Barogenic rupture of esophagus (Boerhaave syndrome) as diagnostic and therapeutic challenge requiring rapid and effective interdisciplinary cooperation - case report.

We describe a 47-year-old male who was admitted to our centre from a local emergency unit with septic shock due to suspected Boerhaave syndrome. After the diagnosis was confirmed, the patient underwent emergency surgery. Postoperatively, the patient had symptoms of acute alcoholic delirium, and developed an oesophagomediastinal fistula as the most serious local complication. Successful conservative treatment enabled complete healing of the fistula, leading to patient recovery. No late complications like oesophageal stenosis were found at 6 months from discharge.

"Dangerous" anatomic varieties of recurrent motor branch of median nerve.

UNLABELLED: Carpal tunnel release became one of the most common operations in the field of hand surgery. Many controversies has been made about frequency of the so-called dangerous variations of motor branch of the median nerve. Knowledge of all the anatomical variations motor branches is the duty of every surgeon dealing with the subject. The aim of the study was to present the incidence of dangerous variants of median nerve motor branch in the carpal tunnel based on both clinical experience and anatomical studies performed on 20 cadaver wrists. MATERIAL AND METHODS: Between 2006-2012 during minimally open carpal tunnel release we made photographic documentation of all visible dangerous varieties of recurrent motor branches of the median nerve. We also studied 20 cadaver wrists in the Department of Anatomy Medical University in Wroclaw. RESULTS: Dangerous varieties of the motor branch of median nerve was found in three clinical cases and in one cadaver wrist. Also In one wrist we found one regular branche, which, however, has atypical two separate branches supplying the thenar muscles. CONCLUSIONS: Dangerous varieties of the motor branch of median nerve occur very rare in the population, but does not release from the fact that in each case special attention must be given.We also conclude that, at the minimally open carpal tunnel release procedure, the transverse carpal ligament should be released rather from the line of radial border of the 4th finger to minimize the risk of injury to the recurrent motor branch of median nerve.

Chimerism in hand transplantation.

Hand transplantation (HTx), a non-life saving reconstructive procedure, significantly improves the quality of life of upper limb amputees. However, HTx recipients need to take immunosuppressive drugs for the remainder of their lives and, despite dramatic improvements in the safety of modern immunosuppressive protocols, these patients continue to suffer from adverse effects, a fact which raises ethical doubts regarding the legitimacy of HTx given its non-life saving nature. Furthermore, the effectiveness of immunosuppressive treatment in preventing chronic rejection remains unclear. In order to circumvent these important impediments, the ultimate goal of composite tissue allografting (CTA) needs to be the induction of donor-specific tolerance. A possible way of attaining this objective may be chimerism, the coexistence in the host organism of 2 populations of cells of both donor and recipient origin. Clinical experiments of solid-organ transplant recipients and CTA research in animal models provide promising perspectives for establishing chimerism with the use of the facilitating cells and regulatory T-cells. This article reviews the available data on achieved chimerism in HTx and the relevant literature.

Immunohistochemical evaluation of metallothionein, Mcm-2 and Ki-67 antigen expression in tumors of the adrenal cortex.

BACKGROUND: The aim of this study was to assess the metallothionein (MT), maintenance protein 2 (Mcm-2) and Ki-67 expressions in adrenocortical adenomas and carcinomas in comparison to normal tissue and evaluate the correlations between these markers of proliferation and between these markers and tumor diameter. MATERIALS AND METHODS: The expression of MT, Mcm-2 and Ki-67 was assessed by immunochemistry in forty-eight adrenocortical adenomas, six adrenocortical carcinomas and eleven normal adrenal cortex tissue samples. RESULTS: The expressions of MT, Mcm-2 and Ki-67 in the adrenocortical carcinomas were significantly higher than in the adenomas and normal tissue (p<0.05). The levels of Mcm-2 were also higher in the adrenocortical adenomas compared to the normal tissue (p<0.05). The Mcm-2 expression showed a positive correlation to the expression of MT in the adrenocortical carcinomas (r=0.773; p<0.05) and to the expression of Ki-67 in the adrenocortical adenomas (r=0.432; p<0.05). The malignant tumor diameter was positively correlated with the MT and Mcm-2 expressions (r=0.766, p<0.05 and r=0.620, p<0.05, respectively). CONCLUSION: The assessment of Mcm-2 expression seems to be of special importance as a marker of adrenocortical dysplasia and a reliable indicator of malignancy in suspicious masses of the adrenal cortex.

Kaposi's sarcoma revisited.

Kaposi's sarcoma is a puzzling condition of unclear, possibly endothelial origin. It is divided into four distinct types regarding the affected population: classic in elder men of Ashkenazi Jewish and Mediterranean origin; endemic in African infants and young males; iatrogenic in patients under immunosuppressive regimens; epidemic in men having sex with men affected by AIDS. The exact etiopathogenesis of Kaposi's sarcoma continues to elude its researchers. Nonetheless, it has been discovered that human herpesvirus 8 is essential but not sufficient for sarcoma development. Also, iron exposure of populations inhabiting regions with volcanic soils has been suggested to play a pivotal role in the classic and endemic Kaposi's sarcoma etiology. The epidemic Kaposi's sarcoma is strongly associated with HIV's detrimental effect on immune system and HIV's Tat protein proangiogenic properties. Because Kaposi's sarcoma is found also in men having sex with men without AIDS, it has been proposed that certain lifestyle features (e.g. massive semen exposure and inhalant nitrites) may promote transformation of endothelial cells of both lymphatic and vascular origin. Despite numerous studies on Kaposi's sarcoma, it continues to be an incurable disease. The therapeutic approach includes local treatment and systemic administration of cytotoxic, immunomodulator and antiviral drugs. Because of the increasing prevalence of Kaposi's sarcoma, especially in certain parts of Africa, a better understanding of this condition is necessary.