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Copyright of Acta Angiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Angiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Angiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Wstęp: Celem pracy była ocena postępu w leczeniu pękniętych tętniaków aorty brzusznej. Materiał i metody: Ocenie poddano grupę 246 chorych z pękniętym tętniakiem aorty brzusznej leczonych w Klinice Chirurgii Ogólnej i Naczyń w latach 1987-2005. Wśród badanych było 219 (89%) mężczyzn i 27 (11%) kobiet. Średni wiek chorych wynosił 69,6 lat (± 8,6 roku). Zebrano dokładne dane dotyczące przedoperacyjnych poziomów hemoglobiny, hematokrytu, erytrocytów, leukocytów, płytek krwi, mocznika i kreatyniny. Odnotowano również wartości ciśnienia skurczowego i rozkurczowego przy przyjęciu chorego do Kliniki. Oceniano również odległość miejsca zamieszkania chorego od Kliniki. Trzydziestu jeden (12,6%) chorych nie było operowanych. Aby ocenić postęp w wynikach leczenia chorych podzielono na dwie grupy, 111 chorych leczonych w latach 1987-2000 (grupa I) oraz 135 chorych leczonych w latach 2001-2005 (grupa II). Głównym punktem końcowym była śmiertelność szpitalna. Oceniano śmiertelność szpitalną wszystkich chorych oraz śmiertelność szpitalną chorych operowanych. Uzyskane wyniki zostały poddane analizie statystycznej. Wyniki: Śmiertelność szpitalna wszystkich chorych była istotnie niższa w grupie II w porównaniu z grupą I (p = 0,0048). Odnotowano również zmniejszenie śmiertelności szpitalnej chorych operowanych, różnica ta nie była jednak statystycznie istotna (p = 0,06). W grupie II stwierdzano istotnie statycznie wyższe przedoperacyjne poziomy hemoglobiny, hematokrytu, erytrocytów i płytek krwi oraz skurczowego i rozkurczowego ciśnienia krwi w porównaniu z grupą I. Wiek i płeć chorych oraz przedoperacyjne wartości leukocytów, mocznika i kreatyniny, a także odległość miejsca zamieszkania chorego od Kliniki były porównywalne w obu grupach chorych. Dwudziestu trzech chorych z grupy I i 8 chorych z grupy II było zdyskwalifikowanych lub zmarło przed operacją (p = 0,0005). Wnioski: Wyniki leczenia chorych z pękniętym tętniakiem aorty brzusznej uległy poprawie. Agresywne podejście operacyjne i lepszy stan przyjmowanych chorych wydają się być głównymi czynnikami odpowiedzialnymi za poprawę czynników leczenia. [ABSTRACT FROM AUTHOR]

Wstęp: W ostatnim dziesięcioleciu dość dobrze poznano rolę poszczególnych elementów stanu zapalnego w miażdżycy tętnic. Niektórym z nich, takim jak Il-6, przypisuje się rolę prognostyczną w niedokrwieniu kończyn dolnych. Il-6 jako cytokina pro-zapalna działa wspólnie z Il-1-beta oraz TNF-alfa. Pozostaje nie do końca zbadane, czy surowicze stężenie cytokin prozapalnych odpowiada nasileniu stanu zapalnego w ścianie tętnicy. Celem pracy było porównanie ekspresji TNF-alfa, Il-1-beta oraz Il-6 w ścianie tętnicy z surowiczym stężeniem tych cytokin u chorych z chromaniem przestankowym i krytycznym niedokrwieniem kończyn dolnych Materiał i metody: Do badania włączono 40 chorych operowanych z powodu miażdżycowego niedokrwienia kończyn dolnych. Chorych podzielono na dwie grupy: 1 -- 22 chorych z chromaniem przestankowym o dystansie poniżej 100 m, 2 -- 18 chorych z objawami krytycznego niedokrwienia kończyn dolnych wg kryteriów TASC. Bezpośrednio przed operacją u wszystkich chorych pobierano krew z żył obwodowych. Krew wirowano, a w uzyskanej surowicy oceniano stężenia TNF-alfa, Il-1-beta, oraz Il-6 w metodzie ELISA. Śródoperacyjnie z okolicy planowego zespolenia pobierano niewielki fragment pełnej ściany tętnicy, który był zamrażany, a następnie oceniany histo-logicznie i immunohistochemicznie na obecność wybranych cytokin prozaplnych. Otrzymane wyniki poddano obróbce statystycznej za pomocą testów nieparametrycznych. Wyniki: Ekspresja TNF-alfa, Il-6, Il-1 w ścianie tętnicy pobranej z okolic zespolenia naczyniowego nie wykazuje statystycznie istotnych różnic w grupach chorych z chromaniem przestankowym i krytycznym niedokrwieniem kończyn dolnych. Ekspresja badanych cytokin nie korelowała z ich surowiczym stężeniem w obydwu grupach (p = 0,8, p = 0,6). Stężenie IL-6 znamiennie wzrastało u chorych z krytycznym niedokrwieniem (p = 0,006), czego nie obserwowano w przypadku TNF-alfa i IL-1-beta. Wnioski: Zwiększonej ekspresji Il-6, Il-1-beta i TNF-alfa w ścianie tętnicy nie towarzyszy wzrost ich surowiczego stężenia. Surowicze stężenie Il-6 odzwierciedla zaawansowanie niedokrwienia, a nie stopień nasilenia procesu zapalnego w ścianie tętnicy, co w sposób istotny ogranicza wartość prognostyczna tego parametru stanu zapalnego w niedokrwieniu kończyn. [ABSTRACT FROM AUTHOR]

Copyright of Acta Angiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Angiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Angiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Angiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Angiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Angiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Angiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Angiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Angiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Angiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Angiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The aim of the study was to indicate independent prognostic factors of treatment in group of patients with advanced cancer of the larynx., Material and Method: The paper presents results of univariate and multivariate analysis of selected clinical and morphological factors in the group of 355 patients with advanced laryngeal cancer treated in the ENT Clinical Department in Zabrze in the following years 1998-2007. The analysis of the results of treatment in relation to clinical and morphological features of the tumor was based on overall survival, disease-free survival, local control and locoregional control. The results of analysis allowed to indicate the independent prognostic factors for outcome in patients with advanced laryngeal cancer., Results: Univariate analysis showed that the increase of clinical advancement of laryngeal cancer was associated with worse prognosis, as well as the fact that the primary location of the tumor in supraglottis and infiltration in laryngeal part of pharynx determined the worse outcome. Univariate and multivariate analysis confirmed that the number of lymph node metastases in the surgical specimen and microscopic radical of surgery were the most important prognostic factors for survival and cure in the study group., Conclusion: The strongest independent prognostic significance for all efficacy criteria have: completeness of operation and number of metastatic lymph nodes., (Copyright © 2012 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

Aneurysms of the renal artery are very rare and its incidence is estimated at 0.01% of population. A 50-year-old male was admitted to the Department of General and Vascular Surgery due to incidentally diagnosed aneurysm of the left renal artery. Due to wide neck of the aneurysm, a two-step procedure was planned. First, an intracranial stent was implanted into the left renal artery. Second, after 3 months, platinum coils were deposed in the aneurysm sac through the stent struts. Aneurysmal sac was totally occluded. Periprocedural course was uneventful. The endovascular embolization with the use of stent and detachable coils is a safe method of treatment of wide-necked renal artery aneurysms with preserving parent vessel patency.

Aim: The aim of the study was to evaluate the results of partial laryngectomies in patients with laryngeal cancer treated in the 2(nd) Clinical Department of Laryngology SUM in Zabrze in the years 1990-2000., Materials and Methods: Retrospective clinical material includes 209 patients in whom surgery was a primary treatment method. No distant metastases (M1) or another malignant cancer were found. The group consisted of 20 (10%) women and 189 (90%) men. The mean age was - 51.2 years. The stage of the neoplasm progression was defined as T1 in 91 patients (44%), T2 in 109 patients (52%). In other 9 patients (4%) the progression stage was T3 and T4. Clinical examination in 191 patients (91%) did not show enlarged lymph nodes in the area of head and neck (N0). In the group of remaining 18 patients (9%) the node progression was found to be N1-N3. In all 209 patients the squamous cell carcinoma of various stage of malignancy (G1-G3) was found in preoperative histopathological tests, out of which five cases were of papillary squamous cell carcinoma. The most common operation in the analyzed group was a chordectomy - 83 surgeries (40%), followed by 38 (18%) vertical partial laryngectomies, 28 (13%) horizontal glottis surgeries, 19 (9%) frontal-lateral and frontal-anterior operations, and supracricoid operations with a reconstruction of CHEP and CHP type, a total of 20 operations (9%). Other types of partial operations were performed less commonly. In 79 patients (38%) partial laryngectomy was complemented with a nodal operation, while cervical lymph nodes were not removed in 130 patients (62%). In 19 cases (9%) the metastases of squamous cell carcinoma to regional lymph nodes were confirmed in postoperative material. 82 patients of the study group (39%) underwent radiotherapy. The median of the observation period was 9 years. Local recurrence, nodal recurrence and distant metastasis are rated as treatment failure. Treatment effectiveness was evaluated with relation to local control, overall survival, disease-free survival and cause specific survival. All the aforementioned parameters were analyzed with the method of updated percentages. The level of statistical significance was assumed to be p ≤ 0.05., Results: The updated 5-year and 10-year percentage of overall survivals was respectively 75% and 63%. The updated 5-year and 10-year percentage of cancer specific survivals was 85% and 79%, respectively. The updated 5-year and 10-year percentage of disease-free survivals was 72% and 56%, respectively. The percentage of 5-year and 10 year local controls was 86% and 79%, respectively., (Copyright © 2012 Polish Otolaryngology Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

Aneurysms of the superior mesenteric are very rare and comprises 5.5% of all visceral artery aneurysms. A 60-year-old male was admitted to the General and Vascular Surgery Department due to the superior mesenteric artery (SMA) aneurysm, diagnosed in angio CT. Due to wide neck of the aneurysm and its localization in the mid-die segment of the SMA, a decision to implant a stentgraft was made. After surgical exposure of the right common femoral artery, a stentgraft Viabahn was implanted into the SMA. Control angiography revealed total aneurysm exclusion and patent SMA. Periprocedural course was uneventful. Follow-up CT scan 2 year after the procedure revealed no contrast filling of the aneurysm and patent SMA. A stentgraft implantation is a effective method of treatment of the wide-necked SMA aneurysms.

Introduction: Treatment of patients at the Intensive Care Unit (ICU) always requires maximal efforts of the staff and use of extended resources to save lives and restore health. Therefore, the assessment of therapeutic efficacy at the ICU is of great value. The aim of this study was to assess follow up and the quality of life of patients after treatment at the Intensive Care Unit. We chose the Department of Intensive Care and Anesthesiology with the Acute Intoxication Unit of the Second Clinical Hospital, Pomeranian Medical University in Szczecin., Material and Methods: Patients who stayed at the ICU for at least 14 days in 2002-2007 were qualified and cardiac surgery patients were excluded., Results: Out of 1347 patients treated during this period at the Department of Intensive Care and Anesthesiology with the Acute Intoxication Unit of the Second Clinical Hospital, Pomeranian Medical University in Szczecin, 809 (60.1%) were discharged. The mean annual hospital mortality rate was 104. Eighty patients fulfilled the inclusion criteria. In this group, 32 (40%) survived until year 2010 when our study was undertaken; 26 of them (32.5%) were enrolled. The main part of the study was based on the standardized questionnaire QLQ-C30 (3.0 Polish version). Supplementary questions addressed personal data, occupation, employment status, degree of disability, and posthospital rehabilitation. An attempt was made to assess the quality of medical and nursing care at the ICU. The results were analyzed statistically with Pearson's r and Kruskal-Wallis tests for correlations and significance. Out of 26 patients (18 males and 8 females), mean age 56.4 years, mean ICU stay of 29.7 days (SD +/- 22.3 days), hospitalized for acute cardiopulmonary failure (n = 10; 38.5%), cardiac arrest (n = 9; 34.5%), multiple trauma (n = 5; 19%), and intoxication (n = 2; 8%), only 46% survived two years or more after discharge from ICU; QLQ-C30 demonstrated that their health status and quality of life was good, albeit worse than of healthy persons., Conclusions: There were no correlations between self--assessed health status and quality of life on one side and age, ICU duration, and time from ICU stay on the other. The diagnosis had no significant effect on self-assessment of health status and quality of life.

The authors present a review of trauma in tourist and competitive cycling in Poland in comparison with reports in the literature. Groups of injuries are discussed with a focus on their frequency and threat to life and health. The authors present a case of a road cycler colliding with a car, his first aid, evacuation, and treatment at a hospital. This case, as well as accidents of other competitive cyclers, are analyzed by the authors to demonstrate ways of reducing trauma in cycling. Most importantly, competitive and tourist cyclers should always wear cycle helmets as they reduce head trauma, the main life-threatening trauma in this sport.

Introduction: It is widely known that quality of life of patients after colorectal surgery with creation of stoma substantially deteriorates. In this instance it seems interesting to assess if it is improving in time and what measures are to be undertaken to achieve such improvement. Aims to assess changes in quality of life of patients after colorectal surgery with creation of a stoma, in 3 and 6 months after intervention, and establish possibility of improvement of quality of life in these patients., Materials and Methods: A group of 84 patients 36 men and 48 women after colorectal cancer surgery with creation of a stoma was investigated by means of a standardized questionnaire EORTC QLQ C-30 (version 2.0), filled 3 and 6 months after intervention. Questions about possibilities of improvement of their quality of life were also posed., Results: Compared with representatives of general population, quality of life of investigated group 3 months after surgery was substantially inferior, in almost all items: functional domains and symptomatic ones as well. After 6 months substantial improvement in patients was revealed in functional domains such as physical functioning and fulfilling their role. However improvement of quality of life was observed in majority of items but it did not achieve the level of healthy population. Results achieved in male group which were inferior to results achieved by women after 3 months, exceeded the women' score after 6 months in many aspects. The improvement was influenced by acquaintance of patients with stoma, and by acquiring knowledge about stoma care which were considered low after 3, and after 6 months., Conclusions: Quality of life substantially lower after intervention resulting in stoma formation, improves after 6 months, however there are still deteriorations in private and social life, and financial situation. An adequate education of patients in pre- and postoperative time and active informative support is mandatory to obtain some degree of improvement of their quality of life.

The IGRT notion (image guided radiation therapy) comprises all techniques enabling checking and correction of patients position directly before or during an irradiation session. In last years they became a standard in radiotherapy due to decreasing of geographical misses. The aim of our study was a comparison of two IGRT techniques--CBCT and 2D-2D kV performed for prostate cancer patients and a comparison of two immobilization systems used for them. The performed analysis comprises 3582 2D-2D kV and 2110 CBCT IGRT measurements made for 85 prostate cancer patients. Patients were irradiated using thermoplastic masks and two kinds of immobilizing plates. One subgroup of patients was treated using leg supports and second one without them. Mean, maximum, minimum and standard deviation of absolute values of shifts (cm) measured using 2D-2D kV were 0.27, 0.0, 2.8 and 0.33 respectively. For CBCT these same values were 0.31, 0.0, 4.1 and 0.33. Mean, maximum, minimum and standard deviation of real shifts values (cm) measured using 2D-2D kV were -0.01, -2.5, 2.8 and 0.43 respectively. For CBCT these same values were 0.01, -4.1, 2.3 and 0.45. Comparison of shift absolute values distributions for whole analyzed group showed statistically significant difference (p=0.001) between 2D-2D kV and CBCT with higher mean for CBCT (0.31 vs 0.27) and equal standard deviations. Statistically significant difference (p=0.000...) between distributions of measurements in z axis was found (for 2D-2D kV mean 0.16, SD=0.21, for CBCT mean 0.25, SD=0.25). Comparison of absolute shifts values distributions revealed significant difference for CBCT, for two immobilization plates--in x (p=0.001) and y axis (p=0.007). For the small plate in x axis mean was 0.22 (SD=0.2), and for the large one (with an integrated head support) 0.17 (SD=0.2). Comparison of absolute shifts values for sub- groups created dependently on the leg support use, showed significant differences in x axis for 2D-2D kV (p=0.000...); mean in the subgroup irradiated without leg supports was 0.14 (SD=0.14) and for the subgroup without them was 0.19 (SD=0.15) and in x axis for CBCT (p=0.03); mean in the subgroup irradiated without leg supports was 0.18 (SD=0.18) and for the subgroup without them was 0.23 (SD=0.22). Significant difference was also revealed for the whole group of absolute shift values for 2D-2D kV (p=0.01). For the subgroup irradiated without leg supports mean was 0.27 (SD=0.34), and for the subgroup treated with them was 0.27 (SD=0.31). Obtained results permit us to conclude that in the case of prostate cancer patients IGRT based on the bone anatomy visualization, the method of choice should be 2D-2D kV, because it allows for more precise and shorter patient position evaluation and, that during IGRT of prostate cancer patients using a simple thermoplastic immobilization system is sufficient; use of more sophisticated systems with additional supports did not improve the patient immobilization.

Unlabelled: Combined edema reducing therapy is a recognized method of lymphedema treatment. However such therapy can be difficult to implement from methodological and logistic point of view in cases of advanced forms of lymphedema. The aim of the study was the presentation and discussion of intensive phase of combined treatment in patient with advanced primary lymphedema., Material and Methods: Therapy was conducted on 19 patients (27 limbs) with edema reducing therapy program. Procedures were conducted daily for 4-6 weeks in out-patient and in-wards conditions., Results: Intensive phase of treatment succeeded in 3870-15 330 ml edema reduction, consisting of 48-65% of initial status. Chronic leg ulcers were healed completely in 2 patients. Ten patients underwent minor adverse events (AE), such as superficial skin ulceration (n = 2), popliteal fossa skin maceration (n = 2), neuropathic foot pain (n = 3) and skin scratches (n = 3). Modification of the treatment allowed the complete healing of AEs within 2-7 days, but it produced significant delay in achievement of desired therapeutic result, In 2 cases it prolonged hospital stay for 7 days., Conclusions: 1. Combined edema reducing therapy is very efficient form of treatment in advanced primary lymphedema. 2. Intensive, 4-6 week, phase of the treatment allows 3.8 to 15.3 1 edema reduction. 3. In our opinion this phase should be conducted only in specialized centers for proper final results achievement with adverse events minimization. 4. The main point of the therapy is a combination of appropriate forms of available treatment.

Radiotherapy has not been widely accepted in the treatment of primary and secondary liver tumors due to its limited efficacy. This is caused by insufficient radiation doses and suboptimal techniques, which were used in the past. However, a present technological progress in radiotherapy has led to the application of modern and sophisticated radiation techniques into the treatment of liver tumors. The excellent example of such progress is stereotactic body radiation therapy (SBRT) (or radiosurgery), with respiratory gating. Such treatment method enables delivery of high radiation doses precisely to the tumor with sparing of surrounding critical tissues. It is possible by application of multiple beams and a narrow margin around the tumor considering its respiratory movement. This method of treatment may be applied under the condition of very precise radiological imaging and accurate patients' immobilization. The study presents a method of stereotactic body radiation therapy with respiratory gating introduced in the MSC Cancer Center and Institute of Oncology in Gliwice. The treatment criteria are as follows: patients in good general condition with inoperable primary and secondary tumors, 1-3 lesions with a maximal diameter of 6 cm. The fractionation schedule consists of three doses of 12 Gy delivered in weekly intervals to the total dose of 36 Gy normalized to the minimum in the PTV. Pre-treatment preparation procedures included: patient immobilization in a vacuum pillow, monitoring of respiratory cycle, the choice of respiratory phase suitable for irradiation and computed tomography (CT) for treatment planning. After preparation of treatment plan, the X-ray simulation is performed with verification of the position of isocenter. A respiratory tracking is performed during simulation. At the last stage, patient is immobilized at the couch of linear accelerator, the verification of the isocenter position using MV or kV images is performed and respiratory tracking is once again conducted. Irradiation delivered intermittently in the selected respiratory phase using automatical connection between respiratory tracking system and accelerator. The SBRT with respiratory gating appears to be a promising method of local treatment in patients with inoperable liver tumors.

Pseudoaneurysms are not a common complication of the endovascular procedures but can present a serious therapeutic problem. Both, the application of compression therapy and surgical operation can lead to the development of subsequent complications. The aim of this study was analysis of the treatment results of iatrogenic pseudoaneurysms managed with percutaneous thrombin injection. Treated group consisted of 69 patients diagnosed with iatrogenic femoral pseudoaneurysms. The indication for injection technique was ineffective compression therapy as well as necrotic changes or bacterial skin infection in the groin area or a large diameter of pseudoanurysm's chambers. Thrombin was injected percutaneously during 1-3 sessions in the dose of 100-1200 U into the centre of the chamber under ultrasound control. Primary and secondary success rate was 88% and 94% respectively. The following factors significantly decreased effectiveness of the method: complex pseudoaneurysms (with treatment efficacy 82% and 88% respectively vs 90% and 96% for simple pseudoaneurysms), and large chamber volume. Early and late recanalization of the thrombotic changes appeared in 7% and 3% of treated cases. The most frequent complication was appearance of non-elastic tumor (71%) or pain (64%) in the groin area. The most serious complication was acute lower limb ischemia detected in one case (2%) as a result of femoral artery compression by the thrombosed pseudoaneurysm. Percutaneous thrombin injection should be a preferred method of pseudoaneurysms treatment, especially in cases of ineffective compression therapy or its contraindications due to low cost of the therapy, simplicity of the technique and relatively low percentage of the complications.

Objectives: The purpose of this study was to analyse prevalence of so called classical risk factors for VV in patients with this entity., Materials and Methods: Study consisted of three parts. In the first part the prevalence of risk factors in 130 men and 360 women with VV was compared. In the second part the prevalence of risk factor in 360 women with VV and 162 without VV was compared. In the third part the prevalence of risk factors in pregnant women with and without VV was compared. The age of patients in all groups was comparable. The results were statistically analyzed., Results: There were no differences in prevalence of classical risk factors between men and women with VV. In non pregnant women positive family history (OR 2,27, p=0,018) and previous pregnancies (OR 2,05, p=0,046) were associated with presence of VV. Premenstrual aching of lower extremities and obesity were at the border of statistical significance, OR and p, 1,9 and 0,062 and 1,4 and 0,071, respectively. As many as 47% of pregnant women had VV. Positive family history (OR 2,27, p=0,018), previous pregnancies (OR 2,56, p=0,011) and premenstrual aching of lower extremities (OR 2,03, p=0,021) were associated with presence of VV. Remaining, so called classical risk factors such as oral contraceptive, working in a sitting or standing position or constipations were not associated with occurrence of VV., Conclusions: In conclusion, positive family history and previous pregnancies seem to be principal risk factors for VV in women.

Not all patients with abdominal aortic aneurysm (AAA) are candidates for endovascular aneurysm repair (EVAR), but as further technologic refinements occur, it is likely that an increasing percentage of patients will be candidates. EVAR, pioneered by Parodi in early 1990s, has made significant progress in all aspects. In the early stages of development, stent grafts were used only to repair abdominal aortic aneurysms (AAAs) in patients with comorbidities (e.g. chronic obstructive pulmonary disease or myocardial infarction) significant enough to preclude open repair. With the advent of new technology, the rapid spread of the skill sets needed to place these grafts, and the demonstration that these grafts are not only safe but also durable, EVAR is now being used more commonly in patients who would otherwise undergo open repair. Nevertheless, EVAR is still in the early stages of development, and long-term follow-up of EVAR patients is essential to assure durable protection from AAA rupture. The authors present the review of epidemiology and possibilities of endovascular management of abdominal aortic aneurysm.

Electroconvulsive therapy (ECT) as a medical procedure of higher risk as well as a therapy evoking certain controversies requires strict obedience to the conditions of acquiring the patient's informed consent to the offered method of treatment. To acquire the patient's consent it is necessary to inform him/her about the different aspects of electroconvulsive therapy. The paper stresses that in the case of ECT therapy, the spoken information given to the patient seems insufficient. It is necessary to work out a Polish questionnaire for acquiring the patient's consent to electroconvulsive therapy and to apply it in all psychiatric institutions that carry out ECT procedures.

Unlabelled: Although surgery is the main therapeutic method applied for the treatment of this disease the other therapeutic modalities cannot be neglected. The aim of the study was an assessment of quality of life of patients following operative treatment of uncomplicated varicose veins with regard to applied additional therapy. The study included 100 patients of Swiebodzin district, who underwent surgery for uncomplicated varicose veins in last 6 years. These patients were visited and interviewed by trained nurse. There were four groups of patients defined. The first one received pharmacological therapy after surgery predominantly phlebotrophic agents, second one used compression therapy, third applied both methods, fourth used as controls did not get any additional therapy after surgery at all. As an investigation tool the original quality of life questionnaire CIVIQ was applied taking into account pain, psychological, physical and social aspects. Results revealed significantly better quality of life for patients using both pharmacological and compression therapy over ones applying one of these therapies alone and the group applying no therapy at all. Morbidity rate was 19%. Reintervention rate was 12% and on examinations in 72% varicose veins were seen. The majority of patients (57%) declared improvement of their health status, 10% substantial improvement 20% some improvement and 13% declared no improvement after surgery for varicose veins., Conclusion: Compression and phlebotrophic therapies applied together after surgery are simple an effective methods improving quality of life better than any of these methods applied separately or no additional therapy at all. Their use is still not very common in Poland.

In industrialized countries the number of abdominal aortic aneurysms (AAA) is continuously rising. In recent years the mortality rate tripled and it is the number 13 cause of death in United States. Despite many identified risk factors and understanding of their pathomechanisms, the pathogenesis of AAA remains unclear. Thanks to the epidemiological researches and improvement of molecular techniques it was noted that AAA may have a genetic bases. The diversity between the possible genomic defects that could lead to the development of aneurytic changes was also suggested. This has a direct relationship with the complexity of the aortic wall structure and therefore with the number of potential injury locations. Current genetic research confirms the changes in expression and the many polymorphic variants of genes coding structural and enzymatic proteins. Thus, AAA seems to be a disease with multifactor pathogenesis and numerous possible genome anomaly variants. Hence, it seems that the complete understanding of the genetic bases of AAA continuous to be distant. However, efforts in this matter remain valuable, giving hope for an improved diagnosis, prophylaxis and treatment of this disease. This article is a review of the available knowledge regarding the genetic origin of AAA.

Purpose: The purpose of the study is the evaluation of the efficacy and morbidity of conformal radiotherapy in patients with clinical stage T1-T3 prostate cancer., Material and Methods: The study group comprises 71 patients with clinical stage T1-T3, N0, M0 prostate cancer, treated with conformal radiotherapy between 1998 and 2000. The planned target volume included in all patients prostate a margin (PTV1). Forty patients (56%) were initially irradiated for the pelvic region (PTV2). The mean total radiation dose delivered to prostate was 68 Gy, and to the pelvis--44 Gy. Radiation morbidity was scored by the RTOG/EORTC system, and it was analysed in relation to the total dose. The 2-year biochemical relapse-free survival and 2-year metastatic control rates were compared by clinical T-stage and histologic grade. The probability of biochemical relapse and the probability of distant metastases were estimated as a function of clinical T-stage, histologic grade, the planned target volume (PTV1 vs PTV1+PTV2) and total radiation dose., Results: There were no acute > or = grade III bladder toxicity, and only 3 patients (4%), who were irradiated for the pelvis had acute grade III bowel toxicity. No patient had late grade > or = III toxicity. The actual 2-year biochemical relapse-free survival and 2-year metastatic control according to T-stage were respectively: T1c--89% and 100%, T2a--90% and 100%, T2b--77% and 85%, T2c--62% and 83%, T3--58% and 65%, and by histologic grade they were respectively: G1--100% and 100%, G2--79% and 96%, G3--36% and 50%. Statistically significant relationships were found between the probability of distant metastases or biochemical relapse and histologic grade (p<0.00, p=0.005). Clinical T-stage had significant influence on the probability of distant metastases and borderline influence on the probability of biochemical relapse (p=0.004 and p=0.056). In the multivariate analysis, only histologic grade remained significant., Conclusions: Conformal radiotherapy for prostate cancer is well tolerated, and it yields satisfactory results which depend on histologic grade and clinical T-stage.

The purpose of this work is to evaluate the degree of applicability of the diagnostic laparoscopy (DL) and therapeutic laparoscopy in the acute abdomen and trauma patients. The material of 109 cases of DL performed since 1983 has been evaluated retrospectively. 22 patients were operated by laparoscopy. The patients were assessed in the following groups: I-suspected acute appendicitis, II-acute abdomen of uncertain ethology, III-abdominal trauma. In the first group 60 patients were diagnosed, 13 of them were operated by laparoscopy, 28 by open access, 15 avoided the unnecessary laparotomy. In the second group 30 patients were diagnosed, 6 of them were operated by laparoscopy, 8 open interventions were noted, 16 avoided the non-therapeutic laparotomy. In the third group 19 patients were diagnosed, 13 underwent laparotomy, 6 avoided the unnecessary intervention. There has been one death, not associated with DL (acute bowel ischemia), morbidity was 1% (one case of bleeding from the mesenterial artery, treated by conversion to laparotomy), one DL was considered as falsely negative, one not sufficient to establish the diagnosis. Basing on our experience in DL as a diagnostic tool we can confirm the accuracy of the method in 99.08% with only 1% of morbidity. 20.1% of patients were operated by laparoscopy, without complications. In conclusions the authors consider the DL allows to establish a prompt and accurate diagnosis in the acute abdomen and trauma without a therapeutic delay and unnecessary hospital observation. The fault of the method and morbidity rate is acceptable. The treatment by the same laparoscopic access offers to these patients another benefit, the more the experience is increasing.

Autotransfusion and haemodilution are the most safe and well known methods of blood protection in patients planned for vascular operations. During reconstructive vascular surgery autotransfusion with hypovolemic or normovolemic haemodilution were used. In the I group of patients hypovolemic haemodilution was done. In the II group of patients vascular bed was filed up with Ringer solution or with 6% solution of hydroxyethyl starch. The type of haemodilution and its influence on haemodynamics were estimated. Investigations were done by echocardiograph: ATL ULTRAMARK 8. It was concluded that the most effective are autotransfusion and normovolemic haemodilution with filing up vascular bed with Ringer solution.

Calcium, magnesium, copper and zinc were determined in serum in men with femoral atherosclerosis. Also total cholesterol, HDL- and LDL-cholesterol were estimated. Subjects in control group were in the same range of age. The present study compares two methods of preparing serum for the flame atomic absorption spectrometry. In the first method (I), serum was diluted by the demineralized water. In the second method (II), serum protein was precipitated by trichloracetic acid (TCA). We found that the first method (I) was simpler and more precise than the other. The optimal proportions of serum and water amounted to 1 + 62 for calcium and magnesium and the coefficient of variation (C.V.) was 2.8%. For copper and zinc, the optimal dilution was 1 + 3 (C.V. = 1%). Total cholesterol was significantly higher (p < 0.05) and HDL-cholesterol was lower (p < 0.05) in subjects with femoral atherosclerosis as compared with controls. There was no difference in LDL-cholesterol. Subjects with femoral atherosclerosis had significantly higher level of all micro- and macroelements determined, then those of the control group (p < 0.05). However, higher serum copper does not necessary mean higher copper body status. It is possible that higher serum copper in femoral atherosclerosis reflects the transfer of copper from the tissue to the ceruloplasmin, as an acute phase reaction. On the other hand, the differences in serum magnesium, calcium, copper and zinc concentrations, may indicate the possible involvement of these elements in the disorder of total and HDL-cholesterol in femoral atherosclerosis.

Out of 195 strains of S. aureus isolated from in and outpatients. 43 were proven not to be lysed by the chosen set of bacteriophages. Of these nontypeable strains 14 were isolated from blood cultures and septic wounds of patients from Poznań University Hospital. 29 strains were derived from the anterior nares or throat swabs of outpatients, who were treated for chronic pharyngitis in the children's clinic in Poznań. S. aureus was identified using standard bacteriological method. Sensitivity tests to antibiotics were performed using the ATB computer system (bioMérieux). Beta lactamase production was examined using the iodometric method. The intracellular esterases of S. aureus were separated by polyacrylamid gel electrophoresis and stained with Fast Blue using alpha-naphtyhl acetate, beta-naphthyl propionate and indoxyl acetate as substrates. A much higher percentage of S. aureus strains isolated from specimens obtained from the hospital patients showed the ability to produce beta-lactamase than the strains cultured from outpatients. The esterase patterns of S. aureus are helpful in differentiating bacteriophage nontypeable strains.

Infection of the biliary system in which one of the signs is the presence of bacteria in bile is connected with an increase of incidence of postoperative complications especially in elderly people. Therefore, early diagnosis of infections and their prophylaxis and treatment are an important aspect of surgical management which is particularly significant in view of large number of patients with acute and chronic cholangitis. Proper selection of the operation time and the use of antibiotic therapy with adequate utilization of even broader spectrum of antibiotics may be of decisive importance for effective treatment.

The platelet function as well as parameters of lipid metabolism and glucose tolerance were investigated in 30 men with occlusive atherosclerotic arterial disease of the low extremities (IIIB or IV Fontaine's stage). The platelet aggregation, platelet survival, activity of intraplatelet metabolism of arachidonic acid, radiofibrinogen binding to platelet, circulating platelet aggregates and both the activity of factor VIII and the concentration of von Willebrand factor antigen in the plasma were measured. In the majority of patients the impairment of platelet aggregation with ADP, enhancement of radiofibrinogen binding to platelets and an increase of factor VIII level in the plasma were established. There was an interrelationship between platelet dysfunction and disturbances of lipid metabolism. Platelet survival was shortened in patients with moderate hyperlipidemia and correlated with a concentration of HDL-cholesterol in the serum. The radiofibrinogen binding to platelets was the most pronounced in patients with severe hyperlipidemia and correlated with a concentration of total cholesterol in the serum. The results may suggest the potential usefulness of antiplatelet drugs in patients with occlusive atherosclerotic arterial disease.

In 76 patients with lower limb ulcerations in the course of atherosclerotic arterial occlusion, quantitative and quantitative bacteriological examinations, angiographic examinations and ultrasonographic measurements of pressures with simultaneous calculation of ankle/arm index were performed. At the same time the progression of ulceration healing was assessed after the operation. From the samples from four patients anaerobic bacteria were cultured: three times P. prevotii and twice P. acnes. It was found that these bacteria showed resistance to antibiotics used routinely in the treatment of diseases in which they may be the aetiological factor. The usefulness was demonstrated of quantitative examination of the bacterial flora in the ulcerations for the evaluation of their healing progression. Performing of antibiograms for anaerobic bacteria was found useful.

Investigations were carried in 70 patients with ulceration of lower extremities during chronic aortal obstruction. The patients were subjected to angiography, ultrasonographic determinations of pressure and quantitative and qualitative bacteriological studies. Quantitative studies were carried on by taking a smear from one square centimeter of ulceration surface. The isolated microorganisms were cultured on standard media for bacteria growing in aerobic conditions. Cultures for detection of anaerobic bacteria were performed on thioglycolate media (qualitative study). It was found that clinical symptoms of infection occur when for 1 cm2 of ulceration surface more than 5 x 10(4) of bacterial cell are present. In all patients reconstructive procedures improving blood flow were performed. Comparison of consecutive bacteriological studies performed before and after surgery permitted for evaluation of dynamics of infections and enabled choice of proper treatment and evaluation of its effectiveness.

Multicenter studies involved 1449 male and 131 female patients operated for the atherosclerotic ischemia of the lower limbs. About 50% of all limbs were in the III or IV stage of ischemia (according to Fontaine's classification) before surgery. Atherosclerotic lesions involved mainly aortoiliac segment in the majority of patients. Early results of surgery were similar in both men and women. An improvement during a 5-year follow up period was noted more frequently in women than in men--86% and 68.5% of limbs respectively. Late result of lumbar sympathectomy was similar in both groups. Limb amputation and mortality rates were similar in both groups in the early postoperative period and during a 5-year follow up as well.