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1

Hereditary Nonpolyposis Colorectal Cancer in Lower Silesia

100%

Stal A. , Stembalska A. , Śmigiel R. , Tarkowski R. , Grzebieniak Z. , Sąsiadek M.

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tom 79

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nr 3

182-189

EN

The aim of the study was to assess the frequency of hereditary nonpolyposus colorectal cancer in the Lower Silesia area.Material and methods. The study population consists of 318 patients hospitalized between 2001-2002 on 14 surgical wards in the Lower Silesia area. Patients formed four groups: hereditary nonpolyposis colorectal cancer (HNPCC), suspected HNPCC (S-HNPCC), familial colorectal cancer (FCC) and cancer familial aggregation (CFA). The epidemiological data were analyzed (age on onset, gender, localization, extracolonic tumors in family).Results. 3.77% of all patients with colorectal cancer (CRC) were diagnosed with HNPCC and 6.92% with S-HNPCC. The mean age of CRC onset in HNPCC group was 53.07; in the S-HNPCC group, 62.2. Seven male and 5 female patients were diagnosed with HNPCC; for S-HNPCC, 14 males and 8 females were diagnosed. In the HNPCC group, 55.55% of CRC were situated in the right colon and in 44.55%, the left colon. In the S-HNPCC group, 28.57% CRC was in the right colon and in 71.43%, the left colon. In the HNPCC and S-HNPCC groups, there were 4 patients diagnosed with synchronous sigmoid and rectal adenomas. Two of them were diagnosed during intraoperative colonoscopy. One patient was diagnosed with 3 metachronous lesions. In the families of 6 patients with HNPCC extracolonic tumors were identified.Conclusions. 1. Knowledge of HNPCC criteria ensures proper treatment of the patient and their family. 2. During colonoscopy, the whole colon should be inspected. 3. Patients suspected of HNPCC should undergo intraoperative colonoscopy.

2

Inhibition of Selected Enzymes with Specific Inhibitors in the Tissue Homogenates from Patients with Colorectal Cancer

84%

Hap A. , Kielan W. , Siewiński M. , Tarnawa R. , Agrawal A. , Rudno-Rudzińska J. , Hap W. , Grzebieniak Z.

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tom 82

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nr 9

504-509

EN

Large intestine malignancy is the second most common malignancy and second leading cause of cancer mortality in Poland. This is related to late detection of these lesions, e.g. due to lack of effective screening tests. Lesions found by a surgeon are clinically advanced, making the treatment often ineffective and sometimes even completely impossible. Discovery of a substance that would be able to stop key processes for the development of malignancy could change such situation. Activity of certain enzymes was found to increase in malignant cells and invasion of malignancy could be triggered by inadequate amount of endogenous inhibitors of these enzymes in the surrounding healthy tissues. Inhibitors identical with that produced in human cells were found in egg whites.The aim of the study was to determine ability of cystatin isolated from egg whites to inhibit activity of cathepsin B and L.Material and methods. Immunohistochemistry and histology of tissue specimen collected from malignant lesions resected from 60 patients diagnosed with large intestine adenocarcinoma, who underwent surgical treatment in 2nd Department of General and Oncological Surgery, Medical University of Wrocław between 2007 and 2009.Results. Differences were fund between health tissues, margins and center of the malignant lesions with regard to amount and distribution of stained cathepsin B - cystatin complexes. The above mentioned inhibitors were able to inhibit 90% of primary activity of cathepsin B and L in malignant tissues.Conclusions. Cystatins obtained from egg whites could be used as substances supporting anti-cancer therapy in the future.

3

Splenectomy in Patients with Hematological Disorders - Our Experience

84%

Żukrowski P. , Kielan W. , Grzebieniak Z. , Rudnicki J. , Tarnawa R. , Agrawal A. , Bąk T. , Knakiewicz M.

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tom 79

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nr 6

426-435

EN

The aim of the study. Retrospective analysis of indications for splenectomy in hematological diseases, positive effect of this operation and correlations between objective prognostic factors and good response to splenectomy in patients with different hematological indications for splenectomy.Material and methods. 98 adult patients with hematological disorders, who were splenectomised in the years 1994 - 2004. We evaluated the effects of splenectomy in patients with hematological diseases as defined by patient documentation from the 2nd Department of General and Oncological Surgery, Department of Hematology and Hematological Ambulance and the questionnaires that patients completed by themselves.Results. The beneficial effect of splenectomy was observed in the majority of cases of idiopathic thrombocytopenic purpura (41 of 53 patients), acquired hemolytic anemia (2 of 3 patients) and hereditary spherocytosis (8 of 9 patients). Surgery can provide a high frequency of durable response for adult patients with benign hematological disorders. In malignant hematological diseases, splenectomy eliminates consequences of hypersplenism or splenomegaly. Splenectomy in patients with malignant hematological disorders can improve their condition and relieve symptoms of hypersplenism and splenomegaly to improve their quality of life. There were early complications in 11 patients (11.3%). Mortality was 2%. Late complications appeared in 24 patients out of 96 patients, who survived the perioperative period. The most common late complication was moderate respiratory infections.Conclusions. Splenectomy is the most common operation in patients with hematological disorders. Indications for splenectomy have been hindered by the lack of any objective prognostic factors of good postoperative response. Nevertheless, the effect of splenectomy is positive in many patients with benign and malignant hematological diseases.

4

Analysis of Selected Clinical and Laboratory Parameters in Patients with Splenectomy Complications Due to Hematological Disorders

84%

Żukrowski P. , Kielan W. , Grzebieniak Z. , Rudnicki J. , Tarnawa R. , Agrawal A. , Bąk T. , Knakiewicz M.

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tom 79

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nr 6

418-425

EN

The aim of the study was to investigate the role of certain clinical characteristics and laboratory examination results as prognostic factors for complications after splenectomy in patients with hematological disorders.Material and methods. Ninety-eight adult patients with hematological disorders who underwent splenectomy in our department between years of 1994 and 2004. A retrospective analysis of the medical records from patients who underwent splenectomy was conducted; we divided the patients into 6 groups with various postoperative complications; patients without complications after splenectomy were the control group (the seventh group). Then, we compared patients from groups 1 - 6 with patients from the control group (group 7) before and after splenectomy with regard to various parameters including age, sex, presence of splenomegaly or accessory spleen, the operation's duration, hemoglobin level, number of erythrocytes, leukocytes and plateletes, levels of protein and fibrinogen, activity of prothrombin, INR, APTT, TT, proteinogram and levels of IgG, IgM and IgA.Results. We found that postoperative complications, especially early complications, were more common in groups with malignant hematological complications and in older patients. Infection complications appear more often in men than in women with benign hematological disorders. The sustained platelet level elevation after splenectomy is positively associated with a higher number of thrombotic complications. Also, a lower level of gamma globulin, IgG and IgM after splenectomy correlated with a higher number of infection complications.Conclusions. Splenectomy in patients with hematological disorders is burdened with small risks of postoperative complications. Some clinical and laboratory parameters can be used to select the group of patients with higher risks of complications, but there remains a lack of objective prognostic factors which are sure in every clinical situation.