[Serum level of TNF-alpha receptor type II better correlates with severity of Crohn's disease than other cytokines and conventional clinical activity indicators]. / Surowicze stezenie receptora typu II dla TNF-alpha wykazuje lepsza korelacje z ciezkoscia choroby Lesniowskiego-Crohna niz inne cytokiny i konwencjonalne wskazniki aktywnosci choroby.

UNLABELLED: Crohn's disease activity index (CDAI) and serum C-reactive protein (CRP) levels are not prefect indicators of Crohn's disease severity. Magnetic resonance enteroclysis (MRE) is a method allowing simultaneous assessment of lesions involving an entire intestinal wall as well as intra- and extraintestinal spaces. This method, however, is not appropriate for monitoring the course of disease and therapeutic effects. THE AIM OF THE STUDY: To evaluate which of the extensive panel of pro- and anti- inflammatory cytokines correlates with an actual severity of CD assessed by MRE. MATERIAL AND METHODS. 57 patients with endoscopically diagnosed ileocecal form of CD (28 women, age 29 + 11 yrs, range 18-62 yrs) hospitalized in 2007-2008. The mean CDAI was 293 + 119 points, range 18-503 points and serum CRP level was 17.5 + 31 mg/l, range 0.1-122 mg/l. MRE was performed in each patient not later than 3 days after entry to the study. The summarized score was calculated using standardized protocol, assessing the intestine wall thickness and length of its involvement (ileocecal region), pattern of mural contrast enhancement, presence of fistulas or other extraintestinal lesions and enlargement of mesenteric lymph nodes. At admission the blood was taken to measure following cytokines: IL-la, IL-1 receptor antagonist, IL-6, soluble IL-6 receptor, TNF-alpha, TNF-alpha type II receptor and IL-10. RESULTS: In Spearman's correlation test the MRE score showed the strongest relationship with serum level of TNF-alpha type II receptor (r = 0.52, p < 0.001), correlating less significantly with IL-6 level (r = 0.37, p < 0.01) and CDAI (r = 0.40, p < 0.001). CONCLUSION: TNFalpha receptor type II shows better correlation with the severity of ileocecal CD (assessed by MRE) than CDAI or serum levels of other cytokines and CRP.

Suitability of imaging methods (X-ray, CT, MRI) in the diagnostics of Ewing's sarcoma in children - analysis of own material.

BACKGROUND: Ewing sarcoma is a malignant, small round cell bone tumor, presenting predominantly in children and adolescents. Ewing sarcoma may develop in every bone; diaphyses of long bones, ribs and flat bones are the main locations. Local and systemic clinical symptoms are nonspecific - pain, swelling, fever or ill-being. The aim of the study was to assess the role of radiography, computed tomography and magnetic resonance imaging in the analysis of bone lesions in children and young adults with Ewing sarcoma. MATERIAL/METHODS: Twenty-seven patients, aged between 1 year and 10 months, and 17 years and 2 months, with histologically verified Ewing sarcoma of the bone, referred to the Radiological Department of University Hospital No 6., John Paul II Upper Silesian Centre for Child Health Katowice, in the period from 1996 to 2007, were included in the study.Plain radiography was performed in every child, CT in 20 and MRI in 12 individuals. Tumour location, extension of the tumour, soft tissue mass, and periosteal reaction were taken into consideration in the evaluation of the lesion. In some cases, pathological features of the MRI and CT were compared. The prevalence of some radiological features was compared to the literature data. RESULTS: THE MOST COMMON SITE OF TUMOR WAS: ribs (6 children), femoral bone (6 children), pelvis (4 children) and tibia (3 children). In 2 children, a primary tumor was diagnosed in the spine (multifocal in 1 child). X-rays revealed: periosteal reaction in 17 children (63%), soft tissue involvement in 19 children (70%), permeative component in 16 children (59%), and sclerotic component in 5 children (19%). In 10 children (37%), periosteal reaction was not detected. The examination revealed: soft tissue calcifications in 7 cases (26%), a well-delineated focus of destruction within bones in 3 children (11%), cortical thickening in 4 children (15%), cortical destruction in 4 children (15%), saucerisation in 3 children (11%), bone expansion in 3 children (11%), pathological fracture in 2 children (7%), cystic component in 1 child (4%), and vertebra plana in 1 child (4%).Reaction of tumors after i.v. contrast administration, shown on CT, was visible in 16 children - it was useful for a better description of the tumor and extension of the mass within the soft tissue. All MRI examinations (12 children) showed a heterogenous mass with ill-defined borders and a violated cortex. Low signal intensity of the tumor in a T1-weighted image and high signal intensity in a T2-weighted image was shown as well. Heterogenous enhancement of signal intensity on T1-weighted images could be observed after i.v. contrast administration. MRI EXAMINATIONS SHOWED: tumor in an adjacent soft tissue in 11 children, and involvement of the epiphyseal plate or of the joint cavity in 6 children. CONCLUSIONS: X-ray and MRI are essential in diagnostics. CT examination is more useful to estimate periosteal reactions and destruction of bone and marrow cavity, especially in flat bones. However, to recognise a malignancy, it is necessary to perform a histopathological examination. In doubtful cases, the examination has to be verified as well.