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Background: Ideal pouch created during restorative proctocolectomy is a new gastrointestinal organ--"neorectum". Although it is made from the ileum, it takes over function of the removed rectum. This new function results in significant morphological changes in pouch's mucous membrane, which becomes similar to the large bowel mucosa. The most common pathology of the ileal pouch is its inflammation--pouchitis. One of the suspected causes of pouchitis is bacterial flora disturbance., Objectives: The aim of the study was to analyze the morphological and microbiological changes in ileal pouches in different time periods after ileostomy closure and to evaluate the influence of certain bacterial strains on the degree of inflammation., Material and Methods: The study involved 47 patients who had been treated surgically; they were investigated before and at different stages after ileostomy closure. They underwent repeated rectoscopies with biopsies of pouch mucosa and swabs for microbiological examination. In total 89 rectoscopies were performed, which provided 70 histopathological results according to the Heidelberg Pouchitis Activity Score and 87 microbiological test results., Results: The assessment of the morphology of intestinal pouches showed increased signs of chronic inflammation as the length of time after the closure of a protective ileostomy increased. There was no correlation between the signs of acute inflammation and the length of time after surgery; there were more signs of acute inflammation in cases of pouchitis. The composition of the bacterial flora of intestinal pouches changed as the length of time after ileostomy closure increased, with significant increases in the number of enterobacteriaceae species. The presence of Staphylococcus aureus significantly correlates with a higher degree of chronic inflammation; this bacterium may be a potential infectious factor in pouchitis., Conclusions: Microbiological analysis of intestinal pouch lumen is a useful tool that can be used in routine follow-up assessment of intestinal pouches as well as in diagnosing pouchitis.

Background/aims: Primary retroperitoneal tumours and retroperitoneal organs' tumours represent a variety of lesions that require different treatments and have various prognoses. The aim of this study was to present the author's observations of the histological tumors types occurrence and their surgical treatment., Methodology: One hundred twenty-three cases of retroperitoneal tumours were studied retrospectively in a 6-year period. All cases were investigated for haematological and biochemical parameters. Abdominal ultrasonography, computed tomography or magnetic resonance imaging of abdominal cavity and pelvis were done in the all cases. All cases were subjected to laparotomy with an aim to resect the tumour completely., Results: In the present study we observed primary retroperitoneal tumours like malignant neuroblastoma, paraganglioma, primitive neuroectodermal tumour, cavernous haemangioma and mucinous cystadenoma. Among retroperitoneal organs' tumours pancreatic lesions present the majority of them. There were 6 cases of neuroendocrine pancreatic tumours. We had two cases of retroperitoneal fibrosis in patients with ulcerative colitis. In adrenal glands we observed benign and malignant lesions like pheochromocytoma and fibrosarcoma. All primary retroperitoneal tumours, except two cases of retroperitoneal fibrosis, were an bloc removed., Conclusions: Primary retroperitoneal tumours in contrast to retroperitoneal organs' tumours occur very rare. Their anatomical location makes early detection difficult and as a result they are usually quite extensive when first detected. The clinical manifestations of all retroperitoneal tumours are not specific, so it causes a lot of difficulties in early diagnosis. This is the main reason that contributes to treatment failure.

Background/aims: Crohn's disease is a non-specific, chronic inflammatory disorder affecting any part of alimentary tract. Patients receiving proper medication require surgery in 70-90% of cases. Analysis of results of surgical treatment in Crohn's disease in patients treated at the Medical University of Wrocław and an attempt to elaborate the optimal surgical strategy in Crohn's disease was the aim of the study., Methodology: The medical documentation of 52 patients with confirmed diagnosis of Crohn's disease was analysed, focusing on the course of the disease before surgery linked with its localization, duration and medical treatment. Then indications for surgery, type of surgical procedure performed and perioperative morbidity and mortality were discussed., Results: Thirteen patients had urgent surgery. Thirty-nine patients had planned surgery. The most common procedure was ileocecal resection or right hemicolectomy. In 36 cases the postoperative course was uncomplicated. The most common surgical complication was wound infection. Pneumonia was the most common general complication. Fatal cases occured in elderly patients with long-term and severely complicated disease., Conclusions: The optimal timing of surgery is extremely difficult and remains non-standardized. Key decisions are often established intraoperatively and they require considerable surgeon experience, patient's awareness and close cooperation of surgeons and gastroenterologists.

Introduction: Cancer of thyroid gland is the most common malignancy of the endocrine system. The treatment improvement could be achieved by early diagnosis. The aim of the study was to identify cancer specific antigenes with use of peptide libraries., Material and Methods: The material from 6 patients with thyroid cancer (4 with papillary cancer, 1 with follicular cancer and 1 with oxyphilic tumor) were analyzed. It was performed with use of lipophylic peptide libraries by direct comparison of staining of specimens prepared from normal and malignant tissue., Results: Preliminary results confirm practical value of peptide libraries in early diagnostics of thyroid cancer., Conclusions: It is important to optimize construction of peptide libraries by using different staining agents hydrolyzed by proteases.

Background: The literature contains many controversial or unclearly defined opinions about the risk of development of carcinoma of the exocrine part of the pancreas in patients with chronic pancreatitis. This and our own clinical observations based on analysis of patients with chronic pancreatitis treated surgically (anastomotic and resectional procedures) formed the background to an experimental study to define the risk of carcinogenesis in the course of chronic pancreatitis in rats., Experimental Findings: In Wistar rats with chronic pancreatitis induced by etionine and then exposed to carcinogenic action of azaserine, proliferation, adenomas and acinic cell carcinomas of the exocrine part of the pancreas were diagnosed; the carcinomas were transplantable. In rats treated with azaserine only, benign proliferative lesions and adenomas were found. The presence of the p53 mutation protein was observed in carcinomatous pancreatic cells in malignant lesions of the pancreas in primary and transplantable cancers, but was not detected in benign proliferative lesions and adenomas. Chronic pancreatitis in Wistar rats predisposes the exocrine part of pancreas to malignant transformation. Growth of cancers of the exocrine part of the pancreas in male rats, but not in female rats, suggests hormonal determination of experimental pancreatic cancer., Conclusions: Results demonstrate that chronic pancreatitis in rats predisposes to malignant proliferative lesions, including acinic cell carcinoma. Expression of the protein product of p53 gene mutations correlated with neoplastic transformation of pancreas preceded by chronic pancreatitis, and was also detected in transplantable tumours.