Sarcoidosis of the spleen : rare indications for splenectomy : own experience

The article presents two patients who underwent laparoscopic splenectomy because of splenic sarcoidosis. In onepatient sarcoidosis was diagnosed based on the chest X-ray and computed tomography (CT) scans. Further imagingallowed for the diagnosis of systemic spread of the disease with bone marrow and splenic involvement. The latterlocation was confirmed by pathological examination after the operation. The indication for splenectomy was hypersplenismwith concurrent thrombocytopenia. In the second patient, an abdominal ultrasound scan (US) showed suspiciousfocal lesions in the spleen. Histological examination proved it to be a rare isolated splenic form of sarcoidosis

Stress management: multilayer regulation of the heat shock response

Protein-damaging stresses, such as exposure to elevated temperature, alcohol, and heavy metals and microbial infections, increase the amount of misfolded proteins in cells, which may lead to formation of toxic protein aggregates. In order to counteract detrimental effects of proteotoxic stresses, all organisms have developed a specific response, called the heat shock response (HSR). Upon the HSR activation, synthesis of heat shock proteins (HSPs) increases. HSPs function as molecular chaperones to aid in the refolding of misfolded proteins and prevent formation of protein aggregates. The inducible expression of HSP genes is mediated by heat shock factors (HSFs). Mounting the HSR involves trimerization, nuclear accumulation, gain of DNA-binding and transactivation capacity of HSF1 and coincides with extensive post-translational modifications of HSF1. However, the importance of these modifications on HSF1 activity has remained elusive. This PhD thesis describes the functional impact of stress-inducible phosphorylation of HSF1 on the HSR. While HSF1 phosphorylation upon stress is not required for the HSR activation, it defines the onset of the HSR and fine-tunes the magnitude of the response. Moreover, a chaperone co-inducer BGP-15 was found to augment the HSR, due to its ability to inhibit histone deacetylases (HDACs). BGP-15 as an HDAC inhibitor increases chromatin accessibility at multiple genomic loci including HSP genes and accelerates HSF1 activation in the event of proteotoxic stress. Furthermore, HDAC inhibitors can function as chaperone co-inducers and have cytoprotective effect for cells exposed to stress. Taken together, this study provides valuable information on molecular mechanisms regulating the HSR, which can serve as a basis for further development of pharmaceuticals aimed to activate, enhance or repress the HSR.</p

Laparoscopic Nissen fundoplication in the treatment of Barrett's esophagus : 10 years of experience

INTRODUCTION: Barrett's esophagus (BE) is a state in which the distal portion of esophageal mucosa becomes lined with cylindrical epithelium as a result of adaptive remodeling. It is widely accepted that the metaplastic lesions result from chronic irritation with gastric and/or duodenal contents in the course of reflux disease. For many years, research centered on the risk factors of BE and resulting adenocarcinoma. Anti-reflux operations are the only procedures which offer the possibility of treating the cause by restoring the anatomic barrier responsible for guarding against irritating effects of gastroduodenal content on the distal esophagus. Total (i.e. 360°) laparoscopic Nissen fundoplication (LNF) is considered the most effective amongst these procedures. Still, controversies related to the indications for anti-reflux surgery are frequently encountered. AIM: Retrospective analysis of long-term treatment outcomes in patients with BE subjected to laparoscopic Nissen fundoplication. MATERIAL AND METHODS: The group included 42 BE patients, amongst them 30 men and 12 women. Initially, all the patients were treated conservatively for at least 1 year. The subgroup with dysplasia was subjected to preoperative argon plasma coagulation (APC). From 1 year after surgery (laparoscopic Nissen fundoplication), control biopsy specimens were obtained from the gastroesophageal junction of all the patients. RESULTS: None of the patients showed the development of esophageal adenocarcinoma during the follow-up period. Furthermore, no cases of dysplasia progression or de novo development of dysplasia were observed in the analyzed group. In the initial 12-24 months after surgery, complete regression of metaplasia was documented in 7 (31.8%) patients from group A, and a reduction in the area of Barrett's metaplasia was observed in another 7 patients (31.8%). Throughout the period of this study, persistent planoepithelial re-epithelialization was observed in 14 (70%) group B patients, i.e. in individuals with baseline dysplasia subjected to preoperative argon plasma ablation. In the remaining patients of this group, the developed changes of BE character were less advanced than at baseline. CONCLUSIONS: Our opinion is that laparoscopic Nissen fundoplication, as a result of high effectiveness, represents the method of choice in the treatment of BE in the case of patients who were qualified for surgery

Laparoscopic removal of gastrointestinal stromal tumors of uncinate process of pancreas

The pancreas is an extremely rare location for gastrointestinal stromal tumors (GIST). We present a case of a patient with a GIST located in the uncinate process of the pancreas that was treated successfully with a laparoscopic technique. Computed tomography, magnetic resonance imaging and scintigraphy suggested a neuroendocrine tumor. Due to the fact that the image suggested a neuroendocrine tumor with a diameter below 2 cm, the patient was qualified for a laparoscopic procedure of tumor enucleation. Postoperative care proceeded in accordance with the principles of the ERAS concept. The postoperative course was uncomplicated. He was discharged home on the second postoperative day. In the obtained histopathology result a GIST was found. During a 6-month observation, including control computed tomography examination, no signs of tumor progression were found. Despite the fact that stromal tumors of the gastrointestinal tract localized in the pancreas are very rare, they should be considered in the differential diagnosis of tumors of this organ

Laparoscopic adrenalectomy by the lateral transperitoneal approach in patients with a history of previous abdominal surgery

INTRODUCTION: Even the half of patients undergoing laparoscopic adrenalectomy has history of previous abdominal surgeries. However, it is still uncertain if this fact has an impact on the operation itself as well as the postoperative course. AIM: To analyze the effects of previous abdominal surgery on surgical outcomes in adrenal tumor patients subjected to laparoscopic adrenalectomy. MATERIAL AND METHODS: This study included 268 patients with adrenal gland tumors operated on by means of laparoscopic lateral transperitoneal adrenalectomy: 1) previously subjected to at least one abdominal surgery (group A, n = 101), or 2) with no history of previous abdominal operations (group B, n = 167). RESULTS: Groups A and B did not differ in terms of tumor size (p = 0.132), mean operation time (p = 0.456), mean intraoperative blood loss (p = 0.754), or perioperative complication rate (p = 0.833). Dissection of intraperitoneal adhesions was considered difficult in 32 patients from group A (31.6%) and 8 subjects from group B (4.7%, p < 0.001). Conversion was required in three subjects from group A (2.9%) and 3 patients from group B (1.8%, p = 0.529). CONCLUSIONS: Previous abdominal surgery does not constitute a contraindication to laparoscopic transperitoneal adrenalectomy

The knowledge of Polish medical students about surgical treatment of obesity

BACKGROUND: Surgical treatment of morbid obesity is becoming an increasingly important approach for the treatment of this condition. However, knowledge about the possibility of surgical procedures among general practitioners is far from satisfactory. The source of the problem might be due to a lack of information about bariatric surgery in university curriculum. METHODS: We assessed the knowledge of students from four Polish medical universities. The survey was conducted among 468 students, in their sixth (final) year of study. The survey included two parts—the first nine questions assessed of the level of the students’ knowledge about the methods of surgical treatment of obesity, and the following three questions allowed for an evaluation of the amount of information on metabolic surgery provided to students during surgery courses. RESULTS: The results demonstrate a low level of knowledge on the possibility of applying metabolic surgery to treat morbid obesity. The students themselves expressed a need to improve their knowledge and favorably assessed the proposition of expanding the curriculum to include more information on the subject of metabolic surgery. CONCLUSION: The awareness of surgical treatment for morbid obesity among medical students should be improved. The development of an interesting curriculum that is based on current guidelines should be undertaken