Congenital vascular malformations in scintigraphic evaluation.

BACKGROUND: Congenital vascular malformations are tumour-like, non-neoplastic lesions caused by disorders of vascular tissue morphogenesis. They are characterised by a normal cell replacement cycle throughout all growth phases and do not undergo spontaneous involution. Here we present a scintigraphic image of familial congenital vascular malformations in two sisters. MATERIAL/METHODS: A 17-years-old young woman with a history of multiple hospitalisations for foci of vascular anomalies appearing progressively in the upper and lower right limbs, chest wall and spleen. A Parkes Weber syndrome was diagnosed based on the clinical picture. Due to the occurrence of new foci of malformations, a whole-body scintigraphic examination was performed. A 12-years-old girl reported a lump in the right lower limb present for approximately 2 years, which was clinically identified as a vascular lesion in the area of calcaneus and talus. Phleboscintigraphy visualized normal radiomarker outflow from the feet via the deep venous system, also observed in the superficial venous system once the tourniquets were released. In static and whole-body examinations vascular malformations were visualised in the area of the medial cuneiform, navicular and talus bones of the left foot, as well as in the projection of right calcaneus and above the right talocrural joint. CONCLUSIONS: People with undiagnosed disorders related to the presence of vascular malformations should undergo periodic follow-up to identify lesions that may be the cause of potentially serious complications and to assess the results of treatment. Presented scintigraphic methods may be used for both diagnosing and monitoring of disease progression.

DSA volumetric 3D reconstructions of intracranial aneurysms: A pictorial essay.

A gold standard of cerebral vessel imaging remains the digital subtraction angiography (DSA) performed in three projections. However, in specific clinical cases, many additional projections are required, or a complete visualization of a lesion may even be impossible with 2D angiography. Three-dimensional (3D) reconstructions of rotational angiography were reported to improve the performance of DSA significantly. In this pictorial essay, specific applications of this technique are presented in the management of intracranial aneurysms, including: preoperative aneurysm evaluation, intraoperative imaging, and follow-up. Volumetric reconstructions of 3D DSA are a valuable tool for cerebral vessels imaging. They play a vital role in the assessment of intracranial aneurysms, especially in evaluation of the aneurysm neck and the aneurysm recanalization.

Pneumatosis cystoides interstitialis: A complication of graft-versus-host disease. A report of two cases.

BACKGROUND: Pneumatosis cystoides intestinalis (PCI) is a rare disorder characterized by the presence of multiple gas collections in the subserosal or submucosal intestinal wall of the large or small intestine. We report two cases of PCI in the course of chronic graft-versus-host disease. CASE REPORT: A 5-year-old girl was treated for acute lymphoblastic leukemia. Twenty-four months after the hematopoietic stem cell transplantation, in the course of graft-versus-host disease, she developed subcutaneous emphysema of the right inguinal and pudendal region. PCI was diagnosed based on a CT examination. A 3-year-old boy was treated for juvenile myelomonocytic leukemia. Fourteen months after the hematopoietic stem cell transplantation he presented with an increased severity of intestinal symptoms, including intermittent bleeding from large intestine. PCI was diagnosed based on a CT exam and was confirmed by a colonoscopy. CONCLUSIONS: Pneumatosis cystoides interstitialis in the course of chronic graft-versus-host disease has a heterogeneous clinical presentation that does not correlate with results of imaging. CT is a method of choice to diagnose PCI. In patients with PCI, the presence of free air in the peritoneal cavity does not confirm an intestinal perforation.

Comparison of remnant size in embolized intracranial aneurysms measured at follow-up with DSA and MRA.

INTRODUCTION: The possibility of recanalization and the need for retreatment are the most important limitations of intracranial aneurysm embolization. The purpose of the study was to compare the size of aneurysm remnants measured at follow-up with three-dimensional digital subtracted angiography (3D-DSA) and magnetic resonance angiography (MRA). METHODS: Twenty-six aneurysms were found incompletely occluded in 72 consecutively examined patients at a follow-up after 3 months. The diameters and volume of aneurysm remnants were compared between 3D-DSA, time-of-flight MRA (TOF-MRA), contrast-enhanced TOF-MRA (CE-TOF-MRA), and contrast-enhanced MRA (CE-MRA) at 1.5 T. RESULTS: There was a significant correlation between remnant volumes calculated based on 3D-DSA and all MRA modalities. The intraobserver variability of the measurements ranged from 3.4 to 4.1 % and the interobserver variability from 5.8 to 7.3 %. There were no significant differences in the variability between the techniques. The mean residual filling volume ranged from 16.3 ± 19.0 mm(3) in TOF-MRA to 30.5 ± 44.6 mm(3) in 3D-DSA (P < 0.04). Significant differences were found in the volumes measured with 3D-DSA and CE-MRA as compared to TOF-MRA and CE-TOF-MRA (P < 0.01). There was a moderate significant correlation between the residual filling and the relative error of measurement in the case of TOF-MRA and CE-TOF-MRA. CONCLUSIONS: TOF-MRA seems to underestimate the size of aneurysm remnants detected at follow-up and should not be used as a sole imaging method to decide on re-embolization.

Time-resolved imaging of contrast kinetics does not improve performance of follow-up MRA of embolized intracranial aneurysms.

BACKGROUND: The use of contrast media and the time-resolved imaging of contrast kinetics (TRICKS) technique have some theoretical advantages over time-of-flight magnetic resonance angiography (TOF-MRA) in the follow-up of intracranial aneurysms after endovascular treatment. We prospectively compared the diagnostic performance of TRICKS and TOF-MRA with digital subtracted angiography (DSA) in the assessment of occlusion of embolized aneurysms. MATERIAL/METHODS: Seventy-two consecutive patients with 72 aneurysms were examined 3 months after embolization. Test characteristics of TOF-MRA and TRICKS were calculated for the detection of residual flow. The results of quantification of flow were compared with weighted kappa. Intraobserver and interobserver reproducibility was determined. RESULTS: The sensitivity of TOF-MRA was 85% (95% CI, 65-96%) and of TRICKS, 89% (95% CI, 70-97%). The specificity of both methods was 91% (95% CI, 79-98%). The accuracy of the flow quantification ranged from 0.76 (TOF-MRA) to 0.83 (TRICKS). There was no significant difference between the methods in the area under the ROC curve regarding both the detection and the quantification of flow. Intraobserver reproducibility was very good with both techniques (kappa, 0.86-0.89). The interobserver reproducibility was moderate for TOF-MRA and very good for TRICKS (kappa, 0.74-0.80). CONCLUSIONS: In this study, TOF-MRA and TRICKS presented similar diagnostic performance; therefore, the use of time-resolved contrast-enhanced MRA is not justified in the follow-up of embolized aneurysms.

Follow-up after embolization of ruptured intracranial aneurysms: a prospective comparison of two-dimensional digital subtraction angiography, three-dimensional digital subtraction angiography, and time-of-flight magnetic resonance angiography.

INTRODUCTION: To prospectively compare of the diagnostic value of digital subtraction angiography (DSA) and time-of-flight magnetic resonance angiography (TOF-MRA) in the follow-up of intracranial aneurysms after endovascular treatment. METHODS: Seventy-two consecutive patients were examined 3 months after the embolization. The index tests included: two-dimensional DSA (2D-DSA), three-dimensional DSA (3D-DSA), and TOF-MRA. The reference test was a retrospective consensus between 2D-DSA images, 3D-DSA images, and source rotational DSA images. The evaluation included: detection of the residual flow, quantification of the flow, and validity of the decision regarding retreatment. Intraobserver agreement and interobserver agreement were determined. RESULTS: The sensitivity and specificity of residual flow detection ranged from 84.6 % (2D-DSA and TOF-MRA) to 92.3 % (3D-DSA) and from 91.3 % (TOF-MRA) to 97.8 % (3D-DSA), respectively. The accuracy of occlusion degree evaluation ranged from 0.78 (2D-DSA) to 0.92 (3D-DSA, Cohen's kappa). The 2D-DSA method presented lower performance in the decision on retreatment than 3D-DSA (P < 0.05, ROC analysis). The intraobserver agreement was very good for all techniques (κ = 0.80-0.97). The interobserver agreement was moderate for TOF-MRA and very good for 2D-DSA and 3D-DSA (κ = 0.72-0.94). CONCLUSION: Considering the invasiveness of DSA and the minor difference in the diagnostic performance between 3D-DSA and TOF-MRA, the latter method should be the first-line modality for follow-up after aneurysm embolization.

Comparison of calcium scoring with 4-multidetector computed tomography (4-MDCT) and 64-MDCT: a phantom study.

OBJECTIVE: To determine differences in coronary artery calcium (CAC) measurement performed with the use of 2 generations of multidetector computed tomography (CT) scanners of the same manufacturer. METHODS: Agatston Score (AS) and calcium mass (CM) were measured with a 4-row scanner (AS4 and CM4) and a 64-row scanner (AS64 and CM64) using a cardiac phantom with calcium inserts. RESULTS: The results of the AS measurements (mean ± SD) varied significantly between the equipment: 880.6 ± 30.1 (AS4) vs 586.5 ± 24.0 (AS64; P < 0.0001). The AS interscanner variability was 31.6% for the phantom and from 25.5% to 110.1% for particular inserts. Mean ± SD CM values were different as well: 192.8 ± 5.0 mg (CM4) vs 152.4 ± 2.6 mg (CM64; P < 0.0001). Determination of CM with 64-row CT was more accurate than that with an older scanner; the mean relative error was -9.1% and 15.0%, respectively (P < 0.0001). The CM interscanner variability was 23.3% for the phantom and from 19.0% to 122.8% for particular inserts. The interexamination variability ranged from 1.7% (CM64) to 5.6% (AS4). CONCLUSIONS: Coronary artery calcium scoring with the 64-row CT scanner is more accurate than with the 4-row device The difference between the results of AS and CM measurements carried out with both scanners is statistically significant.

Methods and time schedule for follow-up of intracranial aneurysms treated with endovascular embolization: a systematic review.

BACKGROUND AND PURPOSE: To review the diagnostic value of angiographic methods and the optimal timetable for follow-up imaging of patients after endovascular treatment of intracranial aneurysms. MATERIAL AND METHODS: A comprehensive computer-aided search for relevant primary papers was performed using the MEDLINE, PubMed, Embase, and Cochrane Collaboration database from January 1991 to March 2011. Original papers were included that reported either diagnostic value of angiographic modalities for follow-up vs. digital subtracted angiography (DSA) or comparison of aneurysm occlusion rate in delayed vs. early follow-up. RESULTS: The systematic review identified 35 relevant studies: 3 on the diagnostic value of three-dimensional (3D) DSA, 30 on the performance of magnetic resonance angiography (MRA), and 3 on time schedules for follow-up. 3D DSA had sensitivity of 100%, and specificity of 58.3-94.7%. Magnetic resonance angiography had sensitivity of 28.4-100%, and specificity of 50.0-100%. The proportion of aneurysms that recanalized between the early follow-up examination at 6 months and the delayed imaging at 1.5-6.0 years was 0-2.5%. CONCLUSIONS: Magnetic resonance angiography seems to be the best imaging method for the follow-up. In selected cases, when invasive angiography is necessary, 3D DSA should be considered to improve the diagnostic accuracy. Most patients who present with stable and adequate aneurysm occlusion at 6 months after coiling may not require further follow-up. Key words: intracranial aneurysm, embolization, coils, digital subtracted angiography, magnetic resonance, computed tomography.

High incidence of nephropathy in neurosurgical patients after intra-arterial administration of low-osmolar and iso-osmolar contrast media.

BACKGROUND: Percutaneous endovascular examinations and interventions require significant amounts of iodinated contrast media (CM) and have been reported to be complicated by an increased incidence of post-contrast nephropathy. PURPOSE: To evaluate renal function, the incidence of post-contrast nephropathy, and risk factors after interventional procedures in neurosurgical patients after intra-arterial administration of a low-osmolar contrast medium (LOCM) versus an iso-osmolar contrast medium (IOCM). MATERIAL AND METHODS: This single-center, prospective, randomized, double-blinded study included 92 patients in its final analysis (mean age 49.6 ± 12.6 years, 29.3% men, mean eGFR 97.8 ± 26.3 mL/min/1.73 m(2)). LOCM was used in 48 patients (52.2%) and IOCM in 44 patients (47.8%). The patients were given an average of 151.2 ± 52.1 mL of contrast medium intra-arterially. Serum creatinine (SCr), urinary N-acetyl-ß-glucosaminidase (NAG) excretion, and creatinine clearance (CCr) were measured at baseline, and on days 1 and 3 after the procedure. RESULTS: Baseline risk factors, renal functional parameters, and average CM doses were not statistically different between the two groups. SCr, NAG, and CCr values did not differ significantly between the LOCM and IOCM groups on days 1 and 3 after CM administration. Nephropathy developed in 21 cases (22.8%): 13 (27.1%) after LOCM use and 8 (18.2%) after IOCM; (P = NS). The only significant risk factors of CIN were the diabetes (P = 0.0466) and atherosclerosis (P = 0.0498). CONCLUSION: We found a high incidence of nephropathy in neurosurgical patients after intra-arterial CM administration. The renal function values and incidence of nephropathy following LOCM administration were not statistically different from those following IOCM administration.

CT imaging of aortic intramural hematoma: Report of two cases, and review of literature.

Aortic intramural hematoma (IMH) is a relatively rare, but potentially fatal pathology, which is most commonly diagnosed under emergency conditions with computed tomography angiography (CTA). We present two cases of IMH examined with different CTA protocols, which resulted in diverse diagnoses.In the first patient, contrast-enhanced CTA revealed dilatation of thoracic aorta and polymorphic wall thickening. It was misdiagnosed as being a mural thrombus and was complicated by acute dissection. In the second patient, non-enhanced CT revealed hyperdense aortic wall thickening. The patient was diagnosed as having type B IMH but he died due to aortic rupture.In our opinion, CT examination of the aorta in emergency cases should always include non-enhanced scanning. Any delay in proper diagnosis and treatment of IMH may result in serious complications.

Pancreaticopleural fistulas of different origin: Report of two cases and a review of literature.

BACKGROUND: Pancreaticopleural fistula (PPF), a form of internal pancreatic fistula, is a rare complication of acute or chronic pancreatitis or pancreatic trauma. CASE REPORT: We report two cases of PPF resulting in formation of pleural pancreatic pseudocysts. A 35-year-old male alcoholic patient with a history of recurrent episodes of acute pancreatitis was admitted due to a severe dyspnea. A CT scan showed a significant left pleural effusion with a total left lung atelectasis, compression of the mediastinum, and dislocation of the left diaphragm. A follow-up CT showed a fistula between the abdominal pancreatic pseudocyst and the left pleural cavity. The second case was a 13-year-old male patient, who was admitted for a splenic stump excision. Two weeks after the surgery the patient presented a massive pleural amylase-rich effusion. CT exam suggested a PPF, which was indirectly confirmed by a thoracoscopy. CONCLUSIONS: PPF should be considered in cases of massive pleural effusion and encapsulated pleural fluid collections in patients with a history of acute pancreatitis and surgery involving pancreas.

Single photon emission computed tomography in pulmonary embolism - estimation of selected, scintigraphic regions of interests.

BACKGROUND: Pulmonary embolism is considered dangerous form of thrombo-embolic venous disease contracted by 25000 people annually with around 30% deaths. Accurate diagnosis of the disease and treatment could reduce mortality rate by several per cent. Discernment of ailment is obstructed by variety of clinical picture. Suspicion of pulmonary embolism is verified by diagnostic patterns, among which SPECT is used as well. Aim of this study was to prove perfusion scintigraphy with use of SPECT evaluated together with radiological examinations of chest could be efficient method of pulmonary embolism diagnosis. MATERIAL/METHODS: SPECT of lungs was performed in 92 patients, examinations were compared to X-ray scans of chest and in 13 cases to computer tomography. Regions of interest in symmetric zones of chest were also traced in order to evaluate differences radiotracer accumulation. RESULTS: Pulmonary embolism was diagnosed by means of SPECT in 59 patients (64.1%). Radiological examinations allowed to exclude other causes of decreased pulmonary perfusion. CONCLUSIONS: Difference over 10% in radiotracer accumulation in symmetric zones among patients with pulmonary embolism was stated in 42 patients, 5-10% - in 15,under 5% - in 2. Drawing symmetric regions of interest all over lungs indicates essential points of decreased perfusion whereas difference in radiotracer accumulation is greater than 10%.

A single photon emission computed tomography of the chest with the use of receptor radiotracer (Tc-99m-Depreotide) in sarcoidosis.

BACKGROUND: Sarcoidosis is a systemic and multiorgan disease with unknown etiopathogenesis. Granulomas that do not undergo necrosis and caseous degeneration are distinctive for this disease. Mostly it is connected with young adults, more frequently females than males, and changes are mainly situated in the lymph nodes of the pulmonary hilus and pulmonary parenchyma. Somatotropin release inhibiting hormone receptors could be located in epithelioid and giant cells that create sarcoidal tubercles and lymph nodes. Aim of the study was to determine the usefulness of a single photon emission tomography (SPECT) for an evaluation of the range of sarcoidal changes in the chest after using a receptor tracer. An assumption was made that scintigraphy with the use of Tc-99m-Depreotide could help with location of extrapulmonary sarcoidosis focuses. MATERIAL/METHODS: Authors present five patients with clinically recognized and histopathologically confirmed sarcoidosis. Patients were given Tc-99m-Depreotide and underwent SPECT of chest. The results were compared with X-rays of these patients chests and with the accumulation of radiotracer in 2 other patients with carcinoid syndrome without visible pathological changes in examination. Patients got an intravenous injection of 500 MBq (14mCi) Tc-99m-Depreotide. SPECT of chest together with a "whole body" examination, was performed after 2 hours and 24 hours. RESULTS: Higher radiotracer accumulation was observed in all patients in the area of some chest lymph nodes, in pulmonary tissue in 3 patients and in other groups of lymph nodes in 2 patients. CONCLUSIONS: Emission Tomography of the chest with the use of receptor radiotracer (Tc-99m-Depreotide) can be a crucial complement of sarcoidosis diagnostics in an evaluation of the extent of lung changes together with an estimation of chest lymph nodes abnormalities.

Coronary artery calcifications in renal graft recipients at the time of transplantation.

BACKGROUND: Coronary artery calcifications (CACs) represent an important risk factor of coronary artery disease in the general population. The purpose of the study was to determine the amount of CAC, including calcium mass, in renal graft recipients early after transplantation. MATERIAL/METHODS: Forty-nine patients aged 43.7+/-9.8 years underwent CAC determination with multi-detector row computed tomography within two weeks after transplantation. The calcium scores were compared with the clinical and laboratory data of the subjects. RESULTS: CACs were detected in 73% of the subjects. The mean calcium score (CS) was 500.8+/-1100.4 and the mean calcium mass (CM) 127.0+/-228.6 mg. Presence of diabetes, duration of hypertension, and diastolic blood pressure (DBP) were significantly associated with the presence of CAC in univariate analysis. CS and CM positively correlated with duration of hypertension, time on dialysis, and pulse pressure (PP) and negatively with DBP. In multiple regression analysis the duration of hypertension, DBP, and PP were identified as independent predictors of CAC presence (p<0.01), while the time on dialysis and DBP were independent predictors of CAC severity (p<0.02). CONCLUSIONS: The results suggest that hypertension may play a crucial role in the development of coronary artery calcifications in end-stage renal disease patients, but the nature of the relation between CAC and blood pressure needs further investigation.

Palliative percutaneous kidney embolization with enbucrilate in patients with renal cell carcinoma: safety and symptom control.

BACKGROUND: Primarily palliative renal embolization is a relatively rare procedure which is indicated in patients with unresectable kidney malignancies and in patients in poor general condition. The aim of this paper was to evaluate the role of primarily palliative transarterial renal embolization for the treatment of inoperable patients with renal cell carcinoma, assessing the indications, safety, and efficacy of this procedure. MATERIAL/METHODS: Seventy-three patients scheduled for palliative embolization between 1998 and 2005 were retrospectively analyzed regarding their medical history, the procedure report, and data from the early postoperative period. RESULTS: Sixty-six of the 73 patients presented with renal cell carcinoma stage IV. The most common indication for embolization was hematuria (34%), followed by flank pain (32%), prophylaxis in stage IV (25%), lack of consent for surgery (7%), and poor general condition (3%). Embolizations were performed under local anesthesia with a mixture of enbucrilate and iodinated oil, with the use of additional embolizing materials in two cases. The procedure eliminated hematuria in 100% of cases and removed the loin pain completely in 72%. Migration of the embolizing material was observed in 10% of cases, and in 4% it resulted in symptomatic occlusion of the lower extremity distal arteries. Postembolic syndrome was noted in 92% of the patients CONCLUSIONS: Percutaneous palliative embolization with enbucrilate is a safe and effective method of treating patients with unresectable renal cell carcinoma. The potential effect of the embolization on cancer progression and improvement of survival in these patients still requires prospective investigation.

[Cardiovascular system in patients in different stages of chronic kidney disease]. / Stan ukladu sercowo-naczyniowego u pacjentów w róznych stadiach przewleklej choroby nerek.

The term "chronic kidney disease" (CKD) was introduced recently to nephrological literature. CKD is a growing epidemic problem, which affects 11% of adult US population. CKD, particularly with GFR below 60 ml/min/1, 73 m2 is associated with increased risk of cardiovascular morbidity and mortality. It is a result of coexistance of "traditional" cardiovascular risk factors cumulation such as hypertension, lipid and carbohydrate disorders but also "non-traditional" cardiovascular risk factors such as: anemia, calcium-phosphate metabolism disturbances, chronic inflammation and others. The paper discusses changes in left ventricle structure and function, arterial structure and function and cardiovascular calcifications in different stages of chronic kidney disease, and their prognostic significance. Result of the study in 31 CKD patients (GFR 39,4 +/- 14, 1 ml/min/m2) and 18 appearently healthy controls are also presented in the paper. Cardiovascular risk factors assessment, echocardiography, common carotid artery USG with diameter and intima-media thickness (IMT) measurement and aortic pulse wave velocity (PWV) measurement were performed in all participants. We found higher total cholersterol, LDL-cholesterol, triglicerides, CRP, advanced glycation end-products (AGE), and calcium x phosphorus product and lower hemoglobin concentration in CKD patients. Fasting glucose and insulin concentration did not differ between CKD patients and control group but insulin/glucose ratio was higher in CKD group. Abnormal left ventricular heart structure was found in 55% of CKD patients. Carotid artery internal diameter, intima-media thickness and aortic PWV--a marker of increased arterial stiffness - were higher in CKD patients. The study indicates that cardiovascular risk factors and cardiac and arterial abnormalities should be evaluated from the start of CKD.

Calcified fibromatosis of the neck in 4-year old girl: rapid growth, rapid therapy.

Fibromatosis is a rare soft tissue disease typical for infants and characterized by fibroblastic proliferation, which may appear similar to fibrosarcoma. An unusual case of 4-year old girl presenting large tumor of the neck with massive calcification is described. The growth of the tumor was rapid and mediastinal involvement was observed. The final diagnosis showed benign nature of tumor with microscopic features of fibromatosis calcificans. After surgical resection of neck tumor, residual mass persisted both in the neck and in the mediastinum in 6 years of follow-up without signs of progression.

[The role of preoperative hooked-wire localization of occult lesions for early detection of breast cancer]. / Rola przedoperacyjnego znakowania zmian niepalpacyjnych dla wczesnego wykrywania raka sutka.

OBJECTIVES: Nonpalpable small lesions, usually few millimeters in diameter, consist an important problem in the early diagnostics of breast cancer. DESIGN: An aim of this paper was an evaluation of usefulness of preoperative hooked-wire localization of such lesions for the detection of breast cancer. MATERIALS AND METHODS: Material consisted of 131 patients aged 37-77 in whom 132 procedures of preoperative hooked-wire localization were performed. The correlation between the mammographic findings and the cytologic or histologic results were then evaluated, with the histologic results being treated as standard. RESULTS: Histologic examination of the localized lesions revealed benign changes in 71.2%, atypical ductal hyperplasia in 4.6% and cancer in 24.2%. Positive predictive value for mammography was 24%. Significant correlation was seen between the suspicion of cancer in mammography and the histologic results. CONCLUSIONS: Preoperative localization should be used as a method of choice in radial lesions, suspected clustered microcalcifications and after the positive result from SFAB.

Ultrasound examination in arthropathia humeroscapularis.

This article discusses the diagnostic potential of ultrasonography in a common clinical condition: periarthropathia humeroscapularis. The authors describe pathologies of the rotatory cuff, the tendon of the long head of humeral biceps, the bursa subacromialis, and the articular capsule. The advantages of ultrasonography are emphasized, such as its noninvasiveness, the possibility of performing dynamic examination, and general accessibility. The authors describe pathological changes, such as tendinitis, tenosynovitis, bursitis, tendinitis calcarea, tendinosis, degenerative changes, and partial and complete tear of the tendon. Impingement syndrome and dialysis- related amyloidosis of the shoulder are separately discussed.

[Transvaginal ultrasonography and sonohysterography in the diagnosis of benign uterine lesions in women at peri- and postmenopausal age]. / Przydatnosc endosonografii dopochwowej i sonohisterografii w diagnostyce lagodnych zmian macicy u kobiet w wieku okolo- i pomenopauzalnym.

Abnormal uterine bleeding is important clinical problem in women at peri- and postmenopausal age. It may be caused by the lesions located in endometrium or in deeper uterine wall layers. An aim of this paper was a comparison of transvaginal sonography (TVS) vs. sonohysterography (SIS) in the diagnostics of endometrial polyps, endometrial hyperplasia as well as uterine myomas. Also the results of the sonographic imaging were compared to those of pathologic examination of the specimens taken from the uterine cavity. The material consisted of 100 women aged 40-80 with an irregular menstruation. All of the patients were examined gynecologically, and then the transvaginal sonography, sonohysterography and the curettage of the uterine cavity were performed. Sensitivity of TVS was 43% in endometrial polyps, 77% in endometrial hyperplasia and 69% in uterine myomas imaging. Introduction of SIS increased the sensitivity to 94%, 82%, and 95%, respectively. Specificity was similar in both techniques except endometrial hyperplasia (TVS--68%, SIS--91%). Diagnostic accuracy also improved with the SIS use reaching 93% for polyps, 89% for hyperplasia and 98% for myomas imaging. Our results show higher sensitivity and accuracy of SIS in the diagnostic of benign uterine lesions.