Morphometric features of the right atrioventricular orifice in adult human hearts

The normal data of the tricuspid valve complex is of great clinical importance in the light of progress in cardiosurgery and the development of novel operating techniques. A range of measurements for the right atrioventricular orifice in 96 human adult hearts was examined by means of anatomical dissection, inspection, examination, and statistical analyses. The length of the attachment of the anterior leaflet increased significantly between group I (aged 18-40 years) and group II (aged 41-64 years) in women only. In men there were no significant differences in this parameter between any of the three age groups. In addition, the attachment length of the posterior leaflet in women increased statistically in the second age group. In men, in contrast, the attachment length of the posterior leaflet did not increase significantly between the first and second age groups and became significantly larger only in oldest age group, consisting of men aged over 65. No statistically significant differences between the three age groups were found for the attachment length of the septal leaflet (p>0.05). In female hearts significant increases in the frontal and sagittal dimensions of the tricuspid valve orifice were observed between the second age group and the group aged over 65. In male hearts both the frontal and sagittal dimensions increased significantly with advanced age. The right atrioventricular orifice expressed as the ellipse area was statistically greater than the triangular area (p<0.01) in each age group. It should be noticed that both areas increased significantly during ageing. This study has demonstrated that the shape of the right atrioventricular orifice evolves during life, from a triangular shape to a more elliptical shape.

The morphometry of the accessory leaflets of the tricuspid valve in a four cuspidal model

The tricuspid valve is of great importance because of the progress made in operative techniques and invasive cardiology accidents. This structure is more differentiated during evolution than the mitral valve. Accessory leaflets, their frequency and role are still controversial, despite the fact that they have been known from the beginning of the 20th century. The number of leaflets in the tricuspid valve grows in an evolutionary line, but the rules governing their appearance are still not known. The samples were taken from a group of 107 human adult hearts. The four-cuspidal form of the tricuspid valve was used as the simplest model to show the appearance of accessory leaflets for anatomical and statistical examination. On the basis of the results of this study we conclude that the separation of accessory leaflets is a complex process.

The morphology and distribution of the tendinous chords and their relation to the papillary muscles in the tricuspid valve of the human heart

The tendinous chords of the tricuspid valve are the predominant type of connection between the papillary muscles and the tricuspid valve. Studies describing the evolutionary line of these connections are well known. The flexibility of particular leaflets of the tricuspid valve varies, as does the tension of the blood stream in particular cusps. The present study was performed on a group of 96 formalin-fixed adult human hearts, which ranged in age from 18 to 90 years and gave no evidence of congenital malformations or pathological changes. The valves were divided into five types according to earlier studies and analysis was made in terms of these types. The tendinous chords and their ramifications were counted. The surfaces of particular leaflets were measured. The ratio of marginal to ventricular leaflets was counted for each type of leaflet in particular types of valves. The parts of the main leaflets supported by specific papillary muscles were counted for types 1, 2 and 3. The number of tendinous chords decreased in leaflets in particular types of tricuspid valve, but the ratio of chords attached to the margins and ventricular surfaces was similar. The number of chords for the surface of leaflets (measured in mm2) was similar in particular types of valve for all cusps. The most differentiated were commissural chords in all types of valve. The ratio of chords attached to the margins and ventricular surfaces does not depend on the surface area of the leaflets.

Assessing nonlinear properties of heart rate variability from short-term recordings: are these measurements reliable?

Several parameters assessing nonlinear properties of heart rate variability (HRV) from short-term (<10 min) laboratory recordings have been proposed so far, but their reliability is unknown. In this study, we addressed this issue analysing a comprehensive set of these indices. In 42 healthy subjects (mean age (min-max): 38 (26-56) years, 21 men) we recorded 5 min of supine ECG in two consecutive days. From RR intervals we computed 11 nonlinear HRV indices, representative of symbolic dynamics, entropy, fractality, predictability, empirical mode decomposition and Poincaré plot families. Absolute reliability was assessed by the 95% limits of random variation and relative reliability was assessed computing the intraclass correlation coefficient (ICC). We found marked differences in the reliability of short-term nonlinear indices of HRV. In the majority of indices, changes in test-retest measurements ranged between about -30% and +50%, indicating good absolute reliability while in the others the change was <-60% and >140%. Relative reliability was substantial (0.6 < ICC < 0.8) in half of the indices, moderate in one and poor in the remaining. Compared to classical linear indices, nonlinear HRV parameters seem more suitable for individual test-retest evaluations but, due to a reduced ICC, they need increased sample size in comparative studies involving two groups of subjects.

Renal transplantation in dialysis patients with the history of coronary artery bypass grafting and cardiac valve replacement

Death with a functioning kidney is the most frequent cause of graft failure. Cardiovascular disease is the most frequent cause of death after renal transplantation. Therefore, prior to grafting, it is mandatory to diagnose and treat coronary artery disease and heart valve impairment. Transplantation is the best option for renal replacement therapy as far as the quality of life and life expectancy are concerned, although patients with such comorbidities may experience a higher short-term mortality risk. The objective for this study was to analyze both short- and long-term results of patients after coronary artery bypass grafting (CABG) or cardiac valve replacement (CVR). The cardiac surgery recipient group (CSR) included 16 patients (15 men, 1 woman) aged from 44 to 73 (mean 54.9 +/- 7.8) years. CABG was performed in 13/16 patients, and CVR in 3/16. The rest of our patients were treated as a comparative noncardiac surgery recipient (non-CSR) group. It consisted of 422 patients (264 men, 158 women) aged from 14 to 68 years (mean 43.2 +/- 12.9). The comparison revealed that graft function estimated at 1 year after transplantation was not different: serum creatinine concentrations of 1.7 +/- 0.2 and 1.6 +/- 0.5 mg/dL in CSR and non-CSR, respectively. One-year patient survival in the CVR group of 93.8% was slightly worse than that in the non-CSR group (97.9%), but death-censored 1-year graft survivals were comparable in both groups (93.8% vs 92%). Urinary tract and cytomegalovirus infections were the most common complications in the CSR group. One patient lost his graft in month 3(rd) due to many serious infectious complications. One patient died at the end of 12 months as a result of a cardiovascular event (1/16). Our single-center results confirm that transplantation in patients after CABG or CVR is a safe procedure; therefore, such patients should be referred into the waiting list.

The connection between the papillary muscles and leaflets of the tricuspid valve

The tricuspid valve is more differentiated during evolutionary development than the mitral valve. In birds it is a muscular structure joined directly to the papillary muscles, although the mitral valve of birds resembles that of mammals. There have been well-known studies describing the evolutionary line of connection of the tricuspid valve with the papillary muscles. The present study was performed on a group of 107 formalin-fixed adult human hearts. The valves and papillary muscles were classified according to a scheme for human hearts drawn up earlier. The types of connection between leaflets of the tricuspid valve and the papillary muscles were classified according to a scheme drawn up earlier for vertebrates. We observed 3 types of connection between leaflets of the tricuspid valve and the papillary muscles in the group studied. The muscular and membranous connections were not linked with any one type of tricuspid valve. Atypical forms of distribution of the tendinous chords of the right ventricle were observed. It was found that valves with a higher number of leaflets were (with the exception of type 0) provided with a smaller number of tendinous chords. Atavistic features and atypical forms of distribution of the tendinous chords are present in a small percentage of samples of the human right valvular apparatus.

The morphology of the right atrioventricular valve in the adult human heart

Studies of the morphometry and normal anatomy of the tricuspid valve are in constant demand. Knowledge of the morphology of the normal tricuspid valve may be useful, for example in the context of the transfer of a leaflet of the tricuspid valve for repair or insufficiency of the mitral valve, in repair of the tricuspid valve after blunt chest trauma and in other surgical techniques of this region. In this study, performed in a group of 107 formalin-fixed adult human hearts, we attempted to assess the form and number of the main and accessory cusps in the tricuspid valve. Rare anatomical variants of the tricuspid valve were found. Using a planimeter we evaluated the surface area of the tricuspid valve and particular leaflets. With the help of a Vernier scale we measured the length and height of individual leaflets of the tricuspid valve and the length of the commissures. No differences were found between the length of the anterior and septal leaflets. The posterior leaflet was the shortest, while the anterior leaflet was the widest and had the largest surface area. The posterior leaflet was wider than the septal leaflet and had the smallest surface area. No differences were found between the main and accessory leaflets in the length of the commissures.

Cardiovascular Effects of Successful Renal Transplantation: A 30-Month Study on Left Ventricular Morphology, Systolic and Diastolic Functions

The purpose of this study was to determine the effects of a successful renal transplantation on left ventricular (LV) morphology, systolic and diastolic function. Forty-three renal transplant patients prospectively studied by echocardiography (30 months follow-up) were divided into two groups. The first echocardiographic examination was performed 3.0 +/- 2.8 months after renal transplantation in group I (11 men, 12 women); and 34.4 +/- 29.1 months after transplant in group two (9 men, 11 women). We noticed the following changes in blood pressure (BP): group 1 systolic BP reduction (from 140.5 +/- 23.6 to 126 +/- 6.8 mmHg; P < .01), and pulse pressure reduction (from 59.5 +/- 14.9 to 47.5 +/- 9.8 P < .05); group 2, diastolic BP acceleration (from 78.4 +/- 8.7 to 84 +/- 6.9 mmHg, P < .05). LV mass index decreased in group 1 (from 126.4 +/- 18.0 g/m2 to 104.6 +/- 15.9 g/m2, P < .05). The incidence of LV hypertrophy (LVH) decreased in group 1 from 70% to 40% (P < .05). Only one parameter of systolic function-end systolic stress-significantly decreased in both groups: group 1 from 78 +/- 11 to 61 +/- 12 g/cm2; group 2 from 63.8 +/- 9.0 to 55.1 +/- 9.0 g/cm2, P < .05). The pattern of mitral inflow changed: in group 1, the normal pattern decreased from 30% to 20% and the restrictive pattern increased from 0% to 10%; in group 2, the normal mitral inflow pattern decreased from 60% to 20% and abnormal relaxation type increased from 40% to 80%. Regression of LVH after renal transplant improved LV geometry and systolic function. Despite better systolic function a progression of LV diastolic dysfunction was noticed, which might be explained by cyclosporine treatment. Renal transplantation exerted a beneficial impact on cardiomyopathy manifested by LVH and systolic dysfunction.

Surgical pelvic packing as a means of controlling massive intraoperative bleeding during pelvic posterior exenteration--a case report and review of the literature

This is a report of a case of gynecological hemorrhage after a posterior pelvic exenteration in patients with vulvar cancer treated by temporary pelvic packing at the Department of Gynecology of the Medical University in Gdańsk. The packing was successful and the sponges were removed after 24 h. Twenty-eight days after the operation, the patient was transferred to the Department of Radiotherapy for supplementary treatment. In patients with severe intraoperative hemorrhage, intra-abdominal packing has been successful as a mode of treatment.

Surgical pelvic packing as a means of controlling massive intraoperative bleeding during pelvic posterior exenteration – a case report and review of the literature

This is a report of a case of gynecological hemorrhage after a posterior pelvic exenteration in patients with vulvar cancer treated by temporary pelvic packing at the Department of Gynecology of the Medical University in Gdańsk. The packing was successful and the sponges were removed after 24 h. Twenty-eight days after the operation, the patient was transferred to the Department of Radiotherapy for supplementary treatment. In patients with severe intraoperative hemorrhage, intra-abdominal packing has been successful as a mode of treatment.

[Effectiveness of antiviral treatment of patients with chronic hepatitis C (a Polish multicenter study)]

Interferon alpha (INF) is routine treatment in patients with chronic hepatitis C. Many controlled investigations were evaluated to establish the optimal schedule of treatment with sustained virological and biochemical response. Recently, multicentre meta-analyses suggest that combination therapy (INF + Ribavirin) was more effective than treatment with interferon alone. The aim of this study was to compare the efficacy of four schedules of antiviral treatment in 445 patients with chronic hepatitis C. Combination therapy (INF + Ribavirin) given for 6 mo. and monotherapy (INF) for 18 mo. were more effective than interferon alone given for 6 mo. Treatment with INF alone for 6 mo. was demonstrated to be insufficient.

Two cases of postpartum cardiomyopathy initially misdiagnosed for pulmonary embolism

PURPOSE

To underline the crucial role of urgent echocardiography in the differential diagnosis of acute respiratory and/or circulatory failure in the postpartum period.

CLINICAL FEATURES

A 24-yr-old woman was admitted to the intensive care unit (ICU) with a preliminary diagnosis of pulmonary embolism (PE) one week after Cesarean section. Neither computerized tomography nor Doppler sonography showed any signs of deep venous thrombosis or PE. In the ICU she required intubation and ventilatory support for acute respiratory and circulatory failure. Bedside echocardiography revealed features of left ventricular failure. A diagnosis of postpartum cardiomyopathy (PPCM) was made, appropriate treatment instituted and the patient soon improved. A 29-yr-old, previously healthy primipara presented at the Maternity Clinic on the fourth postpartum day complaining of increasing dyspnea and fatigue. Within eight hours she required intubation, ventilatory support and subsequent defibrillation due to cardiac arrest. She was transferred to the ICU with a preliminary diagnosis of PE. She developed pulmonary edema followed by cardiac arrest with successful resuscitation. Bedside echocardiography revealed a left ventricular ejection fraction below 30% with an increased systolic diameter of the left ventricle, restrictive diastolic abnormalities and no signs of pulmonary hypertension. Peripartum cardiomyopathy was diagnosed and supportive treatment for heart failure was instituted.

CONCLUSION

It is possible to misdiagnose postpartum cardiomyopathy for PE. An error in diagnosis is life-threatening for the patient. Echocardiography is a valuable tool in the differential diagnosis. As a noninvasive procedure, it should be performed at the bedside as soon as possible to institute proper treatment and to avoid potentially fatal errors.

Interrelationship between cardiac structure and function and incidence of arrhythmia in peritoneal dialysis patients

Cardiovascular complications in patients with end-stage renal disease requiring dialytic therapy are frequent and account for approximately 40% of all deaths in these patients. The aim of this study was to analyze the occurrence of cardiac arrhythmia in peritoneal dialysis (PD) patients with respect to the changes in left ventricular structure and function. To determine characteristics of arrhythmia in patients on PD for chronic renal failure, 30 patients (18 male and 12 female; aged 54.1+/-13.8 years) underwent twice (interval of 20+/-4.1 months) ambulatory 24 hour Holter ECG monitoring. At the same time all the patients were analyzed by echocardiography and pulsed Doppler echocardiography to estimate cardiac structure and function. Ventricular arrhythmias were seen in 9 patients (30%) during the first examination and in 13 patients (43.3%) on the second. Ventricular arrhythmias were observed only in patients with left ventricular hypertrophy (LVH). Supraventricular arrhythmias were seen in 12 (40%) and 17 (56.7%) patients. The majority of these patients also had LVH, with 11/12 (91.7%) patients at the first examination and 15/17 (88.2%) at the second respectively. We conclude that the incidence of arrhythmia is primarily dependent on the presence of LVH in PD patients. It appears that peritoneal dialysis does not provoke or aggravate arrhythmia.

MediLink: a wearable telemedicine system for emergency and mobile applications

The practical needs of the medical professional faced with critical care or emergency situations differ from those working in many environments where telemedicine and mobile computing have been introduced and tested. One constructive criticism of the telemedicine initiative has been to question what positive benefits are gained from videoconferencing, paperless transactions, and online access to patient record. With a goal of producing a positive answer to such questions an architecture for multipurpose mobile telemedicine applications has been developed. The core technology is based upon a wearable personal computer with a smart-card interface coupled with speech, pen, video input and wireless intranet connectivity. The TransPAC system with the MedLink software system is designed to provide an integrated solution for a broad range of health care functions where mobile and hands-free or limited-access systems are preferred or necessary and where the capabilities of other mobile devices are insufficient or inappropriate. Structured and noise-resistant speech-to-text interfacing plus the use of a web browser-like display, accessible through either a flatpanel, standard, or headset monitor, gives the beltpack TransPAC computer the functions of a complete desktop including PCMCIA card interfaces for internet connectivity and a secure smartcard with 16-bit microprocessor and upwards of 64K memory. The card acts to provide user access control for security, user custom configuration of applications and display and vocabulary, and memory to diminish the need for PC-server communications while in an active session. TransPAC is being implemented for EMT and ER staff usage.

A rat model of gingivoperiosteoplasty

The ability to avoid a subsequent bone graft makes the use of gingivoperiosteoplasty (GPP) at the time of cleft lip repair an attractive technique. The use of GPP, in combination with presurgical orthodontics, has been shown to result in successful bony union in the majority of patients. However, secondary bone grafting is still necessary in 30% to 40% of patients due to persistent alveolar bony defects. The elucidation of methods to improve the success rates of these procedures has been hampered by the lack of reproducible animal models. The purpose of this study was, therefore, to develop a rodent model of GPP that would facilitate the investigation of methods to improve osteogenesis in alveolar defects. We report a surgically produced rat model (9 x 5 x 3-mm alveolar defect) that is reproducible, inexpensive (relative to large-animal models), and simple technically. In addition, healing in this model occurs in a predictable manner during a 12-week period, thus enabling analysis of methods designed to accelerate or facilitate osseous regeneration.

[Carcinoid: unusual clinical course]

Carcinoid is a slowly developing neuroendocrine tumour. It appears with frequency of 1.5/100,000 persons. Usually it is localized in appendix, small intestine, rectum and bronchi. Clinical sings. of carcinoid syndrome develop in only 10% cases of tumour. We present three cases of carcinoid: the first one with evidences of heart insufficiency, the second one with evidences of colon cancer, the third one coexisting with Graves-Basedow disease.

Regional differentiation of rat cranial suture-derived dural cells is dependent on association with fusing and patent cranial sutures

A significant body of literature supports a role for the dura mater underlying cranial sutures in the regulation of sutural fate. These studies have implicated regional differentiation of the dura mater based on association with fusing and patent rat cranial sutures. The purpose of these experiments was to isolate and characterize dural cells associated with fusing (posterior frontal) and patent (sagittal) rat cranial sutures. Six-day-old rats were killed, and the dura mater underlying the posterior frontal and sagittal sutures was harvested. Dural cells were briefly trypsinized and allowed to reach confluence. Two litters (10 animals per litter) were used for each set of experiments. Cells were harvested after the first and fifth passages for analysis of vimentin and desmoplakin expression (characteristic of human meningeal cells), cellular proliferation, density at confluence (a measure of cellular contact inhibition), and alkaline phosphatase production. In addition, bone nodule formation and collagen I production were analyzed in first passage cells. The results indicate that suture-derived dural cells can be established and that these cells coexpress vimentin and desmoplakin. In addition, it is demonstrated that first-passage sagittal suture-derived dural cells proliferate significantly faster and have decreased cellular contact inhibition than posterior frontal suture-derived cells (p < 0.01). Finally, it is shown that suture-derived dural cells have osteoblast-like properties, including alkaline phosphatase production, collagen I expression, and bone nodule formation in vitro. The possible mechanisms by which regional differentiation of suture-derived dural cells occur are discussed.

Adenovirus-mediated gene therapy of osteoblasts in vitro and in vivo

Modulation of biological pathways governing osteogenesis may accelerate osseous regeneration and reduce the incidence of complications associated with fracture healing. Transforming growth factor beta1 (TGF-beta1) is a potent growth factor implicated in the regulation of osteogenesis and fracture repair. The use of recombinant proteins, however, has significant disadvantages and has limited the clinical utility of these molecules. Targeted gene therapy using adenovirus vectors is a technique that may circumvent difficulties associated with growth factor delivery. In this study, we investigate the efficacy of replication-deficient adenoviruses containing the human TGF-beta1 and the bacterial lacZ genes in transfecting osteoblasts in vitro and osseous tissues in vivo. We demonstrate that adenovirus-mediated gene therapy efficiently transfects osteoblasts in vitro with the TGF-beta1 virus causing a marked up-regulation in TGF-beta1 mRNA expression even 7 days after transfection. Increased TGF-beta1 mRNA expression was efficiently translated into protein production and resulted in approximately a 46-fold increase in TGF-beta1 synthesis as compared with control cells (vehicle- or B-galactosidase-transfected). Moreover, virally produced TGF-beta1 was functionally active and regulated the expression of collagen IalphaI (5-fold increase) and the vascular endothelial growth factor (2.5-fold increase). Using an adenovirus vector encoding the Escherichia coli LacZ gene, we demonstrated that adenovirus-mediated gene transfer efficiently transfects osteoblasts and osteocytes in vivo and that transfection can be performed by a simple percutaneous injection. Finally, we show that delivery of the hTGF-beta1 gene to osseous tissues in vivo results in significant changes in the epiphyseal plate primarily as a result of increased thickness of the provisional calcification zone.

[Amyloid heart disease diagnosed with echocardiography]

A sixty years old woman with amyloid heart disease has been presented. Postural hypotension was the main symptom in this case. Pneumonia and the developing congestive heart failure was the cause of death. Only the last echocardiographic examination: hypertrophied interventicular septum with a peculiar speckled appearance of myocardium, together with low voltage electrocardiography made possible to confirm this diagnosis. It was shown in this case, how difficult it is to diagnose amyloid heart disease. Low ejection fraction together with diastolic abnormalities is usually a forecast of bad prognosis.

[Polymorphism of the ACE gene and left ventricular morphology and function in patients with borderline, mild and moderate hypertension]

It has been reported that the allel D of an insertion/deletion (I/D) polymorphism of the angiotensin I converting enzyme (ACE) gene is associated with the conditions of increased cardiovascular risk, including the left ventricular hypertrophy and the dysfunction. We examined the relation between the genotype of ACE gene and the left ventricular function in normotensives and in borderline, mild and moderate hypertensives. We investigated 128 subjects, 47 first-diagnosed untreated hypertensives and 81 normotensives. The M-mode and Doppler echocardiography were used to quantify LV mass and function. The insertion/deletion ACE polymorphism was identified using polymerase chain reaction. Left ventricular indexes of the morphology and function were analyzed. We compared ambulatory blood pressure profiles between all genotypes in both groups. There were no significant differences in indexes of the left ventricular hypertrophy in studied normotensives and borderline to mild hypertensives. Our results indicate that allel I might be associated with selected parameters of diastolic function, while allel D with selected parameters of systolic function, of the left ventricle. Results of this study suggest also probable relation between allel D and variability of the diastolic arterial pressure in both investigated groups.

[Malignant non-epithelial neoplasms of the uterine body--clinical analysis]

Twenty six cases of primary uterine sarcomas treated between 1980-1990 are analyzed. There were 16 cases (62%) of endometrial stromal sarcoma, 8 cases (31%) of leiomyosarcoma and 2 cases (7%) of botryoid rhabdomyosarcoma. Symptoms of uterine sarcoma are presented. In 19 patients (73%) pathological diagnosis was obtained by endometrial curettage before surgery. Stage of disease was classified according to intraoperative scale of Lewis. Median survival for the whole group treated surgically, by radiotherapy and chemotherapy was 22.2 months. Five patients (19%) in whom the disease was limited to the endometrium survived more than 5 years. Recurrences of the neoplasm and their treatment by secondary cytoreductive surgery are described.

[The use of biodegradable valtrac-bar rings for intestinal anastomosis in advanced ovarian cancer patients]

Intestinal anastomoses using Valtrac-Bar biofragmentable rings were performed in 9 advanced ovarian cancer patients presenting with symptoms of acute or subacute intestinal obstruction. Two ileo-transversal anastomoses, six sigmo-rectal and one ileo-ileal ones were performed. A part of sigmoid colon with tumour causing obstruction was resected in seven patients and in two patients a resection of an ileal loop was performed. In two patients a colostomy was necessary. The result of anastomosis with Valtrac-Bar was satisfactory in all patients: no cases of peritonitis, anastomosis leak or fistulae were observed. The treatment of intestinal obstruction allowed for a prolongation and improvement of quality of life of these patients and enabled further treatment with chemotherapy. We conclude that biofragmentable Valtrac-Bar ring is a safe and effective device enabling easy and fast intestinal anastomosis even in patients with inappropriate healing.

[The value of peritoneal cytology in the staging of ovarian cancer]

The results of peritoneal cytology obtained during primary surgery for stage I ovarian cancer and "second look" operations was assessed. Positive peritoneal smears were found in 10.7% of patients, while neoplastic cells were present in peritoneal fluid in 32.5% of cases. Of 144 patients undergoing "second look" surgery, positive cytology occurred in 55.5% of cases: in 26.4%--in peritoneal smears and in 29.1%--in peritoneal washings. Intraoperative peritoneal cytology was found to be a valuable diagnostic tool in early stage and minimal disease ovarian cancer.

[A case of a foreign body--surgical linen left in the abdominal cavity 25 years earlier]

A case of 2 surgical linen measuring 12 x 7 cm left after surgery for prolapsed recti performed 25 years earlier is presented. Symptoms suggesting ovarian cancer and details of operation performed to remove the foreign body are described.

[Use of intraperitoneal chemotherapy in patients with clinical stage I ovarian neoplasms]

Results of treatment with intraperitoneal cisplatin chemotherapy via Tenckhoff catheter of 14 high-risk stage I ovarian cancer patients are presented. Seven patients had malignant ascites and in 6 a spillage of the tumor occurred before or during surgery. All patients achieved pathological complete remission after IP chemotherapy. During a median follow up of 38.5 months (range: 15-58) one recurrence was noted 16 months after treatment.

[Alveolar rhabdomyosarcoma of the uterine cervix]

A rare case of cervical alveolar rhabdomyosarcoma in a 45-year old female is presented. The removal of the tumour was performed in two stage-procedure, due to its large dimensions: first the bulk of the tumour was removed per vaginam, proceeding afterwards to a radical hysterectomy. Metastases were detected in pelvic lymph nodes. The patient was given postoperative radiotherapy, but a dissemination of the tumour was found at the termination of the treatment and the patent died 3.5 months after surgery.

[A case of epithelioid sarcoma of Bartholin's glands]

A case of vulvar epithelioid sarcoma in 49-year old female was described. The disease originated from Bartholin's gland. The patient was treated by radical surgery and then multidrug chemotherapy and radiotherapy. In spite of intensive, multimodality treatment, the patient died after 8 months.

Epithelioid sarcoma of the Bartholin's gland primarily diagnosed as vulvar carcinoma

A case of vulvar epithelioid sarcoma (VES) in a 49-year-old female is described. The disease originated from Bartholin's gland and was originally diagnosed as vulvar squamous cell carcinoma. The patient was treated by radical vulvectomy and bilateral inguinal lymphadenectomy. Multidrug chemotherapy using doxorubicin, cyclophosphamide, vincristine, and dacarbazine was started, but had to be abandoned because of cardiac toxicity. Despite intensive treatment, the patient developed pulmonary metastatic disease and died after 8 months. The course of epithelioid sarcoma in this site seems to be more aggressive than in typical extremity locations and was consistent with other cases described in the literature.

[Effect of treatment with erythropoietin (r-EPO) on hemodynamics of the cardiovascular system in patients with chronic renal failure (c.r.f.)]

Patients with chronic renal failure (c.r.f.) are at high risks of death from cardiovascular diseases. It was found that successful treatment of anemia could positively influence not only patients well being but also caused some unfavourable hemodynamic changes. The aim of the study was the estimation of some morphological and functional parameters of left ventricle (lv) in dialyzed and predialyzed patients treated with r-Epo. Two groups of patients with c.r.f. were studied. The I group of 10 dialyzed patients (6 W, 4 M, mean age 34 +/- 11, weight 55 +/- 9 kg), and the II group of 9 pre-dialyzed patients (6 W, 3 M, mean age 50.6 +/- 10, weight 63 +/- 14 kg). r-Epo (Eprex Cilag AG) was administered during 6 months s.c. The I group was given initial dose 3 x 2000 u per week (mean dose 24-46 u/kg b.w./per week, the II was on 3 x 2000 u per week (mean dose 24-46 u/kg b.w./per week) subcutaneously. The doses were adjusted by Hb level in order to keep it within limits (10-12 g/dl). Hematological parameters were monitored once a week by Technicon H1. Morphology and function of the lv were evaluated using echocardiographic measurements performed by Irex IIIA system. According to prescriptions of ASE the following parameters have been assessed: lv dimension, thickness of posterior wall in diastole and systole and thickness of interventricular septum in diastole.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hazards of antitubercular treatment--case report]

A case of the female caucasian patient with constricting tuberculous pericarditis is presented. The patient has been treated with tuberculostatics, which produced severe to ic liver damage, and ultimately the death. A risk of liver damage increases with patients' age and the jaundice onset in the period shorter than two months after the start of therapy. Prognosis is poor in case of HBs carrier state, alcohol abuse, therapy with benzodiazepines, and oral contraceptives. A moderate increase in transaminases activity does not require a cessation of the drugs but a reduction of the administered doses is necessary, especially in patients over 35 years of age. Patients of the height risk group require a careful selection of antitubercular+ agents. Patients with suspected chronic liver disease should be carefully examined, together with liver biopsy, before tuberculostatics are given.

[Certain aspects of so-called post cholecystectomy syndrome]

The study involved 126 patients with cholelithiasis. Set of biochemical, radiological, endoscopic, and ultrasound examinations was carried out in these patients. Potential coincidence of clinical symptoms and causes of so-called postcholecystectomy syndrome was the purpose of a 1-year follow-up studies. The significance of the results are discussed.

[Difficulties in diagnosing immunologically determined disease syndromes]

A case of amyloidosis is presented in a man aged 21 years, discussing the diagnostic difficulties in immunologically-determined syndromes, and considerable serious consequences of their inappropriate treatment. On the margin of this case important problems are discussed connected with juvenile rheumatoid arthritis, rheumatic fever and amyloidosis.

[Clinical aspects of intraperitoneal chemotherapy in patients with ovarian carcinoma]

Ten women with primary ovarian carcinoma in clinical progression grade III degree according to FIGO received intraperitoneal chemotherapy. They all had surgical treatment and 9 of them received after operation intravenous cytostatics PAC or PC. Cisplatin 100-220 mg/m2 was given intraperitoneally through a Tenckhoff catheter for long-term dialysis. Before beginning of intraperitoneal chemotherapy in 6 cases the malignant lesions were under 2 cm in diameter, and in 4 cases the size of these lesions was exceeding 2 cm with far advanced disease. In patients with malignant lesions under 2 cm CR was obtained in 4 cases, SD in 1 case and PR in 1 case. In the group with malignant lesions exceeding 2 cm the results of intraperitoneal treatment were: SD in 2 cases and PD in 2 cases. Intraperitoneal chemotherapy is an effective method in ovarian carcinoma when intravenous chemotherapy is ineffective. This is another method which provides a chance of prolongation of the life of the patients.