[Anorectal Lesniowski-Crohn's disease]. / Choroba Lesniowskiego-Crohna okolicy odbytowo-odbytniczej.

UNLABELLED: Authors retrospectively reviewed results of surgical treatment of the patients with anorectal Lesniowski-Crohn's (LC) disease, operated in the Department of General and Gastroenterological Surgery in Warsaw. MATERIAL AND METHODS: In years 1987-2007 we treated 110 patients with LC disease. The anorectal localization of lesions was noticed in 24 patients (13 women, 11 men, average age of fall--28 year), i.e. 21.8% of all patients. The operations performed in other hospitals were taken into account. Results were compared with literature data. RESULTS: Anorectal lesions were the first signs of LC disease in 16/110 patients (14.5%), and there were most often: perianal fistulas (multiple) in 12, perianal abscesses in 2, and rectovaginal fistula in 2 patients. In the remaining 8 patients (7.3%), anorectal lesions emerged in later period of the disease, formerly placed in other part of digestive tract. The primary local surgical treatment (incision/excision offistulas, abscess drainage) was performed in 20/24 patients. Most frequent indications were: perianal fistulas--13, perianal abscesses--6, and rectovaginal fistula--1. Primary abdominal operations were performed in 4/24 patients: Hartman procedure in 2 patients with rectovaginal fistulas and in other 2 patients with severe colitis--subtotal colectomy and restorative proctocolectomy. The follow-up in 23/24 patients exceeded 5 years, only in 1 patient was 4 years. The surgical recurrences were noticed in 19/24 (79.1%) patients. Recurrences of fistulas were noticed in 11 patients, in addiction in 5 patients we noticed anal stenosis, in 3 rectal/sigmoidal stenosis and in 3 proctitis of the remaining rectal stump. Surgical recurrences of LC disease after 5, 10 and 15 years of observation were 18/23--78.2%, 14/15-93.3%, and 7/7--100% respectively. Two patients (8.3%) died from severe general complications of the disease. The primary local surgical treatment was sufficient only in 2 patients. In 18/22 patients 28 abdominal operations were carried out in later period of the disease. In all 24 patients we performed 46 extended abdominal operations. In result of them 13/24 patients have definitive and 1 temporary stoma. CONCLUSIONS: 1. Surgical treatment of anorectal LC disease should be sparing and performed in the proper time. 2. Surgical treatment of anorectal LC disease is difficult and should be carried out in reference centers. 3. Anorectal LC disease has poor prognosis in terms of fecal and gas continence and creates the risk of proctectomy in up to 20% of cases.

[Pouchitis--what do we know after 30 years?]. / Pouchitis--co wiemy po 30 latach?

The restorative proctocolectomy is a surgical procedure performed from 30 years in patients with ulcerative colitis and familial adenomatous polyposis. The ileal pouch anastomosed with anal spincters replaces the function of the excised colon and enables the natural rout of intestinal contents. The most frequent postoperative complication is pouchitis, often lowering the estimation of the operation. Authors described the current opinions in ethiopathogenesis and treatment of this disease.

[Evaluation of the efficacy of surgical treatment of gastroesophageal reflux disease]. / Ocena skutecznosci chirurgicznego leczenia zarzucania zoladkowo-przelykowego.

THE AIM OF THE STUDY: In a group of 100 patients efficacy of surgical treatment of GERD was prospectively assessed. MATERIALS AND METHODS: 37 women and 63 men were qualified into the study. During preoperative period the following symptoms were assessed: heartburn, belching, chest pain, epigastric pain, regurgitations, dysphagia and the following examinations were performed: esophagogastroscopy, esophageal barium meal X-ray examination, esophageal manometry an 24-hours pH-metry. All patients were operated laparoscopically. RESULTS: Based on preoperative esophageal manometry 67 Nissen and 33 Toupet fundoplications were done. Mean patients' age was 51,54 years. Postoperative mortality was 0%. While assessing clinical symptomps one found statistically significant reduction of preoperative complaints, improvement of motility of esophageal body and parameters of lower esophageal sphincter, and normalization of 24-hours pH-metry record. CONCLUSIONS: Antireflux operations effectively reduce pathological GERD and improve esophageal motility.

Pathological analysis of lesions within intestines resected due to ulcerative colitis.

INTRODUCTION: Ulcerative colitis (UC) and Lesniowski-Crohn's disease together constitute a type of intestinal pathology known as Inflammatory Bowel Disease. The etiology of UC still remains unknown, however some epidemiological data suggest the role of bacteria and viruses and also some habitual as well as environmental factors like smoking, diet, drugs, geographical and social status, as well as stress. The genetic predisposition is also suggested. UC affects young people in 2nd - 4th decades of life. Exacerbations of the disease may result in the necessity of surgical treatment, typically in the form of total proctocolectomy accompanied by the subsequent formation of ileo-pouch-anal anastomosis. The aim of our study was to analyze morphological pictures of resected specimens. MATERIAL AND METHODS: We analyzed 67 cases (40 women and 27 men) of UC with the special interest being focused at macro- as well as microscopic features of the intestines resected. We reviewed macroscopic characteristics of intestines (i.e. the length of resected fragments, localization, shape and diameter of the ulcers, polyps, number of resected lymph nodes), as well as microscopic descriptions concerning, among others the character and localization of inflammatory infiltrate, the architecture of glands, the presence of crypt abscesses and Paneth's metaplasia. Special attention was paid to the morphology of intestinal wall vasculature. RESULTS: In 42% of the cases macroscopically the inflammation covered the whole length of the resected colon. In 58% macroscopically detected inflammatory changes were segmental in distribution. In four cases the disease had clinically the fulminant course and the inflammation was transmural. There were 3 cases, in which histological assessment revealed the presence of malignancy (2 cases of mucus producing adenocarcinoma and one case of carcinoma in situ situated in the anal canal). Generally, microscopic findings were typical for the active phase of UC. We found intensive vascularization and hyperemia of the intestinal wall to be the common features accompanying the inflammation. CONCLUSIONS: Young people in the 3rd and 4th decades of life constitute the group being relatively commonly affected by the UC, and undergo the surgical proctocolectomy. Some of the cases present with the fulminant course of the disease. A rich vascular network is a common finding in the inflamed intestinal wall. We hypothesize, that intensive vascularization may play a significant role in the pathogenesis of UC.

Visceral situs inversus in three patients.

Three examples of patients with complete visceral situs inversus are presented from nineteen years of clinical experience. The first case concerns a 16-year-old woman, who suffered from appendicitis and was operated on one day after the admission. The second case presents a 63-year-old woman admitted and operated on because of colorectal carcinoma. The last case involves a 66-year-old man taken in and operated on due to stomach cancer. A surgical patient with complete visceral situs inversus forces an operator to abandon currently used operating standards. This situation should especially mobilize operator's watchfulness while performing the procedure. Non-typical circumstances occurring during operation increase frequency of incidence of intra-operative complications.

[Vagus nerve stimulation in drug-resistant epilepsy. Experience with 23 patients]. / Leczenie padaczki lekoopornej metoda stymulacji nerwu blednego. Doswiadczenia wlasne u 23 chorych.

BACKGROUND: Vagal nerve stimulation (VNS) is a new non-pharmacological method of pharmacoresistant epilepsy treatment. The aim of this paper was to present effects of treatment in 23 patients with drug-resistant epilepsy with a different etiology. MATERIAL AND METHODS: Implantation and treatment was performed in two centers in 1998-2002. The effect of treatment was presented as a reduction of seizures during therapy. RESULTS: The lack of group homogeneity and a small number of patients (especially a small number of patients with a long follow-up period) did not allow a more detailed analysis to be made, although there seems to be a clear tendency to obtain better effects of treatment over follow-up time (at 24 month more than 50% seizure reduction or cease of seizures was observed in 80% of patients). The possibility to turn on the device "on demand" is an important advantage of this method. This raises the effectiveness of treatment in more than 80% of patients, and in more than 20% it stops the seizure. There were two groups of undesired side effects: frequent specific effects caused by local irritation of the vagal nerve in the cervical part of the neck and rare transient general effects. Both groups of effects rarely caused any treatment complications. CONCLUSIONS: VNS is an effective method of treatment, complementary to other epilepsy treatment methods and should be used in patients with drug-resistant epilepsy as an alternative to neurosurgical treatment. VNS improves the quality of life in treated patients.