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Background: With the increased interest in inter-recti distance measurement using ultrasound imaging, there is a question of measurement reliability, and the importance of the examiner’s experience. Methods: The study aimed to investigate the reliability of the inter-recti distance measurement performed offline by an experienced radiologist on linea alba images captured by two novice examiners. Additionally, it was aimed to determinethe number of image repetitions that provide an acceptable measurement reliability level. Ultrasound images were acquired by two novice examiners on repeated occasions (sessions A and B) in twenty-eight nulliparous women of reproductive age. Five images were captured at supraumbilical, umbilical, and infraumbilical points during each session. Results: The excellent intra-examiner reliability of inter-recti distance measurements was shown at the supraumbilical and umbilical levels (ICC=0.894-0.983). Infraumbilical measurements had good to excellent reliability (ICC=0.894-0.972). Session A inter-examiner reliability was excellent for the mean measurements of two, three, four, and five images taken at each location (ICC=0.913-0.954). Session B inter-examiner reliability was excellent for the mean measurements of two, three, four, and five images taken at the supraumbilical and umbilical (ICC=0.94-0.98) and good (ICC≥0.81) at the infraumbilical locations. Some images were unusable (1.6% of images of Examiner 1 and 2.2% of Examiner 2). Conclusions:Novice examiners were able to capture good-quality ultrasound images of the linea alba that allowed for excellent intra- and inter-examiner reliability of supraumbilical and umbilical measurements, and good to excellent reliability of inframbilical measurements in nulliparas.

Review question / Objective: The scoping review aims to identify publications describing the measurement of inter-recti distance (IRD)/diastasis recti abdominis (DRA) using ultrasonographic imaging (USI). The identification is based on the population/concept/context (PCC) framework that concerns human adults that underwent IRD/linea alba width/DRA measurement with USI for physiotherapy/physical exercise purposes. Based on systematically mapped peer-reviewed studies it is aimed to perform data extraction and synthesis of specific aspects of the IRD measurement procedure and discuss their similarities and differences. Related to that the attempt will be made to formulate recommendations on the IRD measurement procedure, which might be considered in future physiotherapy studies and practice. The recommendations will be made based on the synthesis of the results in light of existing literature and as the result of discussions and consensus between the authors (coming from three research centers).

A jejunal gastrointestinal stromal tumor (GIST) is a rare neoplasm of the gastrointestinal (GI) tract. Massive bleeding due to a jejunal GIST is a diagnostic and therapeutic challenge. It may be a life-threatening GIST complication that requires urgent intervention. Acute GI bleeding, which requires urgent surgical intervention, is a very rare clinical manifestation of GIST. A jejunal GIST with massive hemorrhage with coronavirus disease 2019 in a male patient in older age with many comorbidities has been not reported in the worldwide literature.In this case report, we present an 80-year-old man who was admitted to surgery due to abdominal pain, melena, and hematochezia for several hours. An upper endoscopy and colonoscopy were inconclusive. A multidetector contrast-enhanced computed tomography (CT) of the abdominal and pelvic cavity showed concentric irregular thickening in the distal jejunum.The histopathological finding showed a GIST measuring 6 cm with a mitotic index 2/50 high power fields. The patient's hemodynamic condition deteriorated despite initial conservative treatment including a blood transfusion. Therefore, patient underwent the emergency surgery 24 hours after admission: partial jejunal resection with the tumor followed by primary end-to-end anastomosis.The mass was removed completely. There were no surgical complications in the postoperative course. On the first postoperative day, a severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test was performed due to a persistent dry cough, which yielded a positive result. After 14 days, the patient died due to pneumonia and circulatory failure.This case indicates that jejunal GIST can present as massive lower gastrointestinal bleeding and urgent surgery can successfully stop bleeding and save the patient's life. The CT scan was the most effective investigation to find the source of GI bleeding in this case. Therefore, we suggest performing CT in patients with acute massive lower gastrointestinal bleeding when the source of bleeding is not visible on endoscopy, and urgent surgical jejunal resection to stop life-threatening bleeding caused by a jejunal GIST.

Purpose: We report our experience with endovascular treatment of these lesions, with special consideration of angiographic and clinical outcomes and periprocedural complications. Material and methods: The analysis included treatment results of 19 patients with 20 aneurysms. The aneurysm size ranged from 1.9 to 4.7 mm (mean 3.8, SD 0.7). Clinical examinations with the use of modified Rankin Score and angiographic outcomes were evaluated initially postembolisation and at a minimum follow-up of six months. Results: Initial post-treatment complete and near-complete aneurysm occlusion was achieved in 19 (95%) cases and incomplete occlusion in one (5%) case. Imaging follow-up, performed in 17 (89.4%) patients, showed no change in the degree of occlusion in 16 (94.1%) patients and coil compaction in one (5.9%). There were no retreatment procedures. The procedure-related mortality rate was 5% (1/20) and was associated with intraprocedural aneurysm rupture. There was a case of a clinically silent coil prolapse into the parent artery. The clinical follow-up evaluation achieved in 17 (89.4%) patients showed no change in clinical status in all followed patients. Conclusions: Endovascular treatment of small unruptured middle cerebral artery aneurysms is feasible and effective. The procedure-related complications are not negligible, especially in terms of the benign natural course of these lesions.

Rationale: Biliary cysts (BC) are rare dilatations of various parts of a biliary tract. They account for approximately 1% of all benign biliary diseases. Total cyst excision and Roux-Y hepaticojejunostomy is the treatment method of choice in most patients. In this paper, a novel surgical treatment with the use of internal biliary and pancreatic catheters was presented. Patient concerns: A 21-years-old woman with a giant choledochal cyst of Todani IA type presenting with abdominal pain, nausea, fever and palpable abdominal mass. It had been previously drained as a misdiagnosed pancreatic cyst in another hospital. Diagnosis: A very high amylase level (107140,0 U/l) in drain fluid was noted in laboratory tests. Endoscopic retrograde cholangiopancreatography revealed a biliary cyst located in the distal common bile duct and a pancreaticobiliary anomaly was suggested. A cholangiography per catheter inserted to the biliary cyst showed a large round contrast-filled cyst. A cholangiography following cyst decompression revealed a very long, tortuous bile duct entering the duodenum. Interventions: Cholecystectomy, cyst resection, Roux-Y hepaticojejunostomy, and implantation of catheters into pancreatic and bile duct were performed. The postoperative course was uneventful and she was discharged on 12th day without any complications. Histopathology revealed a cyst wall partially lined with biliary-type and mucinous epithelium, with dysplasia ranging from low to high grade (biliary intraepithelial neoplasia, high grade), without invasion. Outcomes: The biliary and pancreatic catheters were removed during endoscopic retrograde cholangiopancreatography 8 weeks following surgery without any complications. Fourteen months later, the patient reported good health. Lessons: Diagnosis of the abdominal cyst should be very precise in order to avoid misdiagnosis and inadequate management. The early diagnosis and proper treatment of BC are needed in order to avoid serious complications. The cholangiocarcinoma is the most dangerous potential complication of BC due to dysplasia within the cyst wall as in our young female patient.

Introduction: Complex intracranial aneurysms (CIA) are heterogenous group of intracranial vascular malformations. Due to its giant size, difficult location, broad neck, branches arising from the aneurysm, wall structure, calcification, presence of intraluminal thrombus or previous treatments it requires more careful approach. The aim of this study was to evaluate endovascular treatment results of CIA in our Department. Material and methods: In order to differentiate CIA from all the aneurysms, treated endovascularly in years 2008-2014, authors proposed their own qualification criteria. Additionally, subgroup of patients with CIA with simultaneous subarachnoid haemorrhage (SAH) was divided. Clinical outcomes of patients were assessed with Glasgow Outcome Scale (GOS), while radiological outcomes were assessed with Montreal Scale. Aneurysm localization, incidence of aborted procedures, intraoperative complications were also evaluated. Results: Internal carotid artery was the most common localization in both CIA and non-complex (nCIA) groups. Incidence of aborted procedures was significantly higher in CIA group than in nCIA (25% vs. 7%; p < 0.01). CIA group had worse Montreal scores then nCIA group (1.90 vs. 1.49; p < 0.01). Clinical outcome in GOS scale in patients with SAH and CIA was significantly worse than in SAH and nCIA (2.86 vs. 4.06; p = 0.04). Conclusions: To conclude, proposed criteria of CIA should be taken into consideration during diagnosis and qualification to invasive treatment. Classifying aneurysm as CIA is related to greater possibility of aborting endovascular procedure due to technical difficulties.

The intraprocedural aneurysm rupture (IPR) is one of the most feared adverse effect associated with the coil embolization therapy. The aim of the study was to identify predisposing factors for IPR, as well as to define patient groups with worse clinical outcome following IPR.From February 2008 to March 2015, 273 consecutive patients were treated at our institution via endovascular coil embolization. Patient medical records were reviewed with emphasis on procedure description, potential risk factors and clinical outcomes related to IPR. The IPR occurred in 14 (5.13%) cases. Multivariate logistic regression models were used to determine independent predictors of IPR. Clinical outcome was analyzed using the Glasgow Outcome Scale (GOS).Multivariate analysis showed that aneurysm location at posterior communicating artery is an independent risk factor for IPR (p = 0.035; OR 3.5; 95%CI 1.09-11.26). The frequencies of favorable disability (GOS 4-5), severe disability (GOS 2-3), and mortality (GOS 1) between patients with IPR and without IPR were significantly different in the general study population (p 0.001, p 0.001 and p = 0.023, respectively) and in patients with previously unruptured aneurysms (p 0.001, p = 0.006 and p = 0.003, respectively) but not in patients with previously ruptured aneurysms (p = 0.187, p = 0.089 and p = 1.0, respectively).Posterior communicating artery aneurysm location is an independent predictor for IPR. IPR is associated with a significant clinical deterioration in a subgroup of patients with previously unruptured aneurysms, but not in patients with ruptured aneurysms.

Since the 1990s, there has been a significant increase in the number of imaging examinations as well as a related increase in the healthcare expenditure and the exposure of the population to X-rays. This study aimed to analyze the workload trends in radiology during the last decade, including the impact of COVID-19 in a single university hospital in Poland and to identify possible solutions to the challenges that radiology could face in the future. We compared the annual amount of computed tomography (CT), radiography (X-ray), and ultrasound (US) examinations performed between the years 2010 and 2020 and analyzed the changes in the number of practicing radiologists in Poland. The mean number of patients treated in our hospital was 60,727 per year. During the last decade, the number of CT and US examinations nearly doubled (from 87.4 to 155.7 and from 52.1 to 86.5 per 1000 patients in 2010 and 2020 respectively), while X-ray examinations decreased from 115.1 to 96.9 per 1000 patients. The SARS-CoV-2 pandemic did not change the workload trends as more chest examinations were performed. AI, which contributed to the COVID-19 diagnosis, could aid radiologists in the future with the growing workload by increasing the efficiency of radiology departments as well as by potentially minimizing the related costs.

Progressive regression of cerebral arteriovenous malformations (AVMs) is a rare phenomenon that may occur spontaneously or after previous surgical or endovascular incomplete obliteration. We present two cases of AVMs occluded partially with Onyx followed by the unexpected cure of the lesions with the angiographic evidences as well as multiannual follow-up.

Purpose: Very small intracranial aneurysms (VSIAs) may cause many neurological complications and even death. Thanks to technological progress and higher quality of non-invasive neuroimaging methods, these pathologies can be investigated sooner and treated earlier. Due to the controversy surrounding invasive treatment of these pathologies, the aim of the study was to analyse methods of treatment, their outcome, and complications in a group of patients with VSIAs. Material and methods: Out of 444 cases of intracranial aneurysms treated in our centre, 65 aneurysms met the radiological criteria of VSIAs. The parameters - width and length of the aneurysm's neck and width, length, and height of the aneurysm's dome - were measured. The analysed parameters were as follows: symptoms upon admission and after treatment, days in hospital, and intraoperative complications. Clinical and radiological intensity of subarachnoid haemorrhage (SAH) was evaluated by using the Hunt-Hess and Fisher scales. The degree of embolisation of the aneurysm after the procedure was assessed using the Montreal Scale. Clinical outcome was assessed by Glasgow Outcome Scale. Results: 50.77% of VSIAs were treated with endovascular procedures and 49.23% with neurosurgical clipping. SAH was presented in 38.46% of patients with VSIAs. Intraoperative complications were presented in 16.92% of patients with VSIAs, and the most common complication was ischaemic stroke. Stents were used in 51.52% of VSIAs. In 69.70% of embolisation procedures at VSIAs complete obliteration was achieved. The average result in the Montreal Scale was 1.31 (SD = 0.66). Conclusion: VSIAs can be treated as effectively and safely as larger aneurysms, by both endovascular and surgical methods.

Objective We report our experience with stent-assisted coiling of anterior communicating artery aneurysms with special consideration of angiographic and clinical outcomes, retreatment rate and periprocedural complications. Materials and methods The analysis included 34 consecutive ruptured and unruptured wide-neck aneurysms. The aneurysm size ranged from 2 to 18 mm (mean 5.47). Clinical examinations with the use of modified Rankin Score and angiographic outcomes were evaluated initially post-embolization and at a minimum follow-up of 6 months. Results Initial post-treatment complete and near-complete aneurysm occlusion was achieved in 32 (94%) and 2 (6%) cases, respectively. Imaging follow-up, performed in 28 (82%) patients, showed no change in the degree of occlusion in 25 (89%) cases and coil compaction in 3 (11%) patients. Of these, one (3.6%) patient underwent a second coil embolization. The periprocedural severe complication rate was 2.9% (1/35) and was associated with prolonged attempt of retrieval of migrated coil resulting in anterior cerebral artery infarct with serious clinical consequences. In another 3 patients periprocedural adverse events without delayed clinical consequences were noticed. The clinical follow-up evaluation achieved in 33 (97%) patients showed no change in 30 (91%) cases, one patient (3%) with clinical improvement and two (6%) cases of neurological deterioration. Conclusions The use of stent is feasible and effective for coil embolization of wide-necked anterior communicating artery aneurysms. Although periprocedural complications resulting in severe morbidity are rare, they should be noted, since in terms of thromboembolic events some of them presumably have a potential to be avoidable.

Introduction : Percutaneous Transhepatic Biliary Drainage (PTBD) is a procedure indicated in patients with non-operative lesions, when endoscopic application of prosthesis is impossible due to anatomic reasons, complications or severe general condition of patient. Most often it is a palliative procedure, aiming for live-quality improvement, although not altering prognosis of basic disease. Aim : This study presents own experience in biliary drainage with the aid of percutaneous transhepatic method and simultaneous assessment of method effectiveness and safety. The aim was to assess outcomes and complications of PTBD in a large group of patients. Materials and method : In time period 2007–2014, 167 patients hospitalized in Radiodiagnostics and Radiology Department of Clinical Hospital, were investigated retrospectively. PTBD procedure was applied to patients with biliary tract obstruction. In total 186 procedures of percutaneous drainage were applied. Average age of patients was 63.6 years. Bilirubin, alkaline phosphatase and gamma-glutamyl transferase were measured before and after procedure. All data were analyzed statistically. Results : In examined group percutaneous drainage was successful in 90.7% interventions. In 8.1% procedures drainage application was ineffective. The most common complication during procedure was hemobilia (3.2%) and the long term complication was drain dislocation (2.7%). The mean bilirubin levels declined from 397.06 lmol/l before drainage to 297.88 lmol/l after drainage (p< 0.05). Conclusions : PTBD is an effective method of biliary tract decompression and it is an important alternative to endoscopic drainage. This method is indicated in patients with neoplastic obstruction of biliary tract with low expected survival rate and thus is a palliative procedure. Keywords : Biliary drainage; Transhepatic cholangiography; Jaundice; Decompressed ducts; Biliary complications; Biliary tract obstruction

AIMS: South Asian (SA) patients are known to have an increased incidence of acute cardiovascular events compared with Caucasians. The aim of this observational study was to compare the prevalence of coronary stenoses, the amount and composition of coronary atherosclerosis in a cohort of Caucasian and SA patients with stable chest pain, in non-acute settings.METHODS AND RESULTS: The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki. In 963 consecutive Caucasian and SA patients undergoing coronary computed tomography angiography, atherosclerotic plaques were quantified using a semi-automated algorithm. The vessel per cent diameter and area stenosis were measured. Plaque composition was examined from the measurement of calcified, non-calcified, and total plaque burden. There were 420 Caucasian (238 males) and 543 SA (297 males) patients. Caucasian patients were older than SA patients (54.39 ± 11.65 vs. 49.83 ± 11.03 years) and had lower prevalence of diabetes (13.13 vs. 32.41%) and hyperlipidaemia (56.90 vs. 68.51%) (all P-values CONCLUSION: This study conducted in non-acute settings showed an ethnic difference in composition of coronary atherosclerotic plaque with lower non-calcified composition in Caucasian patients compared with SA patients, which was independent of age, diabetes, hyperlipidaemia, and the other available cardiovascular risk factors.

Introduction Patients after implantation of flow diverters (FD) due to intracranial aneurysms require radiological and clinical follow-up in view of in-stent stenosis. The aim of the study was to evaluate transcranial Doppler ultrasonography (TCD) as an alternative to more invasive digital subtraction angiography in monitoring patients with FD. Patients and methods Twenty-five patients after FD deployment due to internal carotid artery (ICA) aneurysms were reviewed. The degree stenosis found on TCD was compared with the results of catheter angiography. The TCD examinations were recorded from two sides at the extracranial ICA and the most proximal and distal segment of intracranial ICA. Analyzed TCD factors included: peak systolic blood flow velocity, end diastolic velocity, mean velocity, pulsatility index, and resistivity index. The side-to-side differences and ratios between particular TCD indices were calculated. Results The cumulative frequency of angiographic in-stent stenosis was 5 of 25 (20 %). The analysis showed that pulsatility index measured on the most proximal intracranial segment of ICA is a predictor for angiographic instent stenosis (AUC = 0.854; p = 0.04; 95 % CI 0.59–1.00). The threshold of pulsatility index separating stenosis and non-stenosis groups was 1.05 with a sensitivity of 50 % and a specificity of 100 %. As the cut-off threshold of PI was set 0.75 the sensitivity and specificity was 100 % and 16.7 %, respectively. Conclusions The increased TCD-derived pulsatility index measured on the most proximal intracranial segment of ICA is associated with in-stent stenosis demonstrated on angiograms.

In the face of a growing world population, declining land reserves and climate change, there is an urgent need to increase the efficiency of the production of food. Precision agriculture (PA) is one of the pathways in which the efficiency of agriculture can be increased. The profitability and sustainability of production of potatoes in The Netherlands can be increased by at least 20% by employing a range of PA technologies that are currently available to commercial growers. The systematic collection and processing of data is the cornerstone of precision agriculture. On the one hand, these data are used to derive models that describe the effect of weather, soil, and management on crop growth. On the other hand, data and models are used to support decision-making about when and where to apply inputs: fertilizers, crop protection agents, and irrigation water.

Purpose Arteriovenous malformations (AVMs) are connected with cerebral haemorrhage, seizures, increased intracranial pressure, headaches, mass effect, and ischaemia symptoms. Selection of the best treatment method or even deciding if intervention is required can be difficult. Material and methods The study included 50 patients who were diagnosed with cerebral AVMs and treated in our Centre between 2008 and 2014. A total of 111 procedures were performed, including 94 endovascular embolisations and 17 neurosurgical procedures. Medical records and imaging data were reviewed for all patients. All AVMs were measured and assessed, allowing classification in Spetzler-Martin and Spetzler-Ponce scales. Results Complete or partial treatment was observed in 88.24% of neurosurgical procedures and in 84.00% of embolisations. Early complication rate was 21.28% for embolisation and 17.65% for neurosurgical procedures, while Glasgow Outcome Scale was 4.89 (σ = 0.38) and 5.0 (σ = 0.00), respectively. According to the Spetzler-Martin scale, cerebral haemorrhages occurred more frequently in grade 1, but no statistical significance was observed. In Spetzler-Ponce class B lower grades in Glasgow Coma Scale (GCS) were noticed (p = 0.02). Lower GCS scores were also correlated with deep location of AVM and with eloquence of adjacent brain. Patients with Spetzler-Martin grade 1 were more frequently qualified for neurosurgical procedures than other patients. Conclusions Treating AVMs requires coordination of a multidisciplinary team. Both endovascular embolisation and neurosurgical procedure should be considered as a part of multimodal, frequently multistage treatment. Spetzler-Martin and Spetzler-Ponce scales have an influence on haemorrhage frequency and patients' clinical condition and should be taken into consideration in selecting the treatment method.

Purpose: The patient population that would benefit most from endovascular curative treatment of intracranial arteriovenous malformations has not been clearly established. The aim of the study was to determine the effect of curative embolisation of cerebral arteriovenous malformations with special regard to radiographic and clinical outcomes and procedure-related complications. Material and methods: Between January 2009 and December 2014, 18 patients with intracranial arteriovenous malformations were embolised with Onyx with intent to cure. There were four women and 14 men, with a mean age of 40 years (range 10-62 years). Inclusion criteria were: maximal diameter of the lesions ≤ 3 cm and arterial supply consisting of no more than two major arteries. Five (27.8%) patients had ruptured lesions, and 13 (72.2%) patients had unruptured lesions. Mean arteriovenous malformation size was 2.3 cm (range 1.5-2.9 cm). Results: Thirty-three procedures were performed in 18 patients. Total obliteration was achieved in five patients (27.8%). The most common reason for initial incomplete angiographic occlusion was unfavourable angioarchitectural features of arteriovenous malformations, with the rate of 44.4%. The mean follow-up of patients with complete occlusion was 35.2 months (range 18-60 months). Complication rate was 12.1%. One patient had permanent neurological deficit with resulting morbidity of 5.6%. There were no deaths. Conclusions: Embolisation of intracranial arteriovenous malformations plays a limited role as a sole therapeutic modality even in terms of small lesions with two or fewer arterial feeders, although larger prospective series are necessary to confirm these findings. Associated complications are not trivial and should be considered when choosing this form of treatment.

Background: The aim of the study is to assess the prevalence of anomalous origin of the coronary artery in cardiac computed tomography (CT) and to evaluate its coexistence with other congenital heart disease. Materials and methods: 7,115 patients, who underwent 64-slice or dual source cardiac CT in the years 2005–2011 were screened for the presence of anomalous origin of the coronary artery. Results: Anomalous origin of coronary artery was found in 62 (0.87%) patients (34 males, mean age 57.4 ± 15.1 years). Anomalous aortic and pulmonary origin of coronary artery concerned 59 (0.83%) and 3 (0.04%) cases, respectively. Concomitant heart defects were observed in 5 (0.07%) patients, all with anomalous aortic origin of coronary artery. Malformations included transposition of great arteries (4 patients) and single ventricle in (1 patient). Conclusions: The incidence of anomalous origin of a coronary artery in cardiac CT is similar to invasive coronary angiography. In an adult population the vast majority of those anomalies are isolated abnormalities without concomitant other congenital heart defects.

Objectives Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. Methods and results We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. Results Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250 ± 99 min. 90.3% of the studied patients had MT within 6 h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% – emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b–TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization – in 30.7%, mRS of 0–2 – in 31.4% and mRS of 6 in 22% of cases. Conclusion Our results can help harmonize standards for MT in Poland according to international guidelines.

Summary Background Paragangliomas are benign neuroendocrine tumors derived from the glomus cells of the vegetative nervous system. Typically, they are located in the region of the jugular bulb and middle ear. The optimal management is controversial and can include surgical excision, stereotactic radiosurgery and embolization. Case Report We report the endovascular approach to three patients harboring glomus jugulare paragangliomas. In all cases incomplete occlusion of the lesions was achieved and recanalization in the follow-up period was revealed. Two patients presented no clinical improvement and the remaining one experienced a transient withdrawal of tinnitus. Conclusions It is technically difficult to achieve complete obliteration of glomus jugulare tumors with the use of embolization and the subtotal occlusion poses a high risk of revascularization and is not beneficial in terms of alleviating clinical symptoms.

Summary Background Hydrogel coils were created to improve the chances of an effective endovascular treatment of cerebral aneurysms. Achieving a high packing density of coils in the lumen of aneurysms can decrease the risk of recurrence. The aim of the present study is to report our initial experience on the effectiveness and safety of endovascular treatment of intracranial aneurysms with the use hydrogel coils. Material/Methods Sixty patients (age: 28–72 years) (45 women, 15 men) were treated. In 18 patients (30%), subarachnoid hemorrhage was present. Digital subtraction angiography (DSA) of cerebral vessels with rotational scanning was performed. Image analysis was performed by the Philips Integris 3D RA device,which is a specialized workstation (Three-Dimensional Rotational Angiography). 3D reconstructions of cerebral arteries were created based on the data. Sixty-six cerebral aneurysms were embolized with hydrogel coils, which expand in contact with blood. reaching the maximum diameter in about 20 minutes. In 29 aneurysms (43.9%), the effect of the procedure was confirmed on a follow-up DSA after 8.0±4.1 months from the initial treatment. Results A complete embolization was performed in 55 aneurysms (83.3%), and partial embolization in 11 aneurysms (16.7%). In 6 aneurysms (9.1%), re-embolization was necessary and it resulted in a complete embolization of 5 aneurysms. On a follow-up DSA, complete embolization was present in 25 aneurysms (86.2%), and partial embolization in 4 aneurysms (13.8%), respectively. Conclusions Endovascular embolization with hydrogel coils is an effective and safe treatment method for cerebral aneurysms, although it carries the risk of some complications.

Background Wide-necked intracranial aneurysms have been a challenge for endovascular techniques. With the advent of adjunctive devices such as balloons or stents, recanalisation rates have decreased secondary to better packing. Purpose The purpose of this registry was to evaluate the safety and effectiveness of the new Low-profiled Visualized Intraluminal Support LVIS and LVIS Jr. stents in the treatment of unruptured wide-neck intracranial aneurysms. Methods The LVIS or LVIS Jr. stent-assisted coil embolisation was performed in 78 patients harbouring 78 intracranial aneurysms. There were 59 aneurysms located in the anterior circulation and 19 in the posterior circulation. Clinical data and 6-month follow-up angiograms are presented. Results The LVIS and LVIS Jr. stents were successfully delivered to the target aneurysm; however, there were seven cases in which the LVIS/LVIS Jr. stents had suboptimal opening and apposition to the parent vessel wall. The overall technical success for all groups was 91% (71 of 78 stents). There was complete angiographic occlusion in 66 (85%) of 78 cases and residual neck remnants in 12 (15%) cases. All patients had 6-month angiographic follow-up, which demonstrated complete occlusion of the target aneurysm in 64 (82%) cases, residual neck remnants in 5 (6%) cases and there was aneurysm filling in 9 (12%) cases. Conclusions The LVIS/LVIS Jr. stent system is safe and effective for the treatment of wide-neck intracranial aneurysms, providing suitable support of the coil mass, which allows for a high level of occlusion with low rates of recanalisation and subsequent treatments.

It remains unclear why some patients with cardiomyopathy secondary to anterior infarction do, and others do not develop functional mitral regurgitation (MR).Thirty-six patients after anterior infarction with ejection fraction (EF) below 35%, 18 with no/trivial and 18 with moderate/severe MR, underwent cardiac magnetic resonance imaging. Parameters describing the geometry of the mitral valve, subvalvular apparatus and left ventricle were measured.The septolateral and commissure-to-commissure mitral annular diameters were bigger in patients with MR. The odds ratio (OR) of developing regurgitation was 25.0 (95% confidence interval [95% CI] 4.3-144.3; P0.001) for end-systolic septolateral mitral annulus diameter above 20 mm/m(2). MR was less likely in patients with straighter posterior papillary muscle (OR 0.040, 95% CI 0.007-0.23; P0.001-for the angle between muscle axis and mitral annulus plane81°), and more likely (OR 7.9, 95% CI 1.6-39.4; P = 0.008) with posterior papillary muscle tethering23 mm/m(2). Regurgitation was less likely (OR 0.032, 95% CI 0.003-0.33; P = 0.001) with anterolateral papillary muscle tip to ipsilateral mitral annulus distance in end-diastole longer than 13 mm/m(2). Left ventricular EF, volumes and the overall end-systolic and end-diastolic wall thicknesses did not differ between the groups. Patients with MR had thinner myocardium proximal to the base of the anterior and distal to the base of the posterior papillary muscle.Inferior extension of anterior infarction and more leaning posterior papillary muscle are the major components resulting in the development of ischaemic MR in patients with cardiomyopathy secondary to anterior infarction. Shorter chordae tendineae may constitute the anatomical background that makes the development of ischaemic MR more likely.

Objective We report our experience with endovascular coiling of anterior communicating artery aneurysms with special consideration of angiographic and clinical outcomes and periprocedural complications. Materials and methods The analysis included treatment results of 28 patients with ruptured and unruptured aneurysms. The aneurysm size ranged from 1.8 to 9.8 mm (mean 5.2, SD 1.7). Clinical examinations with the use of modified Rankin Score and angiographic outcomes were evaluated initially post-embolization and at a minimum follow-up of six months. Results Initial post-treatment complete and near-complete aneurysm occlusion was achieved in 27 (96%) cases and incomplete occlusion in one (4%) case. Imaging follow-up, performed in 15 (53.6%) patients, showed no change in the degree of occlusion in 11 (73%), coil compaction in one (7%) and progressive occlusion in three (20%) patients. Three (20%) patients underwent a second coil embolization. The procedure-related severe morbidity and mortality rate was 6.4% (2/31). Coil prolapse was present in one (3.2%) case and intraprocedural aneurysm rupture in three (9.6%) cases. The clinical follow-up evaluation achieved in 19 (67.9%) patients showed no change in 17 (89.5%) patients and improvement in two (10.5%) patients. Conclusions Although the efficacy of coil embolization of anterior communicating artery aneurysms is unquestionable and the procedure-related complications are acceptable, they should not be neglected. Further investigations are needed to better understand protective factors, as well as to establish unequivocally appropriate management strategy of these complications.

Basilar Artery Occlusion (BAO) is a rare cause of stroke, occurring in about 1% of all the cases. BAO is characterized by bad prognosis and high death rate, which is about 75-91%. Neurological symptoms which accompany BAO are of large variety. BAO may occur suddenly, with or without previous prodromal symptoms or it may proceed progressively. Basilar artery occlusion always demands quick diagnosis and treatment. We are describing 5 cases of patients with basilar artery occlusion who were subjected to endovascular methods. The patients were treated with different intravascular techniques. Two patients had a stent Solitaire FR inserted, two others were applied targeted thrombolysis, one patient had combined therapy using targeted thrombolysis and mechanical thrombectomy- Penumbra device. Neurological symptoms were determined by using National Institutes of Health Stroke Scale (NIHSS). 60% of patients achieved the result, according to NIHSS, equal 0 or 1 point or improvement of ≥ 10 points, which is defined as neurological state changing for the better as well as the reduction of symptoms. Unblocking the basilar artery (TICI ≥ 2b) was successful with 80% of patients. The lack of disability was stated with 40% of the group under treatment (mRS ≤ 2). No patient had any complications connected with intravascular treatment. The treatment of basilar artery occlusion is difficult as nowadays there are no precise guidelines defining the most successful therapy. Our study shows that using intravascular methods is a good alternative for standard therapy of basilar artery occlusion, especially with those patients who cannot be qualified for intravenous thrombolysis due to overrunning the time window or with whom intravenous using of rt-PA was not efficient. The usage of endovascular methods is hoped to have great future prospects.

INTRODUCTION Intracranial atherosclerotic disease is one of the major risk factors of ischemic stroke. Percutaneous transluminal angioplasty with stent deployment may be effective for the treatment of symptomatic intracranial stenosis, however its value is yet to be determined. High possibility of serious periprocedural complications, such as acute in-stent thrombosis or stroke, narrows the current recommendations for this treatment to patients with high-grade stenosis (>70%), and to experienced neurointerventional centers. CASE REPORT We present a 44-year-old male with symptomatic high-grade stenosis of the M1 segment of left middle cerebral artery, treated with percutaneous transluminal angioplasty with stenting. The procedure was complicated with acute in-stent thrombosis treated with intra-arterial thrombolysis, which resulted in a nondisabling stroke. CONCLUSIONS The procedure-related stroke in this patient was probably caused by middle cerebral artery perforator ostium occlusion with balloon predilatation and transient in-stent thrombosis related to insufficient antiplatelet pretreatment. Exhausted cerebrovascular reserve due to long-lasting high-grade intracranial stenosis should also be considered as a factor contributing to ischemic complications.

Rationale and Objectives To compare two semiautomated methods for measurement of infarcted myocardium area on delayed contrast enhanced magnetic resonance imaging, with histopathology findings as standard of reference. Materials and Methods Percentage area of myocardial infarction was measured in 10 Yorkshire landrace pigs manually and using two semiautomated methods. The first (standard deviation method) used two operator-selected regions of interest (ROIs) and nine different cutoff values (one to nine times the standard deviation of signal intensity in normal myocardium) to identify infarction. The second (threshold method) used threshold values based on percentages of maximum signal intensity to identify infarction. Results were compared with histopathology findings. Results Difference between percentage area of infarction obtained with standard deviation method and autopsy specimens was in the range: −13.5% to +13.2%. With threshold method (thresholds from 30% to 90% of signal intensity), difference was −15% to +23%. Manual contouring underestimated infarcted area by 2% comparing to autopsy results. The best agreement between histopathology and semi-automated software was achieved for 4 standard deviations with standard deviation method: difference −0.45%, and for a percentage threshold of 70% (difference +0.67%) with threshold method. However, with standard deviation method, there was statistically significant difference between ROIs based on their location in viable myocardium: mean difference 1.7 ± 4%, P Conclusion Semiautomated measurement of myocardial infarcted area on delayed enhanced magnetic resonance images performs well compared to autopsy. The threshold method, based on percentages of maximum signal intensity is preferable over standard deviation method, which is more susceptible to variability from location of ROIs within viable myocardium.

A 31-YEAR-OLD PATIENT was admitted to the Department of Gastrointestinal Surgery because of epigastric pain after meals, nausea, and lack of appetite. Laboratory data, including hepatic and pancreatic profiles, were within normal limits. Computed tomography demonstrated an intussusception of the transverse part of the duodenum into the small intestine (Fig 1, A and B). At laparotomy, a duodenojejunal intussusception was found, with the duodenal bulb invaginated into the proximal jejunum (Fig 2, A). The intussusception was reduced manually. A mass was palpable in the lumen of duodenum (Fig 2, B) and was delivered through a longitudinal duodenotomy (Fig 2, C). The cystic mass had a 1 cm orifice and was filled with bile. The major duodenal papilla was found on the part of the wall shared with the duodenum. The head of the pancreas was hard. A pylorus

Correlations between selected metric parameters of the nasal cavity and nasopharynx in children without atresia may be useful for anticipating probable dimensions of this region in living subjects, in terms of changes with age.One hundred and eighty children, age range 0-3 years, were divided into five age groups, and measurements of 18 distances between structures of nasal cavity and nosopharynx were performed on computed tomography scans. Correlation coefficients and relations between parameters have been determined.Our study confirmed the existence of statistically significant correlations between linear dimensions within nasal cavity in children. The analysis demon-strated that for the values of following indexes: nasal septum length/piriform aperture width, and maximum length of the nasal septum/posterior nares width no statistically significant differences have been noted between age groups of children. All correlations have been positive. No statistically significant differences have been noted between the maximum width of the vomer and osseous parameters measured, both in the anterior and posterior part of the nasal cavity, and nasal septum length.The size of posterior nares changed with age in children by a constant value. So far, no such an analysis has been carried out assessing potential correlations between linear dimensions for the entire nasal cavity, nasopharynx, length of the nasal septum in children, as well as proportions of individual linear dimensions of the anatomical structures analysed, in various age groups.

Background: Structural defects of the hypothalamic-pituitary area in MRI are suggested to be a more accurate marker of growth hormone deficiency (GHD) than laboratory assays. Objective: To compare auxology in GHD children with the normal pituitary (NP) and with ectopic posterior pituitary (EPP), prior to therapy with recombinant human growth hormone (rhGH) , extending the follow-up to two years of the treatment, within one centre. Design: 86 GHD patients were divided in 2 groups depending on the pituitary MRI: EPP (23 children, 3.2-16.8 years old) and the NP group (63 children , 3.3-14.8 years old). Height deficits to the population (hSD), parents (hSD-mpSD), the change of hSD and bone/chronological age ratio were assessed before, after 12 and 24 months of rhGH therapy. Results: Height deficits before treatment were significantly greater in EPP comparing to NP (median -4.07 [7.06;-2.75] vs -3.15 [-4.9;-2.35] for hSD, and -3.65 [-7.06;-1.21] vs -1.83 [-4.31;-0.28] for hSD-mpSD; p

Summary Background: Intervertebral disc calcification is a rare condition in children; in most cases, it is asymptomatic and therefore not diagnosed. Case Reports: In our study, we present a case of idiopathic intervertebral disc calcification within the cervical segment, at the level of C2/C3 and C4/C5 vertebrae in a 5-year-old girl with torticollis. Basic neurological examination supplemented by X-ray examination was performed, showing calcification within the cervical segment at the level of C2/C3 and C4/C5 vertebrae. Conclusions: In order to complement the diagnostics, a CT scan of the cervical spine was performed; the scan confirmed the diagnosis and revealed additional calcification of the anterior longitudinal ligament at the level of C4/C5 vertebrae.

Objective Presentation of the own experience in the treatment of ischemic stroke using endovascular methods of simultaneous evaluation of their effectiveness and safety. Materials and methods The retrospective study involved a group of 18 patients hospitalized in 2005–2012 who were treated with intraarterial thrombolysis and mechanical thrombectomy. Overall there were 24 procedures performed. The investigated group consisted of seven (38.89%) women and 11 (61.11%) men. The average age of the patients was 60 years (SD ± 17, median – 60 years). Results In 62.50% of cases ( n = 15) the effect of revascularization has been achieved and another 12.50% of cases ( n = 3) recanalization was achieved only partially. Only in 25% of procedures ( n = 6) failed to achieve recanalization of the artery (TICI ≤ 1). The highest percentage of recanalized arteries were obtained by following the procedure of thrombolysis targeted – 69.24% (TICI ≥ 2b). In the case of mechanical thrombectomy total patency (TICI ≥ 2b) was 54.55%. The average duration of treatment (operation) is 157 min. After 30 days successful result of the neurological status was achieved in 57.14% of patients ( n = 8). Full return to independent functioning as defined within 3 months after the surgery (mRS ≤ 2) reached 57.14% of patients ( n = 8). Conclusion Studies suggest that endovascular techniques are effective and safe in the treatment of ischemic stroke. Greater efficiency is characterized by intraarterial thrombolysis. Patients who were treated endovascular improved significantly.

Occlusion of the basilar artery (BAO) is a rare cause of stroke, making up approximately 1% of all cases. Ischemic stroke within the basilar artery is associated with serious complications and high mortality (75-91%). BAO may occur initially in the form of mild prodromal symptoms with neurological disorders, the consequences of which can lead to death. For these reasons, BAO requires rapid diagnosis and treatment. We report the case of a 26-year-old man who suffered basilar artery occlusion and was treated with endovascular therapy. The patient was disqualified from intra-venous thrombolysis and endovascular treatment due to exceeding the therapeutic time window. Despite this, due to the location of ischemia and age of the patient, it was decided to proceed with a mechanical thrombectomy (TM). Vessel patency was restored using the Solitaire FR stent. Treatment continued with antiplatelet therapy. Despite a significant overshoot of the time window the procedure was successful and complete recanalization was achieved. During hospitalization, significant neurological symptom reductions were observed. There is no accurate data on which method of treatment of ischemic stroke is best for BAO. Expectations about the effectiveness of endovascular techniques are high.

Atresias of nasal cavity, especially in young children, pose an essential problem in children’s otolaryngology. Only a few morphometric studies of nasal cavity concerning healthy neonates and young infants without nasal stenosis are available. Multislice computed tomography is a perfect tool enabling a precise evaluation of anatomic structures. The aim of this study was a complex morphometric evaluation of clinically important bone and mucosal structures of nasal cavity and examination of their dependence on age and sex in children up to 3 years of age. 180 children, age range 0–3 years, were divided into 5 age groups, and measurements of 18 distances between skeletal structures and between mucosal structures of nasal cavity were performed on their CT scans. A correlation between the widths of selected bone structures was examined. There were no statistically significant differences in analyzed morphometric parameters between adjacent age groups. The differences were statistically significant only between extreme age groups. There was a correlation between evaluated structures and age. Our results are a valuable supplement of nasal cavity morphometric data of young children. They may be useful in setting reference values of evaluated parameters in children and in diagnosis and planning of surgical treatment in children’s otolaryngology.

The article entitled Perihepatic lymphadenopathy in children with chronic viral hepatitis(1) is an original paper of high clinical relevance – viral hepatitis B and C are the main causes of chronic hepatitis and liver cirrhosis in children. Based on ultrasound findings, the authors assessed the presence of the perihepatic lymph nodes and their morphology in 49 children with chronic viral hepatitis B and C (38 and 11 children, respectively). The authors hoped that this investigation would help establish a new, non-invasive marker enabling screening examinations to be conducted in children with chronic viral hepatitis. In adults, a correlation was found between the activity of hepatitis and the morphology of the lymph nodes in a US examination, but such a correlation has, until now, not been reported in children(2–4). The results of the study have a clinically significant aspect – the loops of the hepatoduodenal ligament are relatively readily available in a transabdominal examination, and ultrasonography is an inexpensive and safe method to be conducted in children. The authors assumed that the lymph nodes with the size of over 14 mm in the long axis were pathologically enlarged. In a US examination, such nodes were visualized in 70% of children with viral hepatitis and in 11% of healthy children. Based on the studies conducted, it was concluded that the general volume of the perihepatic lymph nodes is greater in children with chronic hepatitis in a statistically significant way (p < 0.05), compared to healthy children: 1.0 ± 1.2 mL (0.1–5.4 mL) vs 0.1 ± 0.1 mL (0.0–0.4 mL). Ultrasonography demonstrated a moderate level of sensitivity (70%) and NPV (75%), and considerable specificity (89%) and PPV (86%) in detecting enlarged perihepatic lymph nodes in children with chronic viral hepatitis. Enlarged lymph nodes of the hepatoduodenal ligament were present in patients with both chronic hepatitis B and C. There were no significant differences in the sensitivity and specificity levels of ultrasonography between the two types of hepatitis (hepatitis B: sensitivity 69%, specificity 89%; hepatitis C: sensitivity 70%, specificity 89%), but the method was characterized by superior accuracy in confirming hepatitis B (PPV 83%) compared to hepatitis C (PPV merely 58%). However, ruling out chronic viral hepatitis based on US findings was much more accurate in children with hepatitis C than in children with hepatitis B (NPV 93% vs 79%). The article summarized above is a very good example of research methodology, particularly for young scientists. The design is exemplary: the study is prospective, randomized; the inclusion and exclusion criteria are clearly specified. The methods involve the principles of so-called good clinical practice. The accurate assessment of the repeatability of size and volume measurements in a US examination must be emphasized. The evidence for a high repeatability of the measurements is an additional argument for including the perihepatic lymph node assessment into everyday clinical practice involving the treatment of children with chronic viral hepatitis B and C. In the Discussion, the authors prove how innovative their results are and indicate the path for further research – the possibility of monitoring the therapy of chronic viral hepatitis using size measurements of the perihepatic lymph nodes. Moreover, the authors also mention other methods enabling perihepatic lymph node imaging, such as CT and MRI. However, the argument concerning limited possibilities of the lymph node reconstruction in the age of multi-slice CT seems unconvincing. Furthermore, the methods of conducting US examinations applied by the authors seem lacking: the authors used a 3.5 MHz transducer in all patients irrespective of their age (1–17). Yet our experience and literature guidelines suggest that probes of higher frequency should be used for the assessment of visceral lymph nodes in younger children. The results of the measurements of the size and volume of the perihepatic lymph nodes in children with chronic viral hepatitis also raise questions regarding their accurate assessment (configuration of the hilum, blood supply and direction of flow) as well as a possible relationship of these features with the activity of the disease. Further investigations should continue the issues started in this article.

The aim of the study was to assess coronary arteries arising from the wrong coronary sinus, including CT-evaluated high-risk anatomic features, clinical symptoms and cardiac events during follow-up. A total of 7,115 patients scheduled for 64-slice or dual-source cardiac CT were screened for the presence of isolated anomalous origin of the coronary artery from the wrong coronary sinus. Anomalous origin of the coronary artery was found in 54 (0.76 %) patients (29 men, 25 women, mean age 60.9 ± 11.6 years). Sixteen (30 %) patients with abnormal right coronary origin (ARCA) more commonly had a slit-like orifice (15 vs. 3; p

Pulmonary complications during standard therapy of chronic hepatitis C with pegylated interferon and ribavirin are rare but connected with wide spectrum of diseases from sarcoidosis to interstitial pneumonitis. The clinical course of that complications is often serious. In this paper, presentation of two patients with chronic hepatitis C with different anamnesis was shown. In the first case, without pulmonary burden, during therapy the features of pneumonitis were developed. In the second case, in patient with sarcoidosis, the antiviral therapy was carried out without important pulmonary aggravation. In reference to these observations and based on available literature, the pathogenetic mechanisms underlying pulmonary complications during this kind of therapy were discussed. Additionally, the scheme of pulmonary diagnostic proceeding in patients certified and then treated with peginterferon and ribawirin was proposed.