Acardius acephalus fetus--report of distinctive anatomical anomalies with regards to pathophysiology of TRAP sequence.

Acardiac fetuses are consequences of twin reversed arterial perfusion (TRAP). Here the authors present a case of 40-year-old gravida IX who gave birth to a healthy, 2,900 g female child by a cesarean section. Additionally amorphic 1,020 g maldeveloped fetus was removed. There was a diamnion monochorionic type of twin placenta with incorrect single umbilical arteries (SUA) both in umbilical cord of healthy fetus and in atrophic second umbilical cord. A malformed fetus developed a rather well formed lower leg with four digital foot and oval shape amorphous body mass with omphalocele and eventration of the intestines. X-ray picture showed well visible metatarsal and femur bone and anatomically undefined bones cluster in the central part. A cavity of fetal body contained intestines--the only one well-formed organ, nests of heterotopic pilosebaceous residues, remnants of adrenal glands, well-formed ganglia, and nests of neural tissue covered by neuroepithelium.

Is there a place for practical chemoprevention of colorectal cancer in light of COX-2 heterogeneity?

COX-2 overexpression is widely recognized as an accidental and relatively important factor in the progress of colon neoplasia, but the practical significance of it has not yet been defined. As such, the purposes of the study were: an analysis of the changes of COX-2 expression within colon adenomas in the dependence of progress of dysplastic level within colon adenomas, the analysis of COX-2 expression in cryptal and superficial parts of polyp and, additionally, the analysis of the COX-2 heterogeneity between colon adenomas. One hundred and four cases with completely resected adenomas with high-grade epithelial dysplasia were included in the research. Each polyp had persistent low-grade dysplasia and normal colon mucosa at the base as an internal control. Immunohistochemical analysis with monoclonal COX-2 antibody was performed. Regression of COX-2 expression in high-grade colon intraepithelial lesions (HGCoIN) compared with low-grade colon intraepithelial lesions (LGCoIN) (p = 0.00001) was observed. No correlation between stromal COX-2 expression and either LGCoIN or HGCoIN was found (p > 0.05). The next important observation was a difference in superficial and cryptal COX-2 expression (p < 0.001) and the evident heterogeneity of COX-2 expression among adenomas at LGCoIN as well HGCoIN foci (p < 0.01). The regression of COX-2 expression in high-grade parts of adenomas which we described may result in a reduction of the role of chemoprevention by the use of NSAIDs.

[Prevention and principles of management in case of cardiac tamponade after catheterisation of the subclavian vein in parenteral nutrition]. / Profilaktyka i postepowanie w przypadku tamponady serca po cewnikowaniu zyly podobojczykowej w celu zywienia pozajelitowego.

The authors described different complications after the subclavian vein catheterisation, focusing on the cardiac tamponade. The authors presented the prevention and treatment principles respectively in case of the cardiac tamponade and reported experiences in this field.

Influence of nutritional treatment on the postoperative course in patients with gastric cancer.

PURPOSE: Malnutrition occurs in ca. 60% of all patients with gastric cancer. The obligatory standard for a curative radical oncological procedure is gastrectomy inclusive of regional lymph nodes. Nutritional treatment is expected to decrease possibilities of postoperative complications in patients subjected to curative surgery. The study is aimed at comparing treatment results in patients with gastric cancer subjected to radical surgery, nutritional and non-nutritional treatment respectively. MATERIAL AND METHODS: The study included 176 patients qualified for curative surgery of a total or subtotal gastrectomy. Analysed were 2 groups of patients: group I--not subjected to nutritional treatment, group II--subjected to nutritional treatment, both in the circumoperative period. The groups were compared in respect to: 1) age, 2) sex, 3) nutritional condition, 4) degree of clinical cancer development, 5) histopathological cancer type, 6) kind of surgical procedure performed, 7) antibiotic and antithrombotic prevention. All complications observed in the patients were divided into four kinds: surgical of a high or low risk and general of a high or low risk. RESULTS: Given the above-mentioned estimation parameters, no statistically significant differences between both groups were recorded. Of 176 patients, 27% showed surgical complications and 40% had general complications. No difference (p = 0.60) in the incidence of a high and low risk surgical complications between groups I and II in the circumoperative period was observed, a significant difference (p = 0.03) was recorded in the incidence of general complications. Low risk general complications (respiratory infections) were shown to occur significantly more often (p = 0.005) in patients receiving either parenteral or enteral nutrition after surgery. CONCLUSIONS: A significant part of the patients with a medium degree and a medium to heavy degree of malnutrition subjected to a curative gastrectomy can pass through the postoperative period without using either parenteral or enteral nutrition and with no violations of all the other principles of the postoperative procedure as well as without provoking any significant increase of surgical complications. In case surgical complications should occur and delay resuming natural feeding, it is necessary that parenteral and/or enteral nutritional treatment be undertaken according to clinical circumstances and condition of the patient concerned; such proceedings increase chances of cure.

Effects of truncal or highly selective vagotomy on the electron microscopic feature of the rabbit pancreas.

PURPOSE: To perform a comparative study of two types of vagotomy: trunctal vagotomy (TV) and highly selective vagotomy (HSV) effects on pancreatic morphology assessed with light microscope and ultrastructural changes assessed with electron microscope in rabbits 30, 90 and 180 days after the vagotomy. MATERIAL AND METHODS: The experiments were carried out on 89 male Popielno white rabbits, aged 4-6 months, 2.5 to 3.0 kg of body weight. On the 30th, 90th and 180th day after the vagotomy, rabbits were sacrificed and the pancreases were taken for the light and electron microscopic evaluation. RESULTS: The regressive changes coexisting with adaptive like renewal of epithelial cells and mild interstitial fibrosis resulting from vagotomy were more pronounced in the early post-operative period and tended to normalize in the later post-operative one. All the changes seen in post-operative period were more prominent after TV than after HSV. CONCLUSIONS: Both truncal and highly selective vagotomy affects evidently the morphology and ultrastructure of the pancreas in rabbits however the changes after the first procedure were more advanced than after the latter one. The intensity of the changes is highest early after these operations and tend to normalize in the later post-operative period.