Tethered cord syndrome : case report

Background: Tethered cord syndrome is one of the filum terminale congenital defects. It can coexist with anomalies of the spinal canal and column, as well as with anorectal defects. Case report: The authors present a case of tethered cord syndrome diagnosed in a 45-year-old woman. She showed typical lumbo-sacral radicular syndrome with no neurological deficits and no bowel/bladder dysfunction. The anomaly coexisted with fibrolipoma, spina bifida and Tarlov cyst. Conclusions: Magnetic resonance imaging is the method of choice in diagnostics of tethered cord syndrome. It provides crucial information, which is necessary for planning surgical treatment of the anomaly

Successful endovascular treatment of intralobar pulmonary sequestration : an effective alternative to surgery

Introduction: Pulmonary sequestration is a rare congenital malformation characterised by the presence of non-functional and dysplastic pulmonary tissue that lacks communication with the tracheobronchial tree and has an aberrant non-pulmonary blood supply. Depending on its location, presence of the pleura covering, and venous drainage, 2 forms of pulmonary sequestration have been described: intra- and extralobar. Traditionally, surgical resection was performed; however, a growing number of cases have been treated with endovascular intervention. Case report: A 38-year-old female patient was admitted to the hospital with severe haemoptysis for several hours. Examination at admission revealed tachycardia and tachypnoea. Computed tomography-examination disclosed the presence of an area of consolidation in the left lower lobe with a tortuous feeding artery arising from the descending aorta. Visible ground glass opacification indicated diffuse alveolar haemorrhage. Based on these findings, a diagnosis of intralobar sequestration of the left lung was made. The patient was consulted by a cardiothoracic surgeon and an interventional radiologist and qualified for endovascular treatment. In local anaesthesia femoral access was obtained and selective angiography of the common trunk of both bronchial arteries was performed. It depicted a dilated left bronchial artery supplying the sequestration and visible contrast extravasation. Embolisation of the vessel was performed with Glubran (n-butyl-cyanoacrylate). Control contrast injection showed complete elimination of the sequestration’s blood supply with no residual capillary blush. Clinical improvement was observed. No complications were encountered, and the patient was discharged 7 days after the procedure. Conclusions: Arterial embolisation is a promising alternative to surgery in the treatment of symptomatic pulmonary sequestration

Ocena skuteczności wewnątrznaczyniowej metody embolizacji w leczeniu zespołu przekrwienia biernego miednicy - badania wstępne

Objectives: The Aim: The aim of the study was to evaluate the effectiveness, safety and clinical outcomes of endovascular embolisation of pelvic congestion syndrome (PCS). Material and methods: This prospective, observational study carried out between January and May of 2014 encompassed 24 female patients aged 22-44 years (average - 31 years) diagnosed with PCS. Diagnosis of PCS was established by medical history, physical examination, transvaginal Doppler ultrasound examination and confirmed by MRI. The patients were qualified for phlebography and ovarian vein embolization with 0.035” detachable coils and/or microcoils. Pelvic pain scores were assessed before and 3 months after the procedure with the visual analog scale (VAS; 0 – no pain, 10 – unbearable pain). Results: Embolisation procedures were performed in 23 out of 24 patients. Nineteen patients underwent unilateral and 4 patients bilateral embolisation of the ovarian vein. In one case, safe and selective vessel catheterization was not possible due to the anatomical variant of venous flow. Nineteen patients underwent unilateral embolisation of the left ovarian vein. Four patients had the left and right ovarian veins embolized; in one of them, the internal iliac vein was additionally closed (the two-stage procedure). The technical success rate was 96%. Procedures lasted 23-78 minutes (32 minutes on average). An average of 40 ml of contrast was administered during the procedures. The total mean radiation dose at the reference point was 389 mGy (from 127 mGy to 1112 mGy). A decrease in pelvic pain intensity according to VAS was considered a clinical success. The median VAS pelvic pain score before the procedure was 8. Three months after the procedure median pelvic pain score decreased to 1 (p < 0.001). In two cases, the ovarian vein was injured and the contrast medium extravasated, which was clinically insignificant. In one case, a small injection site haematoma developed. Conclusion: Embolisation is a minimally invasive, effective and safe method of treatment for PCS. The cooperation between gynaecologists and interventional radiologists is essential for successful outcomes.Cel pracy: Celem badania była ocena skuteczności, bezpieczeństwa i wyniku klinicznego przeznaczyniowej embolizacji zespołu przekrwienia biernego miednicy. Materiał i metody: W prospektywnym, obserwacyjnym badaniu od stycznia do maja 2014 do zabiegu embolizacji PCS zakwalifikowano 24 chore, w wieku od 22 do 44 lat (średnio 31). Diagnozę postawiono na podstawie objawów klinicznych, badania fizykalnego, przezpochwowego USG Doppler i/lub MRI. Pacjentki zakwalifikowano do badania czynnościowego układu żylnego, flebografii i ewentualnej embolizacji żył jajnikowych przy użyciu spiral. Ocenianio średnie nasilenie dolegliwości bólowych miednicy w wizualnej skali analogowej VAS przed i 3 miesiące po zabiegu embolizacji. Wyniki: Zabieg wykonano u 23 z 24 chorych. U 19 chorych wykonano jednostronną embolizację lewej żyły jajnikowej. U 4 pacjentek wykonano embolizację lewej i prawej żyły jajnikowej. Sukces techniczny wyniósł 96 %. Procedury trwały od 23 do 78 min (średnio 32 minuty). W czasie zabiegu podano średnio 40 ml kontrastu. Łączna średnia dawka promieniowania w punkcie referencyjnym wyniosła 389 mGy. Za sukces kliniczny uznano zmniejszenie stopnia natężenia bólu w miednicy mierzonej w skali VAS. Średni ból miednicy w skali VAS przed zabiegiem wynosił 8 pkt. Trzy miesiące po zabiegu ból miednicy w skali VAS zmniejszył się do 1 (p < 0.001). W dwóch przypadkach doszło do wynaczynienia środka cieniującego bez znaczenia klinicznego. Wnioski: Embolizacja w leczeniu PCS jest małoinwazyjną, skuteczną i bezpieczną metodą leczenia. Współpraca ginekologa i radiologia zabiegowego odgrywa tutaj kluczową rolę

Acute renal artery stenting recovered renal function after spontaneous rupture of renal artery aneurysm : case report

Purpose: Renal artery aneurysms (RAAs) are a rare vascular pathology with an estimated prevalence of 0.1% to 2.5%. Rupture of RAA is an extremely unusual cause of acute flank pain and haemodynamic instability with acute kidney failure and high mortality rate (20%). Case report: A 37-year-old male with no relevant history presented to the Emergency Room with acute right flank pain. Initial examination revealed BP 90/60 mm Hg and tachycardia. Initial blood testing was unremarkable, with a haemoglobin level of 9.4 g/dl. Urinalysis revealed moderate blood. Ultrasound (US) examination depicted aneurysm of the right renal artery 6 x 6 cm, with signs of blood extravasation visible in colour and power Doppler. The patient was referred for urgent computed tomography angiography, which revealed active bleeding from the ruptured aneurysm with haematoma spreading into the right retroperitoneum. He was subjected to emergency endovascular treatment. The patient was treated by successful implantation of a Viabahn stent (GORE, Daleware, USA). Selective nephrography revealed lack of flow through one of the segmental arteries resulting from vasospasm due to the placement of the guiding wire necessary for safe stent implantation. Conclusions: The authors present a rare case of spontaneous RAA rupture in a young male successfully treated with endovascular methods. Stent implantation required selective catheterisation of segmental arteries of the kidney, which resulted in the loss of one of them. However, control Doppler US disclosed no ischaemia and successful exclusion of the aneurysm

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)

Chemoembolization as a minimally invasive treatment of primary malignant liver cancer

Background: Hepatocellular carcinoma (HCC) is the most common type of liver cancer and one of the most malignant neoplasms with high incidence and mortality in humans worldwide. The complex nature of the disease and its high resistance to systemic therapies result in poor prognosis for patients with advanced HCC.  Case Report: In March 2017, the patient was admitted to the Department of Oncological Surgery, where a non-anatomical tumor resection was performed. Three years later, the patient developed a single change in segment 8 of the liver that was a relapse of the neoplastic process. Based on the Bracelon Criteria, the patient was qualified for the 1st stage of chemoembolization using the Seldinger method. In the presented patient as a result of the applied treatment, the neoplastic process was stabilized.  Conclusion: The chemoembolization treatment that was applied to the presented patient turned out to be the correct treatment option. After only the first stage of chemoembolization, the patient regressed the neoplastic lesion.

Endovascular embolisation as minimally-invasive treatment for spinal dural arteriovenous fistulas — evaluation of long-term results

Aim of study. Spinal dural arteriovenous fistulas (sDAVF) are rare spinal cord lesions formed between a radicular artery and medullary vein leading to venous hypertension resulting in neurological impairment. Endovascular embolisation is a minimally-invasive method aiming to interrupt the shunt between the artery and vein. We report our experience with sDAVF treated endovascularly.Material and methods. Clinical and procedural data of 16 consecutive patients diagnosed with sDAVF was reviewed. Pre- and post-operative neurological condition was evaluated using both the Aminoff and Logue disability scale and the VAS scale. Rates of complete occlusions, technical difficulties, and procedural complications were noted.Results. Four of the patients were female and 12 were male; mean age was 62.4 years. Mean interval between symptom onset and treatment was 13.3 months. Complete occlusion was achieved in 88% (14/16 patients). Significant or moderate clinical improvement in long-term follow-up was observed in eight patients (50%). Recurrence was observed in two cases (13%). Conclusions and clinical implications. While endovascular methods are being refined and thus achieving an increasingpercentage of successful occlusions, patients should be closely monitored since this condition is recurrent and the clinicalconsequences of myelopathy can persist despite complete occlusion of the shunt

Clinical consequences of closure of internal iliac arteries in patients with abdominal aortic aneurysms subjected to endovascular treatment

Wstęp. U chorych z tętniakami aorty brzusznej, obejmującymi tętnice biodrowe wspólne i miejsce ich podziału na tętnice biodrowe zewnętrzne i wewnętrzne, stent-graft powinien wyłączyć z krążenia zarówno tętniak aorty, jak i tętnic biodrowych. W takich przypadkach zachodzi konieczność pokrycia stent-graftem ujścia tętnic biodrowych wewnętrznych. Cel pracy. Oceniono kliniczne następstwa zamknięcia tętnic biodrowych wewnętrznych u chorych z tętniakami aorty brzusznej, które obejmowały również tętnice biodrowe wewnętrzne. Materiał i metody. Spośród 104 chorych leczonych śródnaczyniowo u 16 zabieg implantacji stent-graftu wymagał zamknięcia po jednej stronie tętnicy biodrowej wewnętrznej. U 6 osób implantowano jednostronny stent-graft aortalno-biodrowy i wykonano skrzyżowany przeszczep udowo-udowy, a u 10 użyto stent-graftu rozwidlonego. U wszystkich pacjentów embolizację tętnic biodrowych wewnętrznych przeprowadzono przy użyciu spiral embolizacyjnych. Wyniki. Spośród 16 chorych z tętniakami aorty brzusznej leczonych śródnaczyniowo, u których zamknięto na drodze embolizacji tętnicę biodrową wewnętrzną, u 9 osób w okresie pozabiegowym wystąpiły przejściowe objawy, wskazujące na niedokrwienie w obszarze unaczynienia tętnicy biodrowej wewnętrznej. Wszyscy ci chorzy zgłaszali chromanie w obrębie pośladka. U jednego pacjenta podejrzewano zmiany niedokrwienne jelita grubego, jeden chory zgłaszał zaburzenia potencji. Wnioski. U osób leczonych śródnaczyniowo z tętniakami aorty brzusznej, obejmującymi rozwidlenie tętnic biodrowych, zamknięcie tętnicy biodrowej wewnętrznej może być konieczne, lecz wiąże się ono z ryzykiem wystąpienia zmian niedokrwiennych.Background. In patients with abdominal aortic aneurysms affecting the common iliac arteries and the site of their division into external and internal iliac arteries, the stent-graft should exclude both the aneurysm of the aorta and that of the iliac arteries from the circulation. In such cases the stent-graft should cover the ostium of internal iliac arteries. Aim of the study. To determine the clinical outcome of hypogastric artery occlusion in patients who underwent endovascular treatment of aortoiliac aneurysmal disease. Material and methods. Out of 104 patients with abdominal aortic aneurysms, 16 required occlusion of one of the hypogastric arteries because of their involvement in aneurysmal disease. In 6 patients aortounilateral iliac stent-grafts were implanted with cross-femoral by-pass grafts. In 10 patients bifurcated stent-grafts were used. In all 16 patients the hypogastric arteries were closed by means of coils. Results. Out of 16 patients with abdominal aortic aneurysms treated with stent-grafts, 9 developed symptoms attributable to hypogastric artery embolisation. All of them had buttock claudication. One of these patients complained of a worsening of sexual function. In another patient bowel ischaemia was suspected. All the symptoms called for follow-up. Conclusions. When treating aortoiliac aneurysmal disease through an endovascular approach, the occlusion of the internal iliac artery is often necessary but carries with it a small but finite chance of morbidity

The quality of life in patients treated for abdominal aortic aneurysms by classical and endovascular methods

Cel pracy. Porównanie wyników leczenia tętniaków aorty brzusznej metodą operacyjną w trybie planowym oraz leczonych za pomocą endoprotez rozwidlonych. Ocena jakości życia przy użyciu skróconego formularza 36-punktowego SF-36 (Short From 36-Item Health Survey) oraz ankiety specyficznej opracowanej specjalnie dla potrzeb tej pracy. Zestawienie wyników obu metod leczenia i ich porównanie. Materiał i metody. W okresie od stycznia 1998 roku do grudnia 2001 roku leczono 384 chorych z AAA. W trybie nagłym operowano 39 chorych, w trybie planowym - 301 chorych, natomiast 44 chorych leczono techniką endowaskularną za pomocą endoprotez rozwidlonych. Pacjentów poproszono o wypełnienie formularzy przed zabiegiem i 30 dni po operacji podczas wizyty kontrolnej. Pytania dotyczyły: samooceny aktualnego stanu zdrowia pacjenta, dolegliwości bólowych, kłopotów z poruszaniem się, możliwości wykonywania codziennych czynności, kłopotów ze snem, dolegliwości ze strony ran pooperacyjnych. Wyniki. W grupie chorych operowanych planowo z powodu AAA na 301 przypadków wystąpiło 7 zgonów, wykonano 5 reoperacji w tym samym dniu z powodu ostrego niedokrwienia kończyny dolnej oraz 3 relaparotomie z powodu krwawienia do jamy brzusznej. Wszystkie operacje wykonano w znieczuleniu ogólnym przez laparotomię z cięcia pośrodkowego. Wszczepiono 187 protez prostych i 114 rozwidlonych. W powyższej grupie było 38 kobiet i 263 mężczyzn. W drugiej grupie założono 44 endoprotezy z dostępu chirurgicznego do tętnicy udowej w pachwinie po jednej lub obu stronach. Wszystkich 44 chorych zakwalifikowanych do założenia stentgraftów (grupa A) oraz 61 chorych operowanych (grupa B) poproszono o wypełnienie ankiet. W grupie 44 chorych po założeniu endoprotez (grupa A) i w grupie 61 osób po leczeniu operacyjnym (grupa B) 30 dni od zabiegu zanotowano: 6% (A)/24% (B) chorych odczuwało dolegliwości bólowe, 0% (A)/16% (B) miało problemy z poruszaniem się, 23% (A)/24% (B) cierpiało na bezsenność, 20% (A)/49% (B) odczuwało brak energii, 10% (A)/19% (B) zgłaszało stany depresyjne, a 3% (A)/38% - dolegliwości związane z przeprowadzonym zabiegiem, np. ze strony ran pooperacyjnych. Wniosek. Wewnątrznaczyniowe techniki zakładania endoprotez umożliwiają szybszy powrót do zdrowia i są obciążone znacznie mniejszą liczbą dolegliwości pooperacyjnych. Jakość życia chorych w okresie 30 dni od zabiegu jest w sposób istotny lepsza w porównaniu z grupą chorych leczonych klasyczną metodą operacyjną.Aim of the study. A comparison of the results of treatment of patients with abdominal aortic aneurysms (AAA) in the planned procedure by means of operation method and treated by use of Y-grafts; an evaluation of the quality of life by the use of the Short Form 36-Item Health Survey and a specific survey conducted especially for this work; a specification of the results for both methods and a comparison of them. Material and methods. From January 1998 to December 2001, 384 patients suffering from AAA were treated. 39 of them were operated in the acute procedure, 301 in the planned one whereas 44 patients were treated by means of endovascular technique using Y-grafts. The patients were asked to fill in questionnaires before the surgical intervention and 30 days after it, during the control visit. The questions from the survey concerned: patients&#8217; opinion of their actual health status, aches, troubles with moving, the ability to perform everyday activities, sleeping problems and indispositions resulting from postoperative wounds. Results. In the group of patients operated due to AAA according to the plan there were noted: 7 deaths per 301 cases, 5 reoperations because of critical leg ischaemia on the same day and 3 relaparotomies were performed due to bleeding into the abdominal cavity. All of the operations were conducted under general anaesthesia by laparotomy from the intermediate skin incision. 187 normal grafts and 114 bifurcated ones were implanted. The above group included 38 women and 263 men. In the other group 44 endoprostheses were implanted. The endovascular grafts were inserted from the surgical access in the groin to the iliac artery in one or two groins. All the 44 patients classified to the procedure of implantation stentgrafts and 61 patients operated on were asked to fill in the surveys. The results of the performed observations were the following: it was observed that in the group of patients with endoprostheses (group A) and 61 after surgical interventions (group B) in the period of 30 days after the intervention: 6% of A vs. 24% of B patients complained of pain disorders, 0% of A vs. 16% of B had problems with moving, 23% of A vs. 24% of B had troubles with sleeping, 20% of A vs. 49% of B had a feeling of low energy, 10% of A vs. 19% of B reported depression periods, 3% of A vs. 38% of B reported some disorders as a result of the performed operations, e.g. from postoperative wounds. Conclusion. Endovascular techniques of endograft implantation allow a quicker return to good condition and assure one of a significantly smaller number of postoperative disorders. The quality of patients&#8217; life in the period of 30 days after the surgical intervention is significantly better in comparison to the patients treated by means of the classical operation method