The value of ultrasound in the assessment of cervical and abdominal lymph node metastases and selecting surgical strategy in patients with squamous cell carcinoma of the thoracic esophagus treated with neoadjuvant therapy.

PURPOSE: To establish the role of ultrasound (US) in the assessment of cervical and abdominal lymph node metastases and its impact on making decision about surgical strategy in patients with squamous cell carcinoma of the thoracic esophagus. MATERIAL/METHODS: The results of US lymph node assessment before and after a neoadjuvant treatment in 83 patients were compared with the results of histopathological evaluation of lymph nodes harvested during surgery (transthoracic esophagectomy and 2-field extended or 3-field lymph node dissection). A diagnostic value of cervical and abdominal US in terms of sensitivity, specificity, positive and negative predictive value after a neoadjuvant treatment were determined. RESULTS: The sensitivity, specificity, positive and negative predictive value of the US assessment of cervical lymph node metastases were 100%, 96%, 81% and 100%, respectively. The sensitivity, specificity, positive and negative predictive value of the US assessment of abdominal lymph node metastases were 82%, 94%, 91.5% and 87%, respectively. CONCLUSIONS: The high sensitivity and specificity of cervical US make this investigational method sufficient in the assessment of cervical nodal involvement. In esophageal cancer patients with negative cervical lymph nodes on US, three-field lymph node dissection could be avoided. In patients with positive cervical lymph nodes on US one should consider to extend lymph node dissection about lymph nodes of the neck to achieve a curative resection. In patients with negative abdominal US this investigation should be supplemented by more detailed diagnostic methods.

Vascular endothelial growth factor and basic fibroblast growth factor in patients with squamous cell oesophageal cancer.

It is suggested that vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) play an important role in tumor-induced angiogenesis. The purpose of this study was to estimate the correlation between VEGF and bFGF levels and tumor pathological status according to pTNM classification in patients with squamous cell oesophageal cancer. A group of 25 healthy controls and 32 consecutive patients with oesophageal cancer were included in this study. Serum VEGF and bFGF levels were determined by enzyme-linked immunosorbent assay (Quantikine R&D Systems). Serum VEGF and bFGF levels were significantly elevated in the patient groups (VEGF: 146.0 pg/ml, 79.0-386.3 pg/ml vs. 38.0 pg/ml, 6.5-135.1 pg/ml, p<0.005, and bFGF: 5.2 pg/ml, 1.2-10.6 pg/ml vs. 2.06 pg/ml, 0.07-4.0 pg/ml, p<0.02 Fisher test). The highest correlation between serum VEGF and bFGF levels were found in patients with advanced cancers, especially with: T4, N1, and M1 factors. The VEGF and bFGF levels were significantly higher in patients with pT4 (p<0.01). Patients with N1 lymph node invasion, compared with N0 factor, have higher levels of angiogenetic factors (p<0.04). Also in patients with advanced cancers with liver metastases the serum levels VEGF and bFGF were significantly higher (M1 vs. M0, VEGF p<0.001 and bFGF p<0.05). Consecutive monitoring of VEGF and bFGF serum levels may be a useful prognostic marker for patients with squamous cell oesophageal cancer.

[Comparison of combined (endoscopic sphincterotomy + laparoscopic cholecystectomy) and classical treatment of obstructive jaundice in the course of cholelithiasis]. / Porównanie wyników skojarzonego (ES + ChL) i klasycznego leczenia zóltaczki mechanicznej w przebiegu kamicy zólciowej.

UNLABELLED: Since August 1993 till December 1996, 672 patients with the gallstone disease were submitted to the laparoscopic cholecystectomy (LC). In 78 (11.7%) of them, the endoscopic sphincterotomy (ES) was performed before LC for the treatment of the coexistent obstructive jaundice caused by bile duct stones (Group I). ES was successful in 70 patients (90%). The laparoscopic cholecystectomy was done after the bilirubinemia reached the level within the normal ranges. This period (4 days to 35 days) was dependent on the level of hyperbilirubinemia at presentation. In 12 cases both procedures were performed at the same time. LC was successful in 67 patients (96%). The mean period between ES and LC was 2.7 days. The mean time of hospital stay was 6.3 days. In other 52 patients open cholecystectomy with T drainage was done for the treatment of the gall stone disease complicated by the obstructive jaundice (Group II). Comparing the two group of patients, the significantly shorter time of treatment and hospital stay as well as the lower incidence of complications was observed in Group I. CONCLUSION: ES and LC in patients with the obstructive jaundice caused by stones results in lower morbidity and shorter time of treatment when comparing with patients treated by classical open cholecystectomy with T drainage.

[Comparison of the usefulness of ultrasonography and computed tomography in diagnosis of acute necrotizing pancreatitis]. / Porównanie skutecznosci ultrasonografii i tomografii komputerowej w rozpoznawaniu martwiczego ostrego zapalenia trzustki.

The aim of this paper is to evaluate the sensitivity and specificity of ultrasound and computed tomography imaging in necrotizing acute pancreatitis. Since 01'95 till 12'96 we treated 36 patients with acute pancreatitis. They were diagnosed by US and contrast enhanced CT. 15 patients were intraoperatively classified as necrotizing pancreatitis. US done several times before operations positively predicted only 8 cases as having necrosis (sensitivity 53.3%) and in 7 patients the extension of its spread (specificity 87.5%). Preoperative CT positively predicted 13 cases of necrosis (sensitivity 86.6%) and the extension of its spread was properly stated in 7 patients (sensitivity 46.6%). 4 times preoperative CT was done twice. Contrast enhanced CT is better than US in predicting of the existence of pancreatic necrosis but it is not in evaluation of the extension of necrosis spread.

[Pseudoaneurysm of the pancreas]. / Tetniak rzekomy trzustki.

A case pancreas pseudoaneurysm in chronic pancreatitis in 41-years old man is described. A big (12 cm) cyst with rotating fluid inside has been determined in USG examination. The patient has been operated on. The injury of the hepatic communis artery was the source of bleeding into the cyst. The artery has been ligated and the Jurasz operation has been performed. Post-operative course uncomplicated.