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Purpose The variables possibly enabling the prediction of gastric wall thickness during laparoscopic sleeve gastrectomy remain undetermined. The aim of the study was to identify preoperative factors affecting gastric wall thickness in patients undergoing laparoscopic sleeve gastrectomy. Methods The measurements of the double-wall thickness of gastric specimen excised during sleeve gastrectomy were taken at three locations after 15 s of compression with an applied pressure of 8 g/mm2. Statistical calculations were used to determine the influence of preoperative weight loss and other perioperative parameters on gastric wall thickness. Results The study involved one hundred patients (78 female; 22 male). The thickest tissue was observed at the antrum with the mean value 2.55 mm (range 1.77–4.0 mm), followed by the midbody, mean 2.13 mm (range 1.34–3.20 mm), and the fundus, mean 1.69 mm (range 0.99–2.69 mm). Positive relationships were found between gastric wall thickness and both preoperative weight loss and age in all three measured locations; p Conclusion Preoperative weight loss should be considered an important factor influencing gastric wall thickness. Age and gender can also be helpful in predicting the varying tissue thickness. Anatomical region is a key factor determining thickness of the stomach walls.

Introduction: Correct surgical technique and perioperative care are two factors that can reduce the number of complications, improve treatment outcomes and shorten the length of hospital stay. The introduction of enhanced recovery protocols has changed the approach to patient care in some centers. However, there are significant differences among centers, and in some the standard of care has remained unchanged.Aim: the goal of the panel was to develop recommendations for modern perioperative care in accordance with current medical knowledge in order to reduce the number of complications associated with surgical treatment. An additional goal was to optimize and standardize perioperative care among Polish centers.Materials and methods: the development of these recommendations was based on a review of the available literature from the PubMed, Medline and Cochrane Library databases from January 1, 1985 to March 31, 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations were formulated in a directive form and were assessed using the Delphi method.Results and conclusions: 34 recommendations for perioperative care were presented. They cover aspects of pre-, intra- and post-operative care. Implementation of the presented rules allows to improve the results of surgical treatment.

Introduction The aim of the study is to assess the effect of shortening the excluded loop of the small intestine to 150 cm on the effectiveness of one anastomosis gastric bypass (OAGB) in remission of type 2 diabetes with Io obesity. Material and methods The study included 25 patients with a body mass index (BMI) 30–35 kg/m2, with a diagnosis of diabetes mellitus type 2 (T2DM), and undergoing OAGB with excluded 150 cm of the small intestine. Results There were no deaths in the study group, bleeding during the postoperative period requiring reoperation, anastomotic leakage/leakage throught mechanical stitching. The mean a glycated haemoglobin (HbA1C) level 12 months after surgery was 6.16 ± 0.96%, corresponding to a 2.29 ± 3.3% decrease. In more than 85% of the patients taking insulin before surgery, the insulin was discontinued in the postoperative period. Additionally, the level of glycaemia was assessed in patients on the day of surgery (163 ± 58 mg/dl) and on the day of discharge from the hospital (4.7 ± 1.3 days)—it was lower by over 18% (133 ± 39.2 mg). Over the period of 12 months following OAGB, there was a reduction in the mean BMI value from 33.5 ± 2 to 25.5 ± 2.5 kg/m2 and improvement in lipid parameters and mean values of blood pressure. Conclusion OAGB with excluded 150 cm of the small intestine has beneficial effect on the remission of T2DM in patients with a BMI of 30–35kg/m2 and is associated with an acceptable level of complications. The achieved weight loss after surgery is satisfactory.

Obesity in adults and its complications are among the most important problems of public health. The search was conducted by using PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases from January 2010 to December 2022 for English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from all over the world. Six main topics were defined in the joint consensus statement of the Polish Association for the Study on Obesity, the Polish Association of Endocrinology, the Polish Association of Cardio-diabetology, the Polish Psychiatric Association, the Section of Metabolic and Bariatric Surgery of the Society of Polish Surgeons, and the College of Family Physicians in Poland: (1) the definition, causes and diagnosis of obesity; (2) treatment of obesity; (3) treatment of main complications of obesity; (4) bariatric surgery and its limitations; (5) the role of primary care in diagnostics and treatment of obesity and barriers; and (6) recommendations for general practitioners, regional authorities and the Ministry of Health. This statement outlines the role of an individual and the adequate approach to the treatment of obesity: overcoming obstacles in the treatment of obesity by primary health care. The approach to the treatment of obesity in patients with its most common complications is also discussed. Attention was drawn to the importance of interdisciplinary cooperation and considering the needs of patients in increasing the long-term effectiveness of obesity management.

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).

Gastrooesophageal reflux disease is the regurgitation of stomach contents into the esophagus, which causes troublesome symptoms or complications for the patient. Before starting the treatment, it is always necessary to objectively confirm gastroesophageal reflux disease, especially in correlation with ENT symptoms, as extra esophageal complications. In diagnostics, the "gold standard" is a 24-hour impedance-pH supplemented with endoscopy. Treatment without objective confirmation of the disease is not recommended, the more so that non-acid gas proximal reflux, detectable only in the MIIpH test, causes the greatest number of laryngological complications. It is important to confirm the coexistence of clinical symptoms of GERD with ESS. Considering the time of treating the disease and its consequences, it is worthwhile to be cautious and careful with the diagnosis of the disease, and the treatment should be carried out for a long time in relation to the recommendation, preferably in cooperation with an ENT specialist and gastroenterologist. The greatest therapeutic effectiveness is achieved by combining PPI with itopride while maintaining the appropriate doses of drugs and observing a sufficiently long duration of treatment, while maintaining the correct dose reduction and drug discontinuation regimen. In case of failure of pharmacological treatment, antireflux surgery should be take into consideration.

Aim To evaluate the role of oxaliplatin in neoadjuvant chemotherapy delivered after short-course irradiation. Background Using oxaliplatin in the above setting is uncertain. Patients and methods A subgroup of 136 patients managed by short-course radiotherapy and 3 cycles of consolidation chemotherapy within the framework of a randomised study was included in this post-hoc analysis. Sixty-seven patients received FOLFOX4 (oxaliplatin group) while oxaliplatin was omitted in the second period of accrual in 69 patients because of protocol amendment (fluorouracil-only group). Results Grade 3+ acute toxicity from neoadjuvant treatment was observed in 30% of patients in the oxaliplatin group vs. 16% in the fluorouracil-only group (p = 0.053). The corresponding proportions of patients having radical surgery or achieving complete pathological response were 72% vs. 77% (odds ratio [OR] = 0.88; 95% confidence interval [CI]: 0.39–1.98; p = 0.75) and 15% vs. 7% (OR = 2.25; 95% CI: 0.83–6.94; p = 0.16), respectively. The long-term outcomes were similar in the two groups. Overall and disease-free survival rates at 5 years were 63% vs. 56% (p = 0.78) and 49% vs. 44% (p = 0.59), respectively. The corresponding numbers for cumulative incidence of local failure or distant metastases were 33% vs. 38% (hazard ratio [HR] = 0.89; 95% CI: 0.52–1.52; p = 0.68) and 33% vs. 33% (HR = 0.78; 95% CI: 0.43–1.40; p = 0.41), respectively. Conclusion Our findings do not support adding oxaliplatin to three cycles of chemotherapy delivered after short-course irradiation.

Background The aim of the study was to assess changes in body composition in patients subjected to laparoscopic sleeve gastrectomy (LSG). Methods Changes in body composition following LSG were determined in a group of 155 patients with obesity (117 women and 38 men), with dual-energy X-ray absorptiometry (DXA). Whole body fat mass (FM) and lean body mass (LBM) were determined, and abdominal fat mass (AbdF) was assessed within the region extending from the top of the pubic bone up to the line between 12th thoracic and 1st lumbar vertebras. Results Over the period of 12 months following LSG, body mass index decreased by 28.2 ± 9.0% (p p p p p p Conclusions Over the period of 12 months following LSG, the reduction of FM was more than twice as much as decrease of LBM. The loss of AbdF was slower than a loss of peripheral subcutaneous fat.

Estrogen affects adipose tissue function. Therefore, this study aimed at assessing changes in the transcriptional activity of estrogen receptor (ER) α and β genes (ESR1 and ESR2, respectively) in the adipose tissues of obese individuals before and after weight loss and verifying whether epigenetic mechanisms were involved in this phenomenon. ESR1 and ESR2 mRNA and miRNA levels were evaluated using real-time PCR in visceral (VAT) and subcutaneous adipose tissue (SAT) of 78 obese (BMI > 40 kg/m2) and 31 normal-weight (BMI = 20–24.9 kg/m2) individuals and in 19 SAT samples from post-bariatric patients. ESR1 and ESR2 methylation status was studied using the methylation-sensitive digestion/real-time PCR method. Obesity was associated with a decrease in mRNA levels of both ERs in SAT (p < 0.0001) and ESR2 in VAT (p = 0.0001), while weight loss increased ESR transcription (p < 0.0001). Methylation levels of ESR1 and ESR2 promoters were unaffected. However, ESR1 mRNA in the AT of obese subjects correlated negatively with the expression of hsa-miR-18a-5p (rs = −0.444), hsa-miR-18b-5p (rs = −0.329), hsa-miR-22-3p (rs = −0.413), hsa-miR-100-5p (rs = −0.371), and hsa-miR-143-5p (rs = −0.289), while the expression of ESR2 in VAT correlated negatively with hsa-miR-576-5p (rs = −0.353) and in SAT with hsa-miR-495-3p (rs = −0.308). In conclusion, obesity-associated downregulation of ER mRNA levels in adipose tissue may result from miRNA interference.

The growing number of primary bariatric operations has led to an increase in demand for revision surgeries. Higher numbers of revisional operations are also observed in Poland, yet their safety and efficacy remain controversial because of a lack of current recommendations and guidelines.To review risk factors influencing perioperative morbidity.A retrospective study was conducted to analyze the results of surgical treatment among 12 Polish bariatric centers. Inclusion criteria were laparoscopic revisional bariatric surgeries and patients ≥18 years of age. The study included 795 patients, of whom 621 were female; the mean age was 47 years (range: 40-55 years).Perioperative morbidity occurred in 92 patients (11.6%) enrolled in the study, including 76 women (82.6%). The median age was 45 years (range: 39-54 years). Statistically significant risk factors in univariate logistic regression models for perioperative complications were the duration of obesity, revisional surgery after Roux-en-Y gastric bypass (RYGB) or adjustable gastric band (AGB), difference in body mass index before revisional surgery and the lowest achieved after primary surgery, and postoperative morbidity of the primary surgery as the cause for revisional bariatric surgery. These factors were included in the multivariate regression model. Revisional surgery after AGB (odds ratio [OR] = 2.18; 95% confidence interval [CI]: 1.28-3.69; P = .004), revisional surgery performed after RYGB (OR = 6.52; 95% CI: 1.98-21.49; P = .002), and revisions due to complication of the primary surgery (OR = 1.89; 95% CI: 1.06-3.34; P = .030) remained independent risk factors for perioperative morbidity.Revisional operations after RYGB or AGB and those performed because of postoperative morbidity after primary surgery as the main cause for revisional surgery were associated with a significantly increased risk of postoperative morbidity.

Treatment of perianal fistulizing Crohn’s disease is demanding and burdened with a high percentage of failures, which forces clinicians to search for new, more effective therapeutic options. One of these options is the use of adipose-derived mesenchymal stem cells in local administration. Due to their multipotentiality and complex mechanism of action, stem cells are the promising new therapeutic approach for the treatment-refractory complex perianal fistulas - demonstrating both high efficacy and a favorable safety profile. The paper presents current knowledge on the mechanisms of action and manner of administration of mesenchymal stem cells, as well as the effectiveness and safety of their use in the treatment of perianal Crohn's disease based on available literature.

Despite the growing experience of bariatric surgeons in performing laparoscopic sleeve gastrectomy, the number of complications involving staple line leaks remains constant. Hence a solution to avoid such complications is still sought. A defect of the staple line may be the consequence of an inappropriate choice of staple size in relation to gastric wall thickness. Due to the variable nature of gastric wall thickness, the choice of proper staple height is not obvious. In the few studies in which gastric wall thickness was measured, it was observed to decrease gradually from the antrum to the fundus. However, the authors are divided on the issue of whether gender and body mass index influence gastric wall thickness. The question whether there are other perioperative factors that would allow gastric wall thickness to be predicted remains unanswered.

Because the majority of antidiabetic medications are of limited efficacy and patient compliance with treatment is usually poor, new therapies are still being searched for. In the review a newly developed system for treatment of subjects with type 2 diabetes and concomitant overweight/obesity is described. The system consists of an implantable pulse generator that delivers electrical stimuli through leads implanted in the sero-muscular layer of the stomach. The device recognises and automatically modulates natural electrical activity of the stomach during meals, strengthening gastric contractility. This increase in the force of contractions enhances vagal afferent activity. Modulated signals are transmitted to the regulatory centres in the brain in order to provoke an early response of the gut typical of a full meal. Clinical trials performed to date show that the system improves glycaemic control with minimal patient compliance needed and with added benefits of body weight loss, a decrease in blood pressure, and favourable changes in the lipid profile. The system is safe, well-tolerated, with a low risk of hypoglycaemia, and will probably become an alternative to the use of incretins or to bariatric surgery in obese patients who are unwilling to undergo a major and anatomically irreversible operation.

BackgroundGoiter in its various clinical and histopathological forms is accompanied by an inflammatory process requiring intensive therapy. The thyroid gland is an organ specifically exposed to the microbial environment due to its close location to the mouth microbiome. A number of bacterial phenotypes has been detected in the inflamed thyroid gland. A question raises as to whether bacteria have not already been present in the thyroid gland before the clinical symptoms of goiter became evident.AimTo answer the questions: a) do the goiter tissue structures contain bacteria, b) if so, which bacterial phenotypes can be identified, c) what are the genetic similarities of the thyroid and periodontal bacterial strains.Material and methodsStudies were carried out in 60 patients with the non-toxic multinodular goiter in 40 cases, toxic multinodular goiter in 10, single adenoma in 3, Hashimoto’s disease with nodular changes in 4 and recurrent thyroid disease in 3. Tissue fragments harvested during surgery were placed on Columbia blood agar base enriched with 5% defibrinated sheep blood. In this method bacteria present in the tissue slowly proliferate in their in vivo transferred to ex-vivo environment, crawl out and form the on-plate colonies. It enables detection of single bacteria usually difficult in a standard planktonic culture.Resultsa) Coagulase-negative Staphylococci were shown growing on culture plates in above 50% of thyroid parenchyma, veins, arteries and adjacent lymphoid tissue specimens, b) tissue-originating colony-forming bacteria appeared on plates on day 3, but in some as late as after 12-21 days, c) all isolates were sensitive to the basic antibiotics, d) bacterial thyroid and oral DNA tests showed similarities indicating possibility of the oral origin, e) the on-plate time-prolonged cultures showed shrinking of the colonies and upon adding liquid medium formed the small variant colonies.ConclusionsThyroid gland tissues contained in above 50% of specimens the coagulase-negative Staphylococci. Over 88% similarity of the genetic pattern of Staphylococcus epidermidis strain from tooth, oropharyngeal and thyroid tissues, estimated with PCR MP technique, suggested their periodontium origin.

Introduction. Laparoscopic sleeve gastrectomy is one of the most commonly performed bariatric procedures. Despite the popularity of method, there still exist doubts as to the effect of the baseline characteristics of weight, sex of the patients undergoing surgeries and preoperative weight loss for the operative time and intraoperative blood loss. Aim. The aim of the study was to evaluate the impact of initial body weight parameters, gender of patients, and preoperative weight loss on the operative time of the laparoscopic sleeve gastrectomy and intraoperative blood loss. Material and methods. We have prospectively assessed data collected on 93 patients operated on due to morbid obesity in the period from January 2010 to April 2012. All of the patients underwent laparoscopic sleeve gastrectomy. In all cases, the staple line was reinforced with a continuous suture. The impact of gender of the surgical patients, weight loss before surgery, the initial weight and BMI on intraoperative blood loss and operative time were assessed. Results. Laparoscopic sleeve gastrectomy was performed in 93 patients. In any case, there was no conversion. The mean duration of the surgery was 123.1 ± 33.2 min (range: 60-270). Intraoperative blood loss was an average of 46.3 ± 71.6 ml (range: 0-400). There was no significant effect of any of the assessed factors on the operative time and intraoperative blood loss. Conclusions. Initial body mass index, weight, gender, weight loss before surgery do not have a material impact on the operative time of laparoscopic sleeve gastrectomy and intraoperative blood loss.

Introduction. Surgical treatment of obesity enables to obtain a permanent reduction in body weight and promotes resolution of comorbidities of obesity. We continue to seek surgical methods of an advantageous relationship of the obtained benefits and the risks associated with surgery. One-anastomosis gastric bypass is considered one of such methods by some authors. Aim. The aim of the study was to assess the effectiveness of one-anastomosis gastric bypass within weight loss parameters and the safety of the surgery, as based on own material. Material and methods. The paper presents an analysis of data collected prospectively from consecutive patients in whom one-anastomosis gastric bypass was performed in the period from November 2010 to May 2014. The efficacy of the one-anastomosis gastric bypass was assessed in terms of weight loss, the rate of hospital readmissions and complications. Results. One-anastomosis gastric bypass was performed in 39 patients. Mean %EBMIL was 100.2 ± 33.2% (range: 34.5-207.2), and mean %WL was 29.3 ± 8.1% (range: 15.3-49). In one case (2.6%), characteristics of dehydration were observed in the postoperative period. In another patient (2.6%), iron deficiency anemia was diagnosed. Marginal ulcers were noted in two cases (5.2%). Excessive weight loss occurred in one patient (2.6%). In 8 cases (20.5%), rehospitalization took place. Conclusions. One-anastomosis gastric bypass is associated with great efficacy in the reduction of weight and a low rate of early complications. Patients require constant supervision of the team conducting the treatment because of the possibility of the emergence of late complications.

Obesity and type 2 diabetes mellitus have reached epidemic proportions worldwide. As the majority of antidiabetic medications are of limited efficacy and patient adherence to long-term therapy is one of the main limiting factors of effective blood glucose and body weight control, new therapies are still looked for. The DIAMOND system seems to be one of the most promising among them. This system recognizes natural electrical activity of the stomach and automatically applies electrical stimulation treatment during/after eating with subsequent modulation of signals transmitted to the regulatory centers in the brain in order to provoke an early response of the gut typical of a full meal. We present the case of a 47-year-old obese woman with type 2 diabetes. During treatment with this system, serum glucose and hemoglobin A1c levels significantly decreased. Body weight loss and waist circumference reduction were observed. Additionally, beneficial effect on lipid profile was found.

Background Abdominal pain in chronic pancreatitis (CP) is the most common symptom with a highly unfavorable impact on the quality of life. It has been shown that bilateral thoracoscopic splanchnicectomy (BTS) may produce marked pain relief for the majority of patients. The aim of this study was to evaluate the effectiveness of BTS in pain control and quality-of-life improvement in patients with a severe form of CP. Methods Between April 2000 and April 2009, a total of 30 patients qualified for BTS due to CP-related pain. Their age ranged from 28 to 60 years. A 12-month follow-up period was planned for all the patients enrolled. To evaluate effectiveness of BTS, an 11-point Numeric Rating Scale (NRS) and the Quality of Life Questionnaire C-30 (QLQ-C30) in its basic form, developed by European Organization for Research and Treatment of Cancer, were used. An NRS value between 0 and 3 was considered a positive postoperative pain control result. Results The bilateral splanchnicectomy procedure was performed successfully in 27 of 30 qualified patients. A positive effect based on decreased pain (p

Because the majority of antidiabetic medications are of limited efficacy and patient compliance with treatment is usually poor, new therapies are still being searched for. In the review a newly developed system for treatment of subjects with type 2 diabetes and concomitant overweight/obesity is described. The system consists of an implantable pulse generator that delivers electrical stimuli through leads implanted in the sero-muscular layer of the stomach. The device recognises and automatically modulates natural electrical activity of the stomach during meals, strengthening gastric contractility. This increase in the force of contractions enhances vagal afferent activity. Modulated signals are transmitted to the regulatory centres in the brain in order to provoke an early response of the gut typical of a full meal. Clinical trials performed to date show that the system improves glycaemic control with minimal patient compliance needed and with added benefits of body weight loss, a decrease in blood pressure, and favourable changes in the lipid profile. The system is safe, well-tolerated, with a low risk of hypoglycaemia, and will probably become an alternative to the use of incretins or to bariatric surgery in obese patients who are unwilling to undergo a major and anatomically irreversible operation.

Background:Early recognition of patients who have developed anastomotic leakage (AL) after colorectal surgery is crucial for the successful treatment of this complication. The aim of this study was to assess the usefulness of the assessment of procalcitonin (PCT) and interleukin-6 (IL-6) levels in the prognosis of AL.Methods:This observational study included 157 patients who underwent major elective colorectal surgery. The most common indications for surgery were cancer and inflammatory bowel diseases. Serum samples were obtained directly before surgery (D0) and 1 day (D1) after surgery, and the relationships between the serum concentrations of PCT and IL-6 and development of AL were assessed.Results:In total, 10.2% of patients developed post-surgical infections due to AL. PCT levels on D1 were significantly higher in patients who developed AL [2.73 (1.40–4.62)] than in those who recovered without complications [0.2 (0.09–0.44)]. The area under the ROC curve for PCT on D1 was 0.94, 95% CI (0.89–0.98). The sensitivity and specificity of the prediction of an infection were 87% and 87%, respectively, for PCT on D1, which was higher than 1.09 ng/mL. The increase in PCT concentration between D0 and D1 was significantly higher in patients with AL (pConclusions:This study confirms that surgical trauma increases serum PCT concentrations and that the concentration of PCT on D1 can predict AL after colorectal surgery. However, IL-6 is not a good early marker for developing AL.

Background Whether there is any benefit derived from adding oxaliplatin to fluoropyrimidine-based preoperative chemoradiation is currently unknown in cases of advanced cT3 or cT4 tumours. Our aim was to evaluate this issue by analysing a randomized trial, which compared two schedules of preoperative treatment (chemoradiation vs. 5 × 5 Gy with 3 cycles of consolidation chemotherapy) for cT4 or fixed cT3 rectal cancer. Patients and methods Delivery of oxaliplatin was mandatory to the first part of the study. For the second part, its delivery in both treatment-assigned groups was left to the discretion of the local investigator. We analysed a subgroup of 272 patients (136 in the oxaliplatin group and 136 in the fluorouracil-only group) from institutions that had omitted oxaliplatin in the second part of the study. Results Circumferential resection margin negative (CRM−) status rate was 68% in the oxaliplatin group and 70% in the fluorouracil-only group, p = 0.72. The pathological complete response rate (pCR) was correspondingly 14% vs. 7%, p = 0.10. Following multivariable analysis, when comparing the CRM− status in the oxaliplatin group to the fluorouracil-only group, the odds ratio was 0.79 (95 CI 0.35–1.74), p = 0.54; there being no interaction between concomitant chemoradiation and 5 × 5 Gy with consolidation chemotherapy; p interaction = 0.073. For pCR, the corresponding results were 0.47 (95 CI 0.19–1.16), p = 0.10, p interaction = 0.84. Conclusion No benefit was found of adding oxaliplatin in terms of CRM nor pCR rates for either concomitant or sequential settings in preoperative radiochemotherapy for very advanced rectal cancer.

Source of support: Departmental sources Summary Background: The frequency of foreign body retention in the abdominal cavity ranges from 1 in 100 to 1 in 3000 surgeries performed. Worldwide literature describes only a few cases of the migration of misplaced surgical gauze into the colon. Case Reports: The first case is a 60-year-old patient following laparoscopic cholecystectomy, who excreted (on his own) a cotton sheet 30×65 cm after 26 weeks, which did not possess a radiological locator. The latter fact caused diagnostic difficulties in interpreting ultrasonography, CT-scans and abdominal X-rays. Colonoscopy after 4 months following the excretion of the sheet showed flat, stretched ul ceration of the colonic wall near the hepatic turn. The second case is a 76-year-old who had undergone several abdominal surgeries, including a classical cholecystectomy and extirpation of the uterus along with related tissues, as a result of cancer and with subsequent radiotherapy. The reason for the last intervention was an occlusion, which required a resection due to abscesses inside the peritoneal cavity. Abdominal pain continued after the surgery. Uroscopy and abdominal X-rays were performed 3 months later, which confirmed the presence of foreign matter in the abdominal cavity. Conclusions: Most foreign objects that have migrated into the colon will be excreted autonomously, which warrants a conservative assessment. Radiologically-tagged materials should be used, which will greatly ease identification in cases of suspected retention of surgical materials in the abdominal cavity.

Introduction: Effective treatment with H2-blockers and proton pump inhibitors almost removed the necessity of elective surgical treatment of refractory peptic ulcer disease. Life-threatening complications of peptic ulcer still occur and patients with perforated peptic ulcer almost always need surgical treatment. Material and methods: Seventy-five consecutive patients aged 16-91 years (31 women and 44 men) operated on because of perforated peptic ulcer in our department between 1 January 2001 and 31 December 2009 were studied retrospectively. Results: The mean age was 51.5 ±20.5 years. Of the 75 pa tients, 34 (45.3%) had co-morbid disease, 14 (18.6%) presented with a delay of more than 24 h, 16 (21.3%) were older than 70 years and 25 (33.3%) were assessed as ASA grade 3 or more. Postoperative complications occurred in 19 patients (25.9%). Cardio-pulmonary failure (5 patients) and wound infection (4 patients) were the most common. The mean hospital stay of recovered patients was 7.7 days (3-38). Eleven (14.6%) patients died. Age above 70 years, presence of comorbid illness, presence of abdominal postoperative complications, American Society of Anesthesiologists (ASA) grade 3 or more, presence of shock on admission and gastric localisation of ulcer were identified as factors increasing risk of mortality. Conclusions: The incidence of perforated peptic ulcer among elderly patients, females in particular, is increasing. The number of patients with perforated peptic ulcer as the first symptom of peptic ulcer is increasing. Perforated peptic ulcer still involves high postoperative mortality. Streszczenie Wstep: Skuteczne leczenie lekami blokującymi receptory H2 oraz inhibitorami pompy protonowej spowodowalo prawie calkowity zanik wskazan do planowego leczenia operacyjnego choroby wrzodowej opornej na terapie. Ciągle jednak wystepują zagrazające zyciu powiklania choroby wrzodowej, a chorzy z przedziurawionym wrzodem trawiennym prawie zawsze wymagają leczenia operacyjnego. Material i metody: Analizowano retrospektywnie wyniki leczenia 75 chorych w wieku 16–91 lat (31 kobiet i 44 mezczyzn) operowanych w Klinice z powodu przedziurawionego wrzodu trawiennego od 1 stycznia 2001 r. do 31 grudnia 2009 r. Wyniki: Średni wiek chorych wynosil 51,5 ±20,5 roku. W grupie 75 badanych u 34 (45,3%) stwierdzono obecnośc chorob wspolistniejących, 14 osob (18,6%) operowano po uplywie 24 godz. od wystąpienia objawow przedziurawienia, 16 (21,3%) mialo wiecej niz 70 lat, a stan ogolny w stopniu ASA 3–5 oceniono u 25 chorych (33,3%). Powiklania pooperacyjne wystąpily u 19 badanych (25,3%). Niewydolnośc krązeniowo-oddechowa (5 chorych) i zakazenie rany (4 chorych) byly najczestszymi powiklaniami. Średni pooperacyjny pobyt w szpitalu osob wyleczonych wynosil 7,7 dnia (3–38 dni). Zmarlo 11 badanych (14,6%). Wiek powyzej 70 lat, obecnośc chorob wspolistniejących, obecnośc środbrzusznych powiklan pooperacyjnych, stan ogolny chorego oceniony jako 3–5 stopien ASA, obecnośc objawow wstrząsu podczas przyjecia do szpitala oraz przedziurawienie wrzodu zolądka byly czynnikami zwiekszającymi ryzyko zgonu chorego. Wnioski: Zwieksza sie wystepowanie przedziurawienia wrzodu trawiennego wśrod ludzi starszych, zwlaszcza kobiet. Wzrasta liczba osob, u ktorych przedziurawienie wrzodu jest pierwszym objawem choroby wrzodowej. Przedziurawienie wrzodu trawiennego obciązone jest duzą śmiertelnością.

The immune reaction of the peritoneum to growing gastrointestinal neoplasms remains unclear. We investigated mobilization of immune cells in peritoneal fluid of gastric and colon cancer, phenotypes and level of activation of recruited cells, and concentration of cellular and peritoneal fluid cytokines.Peritoneal cells (PCs) were obtained intraoperatively by peritoneal lavage from 18 patients with adenocarcinoma of the stomach and 32 patients with adenocarcinoma of the colon (all were stage T2N0M0) and 52 patients who underwent elective cholecystectomy as control subjects.The number of PCs harvested from cancer patients was 25 times greater than from control patients (P.001). In the patients with colon cancer, the percentage of CD68+ macrophages was 1.2 times, of CD14+ monocytes was 2.3 times, and of CD15+ granulocytes was 3 times greater than in control patients (all P.05). The percentage of HLA DR+ cells exceeded the control values by a factor of 2; and within this population, the percentage of CD3+ HLA DR+ cells exceeded control patients by a factor of 3 (P.05). The percentage of cytokine-producing cells was greater than in control patients, with values 2 times higher for interleukin (IL)-1, 2.5-times for IL-6, and 6-times for IL-8 (P.05). The concentration of IL-1 in peritoneal fluid exceeded control values by a factor of 2.2, of IL-6 by a factor of 5.0, of IL-8 by a factor of 3, and of monocyte chemotactic protein-1 by a factor of 2.0 (P.05). In the patients with gastric cancer, the values for mobilized PC granulocytes were 1.5 times greater than in control patients (P.05). The frequency rate of cytokine-producing cells remained close to control values. The concentration of peritoneal cytokines did not exceed normal values for IL-1 but was 4 times higher for IL-6 and 2 times higher for IL-8 and monocyte chemotactic protein-1 (all P.05). When the cancer groups were compared, there was evidently more activated myeloid- and cytokine-producing PC in the patients with colon cancer than in patients with gastric cancer. There was no correlation between the blood and PC phenotype frequency.Patients with T2N0M0 colon cancer and to lesser extent gastric cancer evoke a slight but measurable mobilization and activation of PCs.

The presence of oncogenic types of human papilloma virus (HPV) in location of the anus is related to anal carcinoma. However, there is little knowledge about the natural history of such infections in patients outside risk groups, its relation to cervical cancer, the risk of anal cancer development as well as any way to prevent it. There are no standard procedures in the case of finding of HPV-associated anal intraepithelial neoplasia in the perianal area. Case report describes an incidental finding of a highly oncogenic type of HPV discovered in a histopathological assessment of a 48-year old woman after a haemorrhoidectomy. This paper presents the approach taken for this patient in terms of diagnosis, treatment and methods of prevention of anal and cervical cancer development.

Ablacja migotania przedsionkow (AF) jest uznaną metodą leczenia tej arytmii. Z powodu bliskości anatomicznej tylnej ściany lewego przedsionka i przelyku istnieje ryzyko jego uszkodzenia, wlącznie z wytworzeniem przetoki przedsionkowo-przelykowej. Znane są takze zaburzenia czynnościowe przelyku wystepujące po zabiegu ablacji. Na Oddzial Kardiologii przyjeto 60-letniego pacjenta z objawowym, opornym na farmakoterapie AF w klasie EHRA 3 w celu wykonania ablacji prądem o wysokiej czestotliwości (RF) — okreznej izolacji zyl plucnych z powodu AF. Zaplanowano diagnostyke zaburzen czynnościowych przelyku przed i po ablacji. Wykonano gastroskopie, impedancje przelykową i manometrie przelykową. Badania te przeprowadzono u pacjenta 3 dni przed zaplanowaną ablacją oraz 3 i 30 dni po zabiegu. W manometrii przelykowej stwierdzono w kolejnych badaniach zmniejszenie średniego ciśnienia spoczynkowego w dolnym zwieraczu przelyku z 38,9 mm Hg (przed ablacją) do 17,8 mm Hg (3 dni po zabiegu). Po miesiącu od ablacji stwierdzono ponowny wzrost wartości średniego ciśnienia spoczynkowego w dolnym zwieraczu przelyku do 28,1 mm Hg. Redukcji napiecia spoczynkowego dolnego zwieracza przelyku towarzyszyl spadek wartości wskaźnika IRP, opisującego relaksacje dolnego zwieracza przelyku po wykonanym przelknieciu. Wskaźnik ten obnizyl sie z początkowego 8,71 mm Hg do 2,915 mm Hg stwierdzonego 3 dni po ablacji, a nastepnie po miesiącu od zabiegu wzrosl do 6,59 mm Hg. U pacjenta początkowo, podczas manometrii przelykowej stwierdzono 100% przelkniec prawidlowych, perystaltycznych. Po ablacji nastąpilo pogorszenie fali perystaltycznej ściany przelyku i zmniejszenia odsetka przelkniec prawidlowych do 65%. Po miesiącu od zabiegu zaobserwowano stopniową poprawe motoryki ściany przelyku i 85% przelkniec perystaltycznych. Upośledzonej perystaltyce ściany przelyku towarzyszylo zmniejszenie średniej amplitudy skurczow ściany przelyku z 89,5 mm Hg do 63,9 mm Hg. stwierdzanej tuz po ablacji i do 64,0 mm Hg miesiąc po zabiegu (ryc. 1). W impedancji przelykowej początkowo obserwowano niskie wartości wskaźnika DeMeestera (1,4) opisującego nasilenie refluksu zolądkowo-przelykowego. Wspolczynnik ten stopniowo wzrastal — do 2,2 podczas badania po 3 dniach od ablacji oraz do 3,4 stwierdzanych po miesiącu od zabiegu. Zwiekszyla sie rowniez calkowita liczba refluksow zolądkowo-przelykowych z 25 (przed zabiegiem) do 47 (3 dni po ablacji). Po miesiącu calkowita liczba refluksow wynosila 10. Zanotowano rowniez wzrost liczby epizodow refluksow niekwaśnych z 18 do 35 stwierdzanych 3 dni po ablacji. Po miesiącu ich liczba wynosila juz tylko 7 (ryc. 2). W gastroskopii wykonanej przed zabiegiem zaobserwowano zapalenie blony śluzowej zolądka i przepukline rozworu przelykowego przepony. Podobny obraz gastroskopowy utrzymywal sie w badaniach wykonanych 3 dni oraz miesiąc po zabiegu. Nie stwierdzono nasilenia zmian zapalnych ani wystąpienia nowych zmian w przelyku po ablacji. Podsumowując, przejściowe zaburzenia czynności przelyku, stwierdzone u opisywanego chorego i wystepujące prawdopodobnie u wiekszości pacjentow poddawanych ablacji AF, dodatkowo wskazują na koniecznośc zachowania szczegolnej ostrozności podczas aplikacji RF w obrebie tylnej ściany lewego przedsionka.