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Vaginal cancer is a rare neoplasm and in about 65% to 90% of cases it is a metastatic one. It is diagnosed in women aged from 60 to 70 years, but it can also appear in younger patients. Squamous cell carcinoma is the most frequently found histopathological type. Risk factors for the development of vaginal cancer are thought to be similar to those of cervical cancer. We present a case of a 52-year old woman with vaginal cancer treated with brachytherapy. Due to neoplasm recurrence, additional examinations were performed in the course of one year. The patient was qualified for total pelvic exenteration. A leakage from the abdominal wound was observed post operatively. It was successfully noninvasively treated. In 3 months time she was hospitalized because of the superficial abdominal abscess which was located next to the left ureterostomy. The patient undergoes regular gynecological, surgical and urological control examinations. So far the results do not show any recurrence of the neoplastic process. Total pelvic exenteration should be considered in selected groups of patients.

Solitary rectal ulcer syndrome (SRUS) is a chronic, benign, polymorphic disease of the rectum, the final diagnosis of which is based on histopathologic criteria. Microscopic examination shows glandular changes, oedema and obliteration of the normal architecture in the region of the lamina propria, with muslce fibre penetrating into lamina. Although SRUS pathogenesis is bound up with defecation disorder, it still remains unclear. Disease symptoms are nonspecific--in most cases defecation disorders appear (incomplete defecation, blood and mucus in stool). In some patients emotional disorders can be observed. SRUS treatment is a complex and long-lasting process. Usually it is ineffective or gives only passing effects. SRUS can often be accompanied by rectal prolapse, sometimes a hidden one. In these cases there are more therapeutic possibilities and the prognosis is slightly better. There is no method of choice for SRUS treatment and the prognosis is hard to predict. The treatment should be selected individually, depending on the symptoms intensity and the occurrence of rectal prolapse.

Madelung's disease (Md) is a rare metabolic disorder which presents with multiple symmetrical nonencapsulated fatty masses situated mainly around the head, neck and nape. The main indications for Md treatment are: shortness of breath, head's movement restrictions, swallowing disorders (dysphagia), aesthetic considerations, and the fear of cancer. The standard treatment of Md is the surgical excision of pathological tissues. The disease is progressive, relapses after removal of tissue are often observed. The discussion is based on a three-year observation of Md patient operated by the authors. A good cosmetic result and symptoms subsidence were observed. There were no sings of disease recurrence.

The paper presents a rare case of jejunum adenocarcinoma at a 66-year old female. The patient was admitted to the hospital due to not characteristic abdominal pain and periodical nausea and vomitting lasting few months. After realized laboratory investigation, especially on the basis of contrast, radiological procedure of the gastrointestinal tract, the high obstruction was detected. Then the patient has been operated on. Postoperative period proceeded without complications. Eleven monthly observation after the operation showed no recurrence of cancer. The presented case confirms vole of contrast radiological procedure of the gastrointestinal tract, which is simple and generaly available examination, in the diagnosis of bowel obstruction. The correct interpretation of the result was an indication of surgical intervention. However the final diagnose is established on the base of postoperative histopatological examination.

Classical performance of bile duct exploration is always strictly connected with the problem of an incised bile duct closure. In majority of surgical centers an external T-tube drainage was carried out in last century. But is an external drainage the best method to be used? The aim of the paper was to establish criteria for including (or excluding) patients to groups undergoing primary suture of bile duct. The comparison of the patients in whom bile duct exploration was followed by primary suture with the group in which T-tube was left in bile duct lumen was performed. Recently in our Department a classical method has been used to operate on 65 patients with cholelithiasis. In 42 patients a preoperatively planned bile duct exploration has been performed. In 14 patients a T-tube was left after the exploration, in 24 patients bile duct was closed with a primary suture. In other 18 patients with residual and recurrent bile duct stones T-tube was left in bile duct only in two patients. Based on literature analysis, our observations, and surgical experience criteria for including and excluding patients for primary suture of bile duct have been established. Groups of patients with and without T-tube were compared, considering complications and economic aspects of hospitalization. Our opinion is that whenever in specialized surgical centers detailed criteria are established and followed precisely, primary bile duct closure is a simple and safe procedure, responsible for few complications. The cost of hospitalization in the case of primary suture is half as much as the price of the hospitalization in the case of T-tube.

103 consecutive hospitalized patients at the age from 23 to 87 years with mechanical jaundice are presented in this study. In 58 patients, a cause of the jaundice was ductal calculosis, in four, a damage to bile duct after cholecystectomy. In 43 patients (74%), a calculus was removed through endoscopy, in 2 patients (4%) through Kehr's drain, 13 patients required an operation, in 41 patients, jaundice resulted from a neoplasm including 22 patients with a tumor of the head of pancreas, in 9 neoplasm of gall bladder, in 4 tumor of liver invagination, in 4 tumor of distal part of bile duct, in 2 neoplasm of Vater's papilla. 8 patients out of 28 with neoplastic tumor of pancreatoduodenal field had proximal pancreatoduodenectomy performed (29%). 1 patient out of 4 with a tumor of liver invagination had a tumor removed together with II and III segment of liver with the following right side hepatoenterostomy. No perioperational deaths were noted. In two patients after pancreatoduodenectomy (25%), a fistula in pancreatoenterostomy occurred. Due to the advanced stage of the neoplastic disease, resections in tumors of pancreatoduodenal fields and of liver invagination were only possible respectively in 29 and 25%. In most case of ductal calculosis or residual ductal calculosis, a removal of calculi was possible through endoscopy.

Pseudomyxoma peritonei is a rare disease leading to the accumulation of gelatinous masses in peritoneal cavity, usually secondary to neoplasmatic process of appendix or ovary. The authors describe a case report of 50 years old man with pseudomyxoma peritonei. Literature based discussion on prognostic difficulties and operative therapy perspectives in patients with this disease is presented.