Spinal tumours: recommendations of the Polish Society of Spine Surgery, the Polish Society of Oncology, the Polish Society of Neurosurgeons, the Polish Society of Oncologic Surgery, the Polish Society of Oncologic Radiotherapy, and the Polish Society of Orthopaedics and Traumatology.

PURPOSE: The purpose of these recommendations is to spread the available evidence for evaluating and managing spinal tumours among clinicians who encounter such entities. METHODS: The recommendations were developed by members of the Development Recommendations Group representing seven stakeholder scientific societies and organizations of specialists involved in various forms of care for patients with spinal tumours in Poland. The recommendations are based on data yielded from systematic reviews of the literature identified through electronic database searches. The strength of the recommendations was graded according to the North American Spine Society's grades of recommendation for summaries or reviews of studies. RESULTS: The recommendation group developed 89 level A-C recommendations and a supplementary list of institutions able to manage primary malignant spinal tumours, namely, spinal sarcomas, at the expert level. This list, further called an appendix, helps clinicians who encounter spinal tumours refer patients with suspected spinal sarcoma or chordoma for pathological diagnosis, surgery and radiosurgery. The list constitutes a basis of the network of expertise for the management of primary malignant spinal tumours and should be understood as a communication network of specialists involved in the care of primary spinal malignancies. CONCLUSION: The developed recommendations together with the national network of expertise should optimize the management of patients with spinal tumours, especially rare malignancies, and optimize their referral and allocation within the Polish national health service system.

Ovarian cancer diagnosed accidentally during treatment for ruptured ectopic pregnancy: is fertility-sparing surgery a viable alternative? Case report and review of the literature.

According to cancer incidence statistics, it is estimated that 226,000 women are diagnosed annually with epithelial ovarian cancer (EOC) and 140,000 die of the disease worldwide. Ovarian cancer represents the fourth leading cause of all cancer-related deaths in women, and the first cause of death among all gynecological malignancies. With the constant shift towards later parenthood, the growing incidence of EOC in women of reproductive age is noted. Most young EOC women are concerned with preserving their fertility despite oncological outcomes. Nowadays gynecologic oncologists are being asked to include into their decision-making processes the patients' desire for fertility preserving alternatives. The question remains whether it is possible to use fertility-sparing surgery (FSS) without compromising the survival. In the present report, the authors present a case of a 27-year-old patient with ovarian cancer accidentally diagnosed during surgical treatment of an ectopic pregnancy. In this paper, the proper selection of the patients for the conservative management, oncological safety, indications for subsequent chemotherapy, the risk of relapses, obstetrical outcomes, and further oncological control were analyzed based on the largest and most relevant series outcomes data and recommendations. Numerous recent studies have confirm that FSS in young women with early stage of epithelial ovarian cancer, who wish to preserve their childbearing potential, after appropriate selection, appears a viable and safe option. However, there is still a possibility of relapse and regular oncological control is strongly recommended.

Influence of intraoperative using of recombinant tissue plasminogen activator on the development of cerebral angiospasm after subarachnoid haemorrhage in patients with ruptured intracranial aneurysms.

For a few years conducted experimental studies and clinical trials set one's hopes on the role of the fibrynolytic treatment using recombinant tissue plasminogen activator (rt-PA) in preventing cerebral vasospasm. In our study the target population was 45 patients with ruptured saccular aneurysms causing severe SAH. In the group of 24 patients treatment consisted of a single intraoperative injection of 10 mg of rt-PA into the opened basal subarachnoid cisterns following aneurysm clipping. The patients underwent surgery with aneurysm clipping within 72 hours from subarachnoid haemorrhage in all patients. Control group of 21 patients underwent early operation after SAH and rt-PA was not given. All patients had significant basal cistern blood accumulation seen on CT scans preoperatively according to Fisher's grade III. Patients in our study were classified in clinical grade I and II according to classification of Hunt/Hess. Transcranial Doppler Daily examinations in postoperative course were performed in all patients. The postoperative results were evaluated according to Glasgow Outcome Scale. Postoperatively patients were evaluated by daily transcranial Doppler and serial CT scans. TCD demonstrated reduction in the development of vasospasm to a greater degree in the rt-PA treated group. Serial CT examinations demonstrated radical blood clot removal in all rt-PA treated patients. The postoperative results according to the Glasgow Outcome Scale in the rt-PA treated group were as follow: 22 patients were grades I and II, 2 patients were grade III. In the control group 13 patients were grades I and II, 6 patients were grade III, and 2 patients died. In the rt-PA treated group only one patient presented delayed ischemic deficit.

[Chronic subdural hematoma with psychopathological manifestations]. / Przewlekly krwiak podtwardówkowy z manifestacja psychopatologiczna.

A seventy-one-year old male patient was consulted by psychiatrist at the request of family physician on account of growing dementia. The first examination revealed deteriorated verbal contact, deficiency of memory and intellect and problems with sense of locality. Neither hallucinations nor delusions were found. However, after a detailed examination it was established that deterioration in verbal contact was due to aphasia and not dementia. Also, right side hemiparesis of small degree was detected. In spite of these symptoms the patient was able to move by himself. After admission to neurological department, computer tomography of brain was performed. It showed big subdural hematoma whose size was 13.2 by 2.9 cm. Adequate surgery was carried out and the patient was discharged from hospital ten days after operation. During supervisory examination, performed two months after intervention, no psychopathological problems were found. Also, deficiencies of memory, intellect and concentration were normal for the patient's age. The presented instance is a good argument for thorough examination of mental and neurological state, even in apparently evident cases. This description is illustrated with two tomograph pictures of brain.