Usefulness of conventional and low-dose hydro-CT in the diagnosis of gastric tumors in comparison to endoscopy

PURPOSE

The aim of this retrospective study was to evaluate the usefulness of hydro-CT in the diagnosis of gastric tumors in comparison to endoscopy.

MATERIAL AND METHODS

The study involved 40 patients with a diagnosis of gastric tumor established by histopathology who underwent endoscopy and conventional or low-dose hydro-CT. Hydro-CT images were retrospectively analyzed based on the consensus of two radiologists who were blinded to the endoscopy findings. The diagnostic accuracy of hydro-CT and endoscopy for the diagnosis of gastric tumors was evaluated using the results of the histopathological examination as the reference standard.

RESULTS

Histopathology confirmed the presence of gastric cancer in 28 patients (70%), while gastrointestinal stromal tumors (GISTs) were recognized in the remaining 12 cases (30%). Correct diagnoses of the type of gastric tumor in hydro-CT were obtained in 37 patients (92.5%). This was not significantly different from the 85% accuracy of endoscopy. Further analysis showed that the correctness of GIST diagnosis in endoscopy and hydro-CT also did not differ significantly (91.7% and 100% respectively). The percentage of correctly diagnosed malignant lesions in hydro-CT was lower than for GISTs at 89.29%, while in endoscopy it was insignificantly lower (82.14%). The diagnostic accuracy of conventional and low-dose hydro-CT in the diagnosis of gastric tumors (95% and 90% respectively) was not significantly different.

CONCLUSIONS

Conventional and low-dose hydro-CT may be a valuable non-invasive diagnostic method in the diagnosis of gastric tumors for patients who have contraindications to endoscopy or who are unable to undergo gastric biopsy.

Popliteal artery thrombosis secondary to a tibial osteochondroma

Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma.

MRI image characteristics of materials implanted at sellar region after transsphenoidal resection of pituitary tumours

BACKGROUND

Post-surgical evaluation of the pituitary gland in MRI is difficult because of a change in anatomical conditions. It depends also on numerous other factors, including: size and expansion of the tumour before surgery, type of surgical access, quality and volume of implanted materials and time of its resorption. The purpose was to demonstrate the characteristics of the implanted materials on MRI performed after transsphenoidal resection of pituitary tumours and to identify imaging criteria helpful in differential diagnosis of masses within the sellar region.

MATERIAL/METHODS

One hundred and fifty-four patients after transsphenoidal resection of pituitary tumours were included in the study. In general, 469 MRI examinations were performed with a 1.5T scanner. We obtained T1-weighted sagittal and coronal, enhanced and unenhanced images. In 102 cases, additional T2-weighted coronal, unenhanced images with 1.5 T unit were obtained as well.

RESULTS

The implanted materials appeared in 95 patient: fat in 86 and muscle with fascia in 3 patients. We could recognise implanted muscle and fascia in T2-weighted images, because of high signal intensity of the degenerating muscle and the line of low signal representing fascia. The implanted titanium mesh was found in 4 patients. Haemostatic materials were visible only in 2 patients in examinations performed at an early postoperative stage (1 month after the procedure).

CONCLUSIONS

The knowledge of MRI characteristics of the materials implanted at the sellar region is very important in postoperative diagnosis of pituitary tumours and may help discriminate between tumorous and non-tumorous involvement of the sellar region. Some implanted materials, like fat, could be seen on MRI for as long as 10 years after the operation, others, like haemostatic materials, for only 1 month after surgery. T2-weighted imaging is a useful assessment method of the implanted muscle and fascia for a long time after surgery.

Evaluation of temporal bone computed tomography and paranasal sinuses magnetic resonance images in acromegalic patients

OBJECTIVE

Acromegaly is a rare disease, which symptoms are caused by excess secretion of a growth hormone (GH) from the anterior pituitary benign tumor - adenoma. Authors present an evaluation of computed tomography (CT) and magnetic resonance (MR) images of temporal bone and paranasal sinuses of patients with acromegaly.

CONCLUSIONS

1. In all patients with acromegaly, morphological changes in paranasal sinuses were shown. They were mostly pronounced within the maxillary sinuses including the mucosa thickening up to 6 mm and encysted fluid occurrence. 2. CT of temporal bone did not reveal structural changes of internal and median ear. 3. There is a need for further studies on hearing impairment in patients with acromegaly.

[Vestibulo-cochlear disturbances in the course of vaso-neural conflict of vestibule-cochlear nerve--diagnostic and therapeutic problems]

INTRODUCTION

Symptoms encompassing sensorineural hearing loss, tinnitus and vertigo occur in many diseases of various origin. The diagnostics in such cases is especially difficult and often requires interdisciplinary cooperation. Despite of that many cases remain unexplained.

MATERIAL AND METHOD

The two cases with above mentioned symptoms (52 year-old woman and 46 year-old man) with differentiated clinical course were presented. The woman for one year experienced left sided, extreme tinnitus with paroxysmal vertigo and dizziness. The man with sudden monolateral hearing loss and tinnitus that disappeared after corticosteroid therapy, complained about recurrence of fluctuating hearing loss and tinnitus accompanied by chronic instability. The diagnostics of hearing and balance organs was performed (pure tone audiometry, impedance audiometry, DPOAE, ABR, ENG) complemented with computed tomography and Nuclear Resonance.

RESULTS

Female patient presented bilateral mild sensorineural hearing loss, more intensive on the left side, male patient right sided sensorineural hearing loss in the frequencies from 250 to 1500 Hz. The elongation of some peak values in ABR test (with bilaterally proper otoacoustic emissions) as well as partial canal paresis on the hearing loss side suggested primary diagnosis of neoplasmatic process. It was an indication to perform radiological diagnostics. The radiologic findings revealed the contact of vestibulo-cochlear nerve with the loop of cerebellar inferior anterior artery within the internal acoustic canal.

CONCLUSIONS

The course of the disease and diagnostic tests do not provide characteristic data that let diagnose neuro-vascular conflict. One has to be aware of such possibility in patients with intensive vertigo and dizziness that do not improve after treatment when other causes do not justify the symptoms.

Middle-ear ceruminous adenoma as a rare cause of hearing loss and vertigo: Case reports

Middle-ear ceruminous adenomas are rare benign neoplasms arising from the epithelium of the middle ear. Progressive hearing loss, ear fullness and tinnitus are common symptoms of this tumour; facial nerve paresis and vestibular disturbances occur very infrequently. We present two cases of middle-ear ceruminous adenomas, one showed rapid unilateral hearing loss with aural fullness, followed by purulent aural discharge and vertigo. In the second case, the disease affected an already deaf ear and the only symptom of the disease was increasing vertigo. The clinical features, intraoperative findings, and histological and radiological findings are presented. The cases are compared to those described in the literature.

[Usefulness of imaging in the diagnosis of salivary gland diseases]

The aim of this study was to evaluate the value of modern imaging modalities in the diagnosis and management of different salivary gland diseases.

MATERIAL AND METHODS

Material comprised of 135 patients (79 women and 56 men) at the age 14-70 (mean aged 35, 7). Ultrasonography (US) was basic examination in every case. Results of US examinations were compared with sialography, CT and MR imaging. Final diagnosis was established on the basis of histopathologic examination.

RESULTS

The big usefulness of new visualization techniques, especially modem ultrasonography in detecting neoplastic and inflammatory processes of salivary glands was stated.

CONCLUSION

US is the first, precious imaging modality to evaluate a small lesions (in diameter above 5 mm) of the parotid and submandibular gland. CT and MR is better to evaluate large tumors and should be performed whenever a malignancy is strongly suspected or has been assessed.

Femoral and iliac vein stenoses after prolonged femoral vein catheter insertion

BACKGROUND/AIMS

Catheterization of the femoral vein is a safe and recommended method of temporary access for haemodialysis. In some patients, however, because of the lack of other possibilities, it is necessary to maintain long-term femoral cannulation. The aim of the study was to evaluate the frequency of stenosis after prolonged femoral cannulation.

METHODS

The 24 patients incorporated in the study were divided into two groups. Group 1 consisted of 10 end-stage kidney failure patients (four females and six males, aged 32-75 years, average 55.6+/-13.6 years) in whom femoral catheters were maintained for less than 2 weeks (5-14 days, average 9.3+/-3.6 days). Group 2 included 14 chronic haemodialysis patients (six females and eight males aged 23-65 years, average 49.5+/-13.27 years). The time of catheter maintenance ranged from 2 to 16 weeks (average 6.4+/-4.2 weeks). Femoral and iliac vein status was evaluated using magnetic resonance imaging.

RESULTS

A feature of venous stenosis of both the femoral and iliac veins was disclosed in four patients in whom femoral cannulation lasted more than 4 weeks. There were no stenoses in group 1.

CONCLUSION

Long-term femoral cannulation for more than 4 weeks may be associated with a significant risk of stenosis in the femoral and/or external iliac veins.

Peripheral blood lymphocytes and selected serum interleukins in workers operating X-ray equipment

The objective of these studies was to determine the effect of low X-ray doses on peripheral blood lymphocytes in the workers operating X-ray equipment. In 30 workers and 18 persons who constituted the control group the absolute number of peripheral blood lymphocytes, the number of T CD4+ and T CD8+ lymphocytes, the ratio CD4+/CD8+ and the concentration of serum interleukins (IL-2, IL-4, IL-6) were tested. Subgroups with respect to sex and employment period were selected. A significant increase in IL-2 concentration in workers as compared to controls was observed and significantly decreased IL-4 level in operating X-ray equipment was revealed. The lowest levels of IL-4 were noted in the women subgroup. A high positive, statistically significant correlations between the number of lymphocytes and the concentration of IL-2 and the level of IL-4 were observed. Moreover, our studies revealed that lymphocyte number and interleukin concentrations in serum of X-ray operators do not depend on the assumed ranges of the length of employment period.

Acromegaly due to GHRH-secreting large bronchial carcinoid. Complete recovery following tumor surgery

A case of acromegaly, secondary to GHRH secretion by a large bronchial carcinoid is reported. A 61-year-old woman presented with typical symptoms and signs of acromegaly for at least 10 years. She suffered from recurrent pneumonias, but repeated chest X-ray examinations failed to demonstrate the bronchial tumor. The diagnosis was confirmed by elevated GH, IGF-1 and GHRH secretion. We have shown an enlarged pituitary gland without focal lesions together with a cerebral meningioma on MRI and the presence of a bronchial carcinoid tumor. The latter was confirmed by histology carried out after bronchoscopy and tumor excision. We observed partial suppression of GH secretion following short-term oral bromocriptine administration in this patient. Surgical removal of the carcinoid tumor resulted in a complete clinical, hormonal and radiological cure of acromegaly. This case of acromegaly due to ectopic GHRH secretion by bronchial carcinoid differs from others described in the literature by an atypical large tumor size, the suppression of elevated GH secretion by oral bromocriptine and a concomitant meningioma.

[Estimation of blood pressure, selected biochemical parameters and indices of left ventricular heart function in patients with mild or moderate essential hypertension treated with potassium losartan]

This study was conducted in 19 patients with mild or moderate essential hypertension randomised open trial to evaluate the influence of potassium losartan dosed 50 mg per day on blood pressure, metabolic processes and left ventricular heart function. The following intervals of examination were accepted-at entry (before therapy with losartan) and then after 10 days; after 30 days and after 60 days of treatment. Mean values of arterial blood pressure and heart rate measured by conventional technics and obtained from 24-hour ambulatory monitoring data, biochemical results (serum levels of glucose, uric acid, creatinine, sodium, potassium, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, bilirubin and serum activity of aminotransferases) and selected indices of left ventricular heart function were evaluated as intragroup differences using Student's paired t test. Afterwards the body mass index was compared. Statistically significant decrease of systolic arterial pressure after 60 days of therapy was revealed and it concerned both diurnal period and sleep time and during whole 24 hours. During treatment with losartan mean creatinine serum level was increased and the serum level of bilirubin was decreased in serum after 10 days of therapy. No significant changes were noted in any other laboratory parameters. After 30 and 60 days of treatment with potassium losartan thickness of interventricular septum end-diastole (IVS-D) diminished and E/A ratio (transmitral flow during early ventricular diastole to peak velocity of late filling) augmented statistically significantly after 30 days of treatment. In addition body mass index was increased after 10 days of therapy with losartan when compared with this index at the entry. This study confirmed profitable antihypertensive losartan effect as significant decrease of systolic blood pressure and demonstrated improve diastolic function of left ventricle during therapy in patients with mild or moderate essential hypertension.

[Hypochromic anemia as a symptom of Zenker's diverticulum]

The case of Zenker's diverticulum with concomitant hypochromic anemia was described. In discussion the explanation of this phenomenon was given.

[Rarely encountered association of hyperthyroidism in the form of Graves-Basedow disease with vitiligo]

A case is described of rarely occurring disease combination, that is Graves-Basedow disease and vitiligo. In the discussion, on the basis of literature data the possibility is presented of simultaneous occurrence of diseases of autoimmunological character.

[Small-cell lung tumor associated with erythroleukemia reaction in peripheral blood and syndrome of disseminated intravascular coagulation]

A case of a 65-year-old man with erythroleukaemic reaction in peripheral blood in the course of untreated lung cancer, and the encountered diagnostic problems are described. In the discussion the possible mechanisms are presented which may explain the occurrence of erythroleukaemia in the course of parvicellular lung carcinoma.

[Evaluation of phagocytic and bactericidal activities of neutrophils in peripheral blood of patients with anemia due to iron deficit]

Phagocytic and bactericidal properties of neutrophils have been evaluated in 20 women with anemia due to iron deficit. Twenty healthy women in corresponding age and domicile served as a control group. No statistically significant difference in both phagocytic and bactericidal properties of peripheral blood neutrophils have been noted in both groups. A decrease in plasma bactericidal activity has been sen in patients with anemia due to iron deficit. It may be one of the causes of increased susceptibility to infections noted in patients with plasma iron deficit.