Contrast-Enhanced Ultrasound in the Diagnosis of Solid Renal Lesions.

The availability of imaging methods has enabled increased detection of kidney lesions, which are a common clinical problem. It is estimated that more than half of patients over the age of 50 have at least one undetermined mass in the kidney. The appropriate characterization and diagnosis of lesions imaged in the kidney allows for proper therapeutic management. Previously, contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) have been used in their extended diagnosis. However, the limitations of these techniques, such as radiation exposure, renal toxicity, and allergies to contrast agents, must be considered. Contrast-enhanced ultrasound (CEUS) is increasingly being used as an examination to resolve interpretive doubts that arise with other diagnostic methods. Indeed, it can be considered both as a problem-solving technique for diagnosing and distinguishing lesions and as a technique used for observation in preservative treatment. Evaluation of the enhancement curve over time on CEUS examination can help to differentiate malignant renal cell carcinoma (RCC) subtypes that should be resected from benign lesions, such as oncocytoma or angiomyolipoma (AML), in which surgery can be avoided. It allows for distinguishing between benign and malignant tumors, renal and pseudotumors, and solid and cystic tumors. Therefore, with recent advances in ultrasound technology, CEUS has emerged as a fast, reliable, and cost-effective imaging tool in the preoperative evaluation and diagnosis of solid renal masses.

Contrast-Enhanced Ultrasound Feasibility in Assessing Carotid Plaque Vulnerability-Narrative Review.

The risk assessment for carotid atherosclerotic lesions involves not only determining the degree of stenosis but also plaque morphology and its composition. Recently, carotid contrast-enhanced ultrasound (CEUS) has gained importance for evaluating vulnerable plaques. This review explores CEUS's utility in detecting carotid plaque surface irregularities and ulcerations as well as intraplaque neovascularization and its alignment with histology. Initial indications suggest that CEUS might have the potential to anticipate cerebrovascular incidents. Nevertheless, there is a need for extensive, multicenter prospective studies that explore the relationships between CEUS observations and patient clinical outcomes in cases of carotid atherosclerotic disease.

Ischemic and Hemorrhagic Cerebrovascular Events Related to COVID-19 Coagulopathy and Hypoxemia.

Since the very beginning of the COVID-19 pandemic, numerous researchers have made an effort to determine the molecular composition of the SARS-CoV-2 virus, and the exact pathomechanism through which the virus exerts such a devastating effect on the host/infected organism. Recent scientific evidence highlights the affinity of the virus towards ACE2 receptors, which are widespread in multiple human systems, including the central nervous system (CNS) and cerebral vessels. Such an affinity may explain endothelial dysfunction and damage that is observed in COVID-positive patients in histopathological studies, with subsequent dysregulation of the cerebral circulation leading to transient or acute cerebrovascular accidents. In this paper, we aimed to evaluate the effects of COVID-related hypoxemia and direct viral invasion on the cerebral circulation, with special respect to the postulated pathomechanism, vulnerable groups of patients, clinical course and outcomes, as well as diagnostic imaging findings.

Functional Magnetic Resonance Imaging and Obesity-Novel Ways to Seen the Unseen.

Obesity remains a pandemic of the 21st century. While there are many causes of obesity and potential treatments that are currently known, source data indicate that the number of patients is constantly increasing. Neural mechanisms have become the subject of research and there has been an introduction of functional magnetic resonance imaging in obesity-associated altered neural signaling. Functional magnetic resonance imaging has been established as the gold standard in the assessment of neuronal functions related to nutrition. Thanks to this, it has become possible to delineate those regions of the brain that show altered activity in obese individuals. An integrative review of the literature was conducted using the keywords ""functional neuroimaging" OR "functional magnetic resonance "OR "fmri" and "obesity" and "reward circuit and obesity" in PubMed and Google Scholar databases from 2017 through May 2022. Results in English and using functional magnetic resonance imaging to evaluate brain response to diet and food images were identified. The results from functional magnetic resonance imaging may help to identify relationships between neuronal mechanisms and causes of obesity. Furthermore, they may provide a substrate for etiology-based treatment and provide new opportunities for the development of obesity pharmacotherapy.

Chronic Appendicitis-From Ambiguous Clinical Image to Inconclusive Imaging Studies.

A six-year-old boy visits a general practitioner due to diarrhea and abdominal pain with a moderate fever of up to 39 °C for 2 days. Treatment is initiated; however, the recurrence of abdominal pain is observed. Physical examination of the child at the emergency department reveals abdominal guarding and visible, palpable, painful intestinal loops in the left iliac and hypogastric regions-this is referred to as an 'acute abdomen'. An X-ray shows single levels of air and fluid indicative of bowel obstruction. Ultrasound reveals distended, fluid-filled intestinal loops with diminished motility. The intestinal wall is swollen. Laboratory tests indicate increased inflammatory indices. Contrast-enhanced computed tomography examination of the abdominal cavity and lesser pelvis shows intestinal dilation. The loops were filled with liquid content and numerous collections of gas. The patient is qualified for a laparotomy. An intraoperative diagnosis of perforated gangrenous appendicitis with autoamputation was made. In addition, numerous interloop and pelvic abscesses, excessive adhesions, signs of small intestine micro-perforation, and diffuse peritonitis are found. The patient's condition and laboratory parameters significantly improve during the following days of hospitalization. Despite the implementation of multidirectional, specialized diagnostics in the case of acute abdomen, in everyday practice we still encounter situations where the final diagnosis is made intraoperatively only.

An Equivocal SCC Lesion-Antiepileptic-Induced CLOCC.

We present a case of a woman who reported to the emergency unit due to recurrent episodes of severe headache and collapse. MRI examination revealed no relevant findings apart from small meningioma of the right parietal region. The patient was diagnosed with epilepsy and received outpatient treatment, which was changed due to poor toleration. A follow-up MRI was performed which revealed an isolated, focal lesion of the splenium of the corpus callosum. The patient underwent extensive laboratory testing and antiseizure medications were started again. Another MRI indicated substantial regression of the splenium of the corpus callosum (SCC) lesion. Both the complete clinical image and results of the diagnostic evaluation spoke in favor of cytotoxicity of the corpus callosum associated with anti-epileptic drug treatment. Pathologies involving the corpus callosum include congenital, demyelination, infection, neoplasm, trauma and vascular changes. Isolated, non-specific lesions of the splenium of corpus callosum usually indicate multiple sclerosis; however, other pathologies should be considered. Anti-epileptic drugs may evoke cytotoxic lesions of the corpus callosum (CLOCCs).

Parkinson's Disease in Light of the COVID-19 Pandemic.

In this review we attempt to collate the existing scientific evidence regarding the possible role of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the pathophysiology of Parkinson's disease (PD), as well as to investigate the impact of PD/parkinsonism on the clinical course of the viral infection itself. Since etiology of PD is not completely understood, various studies suggest different potential links between coronavirus disease 2019 (COVID-19) and PD. Suggested connections include, among others, similar prodromal symptoms, renin-angiotensin-aldosterone system involvement, or gut microbiome dysbiosis participation. Despite the initial assumptions that, as a mainly elderly population suffering from rigidity of respiratory muscles, impairment of cough reflex, and dyspnea, PD patients would be more susceptible to viral infection, and would experience a more aggressive course of COVID-19, the published scientific reports contain mutually exclusive data that require further investigation and meta-analysis.

The Impact of Study Mode (Online vs. Hybrid) on Early Symptoms of Depression and Coping Strategies among University Students in Poland in Time of COVID-19 Pandemic-Preliminary Study.

INTRODUCTION: mental health has been one of the most important issues surrounding the COVID-19 pandemic; mental disorders can be exacerbated by isolation during lockdowns or online learning. The aim of this study was to analyze the relationship between non-clinical (early) symptoms of depressed moods, personality traits, and coping strategies, as well as whether the learning mode (online versus hybrid) differentiates the experiences of these early symptoms and coping strategies. METHODS: 114 university students aged 19 to 34, whose education model was changed from stationary to hybrid or online due to COVID-19 restrictions, participated in the study. The participants completed the online questionnaire, which consisted of two sections: (1) demographic questions to characterize the subjects and 44 questions based on the literature review. (2) Mini-COPE Inventory. RESULTS: the study showed that the fully online study mode has a negative impact on the mental health of students; hybrid students are more likely to use active and positive coping strategies, which effectively help to control negative thoughts and/or reduce negative mental states. CONCLUSIONS: the COVID-19 pandemic has had significant psychological effects that will extend to coming years; therefore, implementing systemic psychological care is of utmost importance.

The definitive role of CEUS in an ambiguous case of renal cell carcinoma.

Angiomyolipoma is a benign tumor consisting of abnormal vessels, smooth muscles, and fatty tissue. Renal cell carcinoma is an insidious neoplasm accounting for approximately 2% of global cancer diagnoses. Due to similar diagnostic features, the differentiation between the two types is sometimes difficult. We hereby present the case of a 60-year-old patient with no clinical symptoms and a focal lesion in the parenchymal layer of the left kidney incidentally detected on ultrasound examination. The putative diagnosis was angiomyolipoma, which was then confirmed by another ultrasound and computed tomography examinations. However, a further radiologic consultation revealed another probable diagnosis - renal cell carcinoma. Contrast-enhanced ultrasound was conducted, and the enhancement pattern was suggestive of cancer. To sum up, a thorough imaging examination plays an important role in the diagnostic work-up of neoplastic lesions in the kidney. Even then, however, the radiological image of the lesion may be misleading, so differential diagnosis is important for making a proper diagnosis.

Perianal lesions as an unusual first manifestation of Crohn's disease in pediatric patients - case series.

Primary symptoms of Crohn's disease usually include, among others, abdominal pain and cramping, recurrent diarrhea, fever and weight loss. The aim of this study was to show the effectiveness of ultrasound in the diagnosis and assessment of the extent of perianal complications in Crohn's disease. Five patients (four boys and one girl) aged from 13 to 16 years, with prolonged pain in the perianal area, which worsened when sitting, were admitted to the Department of Pediatric Gastroenterology between 2017 and 2019. Each patient underwent intestinal ultrasound with a high frequency 7-12 MHz linear probe and transperineal ultrasound to assess the anal canal and the surrounding soft tissues. In each case, the echogenicity of the bowel wall was assessed for mural stratification and possible thickening. Anorectal fistulas were detected in all the five patients. Three patients (12 y.o. male, 12 y.o. female and 16 y.o. male) presented with perianal abscesses drained by fistulas. In the first patient the fistula was limited to the perianal soft tissue (22 × 23 mm); in the second patient it was localized within the ischioanal region (40 × 50 mm); and in the third patient (5-6 mm abscess) the fistula was with a hypoechoic fistulous tract reaching the sphincter. All of the patients were eventually diagnosed with Crohn's disease as a result of further clinical workup. Ultrasound examination is a non-invasive, well-tolerated modality for the evaluation of Crohn's disease activity and its possible complications, e.g. fistulas and abscesses. Ultrasound is especially useful in patients who require repeated follow-up investigations.

Third gender - the clinical image of Morris syndrome.

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