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1
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Neuroendocrine Carcinoma Responsible For Gastrointestinal Tract Perforation

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Domurat M., Juchimiuk M., Kędra B.
Polish Journal of Surgery
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2010
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vol. 82
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issue 10
577-580
EN
In terms of their clinical and histopathologic presentation, neuroendocrine gastrointestinal tumours constitute an extremely diversifed group of malignancies and thus are difficult to diagnose. Late and often accidental diagnosis means a multistage therapeutic process. The authors present the case of a 78-year-old female patient with clinical symptoms of visceral perforation followed by diffuse peritonitis. The patient was immediately operated. Intraoperative presentation revealed annular narrowing of the intestinal lumen by a tumour located in the cecum just above Bauhin's valve. The free tenia was microperforated in the described lesion area and had been the primary cause of diffuse fibrinous and pyogenic peritonitis. In addition, choleliths were found in the gallbladder. Right hemicolectomy with regional lymphadenectomy and cholecystectomy were performed. No postoperative complications. Histopathologic examination of resected specimen returned carcinoma neuroendocrinale. The authors argue, that the uncommon clinical course and circular, closing growth of the small cecum-located tumour with coincident perforation may originally suggest non-epithelial disease background.
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Cecal Volvulus as a Rare Cause of Intestinal Obstruction

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Bandurski R., Zaręba K., Kędra B.
Polish Journal of Surgery
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2011
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vol. 83
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issue 9
515-517
EN
Caecal volvulus is very rare causa of the intestinal obstruction. It ocures in 1- 1,5% of all intestinal obstructions. It is known that there is only on treatment in this situation which is surgery. It is classified as an obstruction because of strangulation.We present a case of the 46 year old patient, who was operated because of intestinal obstruction. During the operation caecal volvulus has been found, with gangrene of the appendices.
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Rare Case of Multifocal (Adrenal and Extra - Adrenal ) Myelolipoma

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Bandurski R., Zaręba K., Kędra B.
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vol. 85
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issue 6
348-350
EN
Adrenal myelolipoma is an extremely rare lesion, which is composed of adipose and hematopoetic tissue. The above-mentioned lesion was first described by Gierke in 1905, with the term myelolipoma used for the first time by Oberling in 1929. The Authors of the study presented a case of a 57 year-old female patient diagnosed with a multifocal adrenal and extra- adrenal myelolipoma.
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Assessment of the accuracy of preoperative imaging methods in the diagnosis of hepatic single-chamber echinococcosis

100%
Hołody-Zaręba J., Zaręba K. P., Kędra B.
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vol. 85
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issue 12
693-698
EN
Echinococcosis is an infectious disease, caused by larval stages of cestode species of the genus Echinococcus. The course of the disease is determined on the basis of the location and larval size. In 80-95% of cases echinococcosis is located in the liver and lungs, rarely in the brain. Symptoms are usually uncharacteristic for an uncomplicated disease. The diagnosis of echinococcosis is based on imaging and immunodiagnostic tests. The aim of the study was to assess the accuracy of preoperative imaging methods in the diagnosis of hepatic single- chamber echinococcosis. Material and methods. Amongst the 110 patients with hepatic cysts diagnosed during the period between 2000 and 2009, a group of 30 subjects with suspicion of single-chamber echinococcosis (ultrasound and CT) was isolated. The imaging methods visualized structures typical for hydatid cysts: the mother cyst with satellite cysts called “ honeycomb appearance”, cysts with calcified walls and compartments, and endocyst separation called “water lily-sign”. The study group comprised 22 female and 8 male patients with an average age of 52±16.2 years. The histopathological examination of the excised cyst verified the diagnosis. Results. Single-chamber echinococcosis was finally recognized in 19 cases, while in the 11 remaining cases the parasitic disease was excluded. The sensitivity of imaging methods was estimated at 73.7%, specificity - 88.9%, negative predictive value - 61.5%, positive predictive value - 93.3%, Youden`s factor - 0.626, and Φ index - 0.586. Conclusions. In conclusion, the presence of an unilocular cyst with an uniform anechoic content can be a simple cyst or single-chamber echinococcus cyst. The typical, characteristic image of a hydatid cyst, such as the “water lily-sign” is rarely observed during imaging examinations. It has also been shown that cystic calcification, observed during ultrasonography and computed tomography was evidence of the parasitic character of the lesion.
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Acute Inflammation of the True Cecal Diverticulum - Case Report

100%
Kamocki Z., Jaroszuk J., Zaręba K., Kędra B.
Polish Journal of Surgery
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2011
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vol. 83
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issue 8
461-464
EN
In this case report, we describe a rare event: acute inflammation of the true cecal diverticulum. Emergency surgery enabled proper diagnosis and management of this condition. Diagnostic approaches and the management of this disease are described in detail and based on literature review. In conclusion, pathologies of cecal diverticula should be considered in differential diagnosis of pain in the right iliac fossa.
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Young Patient Age as the Cause of Delayed Diagnosis of Gastrointestinal Carcinoma

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Zaręba K., Bandurski R., Kędra B.
Polish Journal of Surgery
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2012
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vol. 84
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issue 6
317-321
EN
Most patients diagnosed with gastrointestinal carcinomas are older people. The above-mentioned fact may lead to an erroneous finding that the problem does not concern patients aged between 20 and 30 years. Unfortunately, this assumption is often the reason for late diagnosis and delayed treatment of these malignancies. The study presented an example of three patients subject to surgical management of gastrointestinal carcinomas at the II Department of General and Gastroenterological Surgery, Medical University in Białystok.
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Problem of the Insulin Resistance in Surgery

100%
Zaręba K., Kamocki Z., Kukliński A., Kędra B.
Polish Journal of Surgery
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2011
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vol. 83
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issue 5
287-291
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Assessment of Activity of an Adhesion Molecule CD134 and CD137 in Colorectal Cancer Patients

88%
Cepowicz D., Gryko M., Zaręba K., Stasiak-Bermuta A., Kędra B.
Polish Journal of Surgery
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2011
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vol. 83
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issue 12
641-645
EN
Epidemiological studies prove that incidence of colorectal cancer is increasing. The first line therapy of colorectal cancer is surgical resection of the primary tumor and elimination of regional and remote metastases.The aim of the study was to determine expression of adhesion molecules CD134 and CD137 in the peripheral blood in colorectal cancer patients, depending on clinical cancer stage, size and invasion of the tumor.Material and methods. The study enrolled 72 patients with primary colorectal adenocarcinoma. An average patient age was 64.55 years. Clinical tumor stage was assessed using two scales: Dukes: A and Astler-Coller scale. Expression of adhesion molecules was determined in the peripheral blood collected on the day of the procedure and 10 days after the procedure.Results. An average activity of CD134 molecules (12.66%) was significantly higher than that of CD137 (6.26%) (p<0.001). Clinical tumor stage was assessed on Dukes scale and was unrelated to CD134 activity, while activity of CD137 was related to clinical cancer stage.Conclusions. CD137 activity is directly proportional to colorectal cancer stage. Surgical resection of the tumor results in increased CD134 and CD137 expression. Long term studies, enrolling larger groups of patients, including their subdivision to colon and rectal cancer, are required to utilize CD134 and CD137 in immune therapy of colorectal cancer.
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Determination of the Activity of CD134 (OX-40) and CD137 (4-1BB) Adhesive Nolecules by Means of Flow Cytometry in Patients with Colorectal Cancer Metastases to the Liver

88%
Cepowicz D., Zaręba K., Gryko M., Stasiak-Bermuta A., Kędra B.
Polish Journal of Surgery
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2011
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vol. 83
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issue 8
424-429
EN
Colorectal carcinoma (CRC) is one of the most common reasons of mortality in patients diagnosed with neoplasms. In nearly 20% of patients with colorectal carcinoma metastatic lesions are diagnosed. In general, survival of patients with metastatic lesions to the liver and other organs is poor. Conventional therapy of colorectal carcinoma is based on the surgical excision of the tumor, chemotherapy, and radiotherapy.The aim of the study was to determine the expression of CD134 and CD137 molecules inside the tumor, at the border of the tumor, in the healthy tissue, and peripheral blood, considering patients with colorectal carcinoma metastases to the liver.Material and methods. The study group comprised 39 patients subject to surgical treatment at the Department of General and Gastroenterological Surgery, due to colorectal carcinoma with liver metastases. CD134 and CD137 adhesive molecule levels were determined inside the tumor, at the border of the tumor, and in the healthy margins of the surgical incision. Additionally, the authors evaluated the peripheral blood level of the above-mentioned molecules on the day of the surgical procedure, and 10 days, thereafter.Results. The mean CD134 levels were the highest inside the tumor, significantly decreasing towards the direction of healthy tissues. The average peripheral blood molecule levels were four-fold higher on the day of the surgical procedure, as compared to values obtained on the tenth postoperative day. This dependency also concerned the remaining statistical measures.The mean CD137 levels showed no significant difference, regardless their location. The authors observed significant, peripheral blood, CD137 level differences, considering the day of the surgical procedure and tenth postoperative period. The mean CD137 peripheral blood level was several times higher on the day of the surgical procedure, as compared to the postoperative period.Conclusions. The determination of the activity of CD134 and CD137 molecules might create opportunities to plan treatment and predict prognosis in case of colorectal carcinoma. Proper immuno-therapeutic management which is based on the expression of the above-mentioned molecules might help determine the risk of metastases, preventing from their development. In advanced cases treatment of liver metastases might be possible.
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Double Tract Reconstruction (DTR) - An Alternative Type of Digestive Tract Reconstructive Procedure After Total Gastrectomy - Own Experience

76%
Bandurski R., Gryko M., Kamocki Z., Okulczyk B., Zaręba K., Piotrowski Z., Kędra B.
Polish Journal of Surgery
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2011
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vol. 83
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issue 2
70-75
EN
The only proven, effective therapy in case of the gastric cancers is surgery.The aim of the study. The most common procedure which is made in such a situation is total resection of the stomach. In our publication we would like to present and to recommend a very rare made type of the reconstructive procedures after total gastrectomy, which is called "double tract reconstruction" (DTR). This type of reconstruction is occasionally made mainly in Japan.Material and methods. Double tract reconstruction has been made in 2nd Department of General and Gastroenterological Surgery since 2000. Till today 75 patients were treated with this method.Results. The frequency of complications after double tract reconstruction was occasional, and there were no differences between this procedure and Roux-en-Y method of the reconstruction. There were no differences in the time of the operation between this two methods. The most important advantage of this method is that duodenal passage is extant. Because of that the endoscopic examination of papilla Vateri can be made.Conclusions. We would like to recommend this method as an alternative to Roux-en-Y procedure because of its simplicity and safeness.
11
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Ectopic Pancreas Imitating Gastrointestinal Stromal Tumor (GIST) In The Stomach

76%
Zińczuk J., Bandurski R., Pryczynicz A., Konarzewska-Duchnowska E., Kemona A., Kędra B.
Polish Journal of Surgery
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2015
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vol. 87
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issue 5
268-271
EN
Ectopic pancreas is a rare congenital disorder defined as pancreatic tissue lacking vascular or anatomic communication with the normal body of the pancreas. Most cases of ectopic pancreas are asymptomatic, but it may become clinically evident depending on the size, location and the pathological changes similar to those observed in case of the normal pancreas. It is often an incidental finding and can be located at different sites in the gastrointestinal tract. The most common locations are: the stomach, duodenum or the proximal part of small intestine. The risk of malignancy, bleeding and occlusion are the most serious complications. Despite the development in diagnostics, it still remains a challenge for the clinician to differentiate it from neoplasm. In this report, we described a case of 28-years old woman who presented recurrent epigastric pain. The upper gastrointestinal endoscopy revealed gastrointestinal stromal tumor on the border of the body and antrum of the back wall of great curvature of the stomach. The histopathological examination after surgery showed heterotopic pancreatic tissue. Ectopic pancreas should be considered in the differential diagnosis of gastric mass lesions.
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Relationships between Insulin-Like Growth Factor I and Selected Clinico-Morphological Parameters in Colorectal Cancer Patients

76%
Kukliński A., Kamocki Z., Cepowicz D., Gryko M., Czyżewska J., Pawlak K., Kędra B.
Polish Journal of Surgery
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2011
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vol. 83
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issue 5
250-257
EN
Insulin Like Growth Factor (IGF I) as the one of the strongest growth factors which can affect cancers development including colorectal cancer. IGF I induces processes of the cells growth and division. It regulates cells cycle and inhibits apoptosis. There is limited data about correlation between IGF I and staging of the tumor.The aim of the study was estimation of the clinical usefulness of IGF I concentration in the serum of the patients with colorectal cancer.Material and methods. We have examined 125 individuals with colorectal cancer. The age range was 36 to 92 years. They have been operated in the 2nd Departament of The Gastrointestinal Surgery of the Medical University in Białystok. Serum concentration of the IGF I have been estimated using immunoassay ELISA before and after operation. Correlation between serum level of IGF I and clinicopathologic features: age, gender, localisation of the primary tumor, TNM stage of tumor, histological type and histological grade (G) of the cancer have been estimated.Results. Our study revealed statistically significant increased serum concentration of IGF I in patients with locally advanced colorectal cancer (pT3 and pT4) comparing to less advanced (pT2) The investigations showed higher serum concentration of IGF I in patients with poorly differentiated cancers (G3) than in moderately differentiated. Similarly higher serum concentration of IGF I were found in male, in patients older than 60 years and in mucigenous colorectal cancers.Conclusions. Our results indicated that IGF I can be one of the factors of the prognosis in colorectal cancer development.
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