Abietic Acid as a Novel Agent against Ocular Biofilms: An In Vitro and Preliminary In Vivo Investigation.

Biofilm-related ocular infections can lead to vision loss and are difficult to treat with antibiotics due to challenges with application and increasing microbial resistance. In turn, the design and testing of new synthetic drugs is a time- and cost-consuming process. Therefore, in this work, for the first time, we assessed the in vitro efficacy of the plant-based abietic acid molecule, both alone and when introduced to a polymeric cellulose carrier, against biofilms formed by Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans in standard laboratory settings as well as in a self-designed setting using the topologically challenging surface of the artificial eye. These analyses were performed using the standard microdilution method, the biofilm-oriented antiseptic test (BOAT), a modified disk-diffusion method, and eyeball models. Additionally, we assessed the cytotoxicity of abietic acid against eukaryotic cell lines and its anti-staphylococcal efficacy in an in vivo model using Galleria mellonella larvae. We found that abietic acid was more effective against Staphylococcus than Pseudomonas (from two to four times, depending on the test applied) and that it was generally more effective against the tested bacteria (up to four times) than against the fungus C. albicans at concentrations non-cytotoxic to the eukaryotic cell lines and to G. mellonella (256 and 512 µg/mL, respectively). In the in vivo infection model, abietic acid effectively prevented the spread of staphylococcus throughout the larvae organisms, decreasing their lethality by up to 50%. These initial results obtained indicate promising features of abietic acid, which may potentially be applied to treat ocular infections caused by pathogenic biofilms, with higher efficiency manifested against bacterial than fungal biofilms.

Real-Time Impedance-Based Monitoring of the Growth and Inhibition of Osteomyelitis Biofilm Pathogen Staphylococcus aureus Treated with Novel Bisphosphonate-Fluoroquinolone Antimicrobial Conjugates.

Osteomyelitis is a limb- and life-threatening orthopedic infection predominantly caused by Staphylococcus aureus biofilms. Bone infections are extremely challenging to treat clinically. Therefore, we have been designing, synthesizing, and testing novel antibiotic conjugates to target bone infections. This class of conjugates comprises bone-binding bisphosphonates as biochemical vectors for the delivery of antibiotic agents to bone minerals (hydroxyapatite). In the present study, we utilized a real-time impedance-based assay to study the growth of Staphylococcus aureus biofilms over time and to test the antimicrobial efficacy of our novel conjugates on the inhibition of biofilm growth in the presence and absence of hydroxyapatite. We tested early and newer generation quinolone antibiotics (ciprofloxacin, moxifloxacin, sitafloxacin, and nemonoxacin) and several bisphosphonate-conjugated versions of these antibiotics (bisphosphonate-carbamate-sitafloxacin (BCS), bisphosphonate-carbamate-nemonoxacin (BCN), etidronate-carbamate-ciprofloxacin (ECC), and etidronate-carbamate-moxifloxacin (ECX)) and found that they were able to inhibit Staphylococcus aureus biofilms in a dose-dependent manner. Among the conjugates, the greatest antimicrobial efficacy was observed for BCN with an MIC of 1.48 µg/mL. The conjugates demonstrated varying antimicrobial activity depending on the specific antibiotic used for conjugation, the type of bisphosphonate moiety, the chemical conjugation scheme, and the presence or absence of hydroxyapatite. The conjugates designed and tested in this study retained the bone-binding properties of the parent bisphosphonate moiety as confirmed using high-performance liquid chromatography. They also retained the antimicrobial activity of the parent antibiotic in the presence or absence of hydroxyapatite, albeit at lower levels due to the nature of their chemical modification. These findings will aid in the optimization and testing of this novel class of drugs for future applications to pharmacotherapy in osteomyelitis.

Will We Fly Again? Modeling Air Travel Demand in light of COVID-19 through a London Case Study.

The COVID-19 pandemic and associated travel restrictions have created an unprecedented challenge for the air transport industry, which before the pandemic was facing almost the exact opposite set of problems. Instead of the growing demand and need for capacity expansion warring against environmental concerns, the sector is now facing a slump in demand and the continuing uncertainty about the impacts of the pandemic on people's willingness to fly. To shed light on consumer attitudes toward air travel during and post the pandemic, this study presents an analysis that draws on recently collected survey data (April-July 2020), including both revealed and stated preference components, of 388 respondents who traveled from one of the six London, U.K., airports in 2019. Several travel scenarios considering the circumstances and attitudes related to COVID-19 are explored. The data is analyzed using a hybrid choice model to integrate latent constructs related to attitudinal characteristics. The analysis confirms the impact of consumers' health concerns on their willingness to travel, as a function of travel characteristics, that is, cost and number of transfers. It also provides insights into preference heterogeneity as a function of sociodemographic characteristics. However, no significant effects are observed concerning perceptions of safety arising from wearing a mask, or concerns over the necessity to quarantine. Results also suggest that some respondents may perceive virtual substitutes for business travel, for example video calls and similar software, as only a temporary measure, and seek to return to traveling as soon as it is possible to do so safely.

Results of liver transplantation in the Department of General, Transplant and Liver Surgery at the Medical University of Warsaw in patients with chronic hepatitis B and C viruses infection.

INTRODUCTION: Cirrhosis related to hepatitis C virus (HCV) and hepatitis B virus (HBV) infection is the most frequent indication for liver transplantation worldwide. Progress in prophylaxis of posttransplant HBV recurrence has led to major improvements in long-term outcomes of patients after liver transplantation. Conversely, impaired posttransplant survival of patients with HCV infection was reported in several studies, mainly due to recurrence of viral infection. The purpose of this study was to compare long-term results of liver transplantation between patients with HBV monoinfection, HCV monoinfection and HBV/HCV coinfection. MATERIAL AND METHODS: A total of 1090 liver transplantations were performed in the Department of General, Transplant and Liver Surgery in cooperation with the Department of Immunology, Internal Medicine, and Transplantology at the Transplantation Institute Medical University of Warsaw between December 1994 and May 2012. After exclusion of patients with cirrhosis of non-viral etiology, patients with malignant tumors, and patients with acute liver failure, the final study cohort comprised 209 patients with HBV (HBV+/HCV- subgroup; n = 56) or HCV (HBV-/HCV+ subgroup; n = 119) monoinfection or HBV/HCV coinfection (HBV+/HCV+; n = 34). These subgroups of patients were compared in terms of long-term results of transplantations, defined by 5-year patient and 5-year graft survival estimates. RESULTS: Overall and graft survival rates after 5-years for the whole study cohort were 74.5% and 72.6%, respectively. Five-year overall survival was 70.4% for patients within the HBV+/HCV- subgroup, 77.8% for patients within the HBV-/HCV+ subgroup, and 68.5% for patients within the HBV+/HCV+ subgroup. The corresponding rates of graft survival were 67.0%, 76.3%, and 68.5% for patients within the HBV+/HCV-, HBV-/ HCV+, and HBV+/HCV+ subgroups, respectively. Observed differences were non-significant, both in terms of overall (p = 0.472) and graft (p = 0.461) survival rates. CONCLUSIONS: Both overall and graft survival rates after liver transplantations performed in the Department of General, Transplant and Liver Surgery in cooperation with the Department of Immunology, Internal Medicine, and Transplantology at the Transplantation Institute Medical University of Warsaw in patients with HBV and HCV infection are comparable to those reported by other European and American centers. In contrast to other studies, obtained results do not confirm the negative impact of HCV infection on long-term outcomes of patients.

Impact of perceptions and attitudes on air travel choices in the post-COVID-19 era: A cross-national analysis of stated preference data.

The COVID-19 pandemic and the consequent travel restrictions have had an unprecedented impact on the air travel market. However, a rigorous analysis of the potential role of safety perceptions and attitudes towards COVID-19 interventions on future air passenger choices has been lacking to date. To investigate this matter, 1469 individuals were interviewed between April and September 2020 in four multi-airport cities (London, New York City, Sao Paulo, Shanghai). The core analysis draws upon data from a set of stated preference (SP) experiments in which respondents were asked to reflect on a hypothetical air travel journey taking place when travel restrictions are lifted but there is still a risk of infection. The hybrid choice model results show that alongside traditional attributes, such as fare, duration and transfer, attitudinal and safety perception factors matter to air passengers when making future air travel choices. The cross-national analysis points towards differences in responses across the cities to stem from culturally-driven attitudes towards interpersonal distance and personal space. We also report the willingness to pay for travel attributes under the expected future conditions and discuss post-pandemic implications for the air travel sector, including video-conferencing as a substitute for air travel.

Results of liver transplantation for hepatocellular cancer.

BACKGROUND: Liver transplantation (LTx) for hepatocellular carcinoma (HCC) in cirrhotic liver is nowadays generally accepted treatment modality. AIM OF STUDY: Overview of the indications and results of the LTx in the patients with HCC, the first one performed in 2001. MATERIAL/METHODS: Among 357 adult liver transplant recipients in the period 1994-04.2005, in 26 (7%) the indication was HCC (16 men: 10 women, age 20-65, mean 46.5 years). HCC developed in cirrhotic liver in 25 pts. 12 (48%) were Child C, 10 (30%)--Child B and 3 (12%)--Child A patients. As underlying disease in 2 patients (8%) was alcoholic cirrhosis, in 7 (28%)--HBV cirrhosis, in 12 (48%)--HCV cirrhosis and in 4 (16%)--HBV/HCV cirrhosis. Milano criteria were met in 20 patients (77%). The mean waiting list time was 2.9 months (range 1-6 months). Seven patients underwent liver resection and 1 transarterial chemoembolization prior to LTx. 11 patients (42%) were operated on with use of veno-venous bypass, in 15 patients (58%) the piggy back technique was applied. Rapamycine based immunosuppression was preferred in post-LTx treatment. RESULTS: Operative mortality was 0.4 patients required relaparotomy for intraperitoneal bleeding. 21 patients (81%) are alive in good general condition, 19--free of the disease. 5 patients died 7-28 months after LTx (mean 16.7). The mean survival time is 20 months (range 1-38). CONCLUSIONS: Liver transplantation is safe and effective method of treatment of the selected patients with HCC in cirrhotic liver. Further investigations concerning the precise indications, timing of the transplantation and adjuvant treatment are necessary.

[Role of the pathomorphologist in diagnostic process concerning problems of ortothopic liver transplantation in adults]. / Rola lekarza patomorfologa w procesie diagnostycznym zwiazanym z ortotopowym przeszczepem watroby u doroslych.

In this paper are presented main tasks of the pathologist dealing with liver diagnosis concerning problems of its transplantation in adults. They include: pretransplant diagnosis of recipient's liver, examination of explanted liver, evaluation of donor liver (pretransplant biopsies and performed during the operation), posttransplant assessment of the graft. On the basis of our own experience, the most frequent problems in patologist's work and basic information concerning the diagnostic process in liver transplantation with posibillities and limits of the histopathological method are described. Because of the popularity of transplantation as the method of treatment of advanced liver diseases, the group of transplanted patients continously enlarges and may lead to visit to doctors of different specialties. That is why presentation of this issue seems to be very valuable.

[Focal fatty change (FFC) imitating liver malignancy. Own cases and review of literature]. / Ogniskowe stluszczenie watroby (focal fatty change--FFC) pod postacia guzów imitujacych chorobe nowotworowa. Spostrzezenia wlasne i przeglad literatury.

UNLABELLED: Focal fatty change (FFC) may occur in the form of a single or numerous nodules of different size, located in the liver with otherwise normal structure. These changes, especially when they are large and single, pose an important diagnostic problem as their clinical and radiological picture may imitate malignancy. In the paper we report two cases of large hepatic tumors (12 cm and 8 cm) in patients, who had no factors predisposing to fatty liver changes (such as alcohol abuse, drugs, obesity, hormone disturbances, impaired blood flow through the liver or metabolic disturbances). In microscopic examinations the nodules were diagnosed as foci of large-droplet hepatocellular steatosis. Apart from these changes the liver was normal. CONCLUSION: FFC belongs to a group of pseudotumor changes. It occurs in rare cases and should be distinguished from diffuse changes observed frequently. In the differential diagnosis, the following must also be considered: primary hepatocellular tumors with fatty change, FNH with fatty change, mesenchymal tumors containing adipose tissue, fatty macro-regenerative nodule, adipocytic pseudotumor of the Glisson's capsule.

[Amanita phalloides poisoning as an indication for liver transplantation in three family members]. / Zatrucie muchomorem sromotnikowym jako wskazanie do transplantacji watroby u trzech czlonków rodziny.

Amanita phalloides poisoning is one of the most dramatic medical invents. The course of the illness may vary from mild to the lethal, with signs of fulminant liver insufficiency with coma and multiorgan failure. When hepatic encephalopathy (III/IV degrees) occurs the prognosis is very poor. In definite cases the liver transplantation is necessary. The authors present severe Amanita phalloides poisoning in three family members, who due to fulminant hepatic failure underwent liver transplantation. The two of them (son and father) transplanted accordingly in fifth and seventh day after poisoning, survived. Mother, in whom transplantation started in ninth day after poisoning, died intraoperativel with signs of massive hemorrhage, and cardiac arrest.

Hybrid technique for postoperative ventral hernias - own experience.

INTRODUCTION: There are many techniques which may be involved in abdominal hernia repair, from classical to tension-free. Treatment of complicated hernias has undergone evolution. Many surgeons consider the laparoscopic method as a method of choice for incisional hernia repair. Sometimes miniinvasive repair of complicated hernia is not so easy to perform. We are convinced that selected patients may benefit from combined open and laparoscopic techniques. AIM: To present the operating technique and early results of treatment of 15 patients operated on using the 3 hybrid technique. MATERIAL AND METHODS: Fifteen patients suffering from recurrent incisional hernias underwent the hybrid technique for their repair between June 2012 and April 2015. The hybrid technique was performed using synthetic meshes in 14 cases and a biological implant in 1 case. RESULTS: The early postoperative period was uncomplicated in all cases. Within a maximum follow-up period of 32 months, two deep wound infections were observed. CONCLUSIONS: The hybrid technique may be used in patients with recurrent incisional hernias.

Evolution Of The Results Of 1500 Liver Transplantations Performed In The Department Of General, Transplant And Liver Surgery Medical University Of Warsaw.

UNLABELLED: Liver transplantation is a well-established treatment of patients with end-stage liver disease and selected liver tumors. Remarkable progress has been made over the last years concerning nearly all of its aspects. The aim of this study was to evaluate the evolution of long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery (Medical University of Warsaw). MATERIAL AND METHODS: Data of 1500 liver transplantations performed between 1989 and 2014 were retrospectively analyzed. Transplantations were divided into 3 groups: group 1 including first 500 operations, group 2 including subsequent 500, and group 3 comprising the most recent 500. Five year overall and graft survival were set as outcome measures. RESULTS: Increased number of transplantations performed at the site was associated with increased age of the recipients (p<0.001) and donors (p<0.001), increased rate of male recipients (p<0.001), and increased rate of piggyback operations (p<0.001), and decreased MELD (p<0.001), as well as decreased blood (p=0.006) and plasma (p<0.001) transfusions. Overall survival was 71.6% at 5 years in group 1, 74.5% at 5 years in group 2, and 85% at 2.9 years in group 3 (p=0.008). Improvement of overall survival was particularly observed for primary transplantations (p=0.004). Increased graft survival rates did not reach the level of significance (p=0.136). CONCLUSIONS: Long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery are comparable to those achieved in the largest transplant centers worldwide and are continuously improving despite increasing recipient age and wider utilization of organs procured from older donors.

Association of primary sclerosing cholangitis, ulcerative colitis and coeliac disease in female siblings.

Primary sclerosing cholangitis is a rare, cholestatic liver disease, most commonly affecting young men. The association of primary sclerosing cholangitis with other autoimmune disorders, although rare, indicates a genetic predisposition for this disease. We describe, for the first time, the association of primary sclerosing cholangitis, ulcerative colitis and coeliac disease in two sisters. Ulcerative colitis was mild and preceded liver disease in both patients. There were no symptoms of coeliac disease, and its silent form was diagnosed on the basis of serological tests. Both patients carried HLA molecules DR3 and DQ2. Although HLA DR4 was not found, there was a rapid progression of liver disease to cirrhosis and cholangiocarcinoma in one patient. The familial occurrence of primary sclerosing cholangitis, ulcerative colitis and coeliac disease supports the hypothesis of genetic predisposition for these diseases.

Thrombolytic treatment of portal thrombosis.

BACKGROUND/AIMS: The authors present their experience with thrombolytic treatment of "acute" portal thrombosis. METHODOLOGY: Since 1980, portal thrombosis has been diagnosed in 305 patients treated in our Department. Portal thrombosis, mostly chronic, was associated with liver cirrhosis, Budd-Chiari syndrome, inflammatory and malignant liver tumors, as well as hypercoagulation conditions. In half of the patients the etiology of portal thrombosis remained obscure. Herewith, the authors present a retrospective review of 33 cases of rapidly developing portal thrombosis. Abdominal pain, ascites and jaundice were the most frequent initial symptoms. Time interval from the first symptoms appearance to hospitalization ranged from 8 to 60 days. The acute form of portal thrombosis was confirmed by Doppler sonography, spiral computed tomography and angiography. Sixteen female patients were regularly using oral contraceptives, in 8--portal thrombosis coexisted with the Budd-Chiari syndrome, in another 8--with polycythemia or myeloproliferative disorders and in 1 was observed during acute liver failure following paracetamol ingestion. RESULTS: Conservative treatment was unsuccessful in the first 5 cases: all of them died from esophageal variceal bleeding and liver failure. The next 28 patients received fibrinolytic treatment with streptokinase (3 cases) or recombinated tissue plasminogen activator. The results of therapy were evaluated on the basis of clinical picture and Doppler sonography monitoring. Rapid improvement of general condition, with Doppler sonography signs of the portal vein recanalization was noted in 10 patients, in all of whom the history of the disease did not exceed 14 days. In 13 patients with the longer history, partial portal vein occlusion persisted, but restored hepatopetal flow was sufficient to assure normal liver function. In the remaining 5 patients, with the history of the disease lasting longer than 30-40 days, the treatment failed and no clinical or Doppler sonography evidence of restoring of the portal flow were demonstrated. Four patients died: 2 from portal rethrombosis, 1 from liver failure and 1 from cerebral stroke (12, 16 months, 3 months and 4 years after therapy, respectively). Twenty-four patients are alive, the time of follow-up ranging from 9 months to 6 years. In 8 cases, five years after portal system recanalization the first symptoms of portal hypertension occurred. CONCLUSIONS: Thrombolytic treatment of acute portal thrombosis, if administered promptly, appears to be the only way to improve, or even restore, the portal system patency.

Intraabdominal arterio-venous fistulae and their relation to portal hypertension.

BACKGROUND/AIMS: The aim of the study was to present, on the base of own experience, clinical importance of arterio-venous fistulae involving the vascular system of the abdomen. METHODOLOGY: Clinical material consists of 18 patients in whom abnormal arterio-venous leakage in the abdomen was disclosed by means of imaging diagnostic techniques and Doppler sonographic hemodynamic investigations. Three groups of patients were determined: 1. Patients in whom arterio-venous fistula was a primary cause of portal hypertension (N = 6), 2. Patients in whom the presence of arterio-venous fistulae aggravated portal hypertension due to other pathology (N = 7). 3. Patients in whom the arterio-venous fistulae did not directly affect portal flow (N = 5). As each case presented a different clinical problem, the therapeutic approach had to be individualized. In 12 patients perarterial embolization was performed, 13 patients were operated on, one patient was listed for liver transplantation. RESULTS: Perarterial embolization was fully effective only in 4 cases. In the remaining 8 cases its effect was transient, but in 4 cases of liver tumors it allowed us to proceed with chemoembolization and the others were subsequently treated surgically. In 12 surgically treated patients the operation proved to be curative. In 1 case of multiple arterio-venous fistulae related to diffuse angiomatosis, surgical procedure was unfeasible. One patient, awaiting liver transplantation, died of liver failure. CONCLUSIONS: 1. Arterio-venous fistulae (of various etiology) are rarely found in the abdominal cavity, but their presence means usually serious consequences depending on their morphology and localization. 2. Arterio-venous fistulae involving the portal system may result in severe portal hypertension. 3. Individually chosen method of treatment, aimed at the occlusion of arterio-venous fistula often proves to be curative. 4. Overlooking or ignoring the presence of intraabdominal arterio-venous fistulae leads to unsuccessful, if not harmful treatment.

Surgical and interventional radiological treatment of Budd-Chiari syndrome: report of nine cases.

BACKGROUND/AIMS: The authors present the methods and results of treatment of patients with Budd-Chiari syndrome. METHODOLOGY: From a group of 15 patients with Budd-Chiari syndrome, treated in our department from January 1996 to September 2001, nine patients (6 females and 3 males, aged from 23 to 45 years) were qualified for surgical or radiological treatment. In 3 of them the hepatic vein thrombosis resulted from untreated polycythemia. In the remaining 6 cases the etiology of thrombosis remained unknown. In four patients with dominating portal hypertension symptoms, a meso-caval H-type graft was created. Four patients with severe liver insufficiency were qualified for orthotopic liver transplantation; all of them were transplanted. In 1 patient a balloon dilatation of the right and middle hepatic veins orifices was performed during the diagnostic cavography. The follow-up period ranged from 4 months to 5 years. RESULTS: In 2 patients with Budd-Chiari syndrome of unknown etiology, the "H"-shunt remained patent, and the patients were free of ascites and splenomegaly. During the period of follow-up (more than 5 years) they remained free of symptoms and demonstrated acceptable liver function parameters. Doppler sonography revealed the partial recanalization of the venous system. In 2 polycythemic patients, the shunt thrombosed, which was the indication for orthotopic liver transplantation in one of them. The transplantation was performed, but was unsuccessful because of hepatic graft artery thrombosis. The retransplantation in this case was also unsuccessful. The remaining 3 patients transplanted for cryptogenic Budd-Chiari syndrome are alive and well, 4, 5 and 11 months after orthotopic liver transplantation. In the patient subjected to interventional radiological hepatic veins dilation, the vessels remain patent 26 months post-procedure. The patient is free from ascites. CONCLUSIONS: Shunt surgery and liver transplantation are the valuable methods of treatment in selected cases of Budd-Chiari syndrome. In patients with polycythemia, however, thrombotic complications may occur in spite of anticoagulant and chemotherapeutic treatment. Balloon dilatation may appear an alternative to surgical treatment, but it seems that its indications should be limited to a highly selected group of patients.

Arginase activity concentration marking in monitoring of hepatocytes function after orthotopic liver transplantation--preliminary report.

The constant growth of a liver transplantations performed in Poland is the primary reason for a search for new, better and more exact methods of graft function assessment. They should give an opportunity of early detection of either perfusion disorders or organ's function deterioration. Thus, the goal of the study was assessment of the usefulness of arginase concentration marking in liver function monitoring after orthotopic transplantation. The group of 5 recipients of orthotopic liver transplants were taken into account. They were performed in 2003, in the Medical University of Warsaw Department of General, Transplant and Liver Surgery. Patients were qualified for the operation according to standards in the center. The indication for the operation was end-stage liver insufficiency. The average age in the study group was 45,6 years. The patient's serum was taken two hours before the operation. Subsequently, the concentration of arginase activity was marked in serum and bile, first during day 0, 18 hours after the operation, and later at regular intervals during following days until the patient left the clinic, on average from 12 to 14 days. The arithmetical mean values of serum and bile arginase activity values were compared with the average value of a particular parameter, marked during the days following the liver transplant. Serum and bile arginase level fluctuations were assessed in relation to AST, ALT, bilirubin, LDH, alkaline phosphatase (ALKP) and gamma gluthamylo transpeptydase GGTP

Orthotopic liver transplantation for acute liver failure resulting from "acute fatty liver of pregnancy".

Steatosis of the liver, demonstrating itself as the acute liver failure during the third trimester of pregnancy (Acute Fatty Liver of Pregnancy--AFLP) is a rarely observed liver pathology. Herewith we describe the case of a 19-years old pregnant patient with this rare disease. The authors present the clinical course, dynamics, diagnostics, and outcome of treatment in this unique case. In this patient the ultimate treatment chosen was the liver transplantation. The opinions, concerning liver transplantation in AFLP (expressed in the world literature) are somewhat controversial. This paper presents the first case of AFLP treatment with orthotopic liver transplantation (OLTx) in Poland.

[Granulosa cell tumor of the ovary metastasizing to adrenal gland 13 years after initial diagnosis--diagnostic difficulties and immunohistochemical study]. / Przerzut ziarniszczaka jajnika do nadnercza po 13 latach od pierwotnego rozpoznania--trudnosci diagnostyczne i analiza immunohistochemiczna.

UNLABELLED: We report a case of 49 year old woman with metastasizing granulosa cell tumor of the ovary, adult type, to the right adrenal gland 13 years after initial diagnosis. The tumor was asymptomatic and was detected incidentally by ultrasonography. We performed histopathological analysis of the tumor using immunohistochemical methods. The morphological features, without clinical data, demanded differential diagnosis with a huge group of small cell neoplasms. The immunohistochemical examination: CKAE1 + AE1, CK7, LCA, S-100, chromogranin A, synaptophysin, HMB45, estrogen, progesterone, EMA-negative, vimentine, CD99 and NSE positive, together with clinical data, allowed to make the final diagnosis. CONCLUSIONS: Patients operated due to granulosa cell tumor need long term follow-up, because of possibility of very late recurrences. In the literature review we did not find any case of isolated granular cell tumor metastasis to the adrenal gland. In the differential diagnosis of such tumors, except of histological features, clinical data play the main role. Usefulness of CD99 antibody in granular cell tumor diagnosis was confirmed. Positive reaction with NSE in tumor cells was detected.

Synchronous occurrence of colon and appendiceal adenocarcinoma.

The study presented two cases of synchronous occurrence of colon and appendiceal adenocarcinoma. Both patients required surgical intervention, due to acute peritonitis during the course of acute appendicitis. In case of one patient we performed abdominal CT confirming the presence of sigmoid cancer. The patient was subjected to appendectomy and Hartmann's operation. The second patient underwent an appendectomy, and colonoscopy performed two months later revealed the presence of rectal adenocarcinoma. The patient was subjected to low anterior rectal resection. The histopathological results considering both patients revealed the presence of synchronous colon and appendiceal adenocarcinoma.

Adenocarcinoma of the small bowel - a case report.

The paper presents a rare case of a patient with adenocarcinoma of the small intestine who reported to the hospital due to non-specific gastrointestinal symptoms. Following diagnostic examinations, the patient underwent a surgery. The post-operative period proceeded with no complications. The case presented below confirms the usefulness of imaging examinations (abdominal CT) when pathologies within the small intestine are suspected. An accurate interpretation of the result was an indication for a surgical intervention, but the final diagnosis is still established on the basis of the histopathological examination.