Simultaneous occurance of symptomatic abdominal aortic aneurysm, superior mesenteric artery aneurysm and celiac trunk aneurysm

Chirurgiczne leczenie tętniaków w zakresie naczyń trzewnych w dobie rozwoju technik endowaskularnych jest rzadkie. Istnieją jednak sytuacje uniemożliwiające inne postępowanie. Przedstawiono przypadek 52-letniego mężczyzny z objawowym tętniakiem w zakresie aorty brzusznej w odcinku podnerkowym, tętniakiem tętnicy krezkowej górnej oraz tętniakiem pnia trzewnego. Zastosowane rozwiązanie operacyjne umożliwia łatwiejsze wykonanie technicznie trudnych zespoleń tętnicy krezkowej górnej i pnia trzewnego. Prawdopodobnie takie rozwiązanie techniczne może mieć również zastosowanie przy konieczności rekonstrukcji spowodowanej rozległymi zmianami miażdżycowymi obu głównych naczyń trzewnych pod warunkiem zachowania prawidłowej ściany aorty brzusznej na wysokości planowanej operacji.Surgical treatment of visceral vessel aneurysms in the time of endovascular technique is rare. We present the case of a 52-year-old man with simultaneous symptomatic aneurysm of the abdominal aorta in the subrenal section, superior mesenteric artery aneurysm, and celiac trunk aneurysm. The surgical solution applied in this case wass to carry out the technically difficult anastomoses of the superior mesenteric artery and the celiac trunk. Probably this technical solution could also be applied in situations when it is necessary to reconstruct both main visceral vessels damaged by extensive atherosclerotic changes if the abdominal aorta in the area of planned surgery is in good condition

Acromegaly in a patient with normal pituitary gland and somatotropic adenoma located in the sphenoid sinus

Ectopic acromegaly is a very rare clinical entity occurring in less than 1% of acromegalic patients. In most cases it is caused by GHRH or rarely GH&#8211;secreting neoplasms. Even rarer are ectopic pituitary adenomas located in the sphenoid sinus or nasopharynx that originate from pituitary remnants in the craniopharyngeal duct. This dissertation presents the difficulties in visualizing GH-secreting adenoma located in the sphenoid sinus. A 55-year-old man had somatic features of acromegaly for several years. MRI imaging revealed a slightly asymmetric pituitary gland (14 &#165; 4 mm) without focal lesions. Simultaneously, a spherical mass, 10 mm in diameter, corresponding with ectopic microadenoma was demonstrated on the upper wall of the sphenoid sinus. The serum GH level was 4.3 mg/l, IGF-1 = 615 mg/l, and a lack of GH suppression with oral glucose was proven. After preliminary treatment with a long-acting somatostatin analogue, transsphenoidal pituitary tumour removal was performed. Histopathological, electron microscopical and immunohistochemical analysis revealed densely granulated somatotropic pituitary adenoma: GH(+), PRL(-), ACTH(-), TSH(-), FSH(-), LH(-), MIB1 < 1%, SSTR3(+) and SSTR5(+). Post-surgical evaluation showed normal pituitary MRI scans, GH and IGF-1 levels 0.18 &#956;g/l and 140 mg/l, respectively, as well as normal GH suppression with oral glucose. The careful analysis of possible pituitary embryonic malformations points out their significance for proper localization of extrapituitary adenomas.Ektopowa postać akromegalii występuje u mniej niż 1% chorych. W większości przypadków jest ona spowodowana wydzielaniem GHRH lub sporadycznie GH przez guz nowotworowy. Jeszcze rzadsze są ektopowo położone gruczolaki przysadki. Zlokalizowane najczęściej w zatoce klinowej lub nosogardzieli, rozwijają się z fragmentu przysadki pozostałego w przewodzie czaszkowo-gardłowym. Prezentowana praca ukazuje trudności w wizualizacji gruczolaka somatotropowego położonego w zatoce klinowej. Mężczyzna w wieku 55 lat z somatycznymi cechami akromegalii od kilkunastu lat. W MRI przysadka nieco asymetryczna, 14 &#165; 4 mm, bez zmian ogniskowych. Na górnej ścianie zatoki klinowej obecny kulisty obszar o średnicy 10 mm odpowiadający mikrogruczolakowi. Stężenie GH = 4,3 &#956;g/l, IGF-1 = 615 &#956;g/l, brak hamowania GH glukozą. Po przygotowaniu długodziałającym analogiem somatostatyny guz usunięto z dostępu przez zatokę klinową. Badania histopatologiczne, elektronomikroskopowe oraz immunohistochemiczne wykazały obecność bogatoziarnistego somatotropowego gruczolaka przysadki: GH(+), PRL(-), ACTH(-), TSH(-), FSH(-), LH(-), MIB1 < 1%, SSTR3(+), SSTR5(+). W ocenie pooperacyjnej: prawidłowy obraz przysadki w MRI, GH = 0,18 &#956;g/l; IGF-1 = 140 &#956;g/l, obecne hamowanie GH glukozą. Staranna analiza możliwych zaburzeń rozwoju embrionalnego przysadki potwierdza ich znaczenie dla prawidłowej lokalizacji pozaprzysadkowo położonych gruczolaków

Corpus callosum dysgenesis : a report of four different cases

Background: Callosal anomalies account for approximately 2% of all CNS congenital malformations. Dysgenesis of the corpus callosum (complete or partial agenesis) can be an isolated CNS malformation or coexist with other pathologies. Case report: In all four cases corpus callosum dysgenesis was revealed by MRI (1.5T). The presented cases show examples of wide spectrum of all callosal anomalies - complete agenesis in case 1 and different sort of partial agenesis in cases 2, 3 and 4. In all the presented cases the callosal defect was found incidentally. Conclusions: Diagnostics of the corpus callosum malformations is based on ultrasound scans (pre- and postnatal), CT and most of all, the MR. Except for major callosal defects described in our report, MRI quite often reveals tiny anomalies of callosal shape. Corpus callosum defects can not only be congenital, but also caused by acquired disorders (traumatic, vascular, inflammatory and neoplastic)

Radiologic approach to jugular bulb paragangliomas

Background: Paragangliomas are highly vascular neoplasms that derive from neuroendocrine tissue. They account for about 0.6% of all head and neck tumors and most commonly occur in the carotid bifurcation, tympanic cavity, jugular foramen and in the area of vagal ganglia below the skull base. The aim of the study was retrospective evaluation of radiological features of jugular bulb paragangliomas in the group of 22 patients. Material/Methods: In the analyzed group, there were 16 females and 7 males, aged 14-81. All the patients underwent CT and MRI, in 12 cases carotid angiography and in 3 cases Doppler sonography was performed. We evaluated typical radiological features of jugular bulb paragangliomas and usefulness of various imaging methods in diagnosis and assessment of this pathology. Results: Computed tomography in all patients showed widening of the jugular foramen. MR images in 19 cases revealed the presence of intra-tumoral signal-void areas representing tumor vessels. Both methods showed intensive post-contrast enhancement of all tumors. Carotid angiography presented high vascularity and arterio-venous fistulas in all tumors. In the performed Doppler ultrasound studies, the tumors were not visible. In all cases, increased blood flow in the ipsilateral carotid artery and vein was observed, and in 2 patients with a coexisting carotid body paraganglioma was diagnosed. Conclusions: CT and MRI allow best evaluation of tumor extension and present features characteristic of jugular bulb paraganglioma. Carotid angiography confirms the diagnosis of a vascular tumor and is used for its preoperative embolization. Ultrasonography is a useful technique for exclusion of coexisting carotid body paraganglioma

Disappearance of white matter lesions on MRI and clinical recovery after initiating antiretroviral therapy in a case of HIV infection presenting as spastic paraparesis

We present a case of a 30-year-old Polish female who presented with increasing for about 2 years spastic paraparesis and urinary incontinence. She denied any risky sexual behaviors, drug abuse, there was no history of surgery or blood transfusions. MRI of the brain showed diffuse, hyperintensive in T2, poorly defined lesions in the white matter. About 3 months later paraparesis increased and control MRI showed progression of previously described lesions. She was then diagnosed with HIV infection. There was a suspicion of progressive multifocal leucoencephalopathy (PML) or vacuolar myelopathy in the course of HIV infection. Antiretroviral treatment was initiated leading, together with rehabilitation, to a progressive improvement of symptoms. Pathological lesions on brain MRI completely disappeared. In conclusion, HIV test should be done in every patient with neurological signs of unknown cause

IFN-γ Correlations with Pain Assessment, Radiological Findings, and Clinical Intercourse in Patient after Lumbar Microdiscectomy: Preliminary Study

Objectives. We investigated the influence of pain decrease after lumbar microdiscectomy on the interferon gamma (IFN-γ) serum level in patients with lumbar disc herniations. The study challenges the mechanism of sciatica pain and the role of IFN-γ in radicular pain development. Material and Methods. We performed clinical and immunoenzymatic assessment in a group of 27 patients with lumbar radicular pain due to disc herniations before and 3 months after surgery. Clinical status was assessed with the use of the Numeric Rating Scale (NRS), the Pain Rating Index and Pain Intensity Index of McGill Pain Questionnaire (SF-MPQ), the Oswestry Disability Index (ODI), and Beck Depression Inventory (BDI). The plasma concentrations of IFN-γ were ascertained by an immunoenzymatic method. Results. We observe significant correlations between the results of the pain in the back region assessment NRS back scale after the surgery with the level of IFN-γ before the procedure (rs=0.528; p=0.008) and after the procedure (rs=0.455; p=0.025). These are moderate and positive correlations—the decrease in pain is correlated with the lower IFN-γ level. Additionally, there are significant correlations between the results of the PRI scale and the IFN-γ level. The PRI score before surgery correlates positively with IFN-γ after surgery (rs=0.462; p=0.023), and the PRI score after surgery correlates positively with IFN before surgery (rs=0.529; p=0.005) and after surgery (rs=0.549; p=0.003). All correlations are moderate in severity—severe pain before surgery correlates with a higher level of IFN-γ after surgery and also higher IFN-γ before surgery. There were significant differences in the IFN-γ level before (Z=−2.733; p=0.006) and after (Z=−2.391; p=0.017) surgery in the groups of patients with and without nerve compression. In the group of patients with nerve compression, the level of IFN-γ before and after surgery was lower. Conclusions. Less pain ratio after operation correlates with the level of IFN-γ. In the group of patients without significant nerve compression confirmed by MRI scans, the level of IFN-γ before and after surgery was higher than that in the group with nerve root compression

63-year-old woman with bilateral perineurial cysts on the T1 level (between T1 and T2).

<p>Sagittal section on T1- (A) and FST2-weighted (B) images with a view of the left lesion. Frontal T2-weighted section (C) and MR mielography (D). Axial T2-weighted (E) image.</p

Age (year) and maximal sagittal diameter (mm) of perineurial cysts or the biggest one in case of multiple changes. Data presented as Mean ± S.D.

<p>Age (year) and maximal sagittal diameter (mm) of perineurial cysts or the biggest one in case of multiple changes. Data presented as Mean ± S.D.</p

Incidence of perineurial cysts in relation to the vertebral/spinal level.

<p>Absolute number of MR examinations per selected spinal region: cervical –221 (146/75; female/male), thoracic –108 (69/39), thoraco-cervical –36 (25/11), thoraco-lumbar –55 (35/20), lumbo-sacral –422 (268/154).</p>a<p>absolute number of perineurial cysts/total number of examinations in which the proper part of vertebral column was evaluated.</p>b<p>relative incidence (%) of perineurial cysts in relation to the total number of the proper level of vertebral column.</p>c<p>each patient may be seen more then once in table since some multiple cysts were seen on adjusted parts of the vertebral column (e.g., cervical and thoracic, thoracic and lumbar, lumbar and sacral).</p>*<p>p<0.05 female vs male.</p

60-year-old woman with a perineurial cyst in the right T6 intervertebral foramen (between T6-T7), other cysts are not visible due to scoliosis.

<p>Sagittal section on T1- (A) and T2-weighted (B) images. Axial T2-weighted (C) image.</p