[Morgagni's hernia--still a difficult diagnostic problem]. / Przepuklina przeponowa morgagniego--trudny problem diagnostyczny.

Morgagni's hernia due to its non-specific symptoms and signs along with difficulties to detect it by x-ray imaging is still a disease difficult to diagnose. Patients suffering from this hernia are often treated unsuccessfully because of false diagnosis of other illnesses of the abdomen or thorax. It is only detailed diagnostics that can lead to a proper diagnosis. The authors present the current status of knowledge of Morgagni's hernia, its most common signs and symptoms and available diagnostic and therapeutic methods.

[Bone marrow isolated micrometastases of non-small cell lung cancer]. / Mikroprzerzuty niedrobnokomórkowego raka pluca do szpiku.

UNLABELLED: The ability to detect occult systemic metastases in patients with operable NSCLC could have a significant impact on the management of the disease. The aim of the study was to detect occult micrometastatic tumor cells in bone marrow in patients with resectable NSCLC. MATERIAL AND METHODS: A total of 35 patients (29 men, 6 women), age between 47 and 78 (mean 61.6) were included in the study. In each of the patients bone marrow aspirates from the ribs were sampled during surgery. Both the tumor and the bone marrow aspirate were examined histologically and immunocytochemically with the cytokeratin: AE1/AE3, CAM 5,2, CK-7, CK-18. The presence of grow factors CD 31 and CD 34 were examined as well. RESULTS: No evidence of micrometastases or tumor cells in bone marrow was found in histological examination. Cytokeratin positive (CAM 5,2 +) cells were detected in 33 cases (94.23%) of the tumors and in 21 cases (60.00%) of bone marrow samples. The statistically significant correlation between the presence of CAM 5,2 in tumors and bone marrow was found (p = 0.049). Cytokeratin positive cells were detected in all the 35 tumors (AE1/AE3), in 20 tumors--57.14% (CK-7) and in 23 tumors--65.71% (CK-18). Cytokeratin positive cells (CK-7) were detected in bone marrow sample in one patient only. CONCLUSIONS: Immunocytochemical examination with the use of cytokeratin CAM 5,2 is of use to detect occult micrometastatic tumor cells in bone marrow in NSCLC patients. However, no correlations were found between the presence of cytokeratin CAM 5,2 in bone marrow or tumor and patients' age, sex and the histological type of NSCLC its degree of malignancy and stage.

Factors associated with perioperative complications after pneumonectomy for primary carcinoma of the lung.

According to the literature patient's age, nutrition and smoking status, cardiopulmonary comorbidity and surgeon's experience are the main factors associated with perioperative complications after pulmonary resection. The purpose of the study was to identify the correlation between pre- and intraoperative risk factors and complications after pneumonectomy for primary carcinoma of the lung. Between Sept. 11th 1999 and Dec. 20th 2003 121 standard pneumonectomies were performed in patients with non small-cell lung cancer. Sixteen risk factors noted in the patients before surgery were correlated with complications occurred after pneumonectomy. Overall mortality and morbidity rates were 3.3% and 30.6%, respectively. Twenty patients (16.5%) experienced cardiac rhythm disturbances, six (4.9%)--pleural haematomas, five (4.1%)--main bronchus stump fistulas, four (3.3%)--acute respiratory failure. Chronic obstructive pulmonary disease was correlated with broncho-pleural fistulas and acute respiratory failure after surgery. Chronic coronary disease was associated with postoperative cardiac arrhythmias, whereas postoperative bleeding was correlated with the overweight of the patients. Chronic obstructive pulmonary disease, chronic coronary disease and overweight are the risk factors associated with complications after pneumonectomy.

[Magnetic resonance imaging in the diagnosis of retrosternal anterior diaphragmatic hernia in an adult man]. / Zastosowanie techniki rezonansu magnetycznego do diagnostyki wrodzonej przepukliny przeponowej u doroslego mezczyzny.

The study presents a case report of a retrosternal anterior diaphragmatic hernia in a 46-year-old man presented with abdominal pain, nausea, dyspnoea and treated previously as for chronic pancreatitis. A strong suspicion of the diaphragmatic hernia was generated after chest radiograph. However, the exact diagnosis of the Morgagni hernia was established by magnetic resonance imaging. The hernia was repaired through thoracic incision. The postoperative course proved uneventful: the patient was discharged from the hospital 10 days after surgical intervention.

[Long-term results after resection of IIIA-N2 non-small cell lung cancer and complementary mediastinal irradiation]. / Odlegle wyniki leczenia operacyjnego chorych na niedrobnokomórkowego raka pluca w stadium IIIA-N2 poddanych uzupelniajacej radioterapii sródpiersia.

The authors present a retrospective evaluation of long-term results of treatment of patients with IIIA-N2 non-small cell lung cancer (NSCLC), operated and subjected to complementary irradiation of mediastinum in the years 1987-1990. 60 patients were observed: 10 women and 50 men, aged 37-74 years (mean age 56). In all patients a radical resection of lung parenchyma with the primary tumour and mediastinal lymphadenectomy were performed. The one-year survival was 63% (38 patients), three-year survival--15% (9 patients) and five-year survival 13% (8 patients). It was found that the five year-survival in patients with IIIA-N2 NSCLC, in whom a combined therapy was applied (surgery and irradiation), was low, and the most common cause of death in the first three years of follow-up were distant metastases. Moreover it was observed that the number of mediastinal lymph node groups had a great influence on the time of survival.

[Unsuccessful treatment of pneumothorax which was associated with hilar tumor]. / Nieskutecznosc leczenia odmy jamy oplucnej przy wspólistniejacym guzie wneki pluca.

The authors present a case of unsuccessful treatment of pneumothorax which was associated with hilar tumor. A typical underwater-seal system was installed in a 79-year-old patient, but the lung was still collapsed. Because of prolonged air leak, the patient was operated on. During the surgical procedure several bullae in the lung and the inoperable hilar carcinoma were diagnosed. Despite the absence of air leak, the failure of the lung to re-expand was noted postoperatively. However, recurrent air leak, subcutaneous emphysema and respiratory failure caused the patient's death.

[Fine-needle aspiration biopsy under CT-guidance--usefulness in diagnosis of malignant lung tumors]. / Znaczenie biopsji aspiracyjnej cienkoiglowej wykonywanej pod kontrola tomografii komputerowej w diagnostyce zlosliwych nowotworów pluca.

UNLABELLED: Aim of the study was to evaluate the usefulness of fine-needle aspiration biopsy (FNAB) in diagnosis of malignant lung tumors. MATERIAL AND METHODS: The results of 438 CT guided FNAB of lung lesions performed between Sep. 1st 1999 and Feb. 20th 2004 were evaluated. RESULTS: In 295 cases (67.35%) the cytological diagnosis of lung tumours were established by FNAB. The most common type of the tumours were: non-small cell lung cancer: 222 (50.69%) and small cell lung cancer: 49 (11.19%). 104 of these results were histologically verified and two false positive results were detected. In 143 cases (32.65%) however, the results established by FNAB were non-diagnostic. 63 of the lesions were verified and in 36 cases (57.1%) the malignant tumours were proved. The specificity of the method regarding malignant lesions reached 93.10%, and its sensitivity for patients with malignancy was 73.91%. The average diameter of the malignant tumour was 5.4+/-1.3 cm whereas in case of non-diagnostic results the diameter of the tumour was 4.1+/-1.6 cm. However, there was no significant difference between the two groups. The most common complication of FNAB was pneumothorax, which occurred in 22 patients (5.02%) and in 13 cases (2.97%) required drainage of the chest cavity. CONCLUSION: FNAB is a safe diagnostic method with high specificity and moderate sensitivity in detecting of malignant lung lesions.

[Coin lesion in the lung of patients with known malignancy]. / Cien okragly w polu plucnym u chorych na nowotwór zlosliwy.

Histological examination was performed on 93 pulmonary nodules resected in 90 patients with known malignancy. The diameters of the coin lesions on CT scan were 3-10 mm in 42 cases and 11-30 mm in 51 cases. The most common sources of the previous malignancy were: large bowel (20), breast (14), uterus (12), kidney (11) and larynx (7). In 84 cases the nodules were radically resected through "wedge" resection and in 9 cases lobectomy was performed. Most frequently, coin lesion was caused by metastases of known malignancy (in 69.9%), pulmonary fibrosis (in 11.8%) and by primary lung cancer (in 7.5%). In general, pulmonary nodules were found malignant in 78.5% and benign in 21.5% of the cases. In the subgroup of coin lesions of diameter between 11 and 30 mm malignancy was noted in 94.1%--significantly more frequently than in subgroup of diameter between 3 and 10 mm (59.5%). No significant correlation was found between histological type of pulmonary nodules (malignant or benign) and the type of primary malignancy as well as the time from the treatment of primary malignancy to the detection of the coin lesion.