Repair of postpneumonectomy bronchopleural fistula using pedicled pericardial flap supported by fibrin glue.

Effective closure of the postpneumonectomy bronchopleural fistula (PBF) with the use of different techniques still remains a challenge for thoracic surgeons. The aim of this study was to evaluate the efficacy of modified method of PBF closure using pedicled pericardial flap (PPF) supported by fibrin glue (FG). The efficacy of the late PBF closure with the use of two surgical methods was compared. In 10 patients, the edges of the PBF were covered with FG and PPF. In the second group of nine patients, myoplasty was used to close the bronchial fistula. Postsurgical follow-up was for 1 year. In the first group, the healing of the fistula was achieved in 100% of the cases, whereas in the second, myoplasty group, healing was achieved in only 66·67% of the cases. The number of complications was similar in both groups. Pericardial flap supported by fibrin glue can be an effective method adjunctive to the treatment of PBF in selected patients.

[Acute appendicitis masking adenocarcinoma of the cecum]. / Ostre zapalenie wyrostka robaczkowego jako maska gruczolakoraka katnicy.

Acute appendicitis can be the first symptom of the malignant tumour of the cecum. In the article we described case of 76 years old patient who came to the hospital on account pain in the right iliac hole, occurrent for 4 days with nausea and vomiting. Primarily patient classified to the appendectomy. The ultrasound examination showed the pathological mass in projection ileocecal valve and appendicitis. The computer tomography of the abdomen confirmed this diagnosis. The patient became classified to the right-sides hemicolectomy. The result of histopathological examination is adenocarcinoma of the ileocaecal valve and the appendicitis phlegmonous. Patient became classified to the adiuvant chemotherapy in the regional oncological centre.

Efficacy assessment of the drainage with permanent airflow measurement in the treatment of pneumothorax with air leak.

AIM: The aim of this study was to compare the efficacy of the treatment of patients with spontaneous pneumothorax with air leak (AL) using two different chest drainage systems. METHODS: Patients were randomized into two groups: group A included 30 patients (23 males and 7 females, mean age 41.1 ± 16.29 y, range 17-71 y) in which digital drainage system was used, group B with 30 patients (22 males and 8 females, mean age 40.3 ± 15.74 y, range 18-72 y) in which traditional suction drainage system was applied.The following variables were evaluated: intensity of AL, duration of the chest tube drainage, delay in surgery, length of stay, and the overall hospitalization costs. RESULTS: In group A the mean drainage duration was 47.63 hours, the hospitalization time was about 5.10 days, and the cost of hospitalization was €1,495. In group B the mean drainage duration was 84.93 hours, the hospitalization time was 6.97 days, and the hospitalization cost was €1,925. CONCLUSION: The digital drainage system applied in the treatment of AL in patients with pneumothoraces reduced the duration of the drainage, the length of hospital stay, and overall hospitalization costs.

The estimation of metaloproteinases and their inhibitors blood levels in patients with pancreatic tumors.

BACKGROUND: The aim of the study was to evaluate the concentration of proteolytic enzymes, MMP-2 and MMP-9, and their tissue inhibitors, TIMP-1 and TIMP-2, in the blood of patients with benign and malignant pancreatic tumors. METHODS: MMP-2, MMP-9, TIMP-1, and TIMP-2 were evaluated in the patients with benign and malignant pancreatic tumors before surgery and in the 30-day follow-up. The study covered 134 patients aged 54 to 76 years, who were divided into groups by TNM staging. RESULTS: Before the operation, the highest mean concentration of MMP-2 was found in patients with unresectable cancer, whereas the highest level of MMP-9 was in patients with resectable cancer. The highest level of TIMP-1 was noted in patients with inflammatory tumors. In 1 month following the operation, the highest level of MMP-2 was also in patients with unresectable cancer and the highest level of TIMP-2 in patients with inflammatory tumors. CONCLUSIONS: The evaluation of the level of the studied cytokines in the pancreatic tumor patients can be diagnostically significant in the differentiation of benign and malignant changes. The changes in the levels of the studied enzymes and their inhibitors can have a prognostic value in the clinical severity of pancreatic cancer.

Isolated retroperitoneal mixed germ cell tumor presenting as acute abdomen - case report.

Extragonadal germ cell tumors are an uncommon clinical entity. Their prevalence varies between 1 and 5% of all germ cell tumors. Approximately 85-90% of cases have metastatic changes at the time of diagnosis. In our article we would like to present a case of an 18-year-old patient who was admitted to the hospital due to acute abdominal symptoms. A day earlier, the patient suffered blunt abdominal trauma during workout. Post-traumatic changes, which were described after admission in computed tomography, intraoperatively proved to be masses of extraperitoneal tumor.

Giant mesentery fibromatosis presenting as acute abdomen - case report.

Mesentery fibromatosis, also called abdominal desmoid, is a rare clinical entity. It is part of the clinical-pathologic spectrum of so-called deep fibromatoses. The deep fibromatoses encompass a group of benign fibroproliferative processes that are locally aggressive; they may infiltrate the adjacent organs or recur, but do not create distant metastatic lesions. The small bowel mesentery is the most common site of intraabdominal fibromatosis. However, the omentum, ileocolic mesentery, transverse or sigmoid mesocolon, or ligamentum teres may be the site of origin for intraabdominal fibromatosis. Mesenteric fibromatosis occurs in a wide age range of patients, and has no gender or race predilection. Most cases of abdominal fibromatosis occur sporadically. In this article we would like to present a case report of a patient who was admitted to the clinic due to severe abdominal pain with clinically advanced peritoneal signs. The intraoperative findings were astonishing; we found a giant desmoid which originated in the mesentery. The tumor oppressed the ileum, leading to its obstruction.

A case of upper gastrointestinal acute bleeding as a complication of renal carcinoma metastases to the papilla Vateri.

Acute bleeding from metastatic tumour of the papilla Vateri is an extremely rare case. In this report the case of a woman who suffered from complications after a metastatic tumour of the papilla is described. Seventeen years following resection of the kidney due to clear cell carcinoma the patient was admitted to the clinic because of massive bleeding (Forrest IB) to the upper digestive tract in the form of sanguineous vomiting. The conducted diagnostics revealed a bleeding tumour of the papilla Vateri. Endoscopic treatment could not effectively stop the bleeding. A surgical procedure was performed by Whipple's method. A histopathological examination showed a metastatic clear cell tumour of the kidney. The patient was discharged from hospital on the 8(th) day following her admission and was also referred for further oncological treatment. The discussion is based on other cases of rare bleeding from the digestive tract within tumours of the bile duct and papilla Vateri.

Evaluation of prognostic value of selected biochemical markers in surgically treated patients with acute mediastinitis.

BACKGROUND: Monitoring of biochemical markers of inflammation in acute mediastinitis (AM) can be useful in the modification of treatment. This study was a retrospective evaluation of selected biochemical parameters with negative impact on the prognosis in surgically treated patients. MATERIAL/METHODS: There were 44 consecutive patients treated surgically due to AM of differentiated etiology. Selected biochemical markers (WBC, RBC, HGB, HCT, PLT, CRP, PCT, ionogram, protein and albumins) were assessed before surgery and on the 3rd day after surgery. ANOVA was applied to find factors influencing observations. Numerical data [laboratory parameters] were compared by means of medians. RESULTS: The overall hospital mortality rate was 31.82%. In the group of dead patients, there were observed statistically significant lower mean preoperative values of RBC [p=0.0090], HGB [p=0.0286], HCT [p=0.0354], protein [p= 0.0037], albumins [p=0.0003] and sodium [p<0.0001] and elevated values of CRP [P=0.0107] and PCT p<0.0001]. High level of inflammatory markers on day 3 after surgery was found to increase the risk of death - for WBC (by 67%), for CRP (by 88%) and for PCT (by 100%). CONCLUSIONS: Poor prognosis was more frequent in patients with preoperative high levels of CRP, PCT, anemia, hypoproteinemia and hyponatremia. The risk of death increases significantly if in the immediate postoperative period no distinct decrease in WBC count and of the CRP and PCT level is observed. In such a situation the patients should be qualified earlier for broadened diagnostic workup and for reoperation.

[Influence of the shift work on circadian-rhythms compare survey on health service employees and policemen]. / Wplyw pracy zmianowej na rytmy okolodobowe--badania porównawcze na pracownikach sluzby zdrowia i policjantach.

It has been estimating that about 20% working persons works in the shift system. It concerns health service employees and policemen among others. The shift work causes permanent conflict "of biological clock" with required working hours. The work in the night hours is less effective, it is held with greater expensive and triggering the increased tiredness.The aim of overtaken by the authors questionnaire survey amongst the population working in shifts, was to determining the influence of the shift work on the length and the quality of the dream and the tiredness and the sleepiness during day in comparison to group working only on the day shift. MATERIAL AND THE METHOD: The survey was conducted in the group of employees of the Health Service (30 persons) and policemen (20 persons) working in shifts. Healthy volunteers working in the system of the daily work constituted the control group (30 persons). The examination consisted of questionnaire forms which were filled in anonymously, the duration of examining one person lasted 4 weeks. RESULTS: Age and sex of the examined and control group were similar. In the examined period of time the number of night shift was averaged 6. During holidays 47 persons had night changes. Average time of dream was approximately 7 hours, for those who was working only at daily shift. On the following day after the night shift examined slept additionally average about 3 hours. Those who didn't work in shifts slept average 7.5 hour/24. Clinically significant sleeplessness was developed: examined group--18 persons, control group--3 persons. Amongst respondents we measured level of sleepiness during night shift using carolain scale of the sleepiness. Increase of sleepiness and decrease of activity appeared between 2:00 and 6:00 a.m. In the process of the examination a measurement of appearing the indications of exaggerated sleepiness and tiredness was also conducted using the ATS scale. The frequency of appearing was two or even three times bigger in the examined group. In examined group most common was reduction of psychophysical activity and difficulty in maintaining opened eyes. We have noted most often reduction of psychophysical activity and the problem with concentrating the eyesight on the object in the examined group. CONCLUSIONS: 1. The shift work is connected with a substantial effect to the clinical insomnia. 2. Insufficiency of sleep is a frequent occurrence in those who works in shifts especially having above 6 night shift monthly and also having children below 7 years.

Serum MMP 2 and TIMP 2 in patients with inguinal hernias.

BACKGROUND: More than sixty thousand inguinal hernia operations are performed every year in Poland. Despite many years of related research, the exact pathologic mechanism of this condition is still not fully understood. Recent studies suggested a pronounced relationship between the molecular structure of collagen fibers and the activity of metalloproteinases, the enzymes taking part in the degradation of collagen, as well as their tissue inhibitors. MATERIALS AND METHODS: A prospective study has been established to measure serum levels of the matrix metalloproteinase 2 (MMP-2) and Matrix metalloproteinase tissue inhibitor 2 (TIMP-2) in 150 males between the ages of 26 and 70. The control group (CG) consisted of thirty healthy male volunteers of a similar age distribution. RESULTS: Our results indicate that MMP-2 was highest in the direct hernia group, a statistically very significant elevation (P<0(.) 05) of 1562ng mL(-1) against the CG 684ng mL(-1) . The highest level of TIMP, 78ng mL(-1) , was found in the group with recurrent hernia, against 49(.) 5ng mL(-1) of the CG (statistical significance of P<0(.) 05). DISCUSSION: The MMP-2 and TIMP-2 levels were concurrently elevated only in the recurrent hernia group. CONCLUSIONS: The patients with inguinal hernia have a statistically significant increase in serum levels of MMP-2. Our finding of the MMP-2 and TIMP-2 distinctly higher in the patients suffering from recurrence of direct inguinal hernia (reflecting a previous surgical failure) may suggest the theory that the extracellular matrix defect lies at the basis of this disorder.

[The assessment of modification of prosthesis fixation method on visceral interposition during laparoscopic abdominal hernia reconstruction]. / Ocena wplywu modyfikacji techniki mocowania protez na ryzyko interpozycji trzewi podczas laparoskopowej naprawy przepuklin brzusznych.

UNLABELLED: During laparoscopic abdominal hernia repair (LAHR) there is a discrepancy in relative position of mesh and fixation points during the procedure (while abdominal cavity is distended with gas) and afterwards. Therefore, after the surgery the prosthesis becomes corrugated, and tension develops in suture anchoring points. One of the proposed solutions of this problem is to place stabilizing sutures outside the mesh edges and to tie them after emptying the abdominal cavity of CO2. However, due to lack of visualization, viscera entrapment between the mesh and integuments may occur during this stage of surgery. The aim of the study was to assess the effect of fixation technique modification on the risk of visceral interposition between the mesh and integuments and deformation of prostheses fixated this way. MATERIAL AND METHODS: The study was performed in an experimental animal model (12 pigs) by implanting laparoscopically two 6.6x6 cm mesh fragments per animals and tying fixation sutures after emptying the abdominal cavity of CO2. After 6 weeks, visceral interposition between mesh and integuments and such fixated fragments corrugation were assessed. RESULTS: Visceral dislocation between parietal and visceral surface was absent in all 24 assessed meshes, despite fixation under no visual guidance. There were no mesh deformities between anchoring points. CONCLUSIONS: The analysed modification of laparoscopic abdominal hernia repair does not create risk of internal organ interposition between the prosthesis and integuments and prevents mesh from being corrugated.

Influence of pharmacological treatment on blood flow and muscle perfusion in patients with obliterative atheromatosis assessed with isotopic methods. A pilot study.

BACKGROUND: Most of the methods don't give the comparison between blood flow at rest and after exercise. Nuclear medicine allows for such assessment and determination of muscle perfusion indexes. The aim of the study was the comparison of the radioisotopic assessment of lower limbs perfusion at rest and after exercise in patients with obliterative atheromatosis subjected to combined treatment with the standard vascular examinations. MATERIAL/METHODS: 35 patients with stage II according to Fontaine and claudication distance 30-500 m, subjected to the combined medical treatment were included to the study. Basic examinations, claudication distance measurements, standard vascular examinations, and radioisotopic examinations of lower limbs perfusion with Tc99mMIBI were performed in all patients. RESULTS: After 6 months of therapy the results of perfusion scintigraphy showed that combined pharmacological treatment caused the significant improvement of calf perfusion at rest (p<0.05), which justifies its application in chronic ischemia of lower limbs. Such improvement was not observed while analyzing the results of standard vascular indexes. CONCLUSIONS: The use of perfusion scintigraphy allows for precise definition of the state of the limbs perfusion and shows the improvement of lower limbs perfusion at rest after medical treatment. It is a more precise and sensitive examination, gives more information comparing to the standard vascular examinations, and completes standard vascular diagnostics in patients with obliterative atheromatosis.

[Assessment of glutathione peroxidase activity (GPX) in the diagnosis of diffuse pulmonary parenchymal changes]. / Ocena aktywnosci peroksydazy glutationowej (GPX) w diagnostyce rozsianych zmian miazszowych pluc.

UNLABELLED: DNA damage caused by free radicals is one of the mechanisms which are responsible for the occurrence of lung tumors, especially in case of cigarette smokers.Their tumors are radiologically often disseminated changes. AIM OF THIS STUDY: To define the correlation between GPX activity in erythrocyte hemolysate and pulmonary parenchymal extract and the etiology of diffuse pulmonary parenchymal changes. MATERIAL AND METHODS: The study group comprised 40 subjects classified to VTS due to diffuse pulmonary parenchymal changes. The control group included 40 clinically healthy subjects. In the examined group GPX activity in erythrocyte hemolysate and pulmonary parenchymal extract was marked. The material was 5.4 ml of vein blood taken one-time from all subjects and a sample of pulmonary parenchyma obtained during VTS or toracotomy in patients with pulmonary parenchymal changes. RESULTS: Lower values of GPX activity in erythrocyte hemolysate and pulmonary parenchymal extract which are statistically significant were observed compared with the control group. CONCLUSIONS: Higher GPX activity in erythrocyte hemolysate and healthy pulmonary parenchymal extract compared with pulmonary parenchymal changes can show the influence of GPX on the development of disease process. Higher GPX activity in erythrocte hemolysate and pulmonary parenchymal extract in the "sarcoidosis group" compared with the "lung carcinoma group" can be an additional marker in differential dignostics. The determination of GPX activity in erythrocyte hemolysate can be used as a supplementary laboratory test which will facilitate diagnosis of pulmonary parenchymal changes.

[Upper gastrointestinal bleeding in patients with portal hypertension--review of clinical cases from 2002-2008]. / Krwawienia z górnego odcinka przewodu pokarmowego w nadcisnieniu wrotnym--przeglad klinicznych przypadków z lat 2002-2008.

UNLABELLED: Variceal bleed is the most dangerous complication of portal hypertension in patient with liver cirrhosis. Despite of many years of studies and observations there isn't unequivocal pattern of treatment which may prevent of first time and any further variceal bleeding. AIM OF THIS STUDY: To analyze procedure of treatment that we applied in patients treated in 2002-2008 in our clinic. MATERIAL AND METHODS: In our article we analyzed 43 cases of patients with variceal bleeding treated in our clinic in 2002-2008. In all patients it was first episode of variceal haemorrhage. All patients was addicted to alcohol and with advanced liver cirrhosis. In all cases we inserted Sengstaken-Blekmore tube and started pharmacological treatment. If the second haemorrhage was occurred we applied endoscopic procedure with endoscopic variceal ligation. RESULTS: In all patients treated in our clinic we noted two cases of rebleeding and one fatal cases which occurred during second episode of haemorrhage leading to hypovolemic crisis. CONCLUSIONS: Basing on medical reports that we have taken, we may put a conclusion that medical treatment that we have applied was correct and terminate the variceal bleeding.

[Paliative procedures in cholangiocarcinomas--experience of 5 centers]. / Zabiegi paliatywne w raku pecherzyka i/lub dróg zólciowych--doswiadczenia 5 osrodków.

UNLABELLED: Cholangiocarcinomas have been often met in daily practice. Biliar tract neoplasmas are the most important group in adenomas and papillomas. There is the medical and social problem with cancer patients because they call doctor too late when cancer changes reach a high level and only paliative procedures are recommended. In the most cases the prothesis implanted by ERCP and surgical digestive bypasses are applied. AIM OF THE STUDY: was to evaluate some therapeutic methods in paliative treatment applied in patients with biliary tract cancer. MATERIAL AND METHODS: From 01.2003 to 12.2007 (5 years experience) in 4 departments of general surgery and departments of digestive tract diseases the medical treatment of 430 patients with biliary tract cancer was analyzed. All patients were divided into 3 groups: G1--prosthesis by ERCP; G2--percutaneously, transhepatic drainage of biliary tract; G3--surgical digestive bypass. RESULTS: G1 techniques were applied in 75 patients, G2 in 14 cases and G3 in 74 cases. In the last group of patients the following procedures have been performed: triple bypass (TB) in 45 cases (62%), choledochoduodenostomy (ChD) in 7 cases (9%), gastroenterostomy (GE) in 10 patients (13%) and laparotomy with Kehr drainage in 12 patients (16%). The number of complications in G1 group was observed in 31%, in G2--42%, and in G3--63%. 30 days death rate was 14% in G1, 28% in G2 and 18% in G3. Over 12 months survival rate was in G1, 3 months in G2 and 15 months in G3. Differences are statistically sagnificant (p < 0.05). CONCLUSIONS: From all applied methods of paliative treatment the best results were noticed in surgical digestive bypass and implantation of prosthesis by ERCP. After surgical treatment survival rate was higher, but the number of complications was higher in relation to another methods.

[Nonspecific colon ulcer--case report]. / Niespecyficzne owrzodzenie jelita grubego--opis przypadku.

UNLABELLED: Nonspecific colon ulcer (NSCU) was described by Crulveilhier in 1832, but strict definition, occurrence rates and diagnostic and therapeutic guidelines have not been yet established. AIM: to present a case of a rare disease of the colon with discussion on diagnostic and therapeutic principles. CASE REPORT: A 28-year-old female diagnosed for constipation and flatulence underwent endoscopy and a descending colon lumen stenosis, measuring about 1.0 cm in length, with some mucosal erosions, was found. On the basis of the performed diagnostics, unspecific nature of the disease was determined and conservative treatment with endoscopic follow-up was initiated. In a follow-up examination, performed 2 months later, spontaneous ulceration healing was revealed with a scar replacing the abovementioned lesion. DISCUSSION: Clinical symptoms depend on disease dynamics and lesion location. Diagnosis is based on exclusion of known vascular, infective, unspecific inflammatory and traumatic causes. Therapy of uncomplicated causes is based on conservative treatment with endoscopic follow-up. CONCLUSIONS: The disease does not cause any specific clinical symptoms and often mimics other abdominal diseases. Diagnosis is based on exclusion of known causes. Therapy of most uncomplicated cases comprises conservative therapy and endoscopic follow-up.

[Methods of treatment on different clinical stages in pancreatic cancer]. / Sposoby postepowania na róznych stopniach zaawansowansowania klinicznego raka trzustki.

UNLABELLED: Pancreatic cancer is a great surgical problem. Clinical observations confirm 10-15% level of R0 resection ability. Dissatisfying treatment effects results from: lach of simple screening tests, low specificity of methods used to diagnose less than 2 cm lesions, low availability of advanced diagnostic methods (endoscopic ultrasonography), anatomy of pancreatoduodenic area, ability of infiltration adhering structures and causing metastatic tumors. AIM: Retrospective evaluation of treatment methods administered to patients with pancreatic cancer according to different clinical stages. MATERIAL AND METHODS: Medical documentation of 97 patients treated during 2001-2006 period for pancreatic cancer was analyzed. The age of patients was 42-90 years (medium 66.04, SD 10.27). There were 47 women (48.45% of group) aged 43-90 (medium 67.89, SD 9.93) and 50 men (51.55%) aged 42-86 (medium 64.31, SD 10.64). RESULTS: In analyzed group 87 tumors were located in the head of pancreas, 5 in the corpus and 5 in the cauda. In 13 cases (13.40%) partial resection of pancreas was performed. By passing anastomoses were applied in 45 cases: 26 (26.80% of total group) biliar and gastrointestinal, 19 (19.59%) only biliar anastomoses. Thoracovideoscopic splanchnicectomy was performed 26 times (26.80%) as a method of decreasing pain. 6 patients were treated with bile ducts drainage: endoscopic (4) or percutaneous (2). In 7 cases operations were limited to explorative laparotomy. Complication occurred in 5 (38.46%) cases following resection of the pancreas and 13 cases (15.38%) following paliative operations. Perioperative mortality accomplished 15.38% following pancreatic resection and 4.44% in remaining cases. CONCLUSIONS: Pancreatic cancer is a neoplasm connected with unsuccessfull course. In most of cases diagnose is confirmed in clinical stage that disables resection with the aim of curation. Although huge progress in diagnostic methods, operational technique and perioperative care postoperative mortality is high. Videothoracoscopic splanchnicectomy is a worth reccomending method of decreasing pain.

[Thoracoscopic splanchnicectomy--a good therapy of chronic pain related with advanced stage pancreatic cancer]. / Torakoskopowa splanchnicektomia jako metoda leczenia bólu przewleklego u pacjentów z zaawansowanym rakiem trzustki.

At the beginning 1990s, rapid development of videooptic techniques made possible the introduction to the practice, modern method--thoracoscopic splanchnicectomy. This is a little invasive method use in chronic epigastric visceral pain therapy. The aim of the study is presentation of our own experiences in use thoracoscopic splanchnicectomy in therapy of chronic pain related with advanced stage pancreatic cancer. MATERIAL AND THE METHODS: From 2001 to 2006 in the Department of Chest Surgery, Oncologic and General Surgery, University Hospital No. 2, Medical University of Lodz was made 26 thoracoscopic splanchnicectomy at patients with pancreas cancer. Patients were qualified to the operation on the basis of the Prince Henry Hospital Pain Scale (PHHPS)--medially 2.8 the point. In examined group were 16 men (61%) and 10 women (39%). The average age was 58 years. RESULTS: After the operation obtained the significant decrease of the pain intensity, in the third day after surgery patients ranked their epigastric pain at the average of 1.3 the point in PHHPS. All patients could to decrease significantly the doses of their analgesic medications and three from them completely put it away. CONCLUSIONS: Thoracoscopic splanchnicectomy is effective little invasive method therapy of chronic pain related with advanced stage pancreatic cancer.

[The case of numerous foreign bodies in bronchial tree of both lungs and digestive tract]. / Przypadek wystepowania mnogich cial obcych w drzewie oskrzelowym obu pluc i w przewodzie pokarmowym.

The article shows the description of the seldom met case of simultaneous appearing of numerous foreign bodies situated both in air passages and in the alimentary canal at patient of mentally handicapped with the tendency to swallowing of small objects. After observing by guardians of the patients fact of swallowing metallic foreign bodies by him the specified research were made (X-ray pictures, computer tomography) and the presence in the bronchial tree of both lungs and in the upper and lower section of the alimentary canal were confirmed. Swallowed and aspirated objects did not cause no complaints at the patient. Revealed foreign bodies were removed from air passages by using of the bronchofiberoscopy method and the surgical treatment. Foreign bodies of the alimentary canal were voided by patient through natural tract.

A case of three synchronous primary lung cancers within the same lung lobe.

We present the case of a 74-year-old patient with three synchronous primary lung cancers within the same lung lobe. Computed tomography and positron emission tomography investigations revealed two suspicious nodular lesions in the upper lobe of the left lung. Fine-needle aspiration biopsy confirmed that one of the lesions was non-small cell lung cancer. The patient was qualified for surgical treatment, and left upper lobectomy plus lymphadenectomy was performed. Histopathological examination confirmed the presence of three primary cancers in the left lung: keratinizing squamous cell carcinoma, neuroendocrine carcinoma, and acinar adenocarcinoma, localized within the same lung lobe. The patient was classified as having stage T3N1M0 lung cancer (stage IIIA) according to the latest, 7(th) edition of the TNM classification.