Introduction: The nose is the central and probably the most important anatomical region of the face. Reconstructive surgery after tumor resection in this anatomical region requires from the surgeon knowledge of the anatomy, due to the three-dimensional shape and variety of tissues. Materials and methods: In the years 2010-2019, 48 patients were treated in the Oncological and Reconstructive Surgery Clinic for extended nasal tumors , who required the use of free microvascular flaps after resection for functional and aesthetic supply of anatomical structures of the nose. Results: In 48 patients, a total of 92 free microvascular flap were used for nasal reconstruction including: radial forearm free flap in 24 patients, radial forearm free flap with radial bone in 14 patients, auricle free flap in 16 patients, radial forearm free flap in combination with auricle free flap in 7 patients, double auricle free flap in 6 patients, radial forearm free flap in combination with double auricle free flap in 4 patients. Total necrosis of the free flap was noted in 4 cases, partial in 6 patients. Conclusions: Presented surgical techniques using the microvascular free flaps constitute a recognized method of treatment in the world and should be used in everyday surgeon practice. Discussion: In the reconstructive nose surgery after extended tumor resections due to cancer, there are no uniform treatment standards and algorithms . The surgeon is often dependent on his knowledge, skills and creative thinking . Presented results in this article allows to obtain optimal functional and aesthetic effects.

: Ameloblastoma (AM) is the most common, locally aggressive odontogenic tumor. It comprises about 1% of all head and neck neoplasms. It occurs mainly in young adults in their 3rd and 4th decade of life. It localizes in the mandible in about 80% of the cases. According to the 2017 WHO classification, 4 types of ameloblastoma can be distinguished: ameloblastoma (previously referred to as solid/multicystic-SMA; the “conventional type” AM), unicystic (AM-UA), extraosseous/peripheral (AM-PA), and malignant/metastatic (AM-MA). Solid, multicystic is the most common type. It is characteristic for its aggressiveness and high risk of recurrence. Radical resection with consecutive reconstruction is the treatment of choice of mandibular ameloblastomas. In this study, the authors present their experience in the surgical treatment of mandibular ameloblastomas with vascularized free flap reconstructions. They discuss new technological possibilities that could improve the precision of the reconstructive procedure and therefore result in the better aesthetic outcome. The retrospective study of a group of 21 patients suffering from mandibular ameloblastoma who underwent segmental man-dibulectomy with simultaneous microvascular free flap reconstruction was conducted. A thorough clinical analysis with various aspects was performed. Tumors resected before 2017 were double checked patomorphologically and assigned to the corrected subtype group. Seven patients were admitted to the department due to recurrent ameloblastoma. The most common localization of the tumor was the mandibular body (n = 6) andbodywith ramus of the mandible (n = 6). A total amount of 10 iliac crest free flaps and 12 fibular free flaps were performed. Complications were reported in 4 patients. A purulent oro-cutaneus fistula occurred in 3 patients. There was a flap failure in each reconstructive group. The virtual surgical planning with intraoperative cone-beam computed tomography was used in 3 patients. Dentition implantation was conducted in 4 patients (3 simultaneously, 1 postponed). The mean follow-up was 5 years and 8 months. Radical resection that covers radical segmental mandibulect-omy with immediate microvascular free flap reconstruction is a first-line and only effective treatment of mandibular ameloblas-tomas, that eliminates the risk of recurrence. The extent of surgical margins seems not to influence the recurrence rate, yet further investigation with statistical analysis should be performed. The choice of the adequate free flap must be adapted to dimensions and localization of the tumor and to each patient individually. New technologies such as virtual surgical planning with 3D models and intraoperative cone-beam computed tomography can make the reconstruction more accurate, improving patient's quality of life.

Background Regional lymph node metastases are the main adverse prognostic factor in patients with rectal cancer without distant metastases. There are discrepancies, however, regarding additional risk factors in the group of ypN + M0 patients. The purpose of the study was to assess clinical and pathological factors affecting long-term oncological outcomes in the group of ypN + M0 patients after radical rectal anterior resection. Methods 112 patients with ypN + M0 rectal cancer after neoadjuvant therapy and radical anterior resection were subject to a retrospective analysis. The effect of potential factors on survival was assessed with the use of Kaplan–Meier curves together with a log-rank test and multiple factor Cox proportional hazards model. Results In the multiple factor Cox analysis, adverse factors affecting disease-free survival (DFS) were: the use of angiotensin-converting enzyme inhibitors (ACEIs) (hazard ratio HR: 3.11, 95% CI 1.01–9.56, p = 0.047), presence of perineural invasion (HR: 7.27, 95% CI 2.74–19.3, p < 0.001) and occurrence of postoperative complications (HR: 6.79, 95% CI 2.09–22.11, p = 0.001), while a positive factor was the negative lymph node (NLN) count > 7 (HR: 0.33, 95% CI 0.12–0.88, p = 0.026). In the disease-specific survival (DSS) analysis, an adverse factor was the use of ACEIs (HR: 4.275, 95% CI 1.44–12.694, p = 0.009), while a positive effect was caused by NLN > 5 (HR: 0.22, 95% CI 0.082–0.586, p = 0.002). Conclusions The use of ACEIs may have a negative effect on long-term treatment outcomes in patients with ypN + M0 rectal cancer. In this group of patients, the NLN count seems to be an important prognostic factor, as well.

Introduction. Perianal pruritus is probably the most common cutaneous disorder of the genitoanal area. Studies on the epidemiology of causative factors are rare. It occurs in about 1-5% of the population, four times more often in men than women, most usually between the ages of 40-70. Aim. Evaluation of potential etiologic factors in adult patients with persistent anal pruritus. Material and methods. Over a 4-year period we prospectively studied 55 patients with a presumptive diagnosis of anal pruritus. The diagnostic algorithm comprised medical history, inspection, microbiology, laboratory chemistry, patch tests, proctoscopy, and biopsy if appropriate. Results. Twenty six patients had contact eczema. Idiopathic anal pruritus affected 14 of our patients. Five subjects had perianal streptococcal dermatitis and also 5 patients had intertrigo caused by candida albicans. Other diagnosis included inverted psoriasis, condylomata acuminate, erythrasma, oxyuriasis and paraneoplastic pruritus. Conclusions. Our study showed that the vast majority of patients have the typical characteristics of eczema in the anogenital area. Epidermal testing is a very important component of the diagnostic process. These findings suggest that referral to a dermatologist who cooperate with proctologist is the best option for patients with persistent pruritus ani. S t r e s z c z e n i e Wstęp. Świąd odbytu to najczęstsza dolegliwość dermatologiczna okolicy anogenitalnej. Badania epidemiologiczne dotyczące czynników predysponujących dla tej dolegliwości są rzadkie. Występuje on u około 1-5% populacji, czterokrotnie częściej dotyczy mężczyzn niż kobiet, najczęściej w wieku 40-70 lat. Cel pracy. Ocena potencjalnych czynników etiologicznych u pacjentów z uporczywym świądem odbytu. Materiał i metody. W ciągu czterech lat zbadano 55 chorych z diagnozą uporczywego świądu odbytu. Algorytm diagnostyczny obejmował wywiad lekarski, badanie fizykalne, wymazy bakteriologiczne i mikologiczne, podstawowe badania laboratoryjne, testy naskórkowe, rektoskopię oraz w niektórych przypadkach wykonano biopsję skóry. Wyniki. U 26 pacjentów zdiagnozowano wyprysk kontaktowy. Idiopatyczny świąd odbytu dotyczył 14 naszych chorych. Pięć osób miało paciorkowcowe zapalenie skóry okolicy odbytu, również 5 pacjentów miało wyprzenia drożdzakowe. U pozostałych pacjentów wykryto łuszczycę odwróconą, kłykciny kończyste, łupież rumieniowy, owsicę oraz świąd paraneoplastyczny. Wnioski. Nasze badanie wykazało, iż znaczna większość pacjentów ma typowe cechy wyprysku okolicy anogenitalnej. Testy naskórkowe są bardzo ważną składową procesu diagnostycznego. Wyniki te sugerują, że najlepszą opcją terapeutyczno-diagnostyczną dla pacjentów ze świądem odbytu jest dermatolog współpracujący z proktologiem.

Background: Regional lymph node metastases are the main adverse prognostic factor in patients with rectal cancer without distant metastases. There are discrepancies, however, regarding additional risk factors in the group of ypN+M0 patients.The purpose of the study was to assess clinical and pathological factors affecting long-term oncological outcomes in the group of ypN+M0 patients after radical rectal anterior resection.Methods: 112 patients with ypN+M0 rectal cancer after neoadjuvant therapy and radical anterior resection were subject to a retrospective analysis. The effect of potential factors on survival was assessed with the use of Kaplan-Meier curves together with a log-rank test and multiple factor Cox proportional hazards model.Results: In the multiple factor Cox analysis, adverse factors affecting OS were: the use of angiotensin-converting enzyme inhibitors (ACEIs) (HR: 3.059, 95% CI: 1.349-6.934, p= 0.007) and past <=3 cycles of adjuvant chemotherapy (HR: 2.833, 95% CI: 1.289-6.229, p= 0.01). For DFS, significant adverse factors were: the use of ACEIs (HR: 3.11, 95%CI: 1.01-9.56, p= 0.047), presence of perineural invasion (HR: 7.27, 95% CI: 2.74-19.3, p< 0.001) and occurrence of postoperative complications (HR: 6.79, 95% CI: 2.09-22.11, p= 0.001), while a positive factor was the negative lymph node (NLN) count >7 (HR: 0.33, 95% CI: 0.12-0.88, p= 0.026). Conclusions: The use of ACEIs may have a negative effect on long-term treatment outcomes in patients with ypN+M0 rectal cancer. In this group of patients, the NLN count seems to be an important prognostic factor, as well.