Band 6, Heft 3

Epicardial adipose tissue (EAT) is metabolically active tissue that accumulates around the coronary arteries. Epicardial fat is a rich source of free fatty acids and may contribute to local inflammatory load by increased synthesis of inflammatory cytokines. Direct passage of bioactive molecules into the coronary arteries due to close contact with the vascular wall and the lack of fascia may contribute to the pathogenesis of coronary artery disease. Direct correlation between visceral fat and EAT defines the latter as an indirect marker of intra-abdominal visceral adiposity. EAT is related to anthropometric and clinical features of the metabolic syndrome (MS) and to hepatic transaminases as markers of steatohepatitis. An increase in EAT thickness is related to an increase in left ventricular mass and is correlated with atrial enlargement and impairment in diastolic filling in obesity. Echocardiographic study of EAT is an easy and reliable imaging indicator of visceral adiposity and cardiovascular risk. EAT is an independent factor strongly correlated with significant coronary stenosis. A level of EAT above an established average value can be considered a predictive marker of cardiovascular risk. We review the most recent studies proving the specific active role of EAT in the development of cardiac disease.

Lipoma arborescens, a diffuse articular lipomatosis, is a rare disorder characterized by marked villiform synovial proliferation and diffuse replacement of the subsynovial tissue by mature adipocytes. Unilateral joint involvement is the usual presentation while bilateral joint involvement is more uncommon. We reported a case of bilateral lipoma arborescens in a male patient with associated marked patellofemoral osteoarthritis and described the MR imaging findings.

Rapid prototyping (RP) is a technology used to produce physical models. The RP application is applied in the medical field to build anatomy models from high resolution multiplanar data such as Computed tomography (CT). CT of a female patient diagnosed with hip dysplasia was obtained prior to surgery. Specific software was used to prepare the physical model of the patient and was produced using fused deposition machine. Pre fused deposition models (FDM) were given to the orthopaedic surgeon to plan for the dysplastic hip dysplasia. The patient was scanned again using CT after surgery and a post model was produced. The outcome of the surgery was seen clearly by viewing the post model. Orthopaedic surgeon commented on his experience of using the models for the hip dysplasia surgery. These models were found to be very useful for pre surgery planning, determining procedure, implant sizes, positioning, bone grafting which also reduced surgery time by forty percent and increased surgeon confidence as rehearsal prior to actual surgery was made possible. This paper provides an understanding of the benefits of using RP models in hip dysplasia surgery as a good way to enhance both orthopaedic surgeon skill and knowledge.

To assess the impact of micrometastases in sentinel and non-sentinel lymph nodes on long-term survival rates of patients treated for colorectal cancer (CRC). Data of 57 patients diagnosed with CRC and treated in the Department of Surgical Oncology in Gdansk in the years 2002–2006 were retrospectively analyzed. Clinico-histopathological data were analyzed using chi-square tests. The effect on long-time survival rates was analyzed using Kaplan-Meier survival probability estimates. Identification of the SLN was performed using the blue dye staining method. All regional lymph nodes were subject to standard histopathological examination. Additionally in 32(56.14%) patients whose nodes were found negative for metastases on standard staining further immunohistochemical analyses were performed. In the analyzed group SLNB was performed in 42(73.7%) patients with colon cancer and in 15(26.3%) with rectal cancer. Identification of the SLN was possible in 45(78.9%) patients. The sensitivity of SLNB was 33%. False negatives were found in 66%. SLNB is a feasible method in CRC patients. We presume that lack of micrometastases in the SLN and non-SLN cannot be regarded as a prognostic factor.

This study investigates the incidence of temporary and permanent recurrent laryngeal nerve palsy (RLNP) and possible risk factors for patients with different types of thyroid gland diseases. 1224 consecutive patients who underwent thyroidectomy for treatment of various thyroid diseases between the years 2001–2005. The rates of RLNP were evaluated. The surgeon and type of thyroid gland disorder were recognised as possible risk factors for RLNP. The incidence of temporary/permanent RLNP for the whole group was 4.5/0.8%. The rates of temporary RLNP for groups, classified as multinodular goitre, Graves’ disease, thyroid cancer or Hashimoto’s disease were 4.3%, 4.3%, 5.2% and 5.7%, respectively. The rates of permanent RLNP for the same groups were 0.4%, 0.9%, 1.6% and 1.9%, respectively. The frequency of temporary RLNP for individual surgeons ranges from 2.8 to 7.0% and the rates of permanent RLNP is between 0–3.1%. There was no relationship between the surgeon’s experience (the number of procedures performed) and RLNP rates. Total thyroidectomy is a safe procedure associated with a low incidence of RLNP not only for benign multinodular goitre, but also for Graves’disease, thyroid cancer and Hashimoto’s disease. The rates of RLNP among individual surgeons are acceptable with small inter-individual differences.

We report the diagnostic evaluation, management, and intermediate-term outcomes of a rare variant of bladder cancer and concomitant Abdominal Aortic Aneurysm. A 62 year old male with gross haematuria and Abdominal Aortic Aneurysm was admitted to our hospital. Cystoscopy revealed a large bulky mass occupying the posterior bladder wall. The tumor was transurethrally resected and its histology showed a Sarcomatoid Carcinoma of the urinary bladder. Due to the aggressive behavior of the tumor and the risk of aneurysm rupture, concomitant endovascular exclusion of Aneurysm, total cystectomy with urinary diversion was performed. 12 months after radical surgery the patient was alive without any local recurrence, distant metastasis, and thrombosis of iliac axis. To our knowledge this study is the first report to describe data on the diagnostic evaluation, Management, and intermediate-term outcomes in Sarcomatoid carcinoma and Concomitant Abdominal Aortic Aneurysm. Multi-institutional collaboration is important to perform clinical trials of adequate sample size to design more effective treatments for these aggressive cancers in the presence of Concomitant Abdominal Aortic Aneurysm.

Lymphangioma is a malformation composed of a mass of dilated lymph vessels typically found in the cervical region in children. Mediastinal lymphangioma is a rare condition and accounts for 0.01% to 4.5% of all mediastinal tumors. Only 4 cases of mediastinal lymphangioma involving the heart and great vessels in adults have been described in the available literature. Extremely rarely, lymphangiomas occur as a generalized lymphangiomatosis. We present a case of a woman who coughed up small amounts of fresh blood during 6 months and showed signs of cardiac failure. Several years previously, the patient underwent surgical removal of cystic lymphangiomas from the left ovary, both fallopian tubes and small intestine. A chest radiograph showed an 8-cm round shadow located in the middle lobe. A computerized tomography (CT) scan of the chest with contrast verified the existence of a cyst in the anterior mediastinum. The radiologist suggested that the cyst could have originated in the pericardium. One small cyst also appeared in the projection of the left cardiophrenic sinus. A CT scan with contrast of the patient’s abdomen showed multiple cystic formations in the liver, spleen, kidneys, and left parapelvic region. A fine-needle biopsy of the mediastinal tumor verified the cystic lymphangioma, which was then completely removed surgically. A pathohistological examination confirmed the existence of cystic lymphangioma. The patient was discharged after a period of recovery.

The purpose of this study was to conduct a clinical and pathologic review of endometrial cancers diagnosed and surgically treated in our institution to evaluate results of treatment in relation to current international recommendations. We retrospectively evaluated the clinical history, treatment and follow-up of patients with histologically confirmed endometrial cancer treated in Faculty Hospital Nitra, Slovakia from 1990 to 2005. Data were abstracted regarding tumor histology, grade, age, parity, stage, diabetes, use of oral contraceptives, BMI, survival and treatment modalities including surgery, radiation therapy, chemotherapy, hormonal therapy, and combinations thereof. One hundred and thirty nine patients received surgical treatment for endometrial cancer: stage I -101 (72,6%), stage II - 9 (6,5%), stage III - 23 (16,6%) and stage IV - 6 (4,3%). Tumors were well differentiated in 87(62,6%), moderately differentiated in 32 (23%) and poorly differentiated in 20 (14,4%). There were 45 (32,4%) premenopausal patients and 94 (67,6%) postmenopausal. In multivariate statistical analysis we identified FIGO stage, tumor type, tumor grade, nodal status and depth of myometrial invasion as independent prognostic factors for overall survival, and FIGO stage, nodal status, and tumor grade as independent prognostic factors for recurrence-free interval.

A 64-year-old man with a history of gallstones, common bile duct stones, chronic hepatitis B virus infection, and hepatic cirrhosis with a Child-Pugh score B was satisfactorily treated for hepatocellular carcinoma with radiofrequency ablation and transarterial chemoembolization. His course, however, was complicated by gallbladder actinomycosis 14 months after treatment, resulting in acute cholecystitis. Such a chain of events suggests that gallbladder actinomycosis may develop after radiofrequency ablation and transarterial chemoembolization in patients who are known to have gallstones and that asymptomatic gallstones should be treated before the application of nonsurgical, but invasive procedures for hepatocellular carcinoma.

Mucoceles are common pathological lesions of the oral cavity, usually measuring up to 10 mm. The authors describe a case of deeply located buccal mucocele measuring 35 mm in diameter. The lesion was caused by facial injury in a 54-year old man. The lesion persisted for approximately 2.5 years and was difficult to diagnose because of its unusual size and atypical clinical symptoms. Preoperative ultrasonography excluded a tumor, and this was confirmed by histopathological examination. However, oncological alertness was considered necessary on account of ulcerated mucosa next to the lesion. The mucocele was removed through surgical excision, using a scalpel and tissue scissors. No recurrence was observed in 2.5 postoperative years. It is stressed that histopathological examinations help to differentiate mucoceles from other disease processes.

Left ventricular hypertrabeculation/non-compaction (LVHT) is a cardiac abnormality that is increasingly reported with an association to several genetic disorders. We report an association of LVHT with genetically confirmed hemochromatosis and polyneuropathy in a 54-year old Caucasian female.

Generally, it is assumed that heart-rhythm disorders during hypoxia result from the interplay between the autonomic nervous system (ANS) and the direct effect of hypoxia on cardiorespiratory structures of the central nervous system and on the myocardium. Circadian variability in the ANS may substantially influence the electrical stability of the myocardium, and thus it is associated with the preconditioning protective mechanism. We designed our study using anaesthetized Wistar rats (ketamine/xylazine 100 mg/15 mg/kg, i.m., open chest experiments) to evaluate the effect of preconditioning (PC) induced by 1 to 3 cycles (1 PC–3 PC) of asphyxia (5 min. of artificial hypoventilation, VT = 0.5 ml/100 g of b.w., 20 breaths/min.) and reoxygenation (5 min. of artificial ventilation, VT = 1 ml/100 g of b.w., 50 breaths/min.) on the heart rate (HR) during followed exposure 20 minutes of hypoventilation after adaptation to a light-dark (LD) cycle of 12 hours:12 hours. Hypoxic HR increases were only minimally prevented by 1 to 2 PC pre-treatment, particularly during the dark part of the day. A statistically significant HR increase required 3 PC and was seen only in the light part of the day. We concluded that possible ANS participation in asphyxic preconditioning depends not only on the number of preconditioned cycles but also on the LD cycle, when the ANS participation in preconditioning can be effective only in the light (nonactive) period.

Left ventricular (LV) mass and LV geometry are well-established measures of hypertension chronicity and severity, have a prognostic value on cardiovascular morbidity and mortality, and are related to asymptomatic cerebral small-artery disease (SAD) and largeartery disease (LAD). The aim of the present study was to clarify the different effects of LV mass and LV geometry on underlying SAD compared with its effects on underlying LAD in ischemic stroke patients. Four hundred three ischemic stroke patients underwent echocardiography to determine LV mass index and relative wall thickness. Brain magnetic resonance imaging, angiography, and carotid magnetic resonance angiography were preformed to detect LAD (≥50% stenosis) and SAD (leukoaraiosis, microbleeds, and old lacunar infarction) in the brain. Multivariate analyses showed that the LV mass index was highly associated with underlying SAD but not with underlying LAD. Among the various subtypes of SAD, only cerebral microbleeds were closely related to the LV mass index. Concentric LV hypertrophy was not related to the presence of either SAD or LAD. Subgroup analyses revealed that, among the various subtypes of SAD, only cerebral microbleeds were associated with concentric LV hypertrophy. In conclusion, cerebral microbleeds may imply more advanced target organ damage than underlying LAD and ischemic subtypes of SAD.

In addition to its known classical roles, the renin angiotensin system (RAS) has more subtle functions which include the regulation of emotional responses. Previous studies regarding the anxiety related behavior of RAS have showed controversial results. There is also evidence that oxidative stress accompanies angiotensin II infusion, but the role of AT1/AT2 specific receptors is not clear. The aim of this study was to evaluate the effects of central angiotensin II receptor blockers on anxiety state and oxidative stress. Behavioral testing included elevated plus maze, while oxidative stress status was measured though the extent of a lipid peroxidation product (malondialdehyde-MDA) and the specific activity of some defense antioxidant enzymes (superoxide dismutase-SOD and glutathione peroxidase-GPx). The rats treated with angiotensin II spent significantly less time in the open-arms of elevated-plus-maze, while the administration of losartan resulted in a significant increase of this time. We observed a significant increase of MDA concentration in the angiotensin II group and a decrease of MDA levels in both losartan and PD-123177 groups. In addition, a significant correlation was seen between the time spent in the open arms and oxidative stress markers. These findings could lead to important therapeutic aspects regarding the use of angiotensin II receptor blockers in anxiety-related disorders.

The objective of the study was to estimate the prevalence at birth and epidemiologic characteristics of patients/cases with both isolated and multiple “syndromic” external ear congenital abnormalities (CAs) in Hungary. The Hungarian Congenital Abnormality Registry, 1980–1996, included 649 cases with isolated external ear CAs, while the number of cases with unclassified multiple CA, including ear CAs, was 331. Thus the prevalence at birth of cases with isolated external ear CAs and unclassified multiple CAs was 0.30 and 0.15, respectively, for a total 0.46 per 1000 births. After reevaluation of reported 354 cases with isolated external ears CAs in the Hungarian Case-Control Surveillance of Congenital Abnormalities, 74 (20.9%) and 236 (66.7%) were affected with mild and severe microtia, while 24 (6.8%) had anotia. The fourth group included 20 cases with the combination of anotia/microtia and external/middle ear CAs. Isolated ear CAs showed a slight male excess (54.0%) and strong predominance of unilateral manifestation (93.4%). Multiple ear CAs showed a stronger male excess (65.4%) and less frequent unilateral affection (62.2%). In conclusion, ear CAs had a low diagnostic validity; thus it was necessary to reassess the data and to reclassify several cases.

Presented, is the case of a newborn with left-sided lung agenesis associated with total anomalous pulmonary venous return, atrial septal defect, polysplenia and hypospadias was described. Throughout the entire hospitalization period the newborn was in poor general condition, and dependent on mechanical ventilation with high oxygen concentrations. On day 20, the newborn died. According to the available literature, this case is unique in regard to the type and number of malformations.

The aim of this study was to investigate the prevalence and predictors of alcohol consumption among adolescents in one town in Central Serbia. A questionnaire was used to obtain data from 191 Serbian students aged 18 years regarding personal experience with alcohol consumption and cigarette smoking, along with sociodemographics data. Alcohol consumption was reported by 97.4% subjects, with 34.9% having the first experience with alcohol at the age of 14 years or less. Binge drinking (the intake of five or more drinks at one sitting) was reported by 37.8% subjects. Significantly higher consumption of beer (p<0.0001) and spirits (p=0.03) was observed in boys. The most common reason for both initiation and continuation of drinking, regardless of gender, were celebrations (p≥0.12). Smokers were more likely than nonsmokers to consume all alcoholic beverages more frequently (p≤0.04) and in larger quantities (p≤0.004). More frequent or more extensive alcohol consumption, or both, was associated in boys with frequent going out and socializing (p≤0.01), close peer relationship (p=0.04), alcohol abuse within the immediate environment (p≤0.04), better financial status of family (p=0.04), and parental criticism (p≤0.02); in girls, it was associated with parental disapproval (p≤0.02), alcohol abuse within the immediate environment (p≤0.04), and general discontentedness (p=0.049). Regardless of gender, positive alcohol outcome expectancies increased alcohol consumption (p≤0.048), and negative expectancies decreased intake (p≤0.047).

The work of physicians in primary health care is essential in prevention and early detection of health risk factors. To determine the incidence of depression among patients in family medicine clinics, as well as the correlation between depression, risk factors and NCDs, and to determine correlation between depression (PHQ-9 score) and the level of physical activity. The pilot study was conducted from January to March 2010 on 100 patients using the Patient Health Questionnaire (PHQ-9) and the International Physical Activity Questionnaire (IPAQ). The family doctor randomly interviewed and measured patients’ weight, height, blood pressure, fasting blood glucose and cholesterol and noted the presence of earlier diagnosed non-communicable diseases. The data for 92 patients were processed according to PHQ-9 and IPAQ guidelines. Out of 92 patients, 59 (64,1%) had PHQ-9 score ≤ 4 which suggests the absence of depression. The PHQ-9 score median was within normal limits, therefore, treatment was not required and there was no difference in PHQ-9 score median between patients with respect to age and sex. The level of physical activity was moderate in 39,1%, heavy in 35,9% and walking as physical activity in 25,0% of patients. Correlation coefficient between PHQ-9 score and MET score (r=−0,241) was statistically significant (p<0,05), as well as between PHQ -9 score and anxiety (r=0,27; p<0,01). Most studies show a correlation between depression and physical activity. It is essential to promote physical activity in order to prevent anxiety, depression and non-communicable diseases.