Podwiązanie tętnicy nerkowej i żyły nerkowej w jednym "en block", niezależnie od powodów wykonani... more Podwiązanie tętnicy nerkowej i żyły nerkowej w jednym "en block", niezależnie od powodów wykonania nefrektomii niesie ryzyko powstania przetoki tętniczo-żylnej. Oryginalność przedstawionej pracy wynika z zastosowanej metody naprawczej. Uniknięcie powtórnej operacji naprawczej-poprzez drogę klasyczną i zastąpienie jej techniką małoinwazyjną podkreśla znaczenie ww. pracy. prof. dr hab. n. med. Marek Ostrowski
Introduction: Tuberous sclerosis complex (TSC) is a genetic disorder characterised by lesions aff... more Introduction: Tuberous sclerosis complex (TSC) is a genetic disorder characterised by lesions affecting brain, skin, eyes and internal organs--kidneys, heart, liver and lungs. Renal involvement in individuals with TSC is common and potentially serious, includes angiomyolipomas and cystic lesions. There may also be an increased risk of renal cell carcinoma. Case report: A case of 17-year-old boy with delayed diagnosis of tuberous sclerosis complex with angiomyolipomas and cysts of the kidneys has been described. Conclusion: The authors would like to underlina a very rare incidence of tuberous sclerosis complex and associated renal angiomyolipomas in children, the possibility to maintain normal kidney function for prolonged time despite intensified renal pathology, the need for periodic abdominal imaging and significantly delayed diagnosis in the described case.
Podwiązanie tętnicy nerkowej i żyły nerkowej w jednym "en block", niezależnie od powodów wykonani... more Podwiązanie tętnicy nerkowej i żyły nerkowej w jednym "en block", niezależnie od powodów wykonania nefrektomii niesie ryzyko powstania przetoki tętniczo-żylnej. Oryginalność przedstawionej pracy wynika z zastosowanej metody naprawczej. Uniknięcie powtórnej operacji naprawczej-poprzez drogę klasyczną i zastąpienie jej techniką małoinwazyjną podkreśla znaczenie ww. pracy. prof. dr hab. n. med. Marek Ostrowski
Acute cholecystitis is a rare disorder in the pediatric age group over 10 years of age; female ge... more Acute cholecystitis is a rare disorder in the pediatric age group over 10 years of age; female gender, obesity, and chronic hemolysis are considered to be predisposing factors. We report on three cases of acute cholecystitis complicating intensive chemotherapy of childhood acute lymphoblastic leukemia.
Wstep Nerki są organem szczegolnie narazonym na upośledzenie ich funkcji oraz wystepowanie powikl... more Wstep Nerki są organem szczegolnie narazonym na upośledzenie ich funkcji oraz wystepowanie powiklan w czasie leczenia i po zakonczonym leczeniu ostrej bialaczki limfoblastycznej (OBL), ktore w sposob istotny mogą wplywac na komfort i dlugośc zycia pacjentow. Cel pracy Celem pracy byla ocena wielkości i funkcji nerek u dzieci, oraz określenie czynnikow mających wplyw na wystepowanie nieprawidlowości w ich funkcjonowaniu po zakonczonym leczeniu OBL za pomocą wybranych badan klinicznych, biochemicznych i obrazowych. Material i metody Badaniami objeto grupe 48 dzieci, w tym 29 (60%) chlopcow i 19 (40%) dziewczynek, w wieku 79–275 miesiecy (średnia 159 miesiecy; SD 49 miesiecy), u ktorych w latach 1989–2001 ustalono rozpoznanie OBL. Wyniki i wnioski Wykazano, ze stosowany program chemioterapii i czas obserwacji dluzszy niz 5 lat po zakonczenia leczenia w sposob istotny wplywaly na obnizenie wartości GFR, wystepowanie blizn w nerkach oraz zmniejszenie objetości i dlugości nerek. Dlatego konieczne wydaje sie objecie okresową opieką nefrologiczną pacjentow po zakonczeniu leczenia OBL.
The case of a 70-year-old female with asymptotic parathyroid cyst is presented. It was not possib... more The case of a 70-year-old female with asymptotic parathyroid cyst is presented. It was not possible to make a proper diagnosis preoperatively. The correct diagnosis was based on the result of the postoperative microscopic examination of the resected tissues. The diagnostic difficulties are discussed.
Polski przegla̜d radiologii i medycyny nuklearnej, 2015
Background: Benign metastasizing leiomyoma (BML) is a rare condition described as multiple well-d... more Background: Benign metastasizing leiomyoma (BML) is a rare condition described as multiple well-differentiated leiomyomas at sites distant from the uterus. Apart from lungs it has also been reported in lymph nodes, heart, brain, bone, skin, eye and spinal cord. We present a case of pulmonary benign metastasizing leiomyoma in a female patient admitted to our hospital with suspicion of left adnexal tumor.
Introduction Stasis filling, defined as delayed, weak, and persistent opacification of proximal s... more Introduction Stasis filling, defined as delayed, weak, and persistent opacification of proximal segments of the cerebral arteries, is frequently found in brain dead patients. This phenomenon causes a major problem in the development of reliable computed tomographic angiography (CTA) protocol in the diagnosis of brain death (BD). The aim of our study was to characterize stasis filling in the diagnosis of BD. To achieve this, we performed a dynamic evaluation of contrast enhancement of the cerebral and extracranial arteries in patients with BD and controls. Methods Study population included 30 BD patients, who showed stasis filling in computed tomographic perfusion (CTP) series. Thirty patients, after clipping of an intracranial aneurysm, constituted the control group. The study protocol consisted of CTA, CTP, and angiography. Time-density curves (TDCs) of cerebral and extracranial arteries were generated using 40-s series of CTP. Results Cerebral TDCs in BD patients represented flat curves in contrast to TDCs in controls, which formed steep and narrow Gaussian curves. We found longer time to peak enhancement in BD patients than in controls (32 vs. 21 s; p<0.0001). In BD patients, peak enhancement in the cerebral arteries occurred with a median delay of 14.5 s to peak in extracranial arteries, while no delay was noted in controls (p<0.0001). Cerebral arteries in BD patients showed lower peak enhancement than controls (34.5 vs. 81.5 HU; p<0.0001). In all BD patients, CTP revealed zero values of cerebral blood flow and volume. Angiography showed stasis filling in 14 (46.7 %) and non-filling in 16 (53.3 %) cases. Conclusion A confrontation of stasis filling with CTP results showed that stasis filling is not consistent with preserved cerebral perfusion, thus does not preclude diagnosis of BD. Keywords Brain death. Stasis filling. Catheter angiography. Computed tomographic angiography. Computed tomographic perfusion Background According to the national regulations regarding diagnostic criteria of brain death (BD), instrumental confirmatory tests should be used in certain clinical situations, such as intoxications, infratentorial processes, extensive facial damage, children younger than 2 years of age, or any case in which clinical examinations are inadequate [1]. Electrophysiological tests are often unavailable due to limited access to proper equipment and competent specialists. Therefore, cerebral perfusion tests are methods of choice. Two of them, catheter angiography and computed tomographic angiography (CTA), are
Polski przegla̜d radiologii i medycyny nuklearnej, 2014
Background: Despite the progress in contemporary medicine comprising diagnostic and therapeutic m... more Background: Despite the progress in contemporary medicine comprising diagnostic and therapeutic methods, lung cancer is still one of the biggest health concerns in many countries of the world. The main purpose of the study was to evaluate the detection rate of pulmonary nodules and lung cancer in the initial, helical low-dose CT of the chest as well as the analysis of the relationship between the size and the histopathological character of the detected nodules. Material/Methods: We retrospectively evaluated 1999 initial, consecutive results of the CT examinations performed within the framework of early lung cancer detection program initiated in Szczecin. The project enrolled persons of both sexes, aged 55-65 years, with at least 20 pack-years of cigarette smoking or current smokers. The analysis included assessment of the number of positive results and the evaluation of the detected nodules in relationship to their size. All of the nodules were classified into I of VI groups and subsequently compared with histopathological type of the neoplastic and nonneoplastic pulmonary lesions. Results: Pulmonary nodules were detected in 921 (46%) subjects. What is more, malignant lesions as well as lung cancer were significantly, more frequently discovered in the group of asymptomatic nodules of the largest dimension exceeding 15 mm. Conclusions: The initial, low-dose helical CT of the lungs performed in high risk individuals enables detection of appreciable number of indeterminate pulmonary nodules. In most of the asymptomatic patients with histopathologically proven pulmonary nodules greater than 15 mm, the mentioned lesions are malignant, what warrants further, intensified diagnostics.
Pomeranian Medical University in Szczecin: a Students’ Scientific Circle in Department of Diagno ... more Pomeranian Medical University in Szczecin: a Students’ Scientific Circle in Department of Diagno stic Imaging and Interventional Radiology, Polish p rogram b Department of Diagnostic Imaging and Interventional R diology, Autonomous Public Clinical Hospital No. 1 c Department of Diagnostic Imaging and Interventional R diology Pomorski Uniwersytet Medyczny w Szczecinie: a Studenckie Koło Naukowe przy Zakładzie Diagnostyki Obrazowej i Radiologii Interwencyjnej, dla studentó w polskojęzycznych b Zakład Diagnostyki Obrazowej i Radiologii Interwenc yjnej, Samodzielny Publiczny Szpital Kliniczny Nr 1 d Zakład Diagnostyki Obrazowej i Radiologii Interwen cyjnej
Conclusion This is the first study to illustrate that US-detected TS is predictive of persistent ... more Conclusion This is the first study to illustrate that US-detected TS is predictive of persistent RA in patients with early arthritis. ECU and digit flexor tendon scanning provides optimal predictive data over and above clinical and serological variables.
The presence of a tumour, poor general condition, features of anaemia, increased erythrocyte sedi... more The presence of a tumour, poor general condition, features of anaemia, increased erythrocyte sedimentation rates and imaging suggesting malignancy were the common features in 4 different tumour-like abdominal conditions that are extremely rare in childhood. These conditions included: extensive retroperitoneal tumour with rib involvement that turned out to be an inflammatory lesion caused by Actinomyces in a 12-year-old girl; multi-loculated tumour of the mesentery/ovary caused by mesenteric lymphadenopathy in the course of a Salmonella enteritidis infection in a 2.5-year-old girl; tumour of the VII - VIII hepatic segments that turned out to be the focus of granuloma in the course of lambliasis in a 5.5-year-old boy with a history of purulent neck lymphadenopathy and a final suspicion of immunocompromise; and a multi-loculated tumour of the small pelvis and inguinal area that turned out to be an abscess of the iliopsoas muscle in a 16-year-old boy. Apart from the imaging, the lesions required cytological examination of the material harvested by fine-needle biopsies (liver tumour) or histopathological investigations (retroperitoneal tumour, mesenteric/ovarian tumour, liver tumour and--on second surgery--the pelvic tumour) and/or bacteriological examination (all cases), serological examination (liver tumour and mesenteric/ovarian tumour), protozoal investigation (liver tumour), and measurement of AFP levels (mesenteric/ovarian tumour). Surgical treatment (retroperitoneal tumour, mesenteric/ovarian tumour and tumour of the small pelvis) and guided antibiotic therapy (all cases including 15 weeks of antibiotics in the first case) allowed complete recovery in 3 patients (actinomycosis, mesenteric lymphadenopathy, abscess of the iliopsoas muscle). Antibiotic and antiprotozoal therapy cured the granulomatous hepatitis; however this patient tended to develop severe right-sided pleural/pulmonary changes (the child was referred for further diagnosis with suspicion of immunocompromise).
A patient with a brain injury fulfilled all clinical criteria for brainstem death diagnosis. Two ... more A patient with a brain injury fulfilled all clinical criteria for brainstem death diagnosis. Two standard sets of tests were performed; according to Polish regulations, the patient could be declared brain dead. However, shortly after the completion of the tests and before the final brain death declaration, 6 triggered "assisted" breaths/min were noticed. After careful analysis of the ventilator settings, it was concluded that low trigger sensitivity and airway pressure oscillations during heart contractions were the reasons. Additionally, a few minutes later, spontaneous jerking movements of lower limbs and clonic movements of neck mussles secondary to painful stimuli were noticed. The situation became confusing; therefore, cerebral Doppler sonography was performed, showing circulatory arrest in both of the internal carotid, middle cerebral, and left vertebral arteries. The basilar artery was not visualized. Forward flow with increased pulsatility was recorded in extracranial and intracranial segments of the right vertebral artery. Cerebral circulatory arrest was still uncertain; therefore, the diagnostic procedures were completed with conventional cerebral angiography, which showed a lack of cerebral blood flow. Finally, the patient was declared brain dead; kidneys and bones were harvested. Cardiogenic oscillations associated with incorrect low ventilator trigger settings may falsely suggest persistence of breathing efforts in a brain-dead patient. In the case of any unusual events during brain death diagnosis, cerebral perfusion tests should be performed with cerebral angiography as the "gold standard." From the Department of Anaesthesiology and Intensive Therapy (R.
The authors present the case of a 78-year-old patient with clear cell sarcoma of soft parts of th... more The authors present the case of a 78-year-old patient with clear cell sarcoma of soft parts of the leg imitating chronic haematoma. We describe the pathology and diagnostic process with emphasis on the role of ultrasonographic examination.
Podwiązanie tętnicy nerkowej i żyły nerkowej w jednym "en block", niezależnie od powodów wykonani... more Podwiązanie tętnicy nerkowej i żyły nerkowej w jednym "en block", niezależnie od powodów wykonania nefrektomii niesie ryzyko powstania przetoki tętniczo-żylnej. Oryginalność przedstawionej pracy wynika z zastosowanej metody naprawczej. Uniknięcie powtórnej operacji naprawczej-poprzez drogę klasyczną i zastąpienie jej techniką małoinwazyjną podkreśla znaczenie ww. pracy. prof. dr hab. n. med. Marek Ostrowski
Introduction: Tuberous sclerosis complex (TSC) is a genetic disorder characterised by lesions aff... more Introduction: Tuberous sclerosis complex (TSC) is a genetic disorder characterised by lesions affecting brain, skin, eyes and internal organs--kidneys, heart, liver and lungs. Renal involvement in individuals with TSC is common and potentially serious, includes angiomyolipomas and cystic lesions. There may also be an increased risk of renal cell carcinoma. Case report: A case of 17-year-old boy with delayed diagnosis of tuberous sclerosis complex with angiomyolipomas and cysts of the kidneys has been described. Conclusion: The authors would like to underlina a very rare incidence of tuberous sclerosis complex and associated renal angiomyolipomas in children, the possibility to maintain normal kidney function for prolonged time despite intensified renal pathology, the need for periodic abdominal imaging and significantly delayed diagnosis in the described case.
Podwiązanie tętnicy nerkowej i żyły nerkowej w jednym "en block", niezależnie od powodów wykonani... more Podwiązanie tętnicy nerkowej i żyły nerkowej w jednym "en block", niezależnie od powodów wykonania nefrektomii niesie ryzyko powstania przetoki tętniczo-żylnej. Oryginalność przedstawionej pracy wynika z zastosowanej metody naprawczej. Uniknięcie powtórnej operacji naprawczej-poprzez drogę klasyczną i zastąpienie jej techniką małoinwazyjną podkreśla znaczenie ww. pracy. prof. dr hab. n. med. Marek Ostrowski
Acute cholecystitis is a rare disorder in the pediatric age group over 10 years of age; female ge... more Acute cholecystitis is a rare disorder in the pediatric age group over 10 years of age; female gender, obesity, and chronic hemolysis are considered to be predisposing factors. We report on three cases of acute cholecystitis complicating intensive chemotherapy of childhood acute lymphoblastic leukemia.
Wstep Nerki są organem szczegolnie narazonym na upośledzenie ich funkcji oraz wystepowanie powikl... more Wstep Nerki są organem szczegolnie narazonym na upośledzenie ich funkcji oraz wystepowanie powiklan w czasie leczenia i po zakonczonym leczeniu ostrej bialaczki limfoblastycznej (OBL), ktore w sposob istotny mogą wplywac na komfort i dlugośc zycia pacjentow. Cel pracy Celem pracy byla ocena wielkości i funkcji nerek u dzieci, oraz określenie czynnikow mających wplyw na wystepowanie nieprawidlowości w ich funkcjonowaniu po zakonczonym leczeniu OBL za pomocą wybranych badan klinicznych, biochemicznych i obrazowych. Material i metody Badaniami objeto grupe 48 dzieci, w tym 29 (60%) chlopcow i 19 (40%) dziewczynek, w wieku 79–275 miesiecy (średnia 159 miesiecy; SD 49 miesiecy), u ktorych w latach 1989–2001 ustalono rozpoznanie OBL. Wyniki i wnioski Wykazano, ze stosowany program chemioterapii i czas obserwacji dluzszy niz 5 lat po zakonczenia leczenia w sposob istotny wplywaly na obnizenie wartości GFR, wystepowanie blizn w nerkach oraz zmniejszenie objetości i dlugości nerek. Dlatego konieczne wydaje sie objecie okresową opieką nefrologiczną pacjentow po zakonczeniu leczenia OBL.
The case of a 70-year-old female with asymptotic parathyroid cyst is presented. It was not possib... more The case of a 70-year-old female with asymptotic parathyroid cyst is presented. It was not possible to make a proper diagnosis preoperatively. The correct diagnosis was based on the result of the postoperative microscopic examination of the resected tissues. The diagnostic difficulties are discussed.
Polski przegla̜d radiologii i medycyny nuklearnej, 2015
Background: Benign metastasizing leiomyoma (BML) is a rare condition described as multiple well-d... more Background: Benign metastasizing leiomyoma (BML) is a rare condition described as multiple well-differentiated leiomyomas at sites distant from the uterus. Apart from lungs it has also been reported in lymph nodes, heart, brain, bone, skin, eye and spinal cord. We present a case of pulmonary benign metastasizing leiomyoma in a female patient admitted to our hospital with suspicion of left adnexal tumor.
Introduction Stasis filling, defined as delayed, weak, and persistent opacification of proximal s... more Introduction Stasis filling, defined as delayed, weak, and persistent opacification of proximal segments of the cerebral arteries, is frequently found in brain dead patients. This phenomenon causes a major problem in the development of reliable computed tomographic angiography (CTA) protocol in the diagnosis of brain death (BD). The aim of our study was to characterize stasis filling in the diagnosis of BD. To achieve this, we performed a dynamic evaluation of contrast enhancement of the cerebral and extracranial arteries in patients with BD and controls. Methods Study population included 30 BD patients, who showed stasis filling in computed tomographic perfusion (CTP) series. Thirty patients, after clipping of an intracranial aneurysm, constituted the control group. The study protocol consisted of CTA, CTP, and angiography. Time-density curves (TDCs) of cerebral and extracranial arteries were generated using 40-s series of CTP. Results Cerebral TDCs in BD patients represented flat curves in contrast to TDCs in controls, which formed steep and narrow Gaussian curves. We found longer time to peak enhancement in BD patients than in controls (32 vs. 21 s; p<0.0001). In BD patients, peak enhancement in the cerebral arteries occurred with a median delay of 14.5 s to peak in extracranial arteries, while no delay was noted in controls (p<0.0001). Cerebral arteries in BD patients showed lower peak enhancement than controls (34.5 vs. 81.5 HU; p<0.0001). In all BD patients, CTP revealed zero values of cerebral blood flow and volume. Angiography showed stasis filling in 14 (46.7 %) and non-filling in 16 (53.3 %) cases. Conclusion A confrontation of stasis filling with CTP results showed that stasis filling is not consistent with preserved cerebral perfusion, thus does not preclude diagnosis of BD. Keywords Brain death. Stasis filling. Catheter angiography. Computed tomographic angiography. Computed tomographic perfusion Background According to the national regulations regarding diagnostic criteria of brain death (BD), instrumental confirmatory tests should be used in certain clinical situations, such as intoxications, infratentorial processes, extensive facial damage, children younger than 2 years of age, or any case in which clinical examinations are inadequate [1]. Electrophysiological tests are often unavailable due to limited access to proper equipment and competent specialists. Therefore, cerebral perfusion tests are methods of choice. Two of them, catheter angiography and computed tomographic angiography (CTA), are
Polski przegla̜d radiologii i medycyny nuklearnej, 2014
Background: Despite the progress in contemporary medicine comprising diagnostic and therapeutic m... more Background: Despite the progress in contemporary medicine comprising diagnostic and therapeutic methods, lung cancer is still one of the biggest health concerns in many countries of the world. The main purpose of the study was to evaluate the detection rate of pulmonary nodules and lung cancer in the initial, helical low-dose CT of the chest as well as the analysis of the relationship between the size and the histopathological character of the detected nodules. Material/Methods: We retrospectively evaluated 1999 initial, consecutive results of the CT examinations performed within the framework of early lung cancer detection program initiated in Szczecin. The project enrolled persons of both sexes, aged 55-65 years, with at least 20 pack-years of cigarette smoking or current smokers. The analysis included assessment of the number of positive results and the evaluation of the detected nodules in relationship to their size. All of the nodules were classified into I of VI groups and subsequently compared with histopathological type of the neoplastic and nonneoplastic pulmonary lesions. Results: Pulmonary nodules were detected in 921 (46%) subjects. What is more, malignant lesions as well as lung cancer were significantly, more frequently discovered in the group of asymptomatic nodules of the largest dimension exceeding 15 mm. Conclusions: The initial, low-dose helical CT of the lungs performed in high risk individuals enables detection of appreciable number of indeterminate pulmonary nodules. In most of the asymptomatic patients with histopathologically proven pulmonary nodules greater than 15 mm, the mentioned lesions are malignant, what warrants further, intensified diagnostics.
Pomeranian Medical University in Szczecin: a Students’ Scientific Circle in Department of Diagno ... more Pomeranian Medical University in Szczecin: a Students’ Scientific Circle in Department of Diagno stic Imaging and Interventional Radiology, Polish p rogram b Department of Diagnostic Imaging and Interventional R diology, Autonomous Public Clinical Hospital No. 1 c Department of Diagnostic Imaging and Interventional R diology Pomorski Uniwersytet Medyczny w Szczecinie: a Studenckie Koło Naukowe przy Zakładzie Diagnostyki Obrazowej i Radiologii Interwencyjnej, dla studentó w polskojęzycznych b Zakład Diagnostyki Obrazowej i Radiologii Interwenc yjnej, Samodzielny Publiczny Szpital Kliniczny Nr 1 d Zakład Diagnostyki Obrazowej i Radiologii Interwen cyjnej
Conclusion This is the first study to illustrate that US-detected TS is predictive of persistent ... more Conclusion This is the first study to illustrate that US-detected TS is predictive of persistent RA in patients with early arthritis. ECU and digit flexor tendon scanning provides optimal predictive data over and above clinical and serological variables.
The presence of a tumour, poor general condition, features of anaemia, increased erythrocyte sedi... more The presence of a tumour, poor general condition, features of anaemia, increased erythrocyte sedimentation rates and imaging suggesting malignancy were the common features in 4 different tumour-like abdominal conditions that are extremely rare in childhood. These conditions included: extensive retroperitoneal tumour with rib involvement that turned out to be an inflammatory lesion caused by Actinomyces in a 12-year-old girl; multi-loculated tumour of the mesentery/ovary caused by mesenteric lymphadenopathy in the course of a Salmonella enteritidis infection in a 2.5-year-old girl; tumour of the VII - VIII hepatic segments that turned out to be the focus of granuloma in the course of lambliasis in a 5.5-year-old boy with a history of purulent neck lymphadenopathy and a final suspicion of immunocompromise; and a multi-loculated tumour of the small pelvis and inguinal area that turned out to be an abscess of the iliopsoas muscle in a 16-year-old boy. Apart from the imaging, the lesions required cytological examination of the material harvested by fine-needle biopsies (liver tumour) or histopathological investigations (retroperitoneal tumour, mesenteric/ovarian tumour, liver tumour and--on second surgery--the pelvic tumour) and/or bacteriological examination (all cases), serological examination (liver tumour and mesenteric/ovarian tumour), protozoal investigation (liver tumour), and measurement of AFP levels (mesenteric/ovarian tumour). Surgical treatment (retroperitoneal tumour, mesenteric/ovarian tumour and tumour of the small pelvis) and guided antibiotic therapy (all cases including 15 weeks of antibiotics in the first case) allowed complete recovery in 3 patients (actinomycosis, mesenteric lymphadenopathy, abscess of the iliopsoas muscle). Antibiotic and antiprotozoal therapy cured the granulomatous hepatitis; however this patient tended to develop severe right-sided pleural/pulmonary changes (the child was referred for further diagnosis with suspicion of immunocompromise).
A patient with a brain injury fulfilled all clinical criteria for brainstem death diagnosis. Two ... more A patient with a brain injury fulfilled all clinical criteria for brainstem death diagnosis. Two standard sets of tests were performed; according to Polish regulations, the patient could be declared brain dead. However, shortly after the completion of the tests and before the final brain death declaration, 6 triggered "assisted" breaths/min were noticed. After careful analysis of the ventilator settings, it was concluded that low trigger sensitivity and airway pressure oscillations during heart contractions were the reasons. Additionally, a few minutes later, spontaneous jerking movements of lower limbs and clonic movements of neck mussles secondary to painful stimuli were noticed. The situation became confusing; therefore, cerebral Doppler sonography was performed, showing circulatory arrest in both of the internal carotid, middle cerebral, and left vertebral arteries. The basilar artery was not visualized. Forward flow with increased pulsatility was recorded in extracranial and intracranial segments of the right vertebral artery. Cerebral circulatory arrest was still uncertain; therefore, the diagnostic procedures were completed with conventional cerebral angiography, which showed a lack of cerebral blood flow. Finally, the patient was declared brain dead; kidneys and bones were harvested. Cardiogenic oscillations associated with incorrect low ventilator trigger settings may falsely suggest persistence of breathing efforts in a brain-dead patient. In the case of any unusual events during brain death diagnosis, cerebral perfusion tests should be performed with cerebral angiography as the "gold standard." From the Department of Anaesthesiology and Intensive Therapy (R.
The authors present the case of a 78-year-old patient with clear cell sarcoma of soft parts of th... more The authors present the case of a 78-year-old patient with clear cell sarcoma of soft parts of the leg imitating chronic haematoma. We describe the pathology and diagnostic process with emphasis on the role of ultrasonographic examination.
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Papers by Anna Walecka