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Background: The coronavirus disease 19 (COVID-19) recently became one of the leading causes of death worldwide, similar to cardiovascular disease (CVD). Coexisting CVD may influence the prognosis of patients with COVID-19. Aims: We analyzed the impact of CVD and the use of cardiovascular drugs on the in-hospital course and mortality of patients with COVID-19. Methods: We retrospectively studied data for consecutive patients admitted to our hospital, with COVID-19 between March 6th and October 15th, 2020. Results: 1729 patients (median interquartile range age 63 [50–75] years; women 48.8%) were included. Overall, in-hospital mortality was 12.9%. The most prevalent CVD was arterial hypertension (56.1%), followed by hyperlipidemia (27.4%), diabetes mellitus (DM) (25.7%), coronary artery disease (16.8%), heart failure (HF) (10.3%), atrial fibrillation (13.5%), and stroke (8%). Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) were used in 25.0% of patients, β-blockers in 40.7%, statins in 15.6%, and antiplatelet therapy in 19.9%. Age over 65 years (odds ratio [OR], 6.4; 95% CI, 4.3–9.6), male sex (OR, 1.4; 95% CI, 1.1–2.0), pre-existing DM (OR, 1.5; 95% CI, 1.1–2.1), and HF (OR, 2.3; 95% CI, 1.5–3.5) were independent predictors of in-hospital death, whereas treatment with ACEIs/ARBs (OR, 0.4; 95% CI, 0.3–0.6), β-blockers (OR, 0.6; 95% CI, 0.4–0.9), statins (OR, 0.5; 95% CI, 0.3–0.8), or antiplatelet therapy (OR, 0.6; 95% CI: 0.4–0.9) was associated with lower risk of death. Conclusions: Among cardiovascular risk factors and diseases, HF and DM appeared to increase in-hospital COVID-19 mortality, whereas the use of cardiovascular drugs was associated with lower mortality.

Introduction: Gastrointestinal fistula is one of the most difficult problems in gastrointestinal surgery. It is associated with high morbidity and mortality, numerous complications, prolonged hospitalization, and high cost of treatment. Aim: This project aimed to develop recommendations for the treatment of gastrointestinal fistulas, based on evidence-based medicine and best clinical practice to reduce treatment-related mortality and morbidity. Material and methods: The preparation of these recommendations is based on a review of the literature from the PubMed, Medline, and Cochrane Library databases from 1.01.2010 to 31.12.2020, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations in the form of a directive were formulated and assessed using the Delphi method. Results and conclusions: Nine recommendations were presented along with a discussion and comments of experts. Treatment should be managed by a multidisciplinary team (surgeon, anesthetist, clinical nutritionist/dietician, nurse, pharmacist, endoscopist).

IntroductionThe vacuum-assisted biopsy (VAB) and the Breast Lesion Excision System (BLES) are minimally invasive biopsy techniques, both used as diagnostic and therapeutic tools. The aim of the study is to compare these two methods and assess them in the context of discomfort, early and late complications and their diagnostic and therapeutic potential.Material and methodsThe study involved 173 patients who underwent a VAB or a BLES breast biopsy in the period between 2009 and 2016. Approximately 3 months after the biopsy, the patients completed a questionnaire in which they assessed the procedure for discomfort associated with the procedure and the final cosmetic outcome. The cosmetic effect of the biopsy was also assessed by a surgeon.ResultsThe BLES and the VAB breast biopsies did not differ in terms of pain, duration, and discomfort of the procedure, breast bruising, breast tenderness about 24 h after the procedure or pain lasting over 3 months after the biopsy. Subsequently, the biopsies were evaluated in terms of the cosmetic effect assessed by the patient and by a surgeon and no differences were observed. There were no significant differences between the VAB and the BLES breast biopsies in the course of the procedure, early and late complications and cosmetic effect.ConclusionsSince the BLES breast biopsy makes it possible to evaluate the margins, it is a good alternative to the open breast biopsy.

IntroductionIn order to select high-risk patients, many prognostic scales have been invented. Among them, Rockall, Glasgow-Blatchford and AIMS 65 scales were considered the most useful.Material and methodsPatients with upper GI tract bleeding, treated between 2017 and 2018 were retrospectively enrolled to the study. Every patient had a Rockall, Glasgow-Blatchford and AIMS 65 score calculated retrospectively. Data on hospitalization as blood transfusions, length of hospital stay, rebleeding, intensive care unit (ICU) admission, mortality was included into data-base.ResultsUnivariate logistic regression revealed that only the AIMS65 scale was a prognostic factor for in-hospital mortality (OR 11.028; 95% CI: [2.271, 53.563], p=0.001). The AIMS 65 score >2 was the only factor predicting the need of >4 blood units transfusion during hospitalization (OR 3.977; 95% CI: [1.305, 12.122], p=0.015), whereas Glasgow-Blatchford scale >5 was the only risk factor for the need of fresh frozen plasma transfusion (OR 3.657; 95% CI: [1.010-13.242], p=0.048). The area under a curve (AUC) in the ROC analysis revealed that the AIMS 65 scale was the most accurate in mortality prediction (AUC=0.859, p=0.002), whereas Rockall score and Glasgow-Blatchford were not significant (AUC=0.614, p=0.093 and AUC=0.504, p=0.97, respectively).ConclusionsBased on our results, we recommend using AIMS 65 scoring system. It’s simple and requires few of parameters to be counted. Also, it proved to be the most efficient in predicting in-hospital mortality.

COVID-19 vaccinations are about to begin in various countries or are already ongoing. This is an unprecedented operation that is also met with a loud response from anti-vaccine communities—currently using all available channels to manipulate public opinion. At the same time, the strategy to educate on vaccinations, explain their mechanism of action, and build trust in science is subdued in different world parts. Such actions should go much beyond campaigns promoting the COVID-19 vaccines solely on the information provided by the health institutions and national authorities. In this paper, actions provided by independent expert groups needed to counteract the anti-vaccine propaganda and provide scientific-based information to the general public are offered. These actions encompass organizing groups continuously communicating science on COVID-19 vaccines to the general public; tracking and tackling emerging and circulating fake news; and equipping celebrities and politicians with scientific information to ensure the quality of messages they communicate, as well as public letters, and statements of support for vaccination by healthcare workers, recognized scientists, VIPs, and scientific societies; and no tolerance to false and manipulated claims on vaccination spread via traditional and social media as well as by health professionals, scientists, and academics. These activities should be promptly implemented worldwide, regardless of the current status and availability of the COVID-19 vaccine in a particular region. If we are about to control the pandemic for the sake of public benefit, it is high time to collectively speak out as academic and medical societies with support from decision-makers. Otherwise, the battle will be lost to those who stand against scientific evidence while offering no feasible solution to the problem.

Cholecystolithiasis is one of the most frequent disorders of the human digestive system in a present population. It is common to point out that male gender is one of strong risk factors for complications during cholecystectomy, however the debate about that seems to be still open.The aim of this study was to compare the values related to the course and treatment effects between gender in patients undergoing cholecystectomy, based on own material.The study encompassed 504 patients who were admitted to General Surgery And Polytraumatic Injury Department of University Hospital in Kraków, Poland between 2013 and 2018, with the initial diagnosis of cholecystolithiasis (scheduled cases) and acute cholecystitis (emergency cases). The patients underwent surgical gallbladder removal. In this group there were 326 (64.7%) female and 178 (35.3%) male patients.Statistically significant differences between both genders were found containing age, type of admission, numeric rating scale of pain during admission, results in American Society of Anesthesiologists physical status classification system, outcomes in Acute Physiology And Chronic Health Evaluation II severity-of-disease classification system, percentage of conversions, mortality, period of time from admission to surgical procedure, mean duration of the procedure, blood tests and histopathological results.Subgroups of the cases where determining factor is gender are strongly heterogeneous. Although treatment results were different for both subgroups and these differences were partly statistically significant, it cannot be clearly determined on the basis of a study with such selection of patients, that gender is an independent risk factor for surgical gallbladder removal.

Detailed study of all the ammonite collections gathered by the authors in the Staffin Bay sections has resulted in minor changes in the distribution of ammonite taxa, and slight modification of the position of the Oxfordian/Kimmeridgian boundary. Most significant is the discovery of Pictonia (Triozites) cf. seminudata which results in the placing of the stage boundary 0.16 m below the level formerly proposed. This study discusses the evolution of the Subboreal family Aulacostephanidae, and the Boreal family Cardioceratidae, indicating changes in the patterns of individual development in the evolution of both families in terms of heterochrony. The Oxfordian/ Kimmeridgian boundary interval shows major morphological changes in both ammonite families which were released from phylogenetic constraints by heterochrony, closely related to changes in environmental conditions.

Introduction In 2012, a total of 56 647 inguinal hernia repairs were performed in Poland. However, the absence of a uniform hernia repair register obscures the current herniology status in Poland, especially regarding laparoendoscopic procedures. Aim To determine the awareness of laparoendoscopic procedures among Polish surgeons and to ascertain their everyday clinical practice. Material and methods The data were collected at the national hernia conference in 2016, during an interactive session for surgeons with a special interest in herniology. They could respond to the survey items using the VoxVote application. All items and response options were displayed on participants’ smartphones. The questions were related to transabdominal preperitoneal/totally extraperitoneal (TAPP/TEP) hernia repair. The surgeons responded to 27 questions regarding routine inguinal hernia repair. One hundred and six surgeons from all regions of Poland participated in the survey. Results 19.2% of respondents never inform patients about the possibility of performing laparoendoscopic repair. 45.2% admitted that they had referred a patient with a difficult inguinal hernia to another hospital or surgeon. Seventy-five percent stated they would be willing to perform TAPP/TEP if the reimbursement rates were more favourable. In bilateral hernias, 61.6% of the respondents perform a two-step open repair, while only 25% perform a single-stage laparoendoscopic repair of bilateral hernia. In women, only 13.3% perform laparoendoscopic hernia repairs, and 19.0% do not use mesh. Conclusions The skill level to perform TAPP/TEP repair is still inadequate among Polish surgeons. The absence of accurate data makes it impossible to verify whether the treatment methods used are compliant with the guidelines.

Background Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR) may serve as a simple index of the immune function. The aim of this study was to investigate the prognostic significance of NLR, PLR, and LMR in patients with resectable pancreatic ductal adenocarcinoma (PDAC) and to verify whether such biomarkers are associated with changes in populations of lymphoid cells. Methods The prognostic implications of blood count parameters were evaluated in a retrospective cohort of 442 subjects undergoing pancreatic resections for PDAC. Subpopulations of lymphocytes and monocytes in peripheral blood were identified by FACS in a prospective cohort of 54 patients. Results In the univariate analysis, NLR

This paper reviews the distribution of interstitial cells of Cajal (ICC) in the human gastro-intestinal (GI) tract, based on ultrastructural and immunohistochemical evidence. The distribution and morphology of ICC at each level of the normal GI tracts is addressed from the perspective of their functional significance. Alterations of ICC reported in as well as in GI stromal tumours are reviewed, with emphasis on the place of ICC in the pathophysiology of disease.

Background Laparoscopic surgery has become the standard treatment for colorectal cancer. A tumor that does not involve serosa is invisible intraoperatively, and manual palpation of the tumor during laparoscopy is not possible. Therefore, accurate localization of the neoplastic infiltrate remains one of the most important tasks prior to elective laparoscopic surgery. The aim of this study was to evaluate the utility of a magnetic endoscopic imaging (MEI) for precise preoperative endoscopic localization of neoplastic infiltrate within the large bowel. Materials and methods The study enrolled 246 patients who underwent elective surgery for colorectal cancer in 2012–2015 with accurate preoperative colonoscopic localization of the tumor. The analysis concerned patients with neoplastic infiltrate localized more than 30 cm from the anal verge. For evaluative purposes and accuracy of localization, the intestine was divided anatomically into 13 parts. Colonoscopic examinations were conducted with two types of endoscopes: group I—with MEI and group II—without MEI. Patients were assigned to the groups by random allocation. Ultimate confirmation of the tumor localization was accomplished by intraoperative evaluation. Results Group I involved 127 patients and group II 129. The two groups were compared in terms of age, sex, BMI and frequency of previous abdominal procedures. Proper localization of the lesion was confirmed in 95.23 % of group I patients and in 83.19 % of group II patients (p Conclusions A magnetic endoscopic imaging allows more accurate localization of neoplastic infiltrate within the large intestine compared to standard colonoscopy alone, especially within the sigmoid colon. This method can be particularly useful in planning and performing laparoscopic procedures to diminish the likelihood of improper bowel segment resection. ClinicalTrials.gov number NCT01688557

Tectonic inversion and erosion conceal basin geological history. As simple stratigraphic reconstructions can be inaccurate, thermal modelling techniques are often applied. In this paper, we show the advantages of a multi-proxy approach for exhumation studies, which explores full range of all possible solutions. The part of the Mesozoic Central European Basin that was inverted into the Mid-Polish Anticlinorium in the Late Cretaceous is chosen as a case study. The analysis consists of three steps: First, a wide range of possible geological scenarios is constructed, accounting for two alternatives of the overburden sequence, southern and northern, that result from the impact of the Holy Cross Fault on Mesozoic deposition. The second stage comprises apatite fission track and vitrinite reflectance analyses carried out on a ~1500 m long vertical profile, inverse modelling of these data to obtain thermal histories, and 1D thermal modelling of burial-erosion using the PetroMod software. In the third step, results of modelling exercises are combined with probabilities of the overburden variants to define an ensemble of the most likely geological scenarios. By applying this workflow we conclude that exhumation of the Mid-Polish Anticlinorium began in the latest Turonian–early Campanian and that ~1.7–2.3 km of uppermost Triassic–Cretaceous rocks were removed. The heat flow was similar or slightly higher than the present-day value and during the Jurassic the study area was located on the northern side of the Holy Cross Fault, where deposition was faster. We also investigate the impact of elevated Late Palaeozoic heat flow on our samples and find that it was overprinted by high Late Cretaceous temperatures. All this is achieved by presenting the results as an ensemble of the most likely solutions within the wide modelling space.

Introduction Atypical ductal hyperplasia (ADH) is a benign lesion, which due to the risk of coexisting cancer is classified as a lesion of uncertain malignant potential. Aim To identify clinical predictors of cancer underestimation in patients with ADH diagnosed after vacuum-assisted breast biopsy (VABB). Material and methods Between 2001 and 2016, a total of 3804 vacuum-assisted core needle biopsies were performed at the First Chair of General Surgery of the Jagiellonian University Medical College in Krakow, including 2907 ultrasound (US)-guided biopsies and 897 digital stereotactic procedures. Seventy-six women were diagnosed with ADH and 72 of them underwent subsequent surgical excision. Demographic factors, medical history, family history, clinical symptoms, type and size of lesion determined in imaging scans, size of biopsy needle, and presence of coexisting lesions in VABB specimens were analysed as potential predictors of malignancy underestimation. Results Underestimation of breast carcinoma occurred in 21 (29.2%) patients. The upgrade rate was significantly higher only in patients with a lesion visible both in mammography (MMG) and US examinations and combined BIRADS-5. Conclusions Vacuum-assisted core needle biopsy is a minimally invasive technique used in diagnosing ADH. As the risk of breast malignancy underestimation is relatively high, open surgical biopsy remains the recommended procedure, especially in patients with lesions detected both in mammography and US examination. As we could not identify the factors that preclude cancer underestimation, all the women diagnosed with ADH should be informed about the risk of cancer underestimation.

UPPER JURASSIC STRATIGRAPHY AND FACIES VARIABILITY – A CASE STUDY OF THE CIANOWICE 2 AND TROJANOWICE 2 BOREHOLES (OLKUSZ UPLAND AND KRZESZOWICE GRABEN BORDERLAND Abstract. We present the results of research in two Upper Jurassic drill core sections that have been conducted in the frame of the „Integrated research program of shallow drillings to solve the major problems of geology of Poland“. The sections represent the Upper Jurassic sponge megafacies. The Trojanowice 2 core records the biohermal Oxfordian facies (from the Lower Oxfordian to the lowermost part of the Bimammatum Zone of the Upper Oxfordian). The Cianowice 2 section is characterized by a facies typical of the interbiohermal basins (Korzkiew Basin) area and shows a nearly complete Oxfordian stratigraphy. Significant differences of the sea bottom relief shown by the precise biostratigraphy, evoked various types of mass movements. Rocks representing the effects of such movements have been recognized in the upper part of the Cianowice 2 core. The differences between the two regions mentioned above are evident from the beginning of the Late Callovian.Wehave determined the density of the sponge mummies in the Trojanowice 2 core. It evolves from a few to 63 mummies per 1meter of the section. In the 201 m long profile a total 2199 “generations” of siliceous sponges were found. In the same profile we calculated the shortening of the limestone thickness as a result of pressure dissolution (along a horizontal plane). The minimal shortening, calculated as the stylolite amplitude, was averagely 11.6%.

During the time of organ harvest, it is crucial for the kidney procurement team to consider significant vascular anatomical variations. Multiple renal arteries are not uncommon, and unintentional injury can result in an irreversibly damaged kidney graft that needs to be discarded. We present a kidney graft with 5 renal arteries and a single vein that was successfully procured and implanted with good graft function at discharge and at 4-yr follow-up. According to the literature, additional renal arteries can be found in about 33% of kidneys. This is the first study on a kidney with 5 arteries in the published literature, especially in the context of transplantation.

Introduction: The use of mesh is still controversial in patients undergoing emergency incarcerated hernia repair, mostly because of potential infectious complications. Aim: The main aim of this study was to assess the efficacy of tension-free methods in treating incarcerated inguinal hernias (IIH), with and without intestine resection. The secondary aim was to establish an algorithm on how to pro- ceed with incarcerated hernias. Material and methods: A retrospective analysis of patients who underwent surgery due to an inguinal hernia at the First Department of General Surgery Jagiellonian University Medical College in Krakow, in the period 1999-2009. Operative methods included Lichtenstein, Robbins-Rutkow and Prolene Hernia System. The rate of postoperative complications was compared in patients who underwent elective and emergency surgery. Results: The study group consisted of 567 patients (546 male) age 19-91 years. In this group 624 hernias were treat- ed using the three tension-free techniques - 295 using the Lichtenstein method, 236 using PHS and 93 using the RR technique. Out of the 561 operations 89.9% were elective. No correlation (p > 0.05) was found between the type of surgery and such complications as postoperative pain duration and intensity, fever, micturation disorders, wound healing disorders, testicle hydrocoele, testicle atrophy, spermatic cord cyst, sexual dysfunction, wound dehiscence, wound suppuration, seroma, haematoma and hernia recurrence. Conclusions: Mesh repairs can be safely performed while operating due to an IIH. The use of a synthetic implant, in emergency IIH repairs, does not increase the rate of local complications. Synchronous, partial resection of the small intestine, due to intestinal necrosis, is not a contraindication to use mesh.

New isotope (δ18O, δ13C) and elemental (Mg/Ca, Sr/Ca) data of well-preserved belemnite rostra, ammonite and gastropod shells from the Middle Oxfordian–Lower Kimmerdgian (Densiplicatum–Kitchini zones) of the Russian Platform are presented. This record is supplemented with published data from the Upper Callovian–Lower Kimmeridgian interval (Athleta–Kitchini zones). Significant differences in average temperatures calculated from δ18O values of particular fossil groups (5–15 °C) show the thermal gradient and the presence of cold bottom waters in the Middle Russian Sea during the Late Callovian–Middle Oxfordian. An Upper Oxfordian–lowermost Kimmeridgian decrease in δ18O values and an increase in Sr/Ca ratios of cylindroteuthid belemnite rostra likely reflect a warming of the bottom waters of ca. 3.5 °C. The gradual Late Oxfordian–earliest Kimmeridgian warming is followed by an abrupt temperature rise of 3–6 °C that occurred at the transition of the Early Kimmeridgian Bauhini and Kitchini chrons. The occurrences of cold bottom waters and of (Sub)Mediterranean ammonites and belemnites in the Middle Russian Sea at the Middle–Late Jurassic transition are regarded as a result of the opening of seaways during a sea level highstand. The bottom waters are considered to have been formed in the cool Boreal Sea. The subsequent retreats of the cold bottom waters and of the (Sub)Mediterranean cephalopods from the Middle Russian Sea in the Late Oxfordian are explained by the restriction of water circulation during a sea-level fall. The Early Kimmeridgian rise of bottom temperatures of the sea is linked to a global climate warming. The data presented do not support a major cooling of the Arctic and a consequent glaciation in this region at the Middle–Late Jurassic transition. Since occurrences of cold water masses are diachronous in different European basins, the observed variations in sea water temperatures are interpreted as a result of changes in marine currents and water circulation. δ13C values of belemnite rostra from the Russian Platform are scattered but show the long-term Upper Callovian–Middle Oxfordian positive excursion consistent with the previously published isotope records of the Boreal Realm and terrestrial organic matter.

In the therapy of an inguinal hernia, there is a huge variety in the way of treating and the choice of surgical technique. Practice shows that the intraoperative improvisation and surgeons’ own modifications of the original techniques have become part of routine procedure. No mandatory hernia registration system causes the actual detailed herniology status in our country remains unknown. The aim of the study was to summarize the results of a survey on knowledge of a hernia according to the standards developed by international hernia societies compared with everyday clinical practice. During the International Conference Hernia in Poland, which took place on 10 December 2016 in Zakopane we conducted an interactive session among 106 surgeons dealing with hernias. Surgeons responded to 66 questions about daily surgical practice and decision making in their centers, and 27 questions for the assessment of the world’s latest treatment recommendations regarding groin hernias. The most common method of using the implant technique Lichtenstein, used by 91% of doctors. 20% of surgeons in planned operations in adult men routinely uses no mesh technique. Almost 80% of respondents do not apply TEP or TAPP. Only 45.7% of surgeons customize surgical technique to the patient. Only 7 of the 27 analyzed recommendation has been accepted by more than 90% of respondents. 9 of the 27 recommendations were approved by less than half of the surgeons. In the case of 11 recommendations, surgeons simultaneously failed to comply with these recommendations in daily practice. Deficiencies in the system of training and the underfunding of medical procedures cause insufficient TAPP/ TEP availability in Poland in an inguinal hernia. Improvement of the surgeons’ knowledge on how to perform surgery

Background Interstitial cells of Cajal (ICCs) play an important role in the regulation of gut motility. There is growing evidence that interstitial Cajal-like cells (ICLCs) are present in the gallbladder wall. We hypothesize that changes in the density of ICLCs in the gallbladder wall may lead to the development of cholelithiasis due to the impairment of the gallbladder motility. The purpose of this study was to identify ICLCs in the gallbladders of patients with gallstones and to assess their densities. Methods Data from 30 patients with gallstones and 25 individuals without gallstones were compared. Tissue samples were obtained during surgery, embedded in paraffin, and cut into sections. Following staining for CD117 and mast cell tryptase, the number of ICLCs and mast cells was determined using image analysis. Key Results Cells positive for the c-Kit receptor (CD117) were detected in the gallbladder wall in all cases examined. Interstitial Cajal-like cells were most frequently observed in the muscularis propria. The density of ICLCs in the muscularis propria was significantly lower in the patients with gallstones than the density observed in the controls (26.24 ± 10.89 vs 56.29 ± 13.35 cells/mm2). In contrast, the number of mast cells in the gallbladder was increased in the patients with gallstones when compared with the controls (143 ± 24 vs 112 ± 19 cells/mm2). Conclusions & Inferences The histopathological differences observed in this study may help elucidate the pathophysiology of gallstones. Gallbladder motility may be affected by the decreased number of ICLCs in patients with cholelithiasis.

The “black flysch” deposits (Szlachtowa Formation at Podubocze near Czorsztyn in Poland), attributed so far to the Pieniny Klippen Basin successions, and at Haluszowa in Poland as well as at Kamienka in Eastern Slovakia, attributed to the Grajcarek Succession of the Magura Basin, have yielded rich dinoflagellate cyst assemblages consisting of forms both redeposited (from Upper Triassic to Aalenian) and indigenous (Lower Bajocian to Upper Bajocian). An Early to Late Bajocian age of the deposits investigated is thus indicated, and this along with other stratigraphical, sedimentological and tectonic data indicates that all the deposits in question represent the early stages of development of the Magura Basin. The formation of “black flysch” deposits was possibly related to the Early Bajocian uplift of the Czorsztyn Ridge which resulted from the opening of the Magura Ocean. The occurrence of the deposits of the Magura Basin below the overthrusted deposits of the Klippen Basin (Czorsztyn Unit) in the area of study results in a marked change in the structural interpretation of the Pieniny Klippen Belt.

Background Colorectal cancer is the most common cancer in Europe. Early diagnosis and treatment gives the patient a chance for complete recovery. Screening colonoscopies in the symptom-free patients are currently performed on a wide scale. The examinations are performed under local anesthesia which does not eliminate all discomfort and pain related to the examination. The aim of this study was to evaluate magnetic scope navigation in screening endoscopic examinations performed to detect early-stage colorectal cancer. Methods The study group consisted of 200 patients, aged 40–65 years, who were free from colon cancer symptoms. All patients underwent complete colonoscopy under local anesthesia. The equipment could be fitted with the scope that allows three-dimensional observation of instrument localization in the bowel. The examination was performed by three experienced endoscopists, each of whom performed over 5,000 colonoscopies. The patients were randomized to two groups: those whose equipment did not have 3D navigation (group I) and those whose equipment did have 3D navigation (group II). Each group consisted of 100 cases matched by gender, age, and BMI. The authors compared the duration of introducing instrument to cecum, the pulse rate before the examination and at the time the instrument reached the cecum, and subjective pain evaluation by the patient on the visual analog scale. Results Group I consisted of 54 women and 46 men with a mean age of 54.6 years and mean BMI of 27.8 kg/m2, and group II had 58 women and 42 men, mean age of 55.1 years and mean BMI of 26.4 kg/m2. The average time it took for the instrument to reach the cecum was 216s in group I and 181s in group II (P

Four occurrences of Jurassic stromatactis mud-mounds were found in the Czorsztyn Unit of the Pieniny Klippen Belt (Western Carpathians) — in western Slovakia (Slavnicke Podhorie, Babina), and in the Transcarpathian Ukraine (Priborzhavskoe and Veliky Kamenets). Their stratigraphic range is from Bajocian to Callovian. The mounds consist of micropeloidal mudstones, wackestones to packstones with a fauna including pelecypods, brachiopods, ammonites and crinoids. Spicules and skeletons of siliceous sponges are abundant in every section. All of the mounds contain networks of stromatactis cavities that are partially filled with radiaxial fibrous calcite (RFC) and locally by internal sediments. At Slavnicke Podhorie, the sparry masses that fill stromatactis cavities are weathered out and show casts of sponges. Parallel study of the weathered casts and their cross-sections in slabs showed that they bear all the signs of stromatactis (relatively flat bottoms and digitate upper parts, RFC initial fillings and eventual blocky calcite later filling). Almost no original sponge structures were preserved. This strongly supports the possible sponge-related origin for stromatactis cavities.

Cholesterol gallstone disease is highly prevalent in Western countries, particularly in women and some specific ethnic groups. The mechanisms behind the formation of gallstones are not clearly understood, but gallbladder dysmotility seems to be a key factor that triggers the precipitation of cholesterol microcrystals from supersaturated lithogenic bile.Given that newly described interstitial cells, telocytes, are present in the gallbladder and they are located in close vicinity of smooth muscle cell and neural fibers possibly interfering with gallbladder motility or contractility, authors are trying to summarize the current knowledge on the role of telocytes with respect to disturbed gallbladder function in gallstone disease.

Background Most pancreatoduodenectomy resections do not meet the minimum of 12 lymph nodes recommended by the American Joint Committee on Cancer for accurate staging of periampullary malignancies. The purpose of this study was to investigate factors affecting the likelihood of adequate nodal yield in pancreatoduodenectomy specimens subject to routine pathological assessment. Methods Six hundred sixty-two patients subject to pancreatoduodenectomy between 1990 and 2013 for pancreatic, ampullary, and common bile duct cancers were reviewed. Predictors of yielding at least 12 lymph nodes were evaluated with a logistic regression model, and a survival analysis was carried out to verify the prognostic implications of nodal counts. Results The median number of evaluated nodes was 17 (interquartile range 11 to 25), and less than 12 lymph nodes were reported in surgical specimens of 179 (27 %) patients. Tumor diameter ≥20 mm (odds ratio [OR] 2.547, 95 % confidence interval [CI] 1.225 to 5.329, P = 0.013), lymph node metastases (OR 2.642, 95 % CI 1.378 to 5.061, P = 0.004), and radical lymphadenectomy (OR 5.566, 95 % CI 2.041 to 15.148, P = 0.01) were significant predictors of retrieving 12 or more lymph nodes. Lymph node counts did not influence the overall prognosis of the patients. However, a subgroup analysis carried out for individual cancer sites demonstrated that removing at least 12 lymph nodes is associated with better prognosis for pancreatic cancer. Conclusions Few variables affect adequate nodal yield in pancreatoduodenectomy specimens subject to routine pathological assessment. Considering the ambiguities related to the only modifiable factor identified, appropriate pathology training should be considered to increase nodal yield rather than more aggressive lymphatic dissection.

This paper describes extensive new collections of ammonites made bed-by-bed across the Oxfordian/Kimmeridgian boundary sequence in the Flodigarry sections at Staffin Bay on the Isle of Skye. The ammonites belong to the Sub-Boreal family Aulacostephanidae and the Boreal family Cardioceratidae, enabling recognition of both the current standard Sub-Boreal and Boreal ammonite zonations. In consequence, it is possible to make a close correlation of these two zonal schemes through the interval studied in Skye. The research has provided new palaeontological data at levels of precision that justify the proposal of the section at Staffin as the site of a potential Global Boundary Stratotype Section and Point (GSSP) for the Oxfordian/Kimmeridgian boundary.The traditional Oxfordian/Kimmeridgian boundary placed at the Pseudocordata/Baylei zonal boundary of the Sub-Boreal zonal scheme corresponds precisely to the Rosenkrantzi/Bauhini zonal boundary of the Boreal zonal scheme. This level is characterised by the appearance of the first Pictonia (Pictonia flodigarriensis sp. nov.) together with first Prorasenia, replacing an older assemblage of Ringsteadia–Microbiplices (Sub-Boreal). It is also characterised by the first occurrence of small-sized Amoeboceras (Plasmatites) spp., as well as large Amoeboceras schulginae Mesezhnikov (Boreal). An alternative level that may be considered as a potential GSSP is the boundary between the Bauhini Zone and the Kitchini Zone of the Boreal zonal scheme, characterised by first occurrence of Amoeboceras (Amoebites) of the A. bayi group. This level corresponds to the Planula/Galar subzonal boundary of the Sub-Mediterranean zonal scheme, and lies close to the currently accepted Oxfordian/Kimmeridgian boundary in the Sub-Mediterranean Province.

A 40-m-thick carbonate succession of the Bajocian to Berriasian age from the Veliky Kamenets quarry (Novoselica area, Pieniny Klippen Belt, Ukraine) resembles both the Czorsztyn and Niedzica successions of the Pieniny Klippen Belt, traditionally considered ridge slope-related deposits. A total of 176 individually oriented cores, collected from the bottom to the top of the sequence with sampling density dependent on inferred sedimentation rates, show multicomponent remanent magnetization with magnetite as a main magnetic carrier. Thermal demagnetization revealed two main components of natural remanent magnetization (NRM). A low-blocking temperature component S of normal polarity is considered of posttectonic, probably thermoviscous, origin due to overheating by Neogene volcanics. A stable, high-blocking temperature NRM component P shows dual-polarity distribution and is considered primary. It was possible to recognize 23 polarity zones that have been correlated with a biostratigraphic scale. Since two significant sedimentary gaps occur at 422 and 860 cm (the main hiatus—MS) from the base, the latter comprising the Middle Callovian/Early Oxfordian time span (6–8 Ma), an obtained pattern of magnetic reversals presented in this study cannot be considered complete. A palaeolatitude of 41±5° is calculated for the mid-Jurassic part below MS, similar to that expected for the European Craton at the Kamenets locality. The mid-Oxfordian limestone, directly overlying the MS, has palaeolatitudes around 28±6°. This implies a relatively fast opening of the oceanic domain to the north from the Kamenets block. This conclusion, combined with similarity of the Kamenets sequence to ridge-related sediments of the Pieniny Klippen Belt, makes it possible to speculate on the existence of the Kamenets Ridge (a new term), a structure of uncertain, although possible, structural links to the Czorsztyn Ridge. Palaeomagnetic declinations suggest 100° counterclockwise rotation of the whole section before the Neogene.

Based on current literature authors reviewed information on bile metabolism, i.e. production and chemical compounds, synthesis of bile acids, their hepato-intestinal circulation with respect to etiology of cholelithiasis - its epidemiology and clinical aspects.

the etiology of gallstone disease is considered to be multifactorial, including biliary cholesterol hypersecretion, supersaturation and crystallization, stone formation, bile stasis and mucus hypersecretion and gel formation. Gallbladder hypomotility seems to be a key process that triggers the precipitation of cholesterol microcrystals from supersaturated lithogenic bile. the purpose of the current study was to determine whether ICLCs in the gallbladder were influenced by lithogenic bile. Gallbladder specimens were collected from 30 patients (8 males and 22 females) who underwent elective laparoscopic cholecystectomy for symptomatic gallstone disease. The control group consisted of 25 consecutive patients (11 males and 14 females) who received elective treatment for pancreatic head tumors. ICLCs were visualized in paraffin sections of gallbladders using double immunofluorescence protocol with monoclonal c-kit antibodies and mast cell tryptase. Cholesterol, phospholipid and bile acid concentrations were measured in bile samples obtained by needle aspiration from the gallbladder at the time of surgery. The number of ICLCs in the gallbladder wall was significantly lower in the study group than in the control group (3.35 ± 1.23 vs. 7.06 ± 1.82 cell/FOV in the muscularis propria, P0.001) and correlated with a significant increase in the cholesterol saturation index. The glycocholic and taurocholic acid levels were significantly elevated in the control subjects compared with the study group. The results suggest that bile composition may play an important role in the reduction of ICLC density in the gallbladder.

Based on the review of current literature and on their own studies authors postulate that decreased number of interstitial cells in the wall of gallbladder may be pathognomonic for gallstone disease (cholelithiasis).

SummaryPaget-Schroetter Syndrome is a primary, effort vein thrombosis of the axillo-subclavian level. It occurs predominantly after repetitive sport movements in the dominant limb in young healthy male individuals. Patients refer with pain, swelling and blue discolouration in the affected upper extremity.We present a 33-years-old woman with primary thrombosis of left subclavian vein, with no history of repetitive sport exercises or trauma. The patient’s profession requiring leaning against the desk for hours daily could be a trigger factor for vein thrombosis in presented case. Doppler ultrasonography and venography showed complete occlusion of left subclavian vein. Computed tomography showed no evidence for compression at thoracic outlet level. Patient was successfully treated with anticoagulants and followed for 21 months with repeated duplex ultrasound examinations. The symptoms had resolved. Long time left subclavian vein patency and good quality of life have been achieved.

One of the methods used to reduce pain and discomfort during colonoscopy is insufflation of carbon dioxide instead of air. However, the actual benefit of carbon dioxide insufflation is not unequivocally proven. The aim of the study was to evaluate the advantages of carbon dioxide insufflation during screening colonoscopy. A total of 200 patients undergoing screening colonoscopy between 2010 and 2011 were included in the prospective, randomized study carried out in a surgical referral center. Screening unsedated colonoscopy with either air or carbon dioxide insufflation was performed; patients were randomly assigned to air or carbon dioxide group by means of computer-generated randomization lists. All examinations were performed in an ambulatory setting with standard videocolonoscopes. The main outcomes analyzed were (a) duration of the entire procedure, (b) cecal intubation time, and (c) pain severity immediately, 15, and 60 min after the procedure. Group I included 59 women and 41 men and group II included 51 women and 49 men. The duration of the procedure was circa 10 min in both groups. Pain score values immediately and 15 min after the procedure were similar in both groups (P=0.624 and 0.305, respectively). A lower pain score was observed only after 60 min in patients insufflated with carbon dioxide (1.28 vs. 1.54, P=0.008). No pain reduction was observed in women and in obese patients (BMI>30). Carbon dioxide insufflation during unsedated screening colonoscopy does not decrease the duration of the procedure and appears to reduce pain intensity at 60 min after examination to an extent without clinical significance. The study was registered at ClinicalTrials.gov, number NCT01461564.