Fatal delayed hemopericardium and hemothorax following blunt chest trauma.

Cardiac injury following blunt chest trauma is common in motor vehicle accidents due to a crush or blast injury. Severe cardiac trauma is associated with a very high mortality. If a cardiac injury develops several weeks after non-penetrating chest trauma, establishing a causal link between the traumatic event and the cardiac injury becomes complicated. This article reports a case of fatal delayed hemopericardium and hemothorax following a motor vehicle accident including blunt chest trauma 34 days prior to death. The cardiac injury was caused by displacement of a sharp irregular fragment of one of the decedents fractured ribs and the primary defect was sealed by blood clots. Subsequent bleeding occurred when the thrombus was displaced. Since the incidence of blunt high-energy chest injuries is relatively high, heart and large vessel injuries must be taken into account and a comprehensive examination needs to be done in order to prevent the delayed development of fatal complications.

[Bronchobiliary fistulae as a complication of hepatic cystic echinococcosis]. / Bronchobiliární pístel jako komplikace echinokokové cysty jater.

Cystic hydatid disease or cystic echinococcosis (CE) rarely occurs in the Czech Republic. In 2005 - 2009, eleven cases were recorded, mostly among immigrants from the Balkans. Presented here is a case report of a 38-year-old patient with hepatic CE complicated by bronchobiliary fistulae. Ten days before surgical removal of the hydatid cysts, treatment with mebendazole was started. During surgery the affected part of the lungs was resected and the liver cysts were drained using transthoratic access. The follow-up was complicated by leakage of bile into the pleural cavity. The leakage was associated with continued communication between the liver cyst and the pleural cavity which did not close spontaneously after removal of the drain. Endoscopic nasobiliary drainage decreased pressure in the bile duct and within 14 days, it led to the spontaneous closure of the communication between the liver cyst and the pleural cavity. Seven months after the operation, the patient was in a very good clinical condition.

Distal enlargement of the optic nerve sheath in the hyperacute stage of intracerebral haemorrhage.

AIMS: Optic nerve sheath diameter (ONSD) enlargement is detectable in patients with increased intracranial pressure. The aim was to detect an enlargement of the ONSD using optic nerve sonography in patients with acute intracerebral haemorrhage (ICH) within 6 h of the onset of symptoms. METHODS: Thirty-one acute ICH patients, 15 age-matched acute ischaemic stroke patients and 16 age-matched healthy volunteers were enrolled consecutively in this prospective bi-centre observational study. All acute stroke patients underwent brain CT, optic nerve sonography and transcranial colour-coded duplex sonography (TCCS) at admission within 6 h of stroke onset. The ONSD both 3.0 and 12.0 mm behind the globe using optic nerve sonography were recorded and statistically evaluated, as were age, sex, haemorrhage volume and midline shift measured by CT, and blood flow velocities in both middle cerebral arteries using TCCS. RESULTS: In acute ICH patients, a significant enlargement of ONSD was detected (p < 0.0083). The best cut-off point to predict ICH volume >2.5 cm³ was the relative ONSD enlargement of > 0.66 mm (> 21 %), with 90.3% accuracy and kappa coefficient 0.760 (95% CI 0.509 to 1.000). CONCLUSIONS: Sonographically measured enlargement of the ONSD may already be detectable in the hyperacute stage of increased intracranial pressure.

Moyamoya disease is associated with endothelial activity detected by anti-nestin antibody.

AIM: To describe the case history and new histopathological findings of a young woman suffering from moyamoya disease. METHODS: The patient underwent brain computed tomography, magnetic resonance imaging and brain angiography. Vessel samples of a. temporalis superficialis were processed by standard histopathological and immunohistochemical methods by analysis of VEGF, VEGFR and nestin expression. RESULTS: Brain angiography revealed both internal carotid artery stenoses and stenoses of the anterior cerebral arteries. Stenotic parts of vessels were accompanied by coiled and elongated vessels with a picture of "smoke puffs carried away by breeze" after contrast medium application. Histological examination showed: obstruction of lumen, fibrocellular intimal thickening, tortuosity and disruption of internal elastic lamina. Imunohistochemistry confirmed a defect of the internal elastic membrane of the muscular arteria and progressive intimal thickening accompanied by abnormal smooth muscle cells and, VEGF/VEGFR expression in intima. Nestin positivity in endothelium of arteria indicated that endothelial cells are activated. CONCLUSION: We found that the endothelium of affected vessels is nestin positive. This, together with the finding of VEGF/VEGFR expression, might suggest an active angiogenetic process We present a new conception of pathogenesis but further studies with higher number of patients are necessary to elucidate the role of these growth factors in the moyamoya disease.

Identification of CD133+/nestin+ putative cancer stem cells in non-small cell lung cancer.

AIMS: No effective treatment for lung cancer exists currently. One reason for this, is the development of drug resistance, assumed to be associated with cancer stem cell (CSCs) emergence within the tumour. This pilot study aimed to identify CSCs in 121 non-small cell lung cancer (NSCLC) patient samples via detection of the expression of stem cell markers - CD133 and nestin. MATERIAL AND METHODS: Archived paraffin blocks of 121 patient samples were prepared as Tissue Microarrays (TMA). Indirect immunohistochemical staining was used to determine the level of expression of CD133 and nestin. Double immunofluorescence staining was used to investigate the co-expression of these two markers. To determine the correlation between expression of nestin and CD133 with the length of asymptomatic period and overall patient survival we used the Kaplan-Meyer analysis. RESULTS: CD133 expression was detected in 22 (19%), nestin in the epithelium in 74 (66%) and vasculature in 78 (70%) of patients. Co-expression of these two markers was found in 21 (17%) patients in less than 1% of positive cells without impact on disease free or overall survival. CONCLUSIONS: We identified CD133(+)/nestin(+) cells as novel potential markers of lung cancer CSCs.

Transcranial duplex sonography and CT angiography in acute stroke patients.

Acute occlusion of cervical or intracranial arteries is the most common cause of ischemic stroke (IS). The aims of the current study were to compare the occurrence of acute pathologic findings in intracranial arteries using transcranial color-coded sonography (TCCS) and computed tomographic angiography (CTA) performed within 3 hours of IS onset and to assess the correlation between the vascular findings on admission and the patient's clinical state on admission and 3 months after the IS. Forty-five consecutive patients with an acute IS were included in the prospective study during an 18-month period. All patients underwent CTA and TCCS within the first 3 hours of symptom onset. A high rate of pathologic findings in the intracranial circulation was found (70.9% in CTA and 77.4% in TCCS examinations). The CTA and TCCS findings with respect to the intracranial arteries were consistent in 87.1% of cases (Cohen's kappa, .797). The sensitivity, specificity, and positive and negative predictive values achieved with TCCS in patients with middle cerebral artery main stem occlusion were 92.3%, 94.4%, and 92.3% and 94.4%, respectively. There was no correlation between the patient's clinical status on admission and 3 months after the onset of the IS and the CTA or the TCCS findings (P > .1 in all cases). A substantial agreement was found between TCCS and CTA in the detection of pathologic findings in intracranial vessels in acute stroke patients. Both methods can be used for this purpose.

Brain single photon emission tomography and hypercapnia test in testing cerebrovascular reserve capacity, in Moya moya disease.

Moya moya is a progressive cerebral occlusive vasculopathy, rare in European countries. We describe a case of a young woman with right-hand side hemiparesis, mixed expressive aphasia, organic psychosyndrome and cognitive malfunction. Detailed imaging methods displayed bilateral stenosis of the internal carotid artery, bilateral ischemic cerebral changes and bilateral perfusion deficit, which guided us to the final diagnosis. Before the bypass surgery, cerebrovascular reserve capacity (vasoreactivity), by the brain single photon emission tomography and hypercapnia, were assessed and the lower cerebrovascular reserve was demonstrated. Bilateral bypass surgery with extracranial-intracranial anastomosis, improved the neurological deficit. Diagnosis was confirmed by histological examination of the vessel wall specimen.

The diagnosis of brain death--own experience.

BACKGROUND: The aim of this paper is a description of our experience with scintigraphic detection of brain death. MATERIAL AND METHODS: Thirty-four patients were studied from February 2003 to June 2006. We performed brain scintigraphic examination utilising (99m)Tc-HMPAO and a two-headed SPECT camera E.CAM. We used LEHR collimators. 15% energy window was centred around 140 keV. 650-750 MBq of radiopharmaceutical was injected as a bolus. Then dynamic scintigraphy of the head and neck was done in an anterior projection--2 s per frame for 60 s. Then static scintigraphy of the head in four projections followed (anterior, both lateral and posterior views), for 4 minutes per view. RESULTS: A typical picture of brain death on planar dynamic and static scintigrams showed an absence of perfusion and radiopharmaceutical accumulation in both cereberal and cerebral hemispheres and brain stem. Radioactivity in the area of the scalp and face could be present. Borderline findings, which demanded careful interpretation, were the cases with preservation of minimal cerebral perfusion and simultaneous absence of radiopharmaceutical accumulation in its parenchyma and cutoff of tracer accumulation in cerebral parenchyma only supra or infratentorial. CONCLUSIONS: Cerebral perfusion scintigraphy is the most contributing factor for the diagnosis of brain death in patients after cranial trauma with subsequent neurosurgical operation, when angiography is often unsuitable. In these situations perfusion scintigraphy is able to show the absence of radiopharmaceutical accumulation in cerebral tissue. Scintigraphic detection of brain death gained an important role in new Czech legislation, and the demands of transplant centres for these examinations will certainly grow with the accrual of organ collections.

CT-guided percutaneous fixation of pelvic fractures. Case reports.

Unstable pelvic fractures are usually associated with high impact energy trauma. As to surgical procedures the most frequently used methods are open reduction and inner fixation (ORIF), the other methods of stabilizing the unstable posterior pelvic ring are percutaneous iliosacral screw fixation under fluoroscopic control and CT-guided percutaneous fixation. The last mentioned procedure eliminates some of the problems associated with surgical treatment: prevents excessive blood loss during manipulation of the fracture hematom, lowers the possibility of infection, allows more accurate screw placement with direct measuring of the screw length and decreases the possibility of nerve injury. The CT-guided fixation is a delicate procedure and its result depends among others on the cooperation between operating room and CT room personnel. The radiologist and CT technologist have to know the operation technique and have to understand surgeon's requirements. In the available literature only a little was written and mentioned about the exact role of radiologist and CT technologist in the team. The aim of this article is to present the operation technique according to authors' own experience with two operated patients and to mention the surgeon's requirements on CT team.