Intrahepatična cistična bolest s kongenitalnom fibrozom (Carolijev kompleks) - prikaz slučaja i pregled literature

A female patient affected by Caroli\u27s disease with congenital fibrosis (Caroli\u27s complex), aged 27 years, is described. Caroli\u27s disease had been asymptomatic to the present. It was recognized as an intraoperative finding during the left hepatectomy procedure after an acute abdominal crisis episode. The main reason for this surgery was the incidence of malignant transformation to cholangiocarcinoma of the cells of the cystic walls. The complex Caroli\u27s disease is more common than other forms. The case report is supplemented with literature review and discussion on the etiopathogenetic mechanisms hypothesized.Opisan je slučaj 27-godišnje bolesnice s Carolijevom bolešću i kongenitalnom fibrozom (Carolijev kompleks). Carolijeva bolest dotad je bila asimptomatska. Prepoznata je kao intraoperacijski nalaz tijekom postupka lijevostrane hepatektomije nakon akutne epizode abdominalne krize. Glavni razlog za operacijski zahvat bila je maligna pretvorba u kolangiokarcinom stanica cističnih stjenka. Carolijev kompleks češći je od drugih oblika bolesti. Prikaz slučaja je dopunjen pregledom literature i raspravom o pretpostavljenim etiopatogenetskim mehanizmima

Intrahepatična cistična bolest s kongenitalnom fibrozom (Carolijev kompleks) - prikaz slučaja i pregled literature

A female patient affected by Caroli\u27s disease with congenital fibrosis (Caroli\u27s complex), aged 27 years, is described. Caroli\u27s disease had been asymptomatic to the present. It was recognized as an intraoperative finding during the left hepatectomy procedure after an acute abdominal crisis episode. The main reason for this surgery was the incidence of malignant transformation to cholangiocarcinoma of the cells of the cystic walls. The complex Caroli\u27s disease is more common than other forms. The case report is supplemented with literature review and discussion on the etiopathogenetic mechanisms hypothesized.Opisan je slučaj 27-godišnje bolesnice s Carolijevom bolešću i kongenitalnom fibrozom (Carolijev kompleks). Carolijeva bolest dotad je bila asimptomatska. Prepoznata je kao intraoperacijski nalaz tijekom postupka lijevostrane hepatektomije nakon akutne epizode abdominalne krize. Glavni razlog za operacijski zahvat bila je maligna pretvorba u kolangiokarcinom stanica cističnih stjenka. Carolijev kompleks češći je od drugih oblika bolesti. Prikaz slučaja je dopunjen pregledom literature i raspravom o pretpostavljenim etiopatogenetskim mehanizmima

Anatomic variations in Bowel positioning

Φυσιολογικές ανατομικές παραλλαγές στη θέση τμημάτων του παχέος εντέρου μπορούν να υποδυθούν παθολογική σημειολογία σε απεικονιστικές εξετάσεις και έχουν ενοχοποιηθεί για τον τραυματισμό του εντέρου, στη διάρκεια διαγνωστικών ή θεραπευτικών διαδερμικών παρεμβατικών μεθόδων. Αυτές τις ανατομικές παραλλαγές-την οπισθονεφρική θέση του παχέος εντέρου, την παρεμβολή του μεταξύ νεφρού και ψοΐτου, την οπισθοψοϊτική θέση του, την παρουσία του στον ηπατο- και σπληνο-νεφρικό χώρο, καθώς και μεταξύ ήπατος ή σπληνός και πλαγίου κοιλιακού τοιχώματος και τέλος, το σύνδρομο Κηλαϊδίτη- μελετήσαμε σε μία σειρά 2406 εξετάσεων Υ.Τ. Αναζητήθηκαν τα ιδιαίτερα χαρακτηριστικά κάθε παραλλαγής, έγινε συσχέτιση με την ηλικία, το φύλο και την ποσότητα του ενδοκοιλιακού λίπους και επιχειρήθηκε η ερμηνευτική προσέγγισή τους. Νομίζουμε ότι οι διαδερμικές παρεμβατικές μέθοδοι στον οπισθοπεριτοναΐκό χώρο, το ήπαρ και τα χοληφόρα, θα ήταν χρήσιμο να γίνονται, είτε μετά από εξέταση με Υ.Τ. ή με την καθοδήγηση Y.T., για την αποφυγή τραυματισμού του εντέρου. Τα διαφοροδιαγνωστικά προβλήματα, που μπορούν να προκαλέσουν αυτές οι ανατομικές παραλλαγές είναι δυνατόν να επιλυθούν με την Y.T., μέσω της εφαρμογής τεχνικών καλής σκιαγράφησης του παχέος εντέρου

Apneic oxygenation for elimination of respiratory motion artefact in an intubated patient undergoing helical computed tomography pulmonary angiography

Respiratory motion artifact in intubated and mechanically ventilated patients often reduces the quality of helical computed tomography pulmonary angiography (CTPA). Apneic oxygenation is a well established intra-operative technique that allows adequate oxygenation for short periods (up to 10 min) in sedated and paralyzed patients. We describe the use of the apneic oxygenation for elimination of respiratory motion artefact in an intubated patient undergoing CTPA

CT Findings of Pulmonary Involvement in Antiphospholipid Syndrome

Aims: Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by vascular thrombosis. Pulmonary changes regarding interstitium and airways have not been described in APS. Our aim was to determine the prevalence of nonthrombotic pulmonary CT manifestations in patients with APS. Study Design: Prospective study. Place and Duration of Study: Department of Pneumonology, First Department of Internal Medicine, Department of Cardiology, Department of Radiology Medicine, between June 2009 and May 2011. Methodology: Ten patients who met criteria for APS (5 primary and 5 secondary to systemic lupus erythematosus) were prospectively identified. All patients underwent chest high-resolution computed tomography (HRCT) and functional assessment including spirometry and 6-minute walking distance. Patients were free of respiratory symptoms. HRCT scans were evaluated for presence of air-trapping, subpleural reticular pattern, centrilobular nodules of ground-glass opacity, cysts, emphysema, atelectasis, consolidation and pleural effusion. Extent of air-trapping was estimated based on a HRCT scoring system. Results: All patients exhibited radiological and functional pattern compatible with smallairway disease, irrespective of smoking status. HRCT findings were negatively correlated with reduced levels of maximum midexepiratory flow (MMEF) 25/75%pred (r=-0.936, p<0.0001). Subpleural basal reticular pattern consistent with fibrosis was seen in 3 patients. Thin-walled cysts and upper-lobe hazy micronodular pattern were detected in 4 patients. Conclusion: CT findings of patients with APS may include air-trapping, subpleural reticular pattern, centrilobular nodules of ground-glass opacity and lung cysts irrespective of smoking history and SLE coexistence. HRCT and functional assessment may be valuable tools in evaluating APS patients

Evaluation of the Performance of 18F-Fluorothymidine Positron Emission Tomography/Computed Tomography (18F-FLT-PET/CT) in Metastatic Brain Lesions

18F-fluorothymidine (18F-FLT) is a radiolabeled thymidine analog that has been reported to help monitor tumor proliferation and has been studied in primary brain tumors; however, knowledge about 18F-FLT positron emission tomography/computed tomography (PET/CT) in metastatic brain lesions is limited. The purpose of this study is to evaluate the performance of 18F-FLT-PET/CT in metastatic brain lesions. A total of 20 PET/CT examinations (33 lesions) were included in the study. Semiquantitative analysis was performed: standard uptake value (SUV) with the utilization of SUVmax, tumor-to-background ratio (T/B), SUVpeak, SUV1cm3, SUV0.5cm3, SUV50%, SUV75%, PV50% (volume &#215; SUV50%), and PV75% (volume &#215; SUV75%) were calculated. Sensitivity, specificity, and accuracy for each parameter were calculated. Optimal cutoff values for each parameter were obtained. Using a receiver operating characteristic (ROC) curve analysis, the optimal cutoff values of SUVmax, T/B, and SUVpeak for discriminating active from non-active lesions were found to be 0.615, 4.21, and 0.425, respectively. In an ROC curve analysis, the area under the curve (AUC) is higher for SUVmax (p-value 0.017) compared to the rest of the parameters, while using optimal cutoff T/B shows the highest sensitivity and accuracy. PVs (proliferation &#215; volumes) did not show any significance in discriminating positive from negative lesions. 18F-FLT-PET/CT can detect active metastatic brain lesions and may be used as a complementary tool. Further investigation should be performed

Relationship between Coronary Arterial Geometry and the Presence and Extend of Atherosclerotic Plaque Burden: A Review Discussing Methodology and Findings in the Era of Cardiac Computed Tomography Angiography

Coronary artery disease (CAD) represents a modern pandemic associated with significant morbidity and mortality. The multi-faceted pathogenesis of this entity has long been investigated, highlighting the contribution of systemic factors such as hyperlipidemia and hypertension. Nevertheless, recent research has drawn attention to the importance of geometrical features of coronary vasculature on the complexity and vulnerability of coronary atherosclerosis. Various parameters have been investigated so far, including vessel-length, coronary artery volume index, cross-sectional area, curvature, and tortuosity, using primarily invasive coronary angiography (ICA) and recently non-invasive cardiac computed tomography angiography (CCTA). It is clear that there is correlation between geometrical parameters and both the haemodynamic alterations augmenting the atherosclerosis-prone environment and the extent of plaque burden. The purpose of this review is to discuss the currently available literature regarding this issue and propose a potential non-invasive imaging biomarker, the geometric risk score, which could be of importance to allow the early detection of individuals at increased risk of developing CAD