IntroductionTumours of the sternum are rare and can be malignant, benign or inflammatory.AimTo determine the clinical, pathological and therapeutic options for tumours of the sternum.Material and methodsWe report a series of 30 cases of sternal tumours treated in our institution in the period 2006–2015. There were 10 malignant tumours located in the body of the sternum, 2 in the manubrium (metastases of kidney and thyroid carcinoma) and 18 benign tumours located in different parts of the sternum. Diagnosis was obtained by computed tomography scan of the chest, surgical biopsy or excision of the tumours.ResultsMalignant tumours were excised radically. Reconstruction of the sternum was obtained by allogenic mesh (polypropylene) and local tissues (mainly pectoralis major muscle). There was 1 postoperative cardiac death. Patients with malignancy were referred for adjuvant chemoradiotherapy. After 2 years there were 4 cases of recurrence of chondrosarcoma (1 case of local recurrence and 3 cases of pulmonary metastases). Recurrence of other tumors were not observed.ConclusionsThe management of sternal tumours is dependent on the histological type and the possibility of surgical excision. Reconstruction of the chest wall can be achieved by autogenic or allogenic materials.

Background: Precise and accurate placement of electrodes in DBS surgery is essential in achievement of proper therapeutical effect in movement disorders. Verification of their position in the target is necessary. It can be performed postoperatively. But more convenient for the patient is an intraoperative CT imaging in the operating room. We evaluated the results of DBS electrodes implantation in patients with Parkinson's disease by intraoperative CT. Case series: 21 patients with Parkinson's disease were operated in 2010-2012 in the Military Clinical Hospital in Bydgoszcz, Poland. Standard procedure of electrode implantation was verified by intraoperative CT in operating room. CT scans were fused with preoperative MRI plan of target (STN) and trajectory and accuracy were assessed. Results: Mean differences between positions of tips of electrodes implanted and intended coordinates of targets were: 0.9 mm; 1.6 mm; and 0.8 mm in horizontal line, in vertical line, and in lateral line respectively and remain within the limits of the intraoperative CT resolution. In 1 case the accuracy was not satisfying and replacement of electrodes in one stage surgery was required. Conclusions: Intraoperative CT is a helpful tool in DBS procedures and enables comparison of preoperative plans with the final trajectory and localization of the tip of electrode visualized in CT in appropriate target. It eliminates necessity of post-op verification outside the operating room. All changes can be done during the procedure. It also allows to rule out the intracerebral haematoma caused by implantation.

Implementation of ultrasonography (USG), computed tomography (CT) and magnetic resonance imaging (MRI) into abdominal cavity diagnostics enabled early detection of cT1 graded renal cancers. According to European Association of Urology (EAU) and Polish urological Association (PUA) recommended method of treatment is sparing resection of renal parenchyma with tumour - nephron-sparing surgery (NSS). In selected cases other methods such as thermal ablation (TA) or cryoablation can be introduced /1/. Objectives: To evaluate the results of treatment of cT1 renal tumours with the use of NSS and TA methods. Material and methods: 140 patients with cT1 renal carcinoma were treated in 2nd Department of Urology of Medical University of Lodz between 2014 and 2017. Neuron-sparing surgery was performed in 56 cases (40%), while percutane-ous thermal ablation (TA) in 84 cases (60%). Demographic data, clinical data (lab results, Charlson index), nephrometry data (tumour size, location, R.E.N.A.L. score) post-operative data (Clavien-Dindo classifica-tion) were investigated. Histopathology results, Fuhrman malignancy grading, as total three-year survival of patients were evaluated. The following methods were used for statistical evaluation: Chi2, Fisher, W Shapiro-Wilk, U Mann-Whitney tests, Kaplan-Meier’s curve and Cox model. The results were displayed in a form of median and upper and lower quartile values (25 – 75%). Results: No statistical differences in gender nor left/right kidney location were observed. Patients, who underwent TA were at average 10 years older and had multiple comorbidities (median age for TA was 79, for NSS 68; median Charlson index for TA was 5 and for NSS was 3). TA patients had lesser haematological values (Hb, Ht). R.E.N.A.L. scoring demonstrated comparable nephrometry in both groups. NSS procedure was open laparotomy without temporary clamping of renal vessels. Surgical margins of resected tumours were negative. TA was performed with Cool-Tip Covidienequipment with the use of Cluster electrode and was ultraso-nography-guided. Post-treatment complications evaluated with the use of Clavien-Dindo classification were slightly more frequent for NSS method. Patients after NSS were discharged at average after 8.5 days and after TA after 3 days. Histopathological type and Fuhrman malignancy grading were comparable in both groups. TA treated patients’ death risk was 9-fold of that observed in NSS treated patients. There was 1 death for each group in perioperative period. Conclusion: 1.NSS was associated with slightly higher side effect rate but resulted in prolonged survival. 2. TA was applied to elderly patients with comorbidities. Despite less invasive treatment this group had poorer/reduced survival. 3. Charlson Comorbidity Index (CCI) and the treatment method were relevant survival factors in patients treated due to cT1 renal cancer tumours.

Introduction Descending necrotizing mediastinitis is usually a polymicrobial process and can lead to a serious clinical condition. It can be caused by formation of an oropharyngeal or odontogenic abscess that spreads the infection to the neck tissues and further via the cervical fascia planes to the mediastinum. Clinically there are two forms of cervical necrotizing fasciitis (CNF): suppurative and gaseous which if diagnosed late can have lethal effects. Multidisciplinary treatment is often essential for the recovery. Material and methods We would like to present our experience in managing a young adult patient who suffered from descending necrotizing mediastinitis (DNM) of odontogenic origin and describe controversies associated with its treatment. Incision and drainage of the neck were performed in the patient, antibiotic therapy was given, and oral cavity was irrigated, as well as parenteral and enteral immunonutrition enriched with omega-3 fatty acids (Omegaven) and glutamine (Dipeptiven) were started. Moreover, dental treatment was carried out, after which the patient’s clinical status improved. Results Dental treatment influenced the postoperative course. Multidisciplinary approach led to a full recovery of the patient. Conclusions Early multidisciplinary aggressive treatment of oropharyngeal infection and cervical necrotizing fasciitis is a life-saving procedure. Thorough surveillance with repeated CT scans, white blood cells and C-reactive protein evaluation, monitoring of bacteriological culture and surgical procedures which are performed in descending necrotizing mediastinitis facilitate the treatment and allow to avoid complications