Anna Walecka

Publications of Anna Walecka

• [64-slice computer tomography for diagnostics of the small bowel: computer tomography enteroclysis].

  Authors: Błazej Richter, Anna Walecka, Ewa Gabrysz-Trybek, Wojciech Marlicz, Teresa Starzyńska, Michał Rać

  Annales Academiae Medicae Stetinensis. 01/2010; 56(1):28-35.

  Radiologic imaging of the small bowel is the method of choice because other methods are of limited availability. Computer tomography (CT) enteroclysis is the leading modern method for diagnosticRadiologic imaging of the small bowel is the method of choice because other methods are of limited availability. Computer tomography (CT) enteroclysis is the leading modern method for diagnostic imaging of the small intestine. It combines the advantages of conventional small bowel infusion with those of abdominal CT and can serve to disclose a wide range of small bowel pathologies. 101 patients underwent CT enteroclysis at the Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University in Szczecin. The procedure of CT enteroclysis is described starting from patient preparation and infusion technique to the scanning protocols. The results served to characterize the patients, establish indications and contraindications to CT enteroclysis, and reveal common errors of the method. Preliminary findings bring to light the considerable usefulness of CT enteroclysis. Other methods like ultrasound, MRI, conventional enteroclysis, or capsule endoscopy can be complementary in special cases.

• Lobar holoprosencephaly with a median cleft: case report.

  Authors: Elzbieta Gawrych, Joanna Janiszewska-Olszowska, Anna Walecka, Maria Syryńska, Hanna Chojnacka

  The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. 09/2009; 46(5):549-54.

  Holoprosencephaly is a congenital abnormality of the prosencephalon associated with median facial defects. Its frequency is 1 in 250 pregnancies and 1 in 16,000 live births. The degree of facialHoloprosencephaly is a congenital abnormality of the prosencephalon associated with median facial defects. Its frequency is 1 in 250 pregnancies and 1 in 16,000 live births. The degree of facial deformity usually correlates with the severity of brain malformation. Early mortality is prevalent in severe forms. This report presents a child with lobar holoprosencephaly accompanied by median cleft lip and palate. The treatment and 9 months' follow-up are presented. This unique case shows that holoprosencephaly may present different manifestations of craniofacial malformations, which are not always parallel to the severity of brain abnormalities. Patients with mild to moderate brain abnormalities may survive into childhood and beyond.

• Doppler sonography measurements of renal vascular resistance in autosomal-dominant polycystic kidney disease.

  Authors: Marcin Sawicki, Anna Walecka, Jacek Rozanski, Krzysztof Safranow, Kazimierz Ciechanowski

  Medical science monitor : international medical journal of experimental and clinical research. 08/2009; 15(8):MT101-4.

  BACKGROUND: The aim of this study was to assess the clinical usefulness of duplex Doppler sonography in ADPKD patients by measuring the resistive indices (RIs) and pulsatility indices (PIs) of renalBACKGROUND: The aim of this study was to assess the clinical usefulness of duplex Doppler sonography in ADPKD patients by measuring the resistive indices (RIs) and pulsatility indices (PIs) of renal and interlobar arteries and investigating the correlation between these parameters and relevant clinical data. MATERIAL/METHODS: RI and PI in renal and interlobar arteries of 61 patients with ADPKD and 27 healthy subjects were calculated and correlated with age, serum creatinine, age at diagnosis, and duration of disease. RESULTS: In the control subjects the median RI was 0.61 (interquartile range: 0.075) in the renal arteries and 0.58 (0.06) in the interlobar arteries vs. 0.72 (0.1) and 0.69 (0.1), respectively, in the ADPKD patients. Median PI was 1.07 (0.1425) in the renal arteries and 0.94 (0.1525) in the interlobar arteries vs. 1.41 (0.655) and 1.25 (0.395), respectively, in the ADPKD patients. Doppler indices were significantly higher in the ADPKD patients (p<0.0001). Almost all Doppler indices correlated positively and significantly with age, serum creatinine, age at diagnosis, and duration of disease. No significant correlation was observed between the indices and blood pressure. CONCLUSIONS: Because of the strong correlation between Doppler measurements of renovascular resistance and renal function tests together and duration of the disease observed in this study, this method, despite its pitfalls such as the influence of high blood pressure, compression by renal cysts, vascular calcification, and age, could be useful in the evaluation of disease progression in patients with ADPKD.

• [Efficiency of imaging methods for the diagnosis of some congenital defects in neonates: personal experience].

  Authors: Anna Walecka, Elzbieta Gawrych, Marcin Sawicki, Magdalena Skała, Grzegorz Zaborowski

  Annales Academiae Medicae Stetinensis. 01/2009; 55(3):28-35.

  The aim of this study was to assess the efficiency of imaging methods for the diagnosis of some congenital defects in neonates. Seventy neonates aged 1 to 30 days, referred to the Department ofThe aim of this study was to assess the efficiency of imaging methods for the diagnosis of some congenital defects in neonates. Seventy neonates aged 1 to 30 days, referred to the Department of Pediatric and Oncologic Surgery, Pomeranian Medical University, were examined at the Department of Diagnostic Imaging and Interventional Radiology. Clinical data were analyzed and the imaging method was chosen depending on the clinical symptoms of the defect. The following defects were diagnosed: gastrointestinal tract defects in 41 neonates (58.5%), urinary tract defects in 21 neonates (30%), other defects in eight neonates (11.5%) including ovarian cyst in four, lung cyst in three, and tumor in the sacrococcygeal region in one neonate. The choice of imaging modality was determined by the kind of defect deduced on the basis of clinical examination. Ultrasonography was performed in all 70 neonates (2-3 times in 25 cases). Radiography was performed in 49 cases, including CT in four cases. Defects in the gastrointestinal tract were disclosed in most cases except for three of the neonates (7%) in whom the cause of ileus remained unknown until surgery when the cause was established (enterogenic cyst in two and intestinal sequestration in one neonate). Urinary tract anomalies, ovarian cysts, lung cysts, and tumor in the The efficiency of imaging methods in our hands was very high thanks to good cooperation between the surgeon and the radiologist. Diagnostic accuracy depends on the kind of anomaly. In neonates with urinary tract defects, follow-up examinations preceding planned surgery are essential for a good therapeutic outcome.

• [Intralesional corticosteroid therapy in infantile hemangiomas].

  Authors: Elzbieta Gawrych, Anna Walecka, Justyna Rajewska, Piotr Juszkiewicz

  Annales Academiae Medicae Stetinensis. 01/2009; 55(1):15-21.

  This study was undertaken to evaluate the effectiveness of intralesional corticosteroid therapy in infantile hemangiomas. The study was done in 38 patients aged 1 month to 14 years with infantsThis study was undertaken to evaluate the effectiveness of intralesional corticosteroid therapy in infantile hemangiomas. The study was done in 38 patients aged 1 month to 14 years with infants accounting for 84% of all patients. Physical investigation was carried out before and after treatment. Localization, size of tumor, pressure, and surface features were recorded. Doppler ultrasound was performed concomitantly and served to measure tumor size and blood flow in tumor vasculature. Midazolanium 1-2 mg/kg was administered intravenously without general anesthesia. Treatment consisted of 3-5 doses of Polcortolon with intervals of 5-6 weeks between doses. The corticosteroid dose was individualized and depended on tumor size and age of patient. The results were analyzed with the modified Sloan's scale. Hemangioma was disclosed immediately after birth in 30 patients (78%). The tumor had an intense cherry color and demonstrated increased pressure and fast enlargement during the first weeks of life. In the remaining eight patients (22%), the tumor appeared after the second month of life and failed to show features of fast growth during the first year of life. The location of hemangioma was on the head and neck in 22 children (58%) and on the chest, extremities, abdomen, or lower back (lumbar region) in the remaining children. Doppler ultrasound revealed increased vascular flow in the tumor of all patients. Intralesional corticosteroid therapy resulted in reduction of tumor volume of more than 50% in 18 (47%), less than 50% in 12 (32%), and little or no change in eight (21%) cases. A very good result in one patient was achieved with two weeks of supplemental oral Prednisolon therapy. Total or partial excision of the tumor for aesthetic reasons was done in eight patients in whom intralesional corticosteroid therapy produced substantial reduction in tumor size. Intralesional corticosteroid therapy is an effective and safe modality particularly suitable for the management of extensive hemangiomas of the head and neck when surgical options are limited.

• Arteriovenous fistula: a rare complication of nephrectomy in a child with Wilms tumour.

  Authors: Piotr Juszkiewicz, Andrzej Brodkiewicz, Anna Walecka, Elwira Szychot, Janusz Kordowski, Magdalena Pastuszak-Gabinowska

  Annales Academiae Medicae Stetinensis. 01/2009; 55(2):27-9.

  The case of a 13-year-old boy with a renal arteriovenous fistula in the left renal pedicle after nephrectomy is presented. The fistula was successfully managed by percutaneous transluminalThe case of a 13-year-old boy with a renal arteriovenous fistula in the left renal pedicle after nephrectomy is presented. The fistula was successfully managed by percutaneous transluminal embolization with coils sparing the patient the burden of surgery. Attention is drawn to the very rare incidence of this complication after nephrectomy in children with Wilms tumour.

• Angiomyolipomas, renal manifestation of tuberous sclerosis complex in 17-year-old boy--a case report.

  Authors: Andrzej Brodkiewicz, Hanna Marciniak, Elwira Szychot, Anna Walecka, Jarosław Peregud-Pogorzelski

  Annales Academiae Medicae Stetinensis. 02/2008; 54(2):160-5.

  INTRODUCTION: Tuberous sclerosis complex (TSC) is a genetic disorder characterised by lesions affecting brain, skin, eyes and internal organs--kidneys, heart, liver and lungs. Renal involvement inINTRODUCTION: Tuberous sclerosis complex (TSC) is a genetic disorder characterised by lesions affecting brain, skin, eyes and internal organs--kidneys, heart, liver and lungs. Renal involvement in individuals with TSC is common and potentially serious, includes angiomyolipomas and cystic lesions. There may also be an increased risk of renal cell carcinoma. CASE REPORT: A case of 17-year-old boy with delayed diagnosis of tuberous sclerosis complex with angiomyolipomas and cysts of the kidneys has been described. CONCLUSION: The authors would like to underlina a very rare incidence of tuberous sclerosis complex and associated renal angiomyolipomas in children, the possibility to maintain normal kidney function for prolonged time despite intensified renal pathology, the need for periodic abdominal imaging and significantly delayed diagnosis in the described case.

• [Significance of antiphospholipid syndrome and antiphospholipid antibodies in patients with systemic lupus erythematosus in estimation of risk of subclinical atherosclerosis development]

  Authors: Katarzyna Fischer, Marek Brzosko, Anna Walecka, Lidia Ostanek, Marcin Sawicki

  Polskie archiwum medycyny wewnȩtrznej. 02/2007; 117 Suppl:13-7.

  INTRODUCTION: Atherosclerosis is an important clinical problem in patients with systemic lupus erythematosus (SLE), because of very severe cardiovascular and central nervous system manifestations.INTRODUCTION: Atherosclerosis is an important clinical problem in patients with systemic lupus erythematosus (SLE), because of very severe cardiovascular and central nervous system manifestations. OBJECTIVES: Estimation if antiphospholipid syndrome (APS) and antiphospholipid antibodies (aPL) are risk factors for subclinical atherosclerosis in patients with SLE. PATIENTS AND METHODS: We examined 103 patients with SLE and 30 healthy volunteers, included as the control group. Coexistence of APS was confirmed in 35 patients. Evaluation of subclinical atherosclerosis was done on the basis of measurement of intima-media thickness (IMT) in B-mode ultrasound examination. We considered classical atherosclerotic risk factors and determined profile of aPL: anti-cardiolipine antibodies (aCL), anti beta2 glycoprotein-I antibodies, antiprothrombin antibodies (aPT), anti-oxidized low-density lipoprotein antibodies and lupus anticoagulant (LA). Statistical analysis was performed with chi2 Yates, chi2 Pearson and R rang Spearman tests. Multivariate regression analysis was also done. RESULTS: Thickened IMT was significantly more frequent in patients with SLE than in controls (p = 0.0002). We found that coexistence of APS is a risk factor for moderate thickening of IMT (OR: 3.41; 95% CI: 1.0-11.5). We also confirmed that the presence of aPL is significantly correlated with IMT ranging from 0.66 to 0.86 mm. The highest risk was found in patients with the presence of aPT IgA (OR: 5.50; 95% CI: 1.1-30.2), aCL IgM (OR: 4.36; 95% CI: 1.1-20.7), LA (OR: 4.02; 95% CI: 1.1-19.4) and aCL IgG (OR: 2.99; 95% CI: 1.1-9.7). Moreover, we found that ischaemic heart disease, nephropathy and myocardial infarction were significantly more frequent in patients with thickened IMT. CONCLUSIONS: Patients with SLE develop subclinical atherosclerosis significantly more frequent than the general population. Coexistence of APS and presence of aPL are risk factors for subclinical atherosclerosis development in patients with SLE. Thickened intima-media in patients with SLE is significantly associated with an increased risk of cardiovascular manifestations.

• [Evaluation of oral and pharyngeal phase of swallowing after glossectomy due to neoplasm]

  Authors: Violetta Posio, Ludmila Halczy-Kowalik, Anna Walecka

  Annales Academiae Medicae Stetinensis. 02/2006; 52 Suppl 3:91-6.

  INTRODUCTION: Glossectomy is a disability that leads to dysphagia. AIM: To define oral and pharyngeal dysfunctions with regard to the extent of tongue excision and swallowing efficiency. MATERIAL ANDINTRODUCTION: Glossectomy is a disability that leads to dysphagia. AIM: To define oral and pharyngeal dysfunctions with regard to the extent of tongue excision and swallowing efficiency. MATERIAL AND METHODS: 62 patients were videofluoroscopically examined 2 weeks to 3 months after surgery. Oral and pharyngeal disturbances were analyzed according to W.J. Dodd. RESULTS: Impaired tongue movement and absence of oral transport were the most frequent oral dysfunctions. Lack of glossopharyngeal closure and abnormal epiglottis mobility were the most frequent pharyngeal dysfunctions. CONCLUSIONS: Oral phase abnormalities are the result of resection of anatomical structures, while pharyngeal abnormalities are due to a delay in pharyngeal phase initiation and defect of synchronization. Videofluoroscopy is a fundamental method to define oral and pharyngeal dysfunction.

• [Antiendothelial cell antibodies as a risk factor of atherosclerosis in systemic lupus erythematosus]

  Authors: Katarzyna Fischer, Marek Brzosko, Anna Walecka, Lidia Ostanek, Marcin Sawicki

  Annales Academiae Medicae Stetinensis. 02/2006; 52 Suppl 2:95-9.

  PURPOSE: It was confirmed experimentally that antiendothelial cell antibodies (AECA) react directly with the vascular endothelium and are involved in the pathogenesis of vasculitis. There is evidencePURPOSE: It was confirmed experimentally that antiendothelial cell antibodies (AECA) react directly with the vascular endothelium and are involved in the pathogenesis of vasculitis. There is evidence for a role of AECA in atherosclerosis. To search for correlations between intima-media thickness (IMT) and high titer of AECA in patients with systemic lupus erythematosus (SLE). MATERIAL AND METHODS: IMT of carotid arteries was measured with B-mode ultrasound in 103 SLE patients and 30 healthy subjects (control group). The presence of AECA was determined with indirect immunofluorescence using human umbilical vein endothelial cells as target. Statistical analysis was performed with chi2 Yates, chi2 Pearson, R Spearman rank test, and logistic multivariate regression analysis. RESULTS: Normal IMT (< or = 0.65 mm) was found in 34 patients. In 52 patients, IMT was 0.66-0.86 mm and in 17 it exceeded 0.86 mm. The difference in comparison with the control group was significant (p = 0.0002). High titers of AECA were significantly more frequent in patients with SLE than in controls (p = 0.0001). In SLE patients, high titers of AECA correlated with IMT greater than 0.86 mm (OR = 6.61; 95% CI: 1.6-28.3). CONCLUSIONS: The presence of antiendothelial cell antibodies is a risk factor for premature, subclinical atherosclerosis in patients with SLE.

• Does use of hydrophilic guidewires significantly improve technical success rates of peripheral PTA?

  Authors: Wojciech Poncyliusz, Aleksander Falkowski, Anna Walecka

  Medical science monitor : international medical journal of experimental and clinical research. 07/2004; 10 Suppl 3:55-7.

  Background: To determine whether the use of hydrophilic guidewires has increased the technical success rate of peripheral percutaneous transluminal angioplasty (PTA). Material/Methods: We performedBackground: To determine whether the use of hydrophilic guidewires has increased the technical success rate of peripheral percutaneous transluminal angioplasty (PTA). Material/Methods: We performed 125 procedures and analyzed the technical success rates of PTA using the conventional guidewire first and then if needed, the hydrophilic guidewire for iliac and SFA stenoses or occlusions. Angioplasty was performed on 25 stenosed, 25 occluded iliac arteries and 25 stenosed, 50 occluded femoral arteries. The result was defined as technical success when the lesion was crossed by a guidewire and balloon, then it was dilated with restoration of vessel lumen and less than 30% residual stenosis and the rise in ABI values was at least 0.15 after 24 hours. Results: The technical success rate after PTA of stenosed iliac arteries was achieved in 96% (24/25) using conventional wires and 100% using hydrophilic guidewire; in iliac occlusions, the rates were 60% (15/25) and 96%, respectively; in femoral stenosis - 84% (21/25) and 100%; in occlusions in the first group: lesions <10 cm -64% (16/25) and 96%, in the second group: lesions >10 cm -48% (12/25) and 88%. In the iliac group, there was no significant difference in the success of iliac stenosis PTA. However, there were significant changes in the success rates of PTA performed for SFA stenosis and iliac and SFA occlusions. Conclusions: In summary, we report an overall improvement and high technical success rate for peripherial PTA. The use of hydrophilic guidewires made significant difference to the technical success rate of PTA, especially in occlusion and more complicated lesions.

• Value of high resistance index - HRI calculated from Doppler spectrum of popliteal arteries in patients with systemic lupus erythematosus (SLE).

  Authors: Anna Walecka, Marcin Sawicki, Marek Brzosko, Lidia Ostanek, Katarzyna Fischer, Janusz Kordowski

  Medical science monitor : international medical journal of experimental and clinical research. 07/2004; 10 Suppl 3:58-62.

  Background: HRI is a new Doppler index calculated as a ratio between S -maximal systolic flow and D -maximal early diastolic reversed flow -HRI=D/S. The aim of the study is to evaluate the diagnosticBackground: HRI is a new Doppler index calculated as a ratio between S -maximal systolic flow and D -maximal early diastolic reversed flow -HRI=D/S. The aim of the study is to evaluate the diagnostic significance of HRI calculated from the Doppler spectrum of popliteal arteries in patients with systemic lupus erythematosus (SLE) with and without secondary antiphospholipid syndrome (SAPS) compared with healthy controls. Material/Methods: During 9-month period (May 2003 -January 2004), 93 patients (81 women and 12 men) with SLE (including 24 patients with SAPS) and 30 healthy controls (24 women and 6 men) underwent bilateral duplex Doppler examinations of lower limb arteries. The examinations were performed using HDI 3500 (ATL) with 5 -12 MHz linear transducer under standardized conditions: correct insonation angle and sample volume size, with the patient in a supine position, after 10 minutes rest. Results: Mean HRI value obtained in the control group was 0.415 (range 0.305 -0.555; median 0.402). In the group of SLE patients without SAPS, mean HRI value was decreased to 0.320 (range 0 -0.584;median 0.334) and even lower -0.283 in SLE patients with SAPS (range 0.106 -0.545; median 0.291). Conclusions: Small arteries, arterioles and capillaries are the main affected vessels in SLE. This chronic process stimulates circulation through lower resistance collaterals, decreasing HRI value. The Doppler HRI calculation can be valuable in early diagnosis and monitoring of lower extremity vascular changes in patients suffering from SLE with and without SAPS.

• Differences in the course of acute phase of spontaneous intracerebral haemorrhage in the elderly.

  Authors: Anna Bajer-Czajkowska, Adrian Zywica, Grzegorz Zaborowski, Anna Walecka, Przemysław Nowacki

  Neurologia i neurochirurgia polska. 43(3):245-50.

  BACKGROUND AND PURPOSE: The aim of this study was to examine the correlation between age and clinical course of spontaneous intracerebral haemorrhage (SICH) in its acute phase (within 30 days),BACKGROUND AND PURPOSE: The aim of this study was to examine the correlation between age and clinical course of spontaneous intracerebral haemorrhage (SICH) in its acute phase (within 30 days), including severity of neurological deficit, characteristics and frequency of medical complications as well as 30-day mortality. We also attempted to determine independent predictors of early mortality. MATERIAL AND METHODS: This study comprised 153 patients with SICH admitted within 24 hours after SICH onset who were treated pharmacologically and had complete clinical data. The analysis concerned the correlation between age and neurological deficit on admission and on discharge, assessed with NIHSS score; the types and the frequency of general complications that occurred in the acute phase of SICH; characteristics of head CT images; early mortality; and survival time. Multiple logistic regression analysis was used to determine independent predictors of early mortality. RESULTS: Age of patients correlated with NIHSS score on admission (p = 0.000003) and on discharge (p = 0.02); 35.2% of patients developed medical complications, presumably infectious ones, and the age of patients who developed complications was significantly higher (p = 0.004). Patients who died (21.5%) were significantly older (p = 0.0001). Predictors of death were: age (OR 1.1, 95% CI 1.02-1.19, p = 0.002) and severity of neurological deficit on admission (OR 1.3, 95% CI 1.1-1.6, p < 0.001). CONCLUSIONS: In elderly patients with SICH, the neurological deficit and risk of medical complications are more evident. Greater neurological deficit in these patients may result from coincidence of SICH with earlier brain lesions. Age and greater neurological deficit on admission constitute predictors of early mortality in elderly patients with SICH.

• [Anterior diverticulum after total laryngectomy].

  Authors: Ewa Grochowska-Bohatyrewicz, Czesława Tarnowska, Violetta Posio, Anna Walecka

  Otolaryngologia polska. The Polish otolaryngology. 64(4):240-4.

  Pharyngeal anterior diverticulum, also known as pseudoepiglottis is one of the most common disorders after total laryngectomy. was to evaluate frequency of diverticulum after different types of totalPharyngeal anterior diverticulum, also known as pseudoepiglottis is one of the most common disorders after total laryngectomy. was to evaluate frequency of diverticulum after different types of total laryngectomy and severity of dysphagia in patient with developed pseudoepiglottis. The material consisted of 80 patients after following surgeries: total laryngectomy with hyoid bone resection, total laryngectomy without hyoid bone resection, total laryngectomy with hyoid bone and base of tongue resection, total laryngectomy and partial pharyngectomy with hyoid bone resection and total laryngectomy and partial pharyngectomy with hyoid bone and base of tongue resection. To evaluate morphologic and functional disorders clinical examination, videopharyngoscopy and cineradiography of swallow act were performed. Pseudoepiglottis was present in 34 (43%) of patients, mainly after surgeries without hyoid bone resection. There was no correlation between diverticulum formation and pharyngeal closure (muscular or non-muscular), shape of closure (vertical or "T"), pharyngocutaneous fistula, radiotherapy. This study indicates that leaving hyoid bone is a major risk factor for developing pseudoepiglottis.

• The role of magnetic resonance imaging in early prediction of cerebral palsy.

  Authors: Grazyna Hnatyszyn, Lech Cyrylowski, Maria B Czeszynska, Anna Walecka, Halina Konefal, Olimpia Szmigiel, Maria Gizewska, Grazyna Dawid

  The Turkish journal of pediatrics. 52(3):278-84.

  This work was undertaken to assess the usefulness of magnetic resonance imaging (MRI) of the brain for early prognosis of cerebral palsy. The study group included 47 neonates (24 term and 23 preterm)This work was undertaken to assess the usefulness of magnetic resonance imaging (MRI) of the brain for early prognosis of cerebral palsy. The study group included 47 neonates (24 term and 23 preterm) with symptoms of perinatal asphyxia. MRI examinations in term neonates were performed during the first month of life but not before the second week of life, while in preterm neonates MRI data were acquired between 38 and 40 weeks from conception. MRI of the brain demonstrated hypoxic-ischemic findings in all neonates born with perinatal asphyxia who later progressed to cerebral palsy. These results support the hypothesis that MRI performed in the neonatal period plays an essential role in predicting cerebral palsy in both term and preterm neonates, regardless of their gestational age.