Anti-Phosphatidylethanolamine and Anti-Phosphatidylserine Antibodies-Association with Renal Involvement, Atherosclerosis, Cardiovascular Manifestations, Raynaud Phenomenon and Disease Activity in Polish Patients with Systemic Lupus Erythematosus.

OBJECTIVE: To evaluate the association between anti-phosphatidylethanolamine (aPE) and anti-phosphatidylserine (aPS) antibodies and cardiovascular risk, organ involvement and disease activity in systemic lupus erythematosus (SLE) patients. METHODS: We studied 93 SLE patients and 30 controls. We analyzed levels of anti-phospholipid antibodies, including aPS and aPE, the profiles of antinuclear, anti-neutrophil cytoplasmic (ANCA) and anti-endothelial antibodies, carotid intima-media thickness (cITM) and atherosclerotic plaque presence, ankle-brachial and high resistance indices, atherosclerotic risk factors, organ manifestations and treatment. RESULTS: Levels of aPS and aPE were significantly higher in SLE patients in comparison with the controls (p = 0.038 and p = 0.044, respectively). aPS was associated with the risk of Raynaud's phenomenon (p = 0.021) development. aPE increased the risk of renal involvement (p = 0.049), cerebral stroke (p = 0.050), high vlues of cIMT (p = 0.041) development as well as occurrence of selected serological markers associated with activity of the disease such as anti-double stranded DNA (p = 0.021). The long duration of regular smoking (p = 0.021) and the high number of cigarettes/day (p = 0.015) were significantly associated with the risk of aPE occurrence. CONCLUSIONS: Patients with aPS and aPE are at risk of vascular involvement. Especially the presence of aPE may significantly increase the risk of thrombotic complications development in SLE patients without classical serological markers of APS. Finally, aPE might be used as a marker of disease activity and risk of renal injury development in this patient group. The classical atherosclerotic markers including lipid indices play an important role in complex analysis of cardiovascular risk in lupus patients and enable to identify patients at the highest risk and implement effective preventive, diagnostic and therapeutic procedures.

Serum concentrations of VEGF and bFGF in the course of propranolol therapy of infantile hemangioma in children: Are we closer to understand the mechanism of action of propranolol on hemangiomas?

BACKGROUND: Propranolol has become the treatment of choice for infantile hemangiomas (IH). Neither the pathogenesis of IH nor the mechanism of action of propranolol on them are well understood. Possible explanations include the inhibition of angiogenesis by decreasing vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), induction of vascular endothelial cell apoptosis and vasoconstriction. OBJECTIVES: The aim of the study was to assess serum concentrations of VEGF and bFGF in the course of propranolol therapy of IH in children, and to assess their clinical implications. MATERIAL AND METHODS: The study included 51 children with IH treated with propranolol. The participants were assessed before, during and after the therapy with Hemangioma Activity Score (HAS), Doppler ultrasound (US) of the lesions, as well as VEGF and bFGF serum concentrations. RESULTS: All children showed clinical improvement measured in the HAS. A complete involution of the IH was reported in 32 (63%) children at the time of decision of the gradual withdrawing of propranolol, and in 28 (61%) patients at the end of the treatment (out of 46 patients present at the follow up after 1.5 months). Doppler US at the follow-up showed a complete disappearance of the blood flow in the lesion in 24 (52%) children and its reduction in 12 (26%) children. There was a significant decrease in VEGF and bFGF during and after treatment compared to pretreatment values. There was a correlation between the outcome of the Doppler US and changes in bFGF during and after treatment. Changes in VEGF during treatment did not correlate with changes in the Doppler US. CONCLUSIONS: Serum concentrations of VEGF and bFGF decreased during the propranolol treatment of IH, which may indicate the effect of propranolol on both. However, the statistical analysis showed their low prognostic value as biochemical markers of propranolol treatment. Clinical evaluation combined with Doppler US is the most valuable method of monitoring the therapy.

Accuracy of Computed Tomographic Perfusion in Diagnosis of Brain Death: A Prospective Cohort Study.

BACKGROUND This study was designed to determine diagnostic accuracy of computed tomographic perfusion (CTP) compared to computed tomographic angiography (CTA) for the diagnosis of brain death (BD). MATERIAL AND METHODS Whole-brain CTP was performed in patients diagnosed with BD and in patients with devastating brain injury with preserved brainstem reflexes. CTA was derived from CTP datasets. Cerebral blood flow (CBF) and volume (CBV) were calculated in all brain regions. CTP findings were interpreted as confirming diagnosis of BD (positive) when CBF and CBV in all ROIs were below 10 mL/100 g/min and 1.0 mL/100 g, respectively. CTA findings were interpreted using a 4-point system. RESULTS Fifty brain-dead patients and 5 controls were included. In brain-dead patients, CTP results revealed CBF 0.00-9.98 mL/100 g/min and CBV 0.00-0.99 mL/100 g, and were thus interpreted as positive in all patients. CTA results suggested 7 negative cases, providing 86% sensitivity. In the non-brain-dead group, CTP results revealed CBF 2.37-37.59 mL/100 g/min and CBV 0.73-2.34 mL/100 g. The difference between values of CBF and CBV in the brain-dead and non-brain-dead groups was statistically significant (p=0.002 for CBF and p=0.001 for CBV). CTP findings in all non-brain-dead patients were interpreted as negative. This resulted in a specificity of 100% (95% CI, 0.31-1.00) for CTP in the diagnosis of BD. In all non-brain-dead patients, CTA revealed preserved intracranial filling and was interpreted as negative. This resulted in a specificity of 100% (95% CI, 0.31-1.00) for CTA in diagnosis of BD. CONCLUSIONS Whole-brain CTP seems to be a highly sensitive and specific method in diagnosis of BD.

Serum Interleukin-23 in Polish Patients with Systemic Lupus Erythematosus: Association with Lupus Nephritis, Obesity, and Peripheral Vascular Disease.

OBJECTIVES: To analyze the correlation between the serum concentration of interleukin- (IL-) 23 and atherosclerotic changes, traditional atherosclerotic risk factors, the autoantibody profile, and involvement of selected organs in systemic lupus erythematosus (SLE) patients. PATIENTS AND METHODS: We studied 94 SLE patients and 27 controls. We analyzed the IL-23 serum concentration, autoantibodies, carotid intima-media thickness and atherosclerotic plaque, the ankle-brachial index, atherosclerotic risk factors, and organ manifestations. RESULTS: Concentrations of IL-23 significantly differed between SLE patients and the controls (p = 0.0015). On the basis of multivariate stepwise analysis, we revealed that high levels of IL-23 were associated with atherosclerotic plaque in common femoral arteries (OR = 12.67; 95% CI: 1.41-113.84), lupus nephritis (OR = 3.69; 95% CI: 1.16-12.22), and obesity (OR = 4.21; 95% CI: 1.40-12.67). Autoantibodies related to IL-23 were anti-phosphatidylethanolamine antibodies (OR = 11.06; 95% CI: 1.24-98.65) and anti-SS-B/La antibodies (OR = 15.43; 95% CI: 1.73-137.25). CONCLUSIONS: IL-23 may be involved in lupus nephritis pathogenesis. Through its association with obesity and selected antiphospholipid antibodies, IL-23 might promote a hypercoagulable state contributing to atherothrombosis development in SLE patients.

Propranolol as an effective treatment for inoperable periocular haemangiomas in children.

Introduction: Infantile haemangiomas located in the periocular region are a signi􀏐icant clinical problem. When untreated, they can lead to serious complications that can inhibit the proper development of vision. As they are often inaccessible surgically, a noninvasive eye -saving therapy is required. The aim of the study was to assess the effectiveness of propranolol treatment for inoperable periocular haemangiomas (PH) in children. Material and methods: Seventeen children with haemangiomas of the upper and lower eyelid and internal eyelid angle were thoroughly examined. Lesions were seriously affecting movement of eyelids leading to ptosis in most of cases, but anisometric astigmatism and exophtalmia were also diagnosed. Patients were carefully quali􀏐ied for propranolol treatment and were re -evaluated when therapy was completed. Results: In all of the described cases brightening and softening of the lesion were observed from the 􀏐irst days of therapy. Ninety percent of patients showed signs of complete involution. In 5 cases a mild discolouration or skin enhancement persisted. All children presented signi􀏐icant functional improvement. An 86% reduction of astigmatism was found in cases that were diagnosed initially. Conclusions: In conclusion, early diagnosis and introduction of propranolol for PH reduce the risk of complications that pose a threat to eye function. Measurement of astigmatism reduction may be a useful tool to establish a proper moment to cease the therapy. Propranolol is the 􀏐irst choice treatment option in PH based on its effectiveness, speed of action, and low rate of side effects.

Original Protocol Using Computed Tomographic Angiography for Diagnosis of Brain Death: A Better Alternative to Standard Two-Phase Technique?

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 60th 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 AND METHODS In a prospective multicenter trial, 84 clinically brain-dead patients were examined using CTA and catheter angiography. The sensitivities of original CTA technique, involving an arterial assessment at the 25th second and a venous assessment at the 40th second, and the standard CTA, involving an arterial and venous assessment at the 60th 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.

Pulmonary benign metastasizing leiomyoma from the uterine leiomyoma: a case report.

BACKGROUND: 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. CASE REPORT: 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. CONCLUSIONS: 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.

MR imaging, apparent diffusion coefficient and histopathological features of desmoplastic infantile tumors-own experience and review of the literature.

PURPOSE: Desmoplastic infantile tumors are rare supratentorial brain lesions occurring in children under 18 months of age. We report characteristic neuroimaging with DWI and the histopathological features of these neoplasms. METHODS: Magnetic resonance (MR) examinations of nine patients, aged 0-18 months (median age 3.5 months), were retrospectively analyzed. Analysis of MR images included location and tumor size, signal intensity, contrast enhancement, presence of edema, and hemorrhage. Minimum and mean value of apparent diffusion coefficient (ADC) in the solid component of the tumor and contralateral normal-appearing white matter (NAWM) were measured, and ADC/NAWM ratios were calculated. All patients underwent tumor resection, and diagnosis of grade I desmoplastic tumors was confirmed. RESULTS: The tumors were located in the temporal lobe in seven patients, the parietal lobe in three, and in the frontal lobe in one case (in two children, tumors invaded more than one lobe). Suprasellar localization was observed in two patients; one child had multifocal brain lesions. In five cases, signal intensity of the solid component was hypointense on T2-WI. The measured minimum ADC value of solid tumor varied from 0.606 to 1.020 × 10(-3) mm(2)/s, with a mean value of 0.921 × 10(-3) mm(2)/s. The mean ADC value of NAWM was 1.121 × 10(-3) mm(2)/s. The mean ADC ratio was 0.858 × 10(-3) mm(2)/s. CONCLUSION: From our series, we can assume that restricted diffusion is observed not only in malignant but also in benign brain tumors. Diffusion signals and ADC values in these neoplasms appear to depend on their cellularity and components of the extracellular matrix.

CT Angiography in the Diagnosis of Brain Death.

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.

The assessment of the role of baseline low-dose CT scan in patients at high risk of lung cancer.

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. MATERIAL/METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

[ASSOCIATION OF ANTERIOR AND POSTERIOR URETHRAL VALVES. IS IT POSSIBLE TO RECOGNIZE THIS ASSOCIATION IN CLINICAL SIGNS AND RADIOLOGICAL EXAMINATIONS?]. / WSPÓLISTNIENIE ZASTAWKI CEWKI PRZEDNIEJ I TYLNEJ U NOWORODKA. CZY ROZPOZNANIE KOINCYDENCJI WAD NA PODSTAWIE OBJAWÓW KLINICZNYCH I BADAN OBRAZOWYCH JEST MOZLIWE?

We present a rare association of anterior and posterior urethral valves. A 5 days-old boy was admitted because of clinical presenation of lower urinary tract obstruction. A renal ultrasound and voiding cysto-urethrography revealed obstructive pathology in anterior urethra. On endoscopy an association of anterior and posterior urethral valves was recognized, and the valves were incised. Follow-up demonstrated improvement of preoperative signs. We try to recognize an association of anterior and posterior urethral valves in radiological examinations.

A rare case of peritoneal disseminated angiosarcoma 20 years after ovarian cancer diagnosis.

Angiosarcoma is a rare form of sarcoma which may be either a primary tumor or it may result from previous irradiation because of another tumor. In this paper, we present a case of a female patient diagnosed as having peritoneal disseminated angiosarcoma 20 years after ovarian cancer treatment (surgery, chemotherapy and radiotherapy). The case was very atypical because of an extremely rare peritoneal location and disseminated nature of the changes. Based on the initial histological picture, poorly differentiated cancer metastasis was diagnosed, suggesting a recurrence of the ovarian cancer that had been diagnosed earlier. The time elapsed from the ovarian cancer diagnosis, history of the previous irradiation and concentration of tumor markers were the only additional clinical data provided to the pathologists, which ultimately contributed to a correct diagnosis. The case we present herein shows and emphasizes the importance of proper communication between a clinician and a pathologist, which is a prerequisite for a correct diagnosis and, consequently, for proper treatment of patients. It also confirms the high specificity of the HE4 (human epididymis protein 4) marker in the monitoring of ovarian cancer, which was within normal limits in spite of peritoneal tumor dissemination.

CT and MRI imaging of the brain in MELAS syndrome.

BACKGROUND: 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. CASE REPORT: 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. CONCLUSIONS: 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.

Intra-abdominal adhesions in ultrasound. Part II: The morphology of changes.

Despite their frequent appearance, intra-abdominal adhesions are rarely the subject of clinical studies and academic discussions. For many years the operators have been trying to reduce such unfavourable consequences of interventions in the abdominal structures. The aim of this article is to present the possibilities of intra-abdominal adhesion diagnostics by means of ultrasound imaging based on authors' own experience and information included in pertinent literature. The anatomy and examination technique of the abdominal wall were discussed in Part I of the article. In order to evaluate intraperitoneal adhesions, one should use a convex transducer with the frequency of 3.5-6 MHz. The article provides numerous examples of US images presenting intra-abdominal adhesions, particularly those which appeared after surgical procedures. The significance of determining their localisation and extensiveness prior to a planned surgical treatment is emphasized. Four types of morphological changes in the ultrasound caused by intra-abdominal adhesions are distinguished and described: visceroperitoneal adhesions, intraperitoneal adhesions, adhesive obstructions as well as adhesions between the liver and abdominal wall with a special form of such changes, i.e. hepatic pseudotumour. Its ultrasound features are as follows:The lesion is localised below the scar in the abdominal wall after their incision.The lesion is localised in the abdominal part of the liver segments III, IV and V.With the US beam focus precisely set, the lack of fascia - peritoneum complex may be noticed. An uneven liver outline or its ventral displacement appears.A hepatic adhesion-related pseudotumour usually has indistinct margins, especially the posterior one, and, gradually, from top to bottom, loses its hypoechogenic nature.In a respiration test, this liver fragment does not present the sliding movement - a neoplastic tumour rarely shows such an effect. The immobility of the liver is a permanent symptom of subdiaphragmatic abscess which needs to be included in the differentiation process.In case of doubts, the suspicious liver area may be examined without the consideration of the scar in the abdominal wall. In the differentiation of visceroperitoneal adhesions, firstly, one needs to exclude the peritoneum infiltration in the course of inflammation and neoplastic spreading, which may be very difficult in patients who have undergone a surgery. Pseudomyxoma peritonei constitutes a source of errors much more rarely.

Congenital optic disc cyst concomitant with persistent hyaloid artery--a case report.

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.

Intra-abdominal adhesions in ultrasound. Part I: The visceroperitoneal bordeline, anatomy and the method of examination.

It needs to be emphasized that ultrasonography is a primary test performed in order to evaluate the abdominal wall and structures located in their vicinity. It allows for the determination of the anatomy and lesions in this localization. Thorough knowledge concerning the ultrasound anatomy of the tested structures constitutes a basis of all diagnostic successes. Therefore, this part of the article is devoted to this subject matter. The possibility to diagnose intra-abdominal adhesions with ultrasound is underestimated and rarely used. The aim of this paper is to discuss and document the ultrasound anatomy of the posterior surface of the abdominal wall as well as to present techniques directed at the detection of adhesions, in particular the visceroperitoneal ones. The posterior surface of the abdominal wall constitutes an extensive tissue area of complex structure, with folds and ligaments surrounded by various amounts of the epiperitoneal fat. In some places, this tissue separates the components of the fascia and peritoneum complex. The ultrasound manifestation of this complex is two hyperechogenic lines placed parallelly to each other in the places where they are not separated by the accumulated adipose tissue. Another factor which separates the peritoneum from the viscera is of dynamic character. It is a so-called visceral slide induced by easy or deep breathing. Its size should not be lower than 1 cm and the deflections gradually and symmetrically diminish from the epigastric to hypogastric region. Last but not least, the evaluation of the reciprocal relation of the abdominal wall with viscera may be aided by rhythmical manual compressions on the abdominal wall (ballottement sign) performed below the applied ultrasound transducer. During this test, the size of the visceral slide in relation to the abdominal wall is observed. The maneuver is usually performed in uncooperative patients or those with shallow breath. The authors' own experiences indicate that the effectiveness of the test is increased when lower extremities are moderately bent. This relaxes the muscle tension in the anterior wall of the abdomen. To assess the condition of these structures, linear transducers with the frequency of 5-9 MHz prove the most appropriate. In obese patients, a convex transducer with the frequency of 3.5-5 MHz also may be used. The acoustic focus should be set on the borderline of the abdominal wall and viscera and in order to visualize the changes it might be helpful to use harmonic, compound and XRes imaging. When examining the abdominal wall, the cross and longitudinal sections should be made. The complete evaluation of the visceroperitoneal borderline includes nine segments - three in the epigastrium, three in the mid-abdomen and three in the hypogastrium.

Estimation of vascular endothelial growth factor and placental growth factor serum levels' in infant with hemangioma and population of healthy infants.

INTRODUCTION: 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. MATERIAL AND METHODS: 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. RESULTS: The results in the study group were analyzed statistically and presented as arithmetic means, standard deviations, medians, minimal and maximal values, and percentage distributions. CONCLUSIONS: 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.

Coexistence of splenic hemangioma and vascular malformation of the lower extremity in a child: a case report.

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.

Upper gastrointestinal tract scintigraphy and ultrasonography in diagnosis of gastroesophageal reflux in children.

BACKGROUND: 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. MATERIAL/METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

[Anterior diverticulum after total laryngectomy]. / Uchylki przedniej sciany gardla po laryngektomii calkowitej.

UNLABELLED: Pharyngeal anterior diverticulum, also known as pseudoepiglottis is one of the most common disorders after total laryngectomy. THE AIM OF THIS STUDY: was to evaluate frequency of diverticulum after different types of total laryngectomy and severity of dysphagia in patient with developed pseudoepiglottis. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSIONS: This study indicates that leaving hyoid bone is a major risk factor for developing pseudoepiglottis.