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Achalasia is a rare motility disorder with unknown etiology that results in failure of relaxation of the lower esophageal sphincter (LES). As there is no etiological treatment, different pharmacological agents and invasive techniques have been used for relieving the symptoms. For the past decade, peroral endoscopic myotomy (POEM) has proven to have excellent results. We present a retrospective study of five patients that underwent POEM for primary achalasia. We used anterior approach for the submucosal tunneling. The procedure showed immediate results and no severe short- or long-term adverse events. We have been following the patients up for more than 3 years now. Since its invention more than ten years ago, the POEM procedure and its advantages and disadvantages compared to the pneumatic dilatation and the Heller myotomy have been extensively studied. There is still no universal opinion on which procedure should be the first line treatment.

Background Primary squamous cell carcinoma of the thyroid gland (PSCTC) is a rare malignancy, but demonstrates a very aggressive behaviour and has a poor prognosis. The best treatment is radical surgery and postoperative chemo-and radiotherapy, although there are some reports that this tumour is resistant to conservative therapy. Patients often present with a large tumour mass on the neck with a solid consistency. Diagnosis is usually set during the operation -on a frozen section. Case report We present a case of a 71-year-old man with weight loss and rapidly growing neck mass for the last two months. MRI showed a tumour of the left lobe of the thyroid gland, compressing the trachea and the adjacent structures. A left thyroidectomy with isthmectomy has been performed. Frozen section showed primary squamous cell carcinoma. Tumour recurrence two months later led to the second operation with the same effect. The patient died in a couple of months. Conclusion Because of its rarity and poor biology, treatment of PSCTC remains unsatisfactory. There are still many challenges on its origin, behaviour and prognostic factors. The results of postoperative chemo-or radiotherapy are controversial.

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INTRODUCTION: PMP is a rare disease with a slow but progressive course leading to death. According to the literature PMP encompass wide variety of conditions. To avoid the confusion and to facilitate the treatment and comparison of the results several authors suggested that the term "PMP" should include only the cases with appendiceal origin. CASE REPORT: We report two cases with low-grade paseudomyxoma peritonei. The first case was managed by debulking surgery alone with survival 2 years. The second case underwent complete cytoreduction plus HIPEC and 3 years later is still alive and free of disease. There was one patient with a benign appendiceal mucocele treated by appendectomy, who is free of disease 3 years later. CONCLUSION: Despite the high complication rate, cytoreductive surgery with HIPEC remains the gold standard in the treatment of pseudomyxoma peritonei. The tumor grade and completeness of cytoreduction are the main prognostic factors. Due to the rarity of the condition most of the surgeons are not experienced enough to manage these patients. Additionally, the incomplete cytoreduction is associated with poorer prognosis and significantly hampers the subsequent interventions. Thus, in the cases when it is found incidentally, the best strategy is the taking of biopsy, appendectomy and subsequent referral to a specialized center for a treatment by multidisciplinary team.