Background. Ideal pouch created during restorative proctocolectomy is a new gastrointestinal organ - "neorectum". Although it is made from the ileum, it takes over function of the removed rectum. This new function results in significant morphological changes in pouch's mucous membrane, which becomes similar to the large bowel mucosa. The most common pathology of the ileal pouch is its inflammation - pouchitis. One of the suspected causes of pouchitis is bacterial flora disturbance.Objectives. The aim of the study was to analyze the morphological and microbiological changes in ileal pouches in different time periods after ileostomy closure and to evaluate the influence of certain bacterial strains on the degree of inflammation.Material and Methods. The study involved 47 patients who had been treated surgically; they were investigated before and at different stages after ileostomy closure. They underwent repeated rectoscopies with biopsies of pouch mucosa and swabs for microbiological examination. In total 89 rectoscopies were performed, which provided 70 histopathological results according to the Heidelberg Pouchitis Activity Score and 87 microbiological test results.Results. The assessment of the morphology of intestinal pouches showed increased signs of chronic inflammation as the length of time after the closure of a protective ileostomy increased. There was no correlation between the signs of acute inflammation and the length of time after surgery; there were more signs of acute inflammation in cases of pouchitis. The composition of the bacterial flora of intestinal pouches changed as the length of time after ileostomy closure increased, with significant increases in the number of enterobacteriaceae species. The presence of Staphylococcus aureus significantly correlates with a higher degree of chronic inflammation; this bacterium may be a potential infectious factor in pouchitis.Conclusions. Microbiological analysis of intestinal pouch lumen is a useful tool that can be used in routine follow-up assessment of intestinal pouches as well as in diagnosing pouchitis

BACKGROUND:Acute pancreatitis may be accompanied by a number of complications. They include diffuse peritonitis, intra-abdominal and retroperitoneal abscesses, and severe haemorrhage. These complications are the cause of approximately 50% of all deaths in acute pancreatitis.CASE REPORT:A 33-year-old man was admitted to ITU with septic shock, due to acute pancreatitis and necrosis after multiple surgeries. On the fifth day after admission, his condition deteriorated due to respiratory distress and massive bleeding from the splenic region requiring surgical packing. On the next day, the bleeding became critical. More than 2000 mL of blood was evacuated from the peritoneal cavity, the bleeding site was re-packed, and the patient was transfused with RBCs, FFP and 0.04 mg kg(-1) of recombinant factor VIIa concentrate. This resulted in haemostasis, however the subsequent clinical course was complicated by septic shock, perforation of the transverse colon and peritonitis. The patient eventually recovered and was discharged home after 105 days in hospital.CONCLUSION:Multifactorial management of acute pancreatitis is essential; in cases of severe haemorrhage, surgical packing and administration of recombinant factor VIIa concentrate are key components of successful treatment.

BACKGROUND/AIMS:Primary retroperitoneal tumours and retroperitoneal organs' tumours represent a variety of lesions that require different treatments and have various prognoses. The aim of this study was to present the author's observations of the histological tumors types occurrence and their surgical treatment.METHODOLOGY:One hundred twenty-three cases of retroperitoneal tumours were studied retrospectively in a 6-year period. All cases were investigated for haematological and biochemical parameters. Abdominal ultrasonography, computed tomography or magnetic resonance imaging of abdominal cavity and pelvis were done in the all cases. All cases were subjected to laparotomy with an aim to resect the tumour completely.RESULTS:In the present study we observed primary retroperitoneal tumours like malignant neuroblastoma, paraganglioma, primitive neuroectodermal tumour, cavernous haemangioma and mucinous cystadenoma. Among retroperitoneal organs' tumours pancreatic lesions present the majority of them. There were 6 cases of neuroendocrine pancreatic tumours. We had two cases of retroperitoneal fibrosis in patients with ulcerative colitis. In adrenal glands we observed benign and malignant lesions like pheochromocytoma and fibrosarcoma. All primary retroperitoneal tumours, except two cases of retroperitoneal fibrosis, were an bloc removed.CONCLUSIONS:Primary retroperitoneal tumours in contrast to retroperitoneal organs' tumours occur very rare. Their anatomical location makes early detection difficult and as a result they are usually quite extensive when first detected. The clinical manifestations of all retroperitoneal tumours are not specific, so it causes a lot of difficulties in early diagnosis. This is the main reason that contributes to treatment failure.

BACKGROUND/AIMS:Neuroendocrine tumours are fairly rare neoplasms that require different treatments and have various prognoses. The aim of this study was to present the author's observations of the histological tumor types, occurrence and its surgical treatment.METHODOLOGY:Thirty-five cases of neuroendocrine tumours were studied retrospectively in a 9-year period. All cases were investigated for haematological and biochemical parameters. Ultrasonography, scintigraphy, computed tomography or magnetic resonance imaging of abdominal cavity, pelvis, thorax or neck--depend on the tumor localization--were done in every individual. All cases were subjected to surgical procedure with an aim to resect the tumour completely.RESULTS:In the present study were observed 6 cases of carcinoids localized in ileum, cecum and sigmoid colon, 1 case of gastrinoma in pancreatic head localization, 1 case of insulinoma localized in pancreatic tail, 1 case of vipoma localised in pancreatic head, 2 cases of nesidioblastoma and 1 case of microcystic adenoma with neuroendocrine differentiation in pancreatic tail localization and 1 case of nonspecific apudoma observed in ileum. There were 6 cases of neuroendocrine tumours localized in pancreas. In the study we have also 11 cases of medullary thyroid carcinomas. In adrenal glands we observed 10 benign and 1 malignant pheochromocytoma (one bilateral female case with Multiple Endocrine Neoplasia type 2A).CONCLUSIONS:Neuroendocrine tumours occur very rare. Their clinical course makes recognition difficulties and as a result they are usually quite extensive when first detected. The clinical manifestations of some neuroendocrine tumours are not specific, so it causes a lot of difficulties in early diagnosis and treatment.

Background. Thyroid surgery is connected with postoperative respiratory obstruction which may necessitate tra− cheostomy. Objectives. The aim of the study was to assess the indications, course, and outcomes of patients who underwent thyroidectomy requiring tracheostomy at Wroclaw University 1 st Department and Clinic of General, Gastroente− rological, and Endocrinologic Surgery between 1996 and 2008. Material and Methods. The clinical data of patients who underwent thyroidectomy with tracheostomy were re− trospectively analyzed based on their hospital records. Results. Of the 4971 patients operated on for various diseases of the thyroid, tracheostomy was necessary in 13 (0.26%). The decision to perform tracheostomy was taken intra−operatively because of locally advanced thyroid cancer in 7 (54%) patients (4 patients with anaplastic cancer, 2 with follicular cancer, and 1 with medullar cancer). There were 5 patients requiring tracheostomy because of bilateral injury of the recurrent nerves; 2 had a secondary thyroid operation and 3 had hyperthyroid goiter. Tracheostomy was necessary for one patient who had postoperative hematoma and dyspnea. Conclusions. There are many preoperative factors for the development of serious respiratory complications, such as a secondary procedure on the thyroid, thyroid cancer, huge goiter, retrosternal extension, tracheal deformity with narrowing, or preoperative recurrent laryngeal nerve palsy (Adv Clin Exp Med 2009, 18, 4, 385–388).

Background. Gastroeneteropancreatic neuroendocrine tumors (GEP-NETs) are very rare neoplasms that require different treatment and have various prognoses.Objectives. The aim of this study was to present the authors' observations on histological tumor type occurrence and their surgical treatment.Material and Methods. Thirteen cases of GET-NETs were studied retrospectively in a nine-year period. All cases were investigated for hematological and biochemical parameters. Ultrasonography, angiography, scintigraphy, computed tomography, or magnetic resonance imaging of the abdominal cavity or pelvis, depending on tumor location, were done in each individual. All cases were subjected to surgical procedures with the aim to resect the tumor completely.Results. Six cases of carcinoid tumor located in the ileum, cecum, and sigmoid colon, 1 case of a gastrinoma in the pancreatic head, 1 case of insulinoma in the pancreatic tail, 1 case of vipoma in the pancreatic head, 2 cases of nesidioblastoma and 1 case of microcystic adenoma with neuroendocrine differentiation in the pancreatic tail, and 1 case of nonspecific apudoma in the ileum were observed. As one can see, there were six cases of neuroendocrine tumors in the pancreas.Conclusions. GEP-NETs occur very rarely. Their clinical course makes their recognition difficult and they are thus usually quite extensive when first detected. The clinical manifestations of some GEP-NETs are not specific, which makes their early diagnosis and treatment difficult (Adv Clin Exp Med 2009, 18, 6, 589-594).

BACKGROUND/AIMS:Crohn's disease is a non-specific, chronic inflammatory disorder affecting any part of alimentary tract. Patients receiving proper medication require surgery in 70-90% of cases. Analysis of results of surgical treatment in Crohn's disease in patients treated at the Medical University of Wrocław and an attempt to elaborate the optimal surgical strategy in Crohn's disease was the aim of the study.METHODOLOGY:The medical documentation of 52 patients with confirmed diagnosis of Crohn's disease was analysed, focusing on the course of the disease before surgery linked with its localization, duration and medical treatment. Then indications for surgery, type of surgical procedure performed and perioperative morbidity and mortality were discussed.RESULTS:Thirteen patients had urgent surgery. Thirty-nine patients had planned surgery. The most common procedure was ileocecal resection or right hemicolectomy. In 36 cases the postoperative course was uncomplicated. The most common surgical complication was wound infection. Pneumonia was the most common general complication. Fatal cases occured in elderly patients with long-term and severely complicated disease.CONCLUSIONS:The optimal timing of surgery is extremely difficult and remains non-standardized. Key decisions are often established intraoperatively and they require considerable surgeon experience, patient's awareness and close cooperation of surgeons and gastroenterologists.

Authors present a case of fecalith mimicking inflammatory tumor in right iliac fossa in a 56-year-old woman with Crohn's disease and rheumatoid arthritis, chronically treated with corticosteroids. Patient was admitted to the Department, because of clinical and radiological (CT) symptoms of the Crohn's disease exacerbation. In physical examination we found pathological mass in right iliac fossa, suggesting inflammatory tumor. The barium enema examination revealed a fecalith in the caecum (6 x 7 cm). Patient was recommended to surgical treatment. After laparotomy "caecal tumor" and ileal stenosis were stated. Resection of the ileocaecal segment was performed and the presence of the fecalith was confirmed.

Graves’ disease is an autoimmune disease. One of the most severe complications of Graves’ disease is orbitopathy. The aim of the study was to estimate the influence of total thyroidectomy on the postoperative course of exophthalmus and determine the levels of thyroid antibodies after surgery. Material and methods. During the period between 2002 and 2005, 1514 strumectomies were performed at the I Chair and Department of General, Gastroenterological and Endocrine Surgery, Medical University in Wroclaw. The study included 69 (4.5%) patients, who were operated on because of Graves’ disease. Forty-two (60%) of these patients had progressive opthalmopathy and were subjected to total thyroidectomy (35 women and 7 men, mean age was 31 years). The diagnosis of Graves’ disease was established on the basis of the clinical evaluation, fT3, fT4 and TSH values, as well as the determination of serum thyroid antibody levels. Every patient was subjected to an opthalmological examination, with measurements of the degree of exopthalmus, as compared to the ATA (American Thyroid Association) scale. Above-mentioned parameters were measured before surgery and 6, 12 and 18 months after total thyroidectomy. Results. Considering patients after total thyroidectomy, exophthalmus did not proceed. In 17 (40%) patients, 23 mm of eyeball retraction was noted, mainly during the initial six months. After surgery, a statistically significant reduction of TSH-receptor and anti-TPO antibody values were observed. Conclusions. Total thyroidectomy in patients with Graves’ disease and orbital opthalmopathy significantly reduced the progression of orbitopathy. It also leads to the normalization of serum anti-recepor (TRAb) and anti-peroxidase (anti-TPO) antibody levels. Total thyroidectomy is a quick and effective procedure in the hands of an experienced surgeon and should be performed in secondary or tertiary care centers.

Introduction : Cancer of thyroid gland is the most common malignancy of the endocrine system. The treatment improvement could be achieved by early diagnosis. The aim of the study was to identify cancer specific antigenes with use of peptide libraries. Material and methods : The material from 6 patients with thyroid cancer (4 with papillary cancer, 1 with follicular cancer and 1 with oxyphilic tumor) were analyzed. It was performed with use of lipophylic peptide libraries by direct comparison of staining of specimens prepared from normal and malignant tissue. Results : Preliminary results confirm practical value of peptide libraries in early diagnostics of thyroid cancer. Conclusions : It is important to optimize construction of peptide libraries by using different staining agents hydrolyzed by proteases.

INTRODUCTIONThe relationship between genetically determined polymorphic oxidation and acetylation and susceptibility to some disease was aroused much interest. The aim of our study was to evaluate whether patients with hyperthyreosis differ from healthy persons in their ability to oxidize sparteine and acetylate sulphadimidine as model drugs. Oxidation and acetylation were estimated in 48 patients with hiperthyreosis.MATERIAL AND METHODSThe control group consisted of 160 healthy volunteers for comparison of oxidation phenotype and 60 healthy volunteers for comparison of acetylation phenotype. The phenotyping of oxidation revealed two distinct populations among 40 patients with hyperthyreosis: 38 persons (95%) were extensive metabolizers (EM) of sparteine and 2 persons (5%) was poor metabolizers (PM). In 160 healthy persons (91.2%) were EM and 14 persons (8.8%) were PM. The difference between frequency distribution of PM and EM in healthy persons and in patients with hyperthyreosis was not statistically significant.RESULTSThe phenotyping of acetylation showed among 48 patients with hyperthyreosis 8 persons (13%) were rapid acetylators (RA) and 40 persons (87%) were slow acetylators (SA). In 60 healthy volunteers the phenotype of rapid acetylation was observed in 31 persons (51%) and slow acetylation in 29 persons (49%). Relative risk (odds ratio) of development of thyroid diseases was 5.34 times higher for SA in comparison to RA. The prevalence of SA among patients with hyperthyreosis in comparison to healthy volunteers was statistically significant (p < 0.0002).CONCLUSIONSThe results of our study may suggest that slow acetylation phenotype is associated with increased risk of the development of hyperthyreosis.

BACKGROUND/AIMS:Restorative proctocolectomy is the "golden standard" in surgical treatment of ulcerative colitis and familial adenomatous polyposis. The two alternative techniques of ileal-pouch-anal anastomosis include hand-made suture and double line stapled suture. The aim of the study was the analysis of postoperative complications and functional results of the two types of anastomosis.METHODOLOGY:Analyzed group consisted of 71 patients operated between 1994 and 2003 for ulcerative colitis (n=62) or familial adenomatous polyposis (n=9). Stapled anastomosis was performed in 56 (79%) cases whereas hand-made suture was performed in 15 (21%) cases.RESULTS:No significant differences between the two anastomosis techniques were found in terms of postoperative complications as well as late functional results.CONCLUSIONS:The low rate of complications and well accepted functional outcome prove that restorative proctocolectomy is a safe surgical procedure which may be offered to patients with ulcerative colitis of familial adenomatous polyposis. Double line stapled suture should be the preferred method of ileal-pouch-anal anastomosis, however hand-made suture remains its valuable alternative and may be considered in selected cases.

Cavernous hemangiomas of the adrenal glands are extremely rare benign lesions and most are incidental findings. The increasing frequency of the adrenal masses detection is due to the widespread use of the contemporary imaging techniques. We review incidence, pathology, clinical features, diagnostic and therapeutic treatment of the adrenal cavernous hemangiomas.

Constipation is a common symptom in clinical practice. Definition of constipation includes abnormal bowel frequency, difficulty during defecation and abnormal stool consistency. There are many classifications of constipation based on constipation etiology (constipation in healthy people caused by life style, constipation as a symptom of digestive tract diseases, secondary constipation in the course of systemic disorders or associated with drugs) and/or constipation mechanisms (functional, mechanical). The numerous disorders leading to constipation make often diagnostic management difficult and complicated. Treatment of constipation includes dietary and behavioral approaches, pharmacologic therapy and in selected patient surgical treatment. Surgical treatment is recommended in young patients with severe slow transit constipation refractory to conservative treatment. Confirmation of indication to surgical treatment requires studies of colonic and anorectal function (colonic transit studies, anorectal manometry, studies of defecation). Preferred surgical technique is colectomy with ileorectal anastomosis. Authors reported good results and patient satisfaction in 50-100 percent of cases. Postoperative complications include intestinal obstruction, abdominal pain, flatulence, diarrhea.

The authors present biography of Ludwik Rydygier, the great Polish surgeon, with special emphasis on his medical and scientific activity as well as his role in the foundation of Polish surgical school.

The aim of the study was the comparative evaluation of early abdominal wound healing after the first stage of restorative proctocolectomy due to ulcerative colitis and colonic resection due to cancer. Material and methods: Records of 62 patients operated on due to ulcerative colitis and 35 patients operated on due to rectal cancer in B and C Dukes stage in our Department from 1999-2003 were analyzed. Patients' average age was 44 years. In all patients the abdomen was opened with wide median incision. After surgery, the abdominal wall was closed in layers using Dexon 2.0 sutures; running for the peritoneum, interrupted for muscles and propylene single sutures for the skin. Results: Primary wound healing without complications was observed in 53 patients (86%) after surgical treatment of ulcerative colitis. In the remaining 9 patients (14%) the delay in healing was caused by haematomas in 5 (8%) patients and secondary infection in 4 patients (6%). In the group of cancer-suffering patients, primary wound healing was observed in 25 patients (72%). Delay in healing was observed in 10 patients (28%); it was caused by haematomas in 5 (14%) patients and secondary infection in the remaining 5 patients (14%). Conclusions: The delay in early abdominal wound healing caused more problem in patients operated on due to neoplastic disease.