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This study was performed to investigate the relationship between left atrium (LA) volume index (LAVI) and left ventricle electrical activity presumably repolarization in end-stage renal disease patients. Study group was consisted of 120 dialyzed patients divided into two subgroups: 57 (age 50.7 ± 7.1) were on continuous ambulatory peritoneal dialysis (CAPD) and 73 (age 51.6 ± 7.6) were hemodialyzed (HD). All patients were undergoing three-dimensional vectorcardiographic (VCG) monitoring to assess parameters concerning T vector: QRS-T angle, Tel, and Taz. Standard echocardiography was performed to assess: LAmax, LAshort, LAlong. LAVI was calculated due to formula: LAVI = (π/6X [LAmax × LAshort × LAlong])/m2. LAVI in HD as well as in CAPD patients was significantly higher compared with controls (respectively: 36.29 ± 10.92; 36.41 ± 11.06; 20.64 ± 6.77 mL/m2). The calculated cutoff value of LAVI was 36.32 mL/m2. In HD patients, the strong correlations between LAVI and QRS-T angle and Tel were determined (respectively: r = 0.407, P0.001 and r = 0.359, P = 0.006). Similarly in CAPD group were significant associations between LAVI and QRS-T angle and Tel (respectively: r = 0.423, P0.001 and r = 0.374, P = 0.004). The QRS-T angle, Tel and Taz are independently and markedly associated with LAVI in both HD and CAPD patients. LAVI and VCG indices are higher in both HD and CAPD patients. Correlation between QRS-T angle and LAVI may reflect unfavorable influence on the electrical activity of the heart in dialyzed patients with left ventricle diastolic dysfunction. LAVI cutoff value is useful biomarker for stratification of ventricle repolarization disturbances in those patients.

Aim. Study was designed to assess relationship between aortic compliance and homogeneity of heart electrical activity in dialysis patients. Methods. Study group was consisted of 120 dialyzed patients; 57 (age 5 0 , 7 ± 7 , 1 ) were on continuous ambulatory peritoneal dialysis (CAPD) and 73 (age 5 1 , 6 ± 7 , 6 ) were hemodialyzed (HD). Three-dimensional vectorocardiographic (VCG) monitoring was done to assess: QRS- 𝑇 a n g l e , 𝑇 e l and 𝑇 a z . Echocardiography was performed to assess: A o m a x , A o m i n , ASI (aortic siffness index). Results. ASI in HD as well as in CAPD patients was significantly higher compared to controls [resp., 5,51 (±1,32), 5,83 (±1,41), 3,07 (±1,09)]. Cut-off value of ASI was 5,67. In HD patients strong correlations between ASI and QRS- 𝑇 a n g l e , 𝑇 e l and 𝑇 a z were determined (resp., 𝑟 = 0 , 4 2 9 , 𝑃 < 0 , 0 0 1 ; 𝑟 = 0 , 4 3 2 , 𝑃 ≤ 0 , 0 0 1 and 𝑟 = 0 , 3 8 7 , 𝑃 = 0 , 0 0 1 ). In CAPD group were significant association between ASI and QRS- 𝑇 a n g l e , 𝑇 e l and 𝑇 a z (resp., 𝑟 = 0 , 4 5 2 , 𝑃 < 0 , 0 0 1 ; 𝑟 = 0 , 4 1 7 , 𝑃 < 0 , 0 0 1 and 𝑟 = 0 , 3 9 0 , 𝑃 = 0 , 0 0 1 ). ASI was independently and markedly associated with: QRS- 𝑇 a n g l e , 𝑇 e l e v , 𝑇 a z , ADMA, cTnT, CRP, Total-chol, LDL-chol in HD and CAPD patients. Conclusions. ASI and VCG indices are higher in HD and CAPD patients. Correlation between ASI and VCG parameters may reflect unfavourable influence of poor aortic compliance on the electrical activity of the heart in dialyzed patients. Hypertrophy aggravates repolarization disturbances in hemodialyzed patients.

Ventilator-associated pneumonia (VAP) occurs in approximately 10-20% of mechanically ventilated patients, and is associated with an extremely high mortality rate (up to 70%). The purpose of the study was to determine the susceptibility spectrum of Klebsiella, Pseudomonas and Acinetobacter strains isolated from VAP patients.We analysed 81 strains of microorganisms isolated from bronchoalveolar lavages (BAL) of VAP patients. The minimal inhibitory concentrations (MIC) of antibiotics recommended for empirical therapy were determined using an automated VITEK 2 system, and for the MIC of doripenem - the Etest assay. Results were analysed following the guidelines of the Clinical and Laboratory Standards Institute.For infections caused by the group of bacteria under investigation, the most successful regimen was monotherapy with carbapenems (doripenem, meropenem and imipenem). Cephalosporins (cefepim and ceftazidim) were less effective in vitro. The worst results were obtained with the combination of piperacillin/tazobactam with aminoglycosides (amikacin or gentamicin) or fluoroquinolones (ciprofloxacin).Antibiotic monotherapy proved to be more effective in VAP patients than combined therapy; the best results were achieved with carbapenems. Doripenem showed strong activity in vitro against P. aeruginosa and Klebsiella sp. and should be considered for empirical VAP therapy; however, carbapenems may be less effective against Acinetobacter baumannii. The wide range of bacteria, and their broad range of susceptibility to antibiotics, suggests the need for modification of current recommendations.

Background The transmission of cancerous cells with a transplanted organ is among the most serious complications of transplant surgery. Detailed preoperative tests seek to reduce the risk of transmission of viral and bacterial infections as well as to prevent donor-derived malignancy following organ transplantation. The objective of this study was to report our experience among cadaveric donors who we suspected of cancer. Materials and methods We performed a retrospective search of the medical records of 75 potential cadaveric donors referred to our unit between January 2007 and December 2010. Our focus, however, was on donors suspected of cancer. Results Among 75 potential cadaveric donors 22 (29%) revealed features suggestive of cancer: physical signs of tumor pre- or intraoperatively: elevation of serum levels of a cancer marker; or an abnormal finding on radiological imaging. Among the latter group, 15 donors necessitated urgent histopathologic examination to rule out or confirm cancer. In four cases, organ transplantation was abandoned following the examination, including three cases in which a tissue diagnosis of cancer was evident and in one case, the examination was inconclusive to exclude cancer. In the remaining 14 cases, the histopathologic examination did not reveal cancer; thus transplantation was performed. Conclusions Thorough histopathologic examination is essential in all potential donors who are suspected of cancer to prevent donor-derived malignancy following transplantation. In some cases, however, the tissue sampling is not conclusive; hence, transplantation must be abandoned. Even the most precise examination of the donor does not protect the recipient from the risk of transmission of cancer.

Total parenteral nutrition (TPN) is essential for patients with postoperative impairing gastrointestinal function who are unable to receive and absorb oral/enteral feeding for at least 7 days. Oxidative stress plays a major role in the ethiopathogenesis of cancers. In this study, total antioxidant status (TAS), glutathione peroxidase (GPx), superoxide dismutase, malondialdehyde and ascorbic acid were studied in patients operated because of small intestine, colorectal or pancreatic cancer and subsequently receiving TPN in comparison with patients receiving standard nutrition after the operation. TAS level and GPx activity were decreased in patients with small intestine cancer but did not differ in patients with colorectal and pancreatic cancer before and after surgery. In all patient groups receiving TPN, superoxide dismutase activity after the surgery was kept at the same level as before. On the fifth day after the surgery, malondialdehyde concentration in each group was restored to the value observed before surgery. On the fifth day of TPN treatment, ascorbic acid concentration was increased in every group of patients. TPN applied during the postoperative period alleviates oxidative stress resulting from surgery. In the case of small intestine cancer, the addition of vitamins and antioxidants to the nutrition mixture seems to result in depletion of antioxidant enzymes' activities.

TA90 is a glycoprotein, occurring on the cell surface of many types of cancer. Determination of its concentration in human serum appears to be a good screening test in the direction of many cancers, and also can act as a monitoring index of disease, particularly in respect of melanoma. Further clinical studies are necessary in order to obtain accurate data on the TA90, and after that its determination might be made to everyday clinical practice in oncology.

The neuroendocrine tumors (NET) of the colon are rare with a rising incidence due to an increased number of diagnostic examination including screening colonoscopy. According to distinct prognosis and treatment these tumors are classified as colonic or rectal NET. This paper provides the consensus guidelines for management of patients with these neoplasms recommended by the Polish Neuroendocrine Tumor Network Group. Furthermore the epidemiology and clinical presentation are described.

The aim of the study was the analysis of early surgical complications after strumectomy.The study involved 578 patients operated on in I Clinic of General Surgery and Transplant at the Medical Academy in Lublin in the years 1999-2002. The largest group of the operated patients was the one with a non-toxic (neutral) goitre (60.1%). Most of the patients in this group had multinodular neutral goitre. The amount of the surgically treated patients because of the hyperactive goitre prevailed in this group.Early postoperative complications were observe d in 35 cases, which comprise 6.05% of the operated patients. On the basis of the obtained results, we stated that there are evident differences in the frequency of occurrence of early complications depending on the type of the goitre. We concluded that statistically they were more frequent in patients operated on because of Graves-Basedov disease as well as in patients with Hashimoto goitre (chi2 test p0.001). The amount of the strumectomy operations conducted annually by a surgeon did not have direct influence on the occurrence of the early complications.Early postoperative complications after strumectomy are more frequent in patients operated on because of diseases of autoimmunological basis. Operations of the thyroid gland and trainings in the surgery of the thyroid gland should take place in centers where large amount of such operations are conducted.

The study presents a case of ovarian cancer recurrence in extraperitoneal localization observed after twenty nine years of radical surgery and radiotherapy. New focus of ovarian cancer has been placed near right oval ligament of uterus. Long-term survival and ovarian cancer recurrence in extra-abdominal place may be taken as a confirmation an opinion about a role of multifocal neoplasia of mesothelium in pathogenesis and recurrence of ovarian cancer.

Gastrointestinal problems are an infrequent but serious consequence of cardiac surgery that includes cardiopulmonary bypass. Predictors of these complications are not well developed, and the role of fundamental variables remains controversial. Between July 1998 and August 2002, 1,552 patients (1,106 male and 446 female), mean age 56 years, underwent heart surgery with cardiopulmonary bypass. Among those 1,552 patients, 21 (1.35%) had gastrointestinal complications, mainly because of gastrointestinal bleeding due to gastritis and five of them required surgery. We present these five patients, three with intestinal ischemia, two with intestinal bleeding. There Hoffmeister-Finsterer operation, Rydygier resection, hemicolectomy, appendectomy with cecum sewing and sigmoid resection were performed. The mortality in this group was 60% (three of five), and the cause of death was multiorgan insufficiency.Careful monitoring and physical examination of these high-risk patients following cardiac surgery is required for early detection and effective treatment.

Liver metastases develop in 30-50 per cent of patients with colorectal cancer. Without treatment, the median survival is approximately 7 months. Recent results from multiple investigations indicate that several minimally invasive treatment techniques are very effective for treating primary and secondary malignant hepatic tumors and they may replace surgical resection in the near future. Thermal ablation techniques for the treatment of primary and secondary malignant hepatic tumors include both freezing (cryoablation) and heating (microwave, laser, and high-intensity focused ultrasound) are characterized in this article.

A number of alternative therapies have been used for the treatment of malignant hepatic tumors. Radiofrequency ablation (RFA) is an evolving technology being used to treat patients with unresectable primary and metastatic hepatic cancers. RFA produces coagulative necrosis of the tumor through local tissue heating. Liver tumors can be treated percutaneously, laparoscopically, or during laparotomy, using ultrasonography to identify tumors and to guide placement of the RFA needle electrode. In general, RFA is a safe, well-tolerated, effective treatment for unresectable hepatic malignancies less than 6.0 cm in diameter.

Hepatocellular carcinoma (HCC) and metastases from colorectal carcinoma are two most common malignant tumors affecting liver. Of all patients presenting with a malignant hepatic tumor, few are surgical candidates. Contraindications to hepatic resection include too many tumors, tumors in unresectable locations, insufficient hepatic reserve to tolerate resection, and other medical conditions that make the patient a poor surgical risk. A number of alternative therapies have been used for the treatment of malignant hepatic tumors. These include chemoembolization, ethanol injection therapy, and thermal ablation techniques. In this article are described chemoembolization and ethanol injection therapy.

The aim of our study was to investigate the frequency of the CFTR gene mutation in a selected group of patients suffering from severe acute pancreatitis.DNA isolated from peripheral blood samples from forty-one subjects was analyzed for the eight most common CFTR gene mutations (deltaF508, G542X, G551D, R553X, 1717-1(GA), W1282X, N1303K, deltaI507) by the reverse-hybridization technique, using INNO-LIPA CF2 test strips. The level of chloride ions in sweat samples was established using the pilocarpine iontophoresis method.In the study group, none of the patients harbored CFTR gene mutations. In these selected cases, the experiments were repeated twice to ensure the reliability of the results. All of the subjects had a normal level of chloride ions (range 8-38 mmol/l). Comparison with historical carriers revealed no differences between the frequency of carriers of the CFTR gene mutations in the general Polish population (4%) in comparison with the surgical patients with acute pancreatitis (p=0.26; Fisher exact test).We found no patients with severe acute pancreatitis who had CFTR gene mutations, suggesting that these alterations are not a risk factor for the disease in our population. Further studies are warranted to evaluate the frequency and role of rare ('mild') CFTR gene point mutations in subjects suffering from severe acute pancreatitis.

Introduction The development of colorectal cancer is a multistage process associated with multiple somatic mutations and abnormalities in cell proliferation. One of possible factors related to these disorders is the oxidative stress associated with increased production and levels of reactive oxygen species and / or activity inhibition of antioxidant barrier in cancer cells. The aim of this study was to examine selected parameters of antioxidant barrier in colorectal cancer. The activity of superoxide dismutase, glutathione peroxidase and malondialdehyde, which is the product of lipid peroxidation was determined. Methods Enzyme activity was studied in normal and tumor tissues taken from patients with colorectal cancer. The study group included 72 patients: 13 with a cancerous tumor located in the right half of the colon, 16 with the left half of colon tumor, 18 of the sigmoid colon cancer and 25 with rectal cancer. Samples of tumor tissue and healthy mucosa were collected from each patient. Enzyme activity was determined according to the location of the tumor, clinical stage (S) and histopathological grading (G). The testing ready-to-use kits were used for the determination of Oxis Research International, Inc. The activity of superoxide dismutase (SOD), glutathione peroxidase (GSH) and malondialdehyde (MDA) was determined. Results A statistically significant increase of activity of superoxide dismutase (SOD), glutathione peroxidase (GSH) and malondialdehyde (MDA) was found in tumor tissue compared with normal tissue. There were no significant differences in the activity of the enzymes depending on the location of the cancerous tumor, clinical stage of cancer or histopathological grading (G). Conclusion 1. Increased antioxidant potential in colorectal cancer may be associated with increased levels of reactive oxygen species and an increase in generation of lipid peroxidation products. 2. Clinical stage and histopathological grading of the tumor does not alter the activity of antioxidant enzymes. 3. The activity of antioxidant enzymes does not change depending on the location of the cancerous tumor.

Background Atherosclerosis is regarded as a combination of two major separate diseases: atherosis and sclerosis. Sclerotic component depends on deterioration of elastic properties of the aortic wall and is called aortic stiffness. The most valuable, non-invasive method of aortic stiffness assessment is echocardiography, which allows to calculate the aortic stiffness index (ASI). ASI is an independent predictor of all-cause and cardiovascular mortality in different groups of patients. The main aim of study was the assessment of the aortic reverse remodeling in patients with end-stage renal disease (ESRD) after renal transplantation (RT). Methods Study group involved 42 patients aged 43.3 ± 12.6 years, including 19 women aged 49.9 ± 10.9 years and 23 men aged 41.5 ± 12.91 years, who have undergone RT from non-related renal transplant donors, The study protocol has been consisted of 5 stages: 1 week after RT, 3 months after RT, 6 months after RT, 1 year after RT and 3 years after RT. The echocardiographic examination was performed and measurements of Aomax, Aomin were done. On the base of obtained parameters ASI, aortic distensibility (AD) and aortic strain (AS) were calculated according to adequate formulas. Results The improvement of indices characterizing the elastic properties of aorta were noted. These changes attained the statistically significant level only at the end of the observation. ASI just after RT was equal – 4.65 ± 1.58, three months after RT – 4.54 ± 1.49, six months after RT – 4.59 ± 1.61, one year after RT – 4.35 ± 1.21 and three years after RT – 3.35 ± 1.29, while AD reached respectively – 6.55 ± 3.76 cm2/dyn−110−6 just after RT, − 6.38 ± 3.42 cm2/dyn−110−6 three months after RT, − 6.53 ± 3.60 cm2/dyn−110−6 six months after RT, − 6.48 ± 2.79 cm2/dyn−110−6 one year after RT and – 8.03 ± 3.95 cm2/dyn−110−6 three years after RT. Noted AS values were equal – 6.61 ± 4.05%, just after RT, − 6.40 ± 3.58% three months after RT, − 6.56 ± 3.76%, six months after RT, − 6.45 ± 2.80% one year after RT, − 8.01 ± 3.97%. and three years after RT. The exact analysis of parameters concerning aortic function showed that to achieve ASI, AD and AS improvement, long time was needed, because the most significant changes of these indices were observed only between 1 year and 3 years after RT. Conclusions There is a relationship between renal transplantation and improvement of the aortic elastic properties. The recovery of the renal function allows to initiate the reparative processes leading to at least partial restitution of the structure and features of the aorta, which is called reverse remodelling. Improvement of aortic wall elastic properties after renal transplantation is a continuous and prolonged process.

Colorectal cancer (CRC) is one of the most common malignant tumors in developed countries. Oxidative stress can cause damage to colonocytes by inducing cell cytokine synthesis and triggering the process of carcinogenesis.The aim of the study was to analyze relationships between: 1] total antioxidant status (TAS) value in CRC tissue and healthy colon tissue; 2] superoxide dismutase (SOD) activity in CRC tissue and healthy colon tissue; 3] TAS value in CRC tissue and the stage of colorectal cancer; and 4] SOD activity in CRC tissue and the stage of colorectal cancer.Adult patients undergoing colonic surgery for CRC were studied. The patients were divided into four groups according to the TNM Classification of Malignant Tumors. Spectrophotometric methods were used to measure TAS values and SOD activity, using diagnostic kits produced by Randox Laboratories.The mean TAS value in CRC tissue was 0.0073 ± 0.0038 mmol/g of tissue, which was not significantly different from the mean value in healthy tissue (0.0067 ± 0.0035 mmol/g of tissue). SOD activity was 170 ± 32 U/g of tissue and was significantly higher in CRC than in healthy tissue (107 ± 25 U/g of tissue). In stages I, II and III of CRC, SOD activity as well as TAS value were increased in tumor tissue as compared to healthy tissue. Both SOD activity and TAS value markedly decreased in stage IV in contrast to the other stages of the disease.The study results suggest that TAS and SOD monitoring could be valuable during the treatment of CRC.