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Objectives: This study is an attempt to provide an analysis of the influence of implementation of cognitive behavioral intervention (CBI) in patients after cardiovascular implantable electronic device (CIED) implantation on the quality of life following the procedure as well as the level of illness acceptance., Methods: The study group consisted of patients who underwent standard medical care related to CIED implantation and who additionally received CBI. Patients who received only standard medical care related to CIED implantation constituted a control group. CBI consisted of four sessions conducted over 30 (±3) days after the implantation. Demographic, clinicaland psychological factors were assessed.The Acceptance of Illness Scale (AIS) and EuroQol-5D (EQ-5D) were applied., Results: In total, 128 patients (women: 36.7%, mean age 64.5 ± 8.9) were included in the study. The proposed cycle of four structured CBI meetings was well accepted by the patients, which is confirmed by their high turnout for these meetings. After six months, quality of life indices were significantly improved in cardiac electrotherapy recipients assigned to CBI, including: Visual Analogue Scale EQ-5D (80.2 ± 11.8 vs. 64.9 ± 14.3; p < 0.0001) and better acceptance of illness (AIS: 35.6 ± 4.3 vs. 28.7 ± 6.1; p < 0.0001)., Conclusions: Implementation of CBI in patients after CIED implantation significantly improved indices of quality of life as well as illness acceptance, when compared to the control group of patients in standard care following electrotherapy. CBI showed multiple benefits in this population, as well as ensures the fulfilment of its expected therapeutic effect, while short duration of the intervention did not prolong the hospitalization itself.

Introduction: Sexual activity constitutes a significant aspect of health considerably influencing self-assessment of the quality of life. In Poland, data regarding the return in patients with ischaemic heart disease (IHD) to sexual activity are scarce and inadequate., Aim: The aim of this work is to analyse the return to sexual activity in patients with IHD after a hospitalisation related to invasive diagnostics of coronary arteries as well as to identify predisposing factors associated with cessation of sexual activity., Material and Methods: 98 patients with angiographically documented IHD were involved in retrospective analysis. 46 patients (46.9%) were diagnosed with myocardial infarction (MI), 29 (29.6%) with stable angina (SA) and 23 (23.5%) with unstable angina (UA). Demographic, clinical and psychological factors were assessed. Beck Depression Inventory, State-Trait Anxiety Inventory, Acceptance of Illness Scale, and EuroQol-5D health questionnaires were used., Results: The cessation of sexual activity after a hospitalisation due to invasive diagnostics of coronary arteries was noted almost in 1/3 of the IHD patients within 6-months observation period. There were no statistically significant differences in the percentages of sexually active and inactive patients related to gender. The elderly patients were more likely to cease sexual activity (p = 0.006). Sexually active patients also represented significantly lower level of anxiety-trait (p = 0.0003) and anxiety-state (p = 0.001). They also had a higher level of the acceptance of the disease (p = 0.002) at the end of hospitalisation and presented significantly lower severity of depression (p = 0.02)., Conclusions: Cessation of sexual activity in patients with IHD after a hospitalisation due to coronarography is associated with their older age, being single, obesity, lower quality of life, depression, higher level of anxiety, and lower acceptance of illness. Underestimating or omitting the realm of sexual health of hospitalised patients with IHD affects the patients' return to sexual activity. Patients with IHD, who decided to discuss, during their hospitalisation, the impact of cardiac disease and the invasive procedure they had undergone on their sexual activity, more frequently return to sexual activity over the 6-months observation period.

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.

The aim of the present paper was to discuss how different pain management techniques influence the experiences of pain during labor. The techniques are described and the influence of each one is considered in relation to the pain relief and the progress of labor. The paper consists of a theoretical and research parts. Concluding the studies, the analysis is presented based on which it is shown that non-pharmacological methods have a very positive effect on the degree to which women experience the labor pain. What is more, those methods have a very welcome effect on the labor's progress. This is because being active and using different facilities serves the betterment of effectiveness of the effacement and dilation of cervix. Pharmacological methods as well decrease the experience of pain. They are even more effective in easing the pain, however, their influence of the labor progress is lesser sometimes even leading to the labor slowdown. The research was conducted among 100 random women after their labor in natural ways.

Hepatic artery thrombosis is the most frequent arterial complication after orthotopic liver transplantation. In the past, surgical treatment was required to remove the thrombus, otherwise another liver transplantation was needed. Recently, interventional treatment has become an important method in treating hepatic artery occlusion. We present our experience of the case of percutaneous angioplasty in patient with hepatic artery thrombosis after orthotopic liver transplantation. Percutaneous angioplasty with a 5 mm balloon was done immediately after diagnosis and blood flow was obtained. A stent was not placed. We observed good hepatic artery patency and graft function during the followup period of 8 months. Percutaneous angioplasty may be considered the first-line therapy for early hepatic artery thrombosis after OLT.

The overall objective of the Polish guidelines for the prevention and treatment of venous thromboembolism is to increase patient benefit and safety by appropriate prevention and treatment of deep vein thrombosis and pulmonary embolism as well as proper management of the complications associated with antithrombotic and thrombolytic therapy. These guidelines apply to adult trauma, cancer, surgical, and medical patients as well as those at increased risk of venous thromboembolism. Specific recommendations have been formulated for pregnant women, patients requiring surgery while receiving long-term oral anticoagulant treatment, and patients undergoing regional anesthesia and/or analgesia. We chose to update the existing Polish guidelines with the use of the most recent high-quality international guidelines that we identified and adjusted the final product to Polish cultural and organizational setting. We based our recommendations primarily on the 9th edition of the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines on Antithrombotic Therapy and Prevention of Thrombosis, the European Society of Cardiology Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism, the 3rd edition of the American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines on Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy, the ACOG practice bulletin on thromboembolism in pregnancy (Number 123), and Guidance from the Scientific and Standardisation Committee of the International Society on Thrombosis and Haemostasis on the Duration of Anticoagulant Therapy after a First Episode of Unprovoked Pulmonary Embolus or Deep Vein Thrombosis, as well as two other Polish practice guidelines on the prophylaxis and treatment of venous thromboembolism and the management of patients treated with oral direct inhibitors of factor X or factor II. To make recommendations regarding specific management issues that had not been addressed in other guidelines, or whenever the panel members felt they needed additional information to reach the decision, we also consulted the authors of guidelines developed by other professional societies and organizations as well as additional sources of evidence. For each adapted recommendation, we explicitly assessed its relevance and applicability in the context of the healthcare system in Poland. When necessary, we explicitly stated the rationale for modification of the previously published recommendations and judgements about the values and preferences we assumed. The information regarding reimbursement of drugs mentioned in the recommendations was added in chapters 6-9 and 13 and approved by the National Health Fund. The final version of the practice guidelines was officially approved by the scientific societies and institutions listed at the beginning of the document.

Normal undisturbed voiding is a complex mechanism controlled by central nervous system, peripheral autonomic somatic, parasympathetic and sympathetic nervous system. The process of urination is depended on complex coordinated action of bladder and urethra, regulated by action of several neurotransmitters. This interdependent process may lead to various pathologies. One of it is over activity of detrusor muscle which etiology is multifactorial, diagnosis remains a challenge and therapy may be difficult. Multifactorial etiology of overactive bladder with urgency symptoms and urinary frequency with or without urinary incontinence may lead to difficult therapeutic situations. Combination of lifestyle, changes, pharmacological treatment and physiotherapy are all not fully satisfying. Epidemiological data are not completely clear and environmental influences seem to be important. The clinical problems of overactive bladder due to their substantial impact on women's health need further analysis which should improve prophylaxis, diagnosis and therapy.

Unlabelled: Smoking is a significant factor which affects not only reproduction and the process of pregnancy but also the offspring. Endangering for tobacco smoke and nicotine either passive or active has an important influence for shortening the time of pregnancy, the weight of the newborn and the Placenta. The occurrence of complications connected with smoking is probably correlated with the amount of cigarettes smoked per day., Target: The target of the paper was to analyse the influence of passive and active smoking on the course of pregnancy., Methods and Materials: The study involved a group of 113 women who gave birth in Gynaecological and Obstetrics Clinical Hospital of the Karol's Marcinkowski University of Medical Sciences in Poznan during the period from January to June 2011. Based on data gained from documentation and mothers three groups were separated: 22 women who were active smokers, 32 passive smokers and 59 women from control group who have never been smoking. There were analyzed selected obstetric data and term of pregnancy, condition and weight of newborn, blood pH and alkaline balance from umbilical vessels., Results: in research there were no correlation between groups and/ or results of researches of blood Ph, alkaline balance from umbilical vessels and the assessment of the newborn in Apgar score at 1, 3, 5 minute. In fact passive smoking women were younger (the average 27,84) than actively smoking woman (30,23) and non-smokers (30,25) (p=0,03). The most of small as for their gestational age infants were in the group of active smoking women (14%). Non-smokers more often did have a miscarriage (84%) in the past than other groups (active smokers 60%, passive 33%) (p=0,04)., Conclusion: smoking women usually come from countryside or small towns, they were not marriage and they had preterm delivery. In this group there was found the biggest percent of too small newborns for their gestational age - 14%.

67-year old man in a good physical condition was admitted to the Clinic to diagnose mediastinal tumor which was noticed on chest radiogram. The patient reported chronic cough, sweats and weight loss (5 kg during 4 months). The elevated number of monocytes was the only abnormality in his laboratory tests. Chest computer tomography confirmed well separated solid tumor without calcifications (with focal necrosis) in anterior mediastinal area. No lymphadenopathy was observed. Radiological image suggested teratoma or other germ stem tumor. Considering undiagnostic bronchial forceps biopsy during bronchofibroscopy we performed percutaneous fine needle aspiration biopsy which suggested carcinoid. Patient was referred to Surgery Clinic to be operated. Histological examination of resected tumor showed atypical carcinoid of probably thymic origin.

Unlabelled: The aim of the study was to analyze the prognostic factors for the outcome in childhood head/neck soft tissue sarcomas (STS) treated in the Department of Paediatrics, Haematology, Oncology and Endocrinology, Medical University of Gdansk between 1992 and 2007., Material and Methods: Among 23 children with STS in ten it was located in non-parameningeal region, in eight it was in the parameningeal region, and in five in the orbit. Patients were qualified to particular disease stages according to the current diagnostic and therapeutic protocols (Cooperative Weichtel-sarkom Studie-CWS). The qualifications were based on the results of radiologic examinations (ultrasonography, computed tomography and magnetic resonance of the head and neck region, computed tomography of the chest and abdomen and bone scintigraphy) and also on myelogram smears and cerebrospinal fluid investigation., Results: The longest history concerned the parameningeal (8 months), the shortest the orbital soft tissue sarcomas. Six out of ten patients with non-parameningeal STS were referred to the oncologist with a delay of 6.5 months. This was due to the initially false histopathological diagnosis which excluded the neoplastic process. 82.6% of tumours were diagnosed in advanced, inoperable stages. In 16 children rhabdomyosarcomas (including embryonal subtype - RME in 10, alveolar - RMA in five and undifferentiated in one); in seven non-rhabdomyosarcomas (non-RMS) were found. Good response to chemo- and radiotherapy was observed in 60% of children, mainly with RME. Nine children (mainly with non-parameningeal STS) relapsed. 15 patients are alive (including all with orbital, 6/10 with non-parameningeal and 4/8 with parameningeal STS). Eight children died of disease progression., Conclusions: 1. Poor outcome in our patients with non-parameningeal head/neck STS results from false initial diagnosis cansing a delay in referring them to the oncologist. It is essential to give more training to the histopathologists about neoplasms in children. 2. Because complete tumour resection in parameningeal STS is rarely feasible, the prognosis in this group is uncertain despite intense chemo- and radiotherapy. 3. The prognosis in orbital STS is usually good; however, they need mutilating surgery in selected cases not responding to therapy.

The Sopot Program of Cardiac Infarct and Stroke Prevention--SopKard 1999-2009 was established for health promotion to decrease cardio-vascular diseases mortality. To serve these purposes a new project SopKard 15 for adolescents was created. The main aim of SopKard 15 is evaluation of health status with particular attention to risk factors of civilization diseases, with chronic kidney disease (CKD) among them. In population of 14-year-old students a complex nephrological examination including medical history, blood pressure measurements, ultrasound examination, and laboratory tests with e.g. albuminuria, urinalysis, and serum creatinine and cystatin C levels was performed. Nephrology part of Program SopKard 15 aspired to early detection of CKD and verifies normal value for this age group.

Preoperative and postoperative arginase activity was determined in blood serum of 25 patients with liver cirrhosis and 25 patients with hepatocellular carcinoma. The rise of serum arginase activity was observed in the majority of patients before the surgery and the decrease after tumor resection or liver transplantation. The preoperative values of serum arginase activity were similar in both groups of patients. A presence of additional, anionic arginase isoform (All) was demonstrated in serum of studied patients, which was absent in healthy subjects. Thus, our results indicate that the arginase activity cannot differentiate liver cirrhosis and hepatocellular carcinoma. However, arginase isoform All seems to be specific for studied liver diseases.

Background: Caffeine, a methylxanthine derivative, is contained in coffee or tea, chocolate as well as in some beverages. In addition, it may be added to some analgesics. At high doses, similarly to other methylxanthine derivatives (theophylline, pentoxifylline) caffeine induces seizure activity in rodents., The Aim of Study: If caffeine intake from coffee drinking resulting in pharmacologically active plasma caffeine concentrations--can lead to diverse interactions with other medications., Results: Since 90s of the XX century, there are experimental data available pointing to the caffeine-induced impairment of the protective activity of a number of antiepileptic drugs in basic models of epilepsy in rodents. Acute caffeine, in doses far below its convulsive potential (almost 10-20 fold lower than the ED50 of the methylxanthine of 2.03 mmol/kg for the induction of seizures), produced a significant reduction in the anticonvulsant effects of carbamazepine, phenobarbital, phenytoin, and valproate against maximal electroshock-induced seizures in mice. This interaction was pharmacodynamic in nature since caffeine did not affect the plasma concentrations of these anti-epileptics. Interestingly, there was no tolerance to this hazardous effect of caffeine since its administration at the same dosages (0.12-0.24 mmollkg) also resulted in the impairment of the protection provided by antiepileptic drugs, this effect being even more pronounced in the case of phenobarbital and carbamazepine. In case of newer antiepileptics, both acute and chronic caffeine decreased the protective potential of gabapentin and topiramate but not that of lamotrigine and tiagabine., Conclusions: The existing clinical data confirm the experimental results in that caffeine intake in epileptic patients results in increased seizure frequency. It may be concluded that epileptic patients should limit their daily intake of caffeine.

Background and Purpose: According to European Stroke Initiative (EUSI) recommendations every stroke patient should undergo rehabilitation. We aimed to evaluate the needs of comprehensive stroke in-patient rehabilitation in Poland., Materials and Methods: We designed and distributed a questionnaire evaluating rehabilitation departments in Poland, where stroke patients undergo early rehabilitation. Comprehensive rehabilitation was defined as: kinesitherapy (minimum 60 minutes/day), speech therapy (minimum 30 minutes 5 days a week), rehabilitation of other cognitive impairments and group kinesitherapy. We separated rehabilitation departments where comprehensive post-stroke rehabilitation is conducted, and calculated the number of beds in these departments only for stroke patients. We estimated the number of acute stroke patients in Poland. We evaluated the number of patients requiring in-patient rehabilitation based on results from the 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, where all stroke patients who need in-patient rehabilitation have such a possibility. We estimated the number of beds required in rehabilitation departments for stroke patients in Poland., Results: We obtained responses from 115 out of 172 (66.9%) rehabilitation departments. Comprehensive post-stroke rehabilitation is conducted in 11 departments. 159 beds in these departments are for stroke patients. From 64,896 acute stroke patients 9,927 will need in-patient rehabilitation. We need 604 more beds in rehabilitation departments for stroke patients in Poland., Conclusion: Only 10% of rehabilitation departments could provide comprehensive stroke rehabilitation in Poland. At present, the number of beds in rehabilitation departments for stroke patients covers about 20.8% of actual needs. An increased number of rehabilitation beds for stroke patients could result in a decreased number of disabled post-stroke patients.

In this paper the structure of M. tuberculosis cell, especially mycobacterial proteins were analized. Cytoplasmatic and secretory proteins were reviewed according to their function and the role in immunological reactions. Some diagnostic and therapeutic aspects were demonstrated.

Tuberculosis is a burning health issue in the contemporary world. Recognition of mechanisms by means of which pathogenic bacilli affect host cells and their virulence factors is indispensable to developing and synthesis of new drugs and vaccines. The authors discuss groups of the most important chemical compounds from the pathological point of view, which are responsible for morbidity and virulence of tubercle bacillus. They also point out the construction of cellular structures with reference to their functions. High content of lipid compounds especially in bacterial cell wall is a specific feature of tubercle bacillus. These molecules play different and very important roles both in growth and virulence of Mycobacterium tuberculosis.

The primary tracheo-bronchial amyloidosis is a rare entity with long lasting and progressive course. Precise diagnosis can be established on the basis of pathological features seen in samples derived from the airways, obtained during fibreoptic bronchoscopy or during lung biopsy sometimes. Describing the case of an insidious course of primary tracheobronchial AL type amyloidoisis, that was initially recognised and treated as a chronic obstructive pulmonary disease. The authors represent its clinical course and the diagnostic difficulties. The changes in the respiratory tract, both radiological and endoscopic suggested a tuberculous or proliferative process. They were responsible for a severe increasing dyspnoea, due to bronchial obstruction, with muco-haemoptic expectoration. A forceps resection of the endobronchial lesions enabled to established the right diagnosis and further treatment limited to local procedures.

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.

Amyloidosis is a group of biochemical disturbances, leading to extracellular deposition of misfolded protein fibril's. It can be of primary, secondary or hereditary (familial) origin. The disorder is known from 150 years, and as already 23 fibril precursor proteins have been identified. Its symptoms can be systemic, localized; some forms don't produce any clinical manifestation. In this article amyloidosis pathogenesis, classification, epidemiology, prognosis and clinical characteristics are described, mainly with reference to the respiratory system.

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.

Background and Purpose: According to the European Stroke Initiative recommendations every stroke patient should undergo rehabilitation; its program should be tailored according to the individual needs of the patient. The aim of our study was to evaluate the accessibility of comprehensive early stroke rehabilitation at neurological departments in Poland., Materials and Methods: We have sent a questionnaire evaluating neurological and rehabilitation departments in Poland, where stroke patients are treated and undergo early rehabilitation. We divided them into 5 categories -- classes from A to F: class A -- having comprehensive rehabilitation (kinesitherapy minimum 60 minutes/day, speech therapy minimum 30 minutes for 5 days a week and rehabilitation of other cognitive impairments and group kinesitherapy at rehabilitation departments); B -- having the possibility of all types of therapy, but is done less frequently; C -- kinesitherapy and speech therapy; D -- kinesitherapy and cognitive rehabilitation; E -- only kinesitherapy. We also separated neurological departments without trained rehabilitation staff., Results: We obtained responses from 191 of 215 (88.8%) neurological departments. According to criteria: 26 class A, 38 class B, 50 class C, 2 class D, 73 class E, 2 without specialized rehabilitation staff. We received filled questionnaires from 115 of 172 (66.9%) rehabilitation departments. According to criteria: 11 class A, 31 class B, 28 class C, 4 class D and 41 class E., Conclusion: Only 14% of all neurological departments and 10% of rehabilitation departments administered comprehensive early stroke rehabilitation in Poland. Improvement of comprehensive rehabilitation accessibility in Poland is necessary for lowering the number of disabled post-stroke patients.

Barium embolisation is a very rare complication of barium enema, but carries a mortality of about 50%. We report a case of 70-year-old woman with Lesniowski-Crohn disease, who survived after barium intravasation into the portal circulation produced during a barium enema.

The authors present the case of primary malignant thyroid lymphoma and problems with distinguishing between Hashimoto's thyroiditis and primary thyroid lymphoma. Primary malignant thyroid lymphoma (PMTL) is a rare disease and difficult to diagnose. The appearance of PMTL may be preceded by Hashimoto's thyroiditis. The biopsy is useful but often only surgical treatment allows to establish diagnosis. The treatment of PMTL includes surgical treatment, chemo- and radiotherapy. The prognosis depends on the disease period.

The aim of the study was to determine the possible risk of the leptospiral transmission from animals to humans. 457 humans (both men and women) were divided into 2 groups: 1) of possible high risk infection consisted of people dealing as farm workers with cattle and pigs 2) of possible low risk infection consisted of people selected randomly. The animals on the farms were previously tested and found positive. All sera were examined using micro-agglutination test (MAT) with a battery of 18 serovars. The statistical evaluation of the results was performed using chi 2 test. The infection rate in I group was 13.79% and in II group was 1.5%. (p < or = 0.001). Sera of I group reacted with 7 serovars (sejroe, bratislava, canicola, tarassovi, bataviae, celledoni, patoc) and of II with 3 (hebdomadis, sejroe, hardjo). The infection rate in the group I was over 9 times higher than in group II. Thus dealing with infected animals is a high risk factor.

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.

Unlabelled: Hepatocellular carcinoma is one of the most common malignancies worldwide. Invasiveness of this tumour seems to be related to degradation of extracellular matrix. Such proteolytic enzymes as: cathepsin B and L, plasmin, collagenase and trypsin are thought to play a pivotal role in this process. Enzymatic activity depends on balance between enzymes and their inhibitors and--moreover--on interactions among these enzymes. The purpose of our study was to evaluate enzymatic activity of cathepsin B, cathepsin B and L, plasmin, collagenase and trypsin in patients with hepatocellular carcinoma in liver tissue and in peripheral blood. Then correlations between activity of enzymes (mentioned above) and clinical status, pathological findings and laboratory tests were assessed. Our study was conducted on 14 patients who underwent surgery because of hepatocellular carcinoma. Tissue samples were obtained during surgery from neoplastic area and from non-neoplastic area. Peripheral blood was withdrawn before surgery and within early post-operative period. Proteolytic activity of these enzymes was determined with use of fluorometric assay. Enzymatic activity in tissue samples was referred to protein concentration (BCA assay) and to DNA concentration (fluorometric assay)., Results: Proteolytic activity of plasmin and trypsin in neoplastic tissue were significantly lower as compared to non-neoplastic area of these patients (p = 0.0356; p = 0.0412, respectively). Activity of the remaining enzymes: cathepsin B, cathepsin B and L and collagenase did not differ significantly. No difference was demonstrated between activity of enzymes in peripheral blood withdrawn before surgery and in postoperative period. There was a statistically significant inverse correlation between serum AFP level and enzymatic activity of cathepsin B, cathepsin B and L and collagenase in tumor tissue. Lower activity of all investigated enzymes was observed in tumor tissue of HBV related hepatocellular carcinoma in comparison with the remaining tissue samples. Correlation between patients age and activity of enzymes was not statistically significant., Conclusion: Although the evaluation of presented enzymatic profile did not allow for the assessment of associations between investigated enzymes, our results demonstrated correlations between proteolytic activity of enzymes and serum AFP level, viral status, but it requires further investigations.

The present therapies used for post stroke patients are often not effective. Many patients finish the therapy and are not able to function independently. This situation is not in line with the present level of neurobiology: which states that function after focal lesion of C.N.S. can be recovered. Recently many studies have been undertaken which indicate the possibility of cortical plasticity by intensive physiotherapy. The main aims of the study were to review the efficacy and application of Constraint Induced Therapy for post stroke patients in a neurological rehabilitation ward and outpatient clinic. The group was selected from the patients who were admitted into the clinic. The patients signed the agreement that they could walk unaided and their affected arm could use a primitive grip. The patient's unaffected arm was restrained using a sling for 5 hours per day for 15 consecutive days. Also each patient had one hour per day of physiotherapy based on PNF and NDT Bobath concepts. Patients were tested before and after the experiment using functional tests (modified Wolf Test) and testing of motor deficit using Tests for the Quality of Movement Patterns (by Bobath). Seven patients were selected with an average time from stroke of 11 months. The average age was 46 years. All patients completed the study without any adverse affects. All patients increased their functional ability and decreased the motor deficit of the affected arm. The average increase in task function was 27%. The greatest average improvement (40%) was noted in chronic patients who suffered from stroke more than 6 months previous. The experiment was completed without any major reorganisation of the neurological ward and without additional expenditure. The small group of patients that participated in this study indicates that this CI therapy should be utilised for a larger amount of patients with greater neurological deficits.

The liver transplantation (ltx.) is currently the only efficient treatment of the diseases which lead to the end stage liver failure. The proper time to perform the operation and the evaluation of the survival time, with or without transplantation, are the most important aspects of qualifications to the liver transplantation. There are no specific criteria of patient qualification for liver transplantation and there are no objective quantitative liver function tests. There were created many prognostic models for evaluation patients with chronic liver diseases. Some of them, the most popular, are presented in this article. We assume, that probability of one year survival less than 90% is the indication for ltx. However, the most important is total evaluation of clinical condition of the patient with liver failure. Such a complicated problem like qualification patients for ltx. needs to be solved by a team of experts from different medical specializations.

The aim of the study was to investigate the histological structure of the artificial channel connecting one of the portal vein branches with the hepatic vein, as an effect of the transjugular intrahepatic portosystemic shunt (TIPS). The livers of six patients were investigated. In 4 of them recurrent variceal bleedings were an indication for TIPS, in the remaining 2 patients--intractable ascites. In all cases portal hypertension was due to liver cirrhosis. All patients were estimated as Child-Pugh group C. The period from the stent implantation to the moment of investigation ranged from 1 to 7 months. 2 livers were removed at the time of liver transplantation, 4 were procured at the autopsy. All shunts were patent and in none of the 6 cases dislocation of the stent occurred. The wall of the intrahepatic shunts was lined by a granulation tissue (pseudointima) covered with a layer of endothelial cells. No thrombosis, mechanical damage of the stent or extensive hypertrophy of pseudointima were found.

Autologous peripheral blood stem cell transplantation (APBSCT) is a method used analogically to autologous bone marrow transplantation (ABMT) to obtain hematological reconstitution following myeloablative therapy in patients with hematological malignancies. We have now applied this procedure in two patients with recurrent high risk Hodgkin's disease. Collection of circulating stem cells mobilised with cyclophosphamide/G-CSF was performed by several leukaphereses on Fenwal 3000, with access through inferior vena cava. Nucleated cells were separated by dextran sedimentation, cryopreserved, and stored at (-) 196 degrees C. Additional marrow collection was performed in one patient. Conditioning regimen consisted of BCNU, etoposide and cyclophosphamide delivered at days -3 and -2. Collected material containing on average 3.6 x 10(8)/kg nucleated cells and 8.0 x 10(6)/kg CD34(+) cells was transfused at day 0. G-CSF was administered following transplantation to one patient to hasten the recovery. Hematological recovery was relatively quick. Neither serious adverse events nor signs of relapse were observed following transplantation. Our results supported by other's reports indicate, that APBSCT enables hematological recovery similarly to ABMT in Hodgkin's disease. The advantage of APBSCT is a possibility to collect material in patients with marrow involvement, hypoplasia or fibrosis. Outcomes obtained following APBSCT are at least as good as following ABMT. High-dose chemotherapy followed by APBSCT or ABMT should be considered in all patients with recurrent Hodgkin's disease sensitive to chemotherapy.

The aim of the present study was to analyse the rate of postoperative complications in patients after esophageal resection for cancer, as well as the dependence of its frequency from surgical tactics employed during the operation. Postoperative complications occurring in 38 patients who underwent esophagectomy and intrathoracic esophagogastric anastomosis (treated from 1978 to 1987) were compared with the same data of 74 patients (1988-1996) in whom the operation consisted of the total intrathoracic esophagectomy, cardia, lesser curvature of the stomach and large regional lymph nodes dissection. In these latter cases the esophagogastric anastomosis was performed in the neck. The most frequent postoperative complications in both groups were of cardiopulmonary origin. The anastomotic leak occurred less frequently in patients with cervical esophagogastric anastomosis. However, when occurred, healing was more likely by local drainage and conservative treatment. Anastomotic leaks after intrathoracic esophagogatric anastomoses were usually fatal. In these cases the only chance of patient's survival was an aggressive surgical treatment consisting of disconnection of alimentary tract: esophageal fistula in the neck and feeding jejunostomy.

The authors present their own experiences concerning the treatment of the 34 patients with the benign and malignant tumors of the biliary tract. In the group of patients with malignant tumors, the type and extent of the surgery were dictated by the stage of the disease. Patients with benign tumors were subjected to resection of the region of bile duct bifurcation with Roux-Y hepaticojejunostomy.

The majority of liver transplanted patients are severely malnourished that increases the incidence of postoperative morbidity and mortality. The authors analysed the effects of nutritional support-total parenteral nutrition-in 11 adult orthotopic liver allograft recipients (9 women, 2 men) transplanted for chronic or acute liver failure in 1994-1997. 4.3-9.75 g of N/24h, 1200-1700 kcal in 1750-2750 ml, from 2-5th postoperative day was administered via central vein in all-in-one system for 4-46 days. Neither metabolic nor septic complications related to the nutrition were observed. The function of the transplanted liver was not impaired by the nutrition. One patient died in course of hepatic coma, 10 patients are alive and in good general condition (1-29 months). In conclusion, the total parenteral nutrition is safe, beneficial and thus recommended routine therapy in the treatment of the liver transplanted malnourished patients.

The paper presents the results of surgical treatment performed in 54 patients with iatrogenic injury of biliary tract. All cases of injury were made during open and laparoscopic cholecystectomy. We concluded that Roux-en-Y hepatico-jejunostomy should be recommended. There were no deaths after surgery. This technic was successful therapeutic management more than 95% of cases.

On the basis of their own experience the authors present indications and results of pancreatoduodenectomy for chronic pancreatitis. In a group of 18 patients. With appropriate evaluation of patients, meticulous surgical technique and postoperative care the complications aren't life-threatening. The long-term results are fully satisfactory.

The authors present their own experience in the use of veno-venous bypass during the anhepatic phase of orthotopic liver transplantation. The selected hemodynamic parameters (arterial pressure, central venous pressure, peripheral resistance) of the anhepatic phase as well as the effects of the graft reperfusion were analyzed in the group of 14 adult orthotopic liver allograft recipients transplanted in the Dept. of General Surgery & Liver Diseases from December 1994 to April 1997. In conclusion, the use of the veno-venous bypass allowed to avoid severe hemodynamic disturbances during the anhepatic phase and to minimize the complications of the reperfusion syndrome. The possibility of the relatively safe prolongation of the anhepatic phase is particularly important during the period of gaining experience by the surgeons and anesthesiologists.

Complications of laparoscopic cholecystectomy were evaluated in the group of 1.284 patients operated on from June 1991 to December 1996. Serious complications were observed in 38 (2.9%) patients. Conversion to open cholecystectomy was required in 50 patients, including 4 patients with common bile duct injury, 3 patients with bleeding from the gall bladder bed, 2 with cholecysto-duodenal fistula and 6 with intraperitoneal adhesions. In 35 patients the conversion was performed due to inflammatory changes in the Calot triangle. The authors did not observe any serious vascular injury as well as lethal complications. They conclude, that the correct indications to surgery and adequate surgical technique are the most important factors preventing the complications.

The paper presents the results of 76 hepatic resection in the group of patients with benign liver lesions. The most common indication to the resection were liver cysts and hemangioma. Morbidity occurred in 13% of patients. After liver trauma the highest mortality we observed.

The authors present the retrospective analysis of the morbidity risk in patients undergoing hepatic resection for various indications. The most important complications, according to the literature, were: postoperative liver failure, massive pleural effusion, ascites resistant to pharmacological treatment, intraperitoneal hemorrhage or septic complications requiring relaparotomy. There was the correlation between the increased morbidity and preoperative risk factors like: diabetes mellitus, liver insufficiency with coagulopathy, and intraoperative blood loss, requiring massive transfusions.

From 1990 to 1996 two hundred and sixteen patients with abdominal trauma were treated in our Department. In 170 cases there were blunt, and in 46-penetrating injuries (stab and gunshot wounds). Injuries of the other regions of the body coexisted in 117 patients (multiple trauma). In 42 cases (19.4%) abdominal trauma caused injury to the liver. In this group blunt mechanism of trauma also dominated (71%). The victims were usually young men (90% of the group, mean age - 35.3 years). The most common cause of injury were traffic accidents (47.6%), penetrating injury being the second commonest cause (12 patients i.e. 29%). Four patients were treated conservatively, the remaining 38 required surgical intervention. Most frequently liver suture and peritoneal drainage were performed (20), followed by liver tissue resections (16) and liver packing (12). Other surgical procedures to treat coexisting injuries were performed in 24 patients. In 22 patients postoperative complications occurred: liver abscess in 6 cases, hemorrhage in 4, wound infection in 4, biliary fistula in 2, intrahepatic aneurysm in 2 and other complications in 8 patients. The mean time of hospitalisation were of 20 days (range: 0-64 days). Mean volume of blood transfused equaled 6.9 U. There were 16 deaths (38%), in all cases in multiple trauma victims. All patients with penetrating liver trauma survived.

From 1976 to 1996, thirty nine patients were surgically treated for pharyngoesophageal diverticulum. The present study aimed to compare two methods of operative treatment of Zenker's diverticulum: excision (group I) and pexy, both of which were associated with upper esophageal sphincter myotomy. The main indication for surgery was dysphagia. The diagnosis of Zenker's diverticulum was based on clinical symptoms and the result of upper GI tract barium examination. In 75% of patients the diameter of diverticulum exceeded 2 cm. No patient died in the perioperative period. The main complications observed in the postoperative period were of pulmonary origin. In group I (excision) a leakage from the suture line occurred in 2 patients (12.5%). Time of follow-up ranged from 1 to 20 years (mean: 7 years). The comparison of both methods of treatment employed is in favour of diverticulopexy, being a safer and less complications-bearing method, although both of them give similar functional results.

The authors present their own experience in orthotopic liver transplantation as a treatment of acute and chronic liver failure. 18 transplantations were performed in 16 patients. The indications for transplantation: acute liver failure-3 cases, chronic advanced disease of the liver-13 cases, graft failure requiring retransplantation-2 cases. All 3 patients with acute failure died after transplantation. Out of 13 patients after elective transplantations 11 remain alive, (in this number both retransplanted). The longest follow-up period is 2.5 years.