An uncommon case of inflammatory infiltration of the urinary bladder in the long-term process of the purulent inflammation of the cervix and vaginal fornix, complicated with vesicovaginal fistula of unknown etiology.

We shall discuss the case of a female patient, aged 64 years, who was suffering from long-term purulent inflammation of the vaginal fornix that later involved the vaginal stump. This inflammatory process spread to the bladder trigone and resulted in vesicovaginal fistula (VVF) formation together with a bilateral hydronephrosis that required the placement of a temporary percutaneous nephrostomy. A non-cicatrized inflammatory reaction occurred at the right-sided insertion of the nephrostomy, which has yet to be successfully treated despite intensive dermatological and surgical approaches that included skin grafting. In the course of five-year treatment we observed a gradual regression of the inflammatory infiltration of both the trigone of the bladder and the vagina as well as a gradual closing of the VVF. The extremely long-lasting and uncommon local inflammatory reactions in the vagina, bladder, and dermal layers mandated the application of conservative treatment. The possibility of difficulties and defective healing of tissues that could result from surgical correction of the VVF are discouraging for both the patient and medical staff.

[Stevens-Johnson syndrome in the literature and authors' own studies]. / Zespól Stevensa-Johnsona w swietle danych z pismiennictwa i badan wlasnych.

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (Lyell Syndrome) are severe, multisystem disease caused mainly by reaction to drugs. The clinical features include: changes on the skin and mucosa as well as lesions in the internal organs. There are no standards of treatment in this diesease group. There are ongoing trials in various groups of drugs. Apart from providing the appriopriate conditions and symptomatic treatment, immunoglobulins, cytostatics and plasmapheresis are used. The authors present the clinical course of a patient with Stevens-Johnsons Syndrome, probably caused by klaritromycin. The 13 y.o. boy was admitted to a Department of Paediatric Surgery specializing in treatment of burns. Immunoglobulin, cytostatics, antibacterial and antiviral drugs were used as well as topical medicines routinely applied in burns. The method proved to give good results. The treatment of Stevens-Johnsons Syndrome is difficult and expensive. Due to lack of standards, the treatment depends on one's own experience and up to date literature.

[One-stage urethroplasty for penoscrotal hypospadias using Denis Browne (Michalowski's modification) technique in a 50-year-old man]. / Jednoetapowa operacja spodziectwa mosznowo-kroczowego sposobem denisa browne'a w modyfikacji Michalowskiego u 50-letniego mezczyzny.

Authors present a case of 50-year-old man with penoscrotal hypospadias in whom using one-stage techniques repair urethra was reconstructed with good functional and cosmetic effect.

[Congenital duodenal obstruction - part II]. / Wrodzona niedroznosc dwunastnicy -- czesc II.

UNLABELLED: THE AIM of the second part of the study was an evaluation of the treatment in newborns with congenital duodenal obstruction. MATERIAL AND METHODS: In the years 1992-2002 in the Department of Paediatric Surgery at the institute of Mother and Child in Warsaw, 601 newborns with congenital anomalies requiring early surgical intervention were treated. Congenital duodenal obstruction was diagnosed in 35 neonates with birth weight from 800 g to 3450 g. Thirty three patients were operated. Ten of them had associated anomalies of the cardiovascular system, gastro-intestinal and urinary tracts. Additionally, in three of them genetic disorders were suspected. Treatment of all 35 newborns was analysed in order to identify factors influencing prognosis in babies with congenital duodenal obstruction. RESULTS: Twenty-five patients survived (72%), ten patients died (28%). There were not any surgical complications. Two premature infants had died before operative repair, eight neonates after it (8-32 day). Six of them were premature babies with respiratory problems and in three of them genetic disorders were confirmed: Down's syndrome, Cornelia di Lange syndrome and aberration of the fourth and seventh pair of chromosomes. Additionally in six of them serious intrauterine infection was diagnosed. Mortality rate considerably decreased in the last five years, seven deaths occurred between 1992 and 1997 and only one after this time. CONCLUSION: Two groups of risk factors had influence for prognosis in neonates with congenital duodenal obstruction and they were not connected with operative procedures. Associated genetic disorder were the first group of serious risk factors having influence on prognosis, independently of surgical disease. On the other hand prematurity with severe respiratory problems and coexisting intrauterine infection were the most important prognostic factors in survival. Progress in prenatal diagnosis and neonatal intensive care had fundamental influence for improvement of results in the last 5 years.

[Congenital duodenal obstruction -- Part I]. / Wrodzona niedroznosc dwunastnicy -- czesc I.

Congenital duodenal obstruction is a cause of 40% of congenital intestinal obstructions in newborns. In the first part of this study authors describe the etiology, types of this anomaly, clinical symptoms, diagnostic investigation, surgical treatment and problems in postoperative management in the newborns suffering from congenital duodenal obstruction.

[Advances in the treatment of newborns with congenital malformations]. / Postepy w leczeniu noworodków z wadami wrodzonymi wymagajacymi operacji bezposrednio po urodzeniu.

Authors analyzed the type and the number of treated congenital malformations in 544 newborns operated between 1992-2001 in the Department of Paediatric Surgery in the Institute of Mother and Child. The patients were divided in the following groups: digestive tract defects, abdominal wall and diaphragm defects, neural tube defects, urinary track defects, craniofacial and brain defects and others anomalies occurring rarely. Most of the operations were preformed in the first 48 hours of life. Since 1995 special newborn transport, early cardiac surgery and neonatal intensive care have been introduced. Total mortality of operated newborns and death in particular groups were analyzed. The implemented elements caused a decrease in mortality from 36 to 13 percent. In the authors' opinion improvement in treatment results is due to earlier diagnosis and better understanding of pathophysiology of the defects, introduction of noninvasive pre- and postnatal diagnostics and establishment of centres specialized in neonatal surgery and intensive care.

Immunofluorescence in situ and the serologic indices of Chlamydia pneumoniae infection in patients with an abdominal aortic aneurysm.

The aim of the study was to evaluate the frequency of Chlamydia pneumoniae infection in patients with abdominal aortic aneurysm (AAA) using selected methods. The histological specimens of aneurysm wall were evaluated, the method of immunofluorescence was used to reveal the antigen in the wall of AAA and the titers of specific antibodies of IgG, IgM and IgA classes in blood plasma were marked. Atherosclerotic changes in the aneurysm wall were found in all patients. In 20(87%) patients the C. pneumoniae antigen was seen in the wall of abdominal aneurysm using the indirect immunofluorescence method. A significant relation between the method of direct C. pneumoniae diagnosis, aneurysm symptoms and histologically detected inflammation in its wall was confirmed. Serologic markers of the chronic C. pneumoniae infection were seen in 20(87%) out of 23 patients and in 6(30%) out of 20 subjects of the control group and this difference was statistically significant. It was observed, that all patients with serologic indices of active C. pneumoniae infection, had symptomatic aneurysm. The presence of Chlamydia pneumoniae in the wall of AAA as well as the occurrence of serologic indices of the chronic infection in these patients can confirm the hypothesis of the relation between the infection with this microorganism and the development of the disease.