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Introduction: Demographic assessment in Poland allows to show progressive aging of society, which is further related to the growing number of people with cardiovascular diseases, cancer and disabilities of various origins. In November 2020, the World Health Organization (WHO) issued recommendations for physical activity which, for the first time, also apply to people suffering from chronic diseases and to those with disabilities. Compliance with the guidelines is part of prevention with regard to both chronic diseases and disabilities of various origins. Study aim: The aim of the study was to present the latest guidelines of the World Health Organization and, based on the cited literature, to answer the following question: How can changes in physical exercise have impact on the functional state of people above the age of 60? Materials and methods: The aim of the study was carried out on the basis of analysis regarding the quoted WHO guidelines and the cited literature concerning the recommended level of physical activity for people over 60 in overcoming various origins of their disabilities and lesions. Within this context, the following provisions were analysed: the WHO guidelines from 2020 and the quoted literature in the number of 32 positions. Results: Physical activity may delay human aging for up to 2 decades, improve whole-body condition, positively affect the symptoms of depressive disorders, inhibit neurodegenerative diseases and has a beneficial effect on the health of patients suffering from metabolic diseases. Conclusions: Regular physical activity of people over 60 years of age definitely has a positive effect on their functional state, both in terms of disabilities and diseases of various origins.

Paragangliomas of the head and neck region are rare and predominantly asymptomatic tumors. These neoplasms arise from widely distributed paraganglionic cells, which originate from both mesodermal elements of third branchial arch and the neural crest residues. Despite the rare occurrence of paragangliomas, problems encountered in their diagnosis, unclear malignancy and treatment ensure that they still remain in the focus of head and neck surgeons. This is a retrospective study of the medical records of patients treated in the ENT Department of the 5th Military Hospital in Krakow during the period 2010-2014. All the preoperative, intraoperative and postoperative data were carefully analyzed for each patient. Thirteen patients (16 tumors) were treated during the study period. All the patients with a pre-operative suspicion of paraganglioma underwent computed tomography angiography. The whole cohort of patients was treated surgically. Paraganglioma should be always considered in the differential diagnosis for painless neck masses. These tumors require thorough radiological pre-operative evaluation and skilled operative technique. Surgical treatment occurs to provide good cure rates with minimal recurrence and morbidity rates.

Leaving surgical instruments in the patient’s body is one of the most difficult situations in the professional career of an operator and it can also have severe consequences for the patient. Contrary to world literature, there are no reports of such incidents in Polish publications. Lack of such reports creates an illusion that leaving surgical instruments in the patient’s body does not happen in Poland, which is an unsubstantiated thesis. This paper presents two cases of leaving hemostats in the abdominal cavity. According to the authors, similar publications may facilitate critical assessment of the existing rules for inspecting instruments and surgical material by surgical teams. Importantly, confirming the compliance of instruments and material by surgical nurses is not the only criterion of assessment in this matter for the operator.

Endoscopic retrograde cholangiapancreatography (ERCP) is an invasive diagnostic and therapeutic procedure in bile duct diseases. These procedures have severe complications, yet gastric perforation hasn’t been presented in literature.We present a case study of an 82 year old woman admitted to hospital due to suspected choledocolithiasis. The patient underwent two ERCP procedures. Due to acute abdominal pain, abdominal radiography was also performed. The examination revealed intraperitoneal free air. The patient underwent open repair of the perforated stomach. The second day after surgery the patient suffered multiorgan failure and was transmitted to the intensive care unit where she died 2 days later.

Background The aim of the present study was to verify the relationship between the level of neuroticism and selected aspects of life satisfaction in women undergoing breast augmentation surgery. Methods The study group included 109 women, aged 18–46 years, who completed the self-developed survey measuring selected psychological traits before and after (1 year) surgery. Four questions in this survey were related to the level of neuroticism and two pertained to the self-assessment of leading character traits and the level of life satisfaction. Three questions made up the lie scale. Results The studied women were constant in their truthfulness. No statistically significant difference in the level of neuroticism before and after surgery was noticed. However, an increase in the subjective life satisfaction after surgery was highly significant (p

Background The aim of this study was to construct an electronic bowel sound recording system and determine its usefulness for the diagnosis of appendicitis, mechanical ileus and diffuse peritonitis. Materials and methods A group of 67 subjects aged 17 to 88 years including 15 controls was examined. Bowel sounds were recorded using an electret microphone placed on the right side of the hypogastrium and connected to a laptop computer. The method of adjustable grids (converted into binary matrices) was used for bowel sounds analysis. Results Significantly, fewer (p ≤ 0.05) sounds were found in the mechanical ileus (1004.4) and diffuse peritonitis (466.3) groups than in the controls (2179.3). After superimposing adjustable binary matrices on combined sounds (interval between sounds

Wstęp: Appendektomia laparoskopowa przeprowadzana jest standardowo w znieczuleniu ogólnym. Przyjęto, iż taki rodzaj znieczulenia z towarzyszącym zwiotczeniem pacjenta jest najbardziej optymalnym sposobem, aby zapewnić wystarczającą przestrzeń operacyjną oraz odpowiedni efekt przeciwbólowy dla technik operacyjnych wymagających wytworzenia odmy otrzewnowej. Na podstawie doniesień w piśmiennictwie oraz przypadku opisanego w niniejszej pracy śmiało można stwierdzić, iż dotychczasowe podejście do znieczulenia w zabiegach laparoskopowych staje się coraz mniej uzasadnione.Omówienie przypadku: W pracy przedstawiono przypadek młodej, nieobciążonej internistycznie kobiety, u której rozpoznano ostre zapalenie wyrostka robaczkowego i którą zakwalifikowano do laparoskopowej appendektomii. Stopień ryzyka operacyjnego w skali Amerykańskiego Towarzystwa Anestezjologów (American Society of Anaesthesiology) oceniono na Ii zdecydowano o przeprowadzeniu zabiegu w znieczuleniu przewodowym. Zabieg i znieczulenie przebiegały bez komplikacji, jednocześnie chora uniknęła ryzyka potencjalnych powikłań wynikających ze znieczulenia ogólnego i zwiotczenia.Wyniki: Dzięki rozwojowi techniki operacyjnej oraz coraz większemu doświadczeniu operatorów wykonywane obecnie zabiegi laparoskopowe trwają znacznie krócej niż okres działania leków zwiotczających, a efekt przeciwbólowy znieczulenia przewodowego okazuje się zupełnie wystarczający. Ponadto omawiany przypadek chorej dowodzi, iż brak zwiotczenia w żaden sposób nie wpływa negatywnie na przebieg samego zabiegu.Wnioski: Leczenie operacyjne ostrego schorzenia jamy brzusznej metodą laparoskopową w znieczuleniu przewodowym jest wykonalne i bezpieczne u pacjenta bez istotnych obciążeń internistycznych. Przedstawiony w pracy przypadek chorej uzasadnia potrzebę szerszego stosowania tej metody znieczulenia w trakcie laparoskopowych operacji ostrych schorzeń jamy brzusznej, a ostateczna wartość znieczulenia przewodowego podczas zabiegów techniką laparoskopową powinna zostać określona na podstawie dalszych prospektywnych badań porównujących zastosowanie obu metod znieczulenia.

We present a novel solution to soft-body registration between a pre-operative 3D patient model and an intra-operative surface mesh of the patient lying on the operating table, acquired using an inexpensive and portable depth (RGBD) camera. The solution has several clinical applications, including skin dose mapping in interventional radiology and intra-operative image guidance. We propose to solve this with a robust non-rigid registration algorithm that handles partial surface data, significant posture modification and patient-table collisions. We investigate several unstudied and important aspects of this registration problem. These are the benefits of heterogeneous versus homogeneous biomechanical models and the benefits of modeling patient/table interaction as collision constraints. We also study how abdominal registration accuracy varies as a function of scan length in the caudal-cranial axis.

The composition and distribution of storage substances such as proteins, lipids, carbohydrates and phosphates and also some enzymes in dry Iris pseudoacorus endosperm and their changes during germination were investigated with light microscope.

BACKGROUND The aim of this study was to assess the distribution and dynamics of temperature changes on the surface of selected body parts after systemic cryostimulation. The changes that occurred as a reaction to the 1st, 5th, and 10th session of a series of 10 sessions were also analyzed. METHODS The study group consisted of 24 students (12 women and 12 men, ∼21 yr of age) from the University School of Physical Education in Krakow. They were treated in a cryogenic chamber at the Rehabilitation Center in Krakow once daily for 10 d. The mean temperature in the chamber was -130°C ± 10°C and the session duration was 3 min. Thermovisual examination of temperature distribution in the selected parts of the upper and lower extremities was conducted before and immediately after a session on the 1(st) (S1), 5(th) (S2), and 10(th) (S3) day of treatment. All thermograms were digitally recorded using a Flir Therma CAM TM Sc500 camera. RESULTS On the 5th day of treatment, the examined group demonstrated the smallest mean temperature changes (4.57°C-17.31°C for the anterior part of the upper extremities in men and the posterior part of the lower extremities in women, respectively) before and after cryostimulation. The most significant temperature changes were observed in the group of women (6.80°C-20.08°C for the posterior parts of the upper extremities on S2 and the lower extremities on S3, respectively). CONCLUSION There is an important difference in response to cryogenic temperature between men and women in a series.

BACKGROUND This study verifies selected opinions on breast cosmetic surgery in the population of Polish women. MATERIALS AND METHODS A total of 78 women aged 20 to 48 years were surveyed between 2008 and 2010 before and after breast augmentation surgery using a questionnaire. The χ and Wilcoxon signed rank tests were used for statistical analysis. Most were married and single women aged approximately 30 years and residents of large cities. RESULTS The significance of professional success in the hierarchy of values and the level of self-assessment increased after surgery (P = 0.0000 and 0.0213, respectively). The distribution of responses concerning the expectations of surgery and the evaluation of their fulfillment changed significantly (P = 0.0031). In general, the satisfaction with one's life after surgery also increased (P = 0.0000). CONCLUSIONS A well-thought-out decision on breast cosmetic surgery positively affects at least several spheres of psychosocial functioning and fulfills most women's expectations.

Cancer of the larynx is an important epidemiological and oncological problem. According to the National Cancer Registry, 2075 new cases of laryngeal cancer were recorded in 2008 in Poland, which accounts for approximately 50% of malignant head and neck tumours. The modality of treatment and prognosis depend on the primary location of the tumour and the advancement of the symptoms. The main objective of the study was to evaluate the treatment results among patients with laryngeal cancer who were treated surgically and in combination with radiotherapy in the Departments of Otolaryngology and Radiotherapy at the Voivodal Specialist Hospital in Rzeszow between 1996 and 2005. The detailed objectives are 1) impact assessment of selected epidemiological factors on clinical outcomes and prognosis; 2) the risk of locoregional recurrence, depending on the chosen clinical and histopathological features. The clinical material consists of 359 patients diagnosed with laryngeal cancer and treated at the Otolaryngology Department of Voivodal Specialist Hospital in Rzeszow, Poland between 1996 and 2005. Conclusions The results of surgical treatment of patients with laryngeal cancer treated between 1996 and 2005 are comparable with the data which are published at present: 5-year survival of 58.5% and 10-year survival of 38.5% of in the examined group of patients. 1. Gender and the habit of smoking were not factors affecting the survival rate after the surgery. 2. Lower degree of cancer differentiation reduces significantly the probability of survival and shortens the period of survival after the surgery. 3. Histological type of cancer does not affect the survival period, probability of survival and the proportion of surviving patients. 4. The percentage of those surviving and the probability of survival among patients treated surgically for laryngeal cancer in clinical stage I is significantly higher than compared with clinical stage II, III and IV.

An interstitial hernia is one in which the hernia sac is located between the layers of the abdominal wall. The analysis of contemporary literature shows that interstitial hernias are most often seen in children as a type of inguinal hernia and often accompany undescended testis. The hernia sac is usually located between the external-oblique and internal-oblique muscles in a lateral-cephalic direction. The authors present 3 cases of interstitial hernia found during laparoscopic exploration of the front abdominal wall done due to incisional wound site pain. No previous diagnosis of hernia was considered in all the cases. Hernias were found as complications of appendectomy and wound healing after radiotherapy of uterine and cervical cancer. In conclusion, in obscure wound site pain, the presence of an interstitial postoperative hernia should be considered as a possible reason for the complaint. Laparoscopic examination of the anterior abdominal wall during adhesiolysis in patients with abdominal pain enables proper diagnosis and treatment.

Introduction: Haemodynamic depression is a drop in systolic pressure below 90 mmHg and/or heart rate to less than 60 beats per minute. Its incidence during the carotid angioplasty and stenting (CAS) perioperative period is as high as 68%. It is suggested that haemodynamic depression may result in serious perioperative incidents (major adverse cardiac events – MACE) and strokes. Aim: To evaluate the incidence of haemodynamic depression and to attempt to find a relationship with specific risk factors in patients undergoing carotid angioplasty and stenting. Material and methods: The study involved a group of 23 patients aged 40 to 79 (13 men and 10 women) who underwent CAS between August 2009 and July 2010. Initial values of arterial pressure and heart rate, values at moments critical for successful CAS and values at the end of the procedure were recorded. Haemodynamic depression was defined as hypotension below 90 mmHg and/or bradycardia below 60 beats per minute. Results: The incidence of haemodynamic depression was 30.4%. There is a positive and statistically significant correlation between initial systolic pressure and systolic and diastolic pressure and heart rate measured during stent implantation. Gender, artery operated on, previous stroke/TIA or carotid endarterectomy, type 2 diabetes, ischaemic heart disease and smoking did not significantly affect the incidence of haemodynamic depression. A statistically significant correlation with the length of the implanted stent was observed. Conclusions: The probability of haemodynamic depression is markedly higher in patients with low initial systolic pressure and longer stenosis of the carotid artery.

The internal thoracic artery is often used for reconstruction of coronary arteries. In a proportion of cases the reason for bypass failure (internal thoracic artery – coronary artery) is abnormal blood flow in the subclavian artery resulting from its stenosis. The stricture can result from post-surgery progression of atherosclerosis or could have been present and undiagnosed already when cardiac surgery was performed. This may result in exercise angina or even acute coronary syndrome. Interventional intervention is inevitable in these cases. An 84-year-old man was admitted for unstable angina 7 years after coronary artery bypass grafting (CABG) from the internal thoracic artery to the left anterior descending branch of the left coronary artery. In spite of medical treatment the symptoms did not recede and coronary and bypass angiography was performed on the 4 th day of hospitalization, revealing multiple stenoses of the coronary arteries and severe stenosis of the left subclavian artery. Moreover, the symptoms subsided only slightly after angioplasty of the circumflex branch of the left coronary artery. For this reason, angioplasty of the left subclavian artery with stent implantation, widening of the right coronary artery aortic opening, and angioplasty of the left coronary artery trunk and of the circumflex branch at its origin were performed. These procedures resulted in complete cessation of angina, while the patient also observed significant improvement of his left upper limb performance. The coronary-subclavian steal syndrome is defined as reduced flow through the bypass (internal thoracic artery – coronary artery) or reversed flow through the bypass, as a result of the narrowing of the proximal part of the left subclavian artery. In most cases the symptoms are stable and chronic, but in some patients an acute coronary syndrome can develop. Additionally, there are usually disturbances of the left upper limb perfusion. Routine blood pressure measurement on both arms is believed to identify a group of patients with high probability of subclavian artery stenosis, who may benefit from supplementation of coronary angiography with aortic arch imaging. Traditional surgical methods of treatment for subclavian-coronary steal syndrome include bypass between the left common carotid and left subclavian artery. However, intravascular angioplasty with stent implantation is a contemporary method of choice. Intravascular methods allow simultaneous correction of coronary vessels when there is a recurrent stenosis.

Source of support: Departmental sources Summary Background: The frequency of foreign body retention in the abdominal cavity ranges from 1 in 100 to 1 in 3000 surgeries performed. Worldwide literature describes only a few cases of the migration of misplaced surgical gauze into the colon. Case Reports: The first case is a 60-year-old patient following laparoscopic cholecystectomy, who excreted (on his own) a cotton sheet 30×65 cm after 26 weeks, which did not possess a radiological locator. The latter fact caused diagnostic difficulties in interpreting ultrasonography, CT-scans and abdominal X-rays. Colonoscopy after 4 months following the excretion of the sheet showed flat, stretched ul ceration of the colonic wall near the hepatic turn. The second case is a 76-year-old who had undergone several abdominal surgeries, including a classical cholecystectomy and extirpation of the uterus along with related tissues, as a result of cancer and with subsequent radiotherapy. The reason for the last intervention was an occlusion, which required a resection due to abscesses inside the peritoneal cavity. Abdominal pain continued after the surgery. Uroscopy and abdominal X-rays were performed 3 months later, which confirmed the presence of foreign matter in the abdominal cavity. Conclusions: Most foreign objects that have migrated into the colon will be excreted autonomously, which warrants a conservative assessment. Radiologically-tagged materials should be used, which will greatly ease identification in cases of suspected retention of surgical materials in the abdominal cavity.

Summary Background. Several risk factors for varicose veins have been identified: female gender, combined with obesity and pregnancy, occupations requiring standing for long periods, sedentary lifestyle, history of deep-vein thrombosis and family history. However, no specific gene variants related to a wide prevalence of varicosities in general population have been identified. Extracellular matrix composition, predominantly maintained by matrix metalloproteinases (MMPs), may affect the vein-wall structure, which may lead to dilation of vessels and cause varicosities. Aims. MMP-1 (tissue collagenase I) and MMP-3 (stromelysin I) expression was found to be raised in varicose veins compared with normal vessels. Therefore, a study was conducted to evaluate a potential association between MMP1 and MMP3 promoter polymorphisms and a risk of varicose veins. Methods. Genotyping for the presence of the polymorphisms −1607dupG (rs1799750) in MMP1 and −1171dupA (rs3025058) in the MMP3 promoter region was performed using PCR and restriction-fragment length polymorphism assays in a group of 109 patients diagnosed with varicose veins and 112 healthy controls. Results. The frequencies of the MMP1 and MMP3 alleles (minor allele frequency 0.440 in patients vs. 0.451 in the controls for MMP1−1607*G and 0.514 vs. 0.469 for MMP3−1171*dupA, respectively) and of genotypes did not differ significantly between patients and controls. Conclusions. The MMP1−1607dupG and MMP3−1171dupA promoter polymorphisms are not valuable markers of susceptibility for varicose veins.

Summary Introduction The infratemopral fossa pathology cases are very rare. They grow unnoticed for considerable period until there are some impairments of function of the anatomical structures of the place. Aim The aim of the paper was to recollect the information about rare cases the pathological state of the area in common laryngological practice. Material and mehod The study was carried out on three cases with tumors localizated in the infratemporal fossa, treated in Department of Otolaryngology of Military Clinical Hospital in Krakow (Poland) in the period from 2006 to 2008. The surgical treatment was preceded by precise picture diagnostic. The transzygomatiz approach were used in two cases. The buccal approach to maxilla in one case. Furthermore, in the last case the tumor expanded to parapharyngeal space which was explorated by parotido-cervical approach. The delayed post operative follow-up were carried out.

Basal cell carcinoma (BCC) is the most common malignancy in humans [1, 2]. According to the Skin Cancer Foundation, estimated 2.8 million cases are diagnosed annually in the US. Non-melanoma skin cancers (NMSC), the most common neoplasms in Europe, the USA and Australia, despite their low mortality, pose a serious therapeutic, social and economic problem. Worldwide incidence is increasing by about 10% per annum, so the prevalence of basal cell tumor in the near future will equal that of all other cancers together [3]. Basal cell carcinoma occurs in 85–90% of cases on the head, often on the face above the line connecting the mouth corner with the ear lobe [4]. They are less often found in the lower part of the face and on the scalp. In 10–15% of cases, BCC is found on the neck, trunk and limbs. Location of the basal cell carcinoma is closely related to the exposure to ultraviolet radiation [5, 6]. Although rarely metastatic, it has potential of tremendous, in some locations, life-threating, regional destruction and disfigurement [7]. Diseases on the surface of the skin are usually visible and tend to be easily noticed both for health-care professionals and for patients themselves. However, cases of neglected, extensive skin neoplasms are still a fairly common phenomenon in the 21st century. There are several different methods of treatment of BCC tumors: surgical (simple excision, Mosh’ micrographic surgery), destructive (cryosurgery, curettage and cautery) and non-surgical (photodynamic therapy, radiotherapy, topical-5-fluorouracil, imiquimod) [8, 9]. An advantage of surgical proceeding is the possibility of meticulous histological examination of the tumor type and margins of excision to establish clearance. Early treatment produces cure rates of almost 100% (the suggested overall 5-year cure rates for primary and recurrent BCC are 99% and 94.4%, respectively) [10, 11]. In order to decide on the adequate treatment option, several factors should be taken into consideration: biological, histopathological and clinical features of the neoplasm as well as the patient condition. Exact determination of the skin cancer margins is of particular importance in case of lesions developing in areas where the reoperation of a recurring neoplasm would not be possible. When excision is incomplete, the recurrence rate is approximately 30% [12]. Basal cell tumors are easily treated in their early stages. The larger the tumor has grown, however, the more extensive the treatment is needed. Especially some locations (eyelids, nose flap, lips, auricle) pose a challenge for the surgeon to remove the tumor entirely with proper margins and at the same time retain functionality and satisfactory aesthetic appearance. Furthermore, large, neglected tumor, especially located in the face region, demands complex reconstructive procedures after excision, i.e. local reconstruction techniques, free grafts, advanced, island, pedicle or microvascular flaps. A male patient, aged 66, was admitted to the Department of Otolaryngology of the 5th Military Hospital in Krakow due to large, progressive neoplastic ulceration of the right side of his face. He reported 9-year history of a slowly but gradually growing ulcerating lesion of the right buccal region. Three months before admission, he started to suffer from stabbing pain in the lower part of his face, leaking of saliva and bites of food through the ulceration, disturbances in nutrition, and unintentional, significant weight loss (approximately 15 kg in the past 12 months). The patient was in good general condition (concomitant diseases were benign prostate hypertrophy, left inguinal hernia treated surgically in 1994), evaluated as Fitzpatrick's skin photo type II, abusing nicotine. Physical examination revealed extensive, full-thickness ulceration of the right buccal region extending upward to the zygomatic arch, with destruction of the half of the upper lip and one third of the lower lip, infiltrating surrounding mimic muscles, exposing the bone of the body of the mandible, invading the mucosa of the alveolar rim of the mandible (Figures 1 and ​and2)2) [1, 2]. Figure 1 Large, neglected basal cell carcinoma of the right facial region Figure 2 Large, neglected basal cell carcinoma of the facial region In the histological samples taken from the ulceration basal cell carcinoma with perineural infiltration was revealed, but the planoepithelial component could not be excluded. The computed tomography (CT) scans revealed an extensive tissue loss and the possibility of infiltration of the mandible in the region of the right mental foramen. The patient was qualified to the surgical treatment (Figures 3 and ​and44). Figure 3 Harvesting of the musculocutaneous anterolateral thigh flap Figure 4 Microvascular anastomosis with facial vessels The first part of the procedure consisted of resection of the tumor within the histologically clean margins-right buccal region, 1/2 of the upper lip, 1/3 of the lower lip, segmental resection of the right body of the mandible, dental extraction (teeth: 41–45, 12–14) and elective right neck dissection of lymph nodes I–V and submandibular gland (RND (I–V + SG)). The non-lymphatic structures were spared (with special concern for internal jugular vein and facial vessels). The post resection mandible loss was bridged with titanium miniplate. The abundant soft tissue defect was reconstructed with a combination of autologous split-thickness skin graft from the left thigh and microvascular musculocutaneous (based on vastus lateralis muscle) free flap antero-lateral part of the right thigh [3]. Vascular pedicle (6 cm long) consisted of one artery and two veins (diameter approximately 2 cm). The microvascular end-to-end anastomosis was made to the right facial vessels [5]. Evaluation of the patency of the anastomosis was made – the blood flow was satisfactory. In the postoperative care, the patient was monitored every 4 h (general condition, flap color, warmth, pin prick) administered with the analgesics, wide-spectrum antibiotics, low-molecular-weight heparin, nourished by the nasogastric tube. In the eleventh [6] week of the post-operative period he underwent a minor procedure under local anesthesia of the reconstruction of the mouth (Figures 5 and ​and6)6) [7]. Figure 5 Eleven weeks after surgery Figure 6 Reconstruction of the mouth Fifteen weeks after surgery he did not complain of pain, he gained weight of approximately 8 kg, the esthetic outcome was satisfactory. Skin tumors are generally visible and noticeable not only for health care workers but also for the patients themselves. However typical BCCs are indolent and slowly progressive. These tumors remain painless and unobtrusive for long time. In addition, for non-specialists in skin diseases, BCC sometimes resembles noncancerous skin conditions such as psoriasis, eczema or others. The natural history of this cancer makes it an “ideal candidate” for neglected tumor. An extremely important issue in the treatment of locally advanced tumors is the choice of the appropriate method of treatment. Numerous alternatives are available for small BCC lesions: surgical excision, Mosh micrographic surgery, photodynamic therapy, cryosurgery, immunotherapy, and radiotherapy are the most common techniques. The treatment of expansive, neglected tumors, however, often demands a multidisciplinary approach. The treatment of choice for advanced cancers is usually surgery (also neurosurgery, cranio-maxillo-facial surgery, plastic surgery) sometimes combined with radiation therapy. The key point is also the choice of the most beneficial type of reconstructive treatment after ablation of the tumor. The goal is to restore the functionality and esthetically satisfactory appearance, especially after surgery of the tumors of the head and neck with possibly small sacrifice of other tissues [13]. One of attractive reconstructive methods for large defects are free microvascular flaps. Microsurgery has evolved to focus on functional and aesthetic results, as well as donor site morbidity. The qualities of an ideal soft tissue flap for reconstructions in the head and neck region are versatility in design, adequate tissue stock, specific texture, long pedicle with an appropriate diameter of vessels, possibility of two team approach, consistent anatomy, easy and safe dissection and minimal donor site morbidity. One of the alternatives is the anterolateral thigh flap (ALTF). It could be elevated as a cutaneous or musculocutaneous flap (based on vastus lateralis muscle) [14]. It has relatively constant anatomy, which makes dissection safe and easy for a skilled surgeon. Large and long pedicle, with a diameter close to potential recipient vessels of the head and neck make the microvascular anastomosis safe and easy. Harvesting ALTF is related with minimal donor site morbidity. The motor weakness is mild and transient, and the donor site can be closed primarily if the width of the skin island of the flap is less than 8 cm [15, 16]. Although the anterolateral thigh flap has become the workhorse for reconstruction of the skin and soft tissue defects since Song et al. first described it in 1984, are still used very rarely. The basal skin carcinoma, although considered to be the tumor with the low malignancy potential and not significant clinical problem, neglected advanced tumors can be encountered even in the 21th century. There is an entire range of possibilities for the treatment of basal cell lesions, but the therapy of such neglected cases usually demands multidisciplinary surgical and oncological treatment with advanced reconstructive techniques.

Guardianship courts seem to issue decisions in case of the need to obtain consent for surgery, amongst other things, when the patient is unable to consciously express written consent, and at the same time does not have a legal representative or a statutory representative does exist, but settlement with him is impossible. The presented study case demonstrated the abnormalities of applying court procedures, as well as the responsibilities and dilemmas posed in front of a surgeon. A specialist surgeon wanted to help the patient and he was able to accomplish his mission.

The quality of life (QoL) in patients with advanced venous insufficiency (including venous stasis ulcers, skin discoloration, stasis eczema, and lipodermatosclerosis) assessed using the Clinical Etiological Anatomical Pathophysiological (CEAP) and Venous Clinical Severity Score (VCSS) classifications is presented. Also, disease features such as: intensity of pain, edema and inflammatory response that exerted the most profound effect on different domains of QoL are reported. The global QoL in patients with lower leg venous ulcerations was relatively similar to that observed in other patients with chronic venous insufficiency. The presence of venous ulcerations was associated with lower QoL in a Physical domain. Significant correlations were found between pain intensity and the values of Physical, Physiological, Level of Independence and Environmental domains, between edema intensity and Social domain as well as between the intensity of inflammatory response and Physical and Spiritual domains.

OBJECTIVE:To review the pharmacology, virology, pharmacokinetics, safety, and efficacy of the nucleoside reverse transcriptase inhibitor (NRTI) emtricitabine.DATA SOURCES:English-language reports were accessed using MEDLINE (1966-June 2003) and the Iowa Drug Information Service database (1966-June 2003) using emtricitabine and Coviracil as key words. (Coviracil was the proposed trade name for the product prior to approval.) The Internet was also searched using the terms HIV/AIDS conferences, then emtricitabine within the conference proceedings.STUDY SELECTION AND DATA EXTRACTION:Abstracts, posters, and oral presentations from scientific conferences, both published and unpublished, were included. Preference was given to published controlled trials. Studies providing a description of the pharmacology, virology, effectiveness, safety, or pharmacokinetics of emtricitabine were used in this review.DATA SYNTHESIS:Emtricitabine is an NRTI used to treat HIV-1 infection. Once-daily administration can decrease pill burden and potentially increase adherence to multidrug HIV therapy. Further, emtricitabine has shown equivalent or improved outcomes compared with lamivudine and stavudine.CONCLUSIONS:Emtricitabine is a safe and effective option for HIV-1 infection in adults as part of a multidrug regimen. It may be a better alternative than lamivudine for once-daily therapy because of its extended intracellular half-life and better than lamivudine and stavudine because of a possibly decreased potential for drug resistance.

Anatomical location of salivary glands requires from surgeon high precision during the operation in this site. Waterjet is one of the modern tools which allows to perform "minimal invasive" operating procedure. This tool helps to separate pathological structures from healthy tissue with a stream of high pressure saline pumped to the operating area via special designed applicators. Stream of fluid is generated by double piston pummp under 1 to 80 bar pressure that can be regulated. This allows to precise remove tumors, spare nerves and vessels in glandular tissue and minimize use of electrocoagulation. Waterjet is a modern tool that can help to improve the safety of patients and comfort of surgeon's work.

Summary The main problem for nose and paranasal sinuses oncology is not the high incidence but the poor oncological and functional results of the treatment. Aim The aim of the work was presentation the patients and reconstruction methods after oncological ablation of nose and paranasal sinuses area. Material and method The study wa carried out on 14 patients treated in Department of Otolaryngology of The Military Clinical Hospital in Krakow. The patients were divided into groups considering size and localization of the tumor. Results All the patients are in observation without recurrence untill now. Cosmetic and functional results are satisfed. The main problem is total reconstruction of the nose where the cosmetic results are not satisfied. Conclusions The main difficulty is the total and near total reconstruction of the nose especially if it is necessary to reconstruct all nasal structures. From quality of life point of view the cooperation with dental prosthetic doctor is obligated for maxillectomy.

We studied 130 patients, aged 20 to 81 years, with symptoms of tinnitus, vertigo or dizziness. Radiological examinations revealed degenerative changes in the cervical spines of all patients such as discopathy or osteophytes. Head and neck and neurological examinations ruled out other symptoms apart from vertebrobasilar artery flow insufficiency. The vertebrobasilar arteries were examined by means of a color Doppler ultrasonograph using duplex scanning. The correlation coefficient (CC) defining the relationship between the number of patients with abnormal blood flow and the total number of patients with radiologically confirmed changes in the cervical spine was 41.5%. When patients were separated by age, the value of the CC coefficient increased proportionally according to age, changing from 0 to 79.1%. Use of the Doppler ultrasonograph was found to be a safe and non-invasive diagnostic method that enabled us to assess the influence of degenerative changes in the cervical spine on hemodynamic disturbances in the inner ear and brain stem. Our findings demonstrated a pathological decrease of vertebral artery flow velocity in relationship to degenerative changes in the cervical spine.

Measurements of cardiac marker proteins in plasma from patients with acute myocardial infarction (AMI) have become important in the evaluation of recanalization therapy. The validity of this approach has however been questioned, because it was claimed that coronary reperfusion may increase the recovery in plasma of cardiac enzymes, such as creatine kinase (CK). In the present study, possible effects of thrombolytic therapy on the release of enzymatic and nonenzymatic marker proteins were investigated. Activities of CK and lactate dehydrogenase (LDH), and concentrations of myoglobin (Mb) and fatty acid-binding protein (FABP) were determined in serial plasma samples obtained from 50 patients with confirmed AMI, of whom 36 received thrombolytic therapy, and 14 did not. Treatment delay was 2.8+/-1.6 (mean+/-SD) h, and hospital delay in untreated patients was 2.7+/-1.8 h. Average infarct size, expressed in gram-equivalents of heart muscle per litre of plasma (g-eq/l), varied between 5.5 and 7.2 g-eq/l for the four marker proteins in patients treated with thrombolytic therapy, and between 4.6 and 6.4 g-eq/l in untreated patients, with a tendency to larger infarct sizes for Mb and FABP than for CK and LDH. Thrombolytic therapy, although significantly accelerating protein release rates, did not influence the release ratios. These results indicate that thrombolytic therapy has no significant effects on the recovery of cardiac marker proteins in plasma.

Fragestellung: In der vorliegenden Arbeit werden Ergebnisse der chirurgischen Behandlung von Augenhöhlengeschwülsten unter Erhaltung der Sehkraft dargestellt. Die entscheidende Frage lautete, wann und bei welchen Lokalisationen der Geschwülste es möglich ist, die Sehkraft des Kranken zu erhalten. Material: In den Jahren 1981–1991 wurden in der Laryngologischen Klinik in Krakau 101 Kranke im Alter von 2 Monaten bis 81 Jahren behandelt. In der analysierten Gruppe befanden sich 56 Männer und 45 Frauen. In 86 Fällen wurden gutartige, in 15 Fällen bösartige Geschwülste behandelt. Bei 63 Kranken wurde eine laterale Orbitotomie nach der Krönleinschen Methode durchgeführt, bei 10 Kranken wurde die Augenhöhlenoperation über den Uffenorde-Zugang gemacht, und im Falle von 28 Kranken konnte man über einen Schnitt unter dem unteren Augenhöhlenrand in die Augenhöhle gelangen. Innerhalb von 5 Jahren nach dem Eingriff wurden die Patienten einer HNO-ärztlichen und ophthalmologischen Kontrolluntersuchung unterzogen. Alle 6 Monate wurde ein Sonogramm und 1 Jahr nach der Operation eine Computertomographie durchgeführt. Ergebnisse: Ein Rezidiv wurde bei 7 von den wegen eines bösartigen Tumors operierten Kranken festgestellt. In 39 Fällen war es notwendig, einen Teil der externen Augenmuskeln zu entfernen, nur bei 7 Kranken aus der Gruppe kam es jedoch zu einer anhaltenden Diplopie. Ein Kranker erblindete nach dem Eingriff. Schlussfolgerungen: Bei der lateralen und supralateralen Lokalisation der Geschwulst ergeben sich trotz gleichzeitiger onkologischer Radikalität des Eingriffs die besten Chancen, die Sehkraft zu erhalten.

Recurrence and pain are the two most important outcomes after inguinal hernia surgery. The concept of lightweight or partially absorbable macroporous meshes was developed under the assumption that the observed pain rate could be decreased without increasing the number of recurrences. Few randomized trials were published to analyze their clinical value, and some concern was raised because of an increased risk of recurrence. A systematic review and a meta-analysis of RCTs were carried out to determine whether the use of lightweight meshes influenced the pain and recurrence rate after Lichtenstein hernioplasty.To assess the value of the lightweight mesh, an extensive literature search was performed. The random-effect meta-analysis model was used to correct for clinical diversity and methodological variations between studies. Recurrence rate, aspects of chronic pain and foreign body feeling at 6-60 months postoperatively were assessed.Eight prospective RCTs of good quality were identified. Analysis demonstrated no significant difference regarding recurrence (OR, 1.11; 95 % CI, 0.57-2.14; p = 0.77). No significant difference was observed concerning severe pain (OR, 0.99; 95 % CI, 0.48-2.02; p = 0.97). Description of any pain resulted in a significant improvement in the lightweight group (OR, 0.65; 95 % CI, 0.50-0.84; p = 0.001). The presence of foreign body feeling was favoring the lightweight group (OR, 0.62; 95 % CI, 0.41-0.94; p = 0.02).The use of lightweight mesh did not neither increase the recurrence rate nor reduce the incidence of severe pain. A significant reduction in foreign body feeling and overall pain rate in the postoperative period was recorded. Lightweight meshes could be considered as a material of choice in primary inguinal hernioplasty.