Laretta Grabowska-Derlatka

Usefulness of 16-Row Multidetector Computed Tomography With Volume Rendering and Maximum Intensity Projection Reconstruction as a Monitor Pancreatic Graft Vessel Patency During the Early Postoperative Period

Thrombosis of the pancreatic graft vessels is the most common complication after transplantation. It leads to loss of 5% to 8% of grafts during the early postoperative period. The aims of this study were to evaluate the usefulness of 16-row multidetector computed tomography (16-MDCT) with volume rendering (VR) and maximum intensity projection (MIP) reconstruction to monitor pancreatic graft vessel patency during the early postoperative period and the efficacy of a heparin infusion as a treatment for graft thrombosis. Among 40 consecutive simultaneous pancreas-kidney transplant recipients, 16-MDCT was performed at 6 to 8 days after the operation. Secondary reconstructions were obtained with VR and MIP algorithms to evaluate the morphology and patency of the extra- and intrapancreatic arteries and veins. In cases of thrombosis, every patient was treated with an infusion of unfractionated heparin. In 15 recipients, thrombosis of the large vessels was detected by 16-MDCT. Heparin infusions saved five pancreatic grafts (5/15; 33.3%), but the other 10 pancreatic grafts were removed. In another four recipients (4/40; 10%) the thrombi were localized only in small intrapancreatic vessels. Treatment with heparin infusion was successful in 3/4 (75%) cases with patent vessels upon control computed tomography examination. We compared the efficacy of heparin treatment depending on the diameter of the thrombosed vessel, observing a significant difference (5/15 vs 3/4; P < .01; chi-square). 16-MDCT with secondary reconstruction by application of VR and MIP algorithms was an efficient method to visualize not only large pancreatic graft arteries and veins but also intrapancreatic parenchymal vessels. In cases of thrombosis of small intrapancreatic vessels, unfractionated heparin infusion significantly decreased graft loss.

Diffusion-Weighted Imaging of Small Peritoneal Implants in “Potentially” Early-Stage Ovarian Cancer

Introduction. MRI is established modality for the diagnosis of ovarian malignancies. Advances in MRI technology, including DW imaging, could lead to the further increase in the sensitivity of MRI for the detection of peritoneal metastases. The aim of this study was to assess the accuracy of DW imaging for detection of peritoneal metastatic disease in patients suspected of having potentially early ovarian cancer and secondly to evaluate ADC values of peritoneal implants. Materials and Methods. The prospective study group consisted of 26 women with sonographic or/and CT diagnosis of suspected ovarian tumor. Based on the results of the above imaging, in none of them was extraovarian spread of disease or ascites recognized. All patients underwent MRI with DW imaging. Results. Overall, 18 extraovarian peritoneal lesions were found on DW images in 10 from 26 examined patients. All implants had diameter ≤10 mm. The presence of all lesions diagnosed by MRI was confirmed intraoperatively. Histopathologic findings in 17 proofs confirmed ovarian cancer. PPV was 94%. On all DW images (with b values of 0, 50, 100, 150, 200, 400, 800, and 1200 s/mm2) the mean signal intensities of peritoneal lesions were significantly higher than the mean signal intensities of normal adjacent tissue (p = 0.000001).

Differentiation of ovarian cancers from borderline ovarian tumors on the basis of evaluation of tumor vascularity in multi-row detector computed tomography--comparison with histopathology.

Objective The aim of this study was to evaluate the feasibility of multi–detector row computed tomography (MDCT) in the differentiation between borderline ovarian tumors and ovarian cancer on the basis of tumor morphology and specific features of tumor vascularity in correlation with the results at pathology. Methods A triphasic MDCT protocol was used for the analysis of tumor vascularity. The following features were taken into account: (1) The number of vessels in papillary projections, solid-tissue component, and septa (2 vs >2), (2) serpentine and chaotic configuration of vessels, (3) presence of microaneurysms, and (4) presence of arteriovenous microfistulas. Masses with at least 3 of 4 features were considered ovarian cancer (group A) and masses with 2 features or less as borderline tumor (group B). Radiological findings were compared with results of postoperative pathology. Results Pathologic vessels were found in all 56 patients. Thirty-two patients were included in group A and 24 in group B. The results of pathology were as follows: in group A: 31 malignant tumors, including 31 ovarian carcinomas and 1 benign cystadenoma; in group B: 22 borderline ovarian tumors, 1 benign cystadenoma, and 1 ovarian cancer. Conclusions Morphological evaluation of tumor vascularity in MDCT seems to be an efficient method of differentiating between borderline ovarian tumors and ovarian carcinomas. Because of a small number of cases in the current study, a further research seems justified to confirm our results. The presented MDCT-angiographic criteria showed high sensitivity (97%) and specificity (96%) in differentiation of borderline ovarian tumors and ovarian cancers as compared with pathology. The presented CT-angiographic criteria of malignancy showed an excellent interobserver agreement.

Magnetic resonance diffusion-weighted imaging in diagnostics of primary fallopian tube carcinoma – is it useful?

Purpose Primary fallopian tube carcinoma (PFTC) is the rarest form of female genital malignancy. The imaging applied for suspected adnexal masses includes transvaginal ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), but the vast majority of PFTC is recognised intraoperatively. Material and methods The study group consisted of seven women with postoperatively histopathological diagnosis of PFTC. To recognise characteristic findings for PFTC, retrospective analysis of preoperative MRI was performed. All patients underwent MRI of the pelvis and abdomen using a 1.5T MR system. Based on the results of the above imaging, suspected adnexal masses were recognised. MRI protocol contained T2-weighted images, fat-suppressed T2-weighted, T2-TIRM, DW EPI, pre- and postcontrast dynamic 3D T1 GRE in transverse orientation, with diffusion weightings of 0, 50, 100, 150, 200, 400, 800, and 1200 s/mm2. Regions of interest were outlined by a radiologist, who documented the character of adnexal masses on diffusion-weighted (DW) images and apparent diffusion coefficient (ADC) maps. Results In all seven patients with PFTC unilateral tumour was found. On all DW images (with β values of 0, 50, 100, 150, 200, 400, 800, and 1200 s/mm2) the mean signal intensities of solid parts of tumour were significantly higher than the mean signal intensities of normal ovarian tissue (p = 0.0001). There were no statistically significant differences between eight β values applied for ADC calculations. Conclusions Preoperative diagnostics of PFTC is difficult and mainly based on morphological features. Previous research did not show characteristics of PFTC in post-contrast dynamic imaging. In our material a clear increasing of signal intensity in DW imaging occurred independently of the β value.

Treatment Algorithm of Peripancreatic Arteries Aneurysm Coexisting with Coeliac Artery Lesion: Single Institution Experience

Introduction True aneurysms of peripancreatic arterial arcades (PAAAs) coexisting with celiac axis lesion are often asymptomatic. However, they may rupture regardless of their size and cause life-threatening hypovolemia. No treatment guidelines exist to date. We present a series of 21 patients and our management algorithm. Material and Methods For ruptured aneurysms we preformed endovascular embolization. Further treatment was dependent on patients condition and control studies. In case of unruptured aneurysms, we assessed collateral circulation between superior mesenteric artery and celiac axis in angio-CT. If there was a pathway free from aneurysms, endovascular approach was chosen. Otherwise, surgical or combined treatment was favored. Results Endovascular treatment was performed in 14 patients with no complications. Follow-up studies revealed incomplete occlusion of the aneurysms in two cases. Surgical or combined treatment was performed in 7 patients with three serious perioperative complications. They were managed conservatively in two cases and surgically in one. Follow-up studies showed aneurismal dilatation and stenosis of a renohepatic by-pass in one case. Conclusion We present our management algorithm of PAAAs. Our results support the leading role of endovascular treatment. We present its limitations favoring surgical or combined treatment. All patients should be carefully followed.

Correlation between findings of multislice helical computed tomography (CT), endoscopic examinations, endovascular procedures, and surgery in patients with symptoms of acute gastrointestinal bleeding

Summary Background Endoscopic methods (gastroscopy and colonoscopy) are considered fundamental for the diagnosis of gastrointestinal bleeding. In recent years, multidetector computed tomography (MDCT) has also gained importance in diagnosing gastrointestinal bleeding, particularly in hemodynamically unstable patients and in cases with suspected lower gastrointestinal tract bleeding. CT can detect both the source and the cause of active gastrointestinal bleeding, thereby expediting treatment initiation. Material/Methods The study group consisted of 16 patients with clinical symptoms of gastrointestinal bleeding in whom features of active bleeding were observed on CT. In all patients, bleeding was verified by means of other methods such as endoscopic examinations, endovascular procedures, or surgery. Results The bleeding source was identified on CT in all 16 patients. In 14 cases (87.5%), bleeding was confirmed by other methods. Conclusions CT is an efficient, fast, and readily available tool for detecting the location of acute gastrointestinal bleeding.

Angiogenic cytokines VEGF, TGF-β1, IL-8 and TNF secretion by human ovarian cancer cells

© Medical Communications Sp. z o.o. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (CC BY-NC-ND). Reproduction is permitted for personal, educational, non-commercial use, provided that the original article is in whole, unmodified, and properly cited. Angiogenic cytokines VEGF, TGF-β1, IL-8 and TNF secretion by human ovarian cancer cells Wydzielanie angiogennych cytokin VEGF, TGF-β1, IL-8 i TNF przez ludzkie komórki nowotworów jajnika

Aneurysms of Peripancreatic Arterial Arcades Coexisting with Celiac Trunk Stenosis or Occlusion: Single Institution Experience

Introduction. True aneurysms of peripancreatic arterial arcades (PAAAs) are rare. Most of them coexist with celiac axis stenosis/occlusion due to median arcuate ligament (MAL) compression or atherosclerosis. The aim of this study was to evaluate the cause of celiac axis lesion and characterize the anatomy of the aneurysms. These findings may have important management implications. Material and Methods. A retrospective analysis of 15 patients with true PAAAs was performed. The diagnosis was established by contrast-enhanced CT, using a 64-MDCT scanner. We evaluated the most probable cause of celiac axis lesion. Aneurysms were characterized by their number, location, size, and morphology. Location of the aneurysms was classified either as pancreaticoduodenal arteries (PDA) or as dorsal pancreatic arteries (DPA) as they may represent different collateral pathways between superior mesenteric artery and celiac trunk. Results. A total of 32 true PAAAs were identified. Celiac trunk was occluded in 12 patients and critically narrowed in 3 patients. Celiac axis lesion was categorized as secondary to MAL compression in 14 cases and due to atherosclerosis in 1 case. The most common location of the aneurysms was inferior pancreaticoduodenal arteries. Only in 1 case aneurysms involved both PDA and DPA. Conclusions. Coexistence of PAAAs with celiac axis compression as well as involvement of either PDAs or DPAs has important therapeutic implications. The uninvolved collateral pathway may be sufficient to preserve effective circulation in celiac trunk branches in case of resection or embolization of the aneurysms. However, further studies are crucial to confirm our findings.

Quality of Pancreatic Transplant Program Assessment Using a Risk-adjusted Cumulative Sum Chart: Experience From a Single, Small Center

BACKGROUND The high rate of complication after pancreas transplantation not only had an impact on recipient quality of life and survival but also had significant financial implications. Thus, monitoring transplant center performance was crucial to indentifying changes in clinical practice that result in quality deterioration. OBJECTIVE To evaluate retrospectively the quality of the single, small pancreatic transplant program and to establish prospective monitoring of the center using risk-adjusted cumulative sum (CUSUM). METHODOLOGY From 1988 to 2014, 119 simultaneous pancreas and the kidney transplantations (SPKTx) were performed. The program was divided into 3 eras, based on surgical technique and immunosuppression. Analyses of the 15 fatal outcomes due to complication from pancreatic graft were performed. The risk model was developed using multivariable logistic regression analysis based on retrospective data of 112 SPKTx recipients. The risk-adjusted 1-sided CUSUM chart was plotted for retrospective and prospective events. The upper control limit was set to 2. RESULTS There were 2 main causes of death: multiorgan failure (73.3%; 11/15) and septic hemorrhage (26.7%; 4/15). Quality analysis using the CUSUM chart revealed that the process was not homogeneous; however, no significant signal of program deterioration was obtained and the performance of the whole program was within the settled control limit. CONCLUSION For a single pancreatic transplant center. The risk-adjusted CUSUM chart was a useful tool for quality program assessment. It could support decision making during traditional surgical morbidity and mortality conferences. For small transplant centers, increasing the sensitivity of the CUSUM method by lowering the upper control limit should be considered. However, an individual assessment approach of the for particular centers is recommended.