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.

[A severe adverse event after vaccine for diphtheria, tetanus, pertussis and poliomyelitis (DTP + polio) in a 4.5 month old infant]. / Powiklanie o ciezkim przebiegu po szczepieniu przeciw Blonicy, Tezcowi, Krztuscowi oraz Poliomyelitis (DTP + Polio) u 4,5 miesiecznego niemowlecia.

Neurological complications of immunisation are rare. We report the case of neuroallergic reaction 5 days after receiving the second course of DTP + Polio vaccine in a 4.5 month old girl. The pathological signs developed 48 hours after the vaccination. On admission the infant demonstrated a persistent fever (39 degrees C), resistant to Paracetamol, unusual crying, irritability, consciousness disorder, and opistotonus. Physical examination showed generalised mild, macular rash and redness and swelling at the injection site. The neurological assessment revealed weakness of upper and lower limbs, meningeal signs such as stiff neck, Kernigs and Brudzinski signs. There were no pathological changes in the CSF. The diagnosis was established as the neuro-allergic Adverse Event Following DPT + Polio Immunisation. After 10 day treatment with Dexamethasone and Phenobarbital the infant was discharged with no neurological changes. A psychomotorical development is good.

[Recanalization of the ductus arteriosus in a child with non-Hodgkin's lymphoma]. / Rekanalizacja przewodu tetniczego u dziecka z non-Hodgkin lymphoma.

Dissertation describes the case of 7.5-year-old boy with recanalization of the ductus arteriosus. In this patient treated because of the non-Hodgkin lymphoma during the chemotherapy the respiratory failure occurred and mechanical ventilation was required. After the respiratorotherapy in the controlled echocardiography examination the patency of previously closed ductus arteriosus, was described. There was no description of the similar case in available references.

[Acute renal insufficiency during Candida albicans candidiasis in a 2-month old infant]. / Ostra niedomoga nerek w przebiegu zakazenia grzybiczego Candida albicans u dwumiesiecznego niemowlecia.

In this paper has been described the case of 2-month old infant with acute renal insufficiency caused by mechanical obstacle of fungal bezoars. Bilateral pyelostomy has been performed and fungal masses have been washed out from kidney pelvis. The applied treatment including administration of Fluconazole intravenously caused disappearance of acute renal insufficiency. In this paper authors described pathogenesis, clinical symptoms, and treatment of urinary tract fungal infection.

[Thrombus in the right ventricle in an infant--a good result of thrombolytic therapy with recombinant tissue plasminogen activator]. / Skrzeplina w prawej komorze u niemowlecia-dobry wynik leczenia tkankowym aktywatorem plazminogenu.

In a 2 month-old infant presenting with the symptoms of cardio-respiratory failure in the course of staphylococcal septicaemia a thrombus in the right ventricle was detected in an echocardiographic examination. Scintigraphy of the lungs revealed of microthrombosis. Thrombolytic therapy with recombinant tissue plasminogen activator (Actylise) was started on the dose of 0.5 mg/kg/hour in 7-hour constant infusion. After 5 days of treatment the thrombus was completely dissolved. No complication were observed. Indicators of serum clothing remained normal during the treatment.

[The clinical course of fungal urinary tract infection in neonates]. / Grzybica ukladu moczowego noworodków--obserwacje wlasne.

The authors present the clinical course of 8 cases of fungal infection of the urinary tract in newborns. Three of the investigated children were premature or with intrauterine hypotrophy, a congenital defect of the urinary tract was detected in one child. In 5 cases the fungal infection followed bacterial septicaemia. Two of the 8 children required peritoneal dialysis, another two required insertion of intravenous catheters for parenteral feeding, and four required bladder catheterisation. The diagnosis of fungal urinary tract infection was established on the basis of urine culture, the presence of specific serum anti-candida antibodies and results of ultrasonographic examination (vs). In 7 of 8 cases the possibility of fungal infection was suggested by US examination. Seven children were treated with fluconazole combined with 5-fluorocytosine, one was treated with fluconazole. Pyelostomy was performed, in two of the patients all of them received supportive treatment. Our clinical observations point to the necessity of prophylaxis in case of predisposing factors to fungal infection and the use of abdominal ultrasonography for detection of early stages of fungal urinary tract infection.