The significant impact of age on the clinical outcomes of laparoscopic appendectomy : results from the Polish Laparoscopic Appendectomy multicenter large cohort study

Acute appendicitis (AA) is the most common surgical emergency and can occur at any age. Nearly all of the studies comparing outcomes of appendectomy between younger and older patients set cut-off point at 65 years. In this multicenter observational study, we aimed to compare laparoscopic appendectomy for AA in various groups of patients with particular interest in the elderly and very elderly in comparison to younger adults. Our multicenter observational study of 18 surgical units assessed the outcomes of 4618 laparoscopic appendectomies for AA. Patients were divided in 4 groups according to their age: Group 1- 8 days. Logistic regression models comparing perioperative results of each of the 3 oldest groups compared with the youngest one showed significant differences in odds ratios of symptoms lasting >48hours, presence of complicated appendicitis, perioperative morbidity, conversion rate, prolonged LOS (>8 days). The findings of this study confirm that the outcomes of laparoscopic approach to AA in different age groups are not the same regarding outcomes and the clinical picture. Older patients are at high risk both in the preoperative, intraoperative, and postoperative period. The differences are visible already at the age of 40 years old. Since delayed diagnosis and postponed surgery result in the development of complicated appendicitis, more effort should be placed in improving treatment patterns for the elderly and their clinical outcome

Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy : results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study

Laparoscopic appendectomy (LA) for treatment of acute appendicitis has gained acceptance with its considerable benefits over open appendectomy. LA, however, can involve some adverse outcomes: morbidity, prolonged length of hospital stay (LOS) and hospital readmission. Identification of predictive factors may help to identify and tailor treatment for patients with higher risk of these adverse events. Our aim was to identify risk factors for serious morbidity, prolonged LOS and hospital readmission after LA. A database compiled information of patients admitted for acute appendicitis from eighteen Polish and German surgical centers. It included factors related to the patient characteristics, peri- and postoperative period. Univariate and multivariate logistic regression models were used to identify risk factors for serious perioperative complications, prolonged LOS, and hospital readmissions in acute appendicitis cases. 4618 laparoscopic appendectomy patients were included. First, although several risk factors for serious perioperative complications (C-D III-V) were found in the univariate analysis, in the multivariate model only the presence of intraoperative adverse events (OR 4.09, 95% CI 1.32-12.65, p = 0.014) and complicated appendicitis (OR 3.63, 95% CI 1.74-7.61, p = 0.001) was statistically significant. Second, prolonged LOS was associated with the presence of complicated appendicitis (OR 2.8, 95%CI: 1.53-5.12, p = 0.001), postoperative morbidity (OR 5.01, 95% CI: 2.33-10.75, p < 0.001), conversions (OR 6.48, 95% CI: 3.48-12.08, p < 0.001) and reinterventions after primary procedure (OR 8.79, 95% CI: 3.2-24.14, p < 0.001) in the multivariate model. Third, although several risk factors for hospital readmissions were found in univariate analysis, in the multivariate model only the presence of postoperative complications (OR 10.33, 95% CI: 4.27-25.00), reintervention after primary procedure (OR 5.62, 95% CI: 2.17-14.54), and LA performed by resident (OR 1.96, 95%CI: 1.03-3.70) remained significant. Laparoscopic appendectomy is a safe procedure associated with low rates of complications, prolonged LOS, and readmissions. Risk factors for these adverse events include complicated appendicitis, postoperative morbidity, conversion, and re-intervention after the primary procedure. Any occurrence of these factors during treatment should alert the healthcare team to identify the patients that require more customized treatment to minimize the risk for adverse outcomes

AMNESTY IN CASES OF HEAVIEST INTERNATIONAL CRIMES

The article focuses on the question of the suitability of amnesty in tackling national heritage of civil wars, dictatorship, state apparatus disintegration and others. The author furthermore presents a typology of amnesty acts. A question arises as to why amnesty, an instrument typical of national legal systems, rouses such controversy on the international level. However, the controversies arise over only those acts of amnesty that occur in cases of the heaviest international felonies, tortures, and war crimes. The author discusses the motives of applying amnesty in such cases, listing some advantages of such a solution and also mentioning the ‘darker’ sides, or drawbacks of the option. The article is rounded up with an analysis of limitations on the use of amnesty under the international law. 70 Prosecuto

Validity of the rule ignorantia iuris nocet with regards to aliens

In relation to the international personal traffic and tourism there are situations encountered in penal proceedings when defendants are pleading ignorance of the Polish penal law, on top of it, in some cases the ignorance is also fostered by different socio-cultural conditions, system of moral norms and ethical values. According to the ancient Roman principle everyone, including also aliens, must know the penal law, thus ignorance of the law cannot be treated as a circumstance precluding a penal responsibility. Yet, the aliens find themselves in much worse situations then the (locals, a question thus anises whether they could be offered more „priviledged" treatment in the context of the „ignorantia iuris nocet" principle. Art. 24 par. 2 of the Penal Code proclaims that ignorance of illegality of act cannot preclude penal responsibility under condition that a perpetrator was able to avoid his error. If he was able to avoid his ignorance as to illegality, and committed an intentional offence, then the court may apply the extraordinary mitigation of they of the penalty (par. 3). If an allien-defendant explains committing his unlawful act by a custom adopted in his home society the Polish courts cannot take it as a circumstance excluding penal responsibility in principle, nor as mitigating it- contrary to the British jurisdictions, according to which a court may renounce of inflicting a punishment. The effect of ignorance of the law exhibited by aliens ought to be discussed against the background of the division of offences into: mala in są and mala prohibita. The author advocates that the ignorantia iuris is legally irrelevant in relation to the first group offences, but it has to be considered in case of certain offences of the second group.Digitalizacja i deponowanie archiwalnych zeszytów RPEiS sfinansowane przez MNiSW w ramach realizacji umowy nr 541/P-DUN/201

Conditions and principles of liability i n advertising activity

Polish legislation does not contain the act which would comprehenisively regulate numerous and diversified problems connected with advertising activity. The author distinguishes the following grounds of legal regulation of advertising activity: 1) general principles of law and legislation, principles of social co- -existence and constitutional norms; 2) norms contained in particular branches of law, e.g. in civil, penal and copyright law, wich may find application in advertising activity; 3) provisions enacted specifically for advertising activity. Besides, three interdictions should be observed in advertising activity: an interdiction to infringe law, to infringe accepted customs and an interdiction to disinform. The author rejects the presumption according to which each advertising act (irrespective of accompanying circumstances) is to express the advertiser's will be conclude the contract of sale. Otherwise, the advertiser were always bound to conclude such a contract under the sanction of civil-law liability. The Polish legislator regulates legal character of advertising acts in 2 provisions. One of them protects the interests of advertising enterprises (Art. 71 of the Civil Code), while the other protects the interests of consumers (Art. 543 of the Civil Code). According to Art. 71, announcements, advertisement, price-lists and other information addressed to the public or to particular persons are, in case of doubt, not to be considered an offer but an invitation to negotiations. In turn, according to Art. 543, placing a priced thing on public display is to be considered and offer to sale.Digitalizacja i deponowanie archiwalnych zeszytów RPEiS sfinansowane przez MNiSW w ramach realizacji umowy nr 541/P-DUN/201

Credibility of witness'es testimony. Some logical problems

The article discussess two problems of great importance for a judicial practice: 1) conception of reliability of a informant, 2) partial reliability of the evidentiary statement. Two notions of „witness'es credibility" can be differentiated in the judicial practice, although judges are not always aware of that distinction. A type of facts which are foundation for a statement of reasons for the judgement is adopted as a criterion of that distinction. Consequently, one witness is found to be credible, while another is not: 1. a notion of credibility is of a reporting character, the judge finds that a given witness is credible with reference to relations on certain facts, as almost all of his information appeared to be true (mistakes were commuted rarely) and he supplied mny information from a given field. The notion of credibility1 is thus related to frequency of false and true information; 2. a notion of credibility2 has a prognostic character; data related to withness'es attitude, his personality, views, traits of character, knowledge (of facts reported), and situation he was in at the time of percepting facts (or at receiving information in some other way) are a foundation of judicial decision of his credibility. If the court is supplied with a certain amount of information on a witness and his testimony, and they are relevant with reference to a given event (e.g. a crime), the witness will be credible only when: 1. frequence of his mistakes and concealments with reference to that event is not exceeding a certain constant adopted by court and defining a level of its critical judgement towards the witness and his testimony; 2. mistakes and concealments of the witness are unintentional. Irrespective of defining credibility of the witness, the court has to be supplied with a satisfactory amount of information on the witness as well as with his testimony of a substantial duration to be able to estimate his reliability. The notion of credibility of the witness is also used in courts in two different meanings: 1. upon indicating that „the witness is credible", the court relates to the value of the very testimony. Consequently it means a total acceptance of the testimony or its dismission. . - 2. the expression mentioned above can also be a mental abridgement to the effect that credibility of the given witness is in p r i n c i p l e adopted by court, although a question of some statements of the witness may be not settled. In other words, credibility of all the statements separately is examined by court. It does not seem advisable to require from court to offer a total, univocal estimation of the whole of witness'es testimony (point 1). In the result his evidence could be found either totally credible or totally unreliable. In most of the cases, the said testimony is not a single statement of a fact formulated in a simple sentence, but usually it adopts a form of a set of various statements. It can be therefore indicated that a court can make its findings-without a breach of principles of logics-contrary to the testimony of witness who was found credible in principle and vice versa.Digitalizacja i deponowanie archiwalnych zeszytów RPEiS sfinansowane przez MNiSW w ramach realizacji umowy nr 541/P-DUN/201

Conditions and principles of liability i n advertising activity

Polish legislation does not contain the act which would comprehenisively regulate numerous and diversified problems connected with advertising activity. The author distinguishes the following grounds of legal regulation of advertising activity: 1) general principles of law and legislation, principles of social co- -existence and constitutional norms; 2) norms contained in particular branches of law, e.g. in civil, penal and copyright law, wich may find application in advertising activity; 3) provisions enacted specifically for advertising activity. Besides, three interdictions should be observed in advertising activity: an interdiction to infringe law, to infringe accepted customs and an interdiction to disinform. The author rejects the presumption according to which each advertising act (irrespective of accompanying circumstances) is to express the advertiser's will be conclude the contract of sale. Otherwise, the advertiser were always bound to conclude such a contract under the sanction of civil-law liability. The Polish legislator regulates legal character of advertising acts in 2 provisions. One of them protects the interests of advertising enterprises (Art. 71 of the Civil Code), while the other protects the interests of consumers (Art. 543 of the Civil Code). According to Art. 71, announcements, advertisement, price-lists and other information addressed to the public or to particular persons are, in case of doubt, not to be considered an offer but an invitation to negotiations. In turn, according to Art. 543, placing a priced thing on public display is to be considered and offer to sale.Digitalizacja i deponowanie archiwalnych zeszytów RPEiS sfinansowane przez MNiSW w ramach realizacji umowy nr 541/P-DUN/201

LOCKERBIE CASE AS UNIQUE INTERNATIONAL COMPROMISE

The article presents a discussion of the once famous Boeing 747 crash that killed 270 people - 243 passangers, 16 crewmembers and 11 citizens of the Lockerbie town in southern Scotland. The disaster was caused by a terrorist attack organised by two Libyans. The authors present the complex process of preparation for the trial, analyzing in detail their political, legal and social conditions that led to its internationally unique end: sentencing the defendants by a Scotish court in the territory of the Netherlands

LOCKERBIE CASE AS UNIQUE INTERNATIONAL COMPROMISE

The article presents a discussion of the once famous Boeing 747 crash that killed 270 people - 243 passangers, 16 crewmembers and 11 citizens of the Lockerbie town in southern Scotland. The disaster was caused by a terrorist attack organised by two Libyans. The authors present the complex process of preparation for the trial, analyzing in detail their political, legal and social conditions that led to its internationally unique end: sentencing the defendants by a Scotish court in the territory of the Netherlands

Strategy and early results of treatment of advanced cervical cancer patients with synchronous cancers observed in PET-CT imaging

Objectives: The aim of this study was to present strategy and early results of treatment of advanced cervical cancer patients with synchronous cancers observed in PET-CT imaging, treated at the Greater Poland Cancer Center. Material and methods: The study included a group of 200 patients with diagnosed stage IIB-IIIB cervical cancer who received PET-CT for the purpose of radiotherapy treatment planning. Results: Among our study group, four patients (2%) were found to have a synchronous cancer. Two of the cases were diagnosed as breast cancer. However, cancers diagnosed in the other two patients were head and neck malignancies — hypopharyngeal and laryngeal cancer. The choice of an optimal therapeutic approach requires taking into account characteristics of particular malignancies, their stage and histopathology. The whole therapy included radiotherapy of cervical cancer with various combinations of systemic treatment, radiotherapy or surgery of synchronous cancer. According to treatment results, patients diagnosed with breast cancer and hypopharyngeal cancer achieved complete remission of both primary and secondary tumour. Patient diagnosed with laryngeal malignancy, despite achieving complete remission of cervical cancer, finished radiotherapy of the synchronous cancer at a palliative dose. Conclusions: The growing availability of PET-CT and other imaging methods in cancer diagnosis will increase the number of diagnosed synchronous cancers. Second primary cancers are often detected at an early stage, where radical treatment can be performed for both primary and secondary tumour. However, treatment of such complicated clinical cases as synchronous cancers should be carried out by multidisciplinary teams