[Left hepatic vein injury during laparoscopic fundoplication for giant paraoesophageal hiatal hernia]. / Poranení levé hepatické vény v prubehu laparoskopické fundoplikace pro velkou paraezofageální hiátovou kýlu.

INTRODUCTION: After laparoscopic cholecystectomy, laparoscopic fundoplication has become another gold standard of minimal invasive surgery. The level of satisfaction of patients undergoing endoscopic surgery is almost 90%. Laparoscopic fundoplication, like other surgery methods, can also be burdened with grave complications, which could result in a fatal outcome even if the surgery is performed by a skilled surgeon. Even the authors themselves encounter complications despite their rich experience (more than 3,500 laparoscopic operations in the diaphragmatic hiatus area in more than 20 years). CASE REPORT: The authors report on a rare left hepatic vein injury during laparoscopic hiatoplasty and fundoplication according to Toupet for giant paraoesophageal hiatal hernia. CONCLUSION: For its low percentage of complications, laparoscopic fundoplication is considered as a safe operative method for gastroesophageal reflux disease and hiatal hernias. However, severe complications may still arise during the surgery and the surgeon should be familiar with them, be prepared for them and be able to manage such complications.Key words: gastroesophageal reflux disease hiatal hernia laparoscopic fundoplication left hepatic vein.

The role of thoracoscopy in the treatment of pleural empyema in children.

BACKGROUND: The treatment of empyema with pleural drainage is a widely accepted surgical procedure. Currently, thoracoscopy often is used to treat this disease in some thoracic surgery centers. This report aims to present the authors' experience with the treatment of pleural empyema and the benefits of thoracoscopy. METHODS: From 1997 to 2005, 49 children with a diagnosis of pleural empyema were treated by means of thoracoscopy in the authors' department. The study group consisted of 21 girls and 28 boys, ages 1 to 17 years (mean age, 9.2 years). Thoracoscopic cleaning and drainage of the pleural cavity was performed for all the patients. RESULTS: Intraoperatively, stage I empyema was recognized in 7 children (14.3%), stage II in 30 children (61.2%), and stage III in 12 children (24.5%). Very good results were obtained for all the patients. There were no intra- or postoperative major complications. The drainage time was less than 5 days for 63.3% of the children. In the remaining group of patients, drainage exceeded 8 days only for 16.3%. The postoperative time was short. Emptying of the pleural cavity and full lung decompression were achieved in all cases. In four cases, pleural biopsy showed TB, which enabled early proper treatment. CONCLUSIONS: Thoracoscopy can offer good visualization and cleansing of the empyema chambers, establishing efficient drainage even for patients with advanced stages of pleural empyema. Thoracoscopy enables collection of material not only for bacteriologic, but also for histopathologic examination. The method is minimally invasive, and risk for complication is comparable with that for classical thorax drainage.

[Recurrent pneumothorax in a child with Langerhans' cell histiocytosis]. / Nawracajaca odma oplucnowa u dziecka chorego na histiocytoze z komórek Langerhansa.

We are presenting a 16 months old boy, who has been previously developing normally, physically very active, and who suddenly developed right-sided pneumothorax with infiltrations in both lungs, initially defined as inflammatory. After placing suction drainage of the pleural cavity and antibiotic administration the child's condition improved quickly. The infiltration changes still remained in lungs arousing a suspicion of fibrocystic changes. During an attempt at changing the drainage into a water one, the symptoms of pneumothorax with hypertension increased again. A minithoracotomy with an edge resection of segment 4 and pleurectomy were performed, relating to the histopathological test of the sample, Largenhans' cell histiocytosis was diagnosed. The symptoms of diabetes insipidus appeared. The treatment according to the program DAL-HX83/90 modified by the Polish Group for Leukaemia and Malignant Lymphoma was introduced. During the treatment inducing remission a pneumothorax occurred two more times.

[Diagnostic procedure and surgical treatment of lipoblastoma in children. Own experience]. / Postepowanie diagnostyczne i leczenie chirurgiczne lipoblastoma u dzieci na podstawie wlasnego doswiadczenia.

Three cases of surgical treatment of the right supraclavicular fossa lipoblastoma in a 9-year-old boy, the mesentery lipoblastoma in a 13-month-old boy and retroperitoneal space lipoblastoma in a 6-month-old boy are presented. Deformity of supraclavicular fossa in the first patient, abdomen circumference enlargement in the second and right abdomen deformity in the third patient were the only symptoms. The above mentioned symptoms lasted respectively 5, 3 months and 7 days. X-rays and sonography examinations showed the presence of solid capsuled mass of tabular structure each time. CT scans in patient with mesentery lipoblastoma revealed additionally a fat-like tissue of the tumour (CT examination in the third patient gave suspicion of lipopblastoma). All tumours were surgically removed - they had tabular structure and were capsuled. The diameters were respectively: 6.5 x 6x 4 cm, 20 x 16 x 9 cm and 13x16x6 cm. This is to emphasize that the results of preoperative examinations as far as size, borders and tabular character of both tumours were very accurate when compared with intraoperative picture. No postoperative complications were noted. The follow-up recheck period is 2 years in the first, 9 months in the second and I day in the third case. All boys are well.

[Mesenteric lipoblastoma in 13-month-old boy]. / Lipoblastoma krezki u 13-miesiecznego chlopca.

A case of lipoblastoma of mesentery in 13-month-old normally growing up boy was presented. During routine examination due to upper respiratory airways viral infection large abdominal tumor was found. Preoperative diagnostics let us establish its the most probable macro- and microscopic character and the tissue limits. Radical operation was performed. During the 5-month follow up period after the surgery there were not evident complications, we did not find any signs of tumor recurrence.

[A cause of fetal ascites during intrauterine ileus with perforatio intesine]. / Przypadek izolowanego wodobrzusza plodu, w przebiegu wewnatrzmacicznej niedroznosci jelit z perforacja.

Fetal ascites may be caused by different abnormalities. Determining of the cause is very important in terms and the way of treatment. Some cases may require immediate interaction. We presented fetal ascites with atresio intensive with intrauterine perforation--the way of diagnosis and success of therapy.

[A new method of extravesical correction for vesicoureteral reflux]. / Nowy sposób zewnatrzpecherzowej korekcji odplywu pecherzowo-moczowodowego.

New technique of extravesical antireflux surgery was presented and the treatment results were estimated in 16 children. No vesicoureteral reflux was noted in any children after operation during control cystographies. In chosen cases the presented technique corrects ureterovesical reflux, is mildly invasive and shortens child's hospitalization.

[Economical benefits of one-day surgery treatment in children: 10 year of experience]. / Korzysci ekonomiczne leczenia niektórych schorzen chirurgicznych w oddziale chirurgii jednego dnia--10 lat doswiadczen.

The authors present economical benefits of one day surgery treatment in children on the ground of own 10 years experiences. Analysis was made on the basis of 5855 children treated in Department of Pediatric Surgery in Zabrze (Poland) from March 1987 to March 1997. During this time 50.8% operations were performed in ambulatory surgery form. Global savings for hospital budget were achieved 77.2%. Authors point that one day surgery increases the efficiency of the surgical ward.

[Evaluation of the usefulness of palpation and Daniel's biopsy for detection of metastasis to supraclavicular and scalene lymph nodes in patients with lung neoplasms]. / Ocena przydatnosci badania palpacyjnego i biopsji Danielsa w wykrywaniu przerzutów nowotworowych do wezlów znad miesni pochylych i wezlów nadobojczykowych u chorych na raka pluc.

In 169 patients with lung cancer the usefulness of physical examination and Daniel's biopsy in detection of metastases to supraclavicular and scalene lymph nodes were evaluated. In 35 patients with palpable lymph nodes and in 25 patients with nonpalpable lymph nodes metastases were confirmed by histological examination. The sensitivity, the specificity and the likelihood ratio of physical examination in detection lymph nodes metastases were respectively: 58%, 86% and 4.1. In 6 patients (5%) among 119 with nonpalpable lymph nodes the positive Daniel's biopsy was the diagnostic procedure. In 5 patients with non-small carcinoma and in 3 patients with malignant mesothelioma positive results of Daniel's biopsy enabled a change of cancer staging and giving up the eventual surgical operation.

[Filling of the lower segment of the large intestine with fluid to facilitate ultrasonic examination in diseases of the small pelvis]. / Wypelnienie plynem dolnego odcinka jelita grubego jako usprawnienie badania ultradzwiekowego w chorobach miednicy malej.

Small pelvis space is difficult to examine ultrasonographically as several important organs are localized in relatively small area. The most difficult is the interpretation of the standard USG examination of the abdomen in case of pathologies of the end of large intestine, when filled with feces. In such cases repeated ultrasonographic examination is recommended. Authors propose, that this segment of the colon should previously be filled with fluid. Such a technique improves the level of diagnosis or exclusion of any pathology. Forty two patients were examined with the above technique. Authors think, that it is a progress in ultrasonography of pelvic organs.

[Diagnosis of choledochal cysts in children with special reference to ultrasonographic examination]. / Rozpoznawanie torbieli dróg zólciowych u dzieci ze szczególnym uwzglednieniem badania ultrasonograficznego.

Early diagnosis of the choledochal cysts in childhood, especially obstructing bile outflow to the duodenum, is an important clinical problem; often leading to serious complications--if not treated. Authors treated 5 children with choledochal cysts. Three out of them have been treated surgically. Ultrasound examination is sufficient to diagnose the disease, if the cyst is connected with intrahepatic bile ducts. If such a case is not possible to be imaged, cholescintigraphy and thin-needle biopsy with contrast filling are necessary to confirm the diagnosis.

[Recurrent inflammation of the bronchial tree in the course of a congenital tracheo-esophageal fistula]. / Powtarzajace sie stany zapalne drzewa oskrzelowego w nastepstwie wrodzonej przetoki tchawiczo-przelykowej.

A case of a 7 year old boy with chronic inflammatory changes of the bronchial tree in the course of a type H congenital tracheo-esophageal fistula is presented. The diagnosis was made basing of findings during bronchofiberoscopy. Radiological examination of the upper GI tract did not reveal the abnormality. The fistula was closed surgically.

[Selected immunologic parameters and infections in children in over 1 year after completion of the treatment of acute lymphoblastic leukemia]. / Wybrane parametry immunologiczne a zakazenia u dzieci w okresie ponad jednego roku od zakonczenia leczenia ostrej bialaczki limfoblastycznej.

An analysis of infection incidence within one year after completion of the treatment for the acute lymphoblastic leukemia was performed in the group of 24 children. Infections incidence was related to the selected immunological parameters, mainly T4 and T8 lymphocyte subpopulations assayed with monoclonal antibodies. T4/T8 cells ratio (Ix) was determined. It was found that moderate decrease in the total lymphocyte count and Ix exist in children one year after completion of the treatment. This index is more significantly lower in children with more frequent infections while the absolute numbers of T4 and T8 lymphocytes are relatively increased. The obtained results suggest that no significant immunosuppression is observed in children affecting the number and the course of infections.