Comparison of the Color Doppler Vascularity Index in Patients with Pancreatic Adenocarcinoma and Chronic Pancreatitis from a Single Center in Poland.

BACKGROUND Pancreatic cancer is one of the most common cancers in the world and a major cause of cancer mortality. Therefore, it is extremely important to distinguish between malignant and benign changes quickly and accurately. This single-center study aimed to assess the discriminatory properties of the color Doppler vascularity index (CDVI) in the diagnosis of focal chronic pancreatitis and malignant pancreatic tumors. MATERIAL AND METHODS Seventy-nine patients (42 men, 37 women; age 62.0±13.5 years; 46 adenocarcinomas; 33 pancreatitis) qualified for this study. During endosonographic examination, pancreatic tumors were assessed in the color Doppler option. The dynamic tissue perfusion measurement was used to calculate tissue flow velocity (TFV), tissue perfusion intensity (TPI), and vascularization as the CDVI. RESULTS TFV, TPI, and CDVI were significantly lower in the group with malignant tumors than in the group with pancreatitis (P<0.001). In the receiver operating characteristic analysis, results of TFV=2.181 cm/s, TPI=0.009 cm/s, and CDVI=0.268 allowed for significant prediction of malignant tumors (P<0.001), with sensitivity of 75.8%, 69.7%, and 72.7% and specificity of 91.3%, 93.5%, and 80.4%, respectively, without significant differences between perfusion parameters and CDVI (P=0.07). CONCLUSIONS The findings from this study showed that color Doppler imaging and the use of the CDVI could provide an adjunctive diagnostic approach to distinguish between pancreatic adenocarcinoma and focal chronic pancreatitis. Owing to the possibility of calculating vascularization by non-Doppler methods, the method may be an easier and more accessible diagnostic option for malignant pancreatic tumors than perfusion assessed in external software.

Elastography in the Diagnosis of Pancreatic Malignancies.

The study aimed to determine the usefulness of the elastography in the diagnosis of malignancy of solid pancreatic tumors. There were 123 patients (F/M; 51/72, aged 62 ± 14) enrolled into the study with the diagnosis of pancreatic masses. Malignant pancreatic adenocarcinoma was identified in 78 patients and an inflammatory mass corresponding to chronic pancreatitis in the remaining 45 patients. The mass elasticity of a tumor (A-elasticity) and a reference zone (B-elasticity) and the B/A strain ratio were measured. All these elastographic parameters differed between groups and correlated significantly with malignancies (r = 0.841; r = -0.834; r = 0.487, respectively). Receiver operating characteristic (ROC) analysis showed that A-elasticity between 0.05% and 0.14% alone, as well as the B/A strain ratio between 7.87 and 18.23 alone, enabled the recognition of all malignant pancreatic tumors with 100% sensitivity and ≥ 97.8% specificity. Surprisingly, B-elasticity alone also was helpful in recognizing malignant tumors (71% sensitivity, 80% specificity, 0.74 accuracy, and 0.792 area under the curve), although it appeared worse than A-elasticity and B/A strain ratio (p < 0.001). In multivariable regression analysis, A-elasticity identified 89.5% of malignancies (p < 0.001). A-elasticity and B-elasticity were the only significant independent factors influencing the tumor identification (r2 = 0.927; p < 0.001). The assessment of tumor elasticity appears sufficient to identify malignant tumors of the pancreas.

Doppler tissue perfusion parameters in recognizing pancreatic malignant tumors.

BACKGROUND: Histopathology, radiological imaging methods with the administration of contrast agents are efficient to differentiate focal lesions of the pancreas. Invasiveness, contrast toxicity, and limited accessibility ameliorate their application. Noninvasive and contrast-agent-free method could improve diagnostics and accelerate treatment. AIMS: The aim of the study is to evaluate the diagnostic properties of ultrasound parameters of organ perfusion in the detection of malignant tumors of the pancreas. METHODS: Thirty-six patients with a focal lesion of the pancreas underwent endosonography with color flow imaging and biopsy for histological evaluation. Five patients were excluded because of the absence of the Doppler signal in pancreatic lesion. In the dynamic tissue perfusion measurement (DTPM) means of flow velocity (FV), resistive index, pulsatility index, and perfusion relief intensity (PR) were estimated. RESULTS: In the group with malignant tumors FV was significantly lower compared with the group with inflammatory changes. In receiver operating characteristic (ROC) analysis FV below the optimal cut-off point of 2.382 cm/s identified patients with malignant lesions with a sensitivity of 92% and specificity of 90%. In the group with malignant tumors significantly lower values of PR in all considered percentiles were observed. Based on the ROC analysis in the group with solid tumors, it was found that PR25 ≤ 0.057 allowed to recognize malignancies with a sensitivity of 100% and specificity of 80%, and in the groups with solid and cystic tumors with a sensitivity of 100% and specificity of 79%. CONCLUSIONS: FV and PR intensity derived from DTPM are reliable markers in recognition of pancreatic malignant masses.

[Hereditary pancreatitis]. / Dziedziczne zapalenie trzustki.

Hereditary pancreatitis (HP) is a rare, heterogeneous familial disease and should be suspected in any patient who has suffered at least two attacks of acute pancreatitis for which there is no underlying cause and unexplained chronic pancreatitis with a family history in a first- or second degree relative. with an early onset, mostly during childhood. Genetic factors have been implied in cases of familial chronic pancreatitis. The most common are mutations of the PRSS1 gene on the long arm of the chromosome 7, encoding for the cationic trypsinogen. The inheritance pattern is autosomal dominant with an incomplete penetrance (80%). The inflammation results in repeated DNA damage, error-prone repair mechanisms and the progressive accumulation of genetic mutations. Risk of pancreatic adenocarcinoma is a major concern of many patients with hereditary chronic pancreatitis, but the individual risk is poorly defined. Better risk models of pancreatic cancer in individual patients based on etiology of pancreatitis, family history, genetics, smoking, alcohol, diabetes and the patient's age are needed.

[Autoimmune pancreatitis as an element of autoimmune polyglandular syndrome]. / Autoimmunologiczne zapalenie trzustki jako skladowa autoimmunologicznego zespolu wielogruczolowego.

Autoimmune pancreatitis constantly belongs to diseases which often causes significant diagnostic problem and often runs out with surgical intervention as considered to be a pancreatic cancer. Important although usually underestimated problems are polyglandular syndromes, which may consist of autoimmune pancreatitis (AIP) problem as well. This case report is an example of autoimmune polyglandular syndrome (APS), which was connected with the surgical treatment with biliary bypass anastomosis because of the unresectable lesion in the head of pancreas. The definite remission of the pancreatic lesion finally came after a steroid therapy. Differentiation between neoplastic and inflammatory pancreatic tumors very often remains a serious clinical problem. On grounds of imaging and cytopathology exams it is often difficult to decide about the nature of a lesion. The negative result of cytopathological biopsy examination does not finally settle straightforward diagnosis. Diagnostic problems affect also autoimmune pancreatitis. It is worth to undertake attempts to differentiate pancreatic lesions especially in cases of concomitance with other autoimmune polyglandular syndromes. That is because it is connected with completely different treatment and outcome. We should remember about diagnostic criteria of autoimmune pancreatitis. Appropriate diagnosis for patients with AIP gives them a chance to avoid serious surgical resection and possible complications.

D-Galactosamine Intoxication in Experimental Animals: Is it Only an Experimental Model of Acute Liver Failure?

BACKGROUND: Short-term administration of Galactosamine to experimental animals causes liver damage and acute liver failure (ALF), as well as acute renal failure in some cases. The aim of our study was to describe kidney disorders that developed in the course of galactosamine-induced liver failure. MATERIAL AND METHODS: Sprague-Dawley rats were randomly divided into 2 groups: a study group administered galactosamine intraperitoneally and a control group administered saline. RESULTS: All the animals in the study group developed liver damage and failure within 48 h, with significant increase of alanine (p<0.001), aspartate aminotransferases (p<0.0001), bilirubin (p<0.004), and ammonia (p<0.005) and decrease of albumin (p<0.001) concentrations. Acute renal failure was observed in all test animals, with a significant increase in creatinine (p<0.001) and urea (p<0.001) concentrations and a decrease in creatinine clearance (p<0.0012). Moreover, osmotic clearance (p<0.001), daily natriuresis (p<0.003), and fractional sodium excretion (p<0.016) decreased significantly in this group of animals. The ratio of urine osmolality to serum osmolality did not change. Histopathology of the liver revealed massive necrosis of hepatocytes, whereas renal histopathology showed no changes. CONCLUSIONS: Acute renal failure that developed in the course of galactosamine-induced ALF was of a functional nature, with the kidneys retaining the ability to concentrate urine and retain sodium, and there were no renal changes in the histopathological examination. It seems that the experimental model of ALF induced by galactosamine can be viewed as a model of hepatorenal syndrome that occurs in the course of acute damage and liver failure.

[The diagnostic impact and limitations of 24 hour pH monitoring with multichannel intraluminal impedance]. / Znaczenie diagnostyczne i ograniczenia 24 godzinnej pH-metrii przelyku z impedancja.

Gastroesophageal reflux disease (GERD) is a result of reflux of gastric contents into the esophagus. Gastroscopy is often the first examination performed in GERD diagnosis. Some patients have macroscopic lesions, namely erosions, in the esophagus above the cardia of stomach. It enables to diagnose gastroesophageal reflux disease. However, many patients have no macroscopic lesions of the esophageal mucosa in endoscopy. That is why 24-hour pH monitoring with multichannel intraluminal impedance is the gold standard in diagnosis establishing of GERD and make feasible to distinguish acid, weakly acid and nonacid reflux and its correlation with reported symptoms. Impedance-pH is used to establish diagnosis of GERD, in patient qualification to anti-reflux surgery, to find the cause of not efficient reflux disease treatment as well as the cause of extra-esophageal symptoms of reflux disease. During impedance-pH test catheter connected with the recorder is placed in patient's esophagus. Recorded data is analyzed with the computer program. The examination is safe, the only complication that can occur is nasal bleeding, which can be a result of mucosa damage caused while catheter implementation. Nowadays disposable catheters are used, that excludes the risk of catheter related infection. On the basis of pH-impedance results it is possible to divide patients into 3 groups: patients with functional heartburn, patients with esophageal hypersensitivity and abnormal esophageal acid exposure. This classification is very helpful in the choice of treatment - antireflux surgery, proton pump inhibitor or prokinetic therapy.

[Groove pancreatitis--case report]. / Zapalenie trzustki okolicy "bruzdy"--opis przypadku.

Groove pancreatitis is an uncommon type of chronic pancreatitis. Most patients with groove pancreatitis are middle-aged men, smokers with excessive alcohol consumption. The describing patient is male admitted to hospital for fourth time during last six months because of recurrent abdominal pain, vomiting and lost weight. He has abused an alcohol in the history. The preliminary diagnosis of chronic pancreatitis was made. During hospitalization it was ordinated spasmolitic and analgesic therapy, antibiotic and enteral nutrition. The result of the implemented conservative therapy was successful, but the symptoms recurrented in very short period of time. Due to lack of long term improvement, patient was treated by pancreatoduodenectomy (Whipple's operation). The postoperative material was assessed by the patologist, and it was described focal chronic inflammation of the head of pancreas with fibrosis involving the wall of the duodenum. To diagnose groove pancreatitis in this case many diagnostic test, including endoscopy, imaging were required, but the histopathology was crucial. The patients should be diagnosed very carefully, because of the risk of the overlook of the cancer, which can be very similar in symptoms. The operation is recommended therapy in situation when improvement is short-period, with frequent recurrences or additional examination are uncertain.

Dynamic Doppler Ultrasound Assessment of Tissue Perfusion Is a Better Tool than a Single Vessel Doppler Examination in Differentiating Malignant and Inflammatory Pancreatic Lesions.

Dynamic tissue perfusion measurement (DTPM) and single vessel flow measurement (SVFM) were assessed in differentiating inflammatory and malignant lesions of the pancreas. Sixty-nine patients (age 62.0 ± 14.7; 33 Female and 36 Men; 40 with malignant and 29 with inflammatory lesions) in whom during the endoscopic ultrasound (EUS) of focal pancreatic lesions it was possible to adequately evaluate the flow in the color Doppler, and then perform a biopsy, were qualified for the study. The assessed DTPM parameters flow velocity (TFV), perfusion intensity (TPI), and resistive index (TRI) as well as the following SVFM parameters: flow velocity (FV), volume flow (VolF), and resistive index (RI) differed significantly between the malignant and inflammatory lesions (p < 0.005). TFV and TPI have slightly better discriminatory properties than the corresponding FV and VolF parameters (p < 0.10). Considering the Doppler parameters usually evaluated in a given method, the TPI = 0.009 cm/s (sensitivity 79%, specificity 92%, AUC 0.899, p < 0.001) was significantly better (p = 0.014) in differentiating between inflammatory and malignant pancreatic lesions in comparison to FV = 2.526 cm/s (sensitivity 79%, specificity 70%, AUC 0.731, p < 0.001). Tissue perfusion has better discriminatory properties in the differentiation of solid pancreatic lesions than the Doppler blood flow examination in the single vessel within the tumor.

[Treatment and prophylaxis of alimentary tract lesions caused by non-steroid anti-inflammatory drugs]. / Profilaktyka i leczenie uszkodzen przewodu pokarmowego spowodowanych niesteroidowymi lekami przeciwzapalnymi.

Non steroidal anti-inflammatory drugs (NSAIDs) are of common use. Apart from indisputable advantages their use is associated with adverse events. Those in alimentary tract are the most common and could be serious. Although alimentary tract damage can happen without warning, it is possible to anticipate them and are dependent on known risk factors. Therefore it is advisable to assess gastroenterologic and cardiac risk factors in all patients planned to be treated with those drugs. If there are gastric risk factors prophylactic proton pump inhibitors should be prescribed. The same should be in case of patients receiving small dose of acetylsalicylic acid. In patients with high risk of gastric adverse events and low cardiac, selective COX-2 inhibitors could be used but with proton pump inhibitors. In patients planned with protracted NSAIDs treatment it is advisable to use Helicobacter pylori infection test and in case of eradication should be introduced. After successful Helicobacter pylori treatment in case of other risk factors existence inhibitor proton pump should be used. In paper authors presented prevalence of adverse events associated with non-steroidal anti-inflammatory drugs and possibility of their treatment and prophylaxis.

[Non-variceal bleeding from the upper gastrointestinal tract]. / Krwawienie niezylakowe z górnego odcinka przewodu pokarmowego.

UNLABELLED: Bleeding from the upper part of gastrointestinal tract is very often complication of gastrointestinal diseases. Bleeding is one of the most common cause of hospitalisation in surgical wards. It's found in 15-20% gastric and duodenal ulcer. Bleeding's occurrence is 50-100 on 100,000 citizens. AIM OF THE STUDY: Answers on questions: what was the best procedure with bleeding patient, what were indications to urgent endoscopy in bleeding, what was the best time to endoscopy and what was influence of endoscopy for volume of transfused blood in bleeding patient. MATERIAL AND METHODS: In the years 1999-2003 81 patients were treated by endoscopy because of bleeding from the upper gastrointestinal tract in Ward of General Surgery in hospital in Zyrardow. There were 31 women in medium age 68 and 50 men in medium age 57. All group was divided on 3 smaller groups: A--patients endoscoped in 6 hours from admitting, B--6-12 hours from admitting and C--12-24 hours from admitting. Each place and kind of bleeding was diagnosed in every case and each bleeding was classified to appropriate group according to Forrest's scale, each was treated by an injection endoscopic therapy (adrenalin was used in concentration 1:10.000 in 0.9% of natrium chloratum). RESULTS: Full hemostasis was achieved in 95.1% cases. The recurrence of bleeding was stated in 6 cases (7.4%), in 2 cases (2.5%) hemostasis was obtained by endoscopy (second-look endoscopy), 4 patients (5%) were operated on because of the recurrence and the dynamics of bleeding as well as the lack of possibility of carrying out the endoscopy. Four deaths (5%) were stated although the bleeding of the upper gastrointestinal tract was not the direct reason. The bleeding in each patient was restrained in our own capacity and nobody was directed to a hospital of higher level of reference.It was stated that the endoscopy of upper gastrointestinal tract gave the best effects if it was done as quickly as possible after the patient had been admitted to hospital - in this material 6 hours from admitting. It allows us to diagnose the cause of bleeding and to treat the disease at the time of diagnosing as well as to reduce of the amount of transfused blood. It also makes possible to prepare elective operation, that is to say "buy" time needed for operation when the endoscopy is not sufficient for successful healing. CONCLUSIONS: Endoscopy is the right and repeatable diagnostic and therapeutic tool for treating the bleeding from the upper part of the gastrointestinal tract which allows us to avoid the unnecessary laparotomy. It also makes possible to plan and control the procedure in the circumstances of bleeding from the upper part of gastrointestinal tract. In relation to not numerous contradictions endoscopic therapy of bleeding from the upper gastrointestinal tract should be fundamental diagnostic and healing method in bleeding from the upper part of gastrointestinal tract in each medical unit, which posseses suitable equipment and qualified staff.

[Historical schedule of management of bleeding from the upper part of gastrointestinal tract]. / Rys historyczny postepowania w krwawieniu z górnego odcinka przewodu pokarmowego.

Treatment of bleeding from the upper part of gastrointestinal tract were changed many times. First there were waiting (Hipocrates, Sydenham, Stahl), next transfusion of the blood were initiated (Denis, Blundell, Dieffenbach, Bierkowski, Dungren, Hirszfeld). Big (Rydygier) and small (Dragstedt) operations procedures were attempted. Discovery of endoscopy of gastrointestinal tract (Mikulicz) and initiation of elastic scopes (Hirschowitz) and exploration inhibitor of histamine receptors (H2) and proton pump inhibitors with recognition of role Helicobacter pylori in bleeding were permitted elaborate actual schemas of proceedings.

[New methods of identification and screening of Barrett's esophagus]. / Nowe mozliwosci rozpoznawania i monitorowania przelyku Barretta.

The increase of patients number suffering from neoplastic esophageal diseases bring about application of most modern technics aiming at the earliest possible detection of pathology and the possibility of its efficient screening. The new technics detecting pathology on the cellular level join with the well-known chromo- and magnifying endoscopy. These include the spectroscopy analysis, getting 3D view of magnifying esophageal mucosa. Nowadays, we observe the gradual come back of chromoendoscopy methods that can be enhanced by the picture magnification. High sensitivity and specificity feature the most modern technics though we notice restrictions associated with these methods. In the years to come we believe that some of these methods will become standard with regards to detection and screening of esophageal metaplasia.

[New possibilities for detection of adenomas of the colon]. / Nowe mozliwosci diagnostyczne w ocenie polipów gruczolakowych jelita grubego.

More and more modern diagnostic methods are utilised in detection of colon adenomatous lesions. This trend is associated with increased efficiency of new research techniques as well as the necessity of more accurate assessment of discovered lesions during endoscopic examinations. New techniques can be particularly utilised in detection of flat polypous lesions, whose localisation is especially difficult. Chromoendoscopy, magnifying endoscopy and high-resolution endoscopy are used in diagnostics on a daily basis. Currently developed new diagnostics methods can set new standards in detection of colon adenomatous lesions in the future. The study targets to present modern diagnostic methods and their utilisation in detection of various colon adenomatous lesions.

[Abdominal angina syndrome--case report]. / Zespól anginy brzusznej--opis przypadku.

Bowel atherosclerotic ischemia is one of the type of clinical presentation of this general inflammatory arterial disease. In this article was depicted a case of 58-year-old female with clinical presentation of chronic bowel ischemia, e.g., chronic stomach pain, defecation disturbance and cachexia. Diagnostic process, difficulties during diagnostic and therapy were presented. The patient was referred to the surgery The diagnostic process and surgical treatment performed in our hospital were compared with actual recommendations of specialists and standards.

[Combined management of pancreatic injury after airgunshot--case report]. / Skojarzone leczenie obrazenia trzustki po postrzale z broni pneumatycznej--opis przypadku.

Pancreatic trauma is a big diagnostic and therapeutic challenge for physicians. Because of retroperitoneal localization pancreas is protected from damages. Isolated pancreatic injury is rare. Usually it is connected with a multiple trauma. Damages of the other organs mask the symptoms of pancreas disorders and delay the diagnosis. On the other hand the prognosis is strictly connected with the state of the other organs. Early diagnosis and precise evaluation of the trauma extensiveness determines the appropriate method of the treatment. Surgery is a main therapy but the combined method of management is often necessary, including endoscopy. Computed tomography (CT) is the first diagnostic method showing the pancreatic parenchymas damage and its complications. Endoscopic Retrograde Cholangiopancreatography (ERCP) is the best tool to show the major ductal injury. The status of the major pancreas duct determines surgery management. Often the placement of stents is required. This therapy can save the patient from pancreatectomy. In this article was depicted a case of 19th patient with pancreatic injury who sustained airgun shot. Despite laparotomy and surgery external drainage the pancreatocutaneous fistula appeared. It was successfully treated by endoscopic placement of stent during ERCP.

[Gastroesophageal reflux disease--diagnosis and management]. / Choroba refluksowa przelyku--rozpoznawanie i leczenie.

Gastroesophageal reflux disease is a serious clinical problem. In clinical classification of gastroesophageal reflux disease we differentiate esophageal and non-esophageal syndromes. In case of esophageal syndromes we differentiate based on clinical signs and syndromes with esophageal mucosal lesions based diagnosed on base of upper alimentary tract endoscopic and histopathologic assessment. In clinical diagnosis establishing basics are clinical symptoms as heartburn, regurgitation. Usually, recently found typical symptoms of light intensification can be concluded with diagnosis gastroesophageal reflux disease and without other diagnostic tools treatment could be introduced. Helpful diagnostic test is a test with proton pump inhibitors. Endoscopic assessment should be performed at least once in every patient with chronic gastroesophageal reflux disease in order to eliminate complications (Barrett disease). Main impedance advantage is possibility of reflux diagnosis disregarding ph value. Continuous monitoring of impedance in many segments of esophagus can help to establish direction of reflux and its characteristics and extent establishment. (liquid, gaseous, mixed). The main role in pharmacological gastroesophageal reflux disease treatment plays drugs decreasing acid output, proton pump inhibitors (PPI). Dosage of chronic use should be assess individually. The Basic rule is the use of possibly minimal therapeutic dose of PPI. In this paper authors presented basics of gastroesophageal reflux disease diagnosing, monitoring and treatment.

[Chemoprevention of colorectal cancer]. / Chemoprewencja raka jelita grubego.

Gastrointestinal cancer poses a major clinical challenge in the developed world where the disease is common. Cancer chemoprevention is defined as the use of natural, synthetic or chemical agents to reverse, suppress or prevent carcinogenic progression to invasive cancer. The success of several clinical trials in preventing cancer in high-risk populations suggests that chemoprevention can be rational strategy. Besides, in population-based observational studies, people had lower rates of colorectal cancer if they were taking various agents, including nonsteroidal anti-inflammatory drugs, calcium, folate. Cyclooxygenase-2 inhibitors and NSAIDs reduce the incidence of colonic adenomas. However, these agents are associated with important cardiovascular events and gastrointestinal harms. Contemporary, the balance of benefits to risk does not favor chemoprevention in average-risk individualse.

[TNF alfa polymorphism and course of ulcerative colitis]. / Wplyw polimorfizmu TNF alfa na przebieg wrzodziejacego zapalenia jelita grubego.

UNLABELLED: Inflammatory bowel diseases including ulcerative colitis are associated with prolonged inflammatory process, that is dependent on cytokine production. Among them crucial role plays tumor necrosis factor TNF-alpha. There is proven association between single nucleotyde polimorphism and ability to produce cytokines. AIM: We analyzed association between TNF-alpha (-308) promoter polymorphism and extension of lesions in ulcerative colitis. TNF-alpha (-308) promoter polymorphism. MATERIALS AND METHODS: Analysis was performed using polymerase chain reaction with sequence specific primers method (PCR-SSP) in 48 patients suffering from ulcerative colitis and association between TNF-alpha (-308) promoter polymorphism and ulcerative colitis macroscopic lesions classified according Montreal classification was investigated. RESULTS: No statistically significant association among groups of patients and TNF-alpha (-308) promoter polymorphism was observed. More cases of TNF-alpha (-308) promoter polymorphism associated with low TNF-alpha production were observed in patients with E2 and E3 lesions according to Montreal classification. CONCLUSIONS. There is no direct association between TNF-alpha (-308) promoter polymorphism and ulcerative colitis macroscopic inflammatory lesions evaluated on basis of Montreal classification. There is statistically irrelevant tendency of more cases of pancolitis in group of patient with TNF-alpha (-308) promoter polymorphism associated with low TNF-alpha production.

[Oligosymptomatic alimentary tract perforation in course of Crohn's disease in patient treated with anti-TNF alfa antibodies]. / Skapoobjawowa perforacja przewodu pokarmowego u pacjentki z choroba Lesniowskiego-Crohna leczona przeciwcialem anty-TNF alfa.

Successful Crohn's disease conservative treatment is often associated with use of few, sometimes new drugs. Their clinical use apart from inflammatory process decrease is associated with some risk. In the paper we report a case of 23-year-old woman suffering from Crohn's disease treated successfully with anti-TNF antibodies. Apart from successful anti-inflammatory there were observed not symptomatic perforation of the alimentary tract. Patients treated with strong anti-inflammatory drugs require especially careful monitoring also because of possibility of occurrence of not symptomatic life-threatening conditions.