Aluminum Nanoparticles Affect Human Platelet Function In Vitro.

Endoprostheses are prone to tribological wear and biological processes that lead to the release of particles, including aluminum nanoparticles (Al NPs). Those particles can diffuse into circulation. However, the toxic effects of NPs on platelets have not been comprehensively analyzed. The aim of our work was to investigate the impact of Al NPs on human platelet function using a novel quartz crystal microbalance with dissipation (QCM-D) methodology. Moreover, a suite of assays, including light transmission aggregometry, flow cytometry, optical microscopy and transmission electron microscopy, were utilized. All Al NPs caused a significant increase in dissipation (D) and frequency (F), indicating platelet aggregation even at the lowest tested concentration (0.5 µg/mL), except for the largest (80 nm) Al NPs. A size-dependent effect on platelet aggregation was observed for the 5-20 nm NPs and the 30-50 nm NPs, with the larger Al NPs causing smaller increases in D and F; however, this was not observed for the 20-30 nm NPs. In conclusion, our study showed that small (5-50 nm) Al NPs caused platelet aggregation, and larger (80 nm) caused a bridging-penetrating effect in entering platelets, resulting in the formation of heterologous platelet-Al NPs structures. Therefore, physicians should consider monitoring NP serum levels and platelet activation indices in patients with orthopedic implants.

Anatomy of the greater palatine foramen and canal and their clinical significance in relation to the greater palatine artery: a systematic review and meta-analysis.

PURPOSE: Accurate knowledge of greater palatine foramen (GPF) and greater palatine canal (GPC) anatomy is necessary to avoid injury to the greater palatine artery (GPA) when performing a variety of anesthesiologic, dental or surgical procedures. The aim of this paper was to perform a systematic review and meta-analysis of literature on the anatomy and localization of bony structures associated with the GPA, namely the GPF and GPC. METHODS: A systematic literature search was performed using PubMed, Embase, ScienceDirect, and Web of Science databases. Seventy-five studies were included in the meta-analysis (n = 22,202 subjects). RESULTS: The meta-analysis showed that the GPF is positioned 17.21 mm (95% CI = 16.34-18.09 mm) from the posterior nasal spine, 2.56 mm (95% CI = 1.90-3.22 mm) from the posterior border of the hard palate, 46.24 mm (95% CI = 44.30-48.18 mm) from the anterior nasal spine, 15.22 mm (95% CI = 15.00-15.43 mm) from the midline maxillary suture, 37.32 mm (95% CI = 36.19-38.45 mm) from the incisive foramen, and opposite the third maxillary molar (M3) in 64.9% (58.7-70.7%) of the total population. CONCLUSION: An up-to-date, comprehensive analysis of GPF and GPC clinical anatomy is presented. The results from this evidence-based anatomical study provides a unified set of data to aid clinicians in their practice.

Methodological approach for determining the Minimal Important Difference and Minimal Important Change scores for the European Organisation for Research and Treatment of Cancer Head and Neck Cancer Module (EORTC QLQ-HN43) exemplified by the Swallowing scale.

PURPOSE: The aim of this study was to explore what methods should be used to determine the minimal important difference (MID) and minimal important change (MIC) in scores for the European Organisation for Research and Treatment of Cancer Head and Neck Cancer Module, the EORTC QLQ-HN43. METHODS: In an international multi-centre study, patients with head and neck cancer completed the EORTC QLQ-HN43 before the onset of treatment (t1), three months after baseline (t2), and six months after baseline (t3). The methods explored for determining the MID were: (1) group comparisons based on performance status; (2) 0.5 and 0.3 standard deviation and standard error of the mean. The methods examined for the MIC were patients' subjective change ratings and receiver-operating characteristics (ROC) curves, predictive modelling, standard deviation, and standard error of the mean. The EORTC QLQ-HN43 Swallowing scale was used to investigate these methods. RESULTS: From 28 hospitals in 18 countries, 503 patients participated. Correlations with the performance status were |r|< 0.4 in 17 out of 19 scales; hence, performance status was regarded as an unsuitable anchor. The ROC approach yielded an implausible MIC and was also discarded. The remaining approaches worked well and delivered MID values ranging from 10 to 14; the MIC for deterioration ranged from 8 to 16 and the MIC for improvement from - 3 to - 14. CONCLUSIONS: For determining MIDs of the remaining scales of the EORTC QLQ-HN43, we will omit comparisons of groups based on the Karnofsky Performance Score. Other external anchors are needed instead. Distribution-based methods worked well and will be applied as a starting strategy for analyses. For the calculation of MICs, subjective change ratings, predictive modelling, and standard-deviation based approaches are suitable methods whereas ROC analyses seem to be inappropriate.

Prevalence, morphology, and morphometry of the pterygospinous bar: a meta-analysis.

PURPOSE: The purpose of the study was to analyze the total prevalence, morphologic, and morphometric characteristics of the pterygospinous (PS) bar and its gender and ethnic differences among populations. PS bar is an ossified anatomic structure stretching between the posterior margin of the lateral pterygoid lamina to the angular spine of the undersurface of the sphenoid, with potential clinical implications. There is no consensus in the literature on its prevalence, morphologic, and morphometric characteristics. METHODS: A thorough search of databases was conducted. Data on the prevalence, morphology, i.e., ossification type (complete and incomplete), side, gender, laterality, and morphometrics, of the PS bar were extracted and pooled into a meta-analysis. RESULTS: A total of 35 studies (n = 14,047 subjects) were analyzed. The overall pooled prevalence of a complete PS bar was 4.4% (95% CI 3.7-5.1), while the overall pooled prevalence of an incomplete PS bar was significantly higher (11.6% [95% CI 8.5-15.2]). A complete PS bar was more prevalent among males and was more commonly unilaterally, on the left side. CONCLUSION: The overall prevalence of PS bar is quite common. It could be of importance for clinicians who should consider its potential presence when planning surgical approaches to the retropharyngeal and parapharyngeal space.

Does age matter? A comparison of health-related quality of life issues of adolescents and young adults with cancer.

OBJECTIVE: Health-related quality of life (HRQoL) concerns of adolescents and young adults (AYAs) aged 14-25 years were compared with those of older adults (26-60 years) with cancer. METHODS: AYAs and older adults receiving curative intent treatment or supportive palliative care for cancer were recruited from eight research centres across Europe. Participants used a rating scale to score the relevance and importance of a list of 77 issues covering 10 areas of HRQoL concern: symptoms; activity restrictions; social; emotional; body image; self-appraisals; outlook on life; lifestyle; treatment-related and life beyond treatment. RESULTS: HRQoL issues were reviewed by 33 AYAs and 25 older adults. Several issues were recognised as relevant and important across all age groups: symptoms, emotional impact, outlook on life, lifestyle and treatment-related. A number of issues were more relevant or important to AYAs including interrupted education, greater motivation to achieve academic goals, increased maturity, boredom, fertility and change in living situation. CONCLUSION: While there is overlap in several of the HRQoL concerns across the age span, it is important that HRQoL measures used with AYAs capture the diverse and unique psychosocial aspects of this developmental stage.

Internal and external morphology of mandibular molars: An original micro-CT study and meta-analysis with review of implications for endodontic therapy.

The aim of this radiological micro-CT study and meta-analysis was to determine the morphological features of the root canal anatomy of the mandibular molars. The radiological study included micro-CT scans of 108 mandibular first, 120 mandibular second, and 146 mandibular third molars. For our meta-analysis, an extensive search was conducted through PubMed, Embase, and Web of Science to identify articles eligible for inclusion. Data extracted included investigative method (cadaveric, intraoperative, or imaging), Vertucci type of canal configuration, presence/number of canals, roots, apical foramina, apical deltas, and intercanal communications. In the mesial roots of mandibular molars, the most frequent Vertucci type of canal configuration was type IV, except for the mandibular third molar where type I was most common. Type I was most common in the distal root. There were usually two canals in the mesial root and one in the distal root. Two was the most common number of roots, and a third root was most prevalent in Asia. One apical foramen was most common in the distal root and two apical foramina in the mesial root. Intercanal communications were most frequent in the mesial root. Knowledge of the complex anatomy of the mandibular molars can make root canal therapy more likely to succeed. We recommend the use of cone-beam computed tomography before and after endodontic treatment to enable the root anatomy to be accurately described and properly diagnosed, and treatment outcome to be assessed. Clin. Anat. 31:797-811, 2018. © 2018 Wiley Periodicals, Inc.

An original micro-CT study and meta-analysis of the internal and external anatomy of maxillary molars-implications for endodontic treatment.

The aim of this work was to conduct a radiological micro-CT study and meta-analysis to determine the morphological features of the root canal anatomy of the maxillary molars. The radiological study included micro-CT scans of 110 maxillary first molars and 98 maxillary second molars. To identify articles eligible for inclusion in our meta-analysis, PubMed, Embase, and Web of Science were search comprehensively. The following data were extracted: study type (cadaveric, intraoperative or imaging), Vertucci types of canal configuration, presence/number of canals, roots, apical foramina, apical deltas, and inter-canal communications. The mesiobuccal root was the most variable with respect to canal configuration, type I being the most common configuration followed by type II and type IV. Type I was the most common canal configuration in the distobuccal and palatal root. Regarding the number of canals in the maxillary first and second molars, one canal was most prevalent in all roots of the three molars, except for the mesiobuccal root of maxillary first molar, in which two canals were most prevalent. The most prevalent number of roots in all maxillary molars was three. Knowledge of endodontic anatomy determines the parameters of root canal treatment and significantly affects the probability of success. It is therefore especially important to know the morphology of the root canal system in order to perform endodontic treatment correctly. Clin. Anat. 31:838-853, 2018. © 2018 Wiley Periodicals, Inc.

Anatomical study of the palatine aponeurosis: application to posterior palatal seal of the complete maxillary denture.

The palatine aponeurosis is a thin, fibrous lamella comprising the extended tendons of the tensor veli palatini muscles, attached to the posterior border and inferior surface of the palatine bone. In dentistry, the relationship between the "vibrating line" and the border of the hard and soft palate has long been discussed. However, to our knowledge, there has been no discussion of the relationship between the palatine aponeurosis and the vibrating line(s). Twenty sides from ten fresh frozen White cadaveric heads (seven males and three females) whose mean age at death was 79 years) were used in this study. The thickness of the mucosa including the submucosal tissue was measured. The maximum length of the palatine aponeurosis on each side and the distance from the posterior nasal spine to the posterior border of the palatine aponeurosis in the midline were also measured. The relationship between the marked borderlines and the posterior border of the palatine bone was observed. The thickness of the mucosa and submucosal tissue on the posterior nasal spine and the maximum length of the palatine aponeurosis were 3.4 mm, and 12.2 mm on right side and 12.8 mm on left, respectively. The length of the palatine aponeurosis in the midline was 4.9 mm. In all specimens, the borderline between the compressible and incompressible parts corresponded to the posterior border of the palatine bone.

EORTC QLQ-COMU26: a questionnaire for the assessment of communication between patients and professionals. Phase III of the module development in ten countries.

PURPOSE: Communication between patients and professionals is one major aspect of the support offered to cancer patients. The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group (QLG) has developed a cancer-specific instrument for the measurement of different issues related to the communication between cancer patients and their health care professionals. METHODS: Questionnaire development followed the EORTC QLG Module Development Guidelines. A provisional questionnaire was pre-tested (phase III) in a multicenter study within ten countries from five cultural areas (Northern and South Europe, UK, Poland and Taiwan). Patients from seven subgroups (before, during and after treatment, for localized and advanced disease each, plus palliative patients) were recruited. Structured interviews were conducted. Qualitative and quantitative analyses have been performed. RESULTS: One hundred forty patients were interviewed. Nine items were deleted and one shortened. Patients' comments had a key role in item selection. No item was deleted due to just quantitative criteria. Consistency was observed in patients' answers across cultural areas. The revised version of the module EORTC QLQ-COMU26 has 26 items, organized in 6 scales and 4 individual items. CONCLUSIONS: The EORTC COMU26 questionnaire can be used in daily clinical practice and research, in various patient groups from different cultures. The next step will be an international field test with a large heterogeneous group of cancer patients.

Systematic review of the health-related quality of life issues facing adolescents and young adults with cancer.

PURPOSE: For adolescents and young adults (AYAs), the impact of a cancer diagnosis and subsequent treatment is likely to be distinct from other age groups given the unique and complex psychosocial challenges of this developmental phase. In this review of the literature, we report the health-related quality of life (HRQoL) issues experienced by AYAs diagnosed with cancer and undergoing treatment. METHODS: MEDLINE, EMBASE, CINAHL, PsychINFO and the Cochrane Library Databases were searched for publications reporting HRQoL of AYAs. Issues generated from interviews with AYAs or from responses to patient reported outcome measures (PROMs) were extracted. RESULTS: 166 papers were reviewed in full and comprised 72 papers covering 69 primary studies, 49 measurement development or evaluation papers and 45 reviews. Of the 69 studies reviewed, 11 (16%) used interviews to elicit AYAs' descriptions of HRQoL issues. The majority of the PROMs used in the studies represent adaptations of paediatric or adult measures. HRQoL issues were organised into the following categories: physical, cognitive, restricted activities, relationships with others, fertility, emotions, body image and spirituality/outlook on life. CONCLUSION: The HRQoL issues presented within this review are likely to be informative to health care professionals and AYAs. The extensive list of issues suggests that the impact of a cancer diagnosis and treatment during adolescence and young adulthood is widespread and reflects the complexities of this developmental phase.

International field testing of the psychometric properties of an EORTC quality of life module for oral health: the EORTC QLQ-OH15.

PURPOSE: This international EORTC validation study (phase IV) is aimed at testing the psychometric properties of a quality of life (QoL) module related to oral health problems in cancer patients. METHODS: The phase III module comprised 17 items with four hypothesized multi-item scales and three single items. In phase IV, patients with mixed cancers, in different treatment phases from 10 countries completed the EORTC QLQ-C30, the QLQ-OH module, and a debriefing interview. The hypothesized structure was tested using combinations of classical test theory and item response theory, following EORTC guidelines. Test-retest assessments and responsiveness to change analysis (RCA) were performed after 2 weeks. RESULTS: Five hundred seventy-two patients (median age 60.3, 54 % females) were analyzed. Completion took <10 min for 84 %, 40 % expressed satisfaction that these issues were addressed. Analyses suggested a revision of the phase III hypothesized scale structure. Two items were deleted based on a high degree of item misfit, together with negative patient feedback. The remaining 15 items formed one eight-item scale named OH-QoL score, a two-item information scale, a two-item scale regarding dentures, and three single items (sticky saliva/mouth soreness/sensitivity to food/drink). Face and convergent validity and internal consistency were confirmed. Test-retest reliability (n = 60) was demonstrated as was RCA for patients undergoing chemotherapy (n = 117; p = 0.06). The resulting QLQ-OH15 discriminated between clinically distinct patient groups, e.g., low performance status vs. higher (p < 000.1), and head-and-neck cancer versus other cancers (p < 0.03). CONCLUSION: The EORTC module QLQ-OH15 is a short, well-accepted assessment tool focusing on oral problems and QoL to improve clinical management. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01724333.

Extralaryngeal branching of the recurrent laryngeal nerve: a meta-analysis of 28,387 nerves.

INTRODUCTION: The recurrent laryngeal nerves (RLN) are branches of the vagus nerve that go on to innervate most of the intrinsic muscles of the larynx. Historically, the RLN has been considered to branch after it enters the larynx, but numerous studies have demonstrated that it often branches before. The wide variability of this extralaryngeal branching (ELB) has significant implications for the risk of iatrogenic injury. We aimed to assess the anatomical characteristics of ELB comprehensively. METHODS: Articles on the ELB of the RLN were identified by a comprehensive database search. Relevant data were extracted and pooled into a meta-analysis of the prevalence of branching, branching pattern, distance of ELB point from the larynx, and presence of positive motor signals in anterior and posterior ELB branches. RESULTS: A total of 69 articles (n = 28,387 nerves) from both intraoperative and cadaveric modalities were included in the meta-analysis. The overall pooled prevalence of ELB was 60.0 % (95 % CI 52.0-67.7). Cadaveric and intraoperative subgroups differed with prevalence rates of 73.3 % (95 % CI 61.0-84.0) and 39.2 % (95 % CI 29.0-49.9), respectively. Cadavers most often presented with a ELB pattern of bifurcation, with a prevalence of 61.1 %, followed by no branching at 23.4 %. Branching of the RLN occurred most often at a distance of 1-2 cm (74.8 % of cases) prior to entering the larynx. A positive motor signal was most often noted in anterior RLN branches (99.9 %) but only in 1.5 % of posterior branches. CONCLUSIONS: The anatomy of the RLN is highly variable, and ELB is likely to have been underreported in intraoperative studies. Because of its high likelihood, the possibility of ELB needs to be assessed in patients to prevent iatrogenic injury and long-term postoperative complications.

Validation of the Polish version of the EORTC Head and Neck module (QLQ-H&N35).

AIM: The aim of this study was to psychometrically validate the EORTC translated, Polish version of the EORTC QLQ-H&N35 questionnaire to support using it in the Polish clinical setting in patients with head and neck malignancies. MATERIALS AND METHODS: Patients with histologically confirmed head and neck malignancies were included in the study. All patients filled in the Polish version of the EORTC QLQ-C30, the EORTC QLQ-H&N35 module, and a demographic questionnaire. Standardized validity and reliability analyses were performed. RESULTS: During the recruitment period a total of 176 patients (82 females - 46.6%) were enrolled into the study, with a mean age of 54.3 ± 11.2 years. Cronbach alpha values ranged from 0.71 to 0.87. Satisfactory convergent and discriminant validity in multi-trait scaling analyses was seen. CONCLUSIONS: The Polish version of the EORTC QLQ-H&N35 module is a reliable and valid tool for measuring HRQoL in Polish patients with head and neck malignancies. It can be fully recommended for use in the Polish clinical setting.

Anatomical landmarks for the localization of the greater palatine foramen--a study of 1200 head CTs, 150 dry skulls, systematic review of literature and meta-analysis.

Accurate knowledge of greater palatine foramen (GPF) anatomy is necessary when performing a variety of anaesthesiological, dental or surgical procedures. The first aim of this study was to localize the GPF in relation to multiple anatomical landmarks. The second aim was to perform a systematic review of literature, and to conduct a meta-analysis on the subject of GPF position to aid clinicians in their practice. One-hundred and fifty dry, adult, human skulls and 1200 archived head computed tomography scans were assessed and measured in terms of GPF relation to other anatomical reference points. A systematic literature search was performed using the PubMed, Embase and Web of Science databases, and a meta-analysis on the subject of GPF relation to the maxillary molars was conducted. On average, in the Polish population, the GPF was positioned 15.9 ±â€…1.5 mm from the midline maxillary suture (MMS), 3.0 ±â€…1.2 mm from the alveolar ridge (AR) and 17.0 ±â€…1.5 mm from the posterior nasal spine (PNS); 74.7% of GPF were positioned opposite the third maxillary molar (M3). Twenty-seven studies were included in the systematic review and 23 in the meta-analysis (n = 6927 GPF). The pooled prevalence of the GPF being positioned opposite the M3 was 63.9% (95% confidence interval = 56.6-70.9%). Concluding, the GPF is most often located opposite the M3 in the majority of the world's populations. The maxillary molars are the best landmarks for locating the GPF. In edentulous patients the most useful points for approximating the position of the GPF are the AR, MMS and PNS. This study introduces an easy and repeatable classification to reference the GPF to the maxillary molars.

Validation of the Polish version of the EORTC QLQ-BM22 module for the assessment of health-related quality of life in patients with bone metastases.

PURPOSE: The aim of our study was to undertake a prospective validation study of the Polish version of the European Organization for Research and Treatment of Cancer (EORTC) bone metastases (QLQ-BM22) module used alongside the EORTC core measure. METHODS: The translated module was pilot-tested according to the established EORTC guidelines. Patients with histological confirmation of malignancy and bone metastases, diagnosed by imaging studies, were eligible for the study. All patients filled out the Polish version of the QLQ-BM22 module in addition to QLQ-C30 and a demographic questionnaire. Standard validity and reliability analyses were performed. RESULTS: One hundred and fifty-five patients were enrolled into the study, including 94 women (60.7 %) and 61 men (mean age ± SD; 59.1 ± 12.1). Cronbach's alpha coefficients, range 0.68-0.93, showed positive internal consistency. Re-test was undertaken with fifty patients (32.3 %). Interclass correlations for the EORTC QLQ-BM22 ranged from 0.91 to 0.93 and proved sufficient test-retest reliability. Satisfactory convergent and discriminant validity in multi-trait scaling analyses was seen. CONCLUSIONS: Our study provides new and robust evidence which shows that the Polish version of the QLQ-BM22 module is a valid and reliable instrument for measuring health-related quality of life in patients with bone metastases. It is suitable for use in clinical trials and in research.

The influence of bacterial biofilm on the clinical outcome of chronic rhinosinusitis: a prospective, double-blind, scanning electron microscopy study.

The aim of this study was to assess the influence of bacterial biofilms in chronic rhinosinusitis (CRS) patients on the clinical outcomes following endoscopic sinus surgery (ESS). This was a prospective, double-blind study. Patients undergoing ESS, because of CRS, were recruited. Overall 80 patients were qualified. For each of these demographic, clinical and radiologic characteristics were recorded. During surgery each patient had at least 7 mucosal specimens taken to assess, using scanning electron microscopy, the possible presence of bacterial biofilms. Prior to mucosa specimen excision, swabs for bacteriological and fungal analyses were taken. Each patient underwent perioperative and follow-up assessment at 3 and 6 months post-ESS. Biofilms were found in 33 (41.3%) patients (study group). From among the 47 patients without the presence of biofilms, 33 (control group) were taken to match the study group in age, gender and clinical characteristics. The intensity of subjective and objective CRS symptoms, as well as patient quality-of-life, did not correlate with the Lund and Mackay score (p > 0.05). Analysis of variance showed that, in the control group or the group as a whole, the intensity of subjective and objective symptoms decreased (p < 0.05), and the quality-of-life increased with time (p < 0.05). In conclusion, biofilm-positive patients tend to have a greater severity of disease preoperatively and continue to have persistent and more severe symptoms post-ESS. This study supports the role of biofilms in maintaining the chronic and recalcitrant nature of CRS. The lack of planktonic bacteria in post-operative sinus swabs does not rule out the presence of bacterial biofilms.

Preliminary psychometric validation of the Polish version of the EORTC elderly module (QLQ-ELD14).

AIM: The aim of our study was to report preliminary validation data on the EORTC translated, Polish version of the EORTC QLQ-ELD14 questionnaire to show that this tool is an acceptable and psychometrically robust measure to collect HRQoL data in Polish elderly patients with cancer. MATERIALS AND METHODS: Patients with histological confirmation of primary cancer were eligible for the study. All patients filled out the Polish version of the EORTC QLQ-ELD14 module in addition to EORTC QLQ-C30 and a demographic questionnaire. Standardized validity and reliability analyses were performed. RESULTS: Sixty-five patients (41 females - 63.1%) were enrolled into the study, with a mean age of 76.4 ± 5.7 years. Cronbach alpha coefficients, range 0.70-0.84, showed positive internal consistency. Satisfactory convergent and discriminant validity in multi-trait scaling analyses was seen. Strong correlations were observed between the EORTC QLQ-ELD14 (especially mobility and burden of illness), and the EORTC QLQ-C30 (r = -0.30-(-0.83); p <0.001). CONCLUSIONS: Basing on the preliminary data from this study, the Polish version of the EORTC QLQ-ELD14 module is a reliable and valid tool for measuring HRQoL in elderly cancer patients. However further research is needed to establish the full psychometric properties of the described module, especially in regards to test-retest and responsiveness over time.

Variations of the anterior communicating artery complex and occurrence of anterior communicating artery aneurysm: A2 segment consideration.

INTRODUCTION: The anterior communicating artery (ACoA) is the most frequent site of intracranial aneurysm location. Despite many studies the frequency of aneurysm occurrence with anatomical anomalies is still poorly described. Moreover the significance of the A2 segment of anterior cerebral artery anomalies has been neglected. The aim of this study was to determine the frequency and types of variations of the anterior cerebral circulation in patients with ACoA aneurysms and to analyze their relation to aneurysm occurrence in the Polish population. MATERIALS AND METHODS: We studied 50 patients with an established radiological diagnosis of ACoA aneurysm and 100 healthy age- and sex-matched controls using Computed Tomgraphy Angio- graphy. Maximum Intensity and Volume Rendering Projections were used to examine the cerebral arterial circulation. Univariate logistic regression was used to determine the statistical association between ACoA complex anomalies and aneurysm occurrence. RESULTS: Patients in the study group had a significantly higher incidence of hypoplastic A1 seg- ment of the anterior cerebral artery (24% vs. 7%; p <0.01) and aplastic A1 segment of the anterior cerebral artery (12% vs. 3%; p = 0.03). The frequency of A1 segment hypoplasia or aplasia in the study group was 36%. There was a statistical trend regarding A2 segment aplasia/hypoplasia as a potential predictor of ACoA aneurysm (6% vs. 1%; p = 0.07). CONCLUSION: Occurrence of an ACoA aneurysm is associated with hypoplasia or aplasia of the A1 segment of the anterior cerebral artery. A2 segment anomalies may potentially be associated with aneurysm formation.

[Cavernous haemangioma of the chest wall--case report]. / Naczyniak jamisty sciany klatki piersiowej--opis przypadku.

BACKGROUND: Cavernous hemangiomas are among the least common benign chest wall masses. The aim of this study is to present a case of a 40-year-old women, with a giant cavernous haemangioma arising in the left axillary area. CASE REPORT: A 40-year-old female, was referred to a pulmonologist, after her chest radiograph showed, in the upper field of the left lung, a peripherally located shading (13 cm long and 3.5 cm deep) connecting with the pleura. The skin above the change was not discoloured. Contrast-enhanced CT showed a cavernous haemangioma (17 cm long and 13 cm wide) located mostly in the left axillary area. The main vascular supply of the haemangioma came from a direct branch of the left axillary artery, the left intervertebral arteries (levels Ill-VII) and a branch of the left internal thoracic artery. CONCLUSIONS: This report illustrates a rare case of a giant cavernous haemangioma and the treatment challenges it poses.

Empathy level differences between Polish surgeons and physicians.

AIM: The aim of this study was to assess the levels of empathy among Polish physicians and surgeons. MATERIALS AND METHODS: Ninety-two physicians took part in the study. The physicians were either employed in hospitals, outpatient clinics or university departments in Krakow. The participants were asked to fill out a personal questionnaire, the Emotional Empathy Scale (EES), as well as describe four chosen tables from the Thematic Apperception Test (TAT). RESULTS: The study group consisted of 92 physicians, including 25 women (27.2%) and 67 men, in the mean age of 42 ± 16.3 years (age span: 27-68 years). The physicians have been divided into two subgroups - non-surgical specialists (52 people - 56.5%) and surgical specialists (40 people - 43.5%). There were no gender differences, as to the level of empathy, in the study group (p >0.05). Non-surgical specialists displayed a higher level of empathy (p=0.03) than their surgical counterparts. There was a positive correlation between age and the level of empathy. This was seen both among non-surgical (r = 0.41; p < 0.0001) and surgical specialists (r = 0.59; p < 0.0001). No correlation was seen between the number of years of experience working as a doctor and the level of empathy (p > 0.05). CONCLUSIONS: Empathy is an essential element in the physician-patient relationship. This study has shown that non-surgical specialists display a higher level of empathy. We have also shown that years of experience working as a doctor do not influence the level of empathy, while age is a beneficial factor.