High-grade surface osteosarcoma of the rib - a case report.

Surface osteosarcomas refers to tumors originating from the surface of bone primarily connected with the periosteum. Approximately 1- 2% of osteosarcomas are located in thoracic bones. These tumors are characterized by wide range of radiologic, morphologic and histologic presentation, mainly affects patients in the second and third decade of life and has very poor prognosis. According to the current WHO classification of OS one of this kind of tumor is highgrade surface osteosarcoma which accounts for 0,4% of all OS cases.

Giant mesentery fibromatosis presenting as acute abdomen - case report.

Mesentery fibromatosis, also called abdominal desmoid, is a rare clinical entity. It is part of the clinical-pathologic spectrum of so-called deep fibromatoses. The deep fibromatoses encompass a group of benign fibroproliferative processes that are locally aggressive; they may infiltrate the adjacent organs or recur, but do not create distant metastatic lesions. The small bowel mesentery is the most common site of intraabdominal fibromatosis. However, the omentum, ileocolic mesentery, transverse or sigmoid mesocolon, or ligamentum teres may be the site of origin for intraabdominal fibromatosis. Mesenteric fibromatosis occurs in a wide age range of patients, and has no gender or race predilection. Most cases of abdominal fibromatosis occur sporadically. In this article we would like to present a case report of a patient who was admitted to the clinic due to severe abdominal pain with clinically advanced peritoneal signs. The intraoperative findings were astonishing; we found a giant desmoid which originated in the mesentery. The tumor oppressed the ileum, leading to its obstruction.

Isolated retroperitoneal mixed germ cell tumor presenting as acute abdomen - case report.

Extragonadal germ cell tumors are an uncommon clinical entity. Their prevalence varies between 1 and 5% of all germ cell tumors. Approximately 85-90% of cases have metastatic changes at the time of diagnosis. In our article we would like to present a case of an 18-year-old patient who was admitted to the hospital due to acute abdominal symptoms. A day earlier, the patient suffered blunt abdominal trauma during workout. Post-traumatic changes, which were described after admission in computed tomography, intraoperatively proved to be masses of extraperitoneal tumor.

[Influence of the shift work on circadian-rhythms compare survey on health service employees and policemen]. / Wplyw pracy zmianowej na rytmy okolodobowe--badania porównawcze na pracownikach sluzby zdrowia i policjantach.

It has been estimating that about 20% working persons works in the shift system. It concerns health service employees and policemen among others. The shift work causes permanent conflict "of biological clock" with required working hours. The work in the night hours is less effective, it is held with greater expensive and triggering the increased tiredness.The aim of overtaken by the authors questionnaire survey amongst the population working in shifts, was to determining the influence of the shift work on the length and the quality of the dream and the tiredness and the sleepiness during day in comparison to group working only on the day shift. MATERIAL AND THE METHOD: The survey was conducted in the group of employees of the Health Service (30 persons) and policemen (20 persons) working in shifts. Healthy volunteers working in the system of the daily work constituted the control group (30 persons). The examination consisted of questionnaire forms which were filled in anonymously, the duration of examining one person lasted 4 weeks. RESULTS: Age and sex of the examined and control group were similar. In the examined period of time the number of night shift was averaged 6. During holidays 47 persons had night changes. Average time of dream was approximately 7 hours, for those who was working only at daily shift. On the following day after the night shift examined slept additionally average about 3 hours. Those who didn't work in shifts slept average 7.5 hour/24. Clinically significant sleeplessness was developed: examined group--18 persons, control group--3 persons. Amongst respondents we measured level of sleepiness during night shift using carolain scale of the sleepiness. Increase of sleepiness and decrease of activity appeared between 2:00 and 6:00 a.m. In the process of the examination a measurement of appearing the indications of exaggerated sleepiness and tiredness was also conducted using the ATS scale. The frequency of appearing was two or even three times bigger in the examined group. In examined group most common was reduction of psychophysical activity and difficulty in maintaining opened eyes. We have noted most often reduction of psychophysical activity and the problem with concentrating the eyesight on the object in the examined group. CONCLUSIONS: 1. The shift work is connected with a substantial effect to the clinical insomnia. 2. Insufficiency of sleep is a frequent occurrence in those who works in shifts especially having above 6 night shift monthly and also having children below 7 years.

Atypical Locations of Renal Cell Carcinoma Metastases to the Pancreas and Duodenum.

INTRODUCTION: Pancreatic tumors account for a small percentage of all malignancies. Most of them are primary and originate from cells of the exocrine pancreas. The remaining primary changes are neuroendocrine tumors. The pancreas may also be a target of metastatic lesions. The most common cancer that metastasizes to the pancreas is renal cell carcinoma. CASE STUDIES: The paper presents two cases of rare metastases to organs of the abdominal cavity: the first patient treated surgically due to two metastatic lesions of renal cell carcinoma in the pancreas, diagnosed many years after radical nephrectomy. The second case of high gastrointestinal obstruction in the course of metastasis of renal cell carcinoma to the duodenum. The first patient underwent distal laparotomic resection of the pancreas. The second patient underwent resection of the duodenum and the first jejunal loop with side-to-side duodeno-jejunal anastomosis. Both patients remain under oncological supervision. CONCLUSION: Patients after radical nephrectomy due to renal cell carcinoma require long-term systematic monitoring. Due to the anatomical position of the pancreas and duodenum as well as the number, location and size of metastatic lesions, the course of the disease may be initially asymptomatic or oligosymptomatic. Aggressive surgical treatment of pancreatic metastases creates opportunities for long-term survival.

[Assessment of glutathione peroxidase activity (GPX) in the diagnosis of diffuse pulmonary parenchymal changes]. / Ocena aktywnosci peroksydazy glutationowej (GPX) w diagnostyce rozsianych zmian miazszowych pluc.

UNLABELLED: DNA damage caused by free radicals is one of the mechanisms which are responsible for the occurrence of lung tumors, especially in case of cigarette smokers.Their tumors are radiologically often disseminated changes. AIM OF THIS STUDY: To define the correlation between GPX activity in erythrocyte hemolysate and pulmonary parenchymal extract and the etiology of diffuse pulmonary parenchymal changes. MATERIAL AND METHODS: The study group comprised 40 subjects classified to VTS due to diffuse pulmonary parenchymal changes. The control group included 40 clinically healthy subjects. In the examined group GPX activity in erythrocyte hemolysate and pulmonary parenchymal extract was marked. The material was 5.4 ml of vein blood taken one-time from all subjects and a sample of pulmonary parenchyma obtained during VTS or toracotomy in patients with pulmonary parenchymal changes. RESULTS: Lower values of GPX activity in erythrocyte hemolysate and pulmonary parenchymal extract which are statistically significant were observed compared with the control group. CONCLUSIONS: Higher GPX activity in erythrocyte hemolysate and healthy pulmonary parenchymal extract compared with pulmonary parenchymal changes can show the influence of GPX on the development of disease process. Higher GPX activity in erythrocte hemolysate and pulmonary parenchymal extract in the "sarcoidosis group" compared with the "lung carcinoma group" can be an additional marker in differential dignostics. The determination of GPX activity in erythrocyte hemolysate can be used as a supplementary laboratory test which will facilitate diagnosis of pulmonary parenchymal changes.

[Postraumatic rupture of diaphragm with projection of the liver into the right pleural cavity--the case description]. / Pourazowe rozerwanie przepony z przemieszczeniem watroby do prawej jamy oplucnej--opis przypadku.

The proper initial diagnosis of acute diaphragm rupture in patients with multiple blunt trauma can be found difficult. It is the result of non specific clinical picture and dominating signs of injuries of other organs. Delayed diagnosis has a serious impact on worse conditions of diaphragm reconstruction and prognosis. A 53-year-old woman, with a severe abdomen injury after a car accident, is reported with perforation of the alimentary tract in two places (the small bowel and the sigmoid) and respiratory insufficiency caused by the projection of the liver into the thoracic cavity due to a large rupture of the right hemidiaphragm. The patient was initialy treated in another hospital in the intensive care ward where she was operated on three times by laparotomy acces owing to the perforations of the small and large bowels and the following complications. Eventually, she was admitted to our hospital one month after the accident so as to be treated for respiratory insufficiency. We described the difficulties in the treatment of this case in the late period after the injury. Finally the woman was treated with moderate success. Diaphragm laceration was repaired by the right thoracotomy access. In the next stage we performed the reconstruction of the alimentary tract and eliminated iloeostomy and colostomy during the fourth in turn laparotomy. Afterwards the patient in the state of the relative respiratory sufficiency was sent to the original hospital for further treatment.

[Upper gastrointestinal bleeding in patients with portal hypertension--review of clinical cases from 2002-2008]. / Krwawienia z górnego odcinka przewodu pokarmowego w nadcisnieniu wrotnym--przeglad klinicznych przypadków z lat 2002-2008.

UNLABELLED: Variceal bleed is the most dangerous complication of portal hypertension in patient with liver cirrhosis. Despite of many years of studies and observations there isn't unequivocal pattern of treatment which may prevent of first time and any further variceal bleeding. AIM OF THIS STUDY: To analyze procedure of treatment that we applied in patients treated in 2002-2008 in our clinic. MATERIAL AND METHODS: In our article we analyzed 43 cases of patients with variceal bleeding treated in our clinic in 2002-2008. In all patients it was first episode of variceal haemorrhage. All patients was addicted to alcohol and with advanced liver cirrhosis. In all cases we inserted Sengstaken-Blekmore tube and started pharmacological treatment. If the second haemorrhage was occurred we applied endoscopic procedure with endoscopic variceal ligation. RESULTS: In all patients treated in our clinic we noted two cases of rebleeding and one fatal cases which occurred during second episode of haemorrhage leading to hypovolemic crisis. CONCLUSIONS: Basing on medical reports that we have taken, we may put a conclusion that medical treatment that we have applied was correct and terminate the variceal bleeding.

[Acute torsion of the gallbladder--case report]. / Ostre zgorzelinowe zapalenie pecherzyka zólciowego-- opis przypadku.

Torsion of gallbladder is simply defined as a rotation of the gallbladder on its mesentery along the axis of the cystic duct and the cystic artery. It is rare disease which etiology it's still unknown. However we can point some factors postulated as playing causative roles. This disease symptoms mimic acute cholecystitis. In spite of advanced radiological imaging technics there are still problems to set up correct preoperative diagnosis of gallbladder torsion.

Outcome of pleurodesis using different agents in management prolonged air leakage following lung resection.

BACKGROUND AND AIMS: Prolonged air leaks (PAL) are a common problem after pulmonary resection. PAL can be a source of significant complications. One of the treatment options is chemical pleurodesis. MATERIAL AND METHODS: The efficiency of three methods of treatment of PAL after lung resection was evaluated. In Iodine_ group aqueous iodine solution (lat.Tinctura Jodi) was applied intrapleurally (30 patients); in Doxycycline_group (34 patients) 200 mg of Doxycyclin was given and in Drainage_group 35 patients were applied Lidocaine solution only. RESULTS: The group investigated was similar with regard to age [F = 0.04, P = 0.96] and the amount of air leakage (approx. 462 mL/min). The shortest drainage time and hospital stay was observed in the Iodine_group [10.57, P < 0.001]. However, this therapy was connected with strongly perceptible chest pain (P < 0.0001]). The number of case of pneumothorax recurrence was low and it was the same was seen in other methods of treatment [F = 0.87, P = 0.42]. Allergic reactions were not observed. The number of episodes of tachycardia, hypotension, dyspnea, pneumonia, subcutaneus empyema, fluid collection, emphysema, pneumothorax recurrence and number of re-thoracotomies were statistically similar in all three methods of treatment. CONCLUSION: Iodine pleurodesis can be considered as one of possible treatment methods of PAL after lung resection as it showed favorable results compared with Doxycycline pleurodesis or drainage alone regarding duration of air leakage, hospitalization and pneumothorax recurrence with only slightly increased pleural pain.

Oesophageal perforation - therapeutic and diagnostics challenge. Retrospective, single-center case report analysis (2009-2015).

BACKGROUND: Esophageal perforation is a life-threatening condition of a complex etiology. No clear guidelines are available regarding the management of this condition. In this study, we review publications related to esophageal perforation, and analyze patients treated for this condition at our Department of Thoracic, General and Oncological Surgery. OBJECTIVE: The objective of the study was to retrospectively assess and analyze management methods for esophageal perforations of different etiologies. All patients were treated in the Department of Thoracic, General and Oncological Surgery in years 2009-2015. Patients with perforations resulting from post-operational leaks within surgical anastomoses were excluded from the study. Material, methods, results: The analysis involved a total of 16 cases of esophageal ruptures. All cases were treated in years 2009-2015. Patients with perforations resulting from postoperative leaks within surgical anastomoses following elective surgeries for either oncological or non-oncological causes were excluded. The most common reason for esophageal rupture was iatrogenic injury (7 cases, 44%). Other causes included Boerhaave syndrome (5 cases, 31.2%), blunt trauma (2 cases, 12.5%), abscess perforation (1 case, 6.2%), and ulcer perforation (1 case, 6.2%). Ten patients underwent surgery, and the rest underwent esophageal prosthesis placement, of whom 2 cases required drainage of the mediastinum and pleural cavity. The mortality rate in the study group was 9/16 cases (56.2%). CONCLUSIONS: Esophageal perforation poses a significant interdisciplinary challenge regarding diagnostic workup, selection of treatment methods, and management of potential postoperative complications. This retrospective study was conducted in a single center. Although the analyzed period was long, we found only 16 cases. In spite of a variety of etiologies present, we found several statistically significant results of potential clinical value. 1. Most perforations that are not diagnosed within 48 hours affected the lower part of the esophagus and presented with unclear symptoms and imaging findings 2. Delaying diagnosis and treatment beyond 24 hours was associated with a higher mortality rate.

A case of three synchronous primary lung cancers within the same lung lobe.

We present the case of a 74-year-old patient with three synchronous primary lung cancers within the same lung lobe. Computed tomography and positron emission tomography investigations revealed two suspicious nodular lesions in the upper lobe of the left lung. Fine-needle aspiration biopsy confirmed that one of the lesions was non-small cell lung cancer. The patient was qualified for surgical treatment, and left upper lobectomy plus lymphadenectomy was performed. Histopathological examination confirmed the presence of three primary cancers in the left lung: keratinizing squamous cell carcinoma, neuroendocrine carcinoma, and acinar adenocarcinoma, localized within the same lung lobe. The patient was classified as having stage T3N1M0 lung cancer (stage IIIA) according to the latest, 7(th) edition of the TNM classification.

Cervical esophageal rupture after blunt trauma resulting from a car accident.

Traumatic perforation of the cervical esophagus due to blunt trauma is a very rare condition which continues to be associated with significant mortality rates. The symptoms and signs of this injury are often masked by or ascribed to more common blunt thoracic injuries. This paper presents a case of cervical esophageal perforation secondary to blunt trauma resulting from a car accident. The injury was diagnosed early by computed tomography examination, and the patient underwent prompt and successful surgical repair performed to prevent the development of descending mediastinitis.

A very unusual case of attempted suicide.

We would like to present a case report of a very unusual suicide attempt. A 48-year-old female patient tried to commit suicide by stabbing herself with a kitchen knife into her neck. Suicide by self-stabbing is uncommon, constituting only 1-3% of suicide attempts. Patients with self-inflicted stab wounds may have a higher incidence of surgical interventions based on the stab location. Surprisingly, the mortality associated with this kind of wound is low. Most medical centers have very limited experience with this infrequent injury. There are only a few case reports and small series published in the literature of the subject.

A new technique of pulmonary hernia surgical repair using intramedullary titanium implants.

INTRODUCTION: In this paper we present a new method of pulmonary hernia surgical treatment. Pulmonary hernia is a rare pathology. The first description of pulmonary hernia was made by Roland in 1499. The world literature describes only a little more than 300 cases of pulmonary hernia. Pulmonary hernia is defined as the projection of the lung tissue covered by the parietal pleura beyond the normal boundaries of the pleural cavity, through the pathological holes in the chest wall. During our work as thoracic surgeons, we have used different ways of thoracic chest wall reconstructive operations and anastomoses of the broken ribs. AIM OF THE STUDY: To search for optimal methods of pulmonary hernia surgery and to evaluate a new technique of pulmonary hernia surgical repair using intramedullary titanium implants. MATERIAL AND METHODS: In 2013 in our clinic, we diagnosed and cured two patients with idiopathic pulmonary hernia. We performed a reconstructive operation of the chest wall with anastomosis of the broken ribs using titanium intramedullary stabilization implants - splints. RESULTS: To date, the annual observation has revealed no recurrence of pulmonary hernia or postoperative complications. At present, the patients demonstrate full life activity. CONCLUSIONS: So far, in the world literature, we have not encountered any information about using such methods to repair pulmonary hernia. We regard our method as safe, easy to use and giving good therapeutic results.

Evaluation of Patient Feedback following Laparoscopic Cholecystectomy based on Information Described in the Informed Consent form Developed by the Association of Polish Surgeons.

UNLABELLED: The cholecystectomy procedure is the most routinely performed intervention in general surgery. The current international gold standard is via the laparoscopic approach. It is a safe, minimally-invasive procedure; however, it is associated with complications in 1% of cases. The aim of the study was to analyze patient feedback, by means of a survey, to determine how much knowledge patients possessed about their disease state and proposed surgical intervention, based primarily on information contained within the informed consent form developed by the Association of Polish Surgeons. MATERIAL AND METHODS: This study involved the participation of 51 patients who underwent laparoscopic cholecystectomy, indicated by a diagnosis of gallstones, in the years 2014 and 2015. RESULTS: Despite having signed the informed consent form, there was considerable variation among the responses given to the survey by the 51 patients in this study. Some patients' responses were tangential to the questions asked; many patients did not respond to any of the sub points. CONCLUSIONS: Given that this study is based on a small sample size of patients, it must be presumed that the process by which the patient declares his or her informed consent requires further consideration with respect to the means by which it is obtained. The authors of this study thus recommend that multimedia resources be harnessed as part of the process of obtaining the informed consent of patients prior to surgical intervention.

Biological properties of benzopyran-based platinum (II) complexes.

UNLABELLED: The aim of the study was to analyze the physicochemical synthesized complex 3 [(1,3- thiazol -2- ylimino) methyl)]-4H- chromene -4 -one with tetrachloroplatinate(II) dipotassium and determination peroxidase activity and glutathione (GPX) in red blood cells of cancer patients and healthy subjects. MATERIALS AND METHODS: Tests were carried out with the approval of the Bioethics Committee No. RNN/260/08/KB. Blood was collected into tubes with anticoagulant (heparin lithium). Determination of glutathione peroxidase activity was performed by methods of Little and O'Brien in 20 person groups hospitalized at the Department of General and Colorectal Surgery Veterans General Hospital in Lódz. RESULTS: The study was an increase of activity in the control without the compound and after the introduction of the complex relative to the treatment groups. In healthy subjects, without the use of glutathione peroxidase complex averaged 73.25 ± 23.88 U / g Hb after application of the compound corresponds to the reference group 81.01 ± 25.94 U / g Hb. In contrast, in patients without the use of the complex activity amounted to 42.85 ± 27.49 U / g Hb. In the study group, which uses synthesized complex GPX activity corresponds to 67.72 ± 13.44 U / g Hb. CONCLUSIONS: The obtained results underline that the introduction of significant blood antioxidant complex research has a significant impact on the results of the determinations. Statistically significant (p < 0.05) difference occurred in both test and no relation to the administration of the complex in relation to the control of 1. 2.

Primary malignant peripheral nerve sheath tumor of the pleural cavity: rapid progression.

Malignant peripheral nerve sheath tumor (MPNST) accounts for 5-10% of all malignant soft tissue tumors. It often affects the extremities and abdominal cavity and very rarely develops in the thoracic cavity. The incidence in the general population is 0.001%. In our paper we would like to present a case report of a 74-year-old female patient with primary MPNST of the pleural cavity which was previously misdiagnosed as a non-small cell lung cancer. Despite the combined treatment, after four months the patient developed a secondary tumor in the contralateral pleural cavity which was also treated operatively.

Comparison of effectiveness of electrocautery and phenol application in partial matricectomy after partial nail extraction in the treatment of ingrown nails.

UNLABELLED: Ingrowing nail also known as onychocryptosis is a common health problem. This disease mostly affects young people, often carrying a considerable amount of socio-economic implications. It's foot problem that usually manifests as inflammation of tissue along the side of a toenail. The aim of the study was to asses and to compare effectiveness of electrocautery and phenol application in partial matrixectomy after partial nail extraction in the treatment of ingrown toenails. MATERIAL AND METHODS: The group of 60 patients with ingrowing toenail which was randomized into two groups underwent partial matrixectomy in surgical outpatient clinic between 2009-2013. This group of patients was under surgical observation for 100 days in outpatient clinic. RESULTS: In all operated patients we obtained surgical success however we had 13 recurrences during the follow up period, 5 in the phenolization group and 8 in the electrocoagulation group. CONCLUSIONS: There was statistically significant difference between these two techniques, which indicated that matrix phenolization is connected with shortened healing time vs the matrix electrocoagulation.

Strangulation of a Meckel's diverticulum in a femoral hernia (Littre's hernia).

Femoral hernia is usually presented as a flexible, round, domed shape lying on the medial side of the thigh about 2-3 cm below the inguinal ligament. Among the external hernias, femoral hernia is the second most common inguinal hernia. Its prevalence reaches 20%. Among all inguinal hernias, femoral hernias are characterised by a high level of incarceration and strangulation. This can be as high as 60%. We would like to present a case of 71-year-old patient who was admitted to the Clinic urgently due to strangulation of Meckel's diverticulum in a right-sided femoral hernia. Strangulation of Meckel's diverticulum in femoral hernia is an extremely rare entity. It was described for the very first time in 1700 by Littre.