[Show abstract][Hide abstract] ABSTRACT: Purpose
To declare death in a patient with coma, the absence of brain stem reflexes and breathing drive must be confirmed by neurological examination. In certain situations, termed as confounding conditions, complete and reliable clinical assessment cannot be performed. In such cases, ancillary tests confirming cerebral circulatory arrest (CCA) are helpful. The existing methods have a number of significant limitations.
The advent of CT scanners capable of covering over 8 cm in z-axis (9.6-cm z-axis coverage for the scanner used in this study, leading to the term “volume perfusion CT“ [VPCT]) enables an assessment of the whole brain perfusion. This would potentially constitute a better alternative to the existing ancillary tests. However, VPCT for the diagnosis of CCA has not been evaluated in quantitative study up to date.
The aim of the study was to assess the sensitivity of VPCT for the confirmation of CCA in the diagnosis of brain death.
Material and Methods
The studied population was recruited from adult patients, who fulfilled the standard clinical criteria of BD.
All subjects underwent VPCT using a 128-slice multidetector CT scanner. CBF and CBV values were calculated using deconvolution algorithm in ROIs covering brain stem, cerebellar hemispheres, cortico-subcortical regions of frontal, parietal and temporal lobes and in basal ganglia.
CCA was diagnosed in cases, in which CBF and CBV in all ROIs were below the well-known thresholds for neuronal necrosis: 12 ml/100g/min and 1.2 ml/100g respectively.
Shortly after VPCT, a complete clinical testing for determination of BD was performed.
Thirteen patients (6 females) with a mean age of 54 years (17-78 years) were examined. VPCT confirmed CCA in 12 out of 13 (92%) cases. In these 12 cases CBF and CBV values in all ROIs were below the thresholds for necrosis. The detailed results are presented in Fig.1 and 2. In one patient (patient 11), who underwent decompressive craniectomy, VPCT showed critically limited, but persistent perfusion in fronto-parietal region and in basal ganglia of the right hemisphere.
VPCT of the entire brain is feasible and highly sensitive test for the confirmation of CCA in the diagnosis of brain death.
38th European Society of Neuroradiology, Diagnostic and Interventional Annual Meeting; 22nd Advanced Course and in Diagnostic Neuroradiology, Naples, Italy; 09/2015
[Show abstract][Hide abstract] ABSTRACT: Background: The application of computed tomographic angiography (CTA) for the diagnosis of brain death (BD) is limited because of the low sensitivity of the commonly used two-phase method consisting of assessing arterial and venous opacification at the 60 th second after contrast injection. The hypothesis was that a reduction in the scanning delay might increase the sensitivity of the test. Therefore, an original technique using CTA was introduced and compared with catheter angiography as a reference. Material/Methods: In a prospective multicenter trial, 84 clinically brain-dead patients were examined using CTA and catheter an-giography. The sensitivities of original CTA technique, involving an arterial assessment at the 25 th second and a venous assessment at the 40 th second, and the standard CTA, involving an arterial and venous assessment at the 60 th second, were compared to catheter angiography. Results: Catheter angiography results were consistent with the clinical diagnosis of BD in all cases. In comparison to catheter angiography, the sensitivity of original CTA technique was 0.93 (95%CI, 0.85–0.97; p<0.001) and 0.57 (95%CI, 0.46–0.68; p<0.001) for the standard protocol. The differences were statistically significant (p=0.03 for original CTA and p<0.001 for standard CTA). Decompressive craniectomy predisposes to a false-negative CTA result with a relative risk of 3.29 (95% CI, 1.76–5.81; p<0.001). Conclusions: Our original technique using CTA for the assessment of the cerebral arteries during the arterial phase and the deep cerebral veins with a delay of 15 seconds is a highly sensitive test for the diagnosis of BD. This method may be a better alternative to the commonly used technique.
[Show abstract][Hide abstract] ABSTRACT: Background and objectives Angiogenesis plays a significant role in the pathogenesis of systemic lupus erythematosus (SLE). Vascular endothelial growth factor (VEGF) is a potent stimulator of angiogenesis as well as vasculogenesis. The study was designed to evaluate the association between VEGF concentrations and immunological parameters, inflammatory markers, classical atherosclerosis risk factors and vascular disorders in SLE patients.
Materials and methods The study was performed in 83 patients with SLE and 20 age and gender matched controls.
The concentrations of VEGF was determined with ELISA method using R&D Systems tests. The presence of inflammatory markers (ESR, CRP and fibrinogen) and selected autoantibodies - anti-endothelial (AECA), anti-nuclear, anti-phospholipid (aPL) and anti-neutrophil cytoplasmic was evaluated. Classical risk factors for atherosclerosis as well as selected organ manifestations (cardiovascular and central nervous system, lupus nephritis, thromboembolic disorders and vasculitis) were taken into account. Carotid intima-media thickness and atherosclerotic plaques were measured with B-mode ultrasound method. Statistical analysis was performed with chi2Yates, chi2Pearson, rank Spearman correlations tests, logistic regression analysis and multivariate stepwise analysis.
Results VEGF levels did not differ significantly between SLE patients and the controls (p > 0.1). The cut-off value of VEGF concentrations was established at 382.4 pg/ml (75- percentile). VEGF levels > 382.4 pg/ml were significantly associated with the elongation of activated partial thromboplastin time (OR = 22.8; 95% CI: 2.3–230.6) and the presence of aPL: anti-prothrombin (aPT) IgA class (OR = 10.7; 95% CI: 2.1–53.4), anti- β2-GPI IgA class (OR = 3.5; 95% CI: 1.1–10.8) and anti-oxidised low density lipoprotein antibodies (OR = 4.8; 95% CI: 1.0–22.8). Myocardial relaxation disorders were significantly more frequent in patients with high concentration of VEGF (OR = 8.0; 95% CI: 1.6–39.5). The low concentration of VEGF significantly decreased the risk of the existence of selected autoantibodies: aPT IgA (OR = 0.18; 95% CI: 0.0–0.72), aβ2-GPI IgA (OR = 0.17; 95% CI: 0.04–0.71), anti-double stranded DNA (OR = 0.31; 95% CI: 0,11–0.91) and AECA (OR = 0.30; 95% CI: 0,11–0.85). Furthermore, they were associated with reduction of the risk of atherosclerotic lesions in iliac arteries (OR = 0.24; 95% CI: 0.0–0.99) and vasculitis development (OR = 0.17; 95% CI = 0.03–0.91).
Conclusions 1. High VEGF levels may increase the prothrombotic risk in SLE patients because of the significant association with the presence of antiphospholipid antibodies. 2. The lower concentrations of VEGF significantly decrease the risk of persistence of selected autoantibodies and atherosclerotic lesions as well as vasculitis development in SLE patients.
Annals of the Rheumatic Diseases 03/2015; 74(Suppl 1):A65-A66. DOI:10.1136/annrheumdis-2015-207259.151 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Benign metastasizing leiomyoma (BML) is a rare condition described as multiple well-differentiated leiomyomas at sites distant from the uterus. Apart from lungs it has also been reported in lymph nodes, heart, brain, bone, skin, eye and spinal cord. We present a case of pulmonary benign metastasizing leiomyoma in a female patient admitted to our hospital with suspicion of left adnexal tumor.
A 45-year-old woman was referred to our hospital with suspicion of left adnexal tumor. The control transvaginal ultrasound examination performed at admission to the Gynecological Department excluded adnexal neoplasm. However, a large amount of fluid within the Douglas pouch raised the oncological concern. The patient underwent myomectomy in 2005. In the same year she was diagnosed with multiple lung nodules and underwent pulmonary wedge resection with the diagnosis of pulmonary benign metastasizing leiomyoma being stated. The decision of reevaluation of the specimen, control CT and puncture of the Douglas pouch fluid was made. Computed tomography performed at the Department of Diagnostic Imaging and Interventional Radiology of the Pomeranian Medical University Hospital revealed multiple, bilateral nodules. The microscopic examination of the samples confirmed the initial diagnosis of benign metastasizing leiomyoma with no evidence of neoplastic cells within the fluid.
Pulmonary benign metastasizing leiomyoma is a rare entity. However, it should be always taken into consideration in women with a previous or coincident history of uterine leiomyoma, especially when no evidence of other malignancy is present.
Polish Journal of Radiology 02/2015; 80(1):107-10. DOI:10.12659/PJR.892733
[Show abstract][Hide abstract] ABSTRACT: Summary Brain death is defined as the irreversible cessation of functioning of the entire brain, including the brainstem. Brain death is principally established using clinical criteria including coma, absence of brainstem reflexes and loss of central drive to breathe assessed with apnea test. In situations in which clinical testing cannot be performed or when uncertainty exists about the reliability of its parts due to confounding conditions ancillary tests (i.a. imaging studies) may be useful. The objective of ancillary tests in the diagnosis of brain death is to demonstrate the absence of cerebral electrical activity (EEG and evoked potentials) or cerebral circulatory arrest. In clinical practice catheter cerebral angiography, perfusion scintigraphy, transcranial Doppler sonography, CT angiography and MR angiography are used. Other methods, like perfusion CT, xenon CT, MR spectroscopy, diffusion weighted MRI and functional MRI are being studied as potentially useful in the diagnosis of brain death. CT angiography has recently attracted attention as a promising alternative to catheter angiography - a reference test in the diagnosis of brain death. Since 1998 several major studies were published and national guidelines were introduced in several countries (e.g. in France, Austria, Switzerland, the Netherlands and Canada). This paper reviews technique, characteristic findings and criteria for the diagnosis of cerebral circulatory arrest in CT angiography.
Polish Journal of Radiology 11/2014; 79:417-421. DOI:10.12659/PJR.891114
[Show abstract][Hide abstract] ABSTRACT: Background
Despite the progress in contemporary medicine comprising diagnostic and therapeutic methods, lung cancer is still one of the biggest health concerns in many countries of the world. The main purpose of the study was to evaluate the detection rate of pulmonary nodules and lung cancer in the initial, helical low-dose CT of the chest as well as the analysis of the relationship between the size and the histopathological character of the detected nodules.
We retrospectively evaluated 1999 initial, consecutive results of the CT examinations performed within the framework of early lung cancer detection program initiated in Szczecin. The project enrolled persons of both sexes, aged 55–65 years, with at least 20 pack-years of cigarette smoking or current smokers. The analysis included assessment of the number of positive results and the evaluation of the detected nodules in relationship to their size. All of the nodules were classified into I of VI groups and subsequently compared with histopathological type of the neoplastic and nonneoplastic pulmonary lesions.
Pulmonary nodules were detected in 921 (46%) subjects. What is more, malignant lesions as well as lung cancer were significantly, more frequently discovered in the group of asymptomatic nodules of the largest dimension exceeding 15 mm.
The initial, low-dose helical CT of the lungs performed in high risk individuals enables detection of appreciable number of indeterminate pulmonary nodules. In most of the asymptomatic patients with histopathologically proven pulmonary nodules greater than 15 mm, the mentioned lesions are malignant, what warrants further, intensified diagnostics.
Polish Journal of Radiology 07/2014; 79:210-8. DOI:10.12659/PJR.890103
[Show abstract][Hide abstract] ABSTRACT: The standardized diagnostic criteria for computed tomographic angiography (CTA) in diagnosis of brain death (BD) are not yet established. The aim of the study was to compare the sensitivity and interobserver agreement of the three previously used scales of CTA for the diagnosis of BD.
Eighty-two clinically brain-dead patients underwent CTA with a delay of 40 s after contrast injection. Catheter angiography was used as the reference standard. CTA results were assessed by two radiologists, and the diagnosis of BD was established according to 10-, 7-, and 4-point scales.
Catheter angiography confirmed the diagnosis of BD in all cases. Opacification of certain cerebral vessels as indicator of BD was highly sensitive: cortical segments of the middle cerebral artery (96.3 %), the internal cerebral vein (98.8 %), and the great cerebral vein (98.8 %). Other vessels were less sensitive: the pericallosal artery (74.4 %), cortical segments of the posterior cerebral artery (79.3 %), and the basilar artery (82.9 %). The sensitivities of the 10-, 7-, and 4-point scales were 67.1, 74.4, and 96.3 %, respectively (p < 0.001). Percentage interobserver agreement in diagnosis of BD reached 93 % for the 10-point scale, 89 % for the 7-point scale, and 95 % for the 4-point scale (p = 0.37).
In the application of CTA to the diagnosis of BD, reducing the assessment of vascular opacification scale from a 10- to a 4-point scale significantly increases the sensitivity and maintains high interobserver reliability.
[Show abstract][Hide abstract] ABSTRACT: High resistance index (HRI), evaluated on the basis of Doppler spectrum of popliteal arteries, enables detection of subclinical changes in small vessels in systemic lupus erythematosus (SLE) patients.
To evaluate the association between decreased values of HRI in SLE patients and selected immunological parameters, the presence of markers of inflammation and classical risk factors for atherosclerosis and also selected clinical manifestations.
The investigation was performed in 76 patients with SLE (age 20-73 years). The mean course of the disease was 8.7 years. The coexistence of APS was confirmed in 17 patients (22.4%). The control group consisted of 30 healthy people. All the duplex Doppler examinations of popliteal arteries were performed with HDI 3500 (ATL) using 5- 12 MHz linear transducer under standardised conditions. We evaluated the presence of anti-endothelial antibodies (AECA) and profiles of anti-nuclear antibodies, anti-phospholipid antibodies (aPL) and anti-neutrophil cytoplasmic antibodies. We also analysed markers of inflammation (C-reactive protein, erythrocyte sedimentation rate and fibrinogen), classical risk factors for atherosclerosis (hypertension, hyperglycaemia, hyperlipidaemia, smoking and positive family history for cardiovascular disease) and clinical complications including cardiovascular and central nervous system manifestations, lupus nephritis, thromboembolic disorders and vasculitis. Statistical analysis was performed with chi(2)Yates, chi(2)Pearson, rank Spearman correlations tests. Logistic regression analysis and multivariate stepwise analysis were also done. All statistical analyses were performed with STATA 11.
We found that HRI values in patients with SLE were significantly lower in comparison with the control group (p< 0.0001). We also showed that the coexistence of APS significantly increased risk of lower values of HRI presence (OR = 11.40; 95% CI:1.69-77.03), and from among aPL the most significant were aCL IgG (OR = 7.43; 95% CI:1.82-30.36), aCL IgM (OR = 7.83; 95% CI:1.08-56.53) and anti- β2-GPI antibodies (OR = 5.76; 95% CI:1.17-28.26). Other serological markers, which significantly influenced decreased values of HRI were AECA (OR = 14.84; 95% CI:2.76-79.66). Furthermore, we found significant negative correlation between HRI values and the presence of thromboembolic disorders (R = -0.25; p = 0.0299) and the duration of SLE (R = -0.23; p = 0.0427). We have found no associations between decreased HRI values and the rest of analysed variables.
1. HRI values are significantly decreased in SLE patients. 2. The coexistence of APS and the presence of aPL and AECA are risk factors for decreased HRI values in SLE patients. 3. There is a significant reverse relationship between HRI values and the duration of the disease and the presence of thromboembolic changes in SLE patients.
Annals of the rheumatic diseases 03/2014; 73 Suppl 1:A46-7. DOI:10.1136/annrheumdis-2013-205124.106 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Cytokine-mediated immunity plays a crucial role in the pathogenesis of various autoimmune diseases including systemic lupus erythematosus (SLE). Interleukin 23 (IL-23) may be involved in pathogenesis of SLE. Moreover, recent studies showed that targeting of IL-23 or the IL-23 receptor is a potential therapeutic approach for autoimmune diseases including SLE.
Objectives To evaluate association between serum levels of IL-23 and selected characteristics of the disease in SLE patients.
Methods Study was performed in 94 SLE patients (82 women and 12 men) aged 19-73 years and in 27 age and gender matched controls. Serum IL-23 was measured by ELISA method with R&D Systems tests.
The evaluation of atherosclerotic changes was performed on the basis of: intima-media thickness measurement and the presence of atherosclerotic plaques in carotid and lower extremities arteries with B-mode ultrasound and ankle-brachial index measurement with Doppler ultrasonography. Furthermore, we assessed vascular resistance on the basis of high resistance index measurement from Doppler spectrum of popliteal arteries. Those investigations were performed using HDI 3500 (ATL) with 5-12 MHz linear transducer.
We also took into account classical cardiovascular risk factors (hypertension, dyslipidemia, hyperglycemia, overweight/obesity, smoking, oral contraceptives, positive family history of cardiovascular disease), selected clinical manifestations (cardiovascular, cerebrovascular, lupus nephritis, Raynaud’s phenomenon, livedo reticularis, vasculitis, other thromboembolic complications), profile of autoantibodies (antinuclear, antiphospholipid, anti-neutrophil cytoplasmic, anti-endothelial cell).
Statistical analysis was performed with: chi2Yates, chi2Pearson, rank Spearman correlations tests, logistic regression analysis and multivariate stepwise analysis.
Results Concentrations of IL-23 significantly differed between SLE patients and the controls (p=0,0005). Patients with high levels of IL-23 more frequently developed atherosclerosis showed as the presence of plaques in right common femoral artery and lupus nephritis (OR=10,1; 95%CI:1,2-85,1 and OR=3,2; 95%CI:1,1-9,6 respectively). However, from classical atherosclerotic risk factors only obesity was significantly associated with IL-23 (OR=3,8; 95%CI:1,2-12,3). Immunological characteristics significantly related to IL-23 were anti-phosphatidylethanolamine antibodies, especially of IgG class (OR=12,7; 95%CI:1,5-108,1) and anti-SS-B antibodies (OR=11,8; 95%CI:1,5-94,8). Association with anti-cardiolipin and anti-prothrombin antibodies of IgG class was on the border of statistical significance (OR=2,3; 95%CI:0,9-5,7 and OR=8,4; 95%CI:1,0-71,1 respectively).
Conclusions 1. IL-23 may be involved in lupus nephritis pathogenesis. 2. IL-23 trough its significant association with obesity and antiphospholipid antibodies may promote hypercoagulable state contributing to atherothrombosis development in SLE patients.
Disclosure of Interest None Declared
Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):642-642. DOI:10.1136/annrheumdis-2012-eular.89 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction
Stasis filling, defined as delayed, weak, and persistent opacification of proximal segments of the cerebral arteries, is frequently found in brain dead patients. This phenomenon causes a major problem in the development of reliable computed tomographic angiography (CTA) protocol in the diagnosis of brain death (BD). The aim of our study was to characterize stasis filling in the diagnosis of BD. To achieve this, we performed a dynamic evaluation of contrast enhancement of the cerebral and extracranial arteries in patients with BD and controls.
Study population included 30 BD patients, who showed stasis filling in computed tomographic perfusion (CTP) series. Thirty patients, after clipping of an intracranial aneurysm, constituted the control group. The study protocol consisted of CTA, CTP, and angiography. Time–density curves (TDCs) of cerebral and extracranial arteries were generated using 40-s series of CTP.
Cerebral TDCs in BD patients represented flat curves in contrast to TDCs in controls, which formed steep and narrow Gaussian curves. We found longer time to peak enhancement in BD patients than in controls (32 vs. 21 s; p < 0.0001). In BD patients, peak enhancement in the cerebral arteries occurred with a median delay of 14.5 s to peak in extracranial arteries, while no delay was noted in controls (p < 0.0001). Cerebral arteries in BD patients showed lower peak enhancement than controls (34.5 vs. 81.5 HU; p < 0.0001). In all BD patients, CTP revealed zero values of cerebral blood flow and volume. Angiography showed stasis filling in 14 (46.7 %) and non-filling in 16 (53.3 %) cases.
A confrontation of stasis filling with CTP results showed that stasis filling is not consistent with preserved cerebral perfusion, thus does not preclude diagnosis of BD.
[Show abstract][Hide abstract] ABSTRACT: We report a rare finding of the coexistence of splenic hemangioma and progressive vascular malformation of the left lower extremity in a child. The lesion on the left calf was described as a vascular malformation in computed tomography and magnetic resonance. At the age of one year, the abdominal Doppler ultrasound was normal. The examination was repeated at the age of six years due to recurrent pain in the left hypochondrium and revealed giant multiple splenic hemangiomas. The girl underwent splenectomy at the age of 14 years. Histological findings demonstrated multiple cavernous hemangiomas. We present our case report regarding the diagnosis of spleen hemangioma and indications for surgical management in children.
The Turkish journal of pediatrics 05/2013; 54(4):436-9. · 0.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis, stroke-like episodes) is a rare, multisystem disorder which belongs to a group of mitochondrial metabolic diseases. As other diseases in this group, it is inherited in the maternal line.
In this report, we discussed a case of a 10-year-old girl with clinical and radiological picture of MELAS syndrome. We would like to describe characteristic radiological features of MELAS syndrome in CT, MRI and MR spectroscopy of the brain and differential diagnosis.
The rarity of this disorder and the complexity of its clinical presentation make MELAS patients among the most difficult to diagnose. Brain imaging studies require a wide differential diagnosis, primarily to distinguish between MELAS and ischemic stroke. Particularly helpful are the MRI and MR spectroscopy techniques.
Polish Journal of Radiology 04/2013; 78(3):61-65. DOI:10.12659/PJR.884010
[Show abstract][Hide abstract] ABSTRACT: The aim is to present a rare case of solitary malformation in the form of a congenital optic disc cyst concomitant with the persistent hyaloid artery. The intrabulbar congenital cyst of the optic disc partially covering the medial part of the disc was found in a 3-month old infant. B-San ultrasound confirmed the presence of the intrabulbar heterogeneous mass (7.0 x 2.5 x 5.4 mm) within the vitreous cavity and the concomitant persistent hyaloid artery was shown in Colour Doppler Imaging. The axial length of the involved eye was shorter than of the healthy one (16.68 mm vs. 18.42 mm). The magnetic resonance imaging of the head and orbits performed in the fast spin echo, spin echo and gradient echo sequences in T1 and T2-weighted scans revealed the intrabulbar cyst (7.0 x 2.5 x 6.4 mm), with sharp margins, whose lower part showed intense contrast enhancement. The pericerebral fluid spaces within the frontal and temporal lobes were dilated. Intrauterine toxoplasmosis, cytomegaly, protozoan and helminth infections as well as metabolic diseases were excluded. Patient leukocyte DNA RB1 gene sequencing and negative results of mutation searching excluded retinoblastoma. In a 2-year follow-up period, regression of the mass with the absence of ophthalmic complications was noted. An important reason for the authors to present the discussed case is possible permanent impairment of visual function in patients with similar presentation of congenital peripapillary lesions. congenital optic disc cyst, developmental anomalies of the optic disc, congenital ocular malformations.
[Show abstract][Hide abstract] ABSTRACT: Hemangioma is found in approximately 10% of infants as the most prevalent benign neoplasm. The natural history of hemangioma is typical for this lesion and includes two phases: fast growth during the first year of life of the child and subsequent slow regression lasting some five years. Even though the etiopathogenesis of hemangioma has not been fully elucidated, the role played in this process by vascular growth factors remains unquestionable. The aim of this work was to assess the value of serum levels of the vascular endothelial growth factor (VEGF) and placental-derived growth factor (PlGF) for therapy planning in infants with hemangiomas.
The study group comprised 43 infants, aged 2 weeks to 6 months, with hemangiomas on the body. 25 girls and 11 boys participated in the second stage of the study done 14 months later. We analyzed correlations between serum levels of vascular growth factors and phase of hemangioma, clinical symptoms, and findings in ultrasonography with Power Doppler visualization. Normal ranges for VEGF and PlUF were established for healthy infants.
The results in the study group were analyzed statistically and presented as arithmetic means, standard deviations, medians, minimal and maximal values, and percentage distributions.
In local population of healthy infants the ranges of VEGF and P1GF serum levels are very wide; VEGF and P1GF serum levels determined in infants affected with hemangioma do not reflect the dynamics of observable lesion's evolution.
Annales Academiae Medicae Stetinensis 01/2012; 58(2):5-10.
[Show abstract][Hide abstract] ABSTRACT: Gastroesophageal reflux (GER) is one of the most common gastrointestinal tract disorders both in adults and children. The study was undertaken to assess the usefulness of gastrointestinal upper tract (GUT) scintigraphy and GUT ultrasonography in detection of GER in children.
The investigated group comprised of 76 children, aged 1-204 months (mean 74 months) with clinical signs and symptoms of GER. All of them underwent GUT scintigraphy, and 42 children had also GUT ultrasonography.
GUT scintigraphy confirmed reflux in 60/76 children (78.9%), GUT ultrasonography - in 17/42 children (40.5%). Airways tract aspiration was detected in one child.
Scintigraphy was found to be a very useful method in detection of GER, as it confirmed the presence of GER in most of the children with signs and symptoms suggestive of GER. It also allows for the detection of airways tract aspiration. GUT ultrasonography showed a lower sensitivity. Both investigations are simple, noninvasive, not changing the physiology of the gastrointestinal tract and can be performed in out-patient conditions.
[Show abstract][Hide abstract] ABSTRACT: According to Polish brain death (BD) criteria, instrumental confirmatory tests should be used in certain clinical situations, particularly any case for which clinical examinations seem inadequate. Electrophysiological tests are often unavailable. Therefore, cerebral perfusion testing is the method of choice with four-vessel digital subtraction angiography (DSA), the gold standard. Unfortunately, DSA is an expensive and invasive examination that requires an experienced neuroradiologist and the availability of an angiography suite. Recently, multirow computed tomographic devices became available, even in smaller hospitals in Poland. Despite this fact, computed tomographic angiography (CTA) and computed tomographic perfusion (CTP) are not accepted in BD diagnosis protocols in Poland because of limited experience and a lack of widely accepted criteria. In this situation, we started a multicenter trial to determine the accuracy of CTA and CTP to confirm BD.
We examined 24 patients who fulfilled standard clinical BD criteria. We recognized the absence of brain perfusion in CTA examination following the criteria proposed by the French Society of Neuroradiology, namely, the absence of opacification of M4 middle cerebral artery segments (M4-MCA) and of deep cerebral veins.
In all of our patients, CTA showed absence of opacification of M4 segments and of deep cerebral veins. In addition, three patients had CTA showing weak opacification of A2 segments of the anterior cerebral artery (A2-ACA) and M2 or M3-MCA. Opacification of the basilar artery or of the posterior cerebral arteries was not noted in any case. In all patients, CTP revealed zero values of regional cerebral blood volume and regional cerebral blood flow. Conventional angiography confirmed cerebral circulatory arrest in all 24 cases.
CTA and CTP seem to be promising radiological examinations for the diagnosis of BD. They may be noninvasive alternatives to conventional cerebral angiography, and to the other instrumental confirmatory tests, that are unavailable or inadequate.
[Show abstract][Hide abstract] ABSTRACT: Several reports indicate that lungs are the extralymphatic site most commonly affected in patients with Hodgkin lymphoma; however, the data in children are rather limited. This retrospective study aimed to assess the frequency, clinical picture, and the impact on prognosis in children with pulmonary Hodgkin lymphoma, who were diagnosed and treated in a single center during a 10-year period. Pulmonary lesions related to HL: nodules and parenchymal infiltrates with cavitations were found in 3 of 32 (9.4%) patients; in 2 cases these were found as the concomitant manifestation whereas in 1 case as the solitary form (Primary Pulmonary Hodgkin Lymphoma). B-DOPA and MVPP chemotherapy combined with mediastinal and pulmonary irradiation resulted in sustained remissions in all 3 patients, lasting 3, 7, and 64 months, respectively. Lung involvement occurs in up to 10% of children with Hodgkin lymphoma. Primary pulmonary Hodgkin lymphoma is a rare and atypical form of Hodgkin lymphoma; thus is associated with delayed diagnosis which does not seem to affect prognosis. It should be suspected in a child with non-resolving pneumonia and pulmonary parenchymal infiltrates with cavitations.
European journal of medical research 11/2010; 15 Suppl 2:206-10. · 1.50 Impact Factor