Epidermoidna cista presakralnog područja

Aim: The aim of this article was to present a case of epidermoid cyst, which is a rare tumor in this area and has some specific imaging features. To our knowledge, intracranial epidermoid cysts and its imaging features were often described, but only a few cases have been previously reported with imaging fetaures of presacral epidemoid cysts. Case report: A 32-year-old woman presented with symptoms of difficult labor, and during the childbirth, a large tumor pressing from behind in to the birth canal was noticed. After recovery, multislice computerized tomography (MSCT) with intravenous contrast administration was performed. A cystic lesion in the presacral space on the left side with thin ring enhancement and no internal enhancement was demonstrated. Further magnetic resonance imaging (MRI) showed morphologic features of epidermoid cyst with high protein content (heterogenous signal on T1W and T2W). Surgery was performed and pathohistological analysis confirmed the diagnosis of epidermoid cyst with high protein content. Discussion and conclusion: Developmental cysts in presacral space are rare and there is not much literature on radiomorphologic features of cysts in this area. Epidermoid cyst has certain morphologic features which can aid in setting the diagnosis.Cilj: Cilj je ovoga rada prikazati epidermoidnu cistu presakralnog područja koja je rijedak tumor ovog područja, te ima osobitosti u prikazu slikovnim metodama. Prema našim saznanjima, često su opisivane slikovne karakteristike intrakranijalnih epidermoidnih cisti, ali su se u samo nekoliko prethodno objavljenih radova opisivale osobitosti epidermoidnih cisti presakralnog područja. Prikaz slučaja: Tridesetdvogodišnjoj ženi pri teškom porodu primijećen je velik tumor koji se sa stražnje strane utiskivao u porođajni kanal. Nakon oporavka javila se zbog daljnje obrade. Učinjen je pregled višeslojnom kompjutoriziranom tomografijom s intravenskom aplikacijom kontrastnog sredstva koji je pokazao cističnu leziju presakralnog područja lijevo s tankom rubnom imbibicijom kontrastnim sredstvom bez unutarnje opacifikacije lezije. Daljnjom obradom koja je uključivala magnetsku rezonanciju dokazane su morfološke karakteristike epidermoidne ciste s visokim sadržajem proteina (heterogeni signali na T1 i T2 sekvenci). Bolesnica je operirana, a patohistološkim nalazom potvrđena je epidermoidna cista s visokim sadržajem proteina. Rasprava i zaključak: Razvojne ciste presakralnog područja su rijetke, te se u literaturi ne nalazi mnogo podataka o radiomorfološkim karakteristikama cista toga područja. Epidermoidna cista ima određene morfološke karakteristike po kojima se može pretpostaviti dijagnoza

Isolated Splenic Metastasis from Colorectal Carcinoma in a High Risk Patient: A Case Report

Isolated splenic metastasis arising from a colorectal carcinoma is a rare finding. We report a case of 74-year-old man with a medical history od diabetes type II and paroxysmal atrial fibrillation, who underwent a right hemicolectomy for an adenocarcinoma of caecum in August 2004. In June 2007 the patient was diagnosed with high grade aortic valve stenosis as well as long segment stenosis of the first obtuse marginal branch of left coronary artery. He was suggested aortic valve replacement with coronary artery bypass grafting but he refused the surgery. In October 2007 the patient underwent a 18FDG – PET scanning, due to increasing values of CEA serum level, which showed a 5 cm big isolated hypermetabolic lesion in the spleen. Due to operative risk, splenectomy was refused by surgeons. The patient underwent a chemotherapy with capecitabine in total of 8 cycles before his CEA level began to rise and MSCT showed a progression in size of splenic metastasis. The patients condition was reevaluated by a team of experts and splenectomy was performed in September 2008. In May 2009 during the postoperative follow up, MSCT scanning revealed enlarged lymph nodes in celiac region and hepatic lesion suspicious of metastasis and the patient was addmited for further chemotherapy treatment. There is still no standardized treatment for this condition due to small number of cases reported in literature. Splenectomy followed by chemotherapy seems to be an optimal treatment but still no final conclusions can be made

Isolated Splenic Metastasis from Colorectal Carcinoma in a High Risk Patient: A Case Report

Isolated splenic metastasis arising from a colorectal carcinoma is a rare finding. We report a case of 74-year-old man with a medical history od diabetes type II and paroxysmal atrial fibrillation, who underwent a right hemicolectomy for an adenocarcinoma of caecum in August 2004. In June 2007 the patient was diagnosed with high grade aortic valve stenosis as well as long segment stenosis of the first obtuse marginal branch of left coronary artery. He was suggested aortic valve replacement with coronary artery bypass grafting but he refused the surgery. In October 2007 the patient underwent a 18FDG – PET scanning, due to increasing values of CEA serum level, which showed a 5 cm big isolated hypermetabolic lesion in the spleen. Due to operative risk, splenectomy was refused by surgeons. The patient underwent a chemotherapy with capecitabine in total of 8 cycles before his CEA level began to rise and MSCT showed a progression in size of splenic metastasis. The patients condition was reevaluated by a team of experts and splenectomy was performed in September 2008. In May 2009 during the postoperative follow up, MSCT scanning revealed enlarged lymph nodes in celiac region and hepatic lesion suspicious of metastasis and the patient was addmited for further chemotherapy treatment. There is still no standardized treatment for this condition due to small number of cases reported in literature. Splenectomy followed by chemotherapy seems to be an optimal treatment but still no final conclusions can be made

Isolated splenic metastasis from colorectal carcinoma in a high risk patient: a case report [Izolirana metastaza kolorektalnog karcinoma u slezenu u visokorizičnog bolesnika: prikaz slučajeva]

Isolated splenic metastasis arising from a colorectal carcinoma is a rare finding. We report a case of 74-year-old man with a medical history of diabetes type II and paroxysmal atrial fibrillation, who underwent a right hemicolectomy for an adenocarcinoma of caecum in August 2004. In June 2007 the patient was diagnosed with high grade aortic valve stenosis as well as long segment stenosis of the first obtuse marginal branch of left coronary artery. He was suggested aortic valve replacement with coronary artery bypass grafting but he refused the surgery. In October 2007 the patient underwent alpha 18FDG - PET scanning, due to increasing values of CEA serum level, which showed a 5 cm big isolated hypermetabolic lesion in the spleen. Due to operative risk, splenectomy was refused by surgeons. The patient underwent a chemotherapy with capecitabine in total of 8 cycles before his CEA level began to rise and MSCT showed a progression in size of splenic metastasis. The patients condition was reevaluated by a team of experts and splenectomy was performed in September 2008. In May 2009 during the postoperative follow up, MSCT scanning revealed enlarged lymph nodes in celiac region and hepatic lesion suspicious of metastasis and the patient was admitted for further chemotherapy treatment. There is still no standardized treatment for this condition due to small number of cases reported in literature. Splenectomy followed by chemotherapy seems to be an optimal treatment but still no final conclusions can be made

Endoscopic ultrasound in solid pancreatic masses - current state and review of the literature [Endoskopski ultrazvuk u dijagnostici solidnih tvorbi gušterače - trenutno stanje i pregled literature]

Some 25 years ago endoscopic ultrasound (EUS) was introduced in clinical practice for better visualization of pancreas. At the time of introduction EUS was superior to other methods in detection of pancreatic masses allowing tissue diagnosis by later introduced EUS-guided fine needle aspiration (FNA). During the time EUS was improved, electronic probes replaced mechanical probes adding ability of color Doppler, power Doppler, contrast enhanced endosonography as well as EUS elastography analysis. Meanwhile, CT technology has also experienced significant improvements raising the question whether EUS has lost ground in diagnostics of solid pancreatic masses. The aim of this review was to discuss the current evidence of clinical impact of EUS and EUS-FNA in evaluation of solid pancreatic masses with special emphasis on differentiation between benign and malignant pancreatic lesions. According to the literature, the detection of small pancreatic tumors, preoperative localization of pancreatic endocrine tumors and tissue sampling by fine-needle aspiration of pancreatic masses in cases with therapeutic consequences are considered firm indications for EUS. Cytological tissue analysis remains undisputed in differentiation benign from malignant lesions, but the question when FNA is needed is discussed. Color Doppler, power Doppler, contrast enhanced endosonography and especially elastography are also discussed as tools that are bringing additional information in evaluation of pancreatic masses, however insufficient for definitive judgment of the lesion’s nature. Pancreatic cancer staging as indication for EUS is discussed controversially, inconsistent results and conflicting evidence in literature making adequate conclusion impossible. However, this indicates that at least the role of EUS is no longer undisputed in this matter. Resuming the role of EUS we can state that despite some controversies EUS is very valuable method in evaluation of solid pancreatic masses and with EUS guided FNA is nowadays by far the best method for obtaining tissue diagnosis

Rupture of abdominal aortic aneurysm with pulmonary embolism and without an aortocaval fistula

In this report, we presented a case of a patient with a rupturedabdominal aortic aneurysm (AAA) accompanied by pulmonaryembolism but without an aortocaval fistula, which has not beenreported so far

Subtypes and clinical significance of common bile duct varices in portal vein thrombosis: diagnosis and follow-up by Doppler US and EUS

PURPOSE: To investigate (1) diagnostic performance of transabdominal color doppler ultrasound (US) and endoscopic ultrasound (EUS) for detection and sub-classification of common bile duct varices (CBDV) in patients with portal vein thrombosis (PVT), and (2) clinical significance and natural history of CBDV subtypes. PATIENTS AND METHODS: During a 4-year period, 56 patients with PVT underwent US and EUS for the presence and subtypes of CBDV. Natural history was analyzed for patients who attended control visits. RESULTS: CBDV were diagnosed in 57 and 59 % of patients with US and EUS, respectively. In 19 % of patients, EUS revealed different CBDV subtypes than previously seen by US. The most common were paracholedochal (PCV), while the least common were epicholedochal (ECV) and Submucosal varices (SMV). Nine patients had obstructive jaundice and underwent ERCP which was complicated by hemobilia in two patients with SMV. Among eight patients who underwent control EUS (median follow-up 60 months), the form of CBDV remained unchanged. Two patients bled from esophageal varices, both with ECV. CONCLUSION: While abdominal US and EUS are equally sensitive for detection of CBDV, EUS allows more precise determination of CBDV subtype. Patients with SMV might be at increased risk of bleeding upon ERCP

Plan general de mejora de las destrezas indispensables : Lengua Castellana en Eduación Primaria

Resumen basado en el de la publicación. Los textos de Pío Baroja con los ejercicios correspondientes pueden consultarse en: http://www.educa.madrid.org/portal/web/planprimariaSe presentan una serie de textos y actividades para trabajar la comprensión lectora y la expresión escrita en el último ciclo de Eduación Primaria. La primera parte consiste en una serie de textos expositivos y narrativos procedentes de autores consagrados o pertenecientes a la literatura juvenil que no suelen figurar en los libros de texto. La segunda parte rinde homenaje al escritor Pío Baroja y Nessi, con diversos fragmentos del segundo tomo de sus 'Memorias'. Los contenidos se han desarrollado según los estándares propuestos en el Plan General de Mejora de las Destrezas Indispensables para la Eduación Primaria de la Comunidad de Madrid..MadridBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín 5 -3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]