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The authors describe the case of survival for the period of 10 years after brain metastasis surgery and removal of the left lung upper lobe due to adeno-squamous cells carcinoma. Surgery did not generate any complications. Within 8 years after the surgery the radiological examination showed infiltrations resembling changes typical for tuberculosis. Microbiological analysis showed a culture of Mycobacterium kansasi leading to diagnosis of mycobacteriosis. Hence the antituberculous treatment was extended to 12 months to be interrupted due to liver damage. Two years later the patient experienced incident of haemoptysis. Detailed examination and assessment of the respiratory tract condition revealed COPD without features of renewal of the neoplastic process or infection by Mycobacterium tuberculosis or mycobacterium other than tuberculosis. This case demonstrates that aggressive surgical approaches to lung cancer with solitary cerebral metastasis significantly improve patient survival and justifies its widespread use.

The stiff man syndrome is a rare CNS disease of a probably autoimmunologic etiology. The paper presents a case of a 45-year-old man hospitalized in our department of neurology because of trunk muscles rigidity and painful, paroxysmal, immobilizing muscle spasms with excessive sweating. On the neurological examination he presented with a restricted range of active movements of the trunk, increased muscle tone in the shoulder girdle, abdominal and paraspinal muscles, as well as lumbar hyperlordosis. The electromyographic needle examination revealed in all his trunk muscles an excess, continuous motor unit activity at rest, diminishing after benzodiazepine administration. This confirmed our initial diagnosis based on clinical symptoms and signs. No abnormalities were found in other examinations, including the cerebrospinal fluid analysis, CT of the brain, and the spinal cord MRI. The patient was treated with glucocorticoids and GABA-ergic drugs (vigabatrin, diazepam and baclofen) with good results, i.e. a considerable amelioration of his complaints. His motor ability has increased so much that he was fully self-dependent. No deterioration in his clinical status has been noted over three years since his discharge.

Unlabelled: Degenerative process in Parkinson's disease affects substantia nigra and other central structures of an extrapyramidal system but it can also affect central and peripheral autonomic centres. One of the most frequent late complications in levodopa therapy is a wearing off phenomenon. We present a patient treated for Parkinson's disease in whom during the period of levodopa wearing off we observed a paroxysmal abdominalgia apart from other features of a typical movement disorders like: increasing rigidity, gait disturbances and tremor. Abdominalgia consisted of stomach cramps, with variable localization in epi-, meso- and hypogastrium. Rectal tenesmus was also present. The patient was treated with analgesics, spasmolytics and carminative drugs with no effect. Abdominal pains regressed after an intake of the next levodopa dose. The patient presented with other features of a gastrointestinal tract autonomic system dysfunction like: chronic constipation, preterm satiety resulting in food intake reduction and a decrease in body weight. There was no organic lesions of the gastrointestinal system that could explain such disturbances. Pharmacologic treatment modification (more frequent levodopa dosage, additional dopamine agonist) resulted in some improvement., Conclusion: It is possible that the abdominal pains could be a clinical manifestation of a digestive tract dyskinesias, occurring during

Progressive supranuclear palsy (PSP) is one of the most frequent causes of an atypical parkinsonism. The cognitive disturbances in PSP gave rise to the term "subcortical dementia". Cognitive impairment is independent of depression, which is also common in PSP. There is no correlation between cognitive impairment and either disease duration or a level of physical disability. We present a clinical picture and difficulties in PSP diagnosis in three patients--63 to 74 years old, who were hospitalized in the Department of Neurology, Medical Academy in Bialystok. A neuropsychological evaluation revealed significant differences among those patients. The patients presented with: 1. depressive and dementive syndrome, 2. executive dysfunction, 3. slowed information processing with no signs of dementia. Our findings are similar with data presented in literature and confirm the observations that: 1. there is a difference in a degree of cognitive impairment in between the patients with PSP, 2. the most frequent cognitive disturbances in PSP patients are: slowness of thought process and executive dysfunction.

Between 1992-1997 185 patients were treated in our Department because of abdominal aortic aneurysm (AAA). The aim of the study was the evaluation of frequency of hospital mortality (30 days) in patients treated because of AAA. One hundred forty eight (80%) patients were operated on and 37 (20%) were treated classically. The surgical group of 148 patients were divided into three parts: group I: 106 patients with asymptomatic AAA, group II: 24 patients with symptomatic AAA and group III: 18 patients with ruptured AAA. Straight graft was performed in 118 patients (79.7%) with hospital mortality rate 8.5% and bifurcated graft implanted in 30 patients with mortality rate 26.7%. Analysis of our material allowed to find that hospital mortality was in group I: 2.8%, group II: 20.8% and in group III: 55.6%. The main cause of deaths in patients from groups I and II was myocardial infarction and hypovolemic shock in group III. The most common postoperative general complications were cardiac and pulmonary and were significantly more often in group III (p < .05). Other not significantly registered postoperative complications as renal insufficiency were also more common in patients from group III. Analysis of our material revealed that patients with abdominal aortic aneurysm should be operated selectively, when aneurysm diameter reaches 50 mm, and optimal method is straight graft which allows to reduce to minimum postoperative complications.

We analysed 148 patients treated surgically from 1992-1997 because of abdominal aortic aneurysm (AAA). All patients were divided into two groups: group I--118 (79.7%) patients operated with the implantation of the straight graft and group II--30(20.3%) with the bifurcated graft. The aim of the study was to analyse early (30 days after operation) complications in both groups. The mortality rate was 8.5% for group I and 26.7% for group II. The mortality was also analysed according to AAA symptoms (asymptomatic, symptomatic and ruptured). The death rate in asymptomatic patients from group I was 1.1% versus 13.3% in group II. In symptomatic patients the difference was not statistically significant--20% in group I versus 22.2% in group II. The mortality rate in patients with ruptured AAA was 50% for group I and 66.7% for group II. The early morbidity rate was significantly higher in the second group(p < 0.05) although coexisting diseases were similar for both groups. According to our material we conclude, that operation of AAA should be finished in abdomen if there is only technical possibility. It is especially important for patients with ruptured AAA.

We describe a 3 patients with Wegener's granulomatosis in remission while taking cyclophosphamide and prednisone who developed upper airway obstruction. The diagnosis was confirmed by parotid gland, pharynx, kidney biopsy. The stenosis developed in the area of previously noted tracheal ulceration and responded satisfactorily to bronchoscopic dilatation. Tracheotomy for progressive upper airway obstruction has remained the mainstay of treatment and was necessary in one of cases. We presented the others techniques of treatment subglottic stenosis-the surgical intervention and carbon dioxide laser photoresection. No antineutrophil cytoplasmic antibodies were found in the patients serum. These antibodies are of auxiliary value in recognizing Wegener's granulomatosis as well as in monitoring the activity of the disease process.

The purpose of an earlier publication [Appl. Opt. 34, 2120 (1995)], to provide an exact formulation of the scattering of beamlike radiation fields from spheres, is clarified and its relation to the treatment of this subject in two more recent publications is described. Also, an error in the reference list in the earlier publication is rectified.

In the Department of General and Thoracic Surgery between 1981 and 1992 497 patients with tracheal stenosis were treated surgically. In 19 (3.8%) cases the stenosis was after previous tracheostomy. In 469 patients (94.4%) the stenosis was caused as the result of compression by goitre and in 9 (1.8%) by neoplastic tumors of mediastinum. Most patients with tracheal stenosis were treated surgically. In 13 cases the stenosis was resected, in 3 cases T-tube was inserted and in 3 cases the stenosis was dilated. In patients with secondary stenosis due to compression by goitre subtotal thyroidectomy was performed. Early good immediate results in both groups of tracheal stenosis were obtained in 90% of cases. Late results obtained 12 months after treatment of primary tracheal stenosis and 4 to 48 months after treatment of secondary tracheal stenosis (due to goitre) revealed 90% of good results.