Search

Introduction: Idiopathic scoliosis is that kind of structural deformation, for which there was no reasonable cause based on the temporary level of science. The conservative treatment of the idiopathic scoliosis is based on a rigid brace. The aim of the study is to establish if Cheneau brace decreases exercise capacity in adolescent patients with mild idiopathic scoliosis., Material and Methods: The research was done in 31 girls aged 11 to 18 years with diagnosed idiopathic adolescent scoliosis. These patients were qualified to conservative treatment with using Cheneau brace., Results: Exercise test with using cycle ergometer proved hightly statistically significant greater end workload at girls without using Cheneau brace in comparison to girls which used Cheneau brace. The study showed also the statistically significant longer distance of the walking test, which was made by patients without direct correction of Cheneau's brace in comparison to patients with direct correction of Cheneau's brace., Conclusions: The initially study showed, that Chenau brace essentially diminishes exercice capacity at patients with idiopathic adolescent scoliosis.

In last years on the whole world violently grows up the number of patients at which occurrence productive degenerative changes of osteoarticular system. Actually these diseases more and more concern the young persons, active professionally. This consequences of these changes lead to limiting the functional functions of pond, pain as well as they worsen the quality of life. Pain in degenerative joint disease of various aetiology can be combated with the new surgical techniques offered by contemporary orthopaedics. Hip alloplasty is the only effective treatment method facilitating the restoration of physical fitness, correct mobility and the eradication of chronic pain. After operating introduces the different methods of improving finally. This work presents physiotherapeutic procedures, commenced on admission to the orthopaedic ward, involved in hip joint alloplasty with the J&J Proxima stem. The disseminating of introduced model of improving as well as the initiation him to program of the treatment confirms the legitimacy of choice, and it influences on improvement of the state of health also and the patients' functional efficiency with degenerative disease of hip joint.

Electrocardiographic stress test EKG is the basic, diagnostic test in the heart failure, it is also used for patients with implanted pacemaker.

Background: Even though heterotopic ossification (HO) is most often asymptomatic in patients after total hip replacement (THR), it remains a serious problem in orthopaedics as it is observed in nearly all operated patients., Materials and Methods: The article presents a pre- and post-operative retrospective analysis of heterotopic ossification based on radiographic evidence. The study involved 77 patients below forty years old who underwent THR due to degenerative changes. Heterotopic ossification was evaluated using Brooker's basic four-grade scale., Results: Heterotopic ossification was diagnosed more often in women. The study confirmed once again that non-steroidal anti-inflammatory drug (NSAID) prophylaxis reduces the risk of ossification. We propose that the hydroxyapatite coating of implants may also contribute to a higher incidence of heterotopic ossification in operated patients., Conclusions: A history of surgical procedures and a lack of NSAID prophylaxis contributed to heterotopic ossification in the region of the replaced hip joint in the study group.

Background: Anterolateral soft tissue impingement of the ankle joint is a common consequence of ankle sprain due to excessive supination and adduction of the foot, injuries to the tibiofibular syndesmosis and lateral malleolus fractures., Material and Methods: Twenty-two arthroscopic procedures to treat anterolateral soft tissue impingement of the ankle joint were performed at the Independent Public Regional Hospital of Trauma Surgery in Piekary Slaskie between 2006 and 2007. The study group included male patients at the mean age of 34 (17 to 55) years. Medical histories revealed ankle sprain in 13 patients, lateral malleolus fracture in 7, and isolated tibiofibular syndesmotic disruption in 2. The mean time from the injury to the arthroscopic treatment was 5 years (range 2 to 8 years). All patients that underwent arthroscopy were evaluated according to the AOFAS score at baseline (before surgery), and at 3 and 12 months after the treatment. The procedure consisted in the removal of hypertrophic, inflamed and scarred soft tissue from the lateral recess., Results: The mean preoperative AOFAS score was 75.4 points. Post-operatively, the AOFAS functional scores increased to 90.6 and 92 points in the third and twelfth month after the procedure respectively. One patient showed temporary neurapraxia of the dorsal intermediate nerve and the ramus cutaneus branch of the superficial peroneal nerve., Conclusion: These results show that arthroscopic treatment of anterolateral soft tissue impingement of the ankle joint produces satisfactory early outcomes.

This work presents the tactics of surgical procedures in 40 patients who underwent revision of the hip joint due to isolated loosening of the acetabular component of the endoprosthesis. The studied group were operated between 2004 to 2006 without the use of mechanical support systems. Realloplasty of the acetabular component involved the evaluation of: etiology of acetabular loosening, concomitant diseases in the operated patients, and the grade of acetabular defects according to Paprosky's classification. In this work we analyze the type of both the loosened acetabulum and that used in revision, and discuss complications. Finally, we present a clinical evaluation of the operated patients according to Harris scale before revision surgery and six and twelve months after, with good early results.

Multislice computed tomography is an imaging method of internal organs including heart and vessels with the use of X-ray. The indications for computed tomography of the heart include also congenital heart diseases and the evaluation of the great arteries. Ultrasonography is a method of choice in heart evaluation. The authors show the possibilities of modern multislice computed tomography in congenital heart diseases imaging based on their own material.

Transcatheter implantation of pulmonary valve became a big step forward in the field of interventional cardiology. It is especially important in the patients with defects of the right ventricular outlet tract, because they were usually candidates for multiple surgical operations. We present first transcatheter replacement of pulmonary valve in 23-years-old man. The 'Melody' valve was implanted successfully. There were no complications and the patient was discharged in good condition.

Introduction: An increasing number of craniocerebral injuries among children is becoming a serious therapeutic problem for emergency wards and for chronic treatment wards. The most important problem among these patients is a lengthening period of consciousness disorders. The aim of the study is to present a sample method of rehabilitation of children with brain injury., Material and Methods: The rehabilitation process comprised 15 children with brain injury, including 8 with cerebral hemisphere injury and 7 with brain stem injury. The method of early motion rehabilitation was applied. It was developed by H. Powiertowski in 1970's. In the years 1991-1999 the method was used at the Children's Ward of the Department of Rehabilitation by Professor Krystyna Dobosiewicz., Results: As a result of the applied method, 13 out of 15 children with brain injuries regained consciousness. 2 girls with severe lesion of the brain, still unconscious were transferred to the intensive care ward in the place of residence., Conclusions: Powiertowski's method of motion stimulation, which is presented in this paper, turned out to be successful in the process of rehabilitation children with brain injury treated in the Department of Rehabilitation.

Implantable cardioverter defibrylator - ICD saves people's life and it protections against sudden cardiac death. Myocardial infarction in the past is the most often factor of the sudden cardiac death risk. The controlled physical activity and psychologists therapeuthical sessions are very important in improvement of quality of life for patients who have implanted ICD.

The aim of this study is to present the physiotherapeutic procedure in patients after total cementless ankle atrhroplastics. It was introduced thus far methods and resources in the way of physics and kinesitherapy, how also methods in physical medicine, which there are introduced to numerous department of medicine also in orthopedics. From reason of small number of reports, the authors present in this work current dates of relate in physiotherapeutic procedure before and after cementless ankle arthroplasty, which profitably influence and show the characteristic improvement of local and general state in patient. In spite of existing limitations the introduced plan with patients after total cementless joint arthroplasty should facilitate taking of sure solutions and workings persons with this patients.

Fracture of the femur head is most ofen caused by car accidents and a falls from a height. Treatment of these fractures is hard and is burden risk of aseptic necrosis of the femoral head and arthritis of the hip joint. In the paper are presented four cases of femur head fracture. Two of them were treated by surgical procedure, one using conservative therapy and one using total hip replacement for reason arthritis of the hip joint.

Unlabelled: THE AIM of the study was to asses the validity of CD20 expression on H-RS cells as independent prognostic factor in patients with Hodgkin's lymphoma., Methods: 72 patients (44 men and 28 women) between 15 and 73 y.o. (av. 36,5 y.o) treated in the Department of Oncological Chemotherapy of Silesian Medical Academy (1992-2002) were included in the study. Tissue specimens were immunohistochemically stained with monoclonal antibodies for CD20., Results: Analyzed group was classified according to histological subtype as follows: LP - n = 3, NS - n = 26, MC - n = 23, LR - n = 7 and LD - n = 13. Overall survival (OS) for the group was from 3 to 169 months (av. 64,5), disease free survival (DFS) - 4 to 167 months (av. 44,8) respectively. CD20 expression on H-RS cells was found in 13,9% subjects. Statistically significant difference (p = 0,0001) in DFS has been found between groups with and without CD20 expression. Results of this study are preliminary and should be confirmed in larger prospective studies.

The complicated process of invasion and metastasis consists of a long series of sequential and interrelated steps. The outcome of the process is dependent on both: the tumour cells and the properties of tissue microenvironments. Many investigators are interested in the influence of extracellular matrix components on that process. Especially matrix metalloproteinases (MMPs)--family of zinc-dependent enzymes, which take part in the coordination of extracellular matrix synthesis and breakdown seems to play crucial role in this process. A positive correlation between different type of MMPs and specific tumors has been demonstrated in many studies. In this article we summarize the current views on the role of MMPs in cancer invasion and metastasis.

It is essential for an embryo's further development that it generate a connection with the mother. The first stage of this process is implantation, a highly coordinated event that involves both embryonic and endometrial participation. A blastocyst may attach to the endometrium only during the "implantation window", when the uterus is receptive. A description of the molecular features of a receptive endometrium is the aim of this review. During the secretory phase, the endometrium synthesizes such cytokines as LIF (leukemia inhibitory factor), HB-EGF (heparin-binding epithelial growth factor), and TGF-alpha (transforming growth factor alpha) as well as special surface structures, such as integrins. There are two types of integrins: cycle dependent and constitutionally expressed. The coexpression of cycle-dependent integrins may mark the "implantation window". The endometrium of fertile and infertile women may vary in expression of the integrins. Insufficient synthesis of integrins may be caused by a luteal phase deficiency. E-cadherin and alpha-crystalin B play an important role during implantation. The expression of pinopodes on endometrial cells during the "implantation window" marks optimal uterine receptivity. The composition of all the factors mentioned above define the unique properties of the endometrium during the "implantation window".

Unlabelled: The mediastinum region may be the primary or secondary localization of neoplasms. The aim of our study was the assessment of clinical symptoms, histopathology and outcome of mediastinal tumours in children., Materials and Methods: A group of 27 children, chosen from the group of 128 patients with malignancies, which were treated in the years 2000-2004 in the Oncology and Haematology Unit of the Paediatric Department in Katowice, has been studied. In this group there were 14 boys and 13 girls at the age between 2 and 12 years. We analysed the clinical symptoms prior to the diagnosis and the duration of these symptoms, histologic type of tumours and results of treatment., Results: The primary localization in the mediastinum was diagnosed in 23 patients (85,2%) among them 15 (55,5%) of these children have been diagnosed as having Hodgkin's disease, and in 8 (29,6%) non Hodgkin's lymphoproliferative disease. Four of the children (14,8%) had mediastinal secondary localization of solid tumours (2 - neuroblastoma, 1 - carcinoma suprarenalis, 1 - carcinoma epitheliale of unknown origin). The most frequent symptoms were: fever (70,3%), weakness (66,6%), cough (55,5%), madiastinalpain (33,3%). The duration of these symptoms prior to the diagnosis was between 5 days and 182 clays., Conclusions: 1. In the group of neoplasms localized in the mediastinum, lymphoproliferative diseases are the most frequently diagnosed disorders. 2. In case of fever of unclear etiology and persistent cough, it is necessary to exclude mediastinal malignancy. 3. There is a need to improve the system of oncological education for medical students and doctors.

Introduction: Orbital pseudotumour is a non-specific inflammatory process of the orbit of unknown origin. It is a rarely diagnosed disease particularly in children, which imitates a neoplastic process. Typical clinical picture is a tumour localized in the orbit, causing various degree of exophtalmus and a decrease of globe mobility and vision. The extent of intraorbital changes are revealed by imaging studies (USG, TK, MR). Diagnosis is based on histopathology of tumour sample. In treatment steroid therapy, radiotherapy or chemotherapy in resistant cases are used. Relapse and malignant transformation are observed., Case Report: We present a case of a 5-years old girl with orbital pseudotumour. In the histopathological examination there a small lymphoid cells, immunohistochemically there is mixed lymphocytic T and B infiltration (CD 3 (+), CD 20 (+), bcl (+), CD 43 (-)). She was treated with steroid therapy, and achieved complete regression of the tumour. At present she is regularly oncologically examined because of the possibility of malignant transformation., Conclusions: 1. Orbital pseudotumour should be included in the differential diagnosis of children with an orbital tumour 2. Corticosteroids seem to be the treatment of choice in orbital pseudotumour 3. Children with orbital pseudotumour should be regularly oncologically examined because of the possibility of malignant transformation.

The first case of osseous metaplasia in rectal cancer is described. The authors present the diagnostic evaluation based on the transrectal ultrasound examination, determination of neoplastic markers, pathological examination, treatment, and follow-up in a 69-year-old man.

A case of pleomorphic malignant fibrous histiocytoma of the right atrium and right ventricle is presented. Primary cardiac malignant fibrous histiocytoma (MFH) is extremely rare and its etiology and clinical course are not precisely known. We treated a 47-year-old female patient with persistent fever and cough, shortness of breath and anasarca. The patient died after eight months with symptoms of cardiac shock. Autopsy revealed a big soft yellow tumor in the right heart. Microscopically, atypical fibroblast-like cells, pleomorphic and multinucleated giant tumor cells with eosinophilic cytoplasm were observed within the myxoid and fibrous stroma. Immunohistochemically, tumor cells were positive for alfa-1-antitrypsin and partially positive for CD68 and vimentin. According to histopathologic and immunohistochemical features we diagnosed pleomorphic MFH.

The authors presented 7 cases of primary extranodal non-l-odgkin's malignant orbital lymphomas in patients treated surgically in the ENT Department of the Medical University of Silesia in the years 1996-2001. In the course of the diagnostic process we examined the patients carefully to be sure that the cancer had not disseminated. We used some imaging techniques such as: ultrasonography (USG), computer tomography (CT) and magnetic resonance imaging (MRI). We also used the needle aspiration biopsy, as an additional examination. However the material was no significant in the most cases and we were unable to make a definitive diagnosis on the basis of this method alone. After prior examinations we performed the radical operations and removed the tumors. In each case the postoperative material was examined using histopatological and immunohistochemical methods. Afterwards the pathomorphological diagnosis was made by the specialists. Next the patients were observed and treated in the Haematological and Radiotherapy Departments.

Authors report two cases of benign, osteogenic neoplasms of the maxilla in children which defined as cemento-ossifying fibroma and juvenile cemento-ossifying fibroma. Difficulty in diagnosis of the tumor is indicated. The importance of clinical data as well as radiology and histopathology examination for a proper diagnosis is indicated. Review of literature is presented.

Despite much progress made in terms of understanding sarcoidosis, it still remains an unknown disease entity. The authors present the basic diagnostic measures clinical picture as well as treatment of patients with sarcoidosis. The study presents a case of a 38-year-old man with sarcoidosis of parotid glands treated with encortone which was followed by remission of the disease.

Metastatic tumors to the parotid gland are very uncommon and it accounts for 8% of all cancers of parotid gland. The parotid gland and its lymph nodes are possible sites of metastases from head and neck cancers. However, metastasis from distant primary neoplasm below clavicle is possible, too. The authors presented the two cases of distant metastases to the parotid gland. The women with breast cancer and metastases to the parotid gland 11 years after surgery, radio- and chemotherapy of breast cancer. She died 7 months after parotid surgery of systemically advanced disease. The man with metastasis of malignant melanoma of unknown primary site. He underwent total parotid surgery with the tumor and lymph nodes. He died 7 months after surgery. In spite of intensive exam the primary location of the melanoma was unknown. The authors described pathophysiology of distant metastases to the parotid gland with special attention to possibilities of treatment and survival.

Unlabelled: Tetralogy of Fallot (TOF) coexisting with atrioventricular canal septal defect (AVC) is a rare combination of anomalies. Additionally, in cases with concomitant Down syndrome, recurrent infections can be a serious problem in patients (pts.) waiting for cardiosurgery treatment. The purpose of the study was an analysis of types of infections and other factors complicating the preoperative period in those patients., Material and Methods: The study group consisted of 17 pts. with TOF and AVC aged from 1 day to 9 years (mean 9.4 month). In this group there were 11 pts. with Down syndrome. All of them were subjected to physical examinations, blood analysis, ECG, chest X-ray and echocardiographic study. Additionally, in 8 pts. we performed catheterization. The signs of different types of infection were analyzed and results were compared in two groups: with and without Down syndrome., Results: The differences were observed in the frequency of recurrent or chronic infections (21 v/s 4), time of hospitalization before surgery (17 v/s 9 days), necessity (11 v/s 3) and duration of antibiotic therapy (19 v/s 7 days) in the two studied groups. Elevated body temperature of unknown etiology was noted in 8 cases with Down syndrome, compared to 1 patient without trisomy 21. Also, the children with Down syndrome had to wait 11 days longer (19 v/s 8) for discharge after operation., Conclusions: Infections in children with TOF, AVC and Down syndrome significantly complicate the natural course of this anomaly. Prolonged preoperation time is characteristic of Down syndrome pts. compared to patients without chromosomal abnormalities.

Infantile myofibromatosis (IM) is a rare condition that usually occurs in newborns and young children under the age of 2 years. Three cases of IM in older children are presented. Clinical, morphological and immunohistochemical features of the lesions are described. The lesions appeared as solitary, fast growing oral tumors. Infantile myofibromatosis rises the oncological concern and requires differentiation with benign and malignant soft tissue tumors as well as juvenile and infantile fibromatosis.

Unlabelled: Ebstein's anomaly is an uncommon lesion of the tricuspid valve characterized by downward displacement of the tricuspid valve. The aim of the study was an analysis of the form, clinical outcome and treatment results in patients (pts) diagnosed with Ebstein anomaly., Methods: 28 pts were analysed. Material has been divided into 3 groups, depending on clinical symptoms. The group A was formed with mild shape of the defect, group B all pts presenting significant clinical symptoms requiring treatment, and group C made of pts having severe symptoms requiring intensive treatment including surgical intervention., Results: Anomaly had been detected in 13 boys and in 15 girls. Group A consisted of 6 children, including one boy diagnosed with defect prenatally. Described patient currently is followed-up in pulmonology outpatient clinic due to asthma. Other children are doing well and require no treatment. Group B was represented by 8 children requiring treatment of: sepsis, arrhythmia due to WPW syndrome and in one case ASD 2. Group C consisted of 14 patients. In 7 pts Ebstein anomaly was part of a complex congenital heart defect. In 5 cases dominating symptoms were severe heart failure with cyanosis and arrhythmia and in two cases sepsis. 10 pts had been treated surgically (7 pts had Blalock-Taussig shunt, 1 pt artificial valve replacement, 1 pt Fontan op. and 1 pt ASD 2 suture) where 8 died. The causes of death were: right ventricle failure and arrhythmia in 4, sepsis in 2, and pulmonary artery hypoplasia and metabolic acidosis also in 2 cases., Conclusions: Ebstein anomaly includes wide spectrum of anatomical and clinical findings. The most severe forms require surgical intervention, however it can be a high risk procedure.

The authors presented 27 cases of primary extranodal non-Hodgkin's malignant lymphomas of the head and neck area in patients treated surgically in the ENT Department in the years 1996-2001. We observed tumors in the various areas: palatine tonsil, naso-pharynx, eye socket, paranasal sinuses, parapharyngeal space and lingual base. In the course of the diagnostic process we examined the patients carefully to be sure that the cancer had not disseminated. We used some imaging techniques such as: ultrasonography, CT and MRI. We also used the needle aspiration biopsy, as a additional examination. However the material was not significant in the most cases and we were unable to make a definitive diagnosis on the basis of this method alone. After prior examinations we performed the radical operations and removed the tumours. In each case the postoperative material was examined using immunohistochemical methods. Afterwards the pathomorphological diagnosis was made by the specialists. Next the patients were observed and treated in the Haematological Department and Radiotherapy Department. In all cases pathomorphological diagnosis were performed on the base of usage postoperative histochemical examinations. All treated patients were performed as diagnostic preoperative USG, CT, MRI and fine-needle biopsy aspiration exam. All patients for further treatment were observed at Haematological Department.

The study presents a case of systemic mastocytosis, discovered in 64 years old male, after two years of persistent fever and chest pain with dyspnea. The authors describe differential diagnostics including imaging and laboratory procedures. Presented material contains pictures of histopathological sections and biopsies. Attention was drawn to the importance of histopathology and immunohistochemical assays in differential diagnostics of uncertain cases.

The case of parotid gland tumour of the carcinoma myoephitelial histological structure in 55 year old patient was described in the paper. The patient had the surgical treatment of total parotid gland removal with the function of the facial nerve preserved and a complementary radiotherapy. The attention is paid to rarity of this type of tumour and difficulties in a proper patomorphological evaluation requiring special immunohistochemical tests.

Objectives: To evaluate the relation among the ultrasonographic, morphometric parameters of the umbilical cord during physiological and pathological pregnancy., Design: Ultrasonographic morphometric parameters were prospectively evaluated in 29 consecutive cases of physiological and 42 cases of pathological pregnancies., Materials and Methods: 71-ultrasonographic examinations was performed between 28-40 weeks of gestation. The examined group consisted of 29-physiological pregnancies and 42-pathologic. 15-was complicated with the risk of preterm delivery. 27-was complicated with hypotrophy caused by Pregnancy Induced Hypertension (PIH) in 14 cases and by exposure to tobacco smoke in 13 cases., Results and Conclusions: We showed no statistically important correlation between the umbilical parameters and the period of pregnancy except of A/B index, measuring Doppler flow in umbilical artery which value was decreasing together with the period of gestation (r = -0.6185, p < 0.05). Hypocoiling umbilical cord characterised the group of patients which pregnancy was complicated with premature delivery. Statistically important decreasing of diameter value of umbilical cord and umbilical vein in cases of pregnancy complicated with hypotrophy was revealed. We found out the strong correlation between hypercoiling of umbilical cord as well as diameter of umbilical cord and degree of intensification of hypotrophy in smoking women (r = -0.8, p < 0.05).

The paper presents a rare case of primary, non-Hodgkin brain lymphoma discovered in 64 years old woman. Non specific symptoms conducted to misdiagnoses of dementia and syderopenic anaemia. The proper identification has been made after 10 months by post-mortem histopathological analysis.

Mucoepidermoid carcinoma is classified among the salivary gland tumors and is commonly found in the parotid gland. In the larynx it is an uncommon tumor that occurs mostly in men. There have been only about 100 cases of laryngeal mucoepidermoid carcinoma reported in the literature. Three cases of mucoepidermoid carcinoma of the larynx are reported. First case--tumor T1N0 localised on the vocal cord was removed using Kleinsasser method. Second and third case--tumor T3N0 was removed by total laryngectomy. The inherent difficulties in histologic diagnosis are noted and treatment of mucoepidermoid carcinoma is discussed. The available literature is reviewed.

Steroid-secreting neoplasms of the ovary and adrenal gland comprise a small group of tumors. A 76-year-old woman presented hair loss, facial hirsutism associated with increased serum total testosterone level. The adrenal glands and the ovaries were normal on radiological and ultrasonographic investigation. The patient was submitted to a pelvic exploratory laparotomy. Hysterectomy and salpingo-oophorectomy were performed. A solid and circumscribed ovarian tumor of 2 cm in diameter was found. The pathological diagnosis was lipid cell tumor with stromal hyperplasia. The purpose of this report is to relate how difficult is to establish the diagnosis and the origin of the hyperandrogenism in a patient with normal image studies.

Introduction: The Norwood operation in neonates with hypoplastic left heart syndrome is associated with very high mortality., Aim: To compare early postoperative period in children who underwent classic operation to that in patients who underwent a new modification of the Norwood procedure., Methods: Evaluation of the early postoperative period (72 h after the operation) in patients who underwent classic operation: Group 1 (31 children) and patients in whom modified Norwood procedure was performed: Group 2 (18 children). The surgical technique of the modified Norwood procedure was presented (right ventricle- to = pulmonary artery shunt and neo-aorta reconstruction by direct anastomosis between aortic arch and main pulmonary artery)., Results: In Group 1 in 15 (48.4%) children circulatory collapse occurred, requiring resuscitation, which was unsuccessful in 9 (60%) cases. In Group 2 one child died and early postoperative period of the other was uneventful. The mean circulatory arrest time in deep hypothermia was significantly (p = 0.002) shorter in Group 2 (mean: 33.7 +/- 8.7 min, range 25-53 min) than in Group 2 (mean: 54.1 +/- 6.6 min, range 41-76 min) and cardiopulmonary bypass time was not significantly prolonged (Group 1: mean 70.5 +/- 24.2 min, range 48-167 min; Group 2: mean 62.5 +/- 9.6 min, 39-84 min) (p = 0.765). In Group 2 there was significantly higher diastolic pressure 4, 8, 12, 24 and 36 h after the operation (p < 0.001, p = 0.005, p = 0.037, p = 0.017, p = 0.022, respectively)., Conclusion: The new modification of the Norwood procedure ensures stable conditions in early postoperative period. We believe that short circulatory arrest time without prolongation of cardiopulmonary bypass time and higher diastolic pressure (the location of the proximal shunt end beneath the valve of the systemic circulation) improves the function of the heart.

Objectives: To estimate the usefulness of hysteroscopy (HSC) and hysterosalpingography (HSG) examination on a retrospective study., Design: Canulisation and morphology of ovarian tube detected during HSG and reactivity of uterine tubal ostia observed in HSC were compared., Material and Methods: The results of HSG and HSC examination performed on 125 young infertile women whom the tubal uterine factor of infertility was suspected were analyzed 250 ovarian tubes, after previous selection were taken into consideration. The analysis had a retrospective character., Results: The analyzed group of women were divided into 3 group which differed from each other in reactivate of uterine ostia of the ovarian tubes. The first group first with correct reactivity of tubal ostia was the largest. The authors observed canulisation, which was the best in the first group and morphologic changes in the internal structure of the ovarian tubes. The highest percentage of these changes were observed in group three with unreactive uterine ostia., Conclusions: The HSG and HSC examination are supplementary examinations. The use of both methods together increases their diagnostic value and gives a more correct estimation of tubal status.

Objectives: Estimation of the long term prophylactic or therapeutic application of low molecular weight heparin (LMWH) on the platelets count, and incidence bleedings during pregnancy, delivery and puerperium in the women with varices of lower extremities and past thrombophlebitis of lower extremities., Material and Methods: 5212 pregnant, women in labour and in puerperium divided into 4 groups.; 142 women with varices and thrombophlebitis of lower extremities (group I); 10 with past thrombophlebitis of lower extremities (group II); 15 with thrombophlebitis in current pregnancy; 5045 without vascular complications (group IV--control). In group I during pregnancy compression therapy was applied (stockings) and low molecular weight heparins (LMWH) in course of puerperium. In group II during the 1st trimester of pregnancy and in labour the same heparin doses were administered, while the doses were increased in the 2nd and 3rd trimester. In group III, when thrombophlebitis was stated non-steroid anti-inflammatory drugs and LMWH were administered. In all cases treated with heparin both number of platelets and incidents of bleedings from genitourinary tract were observed. Presence of embolic complications was also noted., Results: No cases of decrease platelets number or bleedings from genitourinary tract were observed in group I-III during administering of LMWH. In women in group II where prophylactic with LMWH was applied no incidences of recurrent thrombophlebitis during pregnancy and puerperium were observed. In group I-III all newborns were born in good condition and no complications were observed. Average blood loss during both labour and cesarean section, among women in group I-III was not significantly different comparing with control group. No incidences of pulmonary artery embolism or decrease number of platelets were observed., Conclusions: 1. The long term prophylactic or therapeutical administration of LMWH in the women with varices of lower extremities or thrombophlebitis has no influence on the platelets count and incidence of bleedings from genitourinary tract during pregnancy or increase of blood loss during labour and puerperium. 2. In the women with past thrombophlebitis of the lower extremities after application of LMWH during pregnancy there were no recurrence observed.

Objectives: To compare labour induction intervals between vaginal misoprostol and intravenous oxytocin as well as side effects of induction in post term pregnancies with intact membranes., Methods: One hundred women were retrospectively selected to two groups treated with vaginal misoprostol 50 micrograms every 12 hours as needed to maximum 150 micrograms and treated with intravenous oxytocin. The primary outcome measure was time from induction to vaginal delivery. Statistical analysis was performed by t-Student test., Results: Maternal age, parity, gestation were similar. There was a statistically important difference in labour induction intervals between the two groups. The mean time +/- SD to vaginal delivery in misoprostol group was 20.6 +/- 15.2 hours compared with 11.23 +/- 7.4 hours with oxytocin (p = 0.0396). Induction of labour failed in 12% and 32% in misoprostol and oxytocin treated group. Pethidine consumption in oxytocin treated group was higher (41 mg vs 89 mg, p = 0.04). Episodes of vomiting were more frequent in misoprostol treated group (22% vs 6%). There were no episodes of uterine hyperstimulation in both groups., Conclusions: Oxytocin stimulation resulted in a shorter induction to delivery interval. In misoprostol group induction failed in only 12% whereas in oxytocin group in 32%. There were no serious side effects in both groups. In misoprostol treated group patients required less analgetics then in oxytocin treated group.

Objective: The aim of this study was to assess the usefulness of the assessment of cervical length and and measurement of fetal fibronectin level in cervical secretion of pregnant women in prophylaxis of premature deliveries., Material and Methods: 78 pregnant women hospitalized in Department of Fertility and Obstetrics, University School of Medicine Wrocław. They were divided into III groups: Group I-13 pregnant women who had premature delivery and the time between examination and delivery was no longer than 24 hours. Group II-20 women who had premature delivery, and the time between examination and delivery was longer than 24 hours. Group III-pregnant who delivered at term (control group). Between the 25th and the 34th week of pregnancy presence of fetal fibronectin in cervical secretion and ultrasonographic assessment of cervical length were done., Results: Significantly higher percentage of women with presence of fibronectin in cervical secretion and significantly shorter length of cervical length was stated in 13 pregnant women who delivered prematurely, between the 28th and 35th week of pregnancy comparing with other groups. In group II pregnant women delivered between the 28th and 35th week of pregnancy, and the time between examination and delivery was from 3 days to 4 weeks. In this group in 75% examined women fibronectin was present in cervical secretion. Significant was that cervical length in 14 of this group of women (70%) was no longer than 20 mm and in the rest was between 20-30 mm, moreover in no cases was longer than 30 mm. In group III only in 7% women presence of fibronectin in cervical secretion was stated and only in two cases (4%) cervical length was shorter than 20 mm, both of them delivered in 38th week of pregnancy., Conclusions: 1. Examination of fetal fibronectin in cervical secretion allows precisely estimate the risk of premature delivery. 2. Cervical length shorter then 20 mm collerates with the presence of fetal fibronectin in cervical secretion and with increased risk of premature delivery.

Objectives: To evaluate the relation among the concentration of selected air pollution and seminal parameters, examined from 1977 to 2000., Design: Semen analysis and air pollution results were retrospectively evaluated., Materials and Methods: We have analysed semiograms from 1363 men from infertile couples inhabiting Lower Silesia. Seminal volume, sperm concentration, percentage of pathologic sperms were measured in all men. Estimation of mean seminal volume, total sperm number, sperm motility, and percentage of pathologic sperms per year was performed. Average values for NO2, CO, SO2 and dust concentrations during the study were taken from official sources., Results and Conclusions: We showed the statistically significant increase in the percentage of pathological sperms (R2 = 0.9, p < 0.05), the slight increase in the semen volume(R2 = 0.4, p < 0.05). The total sperm count in the semen samples revealed a slight increase (R2 = 0.25, p < 0.05). The sperm concentrations and the percentage of motile sperms remained relatively stable and relatively constant. Statistically important decrease in NO2 (R2 = 0.85, p < 0.05), SO2 (R2 = 0.96, p < 0.05) and dust concentration (R2 = 0.89, p < 0.05) and no change in CO concentration was revealed. There is no correlation among concentrations of dust, NO2, SO2, CO and the increase in percentage of pathologic sperms.

Retroperitoneal fibrosis (Ormond's disease) is rare chronic inflammatory process, that can occur at any age. It is characterised by development of periaortic fibrous mass leading to progressive obstruction of vessels around the abdominal aorta and ureters. In the one third of cases we can find the causes of disease. There are ergotamine abuse, radiation, retroperitoneal surgery or hemorrhage, urine extravasation and response to different cancers. The other cases are idiopathic disease. We report a case of prostate cancer with unique course. The first manifestations of disease were diffuse peritoneal fibrosis and ureteral obstruction leading to bilateral hydronephrosis. Clinical course and histopathology showed idiopathic Ormond's fibrosis. Patient received oral immunosuppressive treatment (prednisolone 1 mg/kg/day + azathioprine 1 mg/kg/day), followed by intravenous methylprednisolone puls (2 g). Treatment also consisted of DJ-stent placement on the left side. On the right side we were unable to overcome the obstruction of ureter. Because of persistent renal failure, thrombocytopenia, DIC and progressive lower back pain we did control MR and CT scan. The CT scans showed multiple osteolytic bone metastases in vertebral column (the sizes of them were between a few millimetres and 1.5 centimetre). Patient died due to renal failure and haemorrhagic diathesis in the course of disseminated cancer of unknown origin. The postmortem examination revealed diffuse peritoneal infiltration surrounding the ureters, intramural ventricular metastases, pulmonary metastases and vertebral metastases. The prostate was only slightly enlarged. Histological and immunohistochemical examinations of prostate showed primary low-differentiated prostate carcinoma (CK/+/, PAP/+/, PSA/+/). Peritoneal, ventricular and bone infiltrations also were metastases from low-differentiated carcinoma of prostate origin (CK/+/, PAP/+/, PSA/-/).

Objectives: Assessment of the effectiveness of using low molecular weight heparin in the prophylaxis of venous thrombo-embolic diseases in pregnant women, parturients and puerperants., Material and Methods: 14,106 female patients were retrospectively analysed in the period between 1990-1999. The patients were divided into 4 groups: I--142 pregnant patients with crural varices, II--10 pregnant patients who had suffered from deep venous thrombosis, III--5 patients with implanted artificial cardiac valves, IV--13,949 patients without any risk factors. In the patients in groups I-III low molecular weight heparin was used prophylactically., Results: In the studied groups no cases of pulmonary embolism were observed. Superficial venous thrombosis occurred in 10 women (3 in group I and 7 in group IV). Deep venous thrombosis occurred in 5 patients (2 in group I and 3 in group IV). In patients who received low molecular weight heparin over a long period of time, no excessive bleeding during delivery was observed. Other complications in the form of osteoporosis and thrombocytopenia were also not observed., Conclusions: 1. Administering of low molecular weight heparin during pregnancy, labour and puerperium has no influence on the increase of maternal et fetal complications. 2. Administering of low molecular weight heparin in pregnant women, in labour and in puerperium with increase risk of thrombo-embolic disease allows to avoid pulmonary arteries embolism. 3. Pregnant women and women in puerperium with increased risk of venous thrombo-embolic disease should be under control of experienced obstetrician in cooperation with vascular surgeon and hematologist.

HELLP syndrome is a serious complication of Pregnancy-Induced Hypertension (PIH) which is very dangerous for the mother and her foetus. The prognosis depends on early diagnosis and correct treatment. The etiopathogenesis of the syndrome is still investigated but remains unclear. Taking as an example the precisely monitored, fully symptomatic case of the HELLP syndrome, we present review of modern opinions on pathogenesis, recognition and treatment.

The paper contains the description of the modification of simplified method for caesarean section, based on the Joel-Cohen and Misgav Ladach method. Advantages of the simplified methods are described on the basis of the cited papers. Following stages of procedure are described in details.

The aim of this study was to estimate type and frequency the bacterial flora of uterine cervix of female in case of preterm labor. There were analyzed 153 uterine cervix swabs of women before 37 weeks of pregnancy. It has been shown that the main etiologic factors of infestations were Escherichia coli and Staphylococcus epidermidis. Positive results of bacterial investigation has been occurred more frequently in multiparas with precocious ammonirrhea.

In the paper we underlined the benefits of the labour in the vertical position in contrast to many disadvantages of parturition in recumbent or semi-recumbent position. These not natural positions are the consequences of the development of obstetrics manoeuvres as late as 200 years ago. In our opinion there is the necessity of the changing our minds on pros and cons of horizontal position during labour.