Intra-abdominal infections after simultaneous pancreas - kidney transplantation.

BACKGROUND: Intra-abdominal infections (IAI) are among the most common causes of pancreatic graft loss and recipient death in the early period after simultaneous pancreas - kidney transplantation (SPK). The aim of the study was to analyze risk factors and clinical consequences of IAI in SPK patients. MATERIAL/METHODS: Forty-six consecutive SPK performed from 2004 to 2010 were subjected to analysis. RESULTS: IAI developed in 10 recipients (21.7%). The group of recipients with IAI had a higher rate of patients that required transfusion of more than 2 blood units (90% vs. 47%, p=0.028) or relaparotomy (80% vs. 14%, p<0.001), in comparison with patients without IAI. Additionally, in patients with IAI, both delayed kidney graft function or primary kidney graft nonfunction (40% vs. 11%, p=0.001) and recipient death (40% vs. 3%, p=0.006) were more frequently observed. Logistic regression analysis revealed an increased risk of IAI development in patients who required early relaparotomy (OR=24.8, p<0.001), transfusion of more than 2 blood units (OR=12.6, p=0.02), or postoperative dialysis therapy (OR=14.1, p=0.003). CONCLUSIONS: Perioperative blood loss requiring transfusion and necessity of relaparotomy increase the risk of IAI after SPK. Development of IAI after SPK may result in impaired kidney graft function and increases patient mortality in the early postoperative period.

[Analysis of adrenocortical tumors morphology as regards their structure and potential malignancy]. / Analiza morfologii guzów kory nadnerczy pod wzgledem ich struktury i potencjalnej zlosliwosci.

INTRODUCTION: A consequence of diagnosis of adrenocortical carcinoma (ACC) is introduction of pharmacological therapy, precise monitoring of the patients and in some cases re-operation. The aim of the study is to analyse morphology of adrenocortical tumours as regards their malignancy by use of criteria proposed by Weiss. MATERIAL AND METHODS: 110 adrenocortical tumours in 107 patients were analysed (M 27.1%, F 72.9%; age 32 to 77 years, mean 55.2 +/- 9.7). Conn syndrome was diagnosed in 16 patients (14.9%), Cushing syndrome in 12 (11.2%), and virilisation in 3 (2.8%). In 76 patients (71.0%) biochemical tests did not reveal hormonal hyperactivity of the tumour. RESULTS: In routine histopatological examination ACC was diagnosed in 6 tumours (5.4%), adrenocortical adenoma (ACA) in 92 (83.6%) and adrenocortical hyperplasia in 12 (10.9%). Nuclear grade III or IV was observed in 8 tumours (7.3%), mitotic rate > 5/50 high power fields in 6 (5.4%), atypical mitoses in 5 (4.5%), clear cells constituting < 25% of the tumour in 10 (9.1%), diffuse architecture in 8 (7.3%), necrosis in 16 (14.5%), veins infiltration in 4 (3.6%), sinusoids infiltration in 7 (6.3%), and tumour capsule infiltration in 5 (4.5%). Among ACC tumours 4-9 features of malignancy were present, among ACA--0-3 features. Statistical analysis revealed correlation between number of criteria proposed by Weiss and maximal tumour size (p < 0.05). CONCLUSION: The structure and cell arrangement in adrenocortical adenoma are heterogeneous. Application of criteria proposed by Weiss in histopathological examination of adrenocortical tumours can be useful in differentiating adrenocortical adenoma from carcinoma.

[Follicular thyroid tumor as a diagnostic and therapeutic problem]. / Guzek pecherzykowy tarczycy jako problem diagnostyczno-leczniczy.

Although the appearance of follicular thyroid tumors in the population is high, only a small part of them are malignant. Follicular tumors are built of follicular epithelial cells and are encapsulated. Cell atypia differentiates follicular adenoma from cancer. Follicular cancer is characterized by vascular invasion and causes metastases through blood vessels, mainly to lungs and bones. In the diagnosis of follicular thyroid neoplasm, pathological examination of postoperative material plays a leading role. In diagnosis before surgical treatment, physical examination, ultrasound (USG), and fine needle aspiration biopsy (FNAB) are of great importance. The choice of treatment in patients in which follicular neoplasm has been diagnosed by FNAB awakes controversies. In practice it is impossible to determine reliably before surgery whether the lesion is malignant or not. Because of the rare incidence of thyroid cancer in the general population, more and more authors tend to decide on partial resection of the thyroid gland and possible radicalization if cancer is diagnosed on paraffin specimen examination.