Ultrasonografia w chorobach nowotworowych u dzieci

Wraz z rozwojem techniki poprawiły się możliwości diagnostyczne ultrasonografii. Możliwe jest coraz bardziej precyzyjne wnioskowanie o nowotworowym bądź nienowotworowym charakterze zmian. Badanie ultrasonograficzne stwarza również możliwość wczesnej diagnostyki powikłań leczenia przeciwnowotworowego. Umożliwia szybką diagnostykę stanów wymagających natychmiastowej interwencji. Znajduje również zastosowanie w ocenie późnych następstw po zakończonym leczeniu. Celem artykułu jest przedstawienie możliwości diagnostycznych ultrasonografii w chorobach nowotworowych u dzieci

Naczyniak limfatyczny moszny i przestrzeni zaotrzewnowej u 12-letniego chłopca : opis przypadku

Background: Lymphangiomas occurs in children quite frequently. They are most commonly localized in the head, neck, axilla, chest, abdomen, and retroperitoneum. Lymphangiomas of the scrotum are very rare and are usually clinically silent, so they are a challenge for radiologists performing US examination in children. They are obliged to differentiate the following lesions: torsion of the testicle, scrotal hernia, hydrocoele, and epididymal cyst, in addition to the masses of primary extratesticular localization such as hemagioma, congenital vascular malformations, fibromas, and malignant tumors. Additional difficulties appear in boys who present acute scrotum syndrome. Case Report: The paper reports the diagnostics and treatment of a huge multicystic lymphangioma situated in the scrotum and retroperitoneum of a 12-year-old boy who had fallen from a bicycle and presented acute scrotum. The lesion of the scrotum was surgically excised. Retroperitoneal lymphangioma was detected during this operation. Subsequent diagnostics was based on ultrasonography, computerized tomography, and magnetic resonance imaging of the abdominal cavity. The lymphangioma of the retroperitoneum was resected. The patient shows no evidence of recurrence after 7 years. Conclusions: Cystic lymphangiomas are rare but benign intrascrotal, extratesticular, painless masses in children. They are sonographically multicystic or multiloculated abnormalities and may show infiltrative extension to the perineum, retroperitoneum, or abdomen. Recognition of this entity and its extent is important for correct clinical management and may be for planning treatment

Ultrasonografia dopplerowska w diagnostyce nowotworów jąder u dzieci

Malignant testicular tumors account for approximately 1-2% of all pediatric malignancies. We evaluated the usefulness of Color Doppler and contrast-enhanced Color Doppler ultrasonography in the detection and diagnostic differentiation of testicular tumors in children. Thirty boys were treated for testicular tumors. They ranged in age from 4 months to 16 years (mean: 4.6 years). All were staged according to the Pediatric Oncology Group/ Children Cancer Study Group staging system. Diagnostic assessment included in all cases conventional ultrasonography (US), Color Doppler (CD), and Power Doppler (PD) before and after the administration of contrast agent. Germinal tumors and tumor arising from the endodermal sinus (yolk sac tumors) were the most common. Eight patients had stage III, four stage IV, and eighteen stages I and II. Histologically, 13 patients had pure endodermal sinus tumor (EST), 4 had EST with embryonal carcinoma, 5 had embryonal carcinoma alone, 8 had teratoma, and 1 had non-germinal tumor. In the group of EST patients, the largest number of lesions were enhanced by 2-3 points, embryonal carcinoma by 4-5 points, and teratoma immatrum by over 4 points. EST and embryonal carcinoma presented peak enhancement in a time under 120 sec., and teratomas in a time under 180 sec. Teratomas and embryonal carcinoma had the longest enhancement times. Three patients with teratoma in stage 1 had only the tumor removed, sparing the testis. Twenty patients had unilateral orchiectomy and three had lymphadenectomy. All children received chemotherapy depending on the character of the tumors. We have observed much better prognosis in children with testicular tumors after surgery of the tumor and subsequent intensive chemotherapy. US examination with unenhanced and contrastenhanced Color Doppler is important in achieving the correct diagnosis and better treatment results. US contrast agent (Levovist) is very helpful in precise visualization of pathological vessels inside the tumor mass, and can be considered useful in the initial differentiation between testicular tumor types

The assessment of the relationship between the traits of temporal muscle and the massiveness of the supraorbital region of the Homo sapiens crania including the influence of the neurocranial shape and size of the occlusal surface of the upper molars – preliminary study

The knowledge about the pattern of the relationship between the morphological variability of the supraorbital region of human skulls and the features of the temporal muscle is far from complete. The main aim of this study was to determine the relationships between the traits of human temporal muscle (i.e., its relative height and length) and the relative massiveness of the supraorbital region of the frontal bone with taking into account the potential influence of the neurocranial shape and the relative area of the occlusal surface of the upper molars.Skulls of African and Australian males (n = 44) exhibiting high variability in the massiveness of the supraorbital region, the presence of two types of the upper molars (first and second, n = 88) and a good state of the preservation of the braincase with the clearly visible inferior temporal line were examined.The qualitative scales were used to assess the degrees of the massiveness of the supraorbital regions. Metric traits of temporal muscle and that used to calculate the index of the neurocranial shape, size of the braincase and the facial skeleton were collected. Values of the occlusal areas of the molars were obtained using the ImageJ software.Spearman’s rank correlation and partial rank correlation analyses were performed.The results of our study showed the relationships between the traits of the temporal muscle and only the degree of the robusticity of most lateral part of the supraorbital area (trigonum). However, when the influences of the neurocranial shape and the relative occlusal area of molars were excluded, these relationships disappeared. The greatest importance of the neurocranial shape for the formation of the morphology of the trigonum was indicated. The results of the study were discussed from the perspective of the potential role of the temporal muscle as the part of the mastication apparatus for the development of the robusticity of the cranial supraorbital region

Iatrogenic hemobilia in 10-year-old boy

Background: Hemobilia in children is a rare phenomenon which has been described mostly in the context of traumas. The descriptions of massive hemobilia in children after liver biopsy are a rarity in the scientific literature because there are only a few examples of it. Hemobilia rarely develops spontaneously. Generally, this is a complication after a blunt abdominal trauma or after medical (especially surgical) procedures. Correct diagnosis and treatment of hemobilia are essential, especially in the case of patients with severe - sometimes life-threatening - haemorrhage from biliary ducts. It should be remembered that the symptoms of hemobilia do not necessarily occur immediately after surgery or trauma. In some cases hemobilia occurs after a changeable, asymptomatic period of time. Case Report: We would like to present a case of a severe form of hemobilia caused by arterio-biliary fistula which developed incidentally after liver biopsy in a 10-year-old boy with chronic hepatitis B. Symptoms of hemobilia appeared on the seventh day after the diagnostic biopsy when the patient’s general condition began to deteriorate. The diagnosis of arterio-biliary fistula was established after angio-CT examination of the liver. A selective embolization of the right hepatic artery was carried out. Hemobilia in children is a rare phenomenon which has been described mostly in the context of traumas. The cases of massive hemobilia in children after liver biopsy are a rarity in the scientific literature because there are only a few examples of it. Hemobilia very rarely develops spontaneously. Generally, this is a complication after a blunt abdominal trauma or after medical (especially surgical) procedures. Conclusions: Correct diagnosis and treatment of hemobilia are essential, especially in the case of patients with severe - sometimes life-threatening - haemorrhage from biliary ducts. It should be remembered that the symptoms of hemobilia do not necessarily occur immediately after surgery or trauma. In some cases hemobilia occurs after a changeable, asymptomatic period of time

Niealkoholowe stłuszczenie wątroby u kobiet z zespołem wielotorbielowatych jajników — aspekty kliniczne i metaboliczne oraz polimorfizm genu lipazy lipoproteinowej

Introduction: The aim was to assess associations among PCOS and NAFLD, the lipoprotein lipase polymorphism gene, and metabolic disorders in PCOS.Material and methods: In 184 women with PCOS and 125 healthy, premenopausal volunteers, sex steroids, lipids, glucose, insulin, aminotransferases, free androgen index (FAI), HOMA-IR and E2/T were calculated. Hepatic steatosis was determined by ultrasound. Whole genomic DNA was isolated from blood leucocytes. Lipoprotein lipase polymorphisms rs268 and rs328 were analysed by polymerase chain reaction (PCR) and minisequencing.Results: 57.6% of PCOS women had NAFLD, while women without PCOS had NAFLD in 49.6%. PCOS-NAFLD women had higher BMI, WHR and waist circumference compared to women with PCOS without NAFLD and women without PCOS. PCOS-NAFLD women had lower SHBG, E2/T ratio, and higher FAI compared to other groups. ALT levels were higher in PCOS women with NAFLD compared to other groups. PCOS women with and without NAFLD had higher fasting glucose and insulin and HOMA compared to women without PCOS. Women with PCOS had higher triglycerides and lower HDL-C compared to women without PCOS. There was no evidence that evaluated polymorphisms influenced hepatic steatosis in women with and without PCOS.Conclusions: PCOS is not an independent factor influencing NAFLD in women. The influences on NAFLD incidence in women are BMI > 25 kg/m², glucose level > 80 mg/dL, E2/T < 80 and ALT > 19 IU/L as independent factors. Hyperandrogenism in PCOS may increase the risk of NAFLD indirectly by obesity, insulin resistance, and directly by the hepatotoxic effect. Polymorphisms rs328 and rs268 of the lipoprotein lipase gene do not affect the occurrence of NAFLD in women with PCOS or without PCOS. (Endokrynol Pol 2014; 65 (6): 416–421) Wstęp: Celem pracy było zbadanie zależności między zespołem wielotorbielowatych jajników (PCOS) a niealkokoholowym stłuszczniem wątroby (NAFLD), polimorfizmem genu lipazy lipoproteinowej oraz zaburzeniami metabolicznymi obserwowanymi w PCOS.Materiał i metody: W grupie 184 kobiet z PCOS i wśród 125 zdrowych kobiet premenopauzalnych badano w surowicy stężenia hormonów płciowych, frakcji lipidowych, glukozy insuliny i transaminaz oraz obliczano wskaźniki wolnych androgenów (FAI), insulinooporności HOMA i E2/T. Stłuszczenie wątroby oceniano ultrasonograficznie. Genomowe DNA izolowano z leukocytów krwi obwodowej metodami standardowymi. Do oznaczanie polimorfizmów rs268 i rs 328 lipazy lipoproteinowej użyto metody PCR i minisekwencjonowania.Wyniki: częstość występowania NAFLD u kobiet z PCOS nie różniła się istotnie w porównaniu do kobiet bez PCOS. Kobiety z PCOS i NAFLD miały istotnie wyższy BMI , WHR i obwód talii w porównaniu z kobietami z PCOS bez NAFLD oraz kobiet bez PCOS. Ponadto stwierdzono u nich istotnie niższe SHBG, E2/T i wyższy FAI w porównaniu z kobietami z pozostałych grup. Stężenia transaminazy alaninowej (ALT) w grupie PCOS z NAFLD były istotnie wyższe niż w pozostałych grupach. U kobiet z PCOS z i bez NAFLD obserwowano istotnie wyższe stężenia glukozy, insuliny i wskaźnika HOMA w porównaniu z kobietami bez PCOS. Nie stwierdzono istotnych różnic w występowaniu określonych polimorfizmów genu lipazy lipoproteinowej w badanych grupach.Wnioski: Zespół wielotorbielowatych jajników nie jest niezależnym czynnikiem wpływającym na NAFLD u kobiet. Niezależnymi czynnikami mającymi wpływ na wystąpienie NAFLD są: BMI > 25 kg/m², stężenie glukozy > 80 mg/dl, E2/T < 80 oraz ALT > 19 IU/l. Hiperandrogenizm w PCOS może pośrednio zwiększać ryzyko NAFLD przez insulinooporność i otyłość oraz bezpośrednio przez efekt hepatotoksyczny. Polimorfizmy rs320 i rs268 genu lipazy lipoproteinowej nie mają wpływu na częstość występowania NAFLD u kobiet z PCOS. (Endokrynol Pol 2014; 65 (6): 416–421

Iron overload related diseases and methods of liver iron quantification

Iron overload refers to the excessive accumulation of iron in different organs. It occurs in the course of increased intestinal absorption in hereditary hemochromatosis, repeated blood transfusions, or liver diseases. Excess of iron exerts toxic effect on internal organs leading to liver damage resulting in liver cirrhosis, liver failure, or hepatocellular carcinoma among others. Assessment of liver iron content is essential for diagnosing diseases caused by iron overload and monitoring of iron-reducing therapy. A biopsy is a gold standard of assessment of liver iron concentration; however, new techniques based on the use of magnetic resonance imaging (MRI) gain in importance, as they are non-invasive, reliable, and enable to evaluate iron content in areas inaccessible by biopsy such as brain. This article reviews the currently used methods for assessment of liver iron overload, especially using MRI, in terms of their clinical usefulness and accuracy in different diseases. The authors conclude that assessment of iron overload is difficult, especially in patients with very high or very low level of iron and should be conducted taking into account the patient's clinical condition and the course of primary disease. Increase in the popularity of magnetic resonance signal intensity ratio (SIR) results from its safety, relatively low costs, availability, and possibility to obtain reliable results