Intragastric balloon therapy leads to normalization of brain magnetic resonance spectroscopic markers of diabetes in morbidly obese patients.

Elevated brain myo-inositol (m-Ins) concentration (a putative marker of neuroinflammation) has been reported in patients suffering from type 2 diabetes mellitus (T2DM). Obesity alone and T2DM have been found to be associated with a lower concentration of N-acetyloaspartate and N-acetylaspartylglutamate (tNAA, a marker of neuronal integrity, reflecting neuronal loss or metabolic derangement). It is not clear if these changes reverse with weight loss. The intra-gastric balloon (IGB) is an endoscopic bariatric therapy that leads to massive weight loss and improvement of glycemic control. In this study we evaluated if tNAA/tCr and m-Ins/tCr metabolite ratios are affected by weight loss, where tCr is the signal of creatine containing compounds. Twenty-three morbidly obese patients, 12 of them with T2DM (OD) and 11 without T2DM (OB), as well as 11 healthy controls of normal weight (CON), underwent single voxel spectroscopy at 3 T. Spectra were obtained within a region in the left parietal white matter one month before IGB insertion, three months after IGB insertion, and one month after IGB removal. Before IGB insertion, m-Ins/tCr was 15% higher in OD than in OB (p = 0.005) and 12% higher in OD than in CON (p = 0.03). m-Ins/tCr decreased significantly by 8% over the first three months after IGB insertion (p = 0.01) and remained normal after IGB removal. tNAA/tCr was normal in all groups throughout the study, pointing to normal brain metabolism. Normalization of m-Ins/tCr is consistent with remission of neuroinflammation in patients with T2DM. An evaluation of long-term effects of IGB treatment is necessary.

Tibial stress injuries - location, severity, and classification in magnetic resonance imaging examination.

PURPOSE: To describe and illustrate the spectrum of magnetic resonance imaging (MRI) findings of tibial stress injuries (TSI) and propose a simplified classification system. MATERIAL AND METHODS: Retrospective analysis of MRI exams of 44 patients with clinical suspicion of unilateral or bilateral TSI, using a modified classification system to evaluate the intensity and location of soft-tissue changes and bone changes. RESULTS: Most of the patients were young athletic men diagnosed in late stage of TSI. Changes were predominantly found in the middle and distal parts of tibias along medial and posterior borders. CONCLUSIONS: TSI may be suspected in young, healthy patients with exertional lower leg pain. MRI is the only diagnostic method to visualise early oedematic signs of TSI. Knowledge of typical locations of TSI can be helpful in proper diagnosis before its evolution to stress fracture.

Correlation Between Findings of Multislice Helical Computed Tomography (CT), Endoscopic Examinations, Endovascular Procedures, and Surgery in Patients with Symptoms of Acute Gastrointestinal Bleeding.

BACKGROUND: Endoscopic methods (gastroscopy and colonoscopy) are considered fundamental for the diagnosis of gastrointestinal bleeding. In recent years, multidetector computed tomography (MDCT) has also gained importance in diagnosing gastrointestinal bleeding, particularly in hemodynamically unstable patients and in cases with suspected lower gastrointestinal tract bleeding. CT can detect both the source and the cause of active gastrointestinal bleeding, thereby expediting treatment initiation. MATERIAL/METHODS: The study group consisted of 16 patients with clinical symptoms of gastrointestinal bleeding in whom features of active bleeding were observed on CT. In all patients, bleeding was verified by means of other methods such as endoscopic examinations, endovascular procedures, or surgery. RESULTS: The bleeding source was identified on CT in all 16 patients. In 14 cases (87.5%), bleeding was confirmed by other methods. CONCLUSIONS: CT is an efficient, fast, and readily available tool for detecting the location of acute gastrointestinal bleeding.

Retroperitoneal Ganglioneuroma Mimicking a Kidney Tumor. Case Report.

BACKGROUND: Ganglioneuroma (GN) is a rare benign tumor arising from the neural crest cells. The reported incidence of GN is one per million population. As a primary retroperitoneal tumor, it constitutes only a small percentage of 0.72 to 1.6%. GN can arise de novo or as a result of maturation of a neuroblastoma either spontaneously or after chemotherapy. The most common location is the posterior paraspinal mediastinum, retroperitoneum, neck and adrenal gland. However, GN can potentially occur anywhere along the peripheral autonomic ganglion sites. Most ganglioneuromas are asymptomatic and found incidentally. CASE REPORT: We present a case of retroperitoneal ganglioneuroma that mimicked renal mass on imaging. The tumor was incidentally discovered during an abdominal ultrasound examination 43-year-old male patient without clinical symptoms. Complete surgical resection was subsequently performed and histopathological examination of the retroperitoneal mass revealed GN. CONCLUSIONS: Retroperitoneal ganglioneuroma is a rare bening tumor, generally asymptomatic, which grows slowly, and appears large when it is identified. Preoperative diagnosis can be challenging, particularly in asymptomatic case. Histopathological examination is currently the mainstay of diagnosis. In the case presented herein GN stricktly adjoined to the left kidney mimicking renal mass.

Assessment of aortic valve in regard to its anatomical variants morphology in 2053 patients using 64-slice CT retrospective coronary angiography.

BACKGROUND: Bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly. Other aortic valve variants are rare but are associated with an increased incidence of various pathologies of the aortic valve (AV). The aim of this study was to assess the AV function in regard to its anatomical variants morphology in patients who underwent 64-slice coronary computed tomography angiography (CCTA) for suspected or known coronary artery disease. METHODS: The results of 64-detector retrospective ECG-gated CCTA of 2053 patients (mean age 58 years; 1265 males) were analyzed retrospectively by experienced cardiovascular radiologist. Coronary anatomy (with coronary artery dominance) and the extent of occlusion in the coronary arteries were assessed. Furthermore morphological and functional status of AV variants were analyzed. Among measured parameters were area at the level of AV annulus, orifice and tubular portion of the ascending aorta. RESULTS: The AV was visualized in all CCTA studies and the analysis of its morphology and function was done in all patients. BAV was found in 19 patients (0.9 %), from which type 0 was diagnosed in five patients (0.2 %) and type 1 in 14 patients (0.7 %) - there was no patient with BAV type 2. Unicuspid (UAV) and quadricuspid (QAV) variant were both observed each in one patient (0.05 %). In rest of the patients from the study group tricuspid AV variant was recognized. Function of AV variants was mostly affected in BAV0 and UAV. Among patients with BAV1 there were patients with normal and abnormal function of AV. QAV variant did not deteriorate AV function. There was no difference in coronary artery disease and dominancy between different anatomical variants of AV. CONCLUSIONS: During CCTA different valve variants can be detected and detailed analysis of valvular function can be proceeded. Larger values of annulus area, wider diameters of ascending aorta and more stenotic profile were observed in BAV 0, BAV 1 and UAV. Among AV variants morphology and function was mostly affected in patients with BAV 0 and UAV variants, while subjects with BAV1 had normal or abnormal function of the AV. Moreover, we noticed that QAV variant did not deteriorate AV function.

The Role of Computed Tomography in the Diagnostics of Diaphragmatic Injury After Blunt Thoraco-Abdominal Trauma.

BACKGROUND: Diaphragmatic injuries occur in 0.8-8% of patients with blunt trauma. The clinical diagnosis of diaphragmatic rupture is difficult and may be overshadowed by associated injuries. Diaphragmatic rupture does not resolve spontaneously and may cause life-threatening complications. The aim of this study was to present radiological findings in patients with diaphragmatic injury. MATERIAL/METHODS: The analysis of computed tomography examinations performed between 2007 and 2012 revealed 200 patients after blunt thoraco-abdominal trauma. Diaphragmatic rupture was diagnosed in 13 patients. Twelve of these patients had suffered traumatic injuries and underwent a surgical procedure that confirmed the rupture of the diaphragm. Most of diaphragmatic ruptures were left-sided (10) while only 2 of them were right-sided. In addition to those 12 patients there, another patient was admitted to the emergency department with left-sided abdominal and chest pain. That patient had undergone a blunt thoracoabdominal trauma 5 years earlier and complained of recurring pain. During surgery there was only partial relaxation of the diaphragm, without rupture. The most important signs of the diaphragmatic rupture in computed tomography include: segmental discontinuity of the diaphragm with herniation through the rupture, dependent viscera sign, collar sign and other signs (sinus cut-off sign, hump sign, band sign). RESULTS: In our study blunt diaphragmatic rupture occurred in 6% of cases as confirmed intraoperatively. In all patients, coronal and sagittal reformatted images showed herniation through the diaphragmatic rupture. In left-sided ruptures, herniation was accompanied by segmental discontinuity of the diaphragm and collar sign. In right-sided ruptures, predominance of hump sign and band sign was observed. Other signs were less common. CONCLUSIONS: The knowledge of the CT findings suggesting diaphragmatic rupture improves the detection of injuries in thoraco-abdominal trauma patients.

Visceral adipose tissue is associated with insulin resistance in hemodialyzed patients.

BACKGROUND: It has not been definitively established which factors affect insulin resistance (IR) and whether dialysis decreases IR. The aim of this study was to investigate factors that may have an influence on homeostasis model assessment (HOMA-IR) in hemodialyzed patients (HDpts) and to compare IR between HDpts and healthy subjects. MATERIAL AND METHODS: We examined 33 HDpts and paired 33 subjects of the control group, matched for sex, age, and BMI. We analyzed concentrations of insulin, glucose, leptin, resistin, and total and high-molecular-weight adiponectin (HMWad) in serum. Using computed tomography in HDpts, we evaluated visceral adipose tissue (VAT), concentrations of visfatin, CRP, and IL-6. RESULTS: HOMA-IR (median, 1.3 vs. 1.4, P=0.19), insulin (median 6.8 vs. 6.0 µIU/mL, P=0.7), glucose (79 mg/dL vs. 93 mg/dL, P=0.001). IR in HDpts is dependent on VAT (r=0.36, P=0.04) and this relationship is stronger than the relationship of BMI and IR (r=0.3, P=0.1). In HDpts we found higher concentrations of leptin (P=0.001) and resistin (P<0.001), with no relation to IR. HMWad and its percentage in relation to total adiponectin are higher in HDpts (P=0.03 and P<0.001, respectively). CONCLUSIONS: HOMA-IR in HDpts does not differ from the control group. In HDpts it depends on the quantity of VAT and this relationship is stronger than with BMI. In HDpts leptin and resistin do not influence IR. HMWad and its percentage in total adiponectin are significantly higher in HDpts.

MR enterography imaging of Crohn's disease in pediatric patients.

BACKGROUND: Crohn disease (CD) is a chronic inflammatory process of gastrointestinal tract, which frequently affects children. Recent advances in Magnetic Resonance Imaging (MRI) technique have made small bowel imaging possible, what is extremely useful in pediatrics. The purpose of this article is to describe the characteristic MR enterography findings and to present the advantages of this modality in pediatric patients. MATERIAL/METHODS: A group of 40 patients referred from the Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw was included in the analysis. The patients' age ranged from 7 to 18 years (mean age 14 years). Among the study participants, 28 patients were diagnosed with CD, whereas 12 patients had a history of ulcerative colitis or were strongly suspected of CD based on clinical data. The examinations were performed on GE Signa HD 1,5 T system. Small bowel distention was achieved by oral administration of 600-1000 ml of hyperosmotic solution of polyetylenglycol (PEG). Prior to the examination, 20-40 mg of a spasmolytic drug, hioscine-N-butylobromide (Buscolysin(®)), was administrated to reduce peristaltic movements. RESULTS: The abnormal small bowel segments were found in 21 patients and the features of colonic disease were detected in 5 patients. In 2 patients the lesions involved both small and large bowel. In 16 subjects mural changes were not found. Among studied patients, following signs of small bowel inflammation were fund: bowel wall thickening (n=21), submucosal edema (n=8), segment wall hyperenhancement (n=18), deep ulceration (n=6), fistula (n=3), stenosis (n=7), mesenteric signs such as hyperemia (n=9), fibrofatty proliferation (n=8) and lymphadenopathy (n=28). CONCLUSIONS: MR enterography is an excellent examination, which provides an accurate information about severity and activity of and complications related to CD. It is especially valuable in children, because of lack of the negative consequences of repeated exposure to ionizing radiation.

Differentiation of ovarian cancers from borderline ovarian tumors on the basis of evaluation of tumor vascularity in multi-row detector computed tomography--comparison with histopathology.

OBJECTIVE: The aim of this study was to evaluate the feasibility of multi-detector row computed tomography (MDCT) in the differentiation between borderline ovarian tumors and ovarian cancer on the basis of tumor morphology and specific features of tumor vascularity in correlation with the results at pathology. METHODS: A triphasic MDCT protocol was used for the analysis of tumor vascularity. The following features were taken into account: (1) The number of vessels in papillary projections, solid-tissue component, and septa (2 vs >2), (2) serpentine and chaotic configuration of vessels, (3) presence of microaneurysms, and (4) presence of arteriovenous microfistulas. Masses with at least 3 of 4 features were considered ovarian cancer (group A) and masses with 2 features or less as borderline tumor (group B). Radiological findings were compared with results of postoperative pathology. RESULTS: Pathologic vessels were found in all 56 patients. Thirty-two patients were included in group A and 24 in group B. The results of pathology were as follows: in group A: 31 malignant tumors, including 31 ovarian carcinomas and 1 benign cystadenoma; in group B: 22 borderline ovarian tumors, 1 benign cystadenoma, and 1 ovarian cancer. CONCLUSIONS: Morphological evaluation of tumor vascularity in MDCT seems to be an efficient method of differentiating between borderline ovarian tumors and ovarian carcinomas. Because of a small number of cases in the current study, a further research seems justified to confirm our results. The presented MDCT-angiographic criteria showed high sensitivity (97%) and specificity (96%) in differentiation of borderline ovarian tumors and ovarian cancers as compared with pathology. The presented CT-angiographic criteria of malignancy showed an excellent interobserver agreement.

The application of MDCT in the diagnosis of chest trauma.

INTRODUCTION: Traumas are the third most common cause of death worldwide, after cardiovascular diseases and neoplasms, and the main cause of death of patients under 40 years of age. Contemporary image diagnosis of chest trauma uses chest X-ray (CXR), multidetector computed tomography (MDCT), transthoracic and transoesophageal ultrasound (USG), X-ray angiography and magnetic resonance. The aim of the present study was to evaluate MDCT results in the examination of posttraumatic chest injuries and to compare the results of CXR and MDCT in chosen chest traumatic injuries. MATERIAL AND METHODS: The sixty patients with chest trauma included in the study were diagnosed at the Department of Radiology of the Institute of Tuberculosis and Lung Diseases between May 2004 and October 2007. MDCT was performed in all patients. Two groups with different types of injury (blunt or penetrating chest trauma) were distinguished. The analysis of injuries in both groups was conducted depending on the mechanism of trauma. The detection of 20 selected injuries at CXR and MDCT was compared. Moreover, the compatibility of MDCT with the results of intraoperative assessment and bronchoscopy was analysed. The influence of MDCT on the treatment modality was also assessed. RESULTS: History of blunt chest trauma was found in 51 patients (group 1) and of penetrating trauma in 9 patients (group 2). The most frequent injuries among group 1 were lung contusion and rib fractures, and among group 2 it was pericardial hematoma. Compared to MDCT, the sensitivity and specificity of CXR were 66.7 and 58%, respectively. Change of treatment modality was observed after MDCT in 83% of patients. The sensitivity and specificity of MDCT in diagnosing tracheobronchial injury, compared to bronchoscopy, were 72.7% and 100%, respectively. Compatibility of MDCT results and intraoperative assessment was observed in 43% of patients, and the main reason for discrepancy was underdiagnosis of diaphragm injury in MDCT. CONCLUSIONS: MDCT was a valuable diagnostic method in recognition of chest trauma, characterized by high sensitivity and specificity in the assessment of life-threatening injures and for depicting tracheal and bronchial injuries. The diagnostic value of CXR was low. The compatibility of MCTD and intraoperative assessment was confirmed, with the exception of diaphragm injures and lung laceration. Change of treatment modality was certified after MDCT in 83% of patients.

Gray matter volume increases induced by intragastric balloon treatment and their associations with neuroinflammation: A magnetic resonance study.

OBJECTIVE: We simultaneously performed structural MRI, 1H magnetic resonance spectroscopy, and whole-body hydration status assessment to evaluate brain changes in patients with morbid obesity treated with intra-gastric balloon (IGB) for six months. We asked, if changes in myo-inositol ratios (marker of neuroinflammation) are related to brain volume increases accompanying IGB-induced weight loss. METHODS: Twenty five patients with morbid obesity (OB, 43.9 ± 11.8 years, BMI = 49.1 ± 7.2, 12 females, 9 without co-morbid conditions) were treated with IGB for six months. They underwent magnetic resonance imaging at 3T one month before IGB insertion, three months after insertion (N = 19), and one month after IGB removal (N = 14). RESULTS: Insertion of IGB lead to 8.9% and 12.3% weight reduction over the first three months and over the entire treatment, respectively. Over the entire treatment, total gray matter volume increased by 2.0% (p = 0.009). These changes were mostly pronounced in the left precuneus and in the right frontal pole (>1.9%, p < 0.009). The increases in cortical volume in the right hemisphere and the left posterior cingulate cortical thickness over the entire treatment were significantly related to decreases in myo-inositol ratios measured over the first three months of the treatment (r < -0.740, p < 0.006). CONCLUSIONS: IGB treatment lead to brain structural improvements consistent with earlier studies of bariatric patients without co-morbid conditions. Our results also pointed to improvements in brain regions, where atrophy in other studies was related to type 2 diabetes and hypertension. The correlations point to neuroinflammation as one of the potential processes behind brain volume reductions in patients with morbid obesity.

Sarcopenia-The Impact on Physical Capacity of Liver Transplant Patients.

Optimizing patients' condition before liver transplantation (LT) could potentially improve survival of LT patients. We focused on sarcopenia, as a common factor in liver transplant candidates that can impact their cardiopulmonary performance at the point of listing, morbidity, and mortality after LT. We performed a single-center cohort study on 98 consecutive patients with liver cirrhosis who were transplanted between March 2015 and December 2017. The third lumbar vertebra skeletal muscle index (L3SMI) was calculated using CT imaging to distinguish sarcopenia at listing for LT. Data regarding liver function, body mass index (BMI), cardiac biomarkers, the peak oxygen uptake (VO2) and LT outcome were collected and correlated to L3SMI. For data analysis the Dell Statistica (Version 13. Dell Inc., Rondrock, TX, USA) was used. In total, 98 cirrhotic patients were included. Fifty-five (56.1%) patients, mostly males, had sarcopenia according to L3SMI, with the lowest L3SMI in males with alcohol-related liver disease. Lower L3SMI correlated with lower BMI, lower VO2 peak, and higher NTproBNP (all p < 0.001) and revealed an essential correlation with prolonged ICU stay (r = -0.21, p < 0.05). 33 patients were unable to perform cardio-pulmonary exercise test, mostly sarcopenic (67%), with more advanced liver insufficiency (assessed with CPC and MELD scores) and longer stay at ICU after LT (all p < 0.001). Sarcopenia was common among LT recipients. It was associated with inferior result in cardio-pulmonary performance before LT and prolonged ICU stay after grafting.

Simplified method of dynamic contrast-enhanced computed tomography in the evaluation of indeterminate pulmonary nodules.

BACKGROUND: Dynamic contrast-enhanced computed tomography (CECT) is one of the methods used in the evaluation of lung nodules. OBJECTIVES: The aim of the study was to evaluate the accuracy of the simplified method (based on only 2 postcontrast measurements) of dynamic CECT in determining the nature of pulmonary nodules. METHODS: Forty nodules (solid, 10-40 mm in diameter, spherical, with no visible calcification or fatty tissue) in 40 patients were analyzed. In 30 patients, the nature of the nodule was confirmed by pathological examination. In 10 cases, the nodules were assumed to be benign, as no growth within 2 years was radiologically documented. All patients underwent CECT according to a simplified protocol (based on pre-enhancement and 2 postcontrast measurements at 30 s and 4 min after contrast injection). RESULTS: Twenty-three (57.5%) nodules were proved to be malignant and 17 (42.5%) benign. The 7 benign and none of the malignant nodules showed an enhancement value of < or = 15 Hounsfield units. Thus, the sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of shortened dynamic CECT were 100, 41, 70, 100 and 75%, respectively. CONCLUSIONS: In CECT, contrast enhancement of a pulmonary nodule < or = 15 Hounsfield units is a reliable predictor of its benignity. Reduction in the number of postcontrast measurements in the simplified method of dynamic CECT does not influence its sensitivity.

[Correlation of mucosal involvement as evaluated by computed tomography and bone single-photon emission tomography findings SPECT in patients with chronic rhinosinusitis]. / Korelacja nasilenia zmian zapalnych blony sluzowej zatok przynosowych w ocenie tomografia komputerowa i tkanki kostnej blednika sitowego w ocenie tomografia emisyjna pojedynczych fotonów SPECT u pacjentów z przewleklym zapaleniem zatok przynosowych.

UNLABELLED: Osteitis has been proven to play important role in patophysiology of chronic rhinosinusitis (CRS). Computed tomography (CT), a standard diagnostic technique used to evaluate the extent of the sinus disease, fails to show the bone involvement in patients with CRS. In contrast single-photon emission tomography (SPECT) yields adequate information on remodeling and bone turnover. Persistent osteitis may be one of the reasons of failure of adequate medical and surgical therapy for CRS and discrepancies between extent of the disease as evaluated by CT and symptom scores. THE AIM OF THE STUDY: is to evaluate correlation between the results of CT and SPECT in patients with CRS. MATERIAL AND METHODS: 29 patients with CRS (15 with nasal polyps and 14 without nasal polyps) were evaluated with CT and SPECT. The mucosal involvement of CRS graded on Lund-Mackay Scale (LMS) was compared to degree of bone involvement evaluated by SPECT with the use of modified LMS. RESULTS: The mean LMS grade was 13,3 for CT and 9,8 for SCPECT (modified LMS). A positive correlation between the results of two imaging methods was found r = 0.72 (p < 0.0001). CONCLUSIONS: The bone involvement as evaluated by SPECT correlates with the degree of mucosal changes showed by CT.

Liver volume: a point of no return in liver transplantation?

INTRODUCTION: In patients with cirrhosis, only a 75% liver volume (LV) is expected compared with age­matched healthy individuals. Changes in LV might be an indicator of therapeutic effectiveness or disease progression. OBJECTIVES: To establish whether LV is a prognostic factor in chronic liver disease irrespective of etiology and LV impacts the outcomes of liver transplant (LT). PATIENTS AND METHODS: In total, 135 consecutive LT recipients were prospectively included in this study: 38 women and 97 men. The median (minimum-maximum) age was 51 (21-70) years; body mass index (BMI), 27.3 (17.3-39.2) kg/m2; Child-Pugh class (CPC), C; Model of End­Stage Liver Disease (MELD), 16 (7-47) points; and the third lumbar vertebra skeletal muscle index (L3SMI), 47.7 (19.7-73.4) cm2/m2. Liver volume and L3SMI were calculated based on computed tomography scans at listing for LT. The receiver operating characteristic (ROC) curve was analyzed to determine the accuracy of LV in mortality prediction after LT. RESULTS: Liver volume differed significantly among patients in terms of chronic liver disease etiology, with the lowest values noted in those with hepatitis C virus infection. Liver volume was neither a prognostic factor of disease progression and need for LT with respect to the CPC and MELD scores nor correlated with BMI and L3SMI (P >0.05). The area under the ROC curve of LV in mortality prediction was 0.573 (95% CI, 0.403-0.743). Liver volume smaller than the median tended to be positively associated with the risk of prolonged intensive care unit stay and death (P = 0.057 and P = 0.058, respectively). CONCLUSIONS: Low liver volume did not seem be a point of no return in LT candidates.

Unusual post-traumatic aortic rupture in a paraglide pilot - A case report.

Post-traumatic aortic injuries are more common in victims of aircraft accidents than in motor vehicle accidents, and are a leading cause of on-site and delayed mortality, regardless of cause. In this case report, we present a history of a nearly isolated aortic post-traumatic injury in a victim of a paragliding accident. The rarity of this case lies in 2 factors, that is, the lack of the other life-threatening injuries usually present in high-energy accidents, and an unusual, exfoliative type of injury not matching more closely the typical classifications made use of currently in clinical practice.

Impact of Body Composition on the Risk of Hepatocellular Carcinoma Recurrence After Liver Transplantation.

BACKGROUND: Body composition parameters are reported to influence the risk of hepatocellular carcinoma (HCC) recurrence after liver resection, yet data on patients undergoing liver transplantation are scarce. The aim of this study was to evaluate the impact of the amount of abdominal adipose tissue and skeletal muscles on the risk of HCC recurrence after liver transplantation. METHODS: This was a retrospective observational study performed on 77 HCC patients after liver transplantation. Subcutaneous fat area (SFA), visceral fat area, psoas muscle area and total skeletal muscle area were assessed on computed tomography on the level of L3 vertebra and divided by square meters of patient height. The primary outcome measure was five-year recurrence-free survival. RESULTS: Recurrence-free survival in the entire cohort was 95.7%, 90.8%, and 86.5% after one, three, and five years post-transplantation, respectively. SFA was significantly associated with the risk of HCC recurrence (p = 0.013), whereas no significant effects were found for visceral fat and skeletal muscle indices. The optimal cut-off for SFA for prediction of recurrence was 71.5 cm2/m2. Patients with SFA < 71.5 cm2/m2 and ≥71.5 cm2/m2 exhibited five-year recurrence-free survival of 96.0% and 55.4%, respectively (p = 0.001). CONCLUSIONS: Excessive amount of subcutaneous adipose tissue is a risk factor for HCC recurrence after liver transplantation and may be considered in patient selection process.

Elevated D-dimer concentration identifies patients with incomplete recanalization of pulmonary artery thromboemboli despite 6 months anticoagulation after the first episode of acute pulmonary embolism.

BACKGROUND: Despite long-term anticoagulation in some patients after acute pulmonary embolism (APE) pulmonary thrombi are not completely resolved. We hypothesized that elevated D-dimer concentration reflecting increased endogenous fibrinolysis may indicate incomplete pulmonary thrombi resolution after the first episode of PE. METHODS: 55 patients aged 54.7+/-18.6 years were anticoagulated for 6 months with acenocumarol (74.5% patients) or low molecular weight heparin (25.5% patients) when control spiral computed tomography (sCT), lung perfusion scintigraphy and D-dimer assessment were performed. RESULTS: Incomplete recanalization of pulmonary circulation was found in 39 (70.9%) patients - thrombi at sCT and/or > or =1 wedge-shaped perfusion defect at scintigraphy. Age, sex, rate of unprovoked APE, malignancies, thrombolysis in the acute phase and type of long-term anticoagulation were similar in patients without and with complete recanalization. D-dimer at follow-up but not on admission was higher in patients with then without incomplete recanalization (median 340 (80-2280) vs 160 (60-390) ng/mL, p=0.02). All 11 (20%) patients with D-dimer level >500 ng/mL at follow-up did not resolve thromboemboli completely. ROC analysis showed that D-dimer at follow-up identified patients with incomplete recanalization (AUC 0.709, 95% CI (0.560-0.831), p=0.007). Multivariable analysis confirmed that D-dimer >350 ng/mL at follow-up and right ventricle dysfunction at the diagnosis were independent predictors of incomplete recanalization (OR 18.58 (95% CI 1.97-175.19) and 7.03 (95% CI 1.43-34.6), respectively, p=0.0006). CONCLUSION: Elevated D-dimer after 6 months anticoagulation and right ventricular dysfunction at the diagnosis predict incomplete recanalization of pulmonary circulation after first episode of APE.

Safety of living donor in pediatric liver transplantation--analysis of 100 consecutive donors.

BACKGROUND/AIM: The aim of this study was to evaluate safety of donors of liver fragments of different size and regeneration of the remaining liver. METHODOLOGY: Between October 1999 and January 2007 liver segments II and III were harvested from 90 donors and segments II, III and IV from 10 donors. Liver volumetry by computed tomography (CT) and biochemical liver function tests were performed at baseline and 7 days, 30 days and 12 months after the operation. RESULTS: CT-assisted volumetry correlated with mass of harvested graft (r=0.779; p<0.05). Twelve months after resection mean regeneration index was 138.64% +/- 23.98% in donors of segments II, III and IV and 109.93% +/- 18.36% in donors of segments II and III (p<0.02). Transient elevation of bilirubin and trans-aminases and decreased prothrombin index were observed in the early postoperative period. Twelve months after the operation mean levels of these parameters were within normal limits. No deaths and no severe complications were observed during the follow-up. CONCLUSIONS: CT-assisted volumetry permits an adequate estimation of liver fragments intended for harvesting. Harvesting of II and III or II, III and IV segments does not compromise donor's safety. Liver regeneration is significantly greater after harvesting of II, III and IV segments than that of II and III segments.

[Unfortunate outcome of subsequent vascular complications in female patients assigned to percutaneous coronary intervention -- case report]. / Niekorzystny przebieg kolejnych powiklan naczyniowych u chorej poddanej zabiegowi planowej angioplastyki wiencowej -- opis przypadku.

We present a case of a 58-year-old female who underwent elective PCI of the left anterior descending coronary artery. The procedure was complicated by vessel dissections and myocardial infarction. Cardiogenic shock complicated acute coronary syndrome required intraaortic balloon pumping what led to descending aortic dissection successfully treated with stent-graft implantation. However, the patient died due to intractable cardiogenic shock.