[Lumbar hernia]. / Przepuklina Iedzwiowa.

Lumbar region constitutes one of the least common localizations for hernia formation. There are only slightly more than 300 cases found in English literature till the end of the 20th century, while there are only 8 cases presented in Polish literature. Exceptionally rare incidence together with diagnostic dilemma related to it made us to present cases of 2 patients operated on in the 2nd Chair of Surgery of Jagiellonian University Medical College due to lumbar hernia.

[Actinomycosis in persistent urachus]. / Promienica w przetrwalym moczowniku.

A 70 -year old woman with tumor of urachus confirmed in USG and CT us described in this article. In this tumor we have found during histopathology Gram-positive Actinomyceces. The location of Actinomyces in urachus is very rare.

[Incidence and risk factors of rebleeding from gastric and duodenal ulcers]. / Czynniki ryzyka i czstosc nawrotu krwawienia z wrzodów zoladka i dwunastnicy w materiale wlasnym.

We present the analysis of risk factors of recurrence of bleeding in patients with gastric and duodenal ulcers. The group consisted of 178 patients hospitalized between 1998-2002. Among them there were 76 patients with gastric ulcers and 102 patients with duodenal ulcers. The recurrence of bleeding was observed in 24.3% patients with gastric ulcer and 21.8% of patients with duodenal ulcer. The most important risk factors were: localization of ulcers, intensity of bleeding according to Forrest scale, presence of concomitant diseases, shock on admission and H. pylori infection. 26.3% of patient with gastric ulcer and 36.4% with duodenal ulcer needed emergency operation. The mortality rate among patients with gastric ulcer was 15.6% and with duodenal ulcer 13.6%.

[Laparoscopic emergency surgery]. / Operacje laparoskopowe ze wskazan naglych.

Up-to-dated concepts about the use of laparoscopy in the "acute abdomen" have been discussed. Most frequently performed procedures in abdominal emergency and trauma were presented. Indications, contra-indications, advantages and drawbacks with regard to own 10 years experience and literature were discussed.

[Acute appendicitis--open or laparoscopic surgery?]. / Ostre zapalenie wyrostka robaczkowego--operacja technika klasyczna czy laparoskopowa?

UNLABELLED: Laparoscopy is used more and more frequently in the treatment of abdominal emergencies including acute appendicitis. This technique has a lot of advantages especially in the group of the young female patients, where the differential diagnosis between gynecological diseases and appendicitis is difficult. AIM OF THE STUDY: The study is designed to compare the results of open and laparoscopic exploration in patients with suspected appendicitis. MATERIAL AND METHODS: From 1998-2001 we performed 278 operations for suspicion of appendicitis in the 2nd Dept. of Surgery of the Jagiellonian University. There were 127 laparoscopic procedures performed in 46 men and 81 women (mean age 28.6 years) and 151 classical exploration in 99 men and 52 women (mean age 37.9 years). We reviewed retrospectively the patients' data analysing age, sex, duration of the procedure, length of the hospital stay, intraoperative and postoperative complication rate. RESULTS: The patients operated classically were older than patients operated laparoscopically. The proportion of male and female patients was reversed in both types of exploration. The female patients composed a majority (2/3) in the case of laparoscopic procedures and minority (1/3) in the case of open operations. The average duration of open appendectomy was 43 min. as compared with 49 min. of laparoscopic procedure, which was however getting shorter in the analysed period. The mean length of the hospital stay was twice shorter after laparoscopic appendectomy (4.8 days vs 8.4 days). There were only 4 (3.15%) complications connected with laparoscopic technique and 34 (22.52%) complications after open appendectomy. There were 12 (9.45%) conversions, most of them in patients with the retrocoecal position of the appendix. The diagnosis of acute appendicitis was confirmed in similar percentage in both operation types (laparoscopy--78.74%, open technique--79.47%). There were also similar proportions of the patients with no macroscopical changes in the appendix and with other abdominal diseases. CONCLUSIONS: Laparoscopy allows for the precise diagnosis and final treatment in most patients with the suspected acute appendicitis. Some patients also avoid laparotomy. Hospital stay is significantly shorter and complication rate is markedly lower among patients operated laparoscopically.

[Well-differentiated papillary mesothelioma--a rare neoplasm of the peritoneum]. / Wysoko zróznicowany miedzybloniak brodawczakowaty (mesothelioma papillare bene differentiatum)--rzadko spotykany nowotwór otrzewnej.

Well differentiated papillary mesothelioma (WDPM) is a very uncommon neoplasm of peritoneum. Most frequently it appears like little numerous nodules on peritoneal surface, omentum or mesentery. WDPM is characterized by indolent course and is diagnosed in most cases incidentally during operations for other reasons. Sometimes differentiation between WDPM and other mesothelial lesions may be difficult. In the described case a 22 year old female, cystic peritoneal lesions were first recognized histological as WDPM. In verification after two months, they were proved to be cystic mesotheliosis. WDPM may cause adhesions followed by torsion or strangulation. In the second reported case a 24 year old male, WDPM provokes torsion of the omentum. Twelve months after operation and diagnosis this patient is symptom free.