Peritonitis caused by a giant trichobezoar ventriculi--a case report

Bezoars are the most common foreign bodies of gastrointestinal tract. They contain swallowed hair, different fibres, seeds, nut shells, sweets or drugs. Clinical manifestations vary, depending on the location and size of bezoar, from "no symptoms" to "acute abdomen" syndrome. In this case report, the authors describe a giant trichobezoar from the stomach of an 18-year-old girl, who had been admitted to the gynecological department with syndromes suggesting an ovarian cyst torsion. The preoperative diagnosis was not confirmed and a giant trichobezoar was found and removed during the surgery.     

Giant benign ovarian tumor coexisting with late pregnancy--a case report

We have reported a rare case of a giant ovarian tumor which, due to the lack of proper health care on the side of the patient, had not been diagnosed until 27 weeks of pregnancy. The patient did not demonstrate any clinical symptoms till the moment of the diagnosis. Peripheral blood analysis showed severe anemia at the admission. The right adnex with the multilocular cystic tumor containing bloody fluid and measuring 40 cm in diameter, was removed in the course of the surgical procedure. The histological diagnosis of the tumor was: serous cyst. Surgical removal of the giant tumor allowed for further development of pregnancy and enabled vaginal delivery of healthy newborn at term.     

Assesment of selected parameters depending on the size of abdominal wall incision in patients subjected to minilaparotomy due to benign gynaecological diseases

OBJECTIVES: Considering the enormous advantages of minimally invasive surgery, attempts to introduce less invasive trans-abdominal incisions might represent an alternative to classic gynecologic surgery. The aim of this study is to assess the feasibility and clinical outcome of minilaparotomy in patients operated due to benign gynecological diseases and to analyze selected parameters with regard to the abdominal wall incision size. DESIGN: In this retrospective study, we have described our experience with 26 patients, undergoing minilaparotomy for benign adnexal or uterine diseases. MATERIAL AND METHODS: 26 patients with benign uterine or adnexal diseases, hospitalized from November 2003 until March 2006 at the Department of Surgical and Endoscopic Gynecology at the Polish Mother's Memorial Hospital--Research Institute in Lód?, had undergone successful surgical treatment by means of minilaparotomy. The following procedures were included in the analysis: myomectomy (17 patients), ovarian cystectomy (3 patients), myomectomy and ovarian cystectomy at the same time (3 patients), bilateral salpingo-oophorectomy (1 patient), supracervical hysterectomy (1 patient) and total abdominal hysterectomy with salpingo--oophorectomy (1 patient). RESULTS: The patients' mean age and BMI were 33.85 years (14-50) and 22.95 (18.73-45.17), respectively. The mean operative time was 72.69 min (45-120). The diameter of trans-abdominal incision was 3-6cm and the mean diameter of removed lesions was 76.88 mm (47-200). The mean intraoperative decrease of haematocrit and haemoglobin value was 4.8% (0.2-12.4) and 1.4 g/dl (0.2-3.7), respectively. Blood transfusion was required in case of 3 patients but only in one case it was caused by intraoperative blood loss. There were no significant intra- or postoperative complications. 16 patients needed analgesics for 2.33 days after surgery. Body temperature up to 38 degrees C was observed in 4 patients for 2.5 days. The average time of hospitalization after the surgery was 4.58 days. We have noted a negative correlation between the size of trans-abdominal incision and several factors: operative time, intraoperative blood loss, period of analgesic therapy and time of hospitalization after the surgery. None of these factors was correlated with patients' age or BMI. One-month follow up after the surgery revealed satisfactory wound healing and no complains in case of all patients. All patients deemed the cosmetic effect of the surgery very good. CONCLUSION: Minilaparotomy seems to be a very simple, useful and safe surgical technique which might be an alternative to laparotomy in the management of benign gynecologic diseases. Minilaparotomy is of great value, especially in situations when laparoscopic or vaginal approach is too complicated or too dangerous due to technical reasons.     

Rho kinase--a new target for pharmacological treatment of an overactive bladder

Rho kinase plays a key role in the regulation of smooth muscles contraction, including those of the urinary bladder detrusor. Rho kinase pathway modulates the level of phosphorylation of the myosin light chain, mainly through the inhibition of myosin phosphatase. Recent experimental data indicate that its role might be exacerbated in local and systemic pathological conditions which affect the bladder. It seems that Rho kinase inhibitors, such as Y27632, may turn out to be an effective group of drugs in pharmacotheraphy of an overactive bladder (OAB), which will influence the storage phase of the micturition cycle, without interfering with the physiological voiding.     

Value of the intraoperative assessment of the depth of myometrial invasion in endometrial carcinoma

OBJECTIVES: The aim of the study was to evaluate the value of intraoperative assessment of depth of myometrial invasion in patients with FIGO stage I of the endometrial carcinoma. MATERIAL AND METHODS: A total number of 112 patients with FIGO stage I of the endometrial carcinoma undergoing surgery were enrolled in the study. All patients had undergone intraoperative assessment of the depth of myometrial invasion performed by a surgeon. The depth was determined as more or less than 50% of myometrial thickness according to FIGO classification. Gross visual estimation of the depth of myometrial invasion at the time of the operation was compared with the final histopathological report. Sensitivity, specificity and positive and negative predictive values of the method were determined by means of statistical analyses. RESULTS: The depth of the myometrial invasion was accurately determined by the surgeon in 82.1% of cases. Sensitivity and specificity were 68% and 82.1%, respectively. The accurate prediction rate of the myometrial invasion in the group of patients with well differentiated (G1) endometrial carcinoma was higher (88.4%) than in group with moderately and low differentiated tumour (78.3%). CONCLUSIONS: The accuracy of macroscopic evaluation of myometrial invasion is high and reaches up to 82.1%. The accurate determination rate increases if the differentiation of tumour is higher.     

Monocyte activity after stimulation by serum of women with endometriosis

OBJECTIVES: Impairments of immune system play an important role in the development and pathogenesis of endometriosis. In affected women peritoneal macrophages are excessively activated, which is visible in an increased synthesis and release of macrophage-derived cytokines and growth factors. Monocytes are precursors of those cells in peripheral blood. The aim of the study was to evaluate the activity of monocyte from a healthy person, after stimulation by serum of women with endometriosis in cell culture conditions. The indicator of monocyte activity was the concentration of neopterin (NPT), produced by those cells. MATERIAL AND METHODS: Twenty nine women with endometriosis (mean age: 28.7+/-4.5 years) were included into this study. Among them were 18 women with moderate endometriosis (I and II stages according to AFS) and 11 women with advanced stages of the disease (III and IV stages according to AFS). Reference group consisted of fifteen healthy women (mean age: 27.4+/-5.3 years), with excluded endometriosis and other pathological disorders within the pelvis. Monocytes used in the study were isolated from peripheral blood of a healthy male and serum of women with endometriosis and control group. Monocytes were cultured in attendance of 15% and 30% serum of studied women. The concentration of NPT in the supernatants of culture was measured by enzyme-linked immunosorbent ELISA assay. RESULTS: The serum of women with endometriosis causes an increased concentration of NPT in supernatants, when comparing with serum of healthy women (p<0. 0001). The highest concentration was observed after stimulation by serum of women with advanced endometriosis. CONCLUSIONS: Serum of women with endometriosis can have an effect on monocyte activity, which is displayed in the increased synthesis and secreted of NPT.     

Studies of Selective Recovery of Zinc and Manganese from Alkaline Batteries Scrap by Leaching and Precipitation

Recovery of zinc and manganese from scrapped alkaline batteries were carried out in the following way: leaching in H₂SO₄ and selective precipitation of zinc and manganese by alkalization/neutralization. As a result of non-selective leaching, 95.6–99.7% Zn was leached and 83.7–99.3% Mn was leached. A critical technological parameter is the liquid/solid treatment (l/s) ratio, which should be at least 20 mL∙g⁻¹. Selective leaching, which allows the leaching of zinc only, takes place with a leaching yield of 84.8–98.5% Zn, with minimal manganese co-leaching, 0.7–12.3%. The optimal H₂SO₄ concentration is 0.25 mol∙L⁻¹. Precipitation of zinc and manganese from the solution after non-selective leaching, with the use of NaOH at pH = 13, and then with H₂SO₄ to pH = 9, turned out to be ineffective: the manganese concentrate contained 19.9 wt.% Zn and zinc concentrate, and 21.46 wt.% Mn. Better selectivity results were obtained if zinc was precipitated from the solution after selective leaching: at pH = 6.5, 90% of Zn precipitated, and only 2% manganese. Moreover, the obtained concentrate contained over 90% of ZnO. The precipitation of zinc with sodium phosphate and sodium carbonate is non-selective, despite its relatively high efficiency: up to 93.70% of Zn and 4.48–93.18% of Mn and up to 95.22% of Zn and 19.55–99.71% Mn, respectively for Na₃PO₄ and Na₂CO₃. Recovered zinc and manganese compounds could have commercial values with suitable refining processes.