G. Staśkiewicz

Cytokine response in the postoperative period after surgical treatment of benign adnexal masses : comparison between laparoscopy and laparotomy

BackgroundCytokines are the main mediators of the inflammation and the response to trauma. The purpose of the present study was the comparative assessment in sera of patients with benign adnexal masses treated by laparoscopy or laparotomy of the following proinflammatory and anti-inflammatory cytokines: interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor-alpha (TNF-α), and IL-10 in the early postoperative period.MethodsA total of 40 patients with benign adnexal masses were studied; 25 of whom underwent laparoscopy and 15, laparotomy. Blood serum concentration of IL-1β, IL-6, IL-8, TNF-α, and IL-10 were measured by commercially available ELISA assays before and 4 h, 24 h, and 48 h after the operation.ResultsConcentrations of IL-6 were significantly increased in both groups at 4 h, 24 h, and 48 h after the surgery; levels of IL-10 showed a significant increase 4 h and 24 h after the operation; an increase in IL-1β levels was observed only after laparotomy; no significant variations were observed in serum levels of IL-8; the postoperative increase of IL-1β, IL-6, and IL-10 levels was more pronounced in patients undergoing laparotomy than in those treated laparoscopically; length of the surgical procedure, amount of CO2 used, tumor diameter, age, and body mass index (BMI) of the patients did not influence the postoperative patterns of the studied cytokines.ConclusionsSystemic cytokine response after operations for benign adnexal masses depends on the degree of the surgical trauma, and is less pronounced in patients undergoing laparoscopy.

Highly increased maspin expression corresponds with up-regulation of miR-21 in endometrial cancer: a preliminary report.

Background: Maspin and programmed cell death 4 (Pdcd4) are tumor suppressor genes, and miR-21 is overexpressed in many solid tumors and was proven to negatively regulate a number of tumor suppressor genes including maspin and Pdcd4. The purpose of this study was to investigate the expression of maspin, Pdcd4, and miR-21 and their interrelations with clinicopathologic features in endometrial cancer using a quantitative approach. Methods: Maspin, Pdcd4, and miR-21 expressions were evaluated by a real-time polymerase chain reaction in 20 endometrial cancer and 10 normal endometrium samples. Results: Maspin showed a significantly increased expression in endometrial cancer samples compared with the control group and was up-regulated by a mean factor of 46.54 (SE range, 2.367-1160.26; 95% confidence interval, 0.515-15001, P < 0.0001). Expression of miR-21 was found significantly up-regulated in the sample group in comparison to control group by a mean factor of 2.312 (SE range, 0.741-7.778; 95% confidence interval 0.191-15.0, P = 0.028). No significant differences were present in the expression level of Pdcd4 between endometrial cancer and control groups. Comparison between IA and more advanced International Federation of Gynecology and Obstetrics stages of endometrial cancer in regard to expression levels of maspin, Pdcd4, and miR-21 did not reveal any significant differences. Similarly, no differences were encountered when histopathologic grading, myometrial invasion, age, body mass index, and parity were taken into consideration. Conclusions: Association between increased maspin expression and up-regulation of miR-21 in endometrial cancer suggests distinct and tissue-specific relationships of the 2 molecules in this type of malignancy and requires further studies that would reveal its clinical relevance.

Changes of procalcitonin level in multiple trauma patients.

BACKGROUND Some aspects of the pathophysiology of complications in multiple-trauma patients still remain unclear. Mediators of inflammation have been postulated as playing a key role in being responsible for life threatening complications of multiple trauma patients. The objective of this study was to evaluate the prognostic value of procalcitonin (PCT) level in multiple trauma patients. METHODS A prospective study took place including patients with multiple trauma hospitalised in several hospital units. PCT level was measured in blood from 45 patients, aged 18-70 years using enzyme-linked immunoassay. The patients were divided into three groups: group I - individuals with multiple trauma with central nervous system injury; group II - those with multiple trauma without CNS injury; and group III - patients with isolated central nervous system injury. RESULTS Initial PCT levels were below 0.5 ng mL(-1) regardless of the cause of trauma. In the 24th hour of observation, a statistically significant increase of PCT concentration vs. initial levels was recorded in all groups of patients. Then PCT levels decreased significantly at the 3rd measurement point in all groups, and they remained unchanged until the last measurement. The highest levels of PCT were observed in multiple trauma patients without CNS injury (group II). In this group of patients, a significantly longer duration of surgery in the post-trauma period affected PCT levels. PCT concentrations in patients who died were significantly greater than in survivors. CONCLUSIONS A long lasting elevated concentration of procalcitonin in the post-traumatic period, or its repeated increase, is a good marker of developing complications observed earlier than clinical manifestations.

Simulation techniques in the anatomy curriculum: review of literature.

Modern medical education faces a problem of combining the latest technology, procedures and information with classic teaching methods. Simulation is a technique, which replaces or amplifies doctor-patient experiences in controlled conditions and therefore evokes or replicates substantial aspects of the real world in a fully interactive manner. The basic course of anatomy in medical education could be recognised as the best example of implementing new educational techniques such as simulation, into the traditional medical curriculum. The PubMed database was searched using specific key words. Finally 72 articles were accepted and were divided into 3 basic categories of teaching methods: Category 1 - cadaveric dissection, Category 2 - simulator based education and Category 3 - other. A state of the art anatomical curriculum offers numerous possibilities and solutions including the oldest like cadaveric dissection and newest like simulators. Different simulation techniques are used with different intensity; however cadaveric dissection is still the most popular method. The second most frequent method is simulation-based training, in which North America is the leading country. The identification of anatomical structures during virtual surgical procedures or laparoscopic robotic procedures can be integrated into the traditional anatomy course. New technologies are supportive and beneficial in anatomy teaching however each excitement of new technologies sometimes should be tempered and evaluated for its usefulness in making the learning process constructive for students and their future practice.

A case of unusual course of adolescent menorrhagia: decidual cast as a side effect of treatment

OBJECTIVE To present an unusual side effect of therapy for adolescent menorrhagia, with commentary on management options. DESIGN Case report. SETTING Tertiary gynecologic center. PATIENT(S) A 13-year-old girl presenting with profuse uterine bleeding. INTERVENTION(S) Dysfunctional uterine bleeding was diagnosed, and pharmacologic therapy with a monophasic oral contraceptive (OC) pill was introduced. MAIN OUTCOME MEASURE(S) A large decidual cast occurred during treatment. RESULT(S) After finishing therapy with OC followed by three cycles of cyclic progestogen, the patient experienced regular menses. CONCLUSION(S) A large decidual cast may occur during treatment of adolescent menorrhagia with OCs; patients should be informed about this possibility, to reduce stress connected with the appearance of this side effect.

Cardiac sympathetic dysfunction in haemodialysed patients.

BACKGROUND The aim of this study was to evaluate the cardiac sympathetic nervous system function in haemodialysed(HD), non-diabetic patients by iodine-123 meta-iodo-benzylguanidine(123I-mIBG). MATERIALS AND METHODS Planar scintigraphy of the chest was performed in 36 HD, male patients; 15 minutes and 4 hours post injection of 370 MBq of 123I-mIBG. The semi quantitative analysis of myocardial tracer uptake was expressed as routine heart to mediastinum (H/M) ratio: 15 minutes (early H/M) and 4 hour (late H/M) post administration as well as washout of the tracer from myocardium (WR). 24-hour Holter studies were recorded and heart rate variability (HRV) was evaluated. Patients were divided into two groups according to the H/M value: group A patients with H/M > 1.8 which has been accepted as a norm,and group B patients with H/M < 1.8. RESULTS In 21/36 patients H/M ratio was below normal values.Significant differences between groups A and B were found among the following parameters: early H/M and late H/M ratios,WR and duration of haemodialysis therapy. CONCLUSIONS In patients with abnormal function of cardiac sympathetic nervous system, expressed by means of H/M ratio below 1.8, duration of haemodialysis treatment was longer.Duration of HD appears to be an important factor influencing cardiac sympathetic nervous system.

Supernumerary renal vessels: analysis of frequency and configuration in 996 computed tomography studies.

BACKGROUND Number, course and division pattern of renal vessels is highly variable. Variant renal vasculature is of high interest in nephrectomy for the renal transplantations, both in deceased and living donors. The purpose of the study was to analyse the frequency of supernumerary renal vessels in a large cohort of patients undergoing the multiphase abdominopelvic computed tomography (CT), as well as analyse the possible patterns of coexisting supernumerary arteries in veins. MATERIALS AND METHODS A retrospective analysis of abdominopelvic CT studies within 1 year period was performed. In each study, number of renal arteries and veins was recorded. Course of left renal vein was classified into normal, retro- or periaortic. For statistical analysis of normal distribution data, t-Student test was used. Chi-square test was used for frequency of variant vessel distribution. Pearson correlation coefficient was used for the analysis of coexistence of supernumerary vessels. RESULTS 996 patients were included in the analysis, male to female ratio: 481:515 (48%:52%). Mean age was 57.9 ± 14.7 years. Single renal arteries were observed in 73% of cases, while single renal veins in 95%. Circumaortic or retroaortic courses of left renal veins were observed in 10% of cases. Number of renal vessels has been compared in patients with and without supernumerary vessels. In patients with supernumerary left renal artery, significantly more right renal vessels were observed. In patients with supernumerary right renal vein, mean number of all remaining vessels was significantly higher. CONCLUSIONS Supernumerary renal vessels are a frequent finding in abdominal CT studies. Finding a supernumerary vessel should increase awareness of possible other supernumerary renal vessels.

Anatomical variations of the coeliac trunk in the homogeneous Polish population

BACKGROUND The abdominal vessels show a number of abnormalities and pathologies knowledge of which is important during open as well as laparoscopic surgeries. One of the most common vessels which pattern has many variations is the coeliac trunk. The present study was undertaken on homogeneous population to assess morphology of the coeliac trunk and to evaluate the possible variability of its branches. MATERIALS AND METHODS Standard abdominal multidetector computed tomography examinations were performed on a total of 1569 patients diagnosed by 2 radiologists independently; in case of doubts common assessment was performed. RESULTS The coeliac trunk followed the classic pattern in 92.7% of the cases (1455/1569 of patients). The gastrosplenic trunk was detected in 4.1% of cases (64/1569); the hepatosplenic trunk in 2.2% of cases (34/1569); the coeliac-mesenteric trunk was observed in 0.5% of cases (8/1569); the hepatogastric trunk in 0.2% of cases (4/1569); the splenomesenteric trunk was detected in 0.1% of cases (2/1569). In the next 0.1% the coeliac trunk was absent. The hepatosplenomesenteric and the coeliac-colic trunk were not observed in the study population. CONCLUSIONS Vascular anatomical abnormality is usually asymptomatic hovewer, its preoperative knowledge is helpful to reduce complications like vascular bleeding when dissecting the hapato-pancreatic region. The coeliac trunk and its branches can be fast and easy evaluated in computed tomography exams performed due to various symptoms from abdominal cavity.

The usefulness of SPECT/CT in characterization of skeletal and soft tissue lesions — report of two cases

SPECT/CT imaging provides detailed information on the radiotracer distribution and enables simultaneous lesion morphology evaluation. This hybrid imaging delivers complementary information about patients disease. We present two cases in which SPECT/CT imaging and cooperation between the nuclear medicine physician and radiologist quickly clarified the diagnosis, sparing patient unnecessary diagnostic procedures or treatment.

Total anomalous pulmonary vein drainage in a 60-year-old woman diagnosed in an ECG-gated multidetector computed tomography – a case report and review of literature

Purpose Total anomalous pulmonary vein drainage (TAPVD) is a congenital cardiac defect in which there is no connection between pulmonary veins and the left atrium. Pulmonary veins form a confluence independent of the left atrium and drain to a systemic vein. TAPVD types are: supracardiac, cardiac, infracardiac, and mixed. TAPVD accounts for approximately 1.5-2.2% of all congenital heart diseases. This anomaly is usually diagnosed in the neonatal period, and it coexists with atrial septal defect. Adult cases of TAPVD are rarely reported. Case report We report a rare case of a 60-year-old woman with incidentally found, uncorrected TAPVD in ECG-gated multidetector computed tomography. In previous echocardiographic examinations partial anomalous pulmonary venous return and atrial septal defect were diagnosed. Conclusions ECG-gated multidetector computed tomography is a valuable diagnostic method for adults with congenital heart disease. It enables evaluation of coronary arteries and simultaneously provides detailed anatomy of great vessels.