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Clinical involvement of the nervous system occurs in about 5% of patients with sarcoidosis. We describe a fatal case of a young patient with neurosarcoidosis with a relatively rare psychotic syndrome in the course of neurosarcoidosis, presenting itself as a depressive syndrome with delusions. The neurological manifestations consisted of cerebellar symptoms, peripheral neuropathy and general epileptic seizures. Cerebrospinal fluid examination, serum angiotensin-converting enzyme level, magnetic resonance imaging, chest radiography, gallium isotope scanning and other tests were used as diagnostic tools. He was treated with steroids, methotrexate and neuroleptics ineffectively. The patient died because of complications related to neurosarcoidosis. The diagnosis of neurosarcoidosis was confirmed by autopsy.

Pancreatic pseudocysts are common complication of both chronic and acute pancreatitis. Sanguination from damaged peripancreatic vessels into the lumen of pseudocyst results in pseudoaneurysm. The rupture of pancreatic pseudoaneurysm into the lumen of digestive tract causes massive bleeding witch source is often difficult to find during endoscopic examination. We present a case of patient with chronic alcohol pancreatitis, with pancreatic pseudocyst and of acute bleeding from upper digestive tract. In the endoscopy we found gastric ulcer with visible vessel. During hospitalization we observed increase the diameter of pseudocyst and circulation of it's liquid contence. Second-look endoscopy showed gastric fundic varices. Surgical operation revealed pseudoaneurysm of splenic artery inserting pressure on gastric wall.

The choice of the most beneficial method of the treatment of patients with esophageal cancer still remains a matter of debate. According majority of epidemiological reports only 10% of esophageal cancer patients has a chance for 5-year survival. Unfortunately, the curative surgical treatment is possible in relatively small number of patients, nevertheless esophagectomy is regarded as a principle method of treatment. Usually it referrers to the group of 50% of patients with locally advanced cancer. Thus, the management of the majority of esophageal cancer patients is palliative. Its main objective is to improve esophageal passage compromised by tumor narrowing esophageal lumen. Maintenance of esophageal passage facilitates food intake and usually postpones the stage of terminal cachexia and thus results in quality of life improvement. As it has been evident from up-to-date research currently used methods of palliative treatment do not significantly improve survival. In this paper we demonstrate a review of currently available methods of palliative treatment of patients with esophageal cancer and brief discussion on our own experience from last four years.

Endoscopic mucosal resection is a minimally invasive technique of resection of large pieces of the superficial layers (the mucosa and partially the submucosa) of the gut wall. In the present study we are presenting currently established indications, recent advances in the technique, early and long-term results of the treatment of esophageal, gastric and colorectal early cancer by endoscopic mucosal resection based on the review of the literature, educational materials and personal experience from the training of the first author (KZ) at the National Cancer Center in Tokyo, Japan. Endoscopic mucosal resection should be indicated for every superficial neoplastic lesion of the gut wall that can be safely removed in its entirety by experienced endoscopic team, and subsequently processed and evaluated properly by cooperating histopathologist specializing in gastrointestinal pathology. Eventually a detailed analysis of a resected specimen enables the precise assessment of curability of the procedure and establishment of the rational management of a patient. Curative endoscopic resection allows for regarding this procedure as sufficient and includes a patient into a follow-up program. Potentially curative endoscopic resection requires to consider the risk of lymph node involvement and discuss with a patient potential benefits and risk associated with surgical treatment or its withholding in reference to patients' age and health condition. Non-curative endoscopic resection requires to recommend an additional local (endoscopic resection, endoscopic ablation, brachytherapy) or surgical treatment after a detailed analysis with a patient a potential benefit and risk associated with each option. Despite enormous advance in medical knowledge the outcome of the gastrointestinal cancer treatment is still far unsatisfactory. Early diagnosis and treatment of less advanced cancer remains the most promising method of improvement of the outcome. We hope that popularization of the knowledge regarding early gastrointestinal cancer may improve their early detection rate and thereby the outcome of the treatment.

The authors presented a case of squamous cell oesophageal cancer in a patient after surgical treatment of achalasia performed five years earlier. The patient complained of the recurrent dysphagia. During endoscopy of the upper gastrointestinal tract a malignant tumor in the lower part of oesophagus was diagnosed and the patient was operated on. He survived for five years.

We are presenting a case report of 57-year-old patient operated on due to primary malignant melanoma of the esophagus. Melanoma was misdiagnosed in biopsy taken during endoscopy. Final precise establishing the character of the lesion was able during histopathological examination of the specimen obtained during surgery. The outcome of the treatment was poor--survival time did not exceed 14 months. Patient died because of pulmonary metastases.

A 61-year old man with fever, diarrhoea, weight loss has been admitted to the hospital. Nine years earlier an air bubble in the lower part of the left lung was recognised during the chest x-ray, four years later diagnostic studies have shown a megacolon situated in the chest that significantly pressed on the flesh of the left lung and shifted the mediastinum to the right side. At that time the patient did not agree for an operation treatment. He decided for surgery in May 2002. During the operation the presence of an enormous large intestine of the megacolon type has been determined which could be found there due to diaphragm loss. The megacolon and spleen were surgically removed and the injured diaphragm was sutured. After 2 years a clinical and functional examinations of the respiratory system were performed. There was an improvement of the exercise capacity, recession of restriction in functional examinations and an increase in body mass.

Unlabelled: To date, the clinical significance of fused T and U waves, termed as TU complexes, has not been evaluated. The aim of the study was to present the clinical characteristics of the patients with TU complexes and to assess the value of this ECG abnormality in risk stratification after myocardial infarction. In the group of 330 postinfarction patients (mean age 61 +/- 10 years, 279 men and 51 women), 50 (15%) had TU complexes in one or more leads of a standard ECG. In patients with TU complexes, the decreased left ventricular ejection fraction, frequent (> or = 10/hour) ventricular premature beats and non-sustained ventricular tachycardia detected on 24-hours ECG monitoring, increased QT dispersion, ST-segment depression and ST-segment elevation on a routine ECG were more common than in patients without TU complexes. During a follow-up period of 43 +/- 17 months, 88 patients died from all causes. At univariate Cox analysis the presence of TU complexes (hazard ratio 3.30; 95% confidence interval 2.09-5.21) and left ventricular ejection fraction < 40% (hazard ratio 3.82; 95% confidence interval 2.51-5.82) were the best predictors of mortality among the 9 evaluated clinical and electrocardiographic variables. The multivariate, stepwise Cox analysis selected ejection fraction < 40% (hazard ratio 3.09; 95% confidence interval 2.00-4.80), TU complexes (hazard ratio 2.28; 95% confidence interval 1.42-3.69), RR interval < 800 ms (hazard ratio 1.62; 95% confidence interval 1.06-2.47), and age of patients > 65 years (hazard ratio 1.58; 95% confidence interval 1.03-2.42) as an independent predictors of all cause mortality., Conclusion: The presence of TU complexes on a routine ECG is associated with impaired left ventricular function, increased predisposition to ventricular arrhythmias and higher risk of mortality. TU complexes may be considered as a new electrocardiographic marker of poor prognosis in patients after myocardial infarction.