Background/Aim: Morphological features, combined with Ki-67 proliferative index, remain the standard for discriminating benign and malignant adrenocortical tumors. The aim of this study was to evaluate the role of minichromosome maintenance proteins MCM-3, MCM-5, MCM-7, and Ki-67 as proliferative markers in adrenocortical tumors. Materials and Methods: Specimens of 81 adrenocortical adenomas and 3 adrenocortical carcinomas were stained with antibodies against MCM-3, 5, 7 and Ki-67. Results: Malignant tumors were characterized by a greater size (p=0.017), volume (p=0.017), and higher levels of Ki-67 (p=0.005), MCM-3 (p=0.005), MCM-7 (p=0.008), but not MCM-5 (p=0.069). The markers' levels were independent from the tumors' size and volume, the patient's age and hormonal status. ROC curves showed Ki-67 (AUC 0.984), MCM-3 (AUC 0.984), and MCM-7 (AUC 0.950), but not MCM-5 (AUC 0.820) to be reliable markers. Conclusion: Ki-67, MCM-3, and MCM-7, but not MCM-5 are reliable proliferative and diagnostic markers in discerning benign and malignant adrenocortical tumors. Adrenal gland tumors (AGTs) are relatively common and constitute 5-9% of all human tumors. The greater accessibility to diagnostic imaging in recent years, especially ultrasound (US) and computed tomography (CT), has revealed that the rate of AGTs is significantly higher than previously reported. The prevalence of incidentally detected adrenal mass (socalled incidentaloma) is greater with age and ranges from 0.2% (20-29 years old) to 3% (over 50 years of age) and even up to 7% (over 70 years of age) (1, 2). The mean value for the general population is about 2-4% (3, 4). An incidentaloma is typically detected in the right adrenal gland, between the 5th and 7th decade of life (mean age 55 years). AGTs are found on average in 1-8.9% (mean 2.3%) of autopsies, and even in as high as 15% according to some authors (2, 4). Apart from an incidentaloma, adrenal tumors may present symptoms, either of hormonal excess or a mass effect (5). Following the finding of an AGT, steps are taken to determine its origin (cortical/medullar) and character (benign/malignant) (1, 3, 6). Most AGTs are of cortical origin and benign, adrenocortical adenoma (ACA) is the most frequent diagnosis (70-94%) (2, 5). The majority of ACAs do not display hormonal activity. The most common functioning ACA is aldosterone-producing adenoma (APA), followed by cortisol-producing adenoma (CPA) (7). A malignant AGT can be either a primary adrenal lesion or a metastasis (3). Primary malignancies consist of cortical (adrenocortical carcinoma-ACC) and medullar lesions (malignant pheochromocytomaabout 10% (2.5-26%) of all pheochromocytomas) (6). Metastatic AGTs vary in origin, including lung, renal, breast, gastrointestinal (gastric, colorectal), hepatocellular carcinoma and melanoma (1, 3, 5, 8). The presence of an extra-adrenal primary malignancy increases significantly the odds of an 1151 This article is freely accessible online.

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Background. Ideal pouch created during restorative proctocolectomy is a new gastrointestinal organ -"neorectum". Although it is made from the ileum, it takes over function of the removed rectum. This new function results in significant morphological changes in pouch's mucous membrane, which becomes similar to the large bowel mucosa. The most common pathology of the ileal pouch is its inflammation -pouchitis. One of the suspected causes of pouchitis is bacterial flora disturbance. Objectives. The aim of the study was to analyze the morphological and microbiological changes in ileal pouches in different time periods after ileostomy closure and to evaluate the influence of certain bacterial strains on the degree of inflammation. Material and Methods. The study involved 47 patients who had been treated surgically; they were investigated before and at different stages after ileostomy closure. They underwent repeated rectoscopies with biopsies of pouch mucosa and swabs for microbiological examination. In total 89 rectoscopies were performed, which provided 70 histopathological results according to the Heidelberg Pouchitis Activity Score and 87 microbiological test results. Results. The assessment of the morphology of intestinal pouches showed increased signs of chronic inflammation as the length of time after the closure of a protective ileostomy increased. There was no correlation between the signs of acute inflammation and the length of time after surgery; there were more signs of acute inflammation in cases of pouchitis. The composition of the bacterial flora of intestinal pouches changed as the length of time after ileostomy closure increased, with significant increases in the number of enterobacteriaceae species. The presence of Staphylococcus aureus significantly correlates with a higher degree of chronic inflammation; this bacterium may be a potential infectious factor in pouchitis. Conclusions. Microbiological analysis of intestinal pouch lumen is a useful tool that can be used in routine follow-up assessment of intestinal pouches as well as in diagnosing pouchitis (Adv Clin Exp Med 2015, 24, 2, 267-274).

IntroductionThe perioperative complication rate of adrenalectomy varies between 1.7% and 30.7% in the medical literature. This study presents outcomes of adrenalectomy in our center and tries to point out risk factors for perioperative problems.Material and methodsWe retrospectively analyzed all patients who underwent adrenalectomy in our department from January 2004 to June 2015. Patient’s sex, indication for procedure, tumor laterality, surgical approach and surgeon’s case volume were taken into consideration as possible risk factors for complications.ResultsThere were 177 adrenalectomies performed on 170 patients. We reported 18 (10.2%) perioperative complications, 12 (6.8%) surgical and 6 (3.4%) medical. Laparotomy was a significant risk factor for medical (p < 0.01) and overall problems (p = 0.02). Operations more expansive than just adrenalectomy were associated with higher risk of medical complications (p = 0.01). Procedures performed by surgeons with higher volume were associated with smaller risk of medical complications (p < 0.01). Right and left adrenalectomies seem to be related to different kinds of risk – bleeding on the right, injury of surrounding structures on the left (p = 0.05). Patient’s sex, indication for procedure, bilateral procedure and side of operation were not statistically significant risk factors for complications.ConclusionsAdrenal glands are surrounded by various anatomic structures (colon, pancreas, spleen, diaphragm) that may be injured during adrenalectomy. Complications following a laparoscopic procedure may arise from the use of monopolar coagulation and the patient’s position on the operating table. High insufflation pressure during retroperitoneoscopic procedures may cause subcutaneous emphysema.

We describe a 47-year-old male who was admitted to our centre from a local emergency unit with septic shock due to suspected Boerhaave syndrome. After the diagnosis was confirmed, the patient underwent emergency surgery. Postoperatively, the patient had symptoms of acute alcoholic delirium, and developed an oesophagomediastinal fistula as the most serious local complication. Successful conservative treatment enabled complete healing of the fistula, leading to patient recovery. No late complications like oesophageal stenosis were found at 6 months from discharge.