Fatal necrotizing fasciitis following two suicide attempts with petroleum oil injection.

PURPOSES: Necrotizing fasciitis is an aggressively progressing complication of the skin and soft tissue infections. It has dramatic course and often leads to patient's death. METHODS: In our research, we present the casuistic case concerning double suicide attempt with petroleum oil injection, complicated by the necrotizing fasciitis, patient was with deliberately withheld mental disorders. RESULTS: During the first suicide attempt, the oil substance was injected into the left cubital fossa and left toes areas, what lead to amputation of the upper left limb above the cubitial fossa and the left toes. Afterward, patient gradually recovered and survived. Two years later, another suicide attempt took place with the same substance: a 27-year-old man injected the petroleum oil into the right supraclavicular area. That affected a necrosis penetrating into the mediastinum and the patient died. CONCLUSIONS: To our knowledge, such case of the necrotizing fasciitis has not been previously reported. The mechanism of derivatives of oil influence on tissues is not investigated yet; therefore, treatment method is uncertain and sometimes ineffective.

The role of a therapeutic team and The Pol-Ilko Association in readaptation of patients with a stoma to the life in a family and society in the 21st century.

Patients who crossed operation where exteriorization stoma was integral her part the aside from of cause, location and far-gone of illness which hereinto brought require special care. In moment of entry we to European Union should advert on introduction by us the surgeons of new operating techniques not only, but to attach importance to quality of sick's life after operations also, particularly these which violate beauty of our body. They are of the patients' groups the nation from stoma, particularly if cause the exteriorization stoma the state the neoplasmic disease of alimentary canal or arrangement urinary. The stay in Clinic whether the surgical squad, perspective of operation which is final effect producing artificial accompanying urinary content tract intestinal or fecal it joins with high-level of phobia. The Information Bureau for Stoma in year 1993 at Medical University was created and on the basis of this the information bureau the therapeutic complex worked out own model of these patients' care over group. The model of care over sick from stomy hugs three periods: preoperative, early and late surgical period (ambulant). On the basis of The Information Bureau from Stoma in 1994 year The Department was created of Podlasie the Society of Care over Patients from Stoma in Bialystok--association of working on thing sick's good. Organization this assembles from stomy the men, their family and guardians, workers of medical service and different men of good will. Meetings are forms of working, which performance of bothering patient's problems connected with nurturing and supply stomy is aim, and also psychical and help support in readaptation to life in family, company and society. The volunteers' training is to help different form of working this sick's group. Volunteer in this case--then living from stomy over year happily, adopted to life in every respect, person which exemplifies for sick prepared to operation positive (exteriorization stoma) or beginning one's "path stoma". Both the analysis and opinion of work of therapeutic complex, as and the workings The Association be made by only patients, their family and guardians, and also the workers of medical service. The elaborate model of care over sick from stoma on the basis of Information Bureau is accepted universally and resoluteness improves quality of life of this patients' group. Patient in XXI age from stomia on Podlasie it can appropriately living in family, work professionally, grow sport and hobby not only thanks to work therapeutic complex, but also and men who earlier found oneself in similar situation, as he alone.

Activity of thyroid parafollicular (C) cells in rats with hyperthyroidism--preliminary ultrastructural investigations.

In the thyroid gland of mammals, except the basic follicular (F) cells, parafollicular (C) cells are detected. They belong to disperse neuroendocrine cells of the APUD system. Co-localisation of F and C cells in the thyroid gland is not accidental. It seems possible that there is an interaction between them, mediated by the peptidergic hormones. Calcitonin (CT) is proposed as an essential indicator of C cells. The role of C cells in the function of the thyroid gland has been not clarified till now, especially in hyperthyroid state. There are only a few data which document the ultrastructure of C cells in the physiological and pathological state. In the present study, the ultrastructure of thyroid C cells in an experimental model of hyperthyroidism was evaluated. Our preliminary study may confirm the functional interaction between follicular and parafollicular cells in the thyroid gland.

Activity of thyroid parafollicular (C) cells in rats with hyperthyroidism--immunohistochemical investigations.

The aim of this study was an evaluation of the activity of parafollicular (C) cells in a rat experimental model of hyperthyroidism, evoked by an intraperitoneal application of L-thyroxine (40 mg/kg daily) over 15 days. For that reason, immunohistochemical investigations and evaluation of calcitonin (CT) plasma concentrations were performed. Differences in the quantity and distribution, together with enhanced CT-immunoreactivity of C cells, were observed in hyperthyroid rats, in comparison to respective values in the control group, accompanied by a significant diminution of plasma TSH and CT levels. Our preliminary study may point to a functional interaction between follicular and parafollicular cells in the thyroid gland.

Percutaneous fine-needle pancreatic pseudocyst puncture guided by three-dimensional sonography.

BACKGROUND/AIMS: At present a pancreatic pseudocyst puncture guided by ultrasonography is a treatment of choice in the majority of hospitals. A classical two-dimensional sonography is usually implemented in these cases. However, its shortcomings, mainly in differential diagnosis, are acknowledged by most physicians. The real time monitoring of a fine-needle pseudocyst procedure by two-dimensional ultrasonography is of questionable reliability. In our study we evaluated the usefulness of three-dimensional sonography in the percutaneous fine-needle pancreatic pseudocyst puncture. METHODOLOGY: We examined fifty-two patients diagnosed as having pancreatic pseudocysts on the basis of clinical symptoms and two-dimensional ultrasonography findings. Then the decision to qualify certain patients for the percutaneous fine-needle aspiration guided by ultrasonography was made on the basis of two- and three-dimensional scan results. The next step in our investigation was to implement color Doppler in order to visualize all blood vessels at the planned biopsy site. Three-dimensional sonography was used to monitor the tip of the needle making its way to the pancreatic pseudocyst and later inside the fluid collection. RESULTS: Pancreatic pseudocysts were diagnosed in all of the 52 cases. Three-dimensional sonography was more precise in visualizing the shape and size than two-dimensional ultrasound scans. CONCLUSIONS: Three-dimensional presentation can better visualize irregular shapes, local thickenings, and calcification of pseudocyst walls than classical two-dimensional ultrasound scans. The use of subtraction in three-dimensional scans of blood vessels increases the safety in performing biopsies. It makes the aspiration of cytologic materials much safer to perform. In our study we have shown that three-dimensional sonography collects extremely useful information about the status of the pseudocyst structure and it should become a complementary method to classical ultrasonography. This technique when used on a routine basis ought to help us change the inclusion criteria for guided biopsies.

Preliminary immunohistochemical investigations of human thyroid C cells in the simple and hyperactive nodular goitre.

The aim of this study was to carry out histomorphological and immunohistochemical analysis of thyroid C cells in 30 patients with simple goitre and hyperactive goitre including Graves-Basedow (G-B) disease, treated surgically. Four tissue samples were always taken from the same internal parts of the gland where the number of C cells in physiological conditions was the highest. C cells were detected in paraffin sections after impregnation with silver salt (Grimelius method) or immunohistochemically, with antibodies against calcitonin, synaptophysin, chromogranin A and neuron-specific enolase. Distinctly less numerous C cells were found in simple and hyperactive goitre than in normal thyroid parenchyma. The majority of C cells showed weak intensity of the examined immunohistochemical reactions. C cells were not observed at all in the texture of nodules well separated by the connective tissue. Proliferative changes concerned only follicular cells.

Preliminary evaluation of influence of gemcitabine (Gemzar) on proliferation and neuroendocrine activity of human TT cell line: immunocytochemical investigations.

The choice treatment of medullary thyroid carcinoma (MTC) is total thyroidectomy. It is difficult to evaluate effectiveness of chemotherapy due to the rare incidence of MTC. Gemcitabine is a new drug of antimetabolite nucleoside group used in treatment of cancers since 1996. The aim of this study was to evaluate the influence of gemcitabine on proliferation and neuroendocrine activity of human TT cell line derived from MTC. The cells were exposed to gemcitabine in the concentration of 10, 25 and 50 microg/ml for 24 hours. Immunocytochemical examinations were carried out by the method of avidin-biotin peroxidase complex (ABC) according to Hsu et al. to detect calcitonin, chromogranin A, synaptophysin and neuron-specific enolase in TT cells. A concentration-dependent inhibitory influence of gemcitabine on proliferative activity of TT cells was observed. It was also shown that the immunostaining was reduced, especially in case of neuron-specific enolase. Only the reaction detecting calcitonin was enhanced in persistin

[Significance of medium molecular weight peptides in pathologic processes]. / Znaczenie peptydów o sredniej masie czasteczkowej w patologii.

The literature concerning of prevalence and meaning of middle molecular peptids in experimental and clinical pathology has been reviewed. Middle molecular peptids have been extracted for the first time from plasma of the patients with renal insufficiency by Babb in 1970.

Proliferative activity of the thyroid oxyphilic tumor cells estimated by means of quantitative analysis of silver stained nucleolar organizer regions (AgNORs).

UNLABELLED: Promising results of studies on different neoplasms, by means of morphometric analysis of argyrophilic nucleolar organizer regions (AgNORs), known as proliferative activity marker, made us undertake an attempt to evaluate of proliferative activity in Hürthle Cell Tumors using the same technique. 78 cases including 20 Hürthle Cell Carcinomas (HCC), 32 Hürthle Cell Adenomas (HCA) and 26 hyperplastic nodules with Hürthle Cell Metaplasia (HCM), diagnosed in the Department of Clinical Pathology, Medical Academy of Bialystok in the years 1990-2000, were subjected to analysis. For visualization of the NORs we used the D. Ploton et al. technique. Mean AgNOR count and NORDS (NOR distribution score--the percentage of nuclei with at least 5 argyrophilic granules) were estimated in each case in 100 randomly chosen nuclei. Non-parametric Mann-Whitney U-test was applied to determine statistically significant differences. RESULTS: Mean AgNoRs counts and NORDS values were 5.1 and 52%, 3.4 and 26%, 2.5 and 7% in HCC, HCA and HCM respectively. Statistically significant differences were found between AgNORs counts in carcinomas and adenomas (p<0.01), HCCs and HCMs (p<0.005) and betwveen NORDS in all groups (p<0.001).

[Malignant or benign thyroid nodules: a diagnostic dilemma]. / Guzki lagodne czy zlosliwe w tarczycy--dylemat diagnostyczny.

The aim of this study was to determine the incidence of cysts and cystoid-solid lesions in thyroid carcinomas basing on preoperative ultrasonographic examinations (USG), fine needle aspiration biopsy (FNAB) and postoperative histopathological examinations. 661 patients with different thyroid disorders were treated surgically. Carcinoma was found in 46 patients (3.9%). Papillary carcinoma was predominant (n = 34). Of the 46 patients with carcinoma, preoperative USG examination revealed cystic or cystoid-solid lesions in 18 patients (39%). FNAB of this 18 patients was positive in 5 cases, negative in 4 and suspect in 9. In 6 cases the neoplastic lesion was strictly connected with cysts (foci in the wall or in solid masses within the cyst) and in the remaining 12 patients lesions were found in the vicinity of the neoplastic focus. We conclude that malignant neoplasms of the thyroid gland are frequently (in approximately 40%) accompanied by cystic and cystoid-solid lesions, FNAB diagnostic material should be obtained even through several USG-controlled punctures and negative FNAB does not exclude thyroid carcinoma, particularly in nodular-cystoid goitre.

Malignant and benign tumours of liver--problems of diagnostics, treatment and complications.

Non-invasive diagnostics development, and particularly introduction of ultrasound to everyday medical practice contributed to early detection of tumour lesions in the liver. The aim of the research was to analyse the patients with tumour lesions of livers in the north-eastern region of Poland. 325 patients with tumour lesions in livers underwent surgical treatment between year 1978 and 2000. In 197 patients metastatic malignant tumours were found in livers, while in 24 cases--primary malignant neoplasms of the organ. In the remaining cases benign tumours, mostly non-parasitic cysts were found. Out of 325 patients, who were surgically treated, 80 underwent resection procedures of liver parenchyma with tumour, 17--enucleation of tumour lesion with the enclosing capsula, 14--abscess drainage with necrotic mass evacuation. In 11 cases of non-parasitic as well as parasitic cysts fenestration was performed due to high risk of surgery, while in the remaining patients laparotomy was only performed and segments for histopathologic examination were taken due to the progression of the neoplasmatic disease. In the patients who had undergone resections of liver parenchyma in the postoperative course we noted complications such as: prolonged cholerrhagia from peritoneal cavity, stress duodenal ulcers complicated by bleeding, bleeding from liver parenchyma at the section line, jaundice as well as cisterns of fluid at the parenchyma section line. Mortality in the patients after the resection procedures of liver in our material was 7.5%. The development of diagnostics contributed to early detection and surgical treatment of tumour lesions of liver. The observation of our patients showed that resection procedures in benign tumours lead to complete recovery, while in malignant lesions--to clearly prolonged survival.

Three-dimensional sonography in the diagnosis of hepatic hemangiomas.

The purpose of the study was to compare power 3-D with conventional 2-D sonography with color and power Doppler in assessment of tumor vascularity in small hepatic hemangiomas. The study group comprised 12 patients (7 males and 5 females) aged 28-60, (mean 44) with diagnosed hemangiomas. In all the patients 2-D and 3-D sonography was performed and their results were compared. Both color and power Doppler 2-D sonography failed to detect blood flow in the tumors. Blood flow signals were detected in 3-D power Doppler sonography. 3-D power Doppler is superior to 2-D color and power Doppler imaging in the detection of blood flow signal in hemangiomas.

Surgical management of chronic pancreatitis.

During the past 21 years 222 patients with chronic pancreatitis have undergone surgery at the Department of General Surgery, Medical School Bialystok. In 117 cases (52.7%) resection was performed and 48 patients (21.6%) had anastomotic procedures and the rest of patients underwent bile duct anastomotic surgery or were re-operated on because of surgical complications. Based on the own clinical experience and the latest data from the world literature diagnostic criteria and indications for surgical treatment of chronic pancreatitis are shown below. Good results obtained in 192 cases (86%) strongly support our opinion that resection procedures in chronic pancreatitis are the most effective management however patients should be operated on in specialized centers with good diagnostic bases because a correct diagnosis is essential while choosing the appropriate line of treatment.

The diagnosis and surgical management of diseases of the adrenal glands.

The authors present their own experience in the diagnosis and management of adrenal tumours and cysts. During the years 1980-2000, 74 patients were underwent surgical treatment. Of this group, 23 had Cushing's syndrome, 19 phaeochromocytomas, 4 Conn's syndrome, 2 virilising tumours, 2 adenocarcinomas, 2 ganglioneuromas, 7 adrenal cysts, 8 adenomas, 3 adenocortical carcinomas, 2 nodular hypertrophies, 1 myelolipoma and 1 liposarcoma. Treatment was effective in 73 (98.6%) of patients. We recommend the transperitoneal approach which allows the visual evaluation of both adrenals and extra adrenal tissue. We regard surgical intervention as being the only effective method of treating adrenal tumours.

[Hydatoid cysts of liver--diagnostic and therapeutic problem]. / Torbiele watroby bablowcowe--problem diagnostyczny i leczniczy.

In the Department of General Surgery of Medical University 11 patients with hydatid cysts of liver were operated. Ultrasonography and computer tomography allowed to define exact localization, size and contents of the cysts, what made possible planning of operating procedure. In 2 cases nonanatomic resection of liver parenchyma was performed, in 2 ones with coexisting stomach neoplasm just excision of the frontal wall of the cyst and emptying of the interior. In all the other cases the cysts were removed with surrounding liver tissue. Late results of surgical treatment with albendazol therapy are good. Diagnosis of echinococcic desease should be precised, considering with possibility of co-existing foci in other organs.

[Surgical treatment of thyroid disease in adolescents]. / Leczenie chirurgiczne chorób tarczycy u mlodocianych.

Surgical treatment of goitre in children and teenagers under 18 is relatively rare and undertaken for strict therapeutic indications. It still arouses much controversy among surgeons, being loaded with a high percentage of complications, usually distant ones. The aim of the study was to analyse the surgical treatment of various goitre types under the age of 18 basing on 65 operations performed in the years 1994-1998. Operations for non-toxic and hyperactive nodular goitre, including Graves-Basedow disease, were predominant. Five cases of thyroid carcinoma were found. No serious complications were observed during and after the surgery. Our own material and the 5-year observation reveal that surgical treatment of thyroid diseases in children and adolescents carried out for definite indications by an experienced operating team is successful and causes only few complications.

[Surgical management in the non-neoplastic and neoplastic thyroid goiter with Hürthla cells]. / Postepowanie chirurgiczne w nienowotworowym i nowotworowym wolu tarczycy z obecnoscia komórek Hürthla.

The routine preoperative cytological evaluation of pathological changes of the thyroid more and more frequently reveals single or multiple Hürthl cells in the material obtained by the method of fine-needle aspiration biopsy (FNA). Hürthl cells are a degenerative form of epithelial follicular cells of the thyroid and cytological examination is insufficient for unequivocal differentiation between adenoma and carcinoma. Management of patients with FNA-diagnosed Hürthl cells arouses a number of controversies. Therefore, the authors of the present study subjected the thyroids of patients with cytologically diagnosed Hürthl cells to postoperative histopathological analysis. Appropriate surgical management was indicated.

[Diagnosis and surgical treatment of pancreatic carcinoma]. / Rak trzustki--diagnostyka i leczenie.

The aim of the study was presentation of our experiences in the diagnostics and treatment of pancreatic carcinoma in confrontation with current opinions. Between 1983 and April 1998 308 patients (198 males and 110 females with mean age 61 years) were treated at our department. In 211 cases tumor was primarily localized in the head and in 97 cases (31.5%) in the body or tail of pancreas. The diagnosis was determined on the basis of clinical symptoms and laboratory investigations. Diagnostic accuracy of performed investigations was as following. Ultrasonography-86%, CT-scan-95%, and ERCP-94%. Ultrasonography or CT guided biopsy and serodiagnostics improved detectability of resectionable carcinoma in the last past years. Among 308 patients, 292 underwent surgery. Since 1997 an intraoperative ultrasonography and cholangioscopy of common bile duct and Virsung were performed as a routine. The procedures depended on the localization and the grade of advance of the tumors. UICC classification of pancreatic tumors, pTNM (4th edition 1987) it was used. Only in 25 patients (8%) (tumors pT1a-bN0M0) it was possible to perform radical operation (resection of the pancreas). However in 172 patients (56%) only palliative procedures were done (pT2N1M0). In 95 patients (31%) only laparotomy and biopsy were performed (tumors pT2N1M1). The study shows that although diagnostic methods are improved, the tumors of the pancreas are diagnosed in stages making unable the radical procedures. Only about 10% of carcinomas are resectable. It is caused by with non-characteristic picture of the disease in its early stage.

Ultrasound guided percutaneous fine-needle biopsy of the liver: efficacy of color doppler sonography.

BACKGROUND/AIMS: Fine-needle biopsy (FNB) is one of the diagnostic methods for the diagnosis of focal lesions in the liver. The method is relatively fast, inexpensive and safe. Complications after FNB are observed in only a few cases. Color Doppler sonography (CDS) is one way of minimizing the number of FNB complications. The aim of the present study is to evaluate CDS in the monitoring of FNB in the diagnosis of focal lesions in the liver. METHODOLOGY: The patient group consisted of 73 patients: 28 male and 45 female with a mean age of 53.5 years. Initially, all patients were examined using traditional B-mode gray-scale sonography. After visualization of focal lesions in the liver their echostructure and position were analyzed. Color Doppler sonography was the introduced for the visualization of vascularization of the liver. FNB was performed under the guidance of CDS. The cytological specimens obtained were microscopically evaluated. RESULTS: Of the 73 patients, 18 cases were diagnosed with liver abscess, 19 with cysts of the liver, and 36 with malignant tumors. Amongst the patients with malignancy tumors, the tumors were unifocal in 15 cases, and multifocal in 221. Histopathologically, there were primary hepatocellular carcinomas in 22 patients and metastatic tumors in 14 patients. During the first 48 hours after FNB no complications such as subcapsular hematoma or intraperitoneal bleeding were observed. CONCLUSIONS: Introducing CDS for ultrasound guided percutaneous FNB of the liver avoids such complications as bleeding, especially in patients with a high risk of hemorrhage.