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Case Reports 2012; 33(6): 600-602 PubMed PMID: 23160223 Citation  Keywords:  Adolescent, Diagnosis, Differential, Female, Fibroma:diagnostic imaging, Humans, Neoplasms:diagnostic imaging, Tomography, X-Ray Computed, Treatment Outcome, Vulvar Neoplasms:diagnostic imaging,.   

BACKGROUND: Fibromas and fibromyomas belong to the most common solid vulvar tumors. Their cause remains unknown.

CASE: A 15-year-old girl arrived at our department for extirpation of a large pendulous vulval fibroma. For three years she had observed a gradually enlarging structure protruding from her external genitals. After a preoperative CT examination the tumor was extirpated with a histological diagnosis of benign soft fibroma.

CONCLUSION: Our report describes a therapeutic management of a large vulval fibroma in a young girl. The extended time from first symptoms to final treatment deserves reflection....

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Case Reports 2012; 33(5): 489-492 PubMed PMID: 23090265 Citation  Keywords:  Basal Ganglia Diseases:diagnostic imaging, Chorea:diagnostic imaging, Diabetes Mellitus, Type 2:complications, Female, Humans, Hyperglycinemia, Nonketotic:complications, Magnetic Resonance Imaging, Middle Aged, Putamen:diagnostic imaging, Tomography, X-Ra.   

: A case of a 61-year-old woman with hemichorea associated with nonketotic hyperglycemia is reported. The typical presentation of this disease is nonketotic hyperglycemia, hemichorea, hyper-intense signal on T1-weighted magnetic resonance imaging (MRI) and high-density on computed tomography (CT) in the contralateral striatum. With good glycemic control, the clinical symptoms disappeared....

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Comparative Study 2012; 33(4): 419-424 PubMed PMID: 22936263 Citation  Keywords:  Adult, Alcohol Drinking:metabolism, Alcoholism:metabolism, Cerebellum:diagnostic imaging, Female, Fluorodeoxyglucose F18:metabolism, Humans, Male, Middle Aged, Positron-Emission Tomography:methods, Radiopharmaceuticals:metabolism, Time Factors, Treatment .   

OBJECTIVES: The acute and maintenance treatment of alcohol addiction represents the clinical challenge. The aims of our study were to evaluate the influence of alcohol consumption on regional brain metabolism and the predictive value of PET by means of the duration and quality of remission which followed the sub-acute treatment.

METHODS: PET investigation with 18 fluoro-deoxyglucose (18FDG) were performed in detoxified patients with alcohol dependence at the end of short-term treatment. Abstinence was evaluated in patients during the one year follow-up period.

RESULTS: We detected the positive correlation between 18FDG uptake in the cerebellar vermis (FWE, p<0.05) and duration of abstinence within one year.

DISCUSSION: Our findings support the assumption that the cerebellum would be involved in the maintenance of abstinence in alcohol dependent subjects. Cerebellar connections with cortical areas critical for addiction such as frontal, parietal, temporal regions would mediate the influence of the cerebellum on emotional systems related to addiction.

CONCLUSIONS: Our study is the first to document that the cerebellum and particularly the vermis is involved in the clinical outcome in terms of abstinence during one year. Our findings support the role of the cerebellum in addiction and the possibility to predict therapeutic outcome....

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Case Reports 2012; 33(3): 273-278 PubMed PMID: 22635083 Citation  Keywords:  Adult, Antineoplastic Agents, Hormonal:therapeutic use, Chemoradiotherapy:methods, Female, Humans, Insulinoma:diagnostic imaging, Octreotide:analogs & derivatives, Organometallic Compounds:therapeutic use, Pancreatic Neoplasms:diagnostic imaging, Radionuc.   

BACKGROUND: Insulinomas are the most common functioning neuroendocrine tumours of the pancreas. Hypoglycemia due to excessive production of insulin is a main feature of this disease. Usually these neoplasms are benign and single with surgical excision as a treatment of choice. About 10% are malignant with tendency to form metastases especially to the liver then therapy requires various medical technics.

CASE REPORT: 43 years old female with reccurent syncopies in course of hypoglycemia was admitted to the hospital to be diagnosed. Having suspected pathology within the pancreas the abdominal MRI was performed. It showed presence of numerous metastatic changes in the liver with no any other deviations in the abdomen including pancreas. Subsequent 18FDG PET-CT revealed metastases to the regional lymph nodes and the liver and suggested the presence of a primary lesion in the tail of the pancreas which was confirmed in EUS. Surgical excision of the tail of the pancreas was done. Pathological result: pancreatic neuroendocrine well differetiated cancer. Due to the recurrence of hypoglycemia patient was admitted to Department of Endocrinology where somatostatin analogue scintigraphy showed the presence of tracer accumulation foci in the liver. Combined long-acting somatostatin analogue (octreotide) and peptide radionuclide receptor ((90)Y-DOTA-TATE) therapy were introduced. Stable blood glucose levels with no tendency to hypoglycemia and partial regression (PR) of liver lesions according to RECIST citeria were observed in course of the treatment....

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Case Reports 2012; 33(3): 260-264 PubMed PMID: 22635080 Citation  Keywords:  Adrenal Gland Neoplasms:diagnostic imaging, Adult, Antineoplastic Agents:administration & dosage, Drug Resistance, Neoplasm, Fatal Outcome, Female, Humans, Indoles:administration & dosage, Pheochromocytoma:diagnostic imaging, Pyrroles:administration & dos.   

: We report the clinical response and adverse events of a female patient treated for recurrent malignant pheochromocytoma using the tyrosine kinase inhibitor sunitinib. A 41-year-old woman underwent adrenectomy and nephrectomy forpotentially malignant adrenal pheochromocytoma. Fifty-four months after surgery, abdominal computed tomography (CT) and Iodine-131 metaiodobenzylguanidine((131)I-MIBG) scintigraphy revealed multiple tumors in the liver. Two chemotherapy protocols were administered in succession (first line: cyclophosphamide/vinblastine/dacarbazine; second line: cisplatin/docetaxel/ifomide). Despite these treatments, however, the tumors continued to progress. Treatment with sunitinib was initiated, but the patient quickly developed critical hypertension caused by tumor lysis syndrome. The sunitinib dose was reduced, and a partial response, as defined by the Response Evaluation Criteria in Solid Tumors (RECIST), was observed after 6 treatment cycles. Moreover, no severe adverse events occurred during this lower-dose sunitinib treatment. Unfortunately, sunitinib treatment became unaffordable for the patient, who eventually resorted to palliative care and died 37 months later. This case study is consistent with previous reports indicating that appropriate doses of sunitinib can induce a partial antitumor response in patients with refractory pheochromocytoma....

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Comparative Study 2012; 33(2): 212-216 PubMed PMID: 22592204 Citation  Keywords:  Adult, Endometrium:diagnostic imaging, Endosonography:methods, Female, Humans, Hysteroscopy:methods, Imaging, Three-Dimensional:methods, Middle Aged, Perimenopause, Sensitivity and Specificity, Uterine Hemorrhage:diagnosis, Uterus:diagnostic imaging,.   

OBJECTIVE: In many publications the transvaginal ultrasound is regarded as the first step to diagnose the cause of uterine bleeding in perimenopausal women. In order to improve the sensitivity and specificity of the conventional ultrasound physiological saline solution was administered to the uterine cavity and after expansion of its walls the interior uterine cavity was examined. And this procedure is called 2D sonohysterography (SIS 2D). By the ultrasound scanners which enable to get 3D real time image a spatial evaluation of the uterine cavity is possible. Clinical value of the real time 3D sonohysterography and 2D sonohysterography compared to hysteroscopy with histopathological examination in perimenopausal women.

MATERIAL AND METHODS: The study concerned a group of 97 perimenopausal women with abnormal uterine bleeding. In all of them after a standard transvaginal ultrasonography a catheter was inserted into the uterine cavity. After expansion of the uterine walls by administering about 10 ml of 0,9% saline solution the uterine cavity was examined by conventional sonohysterography. Then a 3D imaging mode was activated and the uterine interior was examined by real time 3D ultrasonography. The ultrasound results were verified by hysteroscopy, the endometrial lesions were removed and underwent a histopathological examination.

RESULTS: In two cases the SIS examination was impossible because of uterine cervix atresion. In the rest of examined group the SIS 2D sensitivity and specificity came up to 72 and 96% respectively. In the group of SIS 3D the sensitivity and specificity reached 83 and 99% respectively.

CONCLUSIONS: Adding SIS 3D, a minimally invasive method, to conventional sonohysterography improves the precision of diagnosis of endometrial pathology, allows to get three-dimensional image of the uterine cavity and enables examination of endometrial lesions. The diagnostic precision of this procedure is similar to the results achieved by hysteroscopy....

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Case Reports 2011; 32(Suppl 1): 5-7 PubMed PMID: 22167223 Citation  Keywords:  Brain:growth & development, Cardiovascular System:diagnostic imaging, Cerebral Veins:abnormalities, Echoencephalography, Humans, Infant, Newborn, Intracranial Arteriovenous Malformations:diagnosis,.   

OBJECTIVES: Asphyxia of the newborn has a varied etiology. Clinical consequences have a broad spectrum of presentations. Arteriovenous malformation associated with an aneurysm of the Galen vein can be the cause of focal ischemic changes in the nervous parenchyma.

RESULTS: The authors report a case of a term newborn (birth weight 4, 000 grams, Apgar score 7/9). Physical investigation confirmed the presence of a continuous murmur in the area of the anterior fontanelle. Ultrasonic investigation of the brain detected a huge arteriovenous malformation of the Galen vein. Ultrasonic investigation of the heart excluded structural anomaly, but confirmed a huge retrograde flow in the aorta descendens, opened ductus arterious with suspected formation of coarctation of the aorta and dilatation of the vena cava superior.

CONCLUSION: Congenital anomaly of the Galen vein has a negative influence on prenatal and postnatal development of the brain of a newborn. In the case of our patient, it led to rapid severe asphyxiated changes of the brain parenchyma. Diagnosis and management were established, yet endovascular therapy was not indicated in the early neonatal period....

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Clinical Trial 2011; 32(5): 722-726 PubMed PMID: 22167149 Citation  Keywords:  Adult, Fallopian Tube Diseases:diagnostic imaging, Fallopian Tube Patency Tests:instrumentation, Female, Humans, Hysterosalpingography:instrumentation, Infertility, Female:diagnostic imaging, Laparoscopy, Sensitivity and Specificity, Vagina,.   

OBJECTIVE: Infertility problem affects more than 70 million couples worldwide, 5-15% of which are couples in their reproductive age. Less and less invasive endoscopic methods like transvaginal hydrolaparoscopy have been developed by technological progress. This method enables not only precise identification, but is now increasingly used for treatment of tubal and peritoneal factor pathology, which cause approximately 35 per cent of female infertility.

AIM: Evaluation of transvaginal hydrolaparoscopy (HLTV) usefulness for diagnosis of tubal infertility comparing to standard laparoscopy and hysterosalpingography (HSG).

RESULTS: In evaluation of patent fallopian tubes results of HLTV and HSG examinations are coincide in 87%, while obstruction diagnosed in HSG is confirmed only in 37% during HLTV examination. Transvaginal hydrolaparoscopy and HSG have similar sensitivity and specificity in diagnosis of hydrosalpinx, which is up to 100% . In comparison with HLTV histerosalpingography is less effective in evaluation of peritubal dilatations and adhesions. Both laparoscopic surgery and transvaginal laparoscopy have the same high sensitivity in diagnostics of the fallopian tubes patency and hydrosalpinx, which is up to 100%. In evaluation of peritubal adhesions and dilatations the results are very similar.

CONCLUSIONS: 1. HLTV is a highly useful method in evaluation of the fallopian tubes pathologies which is significantly more sensitive than HSG in evaluation of such lesions as peritubal adhesions and obstructed fallopian tubes. 2. HLTV is as effective as laparoscopy in evaluation of patency and lesions of the fallopian tubes. 3. HLTV is a less invasive method, much better tolerated than laparoscopy and more suitable for the group of overweight patients. 4. Final assessment of HTLV technique will be possible following performance of a greater number of studies, where the foregoing conclusions present only initial observations....

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