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Objectives. The aim of this study is to compare the endothelial integrity of saphenous vein grafts harvested by minimally invasive surgery and veins harvested conventionally for coronary artery bypass surgery in 200 participants who were assigned to interventions by using random allocation. Design. Randomized controlled trial. Methods. Immunocytochemistry with anti-CD 31 antibodies and anti-nitric oxide synthase (NOS) antibodies were employed to identify the endothelial integrity. Results. The CD 31 immunostaining showed that the endothelial cell integrity of the minimally invasive harvested veins was preserved in 82±13% of the circumference of luminal endothelium, while in conventionally harvested grafts it was reduced to 64±15% ( p =0.05).> This was associated with the lack of CD 31 expression in vasa vasorum (10 and 18%) in both groups, respectively, ( p =0.02). The NOS immunostaining revealed that the endothelial integrity of the minimally invasive harvested grafts was preserved in 96±4% of the luminal endothelium circumference as compared to 74±10% in conventionally harvested grafts ( p =0.05). The percentage of cases with the lack of NOS expression in all vasa vasorum was 12 and 21%, in G1 and G2, respectively, ( p =0.02). Conclusion. The endothelial integrity of saphenous vein grafts harvested by minimally invasive surgery is better preserved than with the grafts obtained by the conventional manner. This could play an important role in improving vein graft patency rates.

The aim of the study was to assess the early and late results of extended pneumonectomies in lung cancer patients with T3 and T4 disease. Between Jan. 1995 and Dec. 1999--445 pneumonectomies were performed in patients with lung cancer. In 37 patients without preoperative N2 involvement a standard pneumonectomy was extended to include the following additional resections: chest wall (10), pericardium (9), diaphragm (5), VCS (3), descending aorta (2), left atrium (5), esophagus (1) and tracheal bifurcation (2). The effect of various factors on general mortality and morbidity was analyzed with the use of binary logistic regression. There were two early postoperative deaths (6.8%). Major complications occurred in 10 patients (29%). Overall survival rates at 1, 2, and 3 years were 43, 30 and 24%, respectively. The survival rates for the subgroup with chest involvement only were 50, 42 and 30%, respectively. Eight patients survived beyond the 36 month follow-up. The only factor significantly affecting mortality was incomplete resection, as revealed by postoperative microscopic examination (R1, p0.05). Extended operations are justified by a relatively low mortality rate and low number of severe postoperative complications, specially in patients with chest wall involvement only. The result of this treatment predominantly depends upon the completeness of the resection.

The aim of the study was to analyse the prevalence of anti-C. pneumoniae specific IgG, IgA and IgM antibodies in patients undergoing coronary artery bypass engraftment. Sera of forty-six patients aged from 40 to 74 years (mean 57.3) were examined just before the time of operation. Serum samples taken from 21 young healthy blood donors aged from 19 to 28 years (mean 22.4) and 23 sera taken from older blood donors aged 44-60 years (mean 54.7), were used as controls. Specific IgG, IgA and IgM serum antibodies were tested by the enzyme immunoassay kits (Lab-systems, Helsinki). The prevalence of anti-C. pneumoniae IgG was determined within the studied groups, to be independent of their age. On the contrary, the level and seropositivity rate of specific IgA (63.0%), as well as a co-existence of IgA and IgG (60.9%) were significantly higher in coronary patients when compared to healthy blood donors. The presence of specific IgM (positive or borderline values) were detected in 23.9% of patients, whereas they were rarer found in healthy population. In the majority of coronary patients immunological markers of C. pneumoniae infection were found.

The purpose of this study was to assess the risk of coronary artery bypass grafting (CABG) in the group of patients (pts) over 70 years of age and to examine results of surgical treatment in these pts. Between January 1993 to December 1999 1276 pts underwent CABG. From this group 114 consecutive pts at the age over 70 were retrospectively studied. The average age of the pts was 71.8 +/- 2.2 years (range, 70 to 79 years). Eighty nine male (78.1%) and 25 female (21.9%) pts were operated. One or more myocardial infarction had occurred in 64.0% of pts preoperatively. All the pts underwent left cardiac catheterization. The indication for surgery was significant stenosis of the left main trunk in 35 (30.7%) pts and three vessels disease in 54 (47.4%) pts. The total number of peripheral anastomoses was 274 (average 2.4 +/- 0.9 grafts per pts). In 29 cases left internal mammary artery (to left anterior descending artery) and in 245 reversed saphenous vein grafts were used. The early postoperative mortality in the group of pts at the age over 70 (10 pts--8.8%) was significantly higher than in the group of younger pts (41 of 1162 pts). The cause of death in septuagenarians was: low cardiac output syndrome (5 pts), respiratory failure (2 pts), renal insufficiency (2 pts) and cerebral stroke (1 pt). In early postoperative course the incidence of any organ insufficiency (cardiac, respiratory, renal and neurological) was higher in the group of pts over 70 years of age than in the younger pts. Seven-year probability of survival calculated from Kaplan-Meier method was 66 +/- 4%. After operation 84.5% of pts were asymptomatic, while only 5 pts were in III and IV CCS functional class. CABG in pts at the age over 70 is associated with higher operative risk and higher rate of perioperative organ failure. After surgery most pts enjoy improvement in life quality.

Cell adhesion molecules (CAM) represent a large group of cell surface protein moieties with distinctive biological functions. In physiological terms they ascertain cell to cell contact such as cell cohesion of epithelia, condition cell migration and transmigration via biological membranes such as blood vessel walls, provide means for homing cells in a new microenvironment etc. These features of CAM are exploited by tumor cells to grow and spread in a tumor bearing host. CD56/N-CAM antigen is 140 kD isoform of neural cell adhesion molecule. N-CAM belongs to the large Ig superfamily of CAMs. CD56 can be traced at various sites, including nervous tissue, neuro-muscular junctions, neuroendocrine and endocrine organs. It is well known as a differentiation antigen of natural killer (NK) cells. Its role and function are far from clear, but its adhesion properties are evident in cell-cell (homophilic) interactions. CD56 has been, however, demonstrated the cells various human malignancies. Tumors of the nervous system such as neuroblastoma, are well known to express this marker. Malignant lymphomas of T-NK cell origin bear CD56, as well as multiple myeloma, melanoma and some cancers of epithelial origin. These data suggest that CD56/N-CAM antigen is, in some unknown manner involved in tumor biology.

The purpose of this study was to examine the early and late results of CABG in patients with left ventricular ejection fraction (LVEF) lower than 40%. This study comprised 128 patients (114 male and 14 female) at age from 41 to 75 years (mean 58.3 +/- 7.9). Before operation 115 patients (89.8%) were in CCS class III or IV. Before operation in all patients coronary arteriography with left-sided ventriculography were performed. In 12 patients myocardial perfusion in SPECT with Tc-99m-MIBI was assessed. Perioperative mortality in whole group was 12.5% (16 patients). The lowest (9.2%) was in subgroup with LVEF from 0.31 to 0.4 and the highest (27.3%) in patients with LVEF below 0.2. In 8 patients death was caused by low cardiac output, in 4 by ventricular fibrillation, in the others by renal failure or cerebral stroke (2 patients in each). In 45 patients (35.2%) postoperative low cardiac output was observed. In 41 patients was treated with the use of intraaortic balloon pumping (IABP). Twenty seven (65.9%) patients with IABP survived. During follow-up died 5 pts. 24-months probability of survival calculated from Kaplan-Meier method was 82.4%. In follow-up 80.9% of patients were in CCS class I and II. In SPECT, four months after CABG significantly more segments of left ventricle with normal perfusion (45% vs 53%; p0.05) were observed. Patients with LVEF40% are at higher operative risk because of often postoperative low output syndrome. Low output syndrome can by successfully treated with IABP. CABG significantly improves circulatory sufficiency in patients with LVEF40%.

Ostium primum atrial septal defect (ASD I) is very rarely observed in the adults. Although ASD I was first corrected surgically almost 50 years ago, the efficacy of surgical treatment in adults has not been well documented. Thus, the long-term outcome of patients aged over 20 years and having surgical repair of ASD I was examined.Fifteen patients (10 males, five females; mean age 31.4+/-13.1 years; range: 20 to 56 years) who had surgical repair of ASD I between 1982 and 2000 were followed. All patients were examined physically and underwent chest radiography, ECG and echocardiography (cross-sectional and Doppler) before and after surgery. Autologous pericardium was used to close the defect in 14 patients, and a direct suture was used in one patient. Mitral valvuloplasty (repair of the cleft) was performed in 12 patients, and De Vega annuloplasty in eight.There were no hospital deaths. In one case a pacemaker was implanted five days after surgery because of complete heart block. Preoperatively, nine patients (60%) were in NYHA classes III and IV; at the end of follow up, 14 (93.3%) were in classes I and II. Preoperatively, 13 patients had sinus rhythm, and one each had atrial fibrillation (AF) and rhythm from the atrioventricular sinus. During follow up, three patients developed AF which was treated successfully with electrical cardioversion. The preoperative mean cardiac volume index of 695 +/- 216 ml/m(2) was reduced significantly after repair to 523 +/- 108 ml/m(2) (p0.05). Before surgery, mitral regurgitation was observed (severe in five cases, moderate in seven, mild in three). Postoperatively, a residual intracardiac shunt was identified in one case. Postoperative mitral regurgitation was noted in six patients (moderate in two, mild in four). The right ventricular dimension was decreased significantly, from 5.0 +/- 1.5 mm before surgery to 3.2 +/- 0.6 mm after repair (p0.001).Patients aged over 20 years with ASD I benefit from surgical repair of the defect.

Phrenic nerve injury and diaphragmatic dysfunction can be induced by cardiac operation. We evaluated nonconsecutive 34 patients (pts) with elevation of the diaphragma after cardiac operation. 27 pts have coronary artery bypass grafting, 7 pts have prosthetic valve implantation. We have impression that ice/saline slush used along with cold cardioplegia for heart arrest can cause hypothermic damage of phrenic nerve. Palsy of that nerve results in raised hemidiaphragm and delayed recovery of the pts. In our pts normalisation of the diaphragm we observed 6 months after operation in 41% pts and 12 month after in 93% pts. We suggest that results depends on early and well rehabilitation.

The aim of our study was the assessment of the ploidia and its influence on the remission time and the survival of surgically treated patients with squamous cell lung cancer. The results were then related to the clinical staging, grading, size and localization of the tumor. The tissue samples (n = 60) of squamous cell lung carcinoma resected between 1995-1996 at the Department of Thoracic Surgery at University of Medical Sciences in Poznań were prepared using modified Hedley's method. The measurement was done in Cytoron Absolute flow cytometer. The abnormal DNA (aneuploid) was found in 40% of tumors. In two-year observation period more patients died with aneuploid tumors (54.6% deaths) than with diploid tumors (35.2% deaths). No significant correlation was found between the ploidy and frequency of metastasis to regional lymph nodes, tumor size, localization and grading. The estimation of the DNA content in the cancer cells seems to be a significant and valuable prognostic factor. The measurement of the DNA content can be useful in patients to estimate risk of recurrence after surgery.

ObjectivesThe purpose of the study was to evaluate the frequency of abnormal DNA content in squamous cancer cells (SCLC) and analyze its correlation with late survival rates after surgical treatment. Many previous studies included attempts to associate DNA quantification with prognosis for lung cancer. However, there is still considerable divergence of opinion about its prognostic value.MethodsA group of 110 patients surgically treated because of SCC was analyzed. Paraffin-embedded pathologic material underwent cytometric analysis. Post-operative follow-up was performed with standard follow-up visits. The 2 tests to χ statistical analysis was carried out using Mann-Whitney's and compare the following parameters in both groups: clinical staging, grading, tumor size, distant and local metastasis, tumor location, type of surgical procedure, local recurrence and survival time. The survival curves were drawn using the Kaplan-Meier method and two and five years survival rate were assessed. Clinical staging, regional metastasis and ploidy, having a great impact on survival rates, were analyzed with multivariational analysis.Results50 (45%) tumors were DNA aneuploid. There were no significance between the ploidy groups in clinical staging, grading, tumor size and location and type of surgical procedure. The two years survival rate in patients with aneuploid cancers (16,7%) was significantly worse than in those with diploid tumors (50%)(p

Zalozenia i cel pracy Laser neodymowo-jagowy o dlugości fali 1318 nm (Nd:Yag-1318 nm) dzieki swoim parametrą fizycznym zapewnia podczas zabiegu doskonale wlaściwości hemostatyczne i aerostatyczne co pozwolilo na jego szerokie zastosowanie w zabiegach resekcyjnych pluc. W naszym doniesieniu przedstawiamy doświadczenia wstepne resekcji mnogich przerzutow do pluc z wykorzystaniem lasera Nd:Yag-1318 nm. Material i metodyka W okresie od maja do czerwca 2003 w Klinice Torakochirurgii AM im. K. Marcinkowskiego w Poznaniu po raz pierwszy w Polsce wykorzystano laser Nd:Yag-1318 nm do resekcji mnogich przerzutow do pluc. Tą metodą zooperowano 12 chorych, 7 kobiet i 5 mezczyzn w wieku od 39–61 lat (śr. 53+\−7lat). U 9 chorych zmiany byly jednostronne, a u 3 znajdowaly sie w obu plucach. Do zabiegu kwalifikowano chorych zarowno ze zmianami polozonymi centralnie w plucu jak i obwodowo. Standardowym dostepem operacyjnym byla torakotomia przednio-boczna. Technika operacyjna polega na selektywym usunieciu wszystkich ognisk przerzutowych z pozostawieniem zdrowego miązszu pluca. Czas, jaki uplynąl od usuniecia ogniska pierwotnego w tej grupie chorych wahal sie od 3 miesiecy do 7 lat. Wyniki Liczba usunietych ognisk przerzutowych u jednego chorego wynosila od 1–42 średnio 5,2. W omawianej grupie chorych operowano 4 chorych z przerzutami raka nerki, 3 raka jelita grubego, 2 czerniaka, 2 miesaka i sutka. Nie bylo zgonu w okresie okolooperacyjnym ani zadnych powaznych powiklan oddechowych i krązeniowych. U jednego chorego wystąpil pooperacyjny krwiak oplucnej nie wymagający interwencji chirurgicznej. Nie obserwowano przedluzonego przecieku powietrza po zabiegu. Średni czas drenazu oplucnowego wyniosl 3,2 doby. Wnioski Resekcje mnogich ognisk przerzutowych do pluc z zastosowaniem lasera Nd:Yag-1318 nm są bezpieczne i obarczone niska liczba powiklan. Pozwalają na wykonanie zabiegow oszczedzających miązsz pluca nawet w przypadku zmian polozonych centralnie w plucu.

Background Chromosomal rearrangements in the receptor tyrosine kinase (RTK) ROS1 define a new molecular subset of NSCLC. ALK inhibitors can inhibit ROS1 kinase activity in cell lines. We examined the efficacy and safety of crizotinib, a small molecule inhibitor of two other RTKs, MET and ALK, in patients with advanced, ROS1-rearranged NSCLC. Methods Patients with advanced NSCLC harboring ROS1 rearrangement, as determined using a break-apart FISH assay, were recruited into an expansion cohort of the original phase 1 study of crizotinib. Patients were treated with crizotinib at the standard oral dose of 250 mg BID. The objective response rate (ORR) was determined based on RECIST v1.0. The disease control rate (DCR; stable disease [SD] + partial response [PR] + complete response [CR]) was evaluated at weeks 8 and 16. Results At the time of data cut-off on April 19, 2012, 15 patients with ROS1 NSCLC had received crizotinib and 14 were evaluable for response. The median age was 54 years (range 31–72). Fourteen patients were never-smokers and all had adenocarcinoma histology. All patients were confirmed negative for ALK rearrangement. The median number of prior treatments was 1 (range 0–6). The first ROS1 patient received crizotinib on October 19, 2010. To date, the ORR is 57% (8/14; 95% CI 28.9–82.3), with 7 PR and 1 CR. There were 4 SD, one of which was unconfirmed as PR at the time of data cut-off. The DCR at 8 weeks was 79% (11/14). Median duration of treatment was 25.7 weeks (range 0.1 + to 65.3 + ), and 12 patients continue on study. The pharmacokinetics, antitumor activity and safety profile of crizotinib in this group of patients were similar to those observed in patients with ALK-positive NSCLC. Conclusions Crizotinib is associated with clinically significant antitumor activity in patients with ROS1 NSCLC. Similar to ALK, ROS1 rearrangement defines another unique molecular subset of NSCLC patients for whom crizotinib therapy may be highly effective. Importantly, this study represents the first clinical investigation of ROS1 as a driver mutation and therapeutic target in cancer. Disclosure S.I. Ou: Advisory role: Pfizer, Genentech. Compensated Honoraria: Pfizer, Genentech, Lilly. Myself Research funding: Pfizer. Myself (institution). D.R. Camidge: Advisory role: Pfizer. Myself. Honoraria: Pfizer. Myself. L. Tye: Employment: Pfizer. Clinician. Myself. Stock Ownership; Pfizer. Myself. K. Wilner: Emplyement: Pfizer. Senior Director. Myself. Compensated. Stock ownership: Pfizer. Myself. M. Varella-Garcia: Honoraria: Abbott Molecular. Myself. funding for the trial provided by NIH - yes. A.T. Shaw: Advisory role: Pfizer, Ariad, Chugai, Novartis, Daiichi-sankyo. Myself. Compensated Research funding: Astra Zeneca, Novartis. Myself. All other authors have declared no conflicts of interest.

In many patients operated on for valvular heart diseases indications are present to digitalis administration in the preoperative period. During extracorporeal circulation fluctuations occur of blood potassium concentration which increase the risk for toxic effect of digitalis. In the work, digoxin concentration was studied in the serum of patients operated on in extracorporeal circulation in whom administration of this drug was discontinued 48 hours before the operation. The first digoxin dose (0.5 mg) was given directly after withdrawal of extracorporeal circulation, and another 0.5 mg was given after 4 hours. Digoxin concentrations were determined by fluorescence-polarization-immunological method using TD* Abbott device. The digoxin concentration increased rapidly and reached its peak after 6 hours (1.9 ng/ml), decreasing after 12 hours to 0.9 ng/ml and persisted at this therapeutic level in further samples. The present studies demonstrated that digoxin administration directly after withdrawal of extracorporeal circulation and within 24 hours after the operation in commonly accepted doses provided therapeutic concentration of the drug and caused no increase of the risk for toxic reaction development.

The aim of the study was a comparative evaluation of the three diagnostic procedures: fluoroscopy (Rtg-TV), echocardiography (ECHO) and computer assisted tomography (CT) in detection of mitral valve calcifications. These methods were applied to the 46 patients with mitral valve disease (24 males and 22 females which age was 24-56 years). The results were compared with radiograms of isolated valves after surgery. We found that the most efficient diagnostic method is CT which provided following results: sensitivity--100%, specificity-- 89% efficiency--95%, false positives and false negatives rates 11% and 0% respectively. The same diagnostic indices in the other methods were: ECHO--92%, 77%, 85%, 22%, 7%; Rtg-TV--50%, 100%, 75%, 0%, 50%. The last method can not be used as a routine examination in detecting of the mitral valve calcifications because of its low sensitivity+ and high grade of false-negatives rate.

The purpose of this study was to investigate the correlation between mitral valve morphology and amplitude of the first heart sound and the opening snap. The material consisted of 21 women and 19 men with mitral valve disease. They ranged in age from 24 to 56 years. 36 patients had pure or dominant mitral stenosis and 4 patients had combined mitral valve disease with dominant regurgitation. Phonocardiograms were recorded in all patients before mitral valve replacement. We analyzed the presence and the amplitude of opening snap and the amplitude of the first heart sound at the apex. The amplitude of the opening snap was expressed in mm and as a ratio to the maximal vibration of the second sound in the same cycle. The amplitude of the first sound was expressed in mm and as a ratio of the maximal vibration of the first sound to the maximal vibration of the first sound to the maximal vibration of the second sound in the same cycle. All amplitude measurements were made in 10 consecutive cardiac cycles and were then averaged. Then we studied all mitral valves removed in a uniform manner by one surgeon. Excised valves were fixed in 5% solution of formaline. The extent of calcification was determined by radiographs (fig. 1). The mitral valve area and calcification area were estimated by planimetry of radiographs. Then we analyzed the localization of calcification and we calculated the ratio of calcification area to valve area. Valves were divided into three groups according to the degree of the fusion of subvalvular structures ("a funnel") (fig. 2).(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of this study was to investigate the correlation between the histologic changes in the excised mitral valves and the clinical findings in patients with mitral stenosis (with or without regurgitation). The Study group consists of 26 men and 23 women ranged in age from 24 to 56 years. The mitral valves were removed in a uniform manner by one surgeon during mitral valve replacement. The controls were 13 mitral valves removed at necropsy from patients who died of extracardiac causes. Excised valves were fixed in 5% solution of formaline. The extent of calcification was determined by radiographs. Tissue from the center of the anterior and posterior leaflet were selected as the samples. The blocks were paraffin embedded and processed in the conventional manner. For histological examination 11.5 um thick sections were stained with haematoxylin and eosin, Alcian blue, Van Gieson and Von Koss stain. Then the sections were examined under light microscope. We estimated the degree of fibrotic disorganization of architecture, vascularization, acid mucopolysaccharide content, number of fibroblasts, and the presence of calcific deposits and lymphoid infiltrates. The control valves had normal architecture with thick "fibrosa". In all stenotic mitral valves we found complete or partial disorganization of architecture. The most common change was hyalinization present in 94% valves, vascularization in 84% and calcification present in 66% of valves. In 33% of stenotic valves were present infiltrations by lymphocytes. We found a significant correlation (p less than 0.05) between the presence of lymphoid infiltrates and the duration of disease prior to surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of cardioplegic arrest (single or multidose cardioplegia) and subsequent long-term cold storage on myocardial high energy phosphate content was studied in 29 dogs divided into 6 groups of experiments. Three cardioplegic solutions were tested: Bretschneider HTK (intracellular-type solution), St. Thomas' Hospital and N.I.H. solutions (both extracellular-type solutions). In group I, II and III single dose cardioplegic arrest with respectively St. Thomas' Hospital, Bretschneider HTK and N.I.H. solutions was carried out and excised hearts were stored at 0.5 degrees C for 24 hours. In group IV-Bretschneider HTK and in group V-N.I.H. solutions were used for cardioplegic arrest and intermittent perfusion of the cooled hearts at 4, 8 and 12 hours of storage (multidose cardioplegia). In group VI, after cardioplegic arrest with Bretschneider HTK solution, different temperatures of storage (0.5 degrees C, 12 degrees C and 18 degrees C) were studied. Myocardial content of ATP and creatine phosphate was evaluated by means of bioluminescence techniques from serial left ventricular biopsies taken prior to aortic cross-clamping and after 1, 2, 3, 4, 5, 6, 8, 10, 12 and 24 hours. In group I ATP was significantly lower than in groups II and III after 6 h (p less than 0.005). After 24 hours of storage ATP-levels were significantly higher (p less than 0.05) after multidose Bretschneider HTK cardioplegia or N.I.H. cardioplegia than after single dose N.I.H. or St. Thomas' cardioplegia. There was no significant difference in ATP content between multidose Bretschneider and multidose N.I.H. cardioplegia.(ABSTRACT TRUNCATED AT 250 WORDS)

Currently, for practical clinical purposes, the preservation of donor hearts is limited to about 4 h. Transplantation must be finished within this period to assure complete functional recovery upon reperfusion. From the clinical setting it is well known that hypothermia results in a better myocardial preservation during ischemia. During ischemia, rapid catabolism of high-energy phosphates (e.g., ATP and creatine phosphate) occurs. The purpose of this study was to investigate the influence of temperature during a 24-h preservation period on the rate of catabolism of ATP and on the rate of accumulation of breakdown products (ADP, AMP, adenosine, inosine, hypoxanthine, and xanthine). For this purpose, hearts were excised and stored for 24 h at 0.5 degrees, 12 degrees, or 18 degrees C. In addition, the effect of initial cardioplegic arrest was compared with simple normothermic excision of the heart followed by 24 h in cold storage. It was found that the higher the storage temperature, the higher the rate of catabolism of high-energy phosphates and, hence, after 24 h, the lower the final ATP level and the higher the level of breakdown products, mainly nucleosides. It was also found that the initial cardioplegic arrest strongly benefits the preservation of high-energy phosphates as a result of the ATP-sparing effect.

Long-term preservation of dog hearts was performed over 24 h using Bretschneider-HTK cardioplegia and cold storage. Preservation was assessed in terms of conservation of myocardial tissue levels of high-energy phosphates (HEP) and functional outcome after cardiac transplantation. Serial left ventricular biopsies were taken and analysed for ATP, ADP, AMP, adenosine, inosine, hypoxanthine, xanthine and creatine phosphate. Myocardial structure was studied by electron microscopical examination of a similar biopsy specimen. Cardiac performance was measured before and after cardiac transplantation. Several techniques of cardioplegic arrest were studied: single dose cardioplegia, multidose cardioplegia and continuous perfusion with the cardioplegic solution. In all groups, the hearts were stored at 0.5 degree C for 24 h. In the group of single dose Bretschneider-HTK cardioplegia, myocardial ATP content after 24 h of cold storage was only 25% of control. The total sum of nucleotides at that time interval was however 65% of the control value. Reperfusion of these hearts using a support dog (whole blood reperfusion) did not result in any recovery of ATP. Creatinine phosphate however showed an overshoot. Accumulated nucleosides were washed out. The hearts showed electrical activity but were severely arrhythmic. Contractility was poor. In the group of multidose Bretschneider-HTK cardioplegia, HEP preservation was better than after single dose cardioplegia. ATP content was about 50% of control. The total sum of nucleotides was 85% of control. Ultrastructural assessment of the myocytes revealed only slight ischaemic damage to the mitochondria. Reperfusion on cardiopulmonary bypass after cardiac transplantation did not show any restoration of ATP, but a steady catabolism of HEP. The nucleosides adenosine and inosine were not washed out upon reperfusion. After cardiac transplantation, none of these hearts could be weaned from cardiopulmonary bypass due to irreversible low cardiac output. Histological examination demonstrated irreversible myocardial tissue damage. In the group of continuous cold Bretschneider cardioplegia, HEP content was completely preserved throughout the 24 h of perfusion. Ultrastructure of the myocytes was normal. Reperfusion of the transplanted hearts showed a mild breakdown of ATP to 70% of control values accompanied by a slight accumulation of nucleosides. Haemodynamic recovery however was perfect and none of the hearts needed positive inotropic support. Myocytes after reperfusion had a normal subcellular appearance.(ABSTRACT TRUNCATED AT 400 WORDS)

Guzy środpiersia są najcześciej bezobjawowe i najcześciej wykrywane na przypadkowym radiogramie klatki piersiowej. Dokladna diagnostyka jest bardzo trudna i czesto nie jest mozliwe otrzymanie dokladnego rozpoznania bez diagnostyki inwazyjnej. W Klinice Torakochirurgii AM w Poznaniu od marca 1995 r. do maja 1998 bylo 80 pacjentow leczonych z powodu guzow środpiersia. 75% guzow bylo niezlośliwych (grasiaczki, przerost grasicy, wola zamostkowe, torbiele i inne), reszta miala charakter zlośliwy (chloniaki, zlośliwe grasiczaki i inne). Wiekszośc zabiegow (80%)moglo byc polączone z radykalnym usunieciem guza, pozostale byly zabiegami diagnostycznymi. 95% pacjentow z grasi-czakami lub przerostem grasicy przedstawialo kliniczne i elektrofizjologiczne objawy nuzliwości mieśni. Dojście chirurgiczne w 90% bylo podjete metodą klasyczną (toraktomia lub sternotomia), tylko w 10% udalo sie zastosowac procedure mniej inwazyjną – wideotorakoskopie. Wśrod powiklan byl jeden przypadek ARDS i jedno uszkodzenie nerwu przeponowego. Nie bylo przypadku zgonu w okresie okolooperacyjnym. Wnioski 1. Wiekszośc guzow środpiersia wykrytych na RTG klatki piersiowej jest niezlośliwych. 2. Obecne uzywane zabiegi diagnostyczne najcześciej nie dają wyniku dodatniego i ostateczne rozpoznanie musi byc ustalone przez zabieg operacyjny. 3. Tymectomia byla w 65% przypadkow skuteczna w leczeniu objawow nuzliwości mieśni. 4. Procent zabiegow o mniejszej inwazyjności (wideotoraskopia) bedzie mial tendencje wzrostową jako procedury diagnostyczna i lecznicza.