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Background: Providing adequate chest compression is essential during infant cardio-pulmonary-resuscitation (CPR) but was reported to be performed poor. The "new 2-thumb technique" (nTTT), which consists in using 2 thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist, was recently introduced. Therefore, the aim of this study was to compare 3 chest compression techniques, namely, the 2-finger-technique (TFT), the 2-thumb-technique (TTHT), and the nTTT in an randomized infant-CPR manikin setting., Methods: A total of 73 paramedics with at least 1 year of clinical experience performed 3 CPR settings with a chest compression:ventilation ratio of 15:2, according to current guidelines. Chest compression was performed with 1 out of the 3 chest compression techniques in a randomized sequence. Chest compression rate and depth, chest decompression, and adequate ventilation after chest compression served as outcome parameters., Results: The chest compression depth was 29 (IQR, 28-29) mm in the TFT group, 42 (40-43) mm in the TTHT group, and 40 (39-40) mm in the nTTT group (TFT vs TTHT, P < 0.001; TFT vs nTTT, P < 0.001; TTHT vs nTTT, P < 0.01). The median compression rate with TFT, TTHT, and nTTT varied and amounted to 136 (IQR, 133-144) min versus 117 (115-121) min versus 111 (109-113) min. There was a statistically significant difference in the compression rate between TFT and TTHT (P < 0.001), TFT and nTTT (P < 0.001), as well as TTHT and nTTT (P < 0.001). Incorrect decompressions after CC were significantly increased in the TTHT group compared with the TFT (P < 0.001) and the nTTT (P < 0.001) group., Conclusions: The nTTT provides adequate chest compression depth and rate and was associated with adequate chest decompression and possibility to adequately ventilate the infant manikin. Further clinical studies are necessary to confirm these initial findings.

Introduction: The aim of this study was to investigate the effects of plasma and tissue angiotensin-converting enzyme inhibitors (ACE-Is) against propofol-induced endothelial dysfunction and to elucidate the involved mechanisms in vitro., Materials and Methods: We examined the effects of propofol (50 μM), quinaprilat and enalaprilat (10 -5 M) on fibrinolysis (t-PA, PAI-1, TAFI antigen levels), oxidative stress parameters (H 2 O 2 and MDA antigen levels and SOD and NADPH oxidase mRNA levels) and nitric oxide bioavailability (NO 2 /NO 3 concentration and NOS expression at the level of mRNA) in human umbilical vein endothelial cells (HUVECs)., Results: We found that both ACE-Is promoted similar endothelial fibrinolytic properties and decreased oxidative stress in vitro. Propofol alone increased the release of antifibrinolytic and pro-oxidative factors from the endothelium and increased mRNA iNOS expression. We also found that the incubation of HUVECs in the presence of propofol following ACE-Is pre-incubation caused weakness of the antifibrinolytic and pro-oxidative potential of propofol and this effect was similar after both ACE-Is., Conclusions: This observation suggests that the studied ACE-Is exerted protective effects against endothelial cell dysfunction caused by propofol, independently of hemodynamics.

Background: Immobilization of the cervical spine is indicated in all patients with the potential risk of any cervical spine injury. Airway management in these patients is challenging and direct laryngoscopy is the standard of care. Videolaryngoscopes like the ET-View were introduced into clinical practice to provide better airway visualization and ease intubation. The ET-View is essentially a conventional endotracheal tube, but is equipped with a miniature camera on the tip. The ET-View has not been investigated in patients with immobilized cervical spine so far. The aim was to evaluate the performance of the VivaSight SL compared with Macintosh when performed in patients with immobilized cervical spine by unexperienced physicians., Methods: This was prospective, randomized, cross-over manikin trial. 50 novice physicians were randomly assigned to intubate a manikin in three airway scenarios including a normal airway and two cervical immobilization techniques. Overall and first intubation attempt success rate, time to intubation, dental compression and airway visualization according to the Cormack&Lehane graduation were assessed., Results: All physicians were able to intubate the manikin in all scenarios using the ETView, whereas direct laryngoscopy failed in 16 % with immobilized cervical spine using the patriot cervical extraction collar. First intubation attempt success rate was higher and airway visualization was better in all three scenarios using the ET-View compared to direct laryngoscopy., Conclusion: The ET-View offered much better 62 airway visualization and provided higher overall and first intubation attempt success rates. Therefore, the ET-View is a valuable alternative in patients with difficult intubation due to immobilized cervical spine. Further clinical trials are indicated to confirm these findings., Trial Registration: clinicaltrials.gov Identifier: NCT02733536.

Angiotensin converting enzyme inhibitors and propofol both exert hypotensive action and may affect hemostasis. We investigated the influence of quinapril and propofol on hemodynamics and hemostasis in renal-hypertensive rats with induced arterial thrombosis. Two-kidney, one clip hypertensive rats were treated with quinapril (3.0 mg/kg for 10 days), and then received propofol infusion (15 mg/kg/h) during ongoing arterial thrombosis. The hemodynamic and hemostatic parameters were assayed. Quinapril exerted a hypotensive effect increasing after propofol infusion. Quinapril showed an antithrombotic effect with the platelet adhesion reduction, fibrinolysis enhancement and oxidative stress reduction. Propofol did not influence thrombosis; however, it inhibited fibrinolysis and showed prooxidative action. The effect of propofol on fibrinolysis and oxidative stress was significantly lower in quinapril-pretreated rats. Mortality was increased among rats treated with both drugs together. Our study demonstrates that pretreatment with quinapril reduced the adverse effects of propofol on hemostasis. Unfortunately, co-administration of both drugs potentiated hypotension in rats, which corresponds to higher mortality., (© The Author(s) 2016.)

Colorectal cancer (CRC) is one of the most frequent human malignant neoplasms. CRC has an estimated incidence of more than 1,000,000 new cases annually worldwide. Approximately one out of three people who develop CRC dies from the disease. Furthermore, CRC often affects inhabitants of industrialized countries in comparison to less developed countries. Several markers of colon cancer, including CEA, CA-19-9, TPS, TAG-72 and lysosomal hydrolases, have been identified and are now being adopted in routine clinical practice. Increased values of these markers are often the first signal of recurrence or metastases, which is useful in prediction and prognosis of clinical outcome of patients with CRC. Determination of the activity of lysosomal exoglycosidases in body fluids may bring some hope of improving diagnosis of colorectal cancer. However, it has to be remembered that currently the most effective diagnostic method of CRC is endoscopy.

Background: Carnitine transports fatty acids from the cytoplasm to the mitochondrial matrix, where the fatty acids are oxidized. Chronic alcohol consumption reduces the concentration of carnitine and interferes with oxidative processes occurring in the cell., Aim: The assessment of carnitine concentrations in plasma of chronically intoxicated alcohol dependent persons in a 49-day abstinence period., Material/methods: The study included 31 patients (5 women and 27 men) aged from 26 to 60 years (44.6 ± 8.9) and 32 healthy subjects (15 women and 17 men) aged 22-60 years (39.8 ± 9.4). The patients' alcohol dependence ranged from 2 to 30 years (13.6 ± 7.5). Examined subjects consumed 75-700 g of ethanol/day (226.9 ± 151.5). Plasma concentrations of free and total carnitine were measured three times: at the first (T0), 30th (T30) and 49th (T49) day of hospital detoxification. Free (FC) and total (TC) carnitine were determined by the spectrophotometric method. Plasma acylcarnitine (AC) concentration was calculated from the difference between TC and FC; then the AC/FC ratio was calculated. To determine statistically significant differences for related variables, Student's t-test was used., Results: At T0, alcoholics had significantly lower concentration of FC and TC (p < 0.05) in plasma, as compared to the control group. In comparison to controls, at T30, plasma TC and FC (p < 0.01) as well as AC (p < 0.001) were reduced. The lowest concentration of TC, FC and AC (p < 0.001)was found at T49. The ratio of AC/FC at T0 had a tendency to be higher in alcoholics than in the control group (p = 0.05), whereas at T49 it was significantly lower in alcoholics as compared to the control subjects (p < 0.05)., Conclusions: Chronic alcohol intoxication causes a plasma deficiency of carnitine. Forty-nine days of abstinence showed a significant decrease in the concentration of TC, FC and AC. Further research is necessary to clarify whether a low level of plasma carnitine after chronic alcohol intoxication is caused by the uptake of blood carnitine by tissues such as liver or muscles. In alcoholics the supplementation of carnitine is recommended in the case of a low level of plasma carnitine.

Background: Colorectal cancer remains a huge diagnostic and therapeutic issue in Poland and worldwide. World epidemiological data indicates a constant increase in morbidity in recent decades., Objectives: The aim of this research was to present surgical procedures in malignant and benign colorectal neoplasms based on authors' clinical data., Material and Methods: Between 2001 and 2010, in the 1st Department of General and Endocrinological Surgery in Bialystok, 754 patients with malignant colorectal cancer were hospitalized. Precancerous conditions which included polyps and non-specific bowel inflammations were observed in 491 and 52 patients, respectively., Results: The most frequent location of a malignant colorectal tumor was the rectum - 271 (35%) cases and sigmoid colon - 235 (31%) cases. In 8 cases (1%), a multifocal location of colorectal neoplasm was observed. Similar locations were observed in the case of polyps. They were observed the most frequently in the sigmoid colon - 144 (29.3%) cases and rectum - 122 (24.8%) cases. In the cases of colorectal cancer located in the rectum (271), the most frequently applied procedure was abdomino-perineal amputation - 102 (37.6%) patients (T1-3 N1-2 M0). In sigmoid colon cancer (235 cases), sigmoid colon resection was performed most frequently - in 175 patients (74.5%) (T1-3 N0-2 M0-1). Right hemicolectomy was performed in 120 (T1-4 N0-2 M0-1) patients and left hemicolectomy in 52 (T1-4 N02 M0-1) patients. In 482 cases, endoscopic resection of polyps was performed and in 9 patients resection through laparotomy. The majority of operations were performed according to plan, however, many of them were performed in emergency., Conclusions: Colorectal cancers, irrespectively to their location, develop secretly without any symptoms in the early stages which is the reason why patients contact a doctor in the late stadium of the disease. It is also the cause for a majority of the procedures performed in emergency. The best prognosis and long-term results are obtained with treatment combined with radio- and chemotherapy.

Background: In hospital patients suffering from adverse clinical and biochemical symptoms of malnutrition, it is often necessary to employ parenteral nutrition to avoid the body's tissue becoming broken down by being metabolised. Thus, the patient's welfare and survival can be supported throughout any periods of medical crisis. Two of the enzymes responsible for metabolising glycoconjugates are alpha-fucosidase (FUC) and beta-glucuronidase (GLU), present in lysosomes. They release fucose or glucuronic acid from the non-reducing end of oligosaccharide chains., Objective: To determine the effect of parenteral nutrition administered to ill patients, on glycoconjugate metabolism, by measuring serum and urinary activities of FUC and GLU. Material and methods. Blood samples and the daily urine collection were taken from 23 patients' who had been undergoing parenteral nutrition for either 5 or 10 days, as well as from a baseline sample. Enzyme activities in serum and urine were determined by the method of Zwierz et al., Results: Serum FUC activities were significantly lower after 10 days compared to 5, (p< 0.0172), whereas GLU activities were significantly lower after both 5 and 10 days, (p< 0.0007 and p< 0.0208 respectively), compared to levels before starting parenteral nutrition. GLU activities were however higher after 10 days than those after 5 days, (p< 0.0023). In urine, FUC activities were significantly decreased after 10 days compared to 5 days after starting parenteral nutrition, (p< 0.0245). Urine GLU activities were unaffected by parenteral nutrition nor was any effect seen on FUC or GLU activities when calculated per 1mg creatinine., Conclusions: Serum FUC and GLU activities can be used for assessing the effect of parenteral nutrition on glycoconjugate metabolism. The significant decreases of serum GLU activity observed after 5 and 10 days, may serve to indicate that the components of parental nutrition are appropriate and that the body has become suitably adapted to this form of nutrition.

Peroxidase is the most important antioxidant enzyme in saliva. Through peroxidation of thiocyanate in the presence of H₂O₂, peroxidase catalyses the formation of bacteriocidic compounds such as hypothiocyanate.The purpose of this study was to evaluate the effect of chronic alcohol intoxication and smoking on the activity of oral peroxidase (OPO). A total of 37 volunteers participated in the study. This cohort consisted of 17 male alcohol-dependent smoking patients after chronic alcohol intoxication (AS group, alcohol + smoking) (mean age: 42 years; range: 26-55) (100-700 g/day of alcohol; 10-20 cigarettes/day) and 20 control male social drinkers(CNS group, control non-smokers) with no history of alcohol abuse or smoking (mean age: 42 years; range:30-53). Salivary peroxidase activity was measured by the colorimetric method. The differences between groups were evaluated using the Mann-Whitney U test. There was significantly higher activity of OPO (p = 0.00001)and significantly lower salivary flow (SF) (p = 0.007) in alcohol-dependent smokers after chronic alcohol intoxication compared to the control group. OPO activity significantly correlated with the number of days of alcohol intoxication, but not with smoking. Gingival index (GI) was significantly higher in smoking alcohol-dependent persons than in the control group, and correlated with OPO activity. The sensitivity of the OPO test was 70% in smoking alcoholics, while specificity was 95%. The increased activity of OPO suggests chronic oxidative stress is more likely due to ethanol action than to smoking. Smoking alcohol-dependent persons have a worse periodontal status than controls. OPO activity as a marker of chronic alcohol abuse may help in the diagnosis of alcoholism.

The relationship between alcohol consumption and glycoconjugate metabolism is complex and multidimensional. This review summarizes the advances in basic and clinical research on the molecular and cellular events involved in the metabolic effects of alcohol on glycoconjugates (glycoproteins, glycolipids, and proteoglycans). We summarize the action of ethanol, acetaldehyde, reactive oxygen species (ROS), nonoxidative metabolite of alcohol--fatty acid ethyl esters (FAEEs), and the ethanol-water competition mechanism, on glycoconjugate biosynthesis, modification, transport and secretion, as well as on elimination and catabolism processes. As the majority of changes in the cellular metabolism of glycoconjugates are generally ascribed to alterations in synthesis, transport, glycosylation and secretion, the degradation and elimination processes, of which the former occurs also in extracellular matrix, seem to be underappreciated. The pathomechanisms are additionally complicated by the fact that the effect of alcohol intoxication on the glycoconjugate metabolism depends not only on the duration of ethanol exposure, but also demonstrates dose- and regional-sensitivity. Further research is needed to bridge the gap in transdisciplinary research and enhance our understanding of alcohol- and glycoconjugate-related diseases.

The purpose of this study was to evaluate the effect of chronic alcohol intoxication and smoking on the concentration and output of salivary lysozyme. Thirty seven men participated in the study, including 17 male smoking alcohol-dependent patients after chronic alcohol intoxication (AS), and 20 control non-smoking male social drinkers (CNS) with no history of alcohol abuse or smoking. The level of lysozyme was assessed by the radial immunodiffusion method. Significantly lower lysozyme output in the AS group compared to the CNS group was found. Moreover, gingival index was significantly higher in AS than in the CNS group. It appeared that the reduced salivary lysozyme output was more likely the result of ethanol action than smoking. In conclusion, persons addicted to alcohol and nicotine have a poorer periodontal status than non-smoking social drinkers, which may partially be due to the diminished protective effects of lysozyme present in the saliva.

Introduction: Changes in the structure of membrane glycoconjugates and activity of glycosidases and proteases are important in tumor formation., Objectives: The aim of the study was to compare the specific activity of lysosomal exoglycosidases: N-acetyl-β-D-hexosaminidase (HEX), its isoenzymes A (HEX A) and B (HEX B), β-D-galactosidase (GAL), α-fucosidase (FUC), and α-mannosidase (MAN) with the activity of cathepsin D (CD) in serum, urine, and carcinoma tissue of patients with colon adenocarcinoma., Patients and Methods: The specific activity of HEX, HEX A, HEX B, GAL, FUC, MAN, and CD was assayed in serum, urine, and carcinoma tissue of 12 patients with colon adenocarcinoma., Results: Lysosomal exoglycosidases and CD have similar specific activity in colon adenocarcinoma tissue and urine, which is higher than their activity in serum (with the exception of the highest specific activity of CD in urine). A positive correlation was observed between the specific activity of CD and that of HEX, HEX A, FUC, and MAN in the carcinoma tissue and urine as well as between CD and GAL in the urine of patients with colon adenocarcinoma. Negative correlations were observed between protein levels and the specific activity of HEX, HEX A, FUC, MAN, and CD in the carcinoma tissue and urine, and between protein levels and GAL in urine., Conclusions: Increased degradation and remodeling of glycoconjugates in the colon adenocarcinoma tissue is reflected by increased specific activity of exoglycosidases and CD. The results suggest a strong effect of exoglycosidase action on tissue degradation and a potential role of exoglycosidases in the initiation of proteolysis.

The effect of chronic alcohol intoxication and smoking on the output of salivary immunoglobulin A (IgA) was studied in 37 volunteers: 17 male smoking patients after chronic alcohol intoxication (AS) and 20 control non-smoking male social drinkers (CNS). The DMFT index (decayed, missing, or filled teeth), gingival index and papilla bleeding index (PBI) were assessed. Concentration of IgA in saliva was determined by ELISA. Salivary flow (SF) and IgA output were significantly decreased in AS compared to CNS. There were no significant correlations between the amount of alcohol/cigarettes as well as the duration of alcohol intoxication/smoking, and SF or IgA output, nor between IgA level and SF. Gingival index was significantly higher in AS than in CNS, and was inversely correlated with IgA salivary level. The worsened periodontal state in smoking alcohol-dependent persons may result from diminished IgA protection of the oral tissues due to its decreased output.

There were approximately 93,060 deaths from cancers in Poland in 2008, and about 105,000 are predicted for the year 2025. Early detection of cancer is a major problem throughout the world, which is why many researchers are still looking for specific and sensitive markers of malignant tumors. Our work is a review of recent publications on activity of N-acetyl-β-D-hexosaminidase (HEX) and its isoenzymes A (HEX A) and B (HEX B) as potential markers of malignant tumors. HEX is the most active of the lysosomal exoglycosidases, taking part in degradation of glycoconjugates (glycoproteins, glycolipids, proteoglycans). HEX cleaves N-acetyl-D-glucosamine and N-acetyl-D-galactosamine from non-reducing ends of oligosaccharide chains of glycoproteins, glycolipids and glycosaminoglycans. The activity of HEX, and its isoenzymes A (HEX A) and B (HEX B), was determined by spectrophotometric and isoelectric focusing methods. There was a statistically significant increase in activity of HEX in tumors of the kidney, pancreas, thyroid, colon, ovary, brain, salivary gland, stomach and larynx, which suggests potential applicability of HEX and its isoenzymes in cancer diagnosis.

Alcoholism is one of the most frequent dependences among people, leading to damage of the liver and death of the person. Chronic alcohol consumption decreases fatty acid oxidation by interfering with carnitine metabolism and citric acid cycle activity. Block in activity of the citric acid cycle caused by alcohol and its metabolites is partially compensated by increased ketone body production, which results in ketosis. Chronic administration of alcohol induces liver injury, inflammation, cirrhosis, focal necrosis and steatosis. L-carnitine (L-3-hydroxy-4-N, N, N-trimethylaminebutyric acid) is an essential factor in fatty acid metabolism, which plays a major role in transport of activated long-chain fatty acids to sites of β-oxidation in mitochondria. Carnitine also stabilizes cell membranes by removing long-chain acyl-CoA and excess of the acyl group from the body. L-carnitine can be a useful and safe drug in the liver pathology induced by chronic ethanol exposure.

Background: The purpose of the study was to assess the quality of performance of wideband, phase inversion harmonic power Doppler sonography in the diagnosis of focal nodular., Material/methods: During a period of one year, thirty-one patients with FNH previously confirmed by ultrasound-guided biopsy, surgical resection, dynamic helical computed tomography or magnetic resonance imaging were examined. The study protocol consisted of B-mode gray scale sonography, color Doppler, power Doppler examinations, and helical CT scans. Then PI scans were performed after the injection of 2.5 g of Levovist intravenously., Results: The images obtained by the B-mode gray scale were typical for focal nodular hyperplasia in 13 lesions only (32.5%), and obtained by color, power Doppler sonography in 25 lesions (62%). On the contrary all patients with focal nodular hyperplasia were diagnosed based on the wide-band, phase inversion power Doppler sonography findings. The common enhancement pattern at pulseinversion harmonic US was filling in a central tumor artery with further centrifugal development of contrast. Then during early arterial phase, all typical anatomical features of FNH as 'star sign 'or 'spoke-wheel 'pattern were clearly visible .In 3 cases ,computed tomography and magnetic resonance imaging have failed to disclose pathology while phase inversion sonographic images were completely suggestive which was later confirmed by histologic examination., Conclusions: Our data demonstrates the usefulness of wide-band, phase inversion harmonic power Doppler sonography in the differential diagnosis of hepatic focal nodular hyperplasia by visualizing all characteristic anatomical details.

Background/aims: To determine whether examination of hepatic focal nodular hyperplasia by wide-band, phase-inversion sonography offers any advantages over power and color Doppler sonography in the depiction of specific characteristics of these pathologies., Methodology: Twenty-six patients were examined. The presence of focal nodular hyperplasia was confirmed by ultrasound-guided biopsy, surgical resection, dynamic helical computed tomography or magnetic resonance. All patients, prior to enhanced sonography, had undergone B-mode gray-scale sonography, color Doppler, and power Doppler examinations. After injection of 2.5 g of Levovist intravenously, analysis of the contrast agent arrival was performed by wide-band, phase-inversion power Doppler sonography., Results: The B-mode gray-scale sonography, color and power Doppler sonography were non-specific for focal nodular hyperplasia in 14 cases in our examination. However based on the wide-band, phase-inversion power Doppler sonography findings all patients with focal nodular hyperplasia were diagnosed. All typical anatomic features of focal nodular hyperplasia such as "star sign" or "spoke-wheel" pattern were clearly visible. In 3 cases, computed tomography and magnetic resonance imaging had failed to disclose pathology while phase-inversion sonographic images were completely suggestive which was later finally confirmed by histologic examination., Conclusions: Our data demonstrate the usefulness of wide-band, phase-inversion power Doppler sonography in the differential diagnosis of hepatic focal nodular hyperplasia by visualizing all characteristic anatomic details.

In men, androgens and especially testosterone are considered responsible for the much higher rate of coronary artery disease. The male gender is an independent coronary artery disease risk factor. An adverse correlation between endogenous testosterone levels and the extent of coronary atherosclerosis has been demonstrated in just one study. In our study, we investigated the associations between endogenous sex hormone levels and the extent of coronary atherosclerosis, ejection fraction of the left ventricle and coronary heart disease risk factors.

This clinical study investigated the possible associations of male sex hormone with the extensiveness of coronary artery lesions, coronary heart disease risk factors and ejection fraction of the heart. Ninety six Caucasian male subjects were recruited, 76 with positive and 20 with negative coronary angiograms. Early morning, prior to haemodynamic examination all of them had determined levels of total testosterone, free testosterone, free androgen index (FAI), sex hormone-binding globulin (SHBG), oestradiol, luteinizing hormone, follicle-stimulating hormone, plasma lipids, fibrinogen and glucose. The ejection fraction and the extensiveness of coronary lesions of each subject was assessed on the basis of x-ray examination results using Quantitative Coronary Angiography (QCA) and Left Ventricular Analysis (LVA) packages on the TCS Acquisition workstation, Medcon. Men with proven coronary heart disease had significantly lower levels of total testosterone (11.9 vs 21.2 nmol/l), free testosterone (45.53 vs 86.10 pmol/l), free androgen index (36.7 vs 47.3 IU) and oestradiol (109.4 vs 146.4 pmol/l). The level of testosterone was negatively associated with the DUKE Index. The most essential negative correlation was observed between SHBG and atherogenic lipid profile (low high-density lipoprotein, high triglycerides). Ejection fraction was substantially lower in patients (51.85 vs 61.30) (without prior myocardial infarction) with low levels of free-testosterone (23.85 vs. 86.10 pmol/l) and FAI (28.4 vs 47.3 IU). A negative correlation was observed between total testosterone, free testosterone, FAI and blood pressure, especially with diastolic pressure. Men with proven coronary atherosclerosis had lower levels of endogenous androgens than the healthy controls. For the first time in clinical settings it has been demonstrated that low levels of free-testosterone was characteristic for patients with low ejection fraction. Numerous hypothesies for this action can be proposed but all require a proper evaluation process. The main determinant of atherogenic plasma lipid was low levels of SHBG suggesting its main role in developing atheroscerotic lesions.

Unlabelled: BACKGROUND. The aim of this study was to evaluate the efficacy of three-dimensional (3D) sonography in liver biopsies. Primarily, the diagnosis of hepatic tumors is based on 2D sonography. This method allows the noninvasive evaluation of the anatomical structure and tumor localization. Interpretation difficulties emerge most often during the assessment of tumor boundaries and their relationships to the blood vessels., Methods: The study included 19 patients, aged 40-75 years (average, 57.5 years) admitted to the Department of General Surgery due to diagnosed liver tumors., Results: The livers of all the examined patients displayed focal changes. In order to obtain material for histopathologic examinations, percutaneous needle biopsies were performed, with no complications., Conclusions: 3D sonography generated more information about hepatic changes, due to imaging of multiplanar reconstructions in oblique presentations (which are impossible to present in classical 2D), and thus facilitated design of the biopsy. Evaluation of the biopsy needle visualization inside the tumor with the use of both the 2D and the 3D presentations depends on the subjective approach of the examiner. Based on our knowledge and experience in ultrasonography-guided needle biopsy, we believe 3D sonography-guided biopsy has high efficacy.

Background/aims: At present a pancreatic pseudocyst puncture guided by ultrasonography is a treatment of choice in the majority of hospitals. A classical two-dimensional sonography is usually implemented in these cases. However, its shortcomings, mainly in differential diagnosis, are acknowledged by most physicians. The real time monitoring of a fine-needle pseudocyst procedure by two-dimensional ultrasonography is of questionable reliability. In our study we evaluated the usefulness of three-dimensional sonography in the percutaneous fine-needle pancreatic pseudocyst puncture., Methodology: We examined fifty-two patients diagnosed as having pancreatic pseudocysts on the basis of clinical symptoms and two-dimensional ultrasonography findings. Then the decision to qualify certain patients for the percutaneous fine-needle aspiration guided by ultrasonography was made on the basis of two- and three-dimensional scan results. The next step in our investigation was to implement color Doppler in order to visualize all blood vessels at the planned biopsy site. Three-dimensional sonography was used to monitor the tip of the needle making its way to the pancreatic pseudocyst and later inside the fluid collection., Results: Pancreatic pseudocysts were diagnosed in all of the 52 cases. Three-dimensional sonography was more precise in visualizing the shape and size than two-dimensional ultrasound scans., Conclusions: Three-dimensional presentation can better visualize irregular shapes, local thickenings, and calcification of pseudocyst walls than classical two-dimensional ultrasound scans. The use of subtraction in three-dimensional scans of blood vessels increases the safety in performing biopsies. It makes the aspiration of cytologic materials much safer to perform. In our study we have shown that three-dimensional sonography collects extremely useful information about the status of the pseudocyst structure and it should become a complementary method to classical ultrasonography. This technique when used on a routine basis ought to help us change the inclusion criteria for guided biopsies.

The use of the Garamycin sponge in the treatment of infected pseudoarthrosis of the tibia has been presented. The study included 6 male patients aged from 27 to 56 years; the sponge filled the defect after resection of the pseudoarthrosis. The method seems to be the one of choice to support adequate surgical intervention grossly contributing to the final positive result.

The aim of the study was presentation of our experiences in the diagnostics and treatment of pancreatic carcinoma in confrontation with current opinions. Between 1983 and April 1998 308 patients (198 males and 110 females with mean age 61 years) were treated at our department. In 211 cases tumor was primarily localized in the head and in 97 cases (31.5%) in the body or tail of pancreas. The diagnosis was determined on the basis of clinical symptoms and laboratory investigations. Diagnostic accuracy of performed investigations was as following. Ultrasonography-86%, CT-scan-95%, and ERCP-94%. Ultrasonography or CT guided biopsy and serodiagnostics improved detectability of resectionable carcinoma in the last past years. Among 308 patients, 292 underwent surgery. Since 1997 an intraoperative ultrasonography and cholangioscopy of common bile duct and Virsung were performed as a routine. The procedures depended on the localization and the grade of advance of the tumors. UICC classification of pancreatic tumors, pTNM (4th edition 1987) it was used. Only in 25 patients (8%) (tumors pT1a-bN0M0) it was possible to perform radical operation (resection of the pancreas). However in 172 patients (56%) only palliative procedures were done (pT2N1M0). In 95 patients (31%) only laparotomy and biopsy were performed (tumors pT2N1M1). The study shows that although diagnostic methods are improved, the tumors of the pancreas are diagnosed in stages making unable the radical procedures. Only about 10% of carcinomas are resectable. It is caused by with non-characteristic picture of the disease in its early stage.

Background/aims: Fine-needle biopsy (FNB) is one of the diagnostic methods for the diagnosis of focal lesions in the liver. The method is relatively fast, inexpensive and safe. Complications after FNB are observed in only a few cases. Color Doppler sonography (CDS) is one way of minimizing the number of FNB complications. The aim of the present study is to evaluate CDS in the monitoring of FNB in the diagnosis of focal lesions in the liver., Methodology: The patient group consisted of 73 patients: 28 male and 45 female with a mean age of 53.5 years. Initially, all patients were examined using traditional B-mode gray-scale sonography. After visualization of focal lesions in the liver their echostructure and position were analyzed. Color Doppler sonography was the introduced for the visualization of vascularization of the liver. FNB was performed under the guidance of CDS. The cytological specimens obtained were microscopically evaluated., Results: Of the 73 patients, 18 cases were diagnosed with liver abscess, 19 with cysts of the liver, and 36 with malignant tumors. Amongst the patients with malignancy tumors, the tumors were unifocal in 15 cases, and multifocal in 221. Histopathologically, there were primary hepatocellular carcinomas in 22 patients and metastatic tumors in 14 patients. During the first 48 hours after FNB no complications such as subcapsular hematoma or intraperitoneal bleeding were observed., Conclusions: Introducing CDS for ultrasound guided percutaneous FNB of the liver avoids such complications as bleeding, especially in patients with a high risk of hemorrhage.

Therapeutic results obtained in the management of severe acute pancreatitis (AP) complications are still unsatisfactory, and mortality rate is about 40%. An improvement in treatment effectiveness can be related to successful control of infections and prevention of uncontrollable sepsis. The aim of the study was evaluation of effectiveness of Tienam in the management of severe acute pancreatitis complications. The clinical material included 24 patients, treated for AP between 1994 and 1996. All of the patients were operated on and 19 of them required at least one reoperation. During primary surgery we performed necrosectomy and continuous peritoneal lavage. The analysis of cultures obtained from infected necrotic tissue, pancreatic abscesses and whole blood showed that the infections were caused mainly by Gram-negative bacteria. The highest efficiency in infections control was observed in the case of Tienam (15% resistant strains). The authors emphasize also the increasing role of Staphylococcus aureus and Candida albicans in secondary infections.

The paper presents own experience in surgical treatment of nodular goitre with mass exceeding 1000 g. In the analysed material of 1180 strumectomies, three such cases were found. Preparation for surgery included administration of Lugol solution, and possibly anxiolytics. The operation of removal of giant nodular goitre caused no significant technical difficulties. The postoperative course was uncomplicated, and cosmetic effect in remote examination was satisfactory.

The production of tumor necrosis factor (TNF-alpha), and interleukin 1 beta (IL-1 beta), IL-6, sTNFR-p55, sTNFR-p75 and their pharmacomodulation were evaluated in a model of septic shock induced in CD-1 mice by cecal ligation and puncture (CLP). This model of sepsis, which resembles the clinical situation of bowel perforation and peritonitis with subsequent septic shock was compared with that induced by administration of pure endotoxin (LPS). TNF-alpha was detectable in serum, liver, spleen and lungs during the first 4 h, with a peak 2 h after CLP. IL-1 beta was measurable in serum after 24 h, and levels increased significantly in spleen and liver 4 and 8 h after CLP. IL-6 levels increased significantly in serum throughout the first 16 h after CLP. sTNFR-p55 and p75 increased in both models of shock but with different kinetics. Cytokines were also detectable after LPS injection, with kinetics similar to those after CLP but a significantly higher level. Pretreatment with dexamethasone (DEX) and ibuprofen (IBU), significantly reduced survival, while TNF did not affect it. Only pentoxifylline (PTX) significantly increased survival in mice with CLP. However DEX protected the mice from LPS mortality. In conclusion, by inhibiting TNF-alpha with DEX and PTX survival was reduced or unchanged respectively, suggesting that the modulation of this cytokine does not play significant role in sepsis and septic shock induced by CLP, unlike treatment with LPS. The negative effects of IBU suggests a protective role by prostaglandins in sepsis induced by LPS.

Determinations of collagen in specimens of duodenal mucosa taken from 15 patients operated on because of duodenal ulcer with pyloric stenosis were performed. In the ulcer and surrounding tissue, total collagen values were significantly increased when compared with the results in unchanged wall of the duodenum. Collagen polymorphism study showed considerably higher percentage of type I and decreased type III in the ulceration than in control duodenal mucosa. In conclusion, extracellular components of connective tissue may play a role in the formation and course of duodenal ulcer disease.

The aim of the study was the comparative analysis of the degree of intensity of male and female hyperthyroidism treated surgically in the years 1990 to 1996. In this period 295 females and 42 males underwent operation for hyperthyroid goitre. Female predominance was noted in hyperthyroidism (ratio 7:1), in Graves' disease (7.4:1) and in toxic nodular goitre (6.3:1). The clinical findings in pre- and postoperative patients, including laboratory, visual diagnosis, and intra- and postoperative complications were evaluated. In the preoperative period, the incidence of the thyreocardiac syndrome was greater in the male. Male hyperthyroidic goitres were more frequently located retrosternally and caused trachea compression. No significant sexual differences were found in routine laboratory tests. Operations for hyperthyroidic male goitres usually caused more intraoperative problems and were connected with greater blood loss. Estimation of cardio-vascular parameters in the early postoperative period showed higher intensification of hyperkinetic circulation and higher mean body temperature in men. Signs of psychosis developed postoperatively in two men. The analysis of patients with hyperthyroidic goitre treated surgically revealed more severe course of male thyreotoxicosis in the perioperative period.

Ultrasound vascular imaging with subtraction is considered as very useful method to evaluation vascularity of tumor and its relationships to great vessels. Lung tumor was evaluated with power color Doppler ultrasound with and without B-mode scanning. Power color Doppler imaging without B-mode scanning is better depicted tumor internal vascular architecture and its relationships to great vessels then with B-mode. This method makes differentiation of tumor character possibly and interventional procedures more safely.

Between 1992 and 1997, every year, approximately 30,000 examinations of the liver and bile ducts were done. Addition of colour Doppler imaging improves safety of procedures and allowed to perform ultrasound guided biopsy in 73 patients. On the basis of our experience we state that colour Doppler sonography guided percutaneous fine needle biopsy of the liver is useful, sufficient and safety diagnostic method of abscesses, cysts and malignant tumours of the liver.

Between 1986 and 1995, 1800 ultrasound examinations of the chest were done. Addition of colour Doppler imaging improves safety of procedures and allowed to perform ultrasound guided biopsy in 47 patients. On the basis of our experience we state that colour Doppler sonography guided needle aspiration biopsy is useful, sufficient and safety diagnostic method of malignant lung masses, especially peripheral and wall-chest located.

The aim of study was presentation of our experiences in diagnosis and treatment in pancreatic carcinoma in confrontation with current opinions. Between 1984-1995 at our Department was treated 211 patients with carcinoma of exocrine part of the pancreas. It were 137 male and 74 female with mean age 58.9 years. In 151 cases (70.5%) primary seat of tumour was located in the head and in 60 cases (29.5.1%) in the body or tail of pancreas. The diagnosis was determined on the basis of clinical symptoms and laboratory investigation Diagnostic accuracy of X-ray investigations was as follow: Ultrasonography-86%, CT-scan-91%, ERCP-94%. Ultrasonography or CT guided biopsy and serodiagnosis improved detectability of resectionable carcinomas in the last past years. Among 211 patients, 199 underwent surgery. The procedures depended on the localisation and grade of advance of the tumours. UICC classification of pancreatic tumours, pTNM (4th edition 1987) was used. Only in 21 patients (9.9%) (tumours pT1a-b N0M0) was possible to perform radical operation (resection of the pancreas). However in 107 patients (50.7%) were done only paliative procedures (pT2N1M0). In 83 patients (39.3%) only laparotomy and biopsy were performed (tumours pT2N1M1). The study shows that although improvement of the diagnostic methods tumors of the pancreas are diagnosed in stages making unable the radical procedures and only about 10% of carcinomas are resectable. It is relevant with non-characteristic picture of the diseases in its early stages.

On the basis of 162 cases of chronic advanced pancreatitis seen at our Department during the last 15 years the diagnosis, indications and surgical procedures are described in this paper. Quantitative and qualitative changes of pancreatic collagen in chronic inflammation were also analysed. Results of these investigations were compared with histological and ultrastructural pictures of pancreatic tissue. Amongst 162 patients, 142 (88%) were operated upon. 71 underwent pancreatectomy or pancreatoduodenectomy, 14 anastomotic procedures and rest of them various operation of the bile ducts. Overall, 18 (13%) patients experienced significant complications after resectional procedures and 6 (4%) died as well after anastomotic procedures.

A unusual pattern of hepatic fatty infiltration was detected sonographically in 43 patients over a 2-year period. At appropriate gain settings and time gain compensations, the liver parenchyma demonstrated diffuse increased echogenicity except for a solitary hypoechoic area with relatively distinct margins, usually locate in the medial segment of the left hepatic lobe or right lobe in pericholecystic, perivascular or subcapsular locations. This hypoechoic focus varied in size between 15 and 50 mm and was typically ovoid, but was occasionally spherical or irregular in shape. Fourteen patients with such skip area underwent percutaneous needle biopsy because of concern that there was a space-occupying mass. Microscopic examination of specimens from the hypoechoic region revealed normal hepatic parenchymal cells, while tissue samples from the surrounding liver had high fat levels. In the remaining 29 patients, correlative radiologic studies supported the diagnosis of fatty liver and excluded a central-mass lesion. A localized area of normal hepatic tissue should be considered among the possible hypoechoic periportal area demonstrated within a fatty liver.

The aim of this report is to present complex evaluation of the applied treatment with dopamine (DA) and hydrocortisone (H) in experimental endotoxic shock (ES). An evaluation is based on long-term experiences of the author's Clinic. The studies were performed in dogs. ES was evoked by intravenous E. coli endotoxin administration in a dose of 2 mg/kg. An appearance and progress of ES was evaluated by determination of many hemodynamic and biochemical parameters. In the treatment DA and H were used. Besides of mentioned above parameters also morphological, histochemical and ultrastructural investigations of the lung and liver were done. DA and H applied together were the most effective treatment in the course of ES. It could be a theoretical ground for combined ES treatment in people.

Megakaryocytes were evaluated in the blood of the caval vein of rats in the acute stage of hemorrhagic shock. The number and morphological types of MK were analysed. Millipore filters were used for the evaluation. MK were found to be a physiological element of the blood. An increase in the MK number leaving the bone marrow in rats with the acute stage of hemorrhagic shock was observed. A rise in the total MK number was accompanied by an increase in the percentage of mature and "naked nucleus" MK.

Besides being a potent renal vasoconstrictor, endothelin causes diuresis and natriuresis. At which site along the nephron and how endothelin alters water and sodium handling in the tubule remain to be clarified. It was found that endothelin (75 pmol) given as an i.v. infusion in vivo to rats caused diuresis and urinary sodium excretion to double but did not affect glomerular filtration rate and renal plasma flow. On raising the dose of endothelin to 150 pmol, a further increase in diuresis and natriuresis was found, whereas glomerular filtration rate fell 33% and renal plasma flow fell 36%; 300 pmol of endothelin reduced glomerular filtration rate by 73% and renal plasma flow by 77% but did not significantly affect diuresis and absolute sodium excretion. It did, however, increase fractional sodium excretion eightfold. Lithium clearance studies of changes in tubular handling of water and sodium indicated that infusion of 150 pmol of endothelin to rats caused a reduction in absolute (pre, 84.7 +/- 5.9; post, 47.9 +/- 6.1 microEq/min/100 g) and fractional (pre, 85.7 +/- 3.0; post, 64.7 +/- 6.4%) proximal reabsorption of sodium. Endothelin infusion (150 pmol) was not associated with any significant change in plasma atrial natriuretic peptide levels, which on average remained comparable to those in rats given the vehicle alone (49.7 +/- 8.4 versus 46.3 +/- 5.6 pg/mL). In the isolated perfused rat kidney preparation, exposure to 150 pmol of endothelin significantly increased fractional sodium excretion over preinjection values (pre, 2.2 +/- 0.2; post, 7.3 +/- 1.0%) despite a marked decrease in glomerular filtration rate and renal perfusate flow. Additional in vivo experiments showed that oral administration of the specific 5-lipoxygenase inhibitor L-651,392 to rats prevented the increase in urine flow rate (pre, 5.7 +/- 0.1; post, 6.6 +/- 0.8 microL/min), and in absolute (pre, 0.33 +/- 0.04; post, 0.37 +/- 0.05 microEq/min) and fractional (pre, 0.10 +/- 0.02; post, 0.11 +/- 0.03%) sodium excretion caused by bolus i.v. infusion of endothelin (150 pmol). Similarly, a specific leukotriene C4/D4 receptor antagonist, L-649,923, also prevented the diuretic and natriuretic effect of 150 pmol of endothelin i.v. infusion. These findings show that (1) endothelin has a diuretic and natriuretic effect that is independent of its action on renal hemodynamics; (2) this effect depends on a direct action on the proximal tubules; (3) atrial natriuretic peptide does not appear to be involved in this effect; and (4) the diuretic and natriuretic responses to endothelin are mediated by 5-lipoxygenase products.

An effect of hydrocortisone and dopamine on beta-glucuronidase activity in the lung tissue in experimental septic shock was analysed. The study involved 30 mongrel dogs. Septic shock was induced with i.v. E. coli endotoxin. Total and free activity of beta-glucuronidase was determined with Talalay et al. technique in pulmonary parenchyma homogenate, mitochondrial-lysosomal fraction and supernatant. It was found, that hydrocortisone and dopamine given together increase the stability of the pulmonary lysosomes indicating a value of such management of the septic shock in man.