Rationality of using whole-body computed tomography in trauma patients

Purpose: Identification of the group of patients meeting the criteria of a severe multiple trauma (polytrauma) among those admitted to the regional trauma centre and subjected to whole-body computed tomography (WBCT) due to injuries. Identification the patients for whom WBCT was the optimal choice. Material and methods: Retrospective analysis of the data of 303 patients undergoing WBCT in the period 2015-2017 with assessment of the injury severity based on the abbreviated injury scale (AIS) and injury severity score (ISS). Results: Among 303 patients undergoing WBCT due to trauma, multiple injuries with ISS > 15 were found in 74 individuals (24.4%). After excluding patients whose limb fractures increased ISS above 15, the group decreased to 63 patients (20.8%). For these patients, the WBCT may be described as the optimal imaging method at an early stage of management. Conclusions: Trauma patients are too often qualified for WBCT. Exposure to a high dose of ionising radiation associated with this modality requires critical analysis of the scope of indications and rules of conduct for trauma teams

Krwawienie z przewodu pokarmowego jako powikłanie terapii ostrych zespołów wieńcowych

Autorzy skorzystali ze swojego kilkudziesięcioletniego doświadczenia zawodowego zdobytego podczas pracy z chorymi cierpiącymi na schorzenia kardiologiczne i gastrologiczne zarówno w warunkach ambulatoryjnych, jak i oddziału klinicznego. Pełnione w Klinice przez kilka lat całodobowe wojewódzkie dyżury endoskopowego tamowania krwawień z przewodu pokarmowego umożliwiły zebranie niezbędnego doświadczenia w tym zakresie wraz ze sporządzeniem wszechstronnego, ciekawego materiału zdjęciowego. Analiza kliniczna schorzeń leczonych w trybie nagłym pacjentów z ostrym krwawieniem z przewodu pokarmowego pozwoliła zaprezentować poniższe sformułowania i zalecenia prewencyjne jako wnioski z własnych doświadczeń zawodowych. (Folia Cardiologica Excerpta 2012; 7, 2: 84-90

Polyp of jejunum detected by endoscopy as a reason of chronic anemia in a patient with polyps of stomach. A case report

Wstęp: Polipy jelita cienkiego stanowią bardzo rzadką patologię i równie rzadko są przyczyną krwawienia w obrębie przewodu pokarmowego. Opis przypadku: Przedstawiono przypadek chorego z przewlekłą niedokrwistością, okresowo zaostrzającą się, wymagającą wielokrotnych przetoczeń masy erytrocytarnej i suplementacji żelaza, u którego rozpoznano endoskopowo dużego polipa hiperplastycznego w jelicie czczym jako źródło przewlekłego krwawienia do przewodu pokarmowego. Wnioski: Polipy w jelicie czczym mogą być rzadką przyczyną przewlekłych krwawień do przewodu pokarmowego. Aby znaleźć miejsce krwawienia, wykonuje się badanie endoskopowe górnego odcinka przewodu pokarmowego. W badaniu tym należy także ocenić jelito znajdujące się poza częścią zstępującą dwunastnicy, najdalej jak tylko jest to możliwe w zasięgu endoskopu.Background: Polyps of the small intestine are a very rare pathology and they are also a reason for rare gastrointestinal bleeding. Case report: A case of a patient with chronic anemia, periodically becoming aggravated requiring multiple blood transfusions and iron supplementation, with a large hyperplastic polyp of jejunum detected by endoscopy as a source of chronic gastrointestinal bleeding, is described. Conclusions: Polyps of the small intestine can be a rare reason for gastrointestinal bleeding. A gastrointestinal upper endoscopy should be performed in every case of searching for gastrointestinal bleeding, with an attempt to estimate the small intestine beside the descendent part of the duodenum as far as possible

Two cases of dysplasia in heterotopic gastric mucosa in upper oesophagus

Ektopowa (heterotopowa) błona śluzowa żołądka w górnej części przełyku (HGMUE, heterotopic gastric mucosa in upper esophagus), często opisowo określana w piśmiennictwie jako „plama na wejściu” („inlet patch”), jest dostrzegana bezpośrednio pod górnym zwieraczem przełyku podczas powolnego wycofywania endoskopu ze zmienną częstotliwością od 0,1 do 10%. Wydaje się, że znaczenie kliniczne tej najczęściej bezobjawowej anomalii jest niedoceniane. W niniejszej pracy przedstawiono 2 przypadki dysplazji w obrębie makroskopowo typowej HGMUE, poruszając problem potencjalnej transformacji nowotworowej tej wrodzonej zmiany. Opisy przypadków 1. U 65-letniej pacjentki w badaniu endoskopowym stwierdzono w górnej części przełyku wygładzony, nieco zapadnięty obszar zaczerwienionej i połyskliwej błony śluzowej o wymiarach około 20 × 20 mm i ostrych granicach, wysuwając podejrzenie ektopii błony śluzowej żołądka w górnej części przełyku. W badaniu histopatologicznym stwierdzono ognisko dysplazji w obrębie HGMUE. 2. U drugiej, również 65-letniej chorej, po 2 tygodniach leczenia nadżerkowego zapalenia przełyku (Los Angeles) w badaniu kontrolnym stwierdzono wygojenie nadżerek, natomiast przy powolnym wycofywaniu endoskopu uwidoczniono bezpośrednio pod górnym zwieraczem przełyku dobrze ograniczone 2 obszary zmienionej w stosunku do otoczenia śluzówki, połyskliwej, wygładzonej i zaczerwienionej. W badaniu histopatologicznym rozpoznano 2 ektopie błony śluzowej żołądka w przełyku i wykryto w jednym z wycinków dysplazję małego stopnia. Wnioski: Mimo że w większości przypadków ektopia błony śluzowej żołądka pozostaje anomalią asymptomatyczną, to przedstawione 2 przypadki pacjentek z dysplazją w jej obrębie wskazują na możliwość transformacji nowotworowej.Ectopic (heterotopic) gastric mucosa in the upper esophagus (HGMUE), frequently referred to as an “inlet patch” in the literature, is visible directly under the upper oesophageal sphincter during a slow retraction of an endoscope with a variable frequency ranging from 0.1 to 10%. It seems that the clinical significance of this anomaly, most frequently asymptomatic, remains underestimated. By presenting 2 cases of dysplasia within the macroscopically typical HGMUE in this paper we would like to bring up the important problem of potential neoplastic transformation of this congenital change. Case study 1. An endoscopic examination carried out on a 65 year old female patient, complaining of a recurrence of heavy heartburn, discomfort in the epigastrum and other ailments of a dyspeptic character, revealed a slightly collapsed smooth area of reddened and shiny mucosa sized app. 20 × 20 mm, with well-marked borders, suspected to be HGMUE. Results of histopathological examination of the specimen collected in the upper oesophagus disclosed a focus of low grade dysplasia in the heterotopic gastric mucosa. 2. The second patient, also a 65 year old female, was treated for esophagitis erosiva (Los Angeles). A supervisory endoscopic examination carried out after 2 weeks of intensive conservative treatment, introduced with lansoprazole in a dose 2 × 30 mg, revealed almost completely healed erosions. However, it also revealed two well-defined, shiny, smooth and reddened areas of mucosa, different comparing to their surroundings, just below the upper oesophageal sphincter during a slow retraction of the endoscope. Results of the histopathological examination of the bifocal change of the mucosa revealed two ectopies. One of them contained a focus of low grade dysplasia. Conclusion: Despite the fact, that most HGMUE lesions remain asymptomatic anomalies, the two above-presented cases of patients with dysplasia in heterotopic gastric mucosa indicate the possibility of neoplastic transformation

Analysis of the appropriateness of orthopaedic computed tomography scans as exemplified by lower extremity bones and joints

Purpose: The objective of this study is to analyse the appropriateness of lower extremity coputed tomography (CT) scans as performed in a large orthopaedic hospital. Material and methods: A total of 1410 CT scans acquired in the years 2014-2018 were analysed for compliance with the "Guidelines for Physicians Issuing Diagnostic Imaging Referrals" (iRefer). These guidelines were published by the Royal Radiologist Society and recommended for use by the Polish Medical Society of Radiology, the National Consultant for Radiology and Diagnostic Imaging, and the Minister of Health. In addition, the study involved the analysis of information provided on CT referrals by referring clinicians. Results: Nearly 21% of CT referrals were found to be unsubstantiated based on the diagnosis made by the referring physician, the body region of interest, and the clinical department. Most referrals identified as non-compliant with the guidelines were related to cancers followed by inflammatory conditions. The lowest number of unjustified exams was reported for endoprostheses and injury-related cases. Conclusions: The study revealed a significant degree of non-compliance with the diagnostic algorithm as defined in the iRefer guidelines, particularly in cases of cancers and inflammatory conditions. Consequently, the patient's exposure to ionizing radiation is increased. Incorrect decisions regarding the appropriate diagnostic imaging technique are founded on the lack of appropriate cooperation between the clinician and the radiologist, insufficiency or lack of information provided on the referral, as well as the defensive attitude of referring physicians. It is therefore necessary to change appropriate in-hospital management and cooperation models

Real Time Search Algorithm for Observation Outliers During Monitoring Engineering Constructions

Real time monitoring of engineering structures in case of an emergency of disaster requires collection of a large amount of data to be processed by specific analytical techniques. A quick and accurate assessment of the state of the object is crucial for a probable rescue action. One of the more significant evaluation methods of large sets of data, either collected during a specified interval of time or permanently, is the time series analysis. In this paper presented is a search algorithm for those time series elements which deviate from their values expected during monitoring. Quick and proper detection of observations indicating anomalous behavior of the structure allows to take a variety of preventive actions. In the algorithm, the mathematical formulae used provide maximal sensitivity to detect even minimal changes in the object’s behavior. The sensitivity analyses were conducted for the algorithm of moving average as well as for the Douglas-Peucker algorithm used in generalization of linear objects in GIS. In addition to determining the size of deviations from the average it was used the so-called Hausdorff distance. The carried out simulation and verification of laboratory survey data showed that the approach provides sufficient sensitivity for automatic real time analysis of large amount of data obtained from different and various sensors (total stations, leveling, camera, radar)

Colonoscopy: Preparation and Potential Complications

Colonoscopy is a fairly common test that serves both diagnostic and therapeutic purposes. It has been considered the gold standard in colorectal cancer screening for several years. Due to the nature of the examination, various types of complications may occur. The purpose of this analysis is to describe the various complications related to the period of preparation for colonoscopy among hospitalized patients, including life-threatening ones, in order to know how to avoid complications while preparing for a colonoscopy. We analyzed the nursing and medical reports of 9962 patients who were prepared for colonoscopy between 2005 and 2016. The frequency of various side effects associated with intensive bowel cleansing prior to colonoscopy was assessed. In justified cases, additional medical data were collected from patients, their families or from other doctors providing advice to patients after complications. Out of 9962 patients prepared for colonoscopy, 180 procedures were discontinued due to complications and side effects, and in these cases no colonoscopy was performed. The most common complications were: vomiting; epistaxis; loss of consciousness with head injury; abdominal pain; acute diarrhea; symptoms of choking; heart rhythm disturbances; dyspnea; fractures of limbs and hands; acute coronary syndrome; hypotension; hypertension; cerebral ischemia; severe blood glucose fluctuations; increased muscle contraction and allergic reactions. In addition to the documentation of our own research, several works of other research groups were also analyzed. Currently, the literature does not provide data on the frequency and type of complications in the preparation period for colonoscopy. The advantage of our work is the awareness of the possibility of serious complications and postulating the necessary identification of threats. Individualization of the recommended procedures and increased supervision of patients undergoing bowel cleansing procedure, we hope, will reduce the occurrence of complications and side effects

New endoscopic treatment methods for PPI-resistant GERD

Introduction. Gastroesophageal reflux disease (GERD) is a common disease with the highest prevalence in North America. Up to 40% of patients report persistent gastroesophageal reflux disease (GERD) symptoms despite proton pump inhibitor (PPI) therapy. Aim. The aim of this article is to complete discuss the GERD characterized by heartburn and/or regurgitation symptoms. Material and methods. We discuss here the evidence for medical therapy for PPI nonresponsive GERD. Analysis of the literature. GERD may present with a variety of other symptoms, including water brash, chest pain or discomfort, dysphagia, belching, epigastric pain, nausea, and bloating. In addition, patients may experience extraesophageal symptoms like cough, hoarseness, throat clearing, throat pain or burning, wheezing, and sleep disturbances. Conclusion. There has been an increase in GERD prevalence. GERD is one of the most common gastrointestinal disorders managed by gastroenterologists and primary care physicians

New fluorescent imaging technics in gastrology

Introduction. There is a need to develop a new imaging technique in medicine. Gastroenterology is the branch of medicine focused on the digestive system and its disorders therefore for this branch is needed to detect all problems affecting the gastrointestinal tract. Aim. The aim of this article is to complete discuss the possibility of the new fluorescent imaging technics in gastrology to use innovative screening to identify individuals at an early stage. Material and methods. We discuss here imaging techniques such as include x-rays, computed tomography, scans, and magnetic resonance imaging in gastrology. Spectroscopy is the study of the formation and interpretation of spectra resulting from the interaction of all types of radiation on matter understood as a community of atoms and molecules. Various spectroscopic techniques are obtained by combining different types of radiation with different ways of its interaction with the test sample. They provide the opportunity to obtain detailed information about the tested substance – from its atomic composition, through its chemical structure, to its surface structure. Analysis of the literatue. The tissue fluorescence spectrum can be obtained by: (1) autofluorescence, or natural or primary fluorescence, i.e. by direct irradiation of the tissue with laser radiation (laser-induced fluorescence – LIF) and (2) photodynamic diagnosis (PDD), where spectrum analysis is preceded by systemic or local administration of the photosensitizer. Conclusion. The use of fluorescence imaging in colon cancer patient has potential to improve quality of treatment and diagnosis

The role of new biomarkers for the diagnosis and treatment of colon cancer

Introduction. Colorectal cancer may be benign or malignant. According to the World Health Organization and CDC, it is the second most common cancer worldwide, after lung cancer. The mortality of colorectal cancer has been dropping for more than 20 years due to the improvements in screening techniques and treatments. Aim. The aim of this article is to discuss the role of new biomarkers for the diagnosis and treatment of colon cancer. Material and methods. This article is a review done in regards to discuss the role of new biomarkers for the diagnosis and treatment of colon cancer. Analysis of the literature. A review is discussed the role of new biomarkers for the diagnosis and treatment of colon cancer using current literature. Conclusion. The screening tests based on diagnostic new biomarkers may cause faster detection of cancer and risk factors, and provide prognostic information in order to adjust individual therapy