The chronic dialysis is the way of replacing the lost kidney function. Well functioning vascular access is the prerequisite for chronic hemodialysis treatment. The arteriovenous fistulas are the optimal form of vascular access. In patients, in whom the usual sites for fistula have been exhausted the vascular fistula on the arm was placed. 53 dialysis accesses were performed on the arm between 1989 and 1999. All subcutaneous fistulas were created by the junction of the cephalic vein with brachial artery, just above the cubital fossa on the anterior surface of the arm. All anastomoses were created in the operating room under local anesthesia. The preferred route for exposure of cephalic vein was making the single incision along the arm. When the distal part of cephalic vein has been ligated and divided, the adequate space for the graft in the tunnel was performed. End-to-end anastomosis between the distal end of vein and side of brachial artery was completed using the suture material. In 50 hemodialysed patients the regular flow through the arteriovenous fistula was observed. Fistula thrombosis occurred in 2 cases. In 4 examined patients we observed blood extravasation in the subcutaneous tissue, where the tunnel was created. In 5 patients the local cellulitis was noted. The late vascular complications were evaluated in 15 cases. Aneurysms were revealed clinically in 3 patients and false aneurysm occurred in 2 patients. The described late complications required no surgical correction. The anterior side of the arm is the best place for arteriovenous access used for hemodialysis, in patient without the possibilities of surgical creation of the forearm's fistula.

Oxidative stress occurs whenever there is an imbalance between the generation of free radicals and the antioxidant defense. Oxygen is cytotoxic if oxygen concentration is higher than its amount in the atmosphere. This phenomenon is called hyperoxide process. This experiment was performed to determine the influence of normobaric hyperoxide process on peroxidation occurred in the rat's pancreas. Furthermore, the aim of this study was to estimate morphological changes in the pancreas. The studies were carried out on 44 male Wistar strain rats with the initial body weight of 230-250 g. After acclimation period the animals were divided into four experimental groups of 11 in a group. The exposure period of the influence of chemically pure oxygen was the base of the classification of rats into experimental groups labelled as follows: I, II, III. The time of exposure was 12, 24 and 48 hrs, respectively. The animals were dissected immediately after decapitation. The internal organs were investigated during autopsy. The whole pancreas with surrounding fatty tissue and peritoneum was cut out. Ultrastructural identification of different cell types required examination of several sections from each block and careful examination of numerous selected photographs. The histological preparations were evaluated in electron microscope. Histological evaluation revealed the presence of changes which seem to be adaptative and temporary. The B cells of Langerhans' islets were more damaged than other endocrine cells.

The first laparoscopic cholecystectomy was performed thirteen years ago and rapidly became the preferred way of operation in patients suffering from cholelithiasis. The pneumoperitoneum can be responsible for haemodynamic disorders. The abdominal wall lift is an alternative way for pneumoperitoneum during laparoscopic cholecystectomy. The aim of this study was the comparative analysis of operative trauma response in the patients treated by laparoscopic cholecystectomy using abdominal wall lift and in cases which underwent open cholecystectomy or laparoscopic operation using pneumoperitoneum. The concentration of C-reactive protein was measured in patient serum before and twice after surgery. The obtained data underwent a statistic analysis. In all cases the surgery caused the marked changes of CRP-concentration. The mean level of CRP was higher three times in patients after open cholecystectomy than in cases treated by laparoscopic cholecystectomy with the use of abdominal wall lift or with performed pneumoperitoneum. During the experiment the statistically significant different between laparoscopic surgery with the use of the laparolift and laparoscopic with earlier performed pneumoperitoneum was observed. The stress and inflammatory response in cholecystectomy using abdominal wall lift was significant but smaller than the response noted in open cholecystectomy and similar to the response observed after pneumoperitoneum. The replacement of pneumoperitoneum by abdominal wall lift does not change the operative stress in laparoscopic cholecystectomy.

The liver is central to the metabolic disposition of all drugs and foreign substance. Drug-induced liver injury is a potential complication of estrogen preparations. The primary estrogen-induced vascular disorders are peliosis hepatis and vasculitis. Peliosis hepatis has been described as a rare consequence of taking estrogens and contraceptive. This condition is characterized by the presence of blood-filled spaces. Vasculitis has been noted as necrotizing or non-necrotizing hypersensitivity and an inflammatory infiltrate involving all the wall of a vessel. Vasculitis is usually connected with the presence of increased numbers of eosinophils either in blood or tissues. The aim of the study was to determine the influence of estrogen preparations on liver vascular disorders. The experiment was conducted on female rats of Wistar strain with the initial body weight of 180-300 g/kg of the body weight. After acclimation period, animals were gathered in 5 experimental groups of min. 10 in the group. Oestradiolum benzoicum was used for the purpose of this study. It was given i.m. once a week for 8 weeks in three different doses: E1--0.0075 g/kg, E2--0.0015 g/kg; E3--0.003 g/kg of the body weight. Two control groups were designed: K0--the untreated animals, K1--the animals receiving the adequate quantity of oleum pro injection. Fragments of organ assigned for histological examination were fixed in 10% buffered formaldehyde solution and transformed into paraffin sections. Histological preparations were evaluated in the light microscope. The histological assays were determined using: hematoxylin-eosin, azan and histochemical paS (periodic acid-Schiff) stains. In the described experiment large inflammatory infiltrations and vasculitis (E2, E3) were observed. In the animals treated with higher doses of estrogens diffusely distributed infiltrations around spaces with bloody fluid inside were revealed. The lumen of vessels was dilated. Estrogens can be responsible for the development of vascular disorders described as peliosis hepatis. The observed changes were suggestive of drug related vasculitis. An increased awareness of peliosis hepatis may become an important symptom for a pathologist, especially in patients at risk.

Drug-induced kidney injury is a potential complication of a number of medicaments. The wide-spread use of estrogens in the form of oral contraceptives and in the form of hormonal replacement therapy, has necessitated extensive studies on the biochemical alterations. The following effects of estrogens on kidney are discussed in greater detail with special regard to enzyme induction. The aim of the study was to evaluate the influence of long-term activity estrogens on kidney lysosomal enzymes like cathepsin B, D and L. Female rats were divided randomly into eight experimental groups. Oestradiolum benzoicum was used for the purpose of this study. Estrogens were given i.m. one time per week for 8 weeks in different doses, respectively: E1--0.00075 g/kg b.w., one time per week; E1.1--0.00075 g/kg b.w. every three days; E2--0.0015 g/kg b.w.. one time per week. E2.1--0.0015 g/kg b.w.. every three days; E3--0.03 g/kg b.w.. one time per week; E3.1--0.003 g/kg b.w.. every three days; KO--untreated animals; K1--treated control, rats received oleum pro injection at the dose of 1.2 ml/100 g b.w. The activity of free and bound fractions of lysosomal enzymes, such as cathepsin B, D and L were assayed in kidney homogenates using spectrophotometric methods. Differences between various experimental groups were tested with ANOVA test. The activity of cathepsin B, D and L fractions showed significant changes compared to control groups. The observed changes were not characteristic in all the studied groups. The most important changes referred to the activity of cathepsin B and D. Differences were noted between the enzymes activity in animals treated with the smallest dose of estrogen and that in control groups. It was smaller in group E1 than in groups K0 and K1. The activity of cathepsin B was higher in group E1 than in control groups. There was no correlation between the dose of injected estrogens and the observed lysosomal activity changes. The changes in lysosomal activity were uncharacteristic.

The progress made in recent years in the diagnostics of breast cancer, the universal character of mammographic and ultrasonographic screening examinations and the growth of social awareness with respect to this disease have caused a great deal of diagnostic problems. Cases of big, ulcerating cancer tumours, which infiltrate skin have now become history, and are reported sporadically. However, physicians are now facing the problem, which is the diagnosis of 1-5 mm changes detected in examinations. The necessity to diagnose small tumours in combination with 80-90% mammographic sensitivity reported compelled clinical physicists to verify these changes with histopathological examination. In the cases when the clinical examination, the result of a mammographic examination and that of fine needle aspiration biopsy do not provide a coherent picture, a surgeon has to qualify a patient for tumorectomy with an intra-operative study. In the years 1997-2000, 173 breast tumorectomies were made. Patients with benign neoplasm (e.g. adenofibroma, papilloma mammae) or patients with arousing suspicion of oncological anxiety breast tumour were qualified for surgical procedures. Operations were performed in one-day surgery conditions and intra-operative examination was performed in every case. In cases of non-palpable tumours, which were visible in ultrasonography or mammography the changes were marked by an "anchor" in order to be removed and examined histopathologically. The operated patients were 17-89 years old. In the obtained 173 tissue fragments dysplasia benign was recognized in 47.98% of cases, in 42.2% adenofibroma, in 2.31% papilloma mammae, in 1.73% mastitis chronica, in 4.62% ca ductale invasivum and in 1.16% ca ductale in situ has been observed.

Hemodialysis vascular access related problems account for most hospitalizations in chronic hemodialysis patients. Having exhausted classic, primary radio-cephalic fistula on the forearm the secondary vascular access can be created. The secondary access was achieved through a subcutaneous displacement of the basilic vein and through surgical creation of end-to-end fistula between this venous and radial artery on the forearm. The subject of the study were eight patients undergoing chronic hemodialysis. In all patients the type of anastomosis and early and late complications were studied. The preferred route for exposure of the basilic vein was making the single incision along the forearm. Next, the basilic vein was transferred to the subcutaneous tunnel on the anterior side of the forearm. In four cases the classic end-to end anastomosis between the basilic vein and radial artery was performed. In other four patients, the telescopic method of fistula creation was done. In all eight cases the regular flow was observed. In postoperative period no complications were noted.

The main reasons of fistula dysfunction are stenosis and thrombosis. There are two kinds of thrombosis: acute and chronic. Acute thrombosis is total fistula occlusion while chronic occlusion is partial venous occlusion with collateral veins, which lead to impair fistula's function. 450 dialysis fistulas were referred to US (ultrasound) examination. Among 392 patients with fistula dysfunction, 71 presented chronic venous occlusion in hemodialysis shunt. 35 patients were qualified to endovascular recanalization. The mean length of the occluded segment was 3-35 cm (subclavian vein 2-4 cm). 38 patients underwent angiography (35 before endovascular treatment). Technique of recanalization included antegrade venous puncture, insertion guidewire (0.021'), catheter (5 Fr), balloon catheter (5-8 mm) and in 2 cases stent placement. Colour Doppler allowed to diagnose 34 (97%) cases of chronic venous occlusion in hemodialysis shunt. Decrease of mean flow volume in brachial artery--709 +/- 395 ml/min. (50-1500 ml/min) was statistically significant (p = 0.0015). Normal mean flow volume was 1242 +/- 641 ml/min. 20 of 35 recanalization procedures were performed successfully. The main reason of failure was perforation or false channel. Mean primary patency was 75% after 3 months. Mean cumulative was 85% (10/12) after 6 months. Chronic venous occlusion is often present in hemodialysis shunt and reduces flow volume. Percutaneous recanalization results aren't magnificent but there is only kind treatment for many patients with fistula failure.

The role of oxidative stress in toxic injury of the liver has been well documented. Molecular oxygen is indispensable for most of the living organisms but under specific conditions can be cytotoxic for all organisms. If oxygen concentration will be higher than its amount in the atmosphere, different pathological processes can occur in aerobic organisms. In normal hepatocytes, this physiologic oxidant stress is easily handled by mitochondrial defense. On the other hand, there are a lot of clinical indications to therapeutic application of both normobaric and hyperbaric hyperoxide processes. This work was undertaken to determine the influence of normobaric hyperoxide process on morphological structure of rat's hepatic cells. Furthermore, the aim of this study was to determine the degree of dependence between the time of hyperoxide process and morphological changes in the liver. The experiment was conducted on 44 male Wistar strain rats with initial body weight of 230-250 g. After acclimation period, the animals were gathered in experimental groups of 11 in a group. The exposure time of the influence of chemically pure oxygen was the base of the classification of rats into experimental groups labelled as follows: I, II, III. The time of exposure was 12, 24 and 48 hrs, respectively. The control groups also contained 11 animals. The animals were dissected immediately after decapitation. The whole liver was cut out. Fragments from the right central lobe and from the left lateral lobe of the liver were taken. The histological preparations were evaluated in electron microscope. In all the experimental groups adaptative and probably temporary histopathological changes were noted in the liver. The observed damages were probably reversible.

Many specialists: nephrologists, surgeons, radiologists and nurses pay much attention to dialyzed patient using different terminology. The presented work establishes the principal rules of describing hemodialysis fistula to find convergence in terminology.