LARGE INTESTINE OBSTRUCTION CAUSED BY PSEUDOPOLYPOSIS IN THE COURSE OF ULCERATIVE COLITIS - A CASE REPORT.

Ulcerative colitis is an inflammatory bowel disease. Opposite to Crohn's disease, it affects only the mucosa and submucosa of the large intestine. The disease can have episodes of flares and remissions. Endoscopy studies often disclose pseudopolyps, which are perceived as non-neoplastic and usually do not require removal. Rarely pseudopolyps can become big or even gigantic, leading to abdominal pain, bowel movement dysfunction, or even bowel obstruction. We present a case of a 37-year-old male patient with ulcerative colitis who was operated on because of a gigantic pseudopolyp causing bowel obstruction.

CYSTIC LYMPHANGIOMA ARISING FROM THE SMALL INTESTINE MESENTERY INCIDENTALLY FOUND DURING SURGERY FOR A LARGE OVARIAN TUMOR - A CASE REPORT.

The aim of this study was presenting significance of diagnostic process in doctor's daily routine. A 45-year-old patient for a planned laparotomy due to left ovarian cyst detected with a routine transvaginal ultrasound. She did not report any symptoms. Computer tomography of the abdomen and pelvis showed a cystic lesion with segmental wall thick¬ening, measuring 133 ☓ 83 ☓ 135 mm, adjacent to the left ovary and the uterus on the left side. At the laparotomy exploration, a giant cyst, ca. 20 cm in diameter was found above the uterus, on the left side, in the area between the lower and middle abdomen. The histological exam results showed lymphangioma of the small and large intestine mesentery. In this case, lymphangioma was found in a rare location, in the mesentery of the ileocecal valve. It did not present any signs and symptoms. CT used in the present case failed to identify the exact point of origin of the lesion.

Chlorophyll fluorescence as a tool for nutrient status identification in rapeseed plants.

In natural conditions, plants growth and development depends on environmental conditions, including the availability of micro- and macroelements in the soil. Nutrient status should thus be examined not by establishing the effects of single nutrient deficiencies on the physiological state of the plant but by combinations of them. Differences in the nutrient content significantly affect the photochemical process of photosynthesis therefore playing a crucial role in plants growth and development. In this work, an attempt was made to find a connection between element content in (i) different soils, (ii) plant leaves, grown on these soils and (iii) changes in selected chlorophyll a fluorescence parameters, in order to find a method for early detection of plant stress resulting from the combination of nutrient status in natural conditions. To achieve this goal, a mathematical procedure was used which combines principal component analysis (a tool for the reduction of data complexity), hierarchical k-means (a classification method) and a machine-learning method-super-organising maps. Differences in the mineral content of soil and plant leaves resulted in functional changes in the photosynthetic machinery that can be measured by chlorophyll a fluorescent signals. Five groups of patterns in the chlorophyll fluorescent parameters were established: the 'no deficiency', Fe-specific deficiency, slight, moderate and strong deficiency. Unfavourable development in groups with nutrient deficiency of any kind was reflected by a strong increase in F o and ΔV/Δt 0 and decline in φ Po, φ Eo δ Ro and φ Ro. The strong deficiency group showed the suboptimal development of the photosynthetic machinery, which affects both PSII and PSI. The nutrient-deficient groups also differed in antenna complex organisation. Thus, our work suggests that the chlorophyll fluorescent method combined with machine-learning methods can be highly informative and in some cases, it can replace much more expensive and time-consuming procedures such as chemometric analyses.

Activity of hawthorn leaf and bark extracts in relation to biological membrane.

The aim of the study was to identify and determine the percent content of polyphenols in extracts from leaves and hawthorn bark, to examine the effect of the extracts on the properties of the biological membrane as well as to determine their antioxidant activity toward membrane lipids. In particular, a biophysical investigation was conducted on the effect of hawthorn extracts on the osmotic resistance and morphology of erythrocyte cells and on the packing of the heads of membrane lipids. Analysis of the polyphenol content of extracts used the HPLC method. Analysis of the polyphenol composition has shown a dominant share of procyanidins and epicatechin in both extracts. The research showed that the polyphenolic compounds contained in hawthorn extracts are incorporated mainly into the hydrophilic part of the erythrocyte membrane, inducing echinocyte shapes. They also diminish the packing order of the lipid polar heads of the membrane, as evidenced by the lowered generalized polarization values of Laurdan. The substances used induced increased osmotic pressure of erythrocytes, making them less sensitive to changes in osmotic pressure. The presence of the extract compounds in the outer hydrophilic part of the erythrocyte membrane, evidenced by examination of the shapes and packing in the hydrophilic part of membrane, indicates that the substances constitute a kind of barrier that protects the erythrocyte membrane against free radicals, while the membrane-bound extracts do not disturb the membrane structure and, thus, do not cause any side effects.

[Wilson disease as the significant risk factor of surgical treatment--clinical case report]. / Choroba Wilsona jako znaczacy czynnik ryzyka leczenia chirurgicznego--opis przypadku klinicznego.

Wilson Disease (W ) is a rare inborn disorder of cooper metabolism. In approximately 40% of cases signs and symptoms of abnormal liver functions are observed due to hepatic inflammation, cirrhosis or insufficiency. The mainstay treatment is the conservative treatment with zinc (eg Zincteral) or penicillamine. The Authors present a patient with WD who underwent surgery because of an advanced rectal prolapse (laparotomy, rectal mobilization, rectopexy, the partial sigmoid colon resection with the primary anastomosis). The postoperative course was complicated by anastomotic leakage and a subsequent diffuse peritonitis. The patient required relaparotomy and three weeks treatment in the intensive therapy unit. The Authors consider the WD as a significant risk factor for surgical patients. Surgical treatment of patients with WD should be least invasive.

[Anorectal Lesniowski-Crohn's disease]. / Choroba Lesniowskiego-Crohna okolicy odbytowo-odbytniczej.

UNLABELLED: Authors retrospectively reviewed results of surgical treatment of the patients with anorectal Lesniowski-Crohn's (LC) disease, operated in the Department of General and Gastroenterological Surgery in Warsaw. MATERIAL AND METHODS: In years 1987-2007 we treated 110 patients with LC disease. The anorectal localization of lesions was noticed in 24 patients (13 women, 11 men, average age of fall--28 year), i.e. 21.8% of all patients. The operations performed in other hospitals were taken into account. Results were compared with literature data. RESULTS: Anorectal lesions were the first signs of LC disease in 16/110 patients (14.5%), and there were most often: perianal fistulas (multiple) in 12, perianal abscesses in 2, and rectovaginal fistula in 2 patients. In the remaining 8 patients (7.3%), anorectal lesions emerged in later period of the disease, formerly placed in other part of digestive tract. The primary local surgical treatment (incision/excision offistulas, abscess drainage) was performed in 20/24 patients. Most frequent indications were: perianal fistulas--13, perianal abscesses--6, and rectovaginal fistula--1. Primary abdominal operations were performed in 4/24 patients: Hartman procedure in 2 patients with rectovaginal fistulas and in other 2 patients with severe colitis--subtotal colectomy and restorative proctocolectomy. The follow-up in 23/24 patients exceeded 5 years, only in 1 patient was 4 years. The surgical recurrences were noticed in 19/24 (79.1%) patients. Recurrences of fistulas were noticed in 11 patients, in addiction in 5 patients we noticed anal stenosis, in 3 rectal/sigmoidal stenosis and in 3 proctitis of the remaining rectal stump. Surgical recurrences of LC disease after 5, 10 and 15 years of observation were 18/23--78.2%, 14/15-93.3%, and 7/7--100% respectively. Two patients (8.3%) died from severe general complications of the disease. The primary local surgical treatment was sufficient only in 2 patients. In 18/22 patients 28 abdominal operations were carried out in later period of the disease. In all 24 patients we performed 46 extended abdominal operations. In result of them 13/24 patients have definitive and 1 temporary stoma. CONCLUSIONS: 1. Surgical treatment of anorectal LC disease should be sparing and performed in the proper time. 2. Surgical treatment of anorectal LC disease is difficult and should be carried out in reference centers. 3. Anorectal LC disease has poor prognosis in terms of fecal and gas continence and creates the risk of proctectomy in up to 20% of cases.

Activation of human peritoneal immune cells in early stages of gastric and colon cancer.

BACKGROUND: The immune reaction of the peritoneum to growing gastrointestinal neoplasms remains unclear. We investigated mobilization of immune cells in peritoneal fluid of gastric and colon cancer, phenotypes and level of activation of recruited cells, and concentration of cellular and peritoneal fluid cytokines. METHODS: Peritoneal cells (PCs) were obtained intraoperatively by peritoneal lavage from 18 patients with adenocarcinoma of the stomach and 32 patients with adenocarcinoma of the colon (all were stage T2N0M0) and 52 patients who underwent elective cholecystectomy as control subjects. RESULTS: The number of PCs harvested from cancer patients was 25 times greater than from control patients (P < .001). In the patients with colon cancer, the percentage of CD68+ macrophages was 1.2 times, of CD14+ monocytes was 2.3 times, and of CD15+ granulocytes was 3 times greater than in control patients (all P < .05). The percentage of HLA DR+ cells exceeded the control values by a factor of 2; and within this population, the percentage of CD3+ HLA DR+ cells exceeded control patients by a factor of 3 (P < .05). The percentage of cytokine-producing cells was greater than in control patients, with values 2 times higher for interleukin (IL)-1, 2.5-times for IL-6, and 6-times for IL-8 (P < .05). The concentration of IL-1 in peritoneal fluid exceeded control values by a factor of 2.2, of IL-6 by a factor of 5.0, of IL-8 by a factor of 3, and of monocyte chemotactic protein-1 by a factor of 2.0 (P < .05). In the patients with gastric cancer, the values for mobilized PC granulocytes were 1.5 times greater than in control patients (P < .05). The frequency rate of cytokine-producing cells remained close to control values. The concentration of peritoneal cytokines did not exceed normal values for IL-1 but was 4 times higher for IL-6 and 2 times higher for IL-8 and monocyte chemotactic protein-1 (all P < .05). When the cancer groups were compared, there was evidently more activated myeloid- and cytokine-producing PC in the patients with colon cancer than in patients with gastric cancer. There was no correlation between the blood and PC phenotype frequency. CONCLUSION: Patients with T2N0M0 colon cancer and to lesser extent gastric cancer evoke a slight but measurable mobilization and activation of PCs.

[Evaluation of the efficacy of surgical treatment of gastroesophageal reflux disease]. / Ocena skutecznosci chirurgicznego leczenia zarzucania zoladkowo-przelykowego.

THE AIM OF THE STUDY: In a group of 100 patients efficacy of surgical treatment of GERD was prospectively assessed. MATERIALS AND METHODS: 37 women and 63 men were qualified into the study. During preoperative period the following symptoms were assessed: heartburn, belching, chest pain, epigastric pain, regurgitations, dysphagia and the following examinations were performed: esophagogastroscopy, esophageal barium meal X-ray examination, esophageal manometry an 24-hours pH-metry. All patients were operated laparoscopically. RESULTS: Based on preoperative esophageal manometry 67 Nissen and 33 Toupet fundoplications were done. Mean patients' age was 51,54 years. Postoperative mortality was 0%. While assessing clinical symptomps one found statistically significant reduction of preoperative complaints, improvement of motility of esophageal body and parameters of lower esophageal sphincter, and normalization of 24-hours pH-metry record. CONCLUSIONS: Antireflux operations effectively reduce pathological GERD and improve esophageal motility.

[Management of large bowel obstruction--own observation]. / Postiepowanie w niedroznosci jelita grubego--obserwacje wlasne.

UNLABELLED: Large bowel obstruction is still a life threatening condition in spite of advances in surgical treatment and critically ill patients care. This study was designed to assess clinical and pathological features and results of surgical treatment for patients with large bowel obstruction. MATERIAL AND METHODS: We reviewed a series of 130 patients treated during a 17.5 years period at one institution. RESULTS: Patients with large bowel obstruction accounted for 12.6% of 780 patients treated because of primary colorectal malignancy and 6.6% of 486 patients treated because of benign diseases of large bowel. Lesion causing obstruction was located in right half of colon in 43 (33.1%) patients (similarly in malignant and benign diseases: 33.6% vs. 31.2%) and in 73 (66.9%) patients in left colon. Primary resection of the lesion was performed in 110 (84.6%) patients and operation was completed with intestinal anastomosis in 73 (65.4%) of them. Hartmann's operation was the most common procedure in remaining 37 patients without bowel anastomosis performed. Perioperative complications occurred in 54 (41.5%) patients. Wound infection was the most often - 20 (15.3%) patients. Overall operative mortality was 13.8% (18 patients). Mortality was 5.5% in 73 patients with resection of the lesion and primary anastomosis performed, and 21.6% in 37 patients with resected lesion without primary anastomosis and 30% in 20 patients after non resective procedures. CONCLUSIONS: Obstruction is a complication occurring two times more frequently in malignant than benign diseases of large bowel. We recommend radical surgery (resection and primary bowel anastomosis) in low risk patients (American Society of Anesthesiologists - ASA, I-II) independently of localisation of causing lesion and Hartmann's operation for high risk patients (ASA III-V).

[Vaginal eviscentration with secondary strangulation of small bowel]. / Wytrzewienie przez pochwe z wtórnym zadzierzgnieciem jelita cienkiego.

A case of 81 year old patient with eviscentration through vagina with a strangulation of small bowel was described. The woman was treated gynecologically and underwent surgery previously. The eviscentration occurred 21 months after last surgery and was connected with high abdominal pressure during defecation. Woman was qualified to an urgent laparotomy, and the hole about 15 mm length in vaginal posterior vault was found. Through the hole passed small bowel which was strangulated. The bowel was removed to the abdominal cavity and during its control no necrosis was found. The color and vascularity return to normal and right peristaltic was noticed. The hole in parietal peritoneum was closed by a continuous suture. The hole in vagina was also closed by the continuous suture from the perineal side. Woman in good general condition was discharged from hospital in the 13th day after surgery.

Pathological analysis of lesions within intestines resected due to ulcerative colitis.

INTRODUCTION: Ulcerative colitis (UC) and Lesniowski-Crohn's disease together constitute a type of intestinal pathology known as Inflammatory Bowel Disease. The etiology of UC still remains unknown, however some epidemiological data suggest the role of bacteria and viruses and also some habitual as well as environmental factors like smoking, diet, drugs, geographical and social status, as well as stress. The genetic predisposition is also suggested. UC affects young people in 2nd - 4th decades of life. Exacerbations of the disease may result in the necessity of surgical treatment, typically in the form of total proctocolectomy accompanied by the subsequent formation of ileo-pouch-anal anastomosis. The aim of our study was to analyze morphological pictures of resected specimens. MATERIAL AND METHODS: We analyzed 67 cases (40 women and 27 men) of UC with the special interest being focused at macro- as well as microscopic features of the intestines resected. We reviewed macroscopic characteristics of intestines (i.e. the length of resected fragments, localization, shape and diameter of the ulcers, polyps, number of resected lymph nodes), as well as microscopic descriptions concerning, among others the character and localization of inflammatory infiltrate, the architecture of glands, the presence of crypt abscesses and Paneth's metaplasia. Special attention was paid to the morphology of intestinal wall vasculature. RESULTS: In 42% of the cases macroscopically the inflammation covered the whole length of the resected colon. In 58% macroscopically detected inflammatory changes were segmental in distribution. In four cases the disease had clinically the fulminant course and the inflammation was transmural. There were 3 cases, in which histological assessment revealed the presence of malignancy (2 cases of mucus producing adenocarcinoma and one case of carcinoma in situ situated in the anal canal). Generally, microscopic findings were typical for the active phase of UC. We found intensive vascularization and hyperemia of the intestinal wall to be the common features accompanying the inflammation. CONCLUSIONS: Young people in the 3rd and 4th decades of life constitute the group being relatively commonly affected by the UC, and undergo the surgical proctocolectomy. Some of the cases present with the fulminant course of the disease. A rich vascular network is a common finding in the inflamed intestinal wall. We hypothesize, that intensive vascularization may play a significant role in the pathogenesis of UC.

Biological activity of new N-oxides of tertiary amines.

Potential biological properties of newly synthesized single and double alkyl chain N-oxides of tertiary amines (NTA) were studied. Individual compounds in each of the series had alkyl chains of different length. Various experiments were performed to determine a mechanism of the interaction between NTA and model and biological membranes. These were measurements of hemolytic efficiencies of NTA (pig erythrocytes), their influence on the transition temperatures (DPPC liposomes), on potassium leakage from cucumber, its growth and chlorophyll content (Cucumis sativus cv. Krak F1), and on the resting membrane potential in alga cells (Nitellopsis obtusa). Also, prevention of erythrocyte membrane lipid oxidation induced by UV irradiation was studied. Potential antioxidative properties of NTA were additionally tested in radical chromogen (ABTS) experiments in which antioxidative efficiencies of NTA were compared to that of the standard antioxidant Trolox. It was found that NTA readily interacted with erythrocyte membranes. Their hemolyzing efficiency increased with the alkyl chain length. Slightly more intensive interaction was found for double alkyl chain compounds. Similar results were obtained in DSC experiments, where incorporation of NTA into liposomal membranes shifted the main transition temperatures and caused a broadening of the main transition peaks depending on the alkyl chain length. Double alkyl chain compounds were also found more efficiently influencing the growth of cucumber. Influence of NTA on the resting membrane potential of algae cells was not quite following the alkyl chain length rule found in erythrocyte and liposome experiments. Also potassium leakage and chlorophyll content determined in physiological experiments were not following the increase of lipophilicity of compounds. Most efficiently influencing those parameters were NTA having shorter alkyl chains, and efficiencies of single alkyl chain compounds were evidently stronger. Both methods used to test the antioxidative properties of NTA showed that they depended on the alkyl chain lengths of compounds within each series, but double alkyl chain ones exhibited markedly greater efficiency.

[Matrix metalloproteinases. Part I]. / Metaloproteinazy macierzy pozakomórkowej. Czesc I.

Metalloproteinases (MMPs) are the extracellular matrix enzymes indispensable in physiological and pathological matrix remodeling. They are produced intracellulary as endopeptidases and secreted to the extracellular space. Under normal conditions MMPs are present in tissues at low levels which increases dramatically during any changes. To date 28 enzymes have been identified and 23 in humans. This paper is a review of metalloproteinases structure, their natural and artificial inhibitors and regulation mechanisms. Function and distribution are critical for pathogenesis and therapy of diseases.

[Extracellular matrix metalloproteinases. Part II]. / Metaloproteinazy macierzy pozakomórkowej. Czesc II.

Remodeling of extracellular matrix is possible due to activity of specific, skilled proteolytic enzymes present in connective tissue. Metalloproteinases (MMPs) are involved most of physiological and pathological processes in human body. To date 28 enzymes have been identified and 23 in humans. This paper is a systemic review of metalloproteinases family. Identification of enzymes in ethiopathogenesis of various diseases is useful in modern therapy planning.

[Postoperative complications in a teaching surgical ward]. / Powiklania chirurgiczne w oddziale klinicznym.

UNLABELLED: Definitive cure of the disease is the essential aim of surgical proceeding. However in some patients who are operated on, unwanted events happen, which make complete recovery delayed or even impossible. These events are known as surgical complications. THE AIM: Presentation of quantitive and qualitative analysis of surgical complications registered in one year of surgical practice of Department of General Surgery, Orlowski Hospital, Warsaw. MATERIAL AND METHODS: In the period between 1.01 and 31.12.2004 we operated on 1384 patients. Complications were registered prospectively, during monthly analysis of patients' medical records. RESULTS: From the number of 1384 patients operated on, 132 patients developed 141 complications (10.2% complication rate in 9.5% patients). CONCLUSIONS: The number of surgical complications reported by other authors differs. This can be explained by differences in methodology of collecting data of complications between the studies. Registering of postoperative morbidity is an important issue in surgical practice. Analysis of complications can lead to improvement in quality of surgical care and health-care management. Introduction of unified system of registration of postoperative complications in all surgical wards would allow making an objective ranking of surgical wards on a given area.

Visceral situs inversus in three patients.

Three examples of patients with complete visceral situs inversus are presented from nineteen years of clinical experience. The first case concerns a 16-year-old woman, who suffered from appendicitis and was operated on one day after the admission. The second case presents a 63-year-old woman admitted and operated on because of colorectal carcinoma. The last case involves a 66-year-old man taken in and operated on due to stomach cancer. A surgical patient with complete visceral situs inversus forces an operator to abandon currently used operating standards. This situation should especially mobilize operator's watchfulness while performing the procedure. Non-typical circumstances occurring during operation increase frequency of incidence of intra-operative complications.

Quality of life before and after laparoscopic fundoplication. Does quality of life depend on psychological factors? Preliminary report.

UNLABELLED: Gastroesophageal reflux disease (GERD) is the most common benign foregut disorder. In many cases multiple factors contribute to the development of esophagitis and result in GERD symptoms. GERD has a definite negative impact on patients' quality of life. The aim of this study was to assess the postoperative results and compare pre- and postoperative quality of life after laparoscopic Nissen or Toupet fundoplication and also to determine if psychological factors have an influence on the quality of life and surgical outcome. MATERIAL AND METHODS: Fifty patients with a proven GERD and hiatal esophageal hernia (HHE) were included in a prospective study. After routine examinations, assessment of quality of life (Gastrointestinal Quality of Life Index--GIQLI) and psychological investigation (Minnesota Multiphasic Personality Inventory--MMPI) the patients underwent laparoscopic fundoplication. Three months after operation all of the patients had quality of life assessment again. RESULTS: Patients were divided into two groups depending on the result of MMPI test. Patients with conversion disorder (CD) preoperatively had significantly lower mean overall score in GIQLI (84.3 +/- 16.3) in comparison to patients without CD (93.0 +/- 19.4). The mean score increased significantly in both groups 3 month after surgery (to 100.6 +/- 21.2 in patients with CD and to 106.7 +/- 18.1 in patients without CD). CONCLUSION: Quality of life in GERD patients is significantly impaired. It shows general improvement after surgery. There are findings in the literature and in our research project showing that comorbidities or psychological factors are able to affect the subjective outcome without any fundamental explanations or basis. Thus, psychological intervention can decrease the spectrum of symptoms and improve the subjective outcome of fundoplication in selected patients.

[Eventrations--the prospective analysis of risk factors of eventrations patients after laparotomy treated in 8 surgical departments of Podkarpacie District]. / Wytrzewienia--prospektywna analiza czynników ryzyka wytrzewien u chorych po laparotomiach, leczonych w 8 osrodkach chirurgicznych Województwa Podkarpackiego.

UNLABELLED: Eventration is still a major surgical problem. Although not very common, but may cause serious complications leading to patient's death. It is observed in 0.2-7% (average 2%) of all the laparotomy. The aim of the study was the analysis of risk factors and frequency of eventrations. MATERIAL AND METHODS: The study was performed in 8 surgical departments in Podkarpacie district since April 2004 till March 2005. RESULTS: During the analysed period there were 4360 laparotomies performed. Eventration was observed in 23 cases (0.52% of all laparotomies performed)--30.5% of the afflicted were females; males constituted the remaining 69.5%. Patients over the age of 70 represented approximately 70% of all of the eventration cases. The most common risk factors were: ASA (American Society of Anesthesiologists) III or higher, low plasma protein level, operations on the large bowel, abdominal midline incision and emergency operations. Occurring eventrations were aseptic, late, III degree. CONCLUSIONS: (1) The frequency of eventrations in hospitals of podkarpacie district is low (0.52% of all laparotomies indicates good technique of wound suture after laparotomy). (2) The eventrations were associated with the following risk factors: age over 70, ASA greater or equal III, low plasma protein level, operations on the large intestine, midline incision and emergency surgeries.