[The case of concurrent transverse and longitudinal fracture of temporal bones]. / Przypadek jednoczasowego zlamania podluznego i poprzecznego kosci skroniowych.

The authors present a very rare case of concurrent longitudinal and transverse fracture of temporal bones. In this case, both the manifestations as well as the clinical image are quite typical of longitudinal and transverse fractures, the only difference being the lack of posttraumatic paralysis of the facial nerve, which is frequent in the case of transverse fractures. It must be noted that fractures of temporal bones generally occur as the result of road accidents or gunshots, since only a very substantial force may cause the fraction of the cranial basis. Nevertheless, in this case the fracture occurred as the result of an unfortunate fall in the street. The authors did not find any description of a similar case in the available Polish publications.

[The case of a great pharyngeal tonsil hypertrophy in a twenty-one-year-old patient infected with HIV virus]. / Przypadek olbrzymiego przerostu migdalka gardlowego u 21-letniej pacjentki zakazonej wirusem HIV.

Seropositive patients quite often demonstrate symptoms in the area of the head and neck, among which should be mentioned opportunistic infections, neoplasms--Kaposi's sarcoma, as well as progressive generalized lymphadenopathy. These patients quite often complain about difficulties in breathing through the nose as well as of recrudescent auricular inflammation. The authors present descriptions of a great pharyngeal and palatal tonsillar hypertrophy in a twenty-one-year-old patient infected with HIV virus.

[Angiosarcoma (hemangiosarcoma) cordis]. / Naczyniakomiesak krwionosny serca.

The case of a young 32 year old male with a primary cardiac angiosarcoma is reported. The neoplasm manifested itself by a quickly increasing cardiac tamponade but without metastases. The nonradical resection of the tumor was made because of local invasion with tumor tissue. The patient was followed-up for 3 years after the surgery and no recurrence of the malignant process was observed. Cardiac angiosarcoma is a very rare malignant tumor of soft tissues. In spite of significant progress in clinical treatment, for a patient diagnosed antemortem with cardiac angiosarcoma, the long-term expectations are usually very poor. Commonly known risk factors for this group of neoplasms (haemangioma of skin, chroniclymphedema, chronic post-tuberculosis pleurisy, X-ray, thorium dioxide) cannot be easily associated with the primary cardiac angiosarcoma cases. The search for chromosomal anomalies and gene mutations leading to cardiac angiosarcoma is ongoing. There is hope that recently obtained evidence for mutation of the p53gen, will provide a better understanding of this heart neoplasia.

[Epidemiological analysis of leukemia survival in Cracow for cases registered in 1980-1990]. / Ewolucja przezycia chorych na bialaczki w Krakowie--przypadków zarejestrowanych w latach 1980-1990.

The aim of the study was epidemiological analysis of survival from all types of leukemia occurring in Cracow in the years 1980-1990. The study was focused on survival times in patients according to a) cytologico-clinical type of leukemia, b) timeframe in which treatment was initiated (between 1980-1985 and 1986-1090). All patients diagnosed of leukemia between the years 1980-1990, living in Cracow and whose cytologico-clinical picture was determined had their survival times and censored survival times established. Survival until 1997 was taken into account. For each cytologico-clinical type of leukemia survival function according to Kaplan-Meier was calculated. The Cox model was implemented to analyze the risk of death depending on the period in which the disease appeared--two time frames were established 1980-1985 and 1986-1990. Other parameters considered were; age, sex and area in which the patient lived (suburb). Practically in all types of leukemia a higher probability of survival was found in patients in whom leukemia was diagnosed (and consequently treated) in the second period i.e., 1986-1990. The highest achievement was observed in acute lymphoblastic leukemia in children, in which the relative 5-year survival probability rose from 35% in the years 1980-1985 to 78% in the years 1986-1990, thus achieving the level of well developed countries. A similar picture was seen in chronic lymphocytic leukemia where the relative 5 year survival probability rose from 57% to 77%, and in chronic granulocytic leukemia where the 5 year survival probabilities were accordingly 23% and 39%. All cited values for the second period of analysis are at the levels noted in the United States and in Europe. The positive changes in the survival times observed in patients with leukemia seen in the second half of the 80-ies (in comparison to the period 1980-1985) has been interpreted as the result of advancements in therapy of the disease in Cracow.

[Diagnostic difficulties in scanty symptomatic pituitary tumor]. / Trudnosci diagnostyczne w skapoobjawowym guzie przysadki.

Adenomas are the most frequent pituitary tumours and constitute up to 8% of intracranial tumors. They are divided according to size into microadenomas and macroadenomas, the latter are expanding suprasellary, and also infiltrate the base of the skull. Depending on histological staining, they are divided into neutrophilic, acidophilic and basophilic adenomas. Hormonally active adenomas are responsible for Cushing, Forbes and Albright diseases and acromegaly. Macroadenomas are responsible for chronic hypothalamo-pituitary axis insufficiency. Clinically, pituitary tumours produce local (headaches and vision deficiency) and general signs like hormonal disturbances. Diagnosis, localisation and size of pituitary tumours is made using radiological techniques. Treatment may consist of surgical (removing of the tumour and chiasma opticum decompression), pharmaco and radiotherapy. The case described illustrates the diagnosis of an oligosymptomatic pituitary tumour.

[A case of actinomycosis of the palatine tonsils--diagnostic difficulties]. / Przypadek promienicy migdalka podniebiennego--trudnosci diagnostyczne.

Here authors present a rare case of actinomycosis of the pallatinal tonsilla, which had a form of tumor. Bacteriological tests revealed only some saprophytical bacteria in pharynx. After surgical treatment of disease was done, patient got back to health quickly, and histopathological exam showed that this was actinomycosis.

[A case of giant pleomorphic adenoma of the cheek with two malignant centers]. / Przypadek olbrzymiego gruczolaka wielopostaciowego policzka z dwoma ogniskami zezlosliwienia.

The authors present the case pleomorphic adenoma of a patient aged 77 of atypical location with two malignancy center. After performed diagnostic for an operation the tumor resected. The histopathologic examination proved in the pleomorphic adenoma the cylindromatosum and cancer solid vertens.

[A case of Kartagener's syndrome]. / Przypadek zespolu Kartagenera.

The authors present a case of a soldier with Kartagener syndrome and bilateral purulent maxillary sinusitis with nasal polyps and pneumonia. Kartagener syndrome is originally described as the combination of situs inversus, bronchiectasis and sinusitis. Kartagener syndrome is a part of immotile cilia syndrome. Mild before the age of 18 recurrent pneumonia, chronic sinusitis, chronic rhinitis and nasal polyps occurred. Typical therapeutic management is discussed but infections prophylaxis, general treatment and physiotherapy are the base of good general condition and significantly improve prognosis.

[Exogenous nitric oxide and gallbladder contractility in humans]. / Kurczliwosc pecherzyka zólciowego a egzogenny tlenek azotu.

The physiological function of the gallbladder (GB) is to deliver concentrated bile to the duodenum after a meal. This requires a complex coordination of the motor, secretory, and absorptive functions of the gallbladder. Control of GB motor functions involves a constant interplay between a large number of stimulatory and inhibitory hormones and neurotransmitters. With regard to intrinsic neurotransmitters, nitric oxide (NO) acts as a neurotransmitter in nonadrenergic, noncholinergic (NANC) pathways of the gallbladder. This compound has been found to inhibit GB tone and contraction in both animal and human studies. The Purpose of the present study was to examine the effects of exogenous NO donors such as glyceryl trinitrate (GTN), molsidomine (MO) and L-arginine (L-Arg) on fasting GB volume and on meal-stimulated gallbladder contraction expressed as ejection fraction (EF). The healthy subjects (13 men and 17 women), age range 19-41 years participated in this study. GB volume was examined by means of an ultrasonographic method. Volumes of GB were calculated using the sum of cylinders method as described by Dodds. EF was measured every 15 min up to a total observation period of 2 h. After recording of control values, 0.5 mg GTN was administered sub-lingually, or 4 mg MO orally or L-Arg (12.63 g of L-Arg in 300 ml of 0.9% NaCl) was infused i.v. over 120 min. It was found that the fasted GB volume was increased after GTN by 22 +/- 10% and after MO by 28 +/- 4% (p < 0.05). Post-prandial EF was reduced maximally by 22 +/- 9% (p < 0.05) after pretreatment with GTN and by 32 +/- 8% (p < 0.01) after MO. Whereas L-Arg was without any effect on resting GB, however it reduced significantly stimulated EF. These findings support the earlier knowledge that NO, released from its exogenous donors has the potent inhibitory effect on human gallbladder motor activity.