MATERIAL AND METHODS: The article presents the most popular surgical technique to use for retrieving a heart for cardiac homograft in multiorgan procurement and routine autopsy, including the immediate preliminary preparation and transport, as recommended by the majority of tissue bank institutions. The qualification criteria for tissue donation, delicate preparation techniques, and sterility protocols are also important issues for successful cardiac homograft retrieval. Recently a tendency towards a growing number of pediatric donors can be observed. The techniques presented in this article should also be applied in cases of homograft retrieval from pediatric donors. RESULTS: This article analyzes our seven-year-long experience, involving a total number of 608 hearts retrieved for cardiac homografts, with special attention to the main reasons for disqualification of the organs delivered to the tissue bank. CONCLUSIONS: 1. The procedures for the sterility of tissue retrieval, especially in autopsies with heart retrieval, although they may sometimes be difficult for the surgeon or pathologist, are necessary to provide maximum benefit from harvested tissues. 2. The proper technique for pediatric homograft retrieval is twice as important in tissue delivery protocols.

[The first Polish report on congenital diaphragmatic hernia and visceral malrotations]. / Pierwszy polski opis przepukliny przeponowej oraz wad ulozenia narzadów.

The forgotten throughout the years the doctor dissertation from 1837 of the Polish physician Ludwik Przybylko entitled De pravo organorum situ ("About malposition of the human organs") was presented. This paper, excessively modern in its epoch, contains the compendium of the contemporary medical science of the organs' dislocation and malrotation (including heart malposition and coexisting defects). First of all, however, it is the well-scientifically documented case report on the diaphragmatic hernia in the newborn. The summarized historical review of scientific report on diaphragmatic hernia places a special emphasis on the reports that had been published before the dissertation of Przybylko and before the Bochdalek's historical report in 1848, since then the posterolateral defects of the diaphragm have been defined with that name. The extensive fragments of the dissertation translated from Latin into Polish have been cited. Ludwik Przybylko presented not only the clinical report and details of precise anatomopathological description of the newborn with diaphragmatic hernia, but he also cited the relevant literature and discussed the issue with thorough knowledge. Numerous clinical and anatomopathological remarks of the author, based on his own experience and accordingly applied literature, have been current until today. The case report is completed with four engraved illustrations (woodcut) that document the autopsy examination. The work contains extremely interesting and revolutionary for that time considerations on the evolution (22 years prior to the famous work of Darwin) with an attempt to locate the etiology of congenital diaphragmatic hernia in the evolution. The authors of this paper suggest that the dissertation of Ludwik Przybylko should be interesting for paediatric surgeons and, especially because of its unusual and original contents, ought to take constant place in the history of Polish and world's medicine.

[Transcatheter closure of atrial septal defects in adults with the Amplatzer atrial septal occluder]. / Przezcewnikowe zamykanie ubytku miedzyprzedsionkowego u doroslych za pomoca korka Amplatzer.

UNLABELLED: In many centres the Amplatzer Septal Occluder (ASO) (AGA Med. Corp. Minnesota, USA) has become the device of choice for secundum atrial septal defect (ASD) closure in children. Current trend towards transcatheter closure of ASD in children could be translated to adults and many patients (pts) may avoid the need of open heart surgery. Assessment the efficacy and complication of device occlusion of ASD in adults, using ASO. Between October 1997 and April 2001 transcatheter closure of ASD was attempted in 51 pts who fulfilled the inclusion criteria--significant shunt with sufficient rims of interatrial septum. Mean age of pts was 29 (16-63) y, mean ASD diameter assessed by transesophageal echocardiography (TEE) was 14.7 (7-24) mm, assessed during catheterization by balloon sizing (stretched diameter) was 20.2 (8-36) mm. There were 9 pts with multiple ASDs, 2 pts with aneurysm of interatrial septum and 2--after previous surgery (recanalization of ASD). The ASO devices were successfully implanted in all, but one pt. In one patient because of unstable position of ASO (floppy rims), device was removed and bigger one was applied during next session. In one case early embolization to abdominal aorta occurred, ASO was translocated to aortic arch with Dotter basket and removed from aorta during simultaneous surgical closure of ASD. Mean fluoroscopy time was 15 (4-50) min. The occlusion rate after 24 h was 90%, after 1 month (m) 92%, after 3 m 93.5%, after 1 year (y) 93.3% and after 2 y 93.3%. All residual shunts were trivial. There were no late complication. CONCLUSIONS: The excellent results of ASD closure with ASO in adults indicate this treatment as a method of choice in selected patients, but long term follow-up is necessary to state final judgement.

A congenital defect of the pericardium.

Ten patients with congenital defects of the pericardium were treated in Departments of Cardiac Surgery, Silesian School of Medicine in Zabrze and Katowice between 1989 and 1998. There were eight children and two adults, eight males and two females. In each case the pericardial defect was discovered intraoperatively during surgery for congenital heart defect. There were no cases with clinical symptoms that could be clearly related to the defect of the pericardial sac. In the case of a child with a complete absence of the left pericardial wall the heart was significantly rotated contrary to the defect. The final outcome of the congenital heart defect surgery was satisfactory in each case. An abbreviated historical review of the diagnosis and treatment of the pericardial defects is presented with special attention placed on therapeutic management. Surgical correction of pericardial defects is concluded to be justified in patients with clinical symptoms. In most cases pericardial defects are discovered intraoperatively, but when they are large the said defects do not require any treatment.