[Polymorphism of gene p53 and apoptosis in patients with malignant lung disease--our observation]. / Polymorfizmus génu p 53 a apoptóza u pacientov s nádormi pl'úc--nase sledovanie.

BACKGROUND: Many proved alterations in genoms of cells are said to be related to tumorigenesis. Apoptosis--a "programmed" death of cell, which has different morphology from necrosis, is one of the control mechanisms of cell division and participates in tumorigenesis. METHODS AND MATERIAL: The authors present their results of analysis of the relation between genetic polymorphism of the p53 gene and the level of apopotosis in patients with confirmed malignant lung disease. Comparison of genetic polymorphism of the p53 gene in patients with the healthy group showed that allocation of BstUI A2 and MspI A1 alleles was significantly related to lung cancer. The apoptosis of peripheral lymphocytes was significantly increased in lung cancer patients. The highest increase of apoptosis in non-small cell lung cancer (NSCLC) group was found in adenocarcinomas. The level of apoptosis was also studied in correlation to polymorphism of the p53 gen. Substantially higher percentage of apoptotic cells was detected in BstUI 2/2 and MspI 2/2 homozygotes. In response to operation a distinctive increase of apoptosis in the first and second postoperative day was recorded. Therefore a lymphocyte count in peripheral blood was also monitored. The lymphocyte count in patients that underwent the operation proved a decrease in absolute and relative values. CONCLUSION: Observation of known genetic polymorphisms indicates the risk of malignant disease. Together with the analysis of level of apoptosis it may add to complexity of the nature of malignant disease or serve as determinants of its prognosis.

[Autofluorescence videothoracoscopy--our initial experience]. / Autofluorescencná videotorakoskopia--prvé vlastné skúsenosti.

The authors present their initial clinical experience with the use of autofluorescence videothoracoscopy in diagnostics of pleural disorders. The study used Richard Wolf DAFE fluorescence endoscopy system. Preliminary results show that autofluoresence imaging is more precise in locating the pathology, which improved the diagnostic yield of videothoracoscopy in pleural disorders. The resulting indirect autofluorescence image depicts healthy tissues in a white-green colour, while tissues with a roughened surface, resulting from hyperplastic inflammatory processes (pachypleura, adhesions) and tumorous or dysplastic processes, are depicted as vivid blue high-density foci.

[Actinomycosis of the lungs mimicking a Pancoast tumor]. / Aktinomykóza pl'úc predstierajúca pancoastoidný rakovinný nádor.

The authors present a case-review of a patient with a thoracic form of actinomycosis, simulating a "pancoastoid" lung tumor clinical picture- furthermore, confirmed by a false-positive cytological examination. The disorder was managed by enlarged lobectomy from the right lung, followed by postoperative antibiotic therapy, lege artis. The long-term outcome is very good.

[Postintubation stenosis of the trachea--case reviews]. / Postintubacná stenóza trachey--nase skúsenosti.

Stenoses of the respiratory tract are life threatening conditions of various origins. The authors give referrence on 21 patients operated for postintubation stenoses of their trachea at the IInd Surgical Clinic of the UPJS Medical Faculty, the Faculty Hospital of L. Pasteur in Kosice, from 01. 01. 1999 to 30. 06. 2005. All patients had a tracheobronchoscopic examination and a CT examination completed prior to the procedure. Within 24 hours of their admission, 9 patients were operated, 7 underwent resection procedures and 2 patients had Montgomery's T-cannula introduced. 12 patients had their procedures planned, and were operated later than 24 hours after their admission. 10 patients underwent resections of the trachea, 2 had Montgomery's T-cannula implanted. The postoperative course following the resection of the trachea was without complications in 14 patients, 1 patient experienced transitional oedema in the anastomosis and 2 patients suffered restenoses. In this patient group, no fatal case was recorded. The authors stress up multidisciplinary approach in the diagnostics and treatment of the postintubation stenoses of trachea. In cases of postintubation stenoses of trachea, resection of the trachea with primary anastomosis represents the most advantageous treatment approach for the patient.

[Surgical treatment of paraesophageal hernia]. / Chirurgická liecba paraezofageálnej hernie.

Four types of hernia may occur in the area of esophageal hiatus. Type I is represented by hiatus slipping hernia. Type II is represented by hernia, which is generally known as paraesophageal hernia. In this type of hernia, cardia and distal stomach remain under diaphragm. The weakened tissue in phreno-esophageal membrane is the place, where stomach fundus penetrates into thorax above the diaphragm. The authors present 10 patients with paraesophageal hernia, who were operated on at the 2nd Surgery Clinic of Medical Faculty, UPJS, Faculty Hospital L. Pasteur in Kosice. These were adult patients, five man and five women. In four patients, so called "upside-down stomach" was the case. Hernias were operated on in all cases by laparotomy, after reposition of the stomach into abdominal cavity the area of hiatus and diaphragm was reconstructed. One patient was operated on under emergency conditions for bleeding from stomach ulcer. Immediate postoperation results were good, the postoperation course was favorable in all patients, no complications occurred. In conclusion, the authors are of the opinion that every diagnosed paraesophageal hernia should be indicated for surgical intervention. An anti-reflux operation should be executed in symptoms of gastro-esophageal reflux. The question of operation approach (thoracotomy or laparotomy) is a matter of continuous discussion, each of them having its advocates. However, in recent years laparoscopic solution of paraesophageal hernia is getting increasing attention.

[Mediastinal cysts]. / Cysty mediastína.

Mediastinal cysts, described also as homoplastic dysembryomas, account for 20% of mediastinal lesions. There are bronchogenic, oesophageal, gastrogenic and enterogenic, pericardial, non-specific cysts and cystic lymphangiomas. The authors present 6 patients with mediastinal cysts from a total number of 96 patients with mediastinal tumours subjected to surgery during a 14-year period (from Jan. 1 1987 to Dec. 31 2001). The group comprised 5 adults and one child. In four patients the authors selected thoracotomy as the route of access to the mediastinum, in one instance total sternotomy and once upper partial sternotomy. The cysts were removed as a whole. Histological examination revealed in four patients the diagnosis of a bronchogenic cyst, once a connective tissue cyst with respiratory epitheliumm and once a cyst lined with squamous epithelium. The postoperative course was in all patients free from complications. In the conclusion the authors emphasize the importance of complete removal of mediastinal cysts as relapses occur if part of the secretory eoithelium is not removed.

[A "dumbell" tumor of the mediastinum--case report]. / "Dumbbell" tumor mediastína--kazuistika.

Tumours situated in the posterior mediastinum and spreading to the spinal canal via the intervertebral opening are described as "dumbbell" tumours. The authors submit the case-history of a 44-year-old patient admitted to the Second Surgical Clinic Pasteur Faculty Hospital, Safarík University Kosice after repeated laminectomy and extirpation of the intraspinally spreading part of a mediastinal tumour. The mediastinal part of the tumour was removed surgically, the histological result was described as a melanotic schwannoma. The postoperative course was without complications, the patient was discharged home in a good condition on the 8th day after the operation. In the conclusion the authors emphasize the necessity to remove the tumour in toto. A one-stage operation in collaboration with a neurosurgeon seems appropriate.

[Mediastinal teratomas--diagnosis and therapy]. / Teratómy mediastína--diagnostika a liecba.

The authors present an account on patients with a teratoma of the mediastinum who were operated at the Second Surgical Clinic, L. Pasteur Faculty Hospital in Kosice. In the course of 10 years (Jan. 1, 1990-Dec. 31 1999) 73 patients with tumours of the mediastinum were operated. In four the diagnosis of teratoma of the mediastinum was confirmed by histological examination (5.47%): three adult patients and one child. In two patients the tumour of the mediastinum was diagnosed accidentally during X-ray examination of the chest. In one female patient surgical revision was indicated on account of a relapse of the process. In the conclusion the authors emphasize that teratomas of the mediastinum are frequently asymptomatic, and in case the process is in the anterior or upper mediastinum, teratomas must be taken into account and removed as a whole during surgical intervention.

[Spontaneous pneumothorax. Actual aspects]. / Spontánny pneumotorax. Niekol'ko aktuálnych pohl'adov.

Based on a group of 77 patients with 93 attacks of spontaneous pneumothorax the authors submit some unconventional views on this entity and recommend an algorithm of therapy. They assume that the "gold standard" of treatment is tubular drainage of the chest, and only if it fails, surgery is the method of choice.