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.

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.

Doppler tissue perfusion measurement is a sensitive and specific tool for a differentiation between malignant and inflammatory pancreatic tumors.

Differentiation between pancreatic malignant and inflammatory tumors presents an important diagnostic problem. The ability to recognize pancreatic malignant tumors using Doppler evaluation of tissue perfusion has been recently demonstrated. The aim of the study was to assess the diagnostic value of Dynamic Tissue Perfusion Measurement (DTPM) in the differentiation between malignant and inflammatory pancreatic tumors. The study included 60 patients (35M, 25F, age 60.9 ± 2.3 years) with a malignant (Group 1, n = 30) or inflammatory (Group 2, n = 30) pancreatic tumor undergoing endoscopic ultrasound with the evaluation of tissue perfusion by Color Doppler and a simultaneous biopsy of lesions for cytological evaluation. In 20 patients the diagnosis was verified in the postoperative histopathological examination. Flow velocity (FV) and percentiles of the distribution of perfusion intensity (PR) evaluated by DTPM were analyzed with regard to receiver-operator-characteristics. FV as well as PR were significantly higher in Group 2 compared to Group 1. A threshold of 2.0 cm/sec for FV identified patients with malignancies with a sensitivity of 83% and specificity of 86%. In multivariable regression analysis, the best PR parameter for differentiating between malignant and inflammatory tumors was 97.5% percentile, whose value of 0.922 allowed for the recognition of pancreatic malignant tumors with a sensitivity of 62% and specificity of 83% (p < 0.001). In conclusion, Color Doppler ultrasound tissue perfusion parameters are a sensitive and specific tool in the differentiation between malignant and inflammatory pancreatic tumors.

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.

The use of endoscopic ultrasonography in the detection and differentiation of pathology in the wall of the upper gastrointestinal tract.

INTRODUCTION: The growing incidence of gastrointestinal diseases forces to improve imaging techniques. Identification of lesions located inside the wall of intestinal tract or in close proximity often was not possible using endoscopy or computed tomography. AIM: To assess the usefulness of endosonography (EUS) in the differentiation between compression from the outside and intramural lesions of the upper gastrointestinal tract. MATERIAL AND METHODS: For 4 years 20,012 patients with performed gastroscopies were enrolled in the study. One hundred and ninety-nine patients (96 females, 103 males; age 62.2 ±14.1 years) with pathology of the wall of the upper gastrointestinal tract qualified for further diagnosis. Endosonography and computed tomography (CT) were performed in each patient. A chest CT was performed in patients with a lesion in the oesophagus. An abdomen CT was performed in patients with pathology in the stomach or duodenum. Based on the results of EUS, histopathology, and imaging, each patient qualified for treatment, endoscopic observation, surgery, or cancer treatment. RESULTS: In EUS 129 (64.8%) intramural lesions were identified. Five (2.5%) diagnoses were false negative. In 62 (31.2%) patients no intramural changes were recognised and three (1.5%) results were false positive. The sensitivity and specificity of EUS was 96.3% and 95.4%, respectively, with positive predictive value 90.7%, negative predictive value 97.8%, and overall accuracy 95% (p < 0.05). Endoscopic therapy was performed in 31 (15.6%) patients, and 99 (49.8%) were classified for endoscopic observation. Surgery was performed in 50 (25.1%) patients, and 19 (9.5%) patients required oncologic treatment. CONCLUSIONS: Endosonography exceeds computed tomography in differentiating compression from the outside and intramural lesions of the upper gastrointestinal tract.

The impact of age and sex on the occurrence of pathology in the wall of the upper gastrointestinal tract.

INTRODUCTION: The growing incidence of gastrointestinal diseases forces to improve both imaging techniques and the identification of the population with a greater risk of a disease. Identification of lesions located inside the wall of intestinal tract or in close proximity often was not possible using endoscopy or computed tomography. AIM: The study was a retrospective evaluation of the occurrence of submucosal lesions (SML) and thickened wall (TW) of the upper gastrointestinal tract (UGIT) depending on age and sex. MATERIAL AND METHODS: Out of 20012 gastroscopies during the 4-year follow-up study, we enrolled 199 patients with pathological lesions in the wall of the UGIT. All patients underwent computed tomography and endoscopic ultrasound (EUS). RESULTS: We analysed a total of 122 (78 males, 44 females, age: 64.0 ±12.9 years) out of 187 patients. 23.91% of SML in the oesophagus, 56.52% in the stomach, and 19.57% in the duodenum. A higher number of SMLs was found in men than in women (57.14% vs. 40.45%, p = 0.023), and the difference was greater over 50 years of age (85.71% vs. 40.00%, p = 0.031). We found less malignant SMLs compared to benign (35.87% vs. 64.13%, p = 0.026), especially in women (22.86% vs. 47.46%, p = 0.006). 26.67% of TW were in the oesophagus, 66.67% in the stomach, and 6.67% in the duodenum. There was a tendency towards increased incidence of TW over 50 years of age (8.58% vs. 18.30%, p = 0.074), which concerned men in particular (24.10% vs. 11.43%, p = 0.043). Until 65 years of age, these differences were significant for the oesophagus (27.27% vs. 0.00%, p = 0.044) and the stomach (25.93% vs. 4.00%, p = 0.029). As many as 70% of TW pathologies were malignant. CONCLUSIONS: Submucosal lesions and TW of the upper gastrointestinal tract account for 0.61% of performed gastroscopies. They occur in men and usually over 50 years of age.

[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.

[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.

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.

Cytokeratins in gastroenterology. Systematic review.

Keratins are proteins that form intermediate filaments of epithelial cell cytoskeleton. The utility of keratin expression determination is based on the fact that epithelial cells acquire a specific pattern of keratin expression during differentiation and maturation, which reflects the specificity of the tissue and the degree of maturation, and generally remains stable during carcinogenesis. Determination of the pattern makes it possible to identify the origin of cells in diagnosing neoplastic lesions as well as in research on pathophysiology or the possibility to apply keratin-positive cell detection in the process of cancer staging and treatment planning. As keratins undergo degradation during apoptosis as caspase substrate the identification of the caspase-derived K18 fragment by the use of specific monoclonal antibody allows us to estimate the apoptosis/necrosis ratio, especially in liver pathology, e.g. nonalcoholic steatohepatitis, chronic hepatitis or graft-versus-host disease or in assessing response to antiviral or antitumour therapy.

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.

Elastography in pancreatic solid tumours diagnoses.

INTRODUCTION: Pancreatic solid tumour diagnoses remain a challenge for modern medicine. However, using endosonography together with elastography helps to examine the elasticity of tissues and therefore may allow definition of the nature of pancreatic tumours. AIM: To evaluate the usefulness of elastography with the strain ratio method and quantitative evaluation of pancreatic solid tumours. MATERIAL AND METHODS: A total of 54 patients with pancreatic solid tumours were treated with ultrasound endosonography with fine-needle aspiration biopsy. The control group contained 26 patients with normal pancreas. Pancreatic solid tumours and normal pancreas were analysed with elastography and elasticity evaluation of the interest area (A), reference (B), and the strain ratio factor (B/A). Postoperative histopathological or cytological examinations were the final diagnoses. Both postoperative and cytological diagnoses were compared with average elasticity parameters (A) and strain ratio factors (B/A). RESULTS: Average elasticity parameters (A) and the strain ratio factors (B/A) were: 0.025% (0.01-0.05%) for malignant process, and (B/A) 33.93 (18.23-75.45); (A) - 0.26% (0.14-0.35%), and (B/A) 5.35 (3.47-7.8) for inflammatory process; (A) 0.54% (0.35-0.82%), and (B/A) 1.79 (1.02-2.05) for normal pancreatic tissue. CONCLUSIONS: Malignant tumours have higher tightness factor compared to inflammatory tumours and normal pancreatic tissue. Elasticity parameters reach the highest levels in normal pancreatic tissue, lower in inflammatory tumours, and the lowest in malignant tumours.

[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.

[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.

[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-erosive reflux disease in endoscopy and histopathology]. / Nienadzerkowa choroba refluksowa przelyku w obrazi endoskopowym i histopatologicznym.

THE AIM: Non-erosive reflux disease is presented in reflux diseases classifications not adequately Many esophageal lesions were described in different endoscopic techniques but not one classification was proposed. In many patients with signs of prolonged gastro-esophageal reflux in endoscopic assessment pale mucosa above gastro-esophageal junction was observed. In some patients color of esophagus in distal part becomes white and grey. We decided to check what histological lesions appear in all endoscopically visible lesions. MATERIAL AND METHODS: We analyzed 29 patients with chronic reflux disease and with endoscopic assessment of upper alimentary tract in which white color was observed in distal part of esophagus was observed. Biopses were taken from sites at least 2 cm from Z-line. Endoscopic assessment was performed by one endoscopist specialized in reflux disease. Biopsies were assessed by one pathologist specialized in upper alimentary tract diseases assessment. RESULTS: In all cases biopsies taken from distal esophageal, white-coloured mucosa were assessed by pathologist as esophagitis caused by gastro-esophageal reflux. CONCLUSIONS: White color of the distal part of esophagus in patients with chronic reflux disease is unanimously associated with microscopic lesions associated with reflux disease.

[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.

[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.