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Journal Article 2014; 35(7): 608-612 PubMed PMID: 25617884 Citation  Keywords:  Animals, Brain:diagnostic imaging, Brain Edema:diagnostic imaging, Disease Models, Animal, Male, Rats, Wistar, Tomography, X-Ray Computed:methods, Water Intoxication:diagnostic imaging,.   

OBJECTIVES: The aim of this study was to determine whether water intoxication affects the radiodensity of brain tissue in CT scan examination in the rat model of brain oedema.

METHODS: A standard CT scan of the brain was obtained in a group of rats, first at control conditions (controls - CG) and then after hyperhydration (oedema model-EG) in the region of interest (ROI) corresponding to the area of coronary sections with pixel size 0.125 mm in position A (bregma +2.43 mm), position B (bregma -2.92 mm), position C (bregma -12.73 mm). Densitometrically determined mean values (MV), expressed in Hounsfield units (HU) were processed by standard statistical methods.

RESULTS: The average MV density was 120.49±6.79 HU for the control measurement and 88.01±4.72 HU after the hyperhydration, which represents decrease in the density by 32.48 HU (p<0.001). In the control measurement the average value of HU for the position A was 121.98, for position B 112.4 and for position C 127.08. In conditions of hyperhydration, the average MV density in position A was 89.95 HU in position B 84.67 HU and in position C 89.43 HU. The differences between the CG and EG were in all positions A, B, C statistically significant (p<0.001). In the control measurement, the differences between position A×B (p<0.05) and B×C (p<0.001) were statistically significant. After hyperhydration no significant difference between the position A, B, C was found.

CONCLUSION: water intoxication caused by hyperhydration in rats can induce diffuse brain oedema, which is reflected in the CT examination by the decrease of brain tissue density, expressed in HU. The value of the measured density depends on the location and size of the measured brain area....

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Journal Article 2014; 35(1): 28-36 PubMed PMID: 24625918 Citation  Keywords:  Adult, Aged, Aged, 80 and over, Female, Humans, Magnetic Resonance Imaging, Male, Melanoma:pathology, Middle Aged, Multimodal Imaging, Neoplasm Grading, Radiosurgery:instrumentation, Radiotherapy Dosage, Retrospective Studies, Tomography, X-Ray Computed, .   

OBJECTIVE: One day session linear accelerator based stereotactic radiosurgery of intraocular malignant melanoma is a method of "conservative" attitude to treat posterior uveal melanoma.

MATERIAL AND METHODS: Retrospective clinic-based study of patients with posterior uveal melanoma in stage T2/T3 who underwent stereotactic radiosurgery at linear accelerator in period 2001-2011. Immobilization of the affected eye was achieved by mechanical fixation to the stereotactic Leibinger frame. The stereotactic treatment planning after fusion of computed tomography and magnetic resonance imaging was optimized according to the critical structures (lenses, optic nerves, chiasm).

RESULTS: In group of 96 patients with posterior uveal melanoma treated with one day session stereotactic radiosurgery, patient age ranged from 25 to 80 years with a median of 54 years. Median tumor volume at baseline was 0.6 cm(3) (with range from 0.2 to 1.0 cm(3)). Median maximal dose applied was 49.0 Gy (range from 37.0 to 52.0 Gy). Secondary enucleation was necessary in 11 patients (11.5%) due to complications like irradiation neuropathy and secondary glaucoma. Tumor local control was successful in 95% of patients in 3 years interval after stereotactic radiosurgery and in 85% of patients in 5 years interval after stereotactic radiosurgery.

CONCLUSION: One step LINAC based stereotactic radiosurgery with a single dose 35.0 Gy is one of treatment options to treat T2 or T3 stage posterior uveal melanoma....

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Case Reports 2013; 34(7): 601-605 PubMed PMID: 24463996 Citation  Keywords:  Autoantibodies:immunology, Brain Stem:immunology, Encephalitis:complications, Gangliosides:immunology, Guillain-Barre Syndrome:complications, Humans, Magnetic Resonance Imaging, Male, Tomography, X-Ray Computed, Young Adult,.   

: We report a case of a 23-year-old man diagnosed with overlapping Bickerstaff brainstem encephalitis (BBE) and Guillain-Barre syndrome (GBS). The patient initially presented with fever and headache and gradually developed ataxia, disturbance of consciousness, respiratory muscle paralysis, bilateral facial paralysis and quadriplegia accompanied by significant atrophy of limb, temporalis and masseter muscles. Brain MRI revealed abnormality in the left basal ganglia, thalamus, and rightside posterior limb of the internal capsule. Electromyogram indicated neurogenic damage (mainly axonal damage) in the upper and lower limbs and bilateral facial nerve damage. Cerebrospinal fluid (CSF) collected via lumbar puncture was colorless and transparent with a pressure of 330 mm H2O. The white blood cell count in CSF was 200×106/L, the protein concentration was 1.25 g/L, and Pandy's reaction was positive. Both the blood and CSF were negative for GQ1b antibody. The patient was clinically diagnosed with overlapping BBE and GBS. After treatment with ventilator assisted breathing, hormone therapy, neurotrophic and anti-infection therapies, and symptomatic and supportive care for more than three months, spontaneous breathing was restored. By the 5-month follow-up examination, the patient had completely recovered and returned to work. Like GBS and Fisher syndrome, BBE might be an anti-GQlb IgG antibody syndrome. Although the serum GQlb IgG antibody-positive rate for BBE is only 66%, a normal brainstem MRI or GQlb lgG antibody-negative finding cannot completely rule out BBE. Therefore, identifying critical illness polyneuropathy for patients with respiratory muscle paralysis and tracheal extubation difficulties at early stages is clinically important....

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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 2011; 32(4): 421-424 PubMed PMID: 21876495 Citation  Keywords:  ACTH Syndrome, Ectopic:etiology, Adrenocorticotropic Hormone:blood, Biopsy, Carcinoma, Medullary:complications, Carcinoma, Neuroendocrine, Humans, Male, Mediastinal Neoplasms:complications, Middle Aged, Thyroid Neoplasms:complications, Tomography, X-Ray C.   

: A rare case with ectopic adrenocorticotrophic hormone syndrome (EAS) caused by medullar thyroid carcinoma (MTC) in mediastinum was reported. This 49 year-old male patient initially presented with serious and intractable hypokalemia. Endocrine evaluations showed increased levels of adrenocorticotrophic hormone (ACTH) and urinary free cortisol, which could not be suppressed more than 50% by high-dose dexamethasone suppression test. Computed tomography (CT) scan detected a 5×5×5 cm mass at the bottom of thyroid in anterior mediastinum. The patient underwent total thyroidectomy with central compartment and ipsilateral modified radical neck dissection. Pathological examination showed an infiltrating thyroid medullary carcinoma with abundant amyloid deposition, meanwhile immunohistochemical positive for ACTH. After surgery, serum levels of kalium, as well as cortisol and ACTH returned to normal range. During follow-up, the patient's clinical manifestation of Cushing syndrome relieved....

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Case Reports 2011; 32(3): 238-241 PubMed PMID: 21712786 Citation  Keywords:  Atrophy, Brain:diagnostic imaging, Fatal Outcome, Female, Humans, Hydrocortisone:blood, Hypokalemia:etiology, Magnetic Resonance Imaging, Middle Aged, Pituitary ACTH Hypersecretion:pathology, Tomography, X-Ray Computed,.   

: We present a 56-year-old patient with cyclic Cushing's disease (CCD) observed for 28 months, who presented clinically and biochemically with alternating episodes of hyper-, normo- and hypocortisolemia. The course of the disease was fatal, the patient died due to severe hypokalemia....

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Evaluation Studies 2010; 31(6): 796-800 PubMed PMID: 21206436 Citation  Keywords:  Acromegaly:diagnostic imaging, Adult, Aged, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Paranasal Sinuses:diagnostic imaging, Temporal Bone:diagnostic imaging, Tomography, X-Ray Computed,.   

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....

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Journal Article 2010; 31(6): 814-817 PubMed PMID: 21196928 Citation  Keywords:  Adult, Diagnosis, Differential, Electroencephalography, Epilepsy:diagnosis, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Reproducibility of Results, Retrospective Studies, Seizures:diagnosis, Tomography, X-Ray Computed,.   

OBJECTIVE: Authors warn of difficulties in diagnostic of solitary epileptic seizure and epilepsy.

MATERIAL AND METHODS: Our groups have been made up of patients, who have been dismissed from our clinic in the period from January 1997 to January 2007 with diagnosis of solitary unprovoked epileptic seizure (n=84) and epilepsy with sporadic epileptic seizure (n=179). We have evaluated the clinical typology of epileptic seizure, EEG findings and results of imaging methods and we determined the part of patients with complete diagnostic concordance between clinical image of epileptic seizure and results of auxiliary diagnostic methods.

RESULTS: We have denoted the complete diagnostic concordance among the clinical image, EEG findings and results of imaging methods only in 13.1% of patients after solitary unprovoked epileptic seizure and in 24.02% of patients with diagnosis of epilepsy with sporadic epileptic seizures. The receiving diagnosis of unclear seizure status was determined at 49.14% of patients dismissed with diagnosis of solitary epileptic seizure and at 40.78% of patients dismissed with diagnosis of epilepsy with sporadic epileptic seizures in 10 year time period.

CONCLUSION: Our results repeat the confirmation that the diagnostic of seizure disorders, with and without disturbance of consciousness, belong to the difficult part in the clinical praxis....

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