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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.

Background In the diagnosis of brain death (BD), computed tomography angiography (CTA) results in some cases show intracranial filling, leading to diagnostic confusion. Because cerebral circulatory arrest commences at the capillary level, we hypothesized that computed tomography perfusion (CTP) would be a more sensitive approach than CTA; therefore, the aim of the study was to compare the sensitivities of CTP and CTA in the diagnosis of BD. Material and Methods Whole brain CTP was performed in patients in the intensive care unit diagnosed with BD and CTA was derived from CTP datasets. Cerebral blood flow (CBF) and volume (CBV) were calculated in all brain regions. The CTP findings were interpreted as being consistent with a diagnosis of BD (positive) when CBF and CBV in all regions of interest (ROIs) were below 10 ml/100 g/min and 1.0 ml/100 g, respectively. The CTA findings were interpreted using a 4-point grading system. Results A total of 50 patients were included in the study. The CTP results revealed CBF from 0.00 to 9.98 ml/100 g/min (mean, 1.98 ± 1.68 ml/100 g/min) and CBV from 0.00 to 0.99 ml/100 g (mean, 0.14 ± 0.12 ml/100 g) and were thus interpreted as positive in all 50 patients. In contrast, the CTA results suggested 7 negative cases, providing a sensitivity of 86%. The difference between the CTP and CTA sensitivity results for the diagnosis of BD was statistically significant (p = 0.006). Conclusion Whole brain CTP may potentially be a feasible and highly sensitive test for diagnosing BD: therefore, performing CTP in combination with CTA in cases when CTA results are negative for BD could increase the sensitivity of CTA.

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

Summary 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.

Przedstawiono przypadek 78-letniej pacjentki z mięsakiem jasnokomórkowym tkanek miękkich podudzia lewego imitującym przewlekły krwiak. Omówiono tytułową jednostkę chorobową i proces diagnostyczny ze szczególnym uwzględnieniem roli badania ultrasonograficznego.

Wstęp: Naczyniaki wczesnodziecięce w lokalizacji okołoocznej to poważny problem kliniczny. Nieleczone mogą prowadzić do poważnych konsekwencji, stwarzając zagrożenie dla prawidłowego rozwoju wzroku. Z uwagi na trudną lokalizację bywają nieoperacyjne, dlatego niezbędne jest małoinwazyjne leczenie oszczędzające oko. Celem pracy była ocena skuteczności leczenia propranololem nieoperacyjnych naczyniaków okolicy oczodołu u dzieci.Materiał i metody: Do badania włączono 17 dzieci z naczyniakami górnej i dolnej powieki oraz kąta wewnętrznego powiek. Pacjentów poddano szczegółowemu badaniu okulistycznemu. Guzy naczyniowe znacząco wpływały na prawidłowy ruch powiek, powodując w większości przypadków opadanie powieki. Ponadto zdiagnozowano przypadki astygmatyzmu anizometrycznego oraz wytrzeszcz. Pacjenci zostali zakwalifikowani do terapii propranololem i szczegółowo ocenieni po zakończeniu leczenia.Wyniki: We wszystkich opisanych przypadkach od pierwszych dni stosowania leku zaobserwowano rozjaśnienie powierzchni guza oraz zmniejszenie jego napięcia. U 90% pacjentów doszło do całkowitej inwolucji. W 5 przypadkach pozostało delikatne przebarwienie i zgrubienie skóry. U wszystkich dzieci doszło do znaczącej poprawy w zakresie funkcji narządu wzroku. Stwierdzono 86% redukcję astygmatyzmu w przypadkach, gdy był on zdiagnozowany wyjściowo.Wnioski: Wczesna diagnoza i szybkie włączenie propranololu w leczeniu naczyniaków okolicy oczodołu u dzieci obniża ryzyko powikłań zagrażających prawidłowemu widzeniu. Pomiar redukcji astygmatyzmu może być przydatny w monitorowaniu terapii. Propranolol jest lekiem z wyboru w przypadku naczyniaków okołoocznych, uwzględniając jego skuteczność, szybkość działania i mały odsetek występowania objawów ubocznych.

Background Cytokine-mediated immunity plays a crucial role in the pathogenesis of various autoimmune diseases including systemic lupus erythematosus (SLE). The aim of this study was to evaluate association between serum levels of IL-23 and vascular involvement in SLE patients. Materials and 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 with ELISA method using R and D Systems tests. Carotid intima-media thickness and the presence of atherosclerotic plaques in carotid and lower extremities arteries were analysed with B-mode ultrasound. Ankle-brachial and high resistance indexes were measured with Doppler ultrasonography. We 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: chi 2 Yates, chi 2 Pearson, 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 (OR=10.1; 95% CI:1.2–85.1) and lupus nephritis (OR=3.2; 95% CI:1.1–9.6). Among 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 (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 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 IL-23 may be involved in lupus nephritis pathogenesis. 2. IL-23 through its significant association with obesity and antiphospholipid antibodies may promote hypercoagulable state contributing to atherothrombosis development in SLE patients.

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.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.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.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.

Introduction 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. Methods 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. Results 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

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

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.

Summary 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.

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.

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.Należy podkreślić, że ultrasonografia w ocenie powłok brzusznych i struktur położonych w ich pobliżu odgrywa pierwszoplanową rolę, gdyż pozwala z dużą precyzją określić anatomię i zmiany chorobowe w takiej lokalizacji. Podstawą wszelkich sukcesów diagnostycznych jest dokładna znajomość anatomii ultrasonograficznej badanej struktury, dlatego ta część pracy jest poświęcona właśnie tej tematyce. Możliwość diagnostyki zrostów wewnątrzbrzusznych przy użyciu ultrasonografii jest niedoceniana i mało rozpowszechniona. Celem pracy jest omówienie i udokumentowanie anatomii ultrasonograficznej tylnej powierzchni powłok brzusznych oraz zaprezentowanie techniki badania ukierunkowanego na wykrywanie zrostów, głównie trzewno-otrzewnowych. Tylna powierzchnia powłok brzusznych to rozległy obszar tkankowy o złożonej budowie, z obecnością fałdów i więzadeł otoczonych różną ilością tłuszczu nadotrzewnowego. Tkanka ta w pewnych miejscach rozdziela składowe kompleksu powięź – otrzewna. Manifestacją sonograficzną tego kompleksu są dwie linie hiperechogeniczne ułożone równolegle względem siebie, tam gdzie nie są oddzielone nagromadzoną tkanką tłuszczową. Drugi czynnik odgraniczający otrzewną od trzewi ma charakter dynamiczny, jest nim tzw. ślizg trzewi wyzwalany swobodnym lub głębokim oddechem. Jego wielkość nie powinna być mniejsza od 1 cm, a wychylenia stopniowo, symetrycznie maleją od nadbrzusza do podbrzusza. Wreszcie do oceny wzajemnego stosunku powłok z trzewiami służy kilkakrotnie powtarzany, rytmiczny ucisk manualny powłok brzusznych (balotowanie) wykonywany poniżej przyłożonej głowicy ultrasonograficznej. W czasie przeprowadzania tej próby obserwuje się wielkość ślizgu trzewi względem powłok; manewr ten wykonuje się przeważnie u pacjentów z płytkim oddechem lub u osób niewspółpracujących. Z własnych doświadczeń wynika, że efektywność próby zwiększa umiarkowane zgięcie kończyn dolnych, co powoduje zwolnienie napięcia mięśni przedniej ściany jamy brzusznej. Do oceny stanu tych struktur najlepiej nadaje się głowica liniowa o częstotliwości 5–9 MHz. U osób otyłych można zastosować głowicę konweksową o częstotliwości 3,5–5 MHz. Ognisko akustyczne usta-wia się na granicy powłok i trzewi, a w uwidocznieniu zmian będzie pomocne użycie obrazowania harmonicznego, złożonego i XRes. Badając powłoki, należy wykonywać przekroje podłużne i poprzeczne. Pełna ocena pogranicza trzewno-otrzewnowego obejmuje dziewięć segmentów – trzy w nadbrzuszu, trzy w śródbrzuszu i trzy w podbrzuszu.

Wstep Nerki są organem szczegolnie narazonym na upośledzenie ich funkcji oraz wystepowanie powiklan w czasie leczenia i po zakonczonym leczeniu ostrej bialaczki limfoblastycznej (OBL), ktore w sposob istotny mogą wplywac na komfort i dlugośc zycia pacjentow. Cel pracy Celem pracy byla ocena wielkości i funkcji nerek u dzieci, oraz określenie czynnikow mających wplyw na wystepowanie nieprawidlowości w ich funkcjonowaniu po zakonczonym leczeniu OBL za pomocą wybranych badan klinicznych, biochemicznych i obrazowych. Material i metody Badaniami objeto grupe 48 dzieci, w tym 29 (60%) chlopcow i 19 (40%) dziewczynek, w wieku 79–275 miesiecy (średnia 159 miesiecy; SD 49 miesiecy), u ktorych w latach 1989–2001 ustalono rozpoznanie OBL. Wyniki i wnioski Wykazano, ze stosowany program chemioterapii i czas obserwacji dluzszy niz 5 lat po zakonczenia leczenia w sposob istotny wplywaly na obnizenie wartości GFR, wystepowanie blizn w nerkach oraz zmniejszenie objetości i dlugości nerek. Dlatego konieczne wydaje sie objecie okresową opieką nefrologiczną pacjentow po zakonczeniu leczenia OBL.

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.

Summary 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.

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.Mimo częstego występowania zrosty wewnątrzbrzuszne rzadko są przedmiotem rozważań klinicznych i opracowań naukowych. Od wielu lat operatorzy starają się w różny sposób ograniczać takie niekorzystne następstwa interwencji w struktury wewnątrzbrzuszne. Niniejszy artykuł ma na celu zaprezentowanie możliwości ultrasonografii w diagnostyce zrostów wewnątrzbrzusznych w oparciu o własne doświadczenia i dane z piśmiennictwa. Anatomię i technikę badania ultrasonograficznego powłok brzusznych omówiono w I części pracy. Do oceny zrostów wewnątrzotrzewnowych należy wykorzystać głowicę konweksową o częstotliwości 3,5–6 MHz. W artykule zaprezentowano liczne przykłady obrazów ultrasonograficznych zrostów wewnątrzbrzusznych, szczególnie tych powstałych po operacjach, i podkreślono znaczenie określenia ich umiejscowienia i rozległości przed planowanym leczeniem chirurgicznym. Wyróżniono i opisano cztery rodzaje zmian morfologicznych w ultrasonografii spowodowanych przez zrosty wewnątrzbrzuszne: zrosty trzewno-otrzewnowe, zrosty wewnątrzotrzewnowe, niedrożność zrostową oraz zrosty wątroby z powłokami, ze szczególną postacią tych zmian, jaką jest guz rzekomy wątroby. Jego cechy sonograficzne przedstawiają się następująco:Zmiana znajduje się pod blizną w powłokach po ich nacięciu.Lokalizacja zmiany dotyczy brzusznej części segmentów III, IV i V wątroby.Przy dokładnym ustawieniu ogniska wiązki ultradźwiękowej daje się wykazać brak kompleksu powięź – otrzewna, w tym miejscu pojawia się nierówny zarys powierzchni wątroby lub jej dobrzuszne podciągnięcie.Guz rzekomy wątroby zrostopochodny ma zwykle zatarte zarysy, zwłaszcza tylną granicę, i stopniowo od góry do dołu traci swój charakter hipoechogeniczny.W teście oddechowym ten odcinek wątroby nie wykazuje ruchu ślizgowego – guz nowotworowy rzadko powoduje taki efekt. Unieruchomienie wątroby jest stałym objawem w ropniu podprzeponowym, który również należy uwzględnić w różnicowaniu.W przypadku niejasności podejrzaną okolicę wątroby można obrazować z pominięciem blizny w powłokach. W różnicowaniu zrostów trzewno-otrzewnowych należy w pierwszym rzędzie wykluczyć naciek otrzewnej w przebiegu jej zapalenia oraz rozsiew procesu nowotworowego drogą otrzewnej, co może być bardzo trudne u osób wcześniej operowanych. Zdecydowanie rzadziej przyczyną pomyłki jest śluzak rzekomy otrzewnej.

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.

INTRODUCTION Atherosclerosis is an important clinical problem in patients with systemic lupus erythematosus (SLE), because of very severe cardiovascular and central nervous system manifestations. OBJECTIVES Estimation if antiphospholipid syndrome (APS) and antiphospholipid antibodies (aPL) are risk factors for subclinical atherosclerosis in patients with SLE. PATIENTS AND METHODS We examined 103 patients with SLE and 30 healthy volunteers, included as the control group. Coexistence of APS was confirmed in 35 patients. Evaluation of subclinical atherosclerosis was done on the basis of measurement of intima-media thickness (IMT) in B-mode ultrasound examination. We considered classical atherosclerotic risk factors and determined profile of aPL: anti-cardiolipine antibodies (aCL), anti beta2 glycoprotein-I antibodies, antiprothrombin antibodies (aPT), anti-oxidized low-density lipoprotein antibodies and lupus anticoagulant (LA). Statistical analysis was performed with chi2 Yates, chi2 Pearson and R rang Spearman tests. Multivariate regression analysis was also done. RESULTS Thickened IMT was significantly more frequent in patients with SLE than in controls (p = 0.0002). We found that coexistence of APS is a risk factor for moderate thickening of IMT (OR: 3.41; 95% CI: 1.0-11.5). We also confirmed that the presence of aPL is significantly correlated with IMT ranging from 0.66 to 0.86 mm. The highest risk was found in patients with the presence of aPT IgA (OR: 5.50; 95% CI: 1.1-30.2), aCL IgM (OR: 4.36; 95% CI: 1.1-20.7), LA (OR: 4.02; 95% CI: 1.1-19.4) and aCL IgG (OR: 2.99; 95% CI: 1.1-9.7). Moreover, we found that ischaemic heart disease, nephropathy and myocardial infarction were significantly more frequent in patients with thickened IMT. CONCLUSIONS Patients with SLE develop subclinical atherosclerosis significantly more frequent than the general population. Coexistence of APS and presence of aPL are risk factors for subclinical atherosclerosis development in patients with SLE. Thickened intima-media in patients with SLE is significantly associated with an increased risk of cardiovascular manifestations.

Background and objectives Vascular disorders are a well recognised clinical problem in systemic lupus erythematosus (SLE). This preliminary study was designed to evaluate the association between cerebral circulation changes, carotid arteries involvement as well as nailfold capillaroscopy (NC) abnormalities and immunologic/inflammatory markers, classical atherosclerosis risk factors and organ involvement in SLEpatients. Materials and methods The study was performed in 30 SLE patients. Bilateral transcranial doppler (TCD) monitoring over the middle cerebral arteries according to the criteria of the International Consensus Group on Microembolus Detection was performed using two 2-MHz probes of the pulsed Doppler system MultiDop-T Digital (DWL Compumedics). MRI scans of the brain were carried out using a 1.5-T scanner GE Discovery 450 (GE Healthcare). Detection of carotid stenosis was performed using 3D contrast-enhanced MR angiography. Carotid intima-media thickness (cIMT) was measured with B-mode ultrasound. NC was done using Zeiss device. More than 100 variables were taken into account including cytokines, inflammatory markers, autoantibodies, classical risk factors for atherosclerosis and selected organ manifestations. Statistical analysis was performed with chi 2 Yates, chi 2 Pearson, rank Spearman correlations tests and logistic regression analysis. Results Factors which significantly correlated with analysed vascular changes including microemboli in TCD, ischaemic changes in MRI and NC abnormalities, were thrombocytopenia (r = 0.47, p = 0.01), C-reactive protein (CRP) (r = 0.51, p = 0.0039) and antiphospholipid antibodies (aPLs) (r = 0.55, p = 0.0015). There was significant association between vascular endothelial growth factor (VEGF) and IL-6 and high cIMT (r = 0.36, p = 0.0492, r = 0.41, p = 0.0239, respectively) as well as NC abnormalities, especially megacapillaries presence (r = 0.38, p = 0.0415, r = 0.42, p = 0.0226, respectively). Additionally, patients with changes in NC significantly more frequently were dyslipidemic (r = 0.56, p = 0.0015), hypertensive (r = 0.41, p = 0.0252) and unveiled high titers of anti-dsDNA (r = 0.37, p = 0.0492) and cardiac involvement (r = 0.38, p = 0.0441). There was also important positive correlation between cIMT and NC abnormalities (r = 0.40, p = 0.0300) as well as microemboli in TCD (r = 0.44, p = 0.0211). Finally, microemboli in TCD were associated with MRI ischaemic changes (r = 0.45, p = 0.0177). Conclusions NC and cIMT provide the optimal protocol to screen SLE patients for cardiovascular risk. CRP, VEGF, IL-6, aPLs and anti-dsDNA seem to be crucial pathogenic factors in micro- and macrovascular impairment development in SLE. Patients with higher cIMT and aPLs should undergo TCD for cerebrovascular risk assessment.

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 chi 2 Yates, chi 2 Pearson, 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.

Background 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. Objective 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. Methods 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. Results We found that HRI values in patients with SLE were significantly lower in comparison with the control group (p We have found no associations between decreased HRI values and the rest of analysed variables. Conclusions 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.

IntroductionAccording to Polish brain death (BD) criteria instituted in 2007, confirmatory tests should be used in specific situations such as intoxication, infratentorial processes, extensive facial damage, in children up to one year of age and any case when clinical examination seems to be inadequ

To determine the accuracy of CT angiography and CT perfusion for the confirmation of BD multicentre trial was conducted in 7 Polish centres. The study included 119 patients. The CT angiography protocol was similar to the French one as well as evaluation criteria [1].Following potential pitfalls and