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

Magnetic resonance diffusion-weighted imaging in diagnostics of primary fallopian tube carcinoma : is it useful?

Purpose: Primary fallopian tube carcinoma (PFTC) is the rarest form of female genital malignancy. The imaging applied for suspected adnexal masses includes transvaginal ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), but the vast majority of PFTC is recognised intraoperatively. Material and methods: The study group consisted of seven women with postoperatively histopathological diagnosis of PFTC. To recognise characteristic findings for PFTC, retrospective analysis of preoperative MRI was performed. All patients underwent MRI of the pelvis and abdomen using a 1.5T MR system. Based on the results of the above imaging, suspected adnexal masses were recognised. MRI protocol contained T2-weighted images, fat-suppressed T2-weighted, T2-TIRM, DW EPI, pre- and postcontrast dynamic 3D T1 GRE in transverse orientation, with diffusion weightings of 0, 50, 100, 150, 200, 400, 800, and 1200 s/mm2. Regions of interest were outlined by a radiologist, who documented the character of adnexal masses on diffusion-weighted (DW) images and apparent diffusion coefficient (ADC) maps. Results: In all seven patients with PFTC unilateral tumour was found. On all DW images (with b values of 0, 50, 100, 150, 200, 400, 800, and 1200 s/mm2) the mean signal intensities of solid parts of tumour were significantly higher than the mean signal intensities of normal ovarian tissue (p = 0.0001). There were no statistically significant differences between eight b values applied for ADC calculations. Conclusions: Preoperative diagnostics of PFTC is difficult and mainly based on morphological features. Previous research did not show characteristics of PFTC in post-contrast dynamic imaging. In our material a clear increasing of signal intensity in DW imaging occurred independently of the b value

Splenektomia jako część operacji cytoredukcyjnej u pacjentek z zaawansowanym rakiem jajnika

Objectives: The aim of the study was the assessment of perioperative complications in patients with advanced ovarian cancer who underwent splenectomy to achieve optimal debulking. Material and methods: We analyzed eight debulking procedures with splenectomy and the postoperative period in ovarian cancer patients, FIGO stage IIIB-IV. Preoperative diagnostics included multidetector computed tomography (MDCT) or diffusion-weighted echo-planar magnetic resonance (MR-DWI). The following factors were analyzed: size of the removed tumor, size of remains left, blood loss, packed red blood cell transfusion, quantity and reason for reoperations, pancreatic amylase concentrations in the drainage fluid, wound infection, fever over 38°C, and length of hospitalization. Results: Complete debulking was achieved in 8 patients, including 5 cases with no macroscopic residual lesions and 3 patients with lesion diameter ofCel pracy: Celem pracy jest ocena powikłań okołoperacyjnych u chorych leczonych z powodu zaawansowanego raka jajnika, u ktorych w celu uzyskania optymalnej cytoredukcji wykonano usunięcie śledziony. Materiał i metoda: Analizowano 8 operacji cytoredukcyjnych z resekcją śledziony oraz okres pooperacyjny u chorych na raka jajnika w stopniu IIIB-IV wg FIGO. W czasie diagnostyki przedoperacyjnej wykonano wielorzędową tomografię komputerową (MDCT) lub rezonans magnetyczny z wykorzystaniem obrazow zależnych od dyfuzji cząsteczek wody (MR-DWI). W opisowej analizie wynikow uwzględniono: wielkość usuniętego guza, wielkość pozostawionych ognisk nowotworu, utratę krwi, przetoczenia koncentratu krwinek czerwonych, ilość i powody reoperacji, stężenie amylazy trzustkowej w płynie drenowanym z jamy brzusznej, zakażenia rany, gorączkę powyżej 38 stopni i długość hospitalizacji. Wyniki: U wszystkich ośmiu chorych uzyskano optymalną cytoredukcję, w tym u 5 nie pozostawiono choroby resztkowej, u 3 pozostawione resztki nowotworu miały średnicę poniżej 10 mm. Powodem jedynej reoperacji była perforacja ściany żołądka spowodowana jej owrzodzeniem. Mediana utraty krwi wyniosła 1050 ml, a okołooperacyjnego przetoczenia koncentratu krwinek czerwonych wymagało 75% operowanych. U sześciu pacjentek po operacji stwierdzono obecność amylazy trzustkowej w płynie drenowanym z jamy brzusznej. Stężenie amylazy w pierwszej dobie po zabiegu ponad 5-krotnie przekraczało normę stężenia w surowicy. W trzeciej dobie po zabiegu spadało poniżej normy w surowicy. Nie zanotowano występowania gorączki powyżej 38 stopni i zakażeń rany. Nie stwierdzono zgonow okołooperacyjnych. Długość hospitalizacji wynosiła 6 dni. Wnioski: Splenektomia u chorych na zaawansowanego raka jajnika przynosi korzyści i może być wykonywana jeżeli możliwe jest uzyskanie cytoredukcji bez pozostawienia makroskopowych resztek choroby. Ryzyko powikłań okołooperacyjnych jest niskie i możliwe do zaakceptowania

Aortoesophageal fistula as a complication of thoracic aorta stent graft implantation: two cases and literature review

Thoracic endovascular aortic repair (TEVAR) is a method of choice in the treatment of thoracic aorta aneurysmsand dissections. In case of a thoracoabdominal aneurysm, endovascular treatment is also being chosen moreoften, especially in patients with multimorbidity. Despite better results and less invasiveness in comparison toclassic open surgery, endovascular treatment is also associated with complications. One of the rarer and usuallyfatal complications are aortoesophageal fistula (AEF). We present two cases, in which TEVAR complicationwas AEF. Case 1 was an 87-year-old woman with a history of TEVAR 5 years earlier, who presented increasedinflammation parameters, massive gastrointestinal bleeding, and progressive anemia. Case 2 was a 66-year-oldwoman with a history of TEVAR 6 months earlier, who on admission presented medium increased inflammatorymarkers and anemia. None of the patients was qualified for surgical treatment. Both patient 1 and patient 2died during hospitalization. Diagnostic imaging plays a key role in the diagnosis of AEF. CT angiography performedin patients with AEF can show the presence of gas in the sac of aneurysm as a result of infection, a defect inthe aortic wall, or thickened esophagus with fluid level. CT angiography of the aorta combined with esophagogastroduodenoscopy(EGD) and contrast-enhanced X-ray examination of the gastrointestinal tract, enablesto confirm or exclude the diagnosis of AEF. Atypical clinical feature and increased parameters of inflammationin patients with the history of TEVAR should always suggest the presence of AEF

Dopływy lewej żyły ramienno-głowowej, problem kaniulacji żył centralnych/centralnego cewnikowania żylnego i potencjalny wszczepialnych urządzeń elektronicznych serca

Introduction. Intravascular procedures, including central venous catheterization and placement of cardiac implantable electronic device (CIED) leads, present an opportunity for radiological assessment of the relevant vessels. Obtaining vascular access via left clavipectoral triangle veins may lead to an unintentional catheter/lead insertion into a left brachiocephalic vein (BCV) tributary. This article presents the left-BCV tributaries encountered during CIED implantation procedures and discusses the potential impact of vessel topography on the course of such procedures. Material and methods. Venography records of de novo CIED implantation procedures conducted between 2014 and 2018 were analyzed retrospectively. The indication for these venographies had been the need to determine the cause of difficulties in threading a lead through the venous system. As the title suggests, this paper focuses only on the records illustrating the presence and course of left-BCV tributaries. Results. Out of a total of 315 venographies, we found 12 cases of left-BCV tributaries, including nine left superior intercostal veins (SICVs), two left internal thoracic (mammary) veins (IMVs), and one inferior thyroid vein. Other veins had not been visualized. Conclusions. The left SICV and, less commonly, left IMV were the most commonly visualized left-BCV tributaries in the analyzed imaging records of de novo CIED placement procedures. The anatomical variants of those vessels that drain into the left BCV from below, at the outer or convex wall of the bend in the left BCV, increase the risk of unintentional CIED lead or central venous catheter insertion.Wstęp. Wykonywanie procedur inwazyjnych, takie jak zakładanie cewników CVC (central venous catheter) czy elektrod CIED (cardiac implantable electronic device), sprzyja radiologicznym obserwacjom naczyń wykorzystywanych podczas ich realizacji. W przypadku stosowania dostępu żylnego z naczyń lewego trójkąta naramienno-piersiowego może dojść do niezamierzonego wprowadzenia cewnika/elektrody do jednego z dopływów lewej żyły ramienno-głowowej (LBCV). Celem opracowania była prezentacja dopływów LBCV napotkanych podczas CIED i potencjalny wpływ ich topografii na przebieg procedury. Materiał i metody. Ocenie retrospektywnej poddano wenografie wykonane podczas CIED de novo w latach 2014–2018. Wskazaniem do wykonania diagnostyki obrazowej była potrzeba ustalenia przyczyny utrudnionego przeprowadzania elektrody układem żylnym. Z racji tematyki opracowania w powyższej grupie wyodrębniono i poddano analizie jedynie nagrania wizualizujące obecność i charakter dopływów LBCV. Wyniki. Wśród wykonanych 315 wenografii znaleziono 12 przypadków spływów żylnych do LBCV, w tym: 9 lewej górnej żyły międzyżebrowej (LSICV), 2 lewej żyły piersiowej wewnętrznej (LITV/LIMV) oraz 1 lewej żyły tarczowej dolnej (ITV), innych w ocenianym materiale nie zobrazowano. Wnioski. W analizowanym materiale procedur CIED de novo najczęściej obserwowano obecność LSICV, rzadziej LIMV, zaś ich postacie anatomiczne układające się równolegle do osi ciała i łączące się z dolną ścianą LBCV w obszarze jej kątowego zagięcia mogą sprzyjać niezamierzonemu wprowadzeniu tamże elektrody CIED/cewników CVC

Tumor-Bowel Fistula as a Rare Form of Recurrent Ovarian Cancer—Imaging and Treatment: Preliminary Report

Background. The aim of this pilot study was to evaluate the value of imaging techniques, including computed tomography (CT) and magnetic resonance imaging (MRI), in the diagnosis of a tumor-bowel fistula as a rare form of epithelial ovarian cancer (EOC) relapse. We also performed an initial assessment of the effectiveness of the treatment of this form of relapse. Methods. The study group consisted of eight patients with suspected platinum-sensitive recurrence in the form of a tumor/bowel fistula. All patients finished their first line of chemotherapy and subsequently showed complete remission for 6 months or more. To qualify patients for further treatment, CT and MRI were performed, which suggested the presence of a fistula between the recurrent tumor and intestine. DESKTOP study criteria were used to qualify patients for secondary cytoreduction. Second-line chemotherapy was given after secondary debulking. Results. In all patients, fistulas formed between the tumor and large bowel. On CT, the fistulas were indirectly visible. In all cases, the fistula was visible on MR images, which showed hypointensity on the T2 and T1 post-contrast sequences but did not show restricted diffusion on the diffusion-weighted imaging (DWI) sequence. Patients who were qualified for the study underwent secondary debulking with bowel resection. In all eight cases, the fistula between the tumor and surrounding organs was confirmed. During surgery, seven intestinal anastomoses and one colostomy were performed. No residual macroscopic tumor remained in seven cases (resection R0-87.5%). The progression-free survival (PFS) was 8.4–22.6 months (median 13.4). In the group with cytoreduction R0, the median PFS was 15.5 months (12–22). Conclusion. In patients with suspected EOC recurrence with clinically suspected fistula, CT scan is not sufficient. In CT, the presence of a fistula is suspected based on indirect symptoms. MRI, as a method with much greater tissue resolution, confirms the diagnosis. In addition, MRI can identify the point of the tumor/bowel junction. This is especially true with a large infiltration covering several intestinal parts. Bowel resection with simultaneous anastomosis is a good and safe solution for these patients. However, appropriate qualification for the procedure is necessary, which will allow for surgery without residual macroscopic disease (R0 surgery). Due to the small number of cases, our results cannot be generalized. We treat them as a hypothesis that can be verified in a larger study

Diffusion-Weighted Imaging of Small Peritoneal Implants in “Potentially” Early-Stage Ovarian Cancer

Introduction. MRI is established modality for the diagnosis of ovarian malignancies. Advances in MRI technology, including DW imaging, could lead to the further increase in the sensitivity of MRI for the detection of peritoneal metastases. The aim of this study was to assess the accuracy of DW imaging for detection of peritoneal metastatic disease in patients suspected of having potentially early ovarian cancer and secondly to evaluate ADC values of peritoneal implants. Materials and Methods. The prospective study group consisted of 26 women with sonographic or/and CT diagnosis of suspected ovarian tumor. Based on the results of the above imaging, in none of them was extraovarian spread of disease or ascites recognized. All patients underwent MRI with DW imaging. Results. Overall, 18 extraovarian peritoneal lesions were found on DW images in 10 from 26 examined patients. All implants had diameter ≤10 mm. The presence of all lesions diagnosed by MRI was confirmed intraoperatively. Histopathologic findings in 17 proofs confirmed ovarian cancer. PPV was 94%. On all DW images (with b values of 0, 50, 100, 150, 200, 400, 800, and 1200 s/mm2) the mean signal intensities of peritoneal lesions were significantly higher than the mean signal intensities of normal adjacent tissue (p=0.000001)

Wydzielanie angiogennych cytokin VEGF, TGF-β1, IL-8 iTNF przez ludzkie komórki nowotworów jajnika

Objectives: Angiogenesis is a process that is indispensable in cancer progression. A complex network of tumor and microenvironment stimuli regulate angiogenesis. VEGF, TGF-β1, IL-8 and TNF belong to the angiogenic factors that are key points in vessel formation. The aim of the study was to assess h-VEGF, TGF-β1, IL-8 and TNF secretion by human ovarian cell lines. Material and methods: OVA 2, OVA 4, OVA 9, OVA 11 and OVA 14 cell lines were established in our laboratory. The cells derived from primary and metastatic tumors of epithelial and non-epithelial origin. SK-OV-3, MDAH 2774, CAOV-1 and OVP-10 were the cell lines obtained from other sources. The concentration of VEGF, TGF-β1 and IL-8 was determined in culture supernatants by using the ELISA tests. Results: OVA 11 secreted all the evaluated cytokines. MDAH 2774 was the source of h-VEGF, TGF-β1, IL-8. SK-OV-3 secreted h-VEGF and IL-8. OVA 4 secreted TGF-β1 and TNF. TNF was the only studied cytokine secreted by CAOV-1, OVA 2 and OVA 9 cell lines. OVA 14 did not secret any of the cytokines. Conclusions: The investigated cell lines present heterogeneous profile of angiogenic cytokine secretion and seem to be an interesting set of models for the study of angiogenic signaling, or target therapy.Cel: Angiogeneza jest procesem niezbędnym do progresji raka. Złożona sieć bodźców pochodzących od guza i z mikrośrodowiska reguluje angiogenezę. VEGF, TGF-β1, IL-8 i TNF należą do czynników angiogennych, które odgrywają kluczową rolę w tworzeniu naczyń. Celem pracy była ocena wydzielania h-VEGF, TGF-β1, IL-8 i TNF przez ludzkie linie raka jajnika. Materiał i metoda: Linie OVA 2, OVA 4, OVA 9, OVA 11 oraz OVA 14 zostały ustalone samodzielnie. Komórki pochodziły z pierwotnych lub przerzutowych guzów jajnika pochodzenia nabłonkowego lub nienabłonkowego. Linie SK-OV-3, MDAH 2774, CAOV-1 oraz OVP-10 pochodziły z innych źródeł. Stężenie VEGF, TGF-β1 i IL-8 określano w supernatantach hodowli komórkowych w teście ELISA. Wyniki: Linia OVA 11 wydzielała wszystkie badane cytokiny. Linia MDAH 2774 była źródłem h-VEGF, TGF-β1, IL-8. Linia SK-OV-3 wydzielała h-VEGF oraz IL-8. Linia OVA 4 wydzielała TGF-β1 i TNF. TNF był jedyną cytokiną wydzielaną przez linie CAOV-1, OVA 2 oraz OVA 9. Linia OVA 14 nie wydzielała żadnej spośród badanych cytokin. Wnioski: Badane linie komórkowe stanowią heterogenną grupę nowotworów wydzielających cytokiny o właściwościach angiogennych i wydają się interesującym panelem do badań nad procesami angiogenezy czy terapii celowanej

The Value of Magnetic Resonance Diffusion-Weighted Imaging and Dynamic Contrast Enhancement in the Diagnosis and Prognosis of Treatment Response in Patients with Epithelial Serous Ovarian Cancer

Background. The aim of our study was to describe the selected parameters of diffusion-weighted imaging (DWI) and perfusion dynamic contrast enhancement (DCE) MRI in primary tumors in patients with serous epithelial ovarian cancer (EOC), as well as in disease course prognosis and treatment response, including bevacizumab maintenance therapy. Materials and Methods. In total, 55 patients with primary serous EOC were enrolled in the study. All patients underwent MR imaging using a 1.5 T clinical whole-body MR system in preoperative DWI and DCE MRI selected parameters: apparent diffusion coefficients (ADC), time to peek (TTP) and perfusion maximum enhancement (Perf. Max. En.) were measured. The data were compared with histopathological and immunochemistry results (with Ki67 and VEGF expression) and clinical outcomes. Results. Higher mean ADC values were found in low-grade EOC compared to high-grade EOC: 1151.27 vs. 894,918 (p < 0.0001). A negative correlation was found between ADC and Ki67 expression (p = 0.027), and between ADC and VEGF expression (p = 0.042). There was a negative correlation between TTP and PFS (p = 0.0019) and Perf. Max. En. and PSF (p = 0.003). In the Kaplan–Meier analysis (log rank), a longer PFS was found in patients with ADC values greater than the median; p = 0.046. The Kaplan–Meier analysis showed a longer PFS (p = 0.0126) in a group with TTP below the mean value for this parameter in patients who received maintenance treatment with bevacizumab. Conclusions. The described relationships between PFS and DCE and DWI allow us to hope to include these parameters in the group of EOC prognostic factors. This aspect seems to be of particular interest in the case of the association of PFS with DCE values in the group of patients treated with bevacizumab