Usefulness of spinal magnetic resonance imaging in patients with myelodysplastic syndromes.

BACKGROUND: Myelodysplastic syndrome is a rare, chronic hematological disease characterized by heterogeneous clinical presentations. Subtypes of myelodysplastic syndrome are characterized by different survival times and ability to transform into acute myeloid leukemia. OBJECTIVES: The objective of the study included the assessment of the relationship between the images obtained by magnetic resonance scans of lumbar spine and the clinical symptoms of the disease in patients diagnosed with myelodysplastic syndrome, as well as the assessment of the correlation of the images with the phase of transformation into acute myeloid leukemia. MATERIAL/METHODS: The study-related tests were carried out in Specialist Hospital No. 1 in Bytom between 2006 and 2011 and involved 53 patients aged 55÷77, divided into groups according to the diagnosed subtype of myelodysplastic syndrome. The study also included the prognosis of overall survival and time to transformation into AML on the basis of valid classifications. The spinal magnetic resonance scans were obtained from medical documentation. The analysis included images obtained using T1- and T2-weighted sequences in sagittal, transverse and frontal planes in all patients, images obtained using the STIR sequence from 21 patients as well as 40 images obtained after contrast administration. The statistical analysis of the results was carried out using STATISTICA software. CONCLUSIONS: The obtained results demonstrated that the magnetic resonance scans revealed statistically significant changes in the images of bone marrow in vertebral body scans; with a decrease in the intensity of MRI signals correlated with the RAEB subtype, particularly with transformation into acute myeloid leukemia as well as with the high IPSS risk score with regard to the time of survival and transformation into acute myeloid leukemia. The research-related test results indicate the importance of magnetic resonance imaging in diagnostics and the assessment of the disease dynamics.

[Problems of diagnosis and therapy of primary hyperparathyroidism--case report]. / Problemy rozpoznania i leczenia pierwotnej nadczynnosci przytarczyc--opis przypadku.

Primary hyperparathyroidism is systemic, polymorphic disease. Authors present a case of woman suffered from primary hyperparathyroidism misdiagnosed as disseminated neoplastic disease. There was shown a clinical picture complex, difficulties in diagnostic process, treatment and factors provided mistakes in therapy. The work lays stress on importance of routine testing of calcium in serum. It makes a contribution in diagnosis of hyperparathyroidism in symptomless or preclinical phase - before appearance metabolic and organ complications.

[Regional citrate anticoagulation for continuous haemodiafiltration in the postoperative period]. / Ostra pooperacyjna niewydolnosc nerek leczona hemodiafiltracja z wykorzystaniem regionalnej antykoagulacji.

BACKGROUND: Continuous renal replacement therapy (CRRT) is commonly used for the treatment of acute renal failure in haemodynamically unstable patients after cardiac surgery. The main problem associated with CRRT is the need for systemic anticoagulation that may lead to bleeding complications. As an alternative to heparins, and to avoid systemic anticoagulation, the use of regional citrate infusion has been proposed for patients with a high risk of bleeding. CASE REPORTS: We present the clinical course of three patients with a high risk of bleeding after cardiac surgery in which CRRT, based on regional citrate anticoagulation, was conducted safely. Circuit survival times were over 80 hours and filters were changed on schedule, without any signs of dysfunction. Metabolic alkalosis was observed in one patient, who was treated by reducing the circuit blood flow and increasing the dialisate flow. One patient required chronic dialysis, the other two recovering after short-term CRRT. CONCLUSION: Regional citrate anticoagulation during CRRT should be used as a method of choice in patients with a high risk of haemorrhage in the postoperative period.

[Abandoning of breast cancer radical treatment--own observations]. / Zaniechanie radykalnego leczenia raka piersi--spostrzezenia wlasne.

Breast cancer is currently one of the most frequent cancers women in Poland suffer from. Incidence increases after 35 years of age and this rate remains high until the old age. Since the 1980s breast cancer has been the most frequent reason for deaths of women between 40 and 59 years of age. Breast cancer treatment is based on combination of surgical methods, the hormone therapy, chemiotherapy and radiotherapy. However treating the cause and palliative treatment may result in complications. Some patients do not give their consent to suggested medical treatment. The aim of this work is an attempt to stress complexity of breast cancer radical treatment, with patients suffering from breast cancer as an example.

[Abdominal wall endometrioma in the cesarean section scar]. / Guzy endometrialne w bliznach po cieciu cesarskim.

OBJECTIVES: The study presents a retrospective review of patients diagnosed with abdominal wall endometrioma in the cesarean section scar between the years 2001-2006. MATERIAL AND METHODS: The study presented age symptoms, size of tumor, time between cesarean section and symptoms, results of treatment. RESULTS: Between 2001-2006, 34 patients, all of which suffered from abdominal pain and palpable mass, were diagnosed and treated in our hospital. In 8 cases the disease returned and reoperation was necessary. In one case we observed adenocarcinoma papillare. CONCLUSIONS: Endometriosis in postoperative abdominal wall scar after cesarean section is rarely observed. Because to the fact that the number of cesarean sections is constantly increasing, this complication becomes more frequent. The treatment of choice is surgical resection.

[Pioneers of anaesthesiology--Arthur Ernest Guedel (1883-1956)]. / Pionierzy anestezjologii--Arthur Ernest Guedel (1883-1956).

Arthur Ernest Guedel was a US born anaesthetist, whose name found its place among key persons in our specialty. Commonly known as a developer of the oropharyngeal airway, he did much more. Possibly, his major achievements were the detailed description of nitrous oxide and diethyl ether anaesthesia. He was among the firstfull-time US anaesthesiologists, and also served in his profession during the First World War. So called Guedel charts, describing the relationship between the level of anaesthesia and pupillary reactions, allowed many non-anaesthesiologists to administer diethyl ether relatively safely. Together with Waters, he was among pioneers of cuffed endotracheal tubes. At the end of his career, in 1937, he produced a manual "Inhalational Anaesthesia--A Fundamental Guide, which served at least three generations of medical professionals.

[Bourneville-Pringle disease. Case report]. / Choroba Bourneville'a-Pringle'a. Opis przypadku.

We present a case of a 47-year-old woman suffering from Bourneville-Pringle disease and uterus cancer undergoing radical operation. Surgery was performed under general anaesthesia and went uneventfully.

[Fournier's gangrene--serious complication of perianal abscess]. / Zgorzel Fourniera--ciezkie powiklanie ropnia okoloodbytniczego.

Authors present the case of Fournier's gangrene in course of perianal abscess. They pay attention to fulminant clinical course of superficial perineal fascia necrosis caused by mixed bacterial flora included aerobes and anaerobes and difficulties of treatment. They indicate the possibility of septic shock and multiple organ failure leading to death, in spite of intensive surgical and pharmacological treatment.

[Preoperative analysis of vital lung capacity in female patients with flattened thyrotoxicosis]. / Przedoperacyjna ocena pojemnosci zyciowej pluc u kobiet z nadczynnoscia tarczycy w stadium eutyreozy.

Unbalanced hyperthyroidism leads to the feeling of dyspnea and to the decrease of vital lung capacity. Efficacious treatment of thyrotoxicosis relieves mentioned disorders and brings normalization of ventilation parameters. The main issue of this research was the analysis of vital lung capacity in female patients with properly treated hyperthyroidism and comparison of values of these parameters among patients with balanced thyrotoxicosis, non-toxic goitre and with non-thyroid disorders. Research was conducted on 300 randomized female-patients (ASA I, II), aged 18 to 47 with surgically treated hyperthyroidism, non-toxic goitre or non-thyroid disorders. Vital lung capacity (VLC) was analyzed as absolute values and as a percent of predicted values. Statistical analysis revealed that patients in specified groups did not differ in age, weight and frequency of belonging to both ASA categories. Vital lung capacity and percent of predicted values were not significantly different in all groups. Vital lung capacity of female-patients with balanced hyperthyroidism did not differ significantly from vital lung capacity of patients with non-toxic goitre and non-thyroid disorders.

[Malignant thyroid lymphoma--diagnostic and treatment problems]. / Chloniaki zlosliwe tarczycy--problemy rozpoznawcze i lecznicze.

UNLABELLED: The aim of this study was to present our experience in the diagnostics and treatment of primary malignant thyroid lymphoma (PMTL). Five patients at the age of 48-72 years with PMTL were treated at the Department of General Surgery in Bytom in the years 1988-1999. They made up 0.04% of patients operated on at this time in our Department because of different types of goiter and 1.05% because of thyroid carcinoma. The clinical examinations included ultrasonography, radioisotope diagnostics, preoperative thin needle biopsy and hormonal examination of thyroid gland. All patients were operated on under general anesthesia and with intraoperative histopathological examination. They were treated with chemo- and/or radiotherapy in postoperative period. The appearance of PMTL was preceded by nodular goiter or Hashimoto disease. In three cases we observed neck compression symptoms and in two the dramatic course of disease. Ultrasonography revealed hypoechogenic thyroid gland with nodular structures characterized by the decreased J131 uptake. In one case thin needle biopsy confirmed the diagnosis of PMTL. Evident hypothyreosis was diagnosed in one and subclinical in two patients. Surgical treatment--partial excision of neoplastic tumor--was complicated by tracheostomy in two cases. One case with almost total resection of thyroid gland was complicated by lesion of esophagus which was sutured. After operation one patient was treated with chemotherapy, one with radiotherapy and two cases using both of methods. Three patients died: in 3rd, 32nd day and after 3 months since surgery. We confirmed the remission of the disease in two the youngest patients with not advanced state. One of them was treated with Co 60 therapy and the second one with chemotherapy according to COP and radiotherapy. CONCLUSIONS: PMTL is a rare disease and difficult to diagnose. The biopsy is useful. The treatment of PMTL combined, including surgical treatment, chemo- and radiotherapy. The prognosis is uncertain and depends on the disease period.