[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. · 8.11 Impact Factor
[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 / Polish Medical Society of Radiology. 01/2014; 79:417-421.
[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. METHODS: 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. RESULTS: 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. CONCLUSION: 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: 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.
Polish journal of radiology / Polish Medical Society of Radiology. 01/2011; 76(1):63-7.
[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. · 1.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to third-party sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myESR.org Page 2 of 24 Learning objectives In 2007, in accordance with the Act on Tissue and Organ Procurement and Transplantation of 2005, amended Polish criteria of brain death diagnosis were drawn up. A fundamental consequence of that amendment is the need to perform instrumental examinations which confirm an irreversible brain injury when clinical examination is unfeasible or not credible. Of the instrumental confirmatory examinations, cerebral blood flow is the one performed most often, the reference method being four-vessel cerebral angiography. Cerebral Doppler ultrasonography has also been included on the basis of available literature findings. According to the literature, the methods of computed tomography angiography and computed tomography perfusion are gradually being introduced as part of the diagnostic process of cerebral circulatory arrest as well. However, the methods have not been standardized so far and uniform interpretation criteria are lacking. This paper aims to present different available methods enabling the diagnosis of cerebral circulatory arrest, recognizing their merits and flaws.
European Congress of Radiology, Vienna, Austria; 03/2010
[Show abstract][Hide abstract] ABSTRACT: 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 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.
The Cleft Palate-Craniofacial Journal 09/2009; 46(5):549-54. · 1.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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.
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.
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.
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.
Medical science monitor: international medical journal of experimental and clinical research 08/2009; 15(8):MT101-4. · 1.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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 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.
Annales Academiae Medicae Stetinensis 01/2009; 55(2):27-9.
[Show abstract][Hide abstract] ABSTRACT: 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 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.
Annales Academiae Medicae Stetinensis 01/2009; 55(3):28-35.
[Show abstract][Hide abstract] ABSTRACT: According to Polish criteria two neurophysiological methods are used to demonstrate the cessation of brain function: electroencephalography (EEG) and brain stem auditory evoked potentials. Among the techniques measuring cerebral blood flow, conventional angiography of the four cerebral arterial axes is the reference standard for imaging brain death. Thus, it is an invasive examination which needs an experienced neuroradiologist and the availability of an angiography suite. The use of a computed tomographic (CT) scan to diagnose BD was proposed as early as 1978. This exam developed widely these last years thanks to a new generation of multirow CT which allows visualization of opacified cerebral vessels. The aim of the present study was to determine the accuracy of CT-a for the confirmation of BD.
We examined four patients with suspicion of BD according to clinical criteria defined by law. CT scan was performed without and with injection of contrast material, followed by cerebral angiography. In our material CT-angiography showed opacification of A2-ACA in two patients (patient 1 and 2). In all our patients the results of CT-angiography fulfill the criteria proposed by the French Society of Neuroradiology in 2007 – absence of perfusion of M4 middle cerebral artery segments (M4-MCA) and deep cerebral veins. In conventional angiography one patient (patient 2) showed, at the level of the anterior and middle cerebral artery, a phenomenon already described as “stasis filling”.
CT angiography seemes to be a promising radiological exam in the diagnosis of BD. When confirmatory examinations are required among brain-dead patients for whom the clinical diagnosis remains essential, it may be an interesting alternative to conventional cerebral angiography, which is more invasive and constraining, and to EEG when it is unavailable or inadequate.
[Show abstract][Hide abstract] ABSTRACT: 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 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.
Annales Academiae Medicae Stetinensis 01/2009; 55(1):15-21.
[Show abstract][Hide abstract] ABSTRACT: 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.
A case of 17-year-old boy with delayed diagnosis of tuberous sclerosis complex with angiomyolipomas and cysts of the kidneys has been described.
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.
Annales Academiae Medicae Stetinensis 02/2008; 54(2):160-5.