Aspekt ekonomiczny praktycznego wyboru narzędzi skrawających.

Publikacja jest kontynuacją autorskiego cyklu opracowań poświęconych racjonalnemu kształtowaniu wyników ekonomicznych wytwarzania przedmiotów metodami obróbki ubytkowej. Intencją tej publikacji jest prezentacja postępowania zalecanego technologowi modernizującemu/układającemu wielozabiegowy proces technologiczny – znamienny dla wyrobów przemysłu maszynowego

Papillary tumor of the pineal region. Report of two cases and literature review

Papillary tumor of the pineal region (PTPR) was introduced to the WHO classification in 2007. This rare tumor of little known natural history and unpredictable behavior was described in fewer than 100 cases. Its optimal treatment is not established yet. We report another two cases of PTPR in whom tumors were totally removed via supracerebellar infratentorial approach and both were treated with radiotherapy. In a 37-year-old man the operation was delayed 6 years after the first tumor diagnosis and subsequent shunt placement. He has no complaints 10 years after the onset of the disease. A 45-year-old woman has no complaints 24 months after surgery. Our experience and the data from literature indicate that a total tumor removal is the major prognostic factor

Are type I dural arteriovenous fistulas safe? : single-centre experience of endovascular treatment of dural arteriovenous fistulas

Introduction: There are mixed reports on the incidence of intracranial haemorrhage in patients with dural arteriovenous fistulas. We assessed new proposed risk factors (i.a. number of outflows and outflow diameter) of intracerebral haemorrhage due to intracranial dural arteriovenous fistula and presented our personal experience in endovascular treatment of dural arteriovenous fistulas. Material and methods: The patient database from January 2006 and December 2016 was reviewed, and 25 patients with 28 dural arteriovenous fistulas were identified. Results: 50% of patients presented with intracerebral haemorrhage. Multiple dural fistulas occurred in 12% of patients. Spearman's rank correlation coefficient revealed that there was a strong association between Cognard classification type and time needed to treat (r = 0.59, p < 0.05), as well as the volume of contrast used (r = 0.77, p < 0.05). Infratentorial (r = 0.53, p < 0.05) and right-sided (r = 0.66, p < 0.05) localisation were more challenging to treat. Bleeding was associated with poorer clinical outcome (r = 0.48, p < 0.05). No significant differences were found between the non-haemorrhagic group and the haemorrhagic group regarding the number of outflows (p = 0.459) and largest outflow diameter (p = 0.298). Clinical evaluation at follow-up was as follows: 56% of patients were asymptomatic, 24% had non-significant disability, maintaining independency, 16% had moderate disability, and 8% died - one in the course of intracerebral haemorrhage and one due to other sustained injuries. There were no reported embolisation- related complications. Conclusions: To conclude, regardless of presentation, both symptomatic and asymptomatic dural arteriovenous fistulas deserve clinical attention, structured evaluation, and follow-up. Type I fistulas were associated with haemorrhage in 1/3 of all cases. Overall our results indicate that the risk of haemorrhage and dire consequences is multifactorial

Surgical treatment of symptomatic pineal cysts without hydrocephalus-meta-analysis of the published literature

Background To examine published data and assess evidence relating to safety and efficacy of surgical management of symptomatic pineal cysts without hydrocephalus (nhSPC), we performed a systematic review of the literature and meta-analysis. Methods Following the PRISMA guidelines, we searched Pubmed and SCOPUS for all reports with the query 'Pineal Cyst' AND 'Surgery' as of March 2021, without constraints on study design, publication year or status (PROSPERO_CRD:42,021,242,517). Assessment of 1537 hits identified 26 reports that met inclusion and exclusion criteria. Results All 26 input studies were either case reports or single-centre retrospective cohorts. The majority of outcome data were derived from routine physician-recorded notes. A total of 294 patients with surgically managed nhSPC were identified. Demographics: Mean age was 29 (range: 4-63) with 77% females. Mean cyst size was 15 mm (5-35). Supracerebellar-infratentorial approach was adopted in 90% of cases, occipital-transtentorial in 9%, and was not reported in 1%. Most patients were managed by cyst resection (96%), and the remainder by fenestration. Mean post-operative follow-up was 35 months (0-228). Presentation: Headache was the commonest symptom (87%), followed by visual (54%), nausea/vomit (34%) and vertigo/dizziness (31%). Other symptoms included focal neurology (25%), sleep disturbance (17%), cognitive impairment (16%), loss of consciousness (11%), gait disturbance (11%), fatigue (10%), 'psychiatric' (2%) and seizures (1%). Mean number of symptoms reported at presentation was 3 (0-9). Outcomes: Improvement rate was 93% (to minimise reporting bias only consecutive cases from cohort studies were considered, N= 280) and was independent of presentation. Predictors of better outcomes were large cyst size (OR= 5.76; 95% CI: 1.74-19.02) and resection over fenestration (OR= 12.64; 3.07-52.01). Age predicted worse outcomes (OR= 0.95; 0.91-0.99). Overall complication rate was 17% and this was independent of any patient characteristics. Complications with long-term consequences occurred in 10 cases (3.6%): visual disturbance (3), chronic incisional pain (2), sensory disturbance (1), fatigue (1), cervicalgia (1), cerebellar stroke (1) and mortality due to myocardial infarction (1). Conclusions Although the results support the role of surgery in the management of nhSPCs, they have to be interpreted with a great deal of caution as the current evidence is limited, consisting only of case reports and retrospective surgical series. Inherent to such studies are inhomogeneity and incompleteness of data, selection bias and bias related to assessment of outcome carried out by the treating surgeon in the majority of cases. Prospective studies with patient-reported and objective outcome assessment are needed to provide higher level of evidence.Peer reviewe

Udar nieczynnego hormonalnie gruczolaka przysadki w trakcie leczenia przeciwzakrzepowego z następową jego samoistną regresją &#8212; opis przypadku i przegląd piśmiennictwa

Pituitary apoplexy (PA) is a rare, potentially life-threatening medical condition due to acute ischaemia or haemorrhage of the pituitary gland. The main clinical features are: abrupt onset of severe headache, nausea, vomiting, deteriorating level of consciousness, visual impairment and/or endocrine deficiency. Correct and prompt diagnosis is essential for effective therapy, but there are no randomised studies or strict recommendations defining treatment modalities. We present the case of a 59 year-old woman with pituitary tumour apoplexy, presenting with severe headache, vomiting and visual field deterioration. The patient was treated conservatively because of her refusal of surgery and was followed-up for five years. In the course of treatment, recovery of the visual field defects, as well as right sixth cranial nerve paresis, was observed. Repeated magnetic resonance imaging (MRI) revealed regression of the tumour without signs of its re-growth. We discuss therapeutic modalities with particular emphasis on morbidity and review the literature relating to the management of pituitary tumour apoplexy.Udar przysadki jest rzadkim, potencjalnie zagrażającym życiu stanem spowodowanym martwicą niedokrwienną lub krwotoczną. Główne objawy kliniczne udaru przysadki to nagły, silny ból głowy, nudności, wymioty z towarzyszącym pogorszeniem stanu świadomości, zaburzeniami widzenia i upośledzeniem czynności hormonalnej przysadki. Prawidłowe i szybkie rozpoznanie tego stanu ma podstawowe znaczenie dla wdrożenia właściwego leczenia. Dotychczas nie przeprowadzono badań randomizowanych oraz nie opracowano zaleceń wpływających na poprawę skuteczności leczenia udaru przysadki. Autorzy pracy opisują przypadek 59-letniej kobiety hospitalizowanej z powodu silnego bólu głowy, wymiotów i zaburzeń widzenia w przebiegu udaru przysadki. Chora nie wyrażała zgody na leczenie operacyjne i była leczona zachowawczo, a następnie poddana pięcioletniej obserwacji ambulatoryjnej. W trakcie hospitalizacji obserwowano poprawę pola widzenia oraz powrót prawidłowej czynności nerwu odwodzącego prawego. Kontrolne badanie MR przysadki wykazało regresję gruczolaka bez cech jego wznowy w czasie pięcioletniej obserwacji. Autorzy analizują różne metody leczenia udaru przysadki z uwzględnieniem ich następstw (powikłań) oraz prezentują na podstawie przeglądu piśmiennictwa wskazania terapeutyczne

A Study on Pattern Recognition with the Histograms of Oriented Gradients in Distorted and Noisy Images

Histograms of oriented gradients (HOG) are still one of the most frequently used low-level features for pattern recognition in images. Despite their great popularity and simple implementation performance of the HOG features almost always has been measured on relatively high quality data which are far from real conditions. To fill this gap we experimentally evaluate their performance in the more realistic conditions, based on images affected by different types of noise, such as Gaussian, quantization, and salt-and-pepper, as well on images distorted by occlusions. Different noise scenarios were tested such anti-distortions during training as well as application of a proper denoising method in the recognition stage. As underpinned with experimental results, the negative impact of distortions and noise on object recognition with HOG features can be significantly reduced by employment of a proper denoising strategy

Targeted sequencing of cancer-related genes reveals a recurrent TOP2A variant which affects DNA binding and coincides with global transcriptional changes in glioblastoma

High-grade gliomas are aggressive, deadly primary brain tumors. Median survival of patients with glioblastoma (GBM, WHO grade 4) is 14 months and \u3c10% of patients survive 2 years. Despite improved surgical strategies and forceful radiotherapy and chemotherapy, the prognosis of GBM patients is poor and did not improve over decades. We performed targeted next-generation sequencing with a custom panel of 664 cancer- and epigenetics-related genes, and searched for somatic and germline variants in 180 gliomas of different WHO grades. Herein, we focus on 135 GBM IDH-wild type samples. In parallel, mRNA sequencing was accomplished to detect transcriptomic abnormalities. We present the genomic alterations in high-grade gliomas and the associated transcriptomic patterns. Computational analyses and biochemical assays showed the influence of TOP2A variants on enzyme activities. In 4/135 IDH-wild type GBMs we found a novel, recurrent mutation in the TOP2A gene encoding topoisomerase 2A (allele frequency [AF] = 0.03, 4/135 samples). Biochemical assays with recombinant, wild type (WT) and variant proteins demonstrated stronger DNA binding and relaxation activity of the variant protein. GBM patients carrying the altered TOP2A had shorter overall survival (median OS 150 vs 500 days, P = .0018). In the GBMs with the TOP2A variant we found transcriptomic alterations consistent with splicing dysregulation. luA novel, recurrent TOP2A mutation, which was found exclusively in four GBMs, results in the TOP2A E948Q variant with altered DNA binding and relaxation activities. The deleterious TOP2A mutation resulting in transcription deregulation in GBMs may contribute to disease pathology