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Introduction Incidentaloma is defined as an tumor diagnosed accidentally using imaging studies performed due to other indications. The aim of this paper was to describe the diagnostic and treatment problems experienced by patients with adrenal incidentaloma in a clinical practice. Material and methods In years 2009-2012 there were 33(16,5%) adrenal tumors diagnosed incidentally out of 200 cases treated due to adrenal pathology. The group consisted of 54 patients aged 27-77. In 15(45,5%) patients the diagnosis was made based on ultrasound examination, while in 18(54,5%) the tumor was visualized in CT/MRI. Results Only after the diagnostics was finalized, in which in all cases no signs of hormonal activity were detected, 26(78,8%) patients were qualified for the surgery. In 7(21,2%) cases no indications for such a management were found. The latter group was followed-up and in all patients the indications for the surgery arose due to enlargement of the tumor or/and the existence of hormonal activity. Our observations suggest that the incident finding of adrenal tumor is an indication of long-term observation. The analysis of our material shows that all patients observed needed surgical treatment. Conclusions The small adrenal tumors under follow-up have a tendency to enlarge and acquire hormonal activity. Long-term observation significantly increases the costs of treatment in that group, which eventually results in surgical management.

Introduction Adrenal cysts develop in up to about 0.2% of the overall population. They may account for up to 11% of all pathologies of adrenal glands. Aim Is laparoscopic resection of adrenal cysts a method for the treatment of these pathologies? Material and methods In the years 2010–2017, a total of 27 patients underwent surgery due to adrenal cysts; those included 18 (66.7%) women and 9 (33.3%) men aged 29 to 84 years (mean age: 42.7). Cyst diameter ranged from 55 to 130 mm. After exclusion of hormonal hyperactivity, parasitic cysts, or, to the best possible extent, cancer lesions, patients were qualified for adrenal-sparing laparoscopic surgery. Results All patients were subjected to laparoscopic surgery. Cystic wall resection was performed in 15 (55.6%) patients while adrenalectomy was performed in the remaining 12 (44.4%) patients. The decision regarding the extent of the surgery was made intraoperatively. Histopathological assessment revealed pathological adrenal lesions in as few as 3 (11.1%) patients, with the rest of the study population, i.e. 24 (88.9%), presenting with normal adrenal tissue. Conclusions Laparoscopic resection of adrenal cysts appears to be recommendable as a method for the treatment of these pathologies. It is simpler than adrenalectomy and associated with low risk of any pathological lesion remaining within the adrenal gland following careful intraoperative assessment by an experienced surgeon.

Background Carotid endarterectomy (CEA) is a surgical procedure used in ischemic brain stroke prevention in patients with symptomatic and asymptomatic severe carotid artery stenosis. Objectives This study compares perioperative stroke or death rate after carotid endarterectomy (CEA) in male and female patients, and determines risk factors for perioperative incidents in women and men. Material and methods The outcome of surgical treatment of 269 consecutive symptomatic patients (181 men and 88 women) treated from January 2004 to August 2008 in the Department of Vascular, General and Oncologic Surgery was analyzed. Results Perioperative stroke-death rate (within 30 days after the surgery) in women was 6.8% (6/88) and 3.3% (6/181) in men (p > 0.05). In the female group, none of the analyzed risk factors were associated with a higher risk of periprocedural incident, while in men, only hypercholesterolemia was a significant predictor of perioperative stroke (TC > 240 vs 240 vs 200-240: OR = 6.59; 95% CI: 1.12-38.97; p = 0.0375). Conclusions In men, hypercholesterolemia significantly increased the risk of perioperative stroke or death, while in females, none of the analyzed factors were determined as the predictors of the incident. The fact that plaque type VI by AHA was significantly more frequent in women and men more frequently were suffering from ischemic heart disease and peripheral artery occlusive disease appeared not to influence the outcome of CEA.

Introduction: To assess the effectiveness of early unilateral laparoscopic adrenalectomy in ACTH-independent and subclinical hypercor­tisolaemia. Material and methods: We conducted a unicentric, retrospective study. Between 2010 and 2015, 356 laparoscopic adrenalectomies were performed in the Department of General and Endocrine Surgery of the MUW. Hypercortisolaemia was found in 50 (14%) patients, while overt hypercortisolaemia was found in 31 patients. In the hypercortisolaemia group, ACTH-dependent hypercortisolaemia was diagnosed in five (10%) and ACTH-independent hypercortisolaemia in 25 patients (50%). One patient with overt hypercortisolaemia had cancer of the adrenal cortex. The remaining 19 (38%) patients had subclinical Cushing’s syndrome. For our study, we compared patients with ACTH-independent hypercortisolaemia (n = 25) with those with Cushing’s syndrome (n = 19). Patients with ACTH-dependent hyper­cortisolaemia (n = 5) and the patient with cancer of the adrenal cortex (n = 1) were excluded. Results: Patients from both groups (n = 44) underwent a unilateral transperitoneal adrenalectomy. Good early outcomes were observed in 42 patients (93.3%). In one patient, an additional laparoscopic surgery was necessary on postoperative day 0 due to bleeding. In another patient, on day 22 post-surgery, we found an abscess in the site of the excised adrenal gland, which was drained under laparoscopic guid­ance. In three patients (6.8%) with substantial obesity, temporary respiratory insufficiency of varying degrees occurred. We did not observe any thromboembolic complications. All patients with overt hypercortisolaemia and nine patients with subclinical hypercortisolaemia had secondary adrenal insufficiency postoperatively. Conclusions: Transperitoneal unilateral laparoscopic adrenalectomy is an efficient and safe treatment option in patients with ACTH- -independent hypercortisolaemia, both overt and subclinical.

Introduction Phaeochromocytoma is one of the numerous causes of secondary hypertension. Furthermore, phaeochromocytoma may first present with type 2 diabetes mellitus. The objective of our study was to evaluate the effects of adrenalectomy on patient recovery with regards to normotension and well-controlled glycaemia. Material and methods The retrospective analysis involved 67 patients with phaeochromocytoma operated between 2006 and mid-2012. The pre-operative diagnoses were made in the departments of internal medicine and endocrinology. Based on laboratory tests and diagnostic imaging, we were able to confirm the diagnosis of phaeochromocytoma in 42 (62.7%) patients. We verified the influence of adrenalectomy on the level of patient recovery, with regards to normotension and glycaemic control: arterial pressure and fasting glycaemia levels were obtained on the day of hospital discharge, at follow-up 3 months post-operatively and 1 year after surgical intervention. Results Of the 67 patients operated for phaeochromocytoma, 48 (71.6%) were treated laparoscopically, whereas 19 (28.4%) underwent open adrenalectomy. Arterial hypertension was recorded in 53 (79.1%) cases. Furthermore, among this group, diabetes mellitus coexisted in 21 (31.3%) cases. Postoperatively, 70% of cases of arterial hypertension and 90% of type 2 diabetes mellitus were cured. Additionally, a high rate of patients reported a quantitative reduced use of antihypertensive medicines. Conclusions In the majority of patients, surgical treatment of symptomatic phaeochromocytoma leads to a regression of arterial hypertension, or a reduction of the number or doses of medicines taken in one's treatment, and glucose-intolerance symptoms.

Pheochromocytomas may cause life-threatening episodes of arterial hypertension and surgical treatment is obligatory following proper general medical preparation. There were 63 patients in years 2006–2011 operated in the department due to pheochromocytoma. The group comprised 38 women and 25 men of the age range 16–80, mean 44,7. All the specimen were analyzed in pathological examination. The regressive changes that were found were subsequently compared with the clinical course of the pheochromocytoma both in the preoperative period and at the time of the surgery. There were 44 laparoscopic adrenalectomies performed, out of which 5 resulted in conversions to open surgery, while 19 patients were operated primarily via open access. The indications for the open procedures: extraadrenal tumors, fibrotic-infiltrative lesions suggestive of malignancy, vast intratumoral extravasation, and respiratory failure. In all the postoperative specimens pheochromocytomas were found. In 29 cases intratumoral haemorrhages were observed, in 17 — tumoral necrosis at different stages, and in 3 cases posthaemorrhagic cystis. In 6 cases the lesions were accompanied by major fibrosis and hyalinization. There is a statistically significant relationship between regressive changes observed within phaeochromocytomas and a reduction of paroxysmal hypertension at the time of adrenalectomy (p=0,012).

Introduction: Adrenal neoplasms comprise about 10% of all tumours affecting this organ and constitute a significant, at first diagnostic and subsequently therapeutic, problem, especially since a relatively high proportion of neoplastic lesions are asymptomatic. The number of diagnosed metastases to adrenal glands is increasing. Surgical treatment involves both open surgery as well as laparoscopy. Material and methods: There were 245 adrenalectomies performed at our centre due to various indications over the past four years. In 27 (11.5%) cases neoplasms were diagnosed in the final histopahtological examination. In 11 (40.7%) cases primary adrenal cortex tumours were diagnosed, metastases from other solid organ tumours were identified in another 12 (44.4%) patients, and rarer neoplasms were diagnosed in the remaning 4 (14.8%) subjects. Cases of malignant pheochromocytoma were not included in this report. Results: Laparoscopic adrenalectomy was performed in 23 (85.2%) subjects, while the ramaining 4 (12.9%) patients were subject to open adrenalectomy (conversion to open procedure in one case). There were no deaths or significant complications in the perioperative period. Comparing mean duration of open (140 minutes) and laparoscopic (190 minutes) procedures yielded a statistically significant difference (p = 0.02). There was no statistically significant difference found in the duration of operation with regard to laparoscopic adrenalectomies of tumours less than 50 mm and over 55 mm in diameter (p = 0.16). Conclusions: Laparoscopic adrenalectomy is a safe and effective method of treatment of adrenal tumours. Its oncological completeness is comparable (to open surgery) when performed by experienced surgical teams. Laparoscopy is the reason for the smooth postoperative course observed in most patients.

Objectif Le but de cette etude etait d’evaluer l’influence des stenoses intra crâniennes ou des occlusions sur le devenir des patients operes d’une endarteriectomie carotidienne (EAC) pour une stenose de l’artere carotide interne. Les auteurs ont egalement analyse l’influence de la morphologie des plaques de l’artere carotide interne sur les processus atherosclerotiques des arteres intra crâniennes. Methodes L’etude a inclus 154 patients ayant eu une angiographie et une EAC. Des lesions intra crâniennes (stenoses ou occlusions) ont ete observees chez 28 (18,2%) patients. Resultats Le taux combine d’accidents vasculaires et de deces peri-operatoires a ete de 3,9%. L’analyse statistique a montre que les accidents vasculaires cerebraux peri-operatoires apres EAC apparaissaient significativement plus frequemment chez les patients ayant des stenoses ou des occlusions intra-crâniennes (p = 0,0104). Le taux de deces – accidents cerebraux tardifs a ete de 13,6%. Le test du log-rank a montre qu’apres un an de suivi, la survie etait significativement plus elevee chez les patients sans lesion intra-crânienne que chez ceux ayant des lesions intra-crâniennes (p = 0,048). Conclusions Les stenoses et occlusions intra-crâniennes predisent un pronostic neurologique peri-operatoire defavorable. Les patients ayant des lesions intra-crâniennes beneficient moins de l’endarteriectomie apres un an de suivi. Aucune conclusion n’a pu etre etablie concernant l’avancee du processus atherosclereux des arteres intra-crâniennes sur la base de la morphologie des plaques de l’artere carotide interne.

UNLABELLED Anastomotic aneurysms occurs at various levels of arterial system. Determining their location and incidence rate required investigation of large patient clinical material. MATERIAL AND METHODS In the years 1989-2010 in local centre 230 anastomotic aneurysms were operated in 180 patients. RESULTS For 187 (81.3%) patients anastomotic aneurysms were localised in the groin, while for remaining 43 (18.7%) they occurred in other localisations. In aortic arch branch they occurred four times (1.7), in descending aorta--three times (1.3%), in abdominal aorta--14 (6.1%) and in iliac arteries--6 (2.6%). While for anastomosis with popliteal artery they were diagnosed in 16 (7%) patients. Own clinical material was compared with literature data. CONCLUSIONS Anastomotic aneurysms in over 80% of cases occur in the groin, remaining percentage corresponds to other localisations.

UNLABELLED Anastomotic aneurysms may develop after any type of vascular surgery, in different areas of the arterial system, and require reoperation. The frequency of occurrence of the above-mentioned is estimated at 1-5%. MATERIAL AND METHODS During the period between 1989 and 2010, 180 patients with 230 anastomotic aneurysms were subject to surgical intervention at the Department of General and Thoracic Surgery, Warsaw Medical University. The study group comprised 21 (11.7%) female and 159 (88.3%) male patients, aged between 30 and 87 years (mean age - 62.8 years). In relation to the number of anastomoses aneurysms were diagnosed in 2.1% of cases. Twenty-four (10.4%) patients were diagnosed with recurrent aneurysms. RESULTS Surgical procedures performed were as follows: artificial prosthesis implantation (119), reanastomosis (40), patch plasty (25), graftectomy (19), prosthesis replacement (9), and stent-graft (7) implantation. 195 (84.8%) aneurysms were subject to planned surgery, while 35 (15.2%) required emergency intervention. 77.8% of patients were diagnosed with aseptic aneurysms, while the remaining 22.2% with infected perioperative aneurysms. Good treatment results were obtained in 149 (82.8%) patients. Limb amputations were performed in 19 (10.5%) cases. Twelve (6.7%) patients died as a consequence of infection and general complications. CONCLUSIONS Vascular reoperations are a difficult clinical problem and are burdened with a high rate of complications. The above-mentioned often require complex treatment, in order to improve therapeutic results.

UNLABELLED The aim of the study was to evaluate the results of general surgical treatment of patients over 80 years of age. MATERIAL AND METHODS Three hundred and four patients aged 80 to 105 years with general surgical disorders, treated in 2005-2009, were retrospectively included in the study. The collected information included demographic data, coexisting diseases, the mode of admission, the diagnosis, the method and result of treatment, and also potential complications and 30-day mortality. The data were subjected to statistical analysis. RESULTS The study group included 186 women and 118 men. Two hundred patients (65.8%) were admitted in an emergency setting. The most common causes of immediate hospitalisation were: mechanical ileus (26.5%), gastrointestinal bleeding (22%), trauma (16%), and gall-bladder disorders (8.5%). The remaining 104 (34.2%) patients were operated upon on an elective basis. An emergency operation was required by 121 (60%) of the patients admitted in an emergency setting; the remaining ones were treated conservatively. Hernia plasties (27.5%), cholecystectomies (15.3%), colorectal resections (13.2%), strumectomies (11.2%) and endoscopies (6.1%) predominated among elective surgeries.The total number of complications and mortality were 19.4% and 14.5%, respectively. The number of complications and mortality were significantly higher in the group of patients admitted in an emergency setting (25.5% and 20.5%, respectively) than in patients admitted on an elective basis (8.7% and 2.9%, respectively), p

Background The aim of this research was to investigate the influence of intracranial stenoses or occlusions on the outcome of carotid endarterectomy (CEA) in patients with internal carotid artery stenosis. The authors also searched for internal carotid artery plaque's morphology influence on the atherosclerotic process in intracranial arteries. Methods The study included 154 patients who underwent angiography and CEA. Intracranial lesions (stenosis or occlusion) were stated in 28 (18.2%) patients. Results Perioperative stroke - death rate was 3.9%. Statistical analysis revealed that perioperative stroke after CEA appeared significantly more often in patients with intracranial stenoses or occlusions (p = 0.0104). Late death-stroke rate was 13.6%. Log-rank test revealed that after a 1-year follow-up period, there were significantly more survivals in patients without intracranial lesions than in those with intracranial lesions (p = 0.048). Conclusions Intracranial stenosis or occlusion predicts poor perioperative neurological outcome. Patients with intracranial lesions benefit less from endarterectomy in a 1-year follow-up period. On the basis of internal carotid artery plaque's morphology, no conclusions on advancement of intracranial arteries' atherosclerosis can be made.

Subtraction angiography is an invasive diagnostic method, which for a long time was a gold standard in carotid artery and intra-cranial vessel imaging. The aim of this research is to evaluate angiographic imaging in predicting atherosclerotic plaque type VI by AHA morphology and to assess its significance in establishing patients' suitability for a particular operative method. Secondarily, we assessed atherosclerotic lesions in common carotid artery bifurcation. In the paper we analyzed 158 bilateral angiograms of common and internal carotid arteries in extra- and intra-cranial locations. The material consisted of patients hospitalized in the Vascular Surgery Ward of Memorial Copernicus Hospital in Lodz during 2002-2004 who underwent angiography. We concluded that: 1. In symptomatic patients irregular plaque images in subtraction angiography is correlated with plaque type VI by AHA morphology. 2. Angiography is not a sufficient method for selection of the appropriate operative treatment due to its low sensitivity and specificity in plaque morphology imaging. 3. Plaque type VI by AHA is characteristic even for the second group of carotid bifurcation stenosis (by NASCET) and it definitely dominates in group III (by NASCET).