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Ledakowicz-Polak A, Bartodziej J, Majos A, Zielińska M. Inverted stress- induced cardiomyopathy as a unusual variant of acute heart failure after cesarean delivery- a case report. BMC Cardiovasc Disord 2016; 16:76. [PMID: 27130218 PMCID: PMC4850726 DOI: 10.1186/s12872-016-0253-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/22/2016] [Indexed: 11/20/2022] Open
Abstract
Background Stress- induced cardiomyopathy is acute, reversible left ventricle mainly apical dysfunction in patients with normal coronary angiography. Rarely it regards basal segments, therefore defined as “inverted stress- induced cardiomyopathy”. While classic form mostly affects postmenopausal women, inverted variant occurs essentially in younger females, always triggered by stress. It can also develop after medical procedures and surgery. Herein we report such unique case of 36- year old woman after cesarean delivery. Case presentation A 36- year- old white woman at 40 week of gestation was admitted to hospital for elective repeated cesarean delivery. During caesarean delivery under spinal anaesthesia a previously healthy woman became hypotensive, requiring ephedrine to maintain her blood pressure. Three hours after delivery the patient presented acute heart failure and pulmonary oedema. Due to low blood pressure she demanded the administration of inotropic agents. Owing to respiratory failure and gradual deterioration of consciousness, mechanical ventilation was applied. Results of additional tests finally excluded pulmonary thromboembolism and acute coronary syndrome. The transthoracic echocardiography revealed severe left ventricular systolic dysfunction, ejection fraction 30 % with hypokinesis of the mid and basal segments of posterior, anterior and lateral wall with preserved contractility of the apical segments. The diagnosis of inverted stress- induced cardiomyopathy was set upon the overall clinical data. Both echocardiography and magnetic resonance imaging performed on the fifth day showed complete recovery of myocardial function. The patient was discharged after 15 days in good overall condition. At 12- month follow- up she remained asymptomatic with no echocardiographic abnormalities. Conclusions Inverted stress- induced cardiomyopathy may occur in postpartum period, especially in combination with spinal anesthesia and adrenergic stimulants administration. The clinical awareness and multimodality imaging of possible diagnosis and further management of this unexpected variant of acute heart failure after caesarean delivery is required.
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Gulas E, Wysiadecki G, Cecot T, Majos A, Stefańczyk L, Topol M, Polguj M. Accessory (multiple) renal arteries - Differences in frequency according to population, visualizing techniques and stage of morphological development. Vascular 2016; 24:531-7. [PMID: 26945775 DOI: 10.1177/1708538116631223] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this paper is to comprehensively analyze the literature focused on frequency of the presence of the accessory renal arteries in the human body. A systematic analysis of papers has been made. With regard to ethnicity, the incidence of accessory renal arteries fluctuates from 4% in a Malaysian population to 61.5% in a Brazilian population. The frequency is lowest in eastern and southern Asia (from 4% to 18.4%). In some, not ethnically homogenous populations, wide span of occurrence of accessory renal arteries is described (e.g. American - averaging from 18% to 28.8%). A higher frequency of accessory renal arteries was observed in fetuses compared to adults. Moreover, differences in the presence and number of accessory renal arteries reported in different papers are a consequence of type of visualizing technique used in research - especially when computed tomography and anatomical dissection were compared. The increasing number of surgical interventions, especially where laparoscopic methods are concerned, underlines the importance of such knowledge especially to surgeons, interventional radiologists, nephrologists, and vascular surgeons.
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Polguj M, Majos A, Waszczykowski M, Fabiś J, Stefańczyk L, Podgórski M, Topol M. A computed tomography study on the correlation between the morphometry of the suprascapular notch and anthropometric measurements of the scapula. Folia Morphol (Warsz) 2015; 75:87-92. [PMID: 26365856 DOI: 10.5603/fm.a2015.0072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND The suprascapular notch is a clinically important site because it is the main site of injury and compression of the suprascapular nerve. Its shape and size are the most important factors in the aetiopathology of suprascapular nerve neuropathy. This article reports the first computed topography (CT) study on the correlation between the diameters of the suprascapular notch and anthropometric measurements of the human scapula. MATERIALS AND METHODS A total of 130 scans of shoulders by a helical 32-row multidetector CT scanner were retrospectively analysed. The following scapular measurements were performed: morphological length, morphological width, projection length of the scapular spine, maximal width of the scapular spine, length of the acromion, maximal length of the coracoid process, length of the superior border of the scapula, morphological height of the supraspinous fossa, length of the lateral border of the scapula, and morphological height of infraspinous fossa. The following suprascapular notch dimensions were measured: maximal depth, superior transverse diameter, middle transverse diameter. RESULTS The maximum depth of the suprascapular notch correlates with the morphological length of the scapula, the length of the lateral border of the scapula and the morphological width of the scapula. The superior transverse diameter of the suprascapular notch correlates with the length of the superior border of the scapula and negatively with the length of the lateral border of the scapula. In addition it has been shown that the length of the superior border of the scapula correlates more closely with the superior transverse diameter of the suprascapular notch than the middle transverse diameter of the suprascapular notch. CONCLUSIONS It could be supposed that humans with longer scapulae have deeper notches. It may be also concluded that scapulae with a wider superior border have a shallower suprascapular notch.
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Kośla K, Bryszewski B, Jaskólski D, Błasiak-Kołacińska N, Stefańczyk L, Majos A. Reorganization of Language Areas in Patient with a Frontal Lobe Low Grade Glioma - fMRI Case Study. Pol J Radiol 2015; 80:290-5. [PMID: 26097525 PMCID: PMC4461046 DOI: 10.12659/pjr.893897] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/05/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Functional magnetic resonance (fMRI) studies results in case of an adult patient with low grade glioma (LGG) in dominant hemisphere suggest brain plasticity process with acquisition of language functions by the non-dominant hemisphere speech regions. CASE REPORT A 36-years old right-handed woman was admitted to the Department of Neurosurgery for surgical treatment of brain tumor. An MRI examination revealed a pathological mass in the left frontal lobe, in close topographical relationship to the Broca's area. A left fronto-parietal craniotomy was performed, with an intraoperative awake language mapping procedure. A total resection of the pathological mass was achieved. The tumor was examined histologically as LGG. In the follow-up MRI exam 32 months after the operation a tumor recurrence was suggested. The fMRI exams performed preoperative and 3, 32 and 41 months after the operation showed changes in language regions activation patterns, with a progressive right-sided activation of Broca's and Wernicke's areas. Pre- and postoperative cognitive evaluation by a neuropsychologist did not detect any language impairment. We present a running process of reorganization of language areas in a patient after brain tumor resection, from strong left-sided to symmetrical lateralization. CONCLUSIONS 1. FMRI results in comparison with the psychological status of the patient proved contribution of functional reorganization to the preservation of language performance. 2. A slow growing LGG as well as the recurrence of the tumor near the left Broca's area might be the factors leading to reorganization of language-related areas by recruiting the right hemisphe.
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Polguj M, Rożniecki J, Sibiński M, Grzegorzewski A, Majos A, Topol M. The variable morphology of suprascapular nerve and vessels at suprascapular notch: a proposal for classification and its potential clinical implications. Knee Surg Sports Traumatol Arthrosc 2015; 23:1542-1548. [PMID: 24633009 PMCID: PMC4555201 DOI: 10.1007/s00167-014-2937-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 03/04/2014] [Indexed: 12/05/2022]
Abstract
PURPOSE The most common place for suprascapular nerve entrapment is the suprascapular notch. The aim of the study was to determine the morphological variation of the location of the suprascapular nerve, artery and vein, and measure the reduction in size of the suprascapular opening in each type of the passage. METHODS A total of 106 human formalin-fixed cadaveric shoulders were included in the study. After dissection of the suprascapular region, the topography of the suprascapular nerve, artery and vein was evaluated. Additionally, the area of the suprascapular opening was measured using professional image analysis software. RESULTS Four arrangements of the suprascapular vein, artery and nerve were distinguished with regard to the superior transverse scapular ligament: type I (61.3 %) (suprascapular artery was running above ligament, while suprascapular vein and nerve below it), type II (17 %) (both vessels pass above ligament, while nerve passes under it), type III (12.3 %) (suprascapular vessels and nerve lie under ligament) and type IV (9.4 %), which comprises the other variants of these structures. Statistically significant differences regarding the suprascapular opening were observed between the specimens with types II and III. Anterior coracoscapular ligaments were present in 55 from 106 shoulders. CONCLUSION The morphological variations described in this study are necessary to better understand the possible anatomical conditions which may promote suprascapular nerve entrapment (especially type III). They may be useful during open and endoscopic procedures at the suprascapular notch to prevent such complications as unexpected bleeding.
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Olszycki M, Kozakiewicz M, Elgalal M, Majos A, Stefanczyk L. In vitro and in vivo imaging of ultra-high-molecular-weight polyethylene orbital implants. Int J Oral Maxillofac Implants 2015; 30:e24-9. [PMID: 25830408 DOI: 10.11607/jomi.3790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study is to compare magnetic resonance imaging (MRI) with computed tomography (CT) for visualization of an orbital alloplastic prosthesis made of ultra-high-molecular-weight polyethylene (UHMW-PE) both in vitro and in vivo. A study of 15 test implants from UHMW-PE visualized in vitro in CT and MRI and an in vivo visualization in a patient who suffered from orbital injury and underwent reconstructive surgery is presented. The postsurgery MRI showed the UHMW-PE material clearly, with no significant artifacts. The surrounding tissues could be satisfactorily evaluated. The CT scans did not present the graft material. Both techniques were sufficient tools for in vitro evaluation of the shape and measurement of the prosthesis.
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Polguj M, Majos M, Topol M, Majos A, Stefańczyk L. The influence of atherosclerotic abdominal aorta on the shape of duplicated inferior vena cava: its potential clinical implications and vascular complications. Folia Morphol (Warsz) 2014; 73:521-6. [PMID: 25448915 DOI: 10.5603/fm.2014.0080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 03/21/2014] [Accepted: 03/22/2014] [Indexed: 11/25/2022]
Abstract
Duplication of the inferior vena cava (IVC) is a congenital condition where there are 2 large vessels: right IVC (RIVC) and left IVC (LIVC) on both sides of the abdominal aorta. Here, we present 2 cases of duplicated inferior cava coexisting with rare morphology of left gonadal (ovarian/testicular) vein. Both were observed during multidetector 64-row computer tomography. In first case atherosclerotic, tortuous abdominal aorta models both inferior venae cavae. The shape of veins were more- (RIVC) and less-arcuate (LIVC). Two years ago, the patient had been diagnosed with pulmonary thromboembolism. In second case abdominal aortic aneurysm models both large veins. The RIVC has a highly right-arcuate shape, while the LIVC has a less left-arcade shape. Our observation would seem to be especially important, because the tortuous abdominal aorta changes the shape of both IVC, and may predispose them for thrombosis formation. The presented report precisely describes the topography and measurements of the vessels in the retroperitoneal area. The literature concerning this anomaly, potential clinical implications and vascular complications are reviewed and the possible practical aspects are discussed. A familiarity with the anatomy of the most common types of venous anomalies is crucial for all surgeons, urologists and oncologists to reduce the risk of severe haemorrhage during all abdominal procedures.
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Błasiak-Kołacińska N, Pietruszewska W, Grzelak P, Raźniewski M, Stefańczyk L, Majos A. Rare infraglottic lesions in magnetic resonance imaging. Pol J Radiol 2014; 79:305-10. [PMID: 25228940 PMCID: PMC4162451 DOI: 10.12659/pjr.890521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 02/24/2014] [Indexed: 11/24/2022] Open
Abstract
Background Primary pathological laryngeal lesions occur rarely in infraglottic space. Modern possibilities of diagnostic imaging of infraglottic space include computed tomography (CT) and magnetic resonance (MR). Diagnostic imaging was performed in potential lesions in this area: inflammatory process – cicatrical pemphigoid, benign neoplastic process – chondroma, malignant neoplastic – squamous cell carcinoma. The aim of the paper is to present clinical and radiographical characteristics of selected lesions located in infraglottic space in MRI examination. Material/Methods Three patients examined at the Department of Radiology and Diagnostic Imaging of University Hospital No. 1 in Lodz (SPZOZ USK nr 1) from 2010–2011 with a pathological mass in infraglottic space. Standard imaging protocol for MRI of the neck was used in all patients: field of 1.5 T, slice thickness 3 mm, the distance between the scans 10–20%, FOV – 3 mm, sequences: T1 (TR/TE 455/9, 7 ms, T2 (TR/TE 5300/67 ms), T1 + Gd-DTPA (contrast agent Gd-DTPA at 0.2 mmol/kg). Conclusions 1. It is possible to determine characteristic signal pattern for rare lesions of the infraglottic space in MRI. 2. MRI is a valuable complementary modality for the diagnostics and differentiation of lesions in infraglottic space, the evaluation of their advancement and treatment planning.
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Podgórski M, Sibiński M, Majos A, Stefańczyk L, Topol M, Polguj M. The suprascapular vein: a possible etiology for suprascapular nerve entrapment and risk of complication during procedures around the suprascapular foramen region. Orthop Traumatol Surg Res 2014; 100:515-9. [PMID: 25082777 DOI: 10.1016/j.otsr.2014.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 03/20/2014] [Accepted: 05/13/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Nerve can be compressed when traveling through any osteo-fibrous tunnel. Any eventual anatomic structure limiting this passage increases the risk of neuropathy. During dissection of the shoulder region we recognized a vein travelling on the inferior border of the suprascapular notch together with the suprascapular nerve. The aim of this work was to evaluate the morphological characteristics of this vein in cadaveric material. MATERIALS AND METHODS The suprascapular notch (SSN) region was dissected in 60 cadaveric shoulders. The course, number and diameter of nerve and vessels in the suprascapluar notch region were evaluated. Length, proximal and distal width of the superior transverse scapular ligament were measured. Photographic documentation was taken to evaluate the suprascapular nerve passage area. RESULTS The vein identified was named as the suprascapular notch vein. It was present in 58.3% of shoulders. In 11 specimens, it was double. Its mean diameter was 1.7 mm (SD 0.7 mm) and did not correlate with the suprascapular nerve passage area. A suprascapular notch vein co-occurred more often with the anterior coracoscapular ligament (ACSL). In comparison with the SSN without the ACSL, it has a significantly greater diameter (2 mm; SD 0.7 mm vs 1.5 mm; SD 0.6 mm, respectively; P=0.021). CONCLUSIONS The suprascapular notch vein was a common structure that did not replace the suprascapular vein. Its presence correlated with the occurrence of the ACSL and was independent of body side, STSL type and SSN type. TYPE OF STUDY Observational anatomic study.
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Kośla KN, Majos M, Podgórski M, Polguj M, Topol M, Stefańczyk L, Majos A. Anomalous course and diameter of left-sided vertebral arteries – Significance and predisposing factors in clinical practice. Ann Anat 2014; 196:360-4. [DOI: 10.1016/j.aanat.2014.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/16/2014] [Accepted: 04/17/2014] [Indexed: 12/01/2022]
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Polguj M, Chrzanowski Ł, Kasprzak JD, Stefańczyk L, Topol M, Majos A. The aberrant right subclavian artery (arteria lusoria): the morphological and clinical aspects of one of the most important variations--a systematic study of 141 reports. ScientificWorldJournal 2014; 2014:292734. [PMID: 25105156 PMCID: PMC4102086 DOI: 10.1155/2014/292734] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/22/2014] [Accepted: 05/06/2014] [Indexed: 12/20/2022] Open
Abstract
The most important abnormality of the aortic arch is arguably the presence of an aberrant right subclavian artery (arteria lusoria). If this vessel compresses the adjacent structures, several symptoms may be produced. The aim of the study is to present the morphological and clinical aspects of the aberrant right subclavian artery. Three different databases searched for a review of pertinent literature using strictly predetermined criteria. Of 141 cases, 15 were cadaveric and 126 were clinically documented. The gender distribution of the subjects was 55.3% female and 44.7% male. The mean age of the patients at symptoms onset was 49.9 ± 19.4 years for all patients but 54.0 ± 19.6 years and 44.9 ± 18.1 years for female and male subjects, respectively (P = 0.0061). The most common symptoms in this group were dysphagia (71.2%), dyspnea (18.7%), retrosternal pain (17.0%), cough (7.6%), and weight loss (5.9%). The vascular anomalies coexisting with an arteria lusoria were truncus bicaroticus (19.2%), Kommerell's diverticulum (14.9%), aneurysm of the artery itself (12.8%), and a right sided aortic arch (9.2%). In conclusion, compression of adjacent structures by an aberrant right subclavian artery needs to be differentiated from other conditions presenting dysphagia, dyspnea, retrosternal pain, cough, and weight loss.
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Polguj M, Majos M, Topol M, Majos A. An asymmetrical fenestration of the basilar artery coexisting with two aneurysms in a patient with subarachnoid haemorrhage: case report and review of the literature. Folia Morphol (Warsz) 2014; 73:229-33. [PMID: 24902104 DOI: 10.5603/fm.2014.0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/24/2013] [Accepted: 10/25/2013] [Indexed: 11/25/2022]
Abstract
The vertebrobasilar system is a part of the cerebral arterial circle (circle of Willis), which forms the collateral circulation of the brain. A 75-year-old Caucasian female was admitted to hospital because of a strong headache radiating to the neck. On the basis of a neurological examination, the patient was classified into group III of the Hunt and Hess scale. Subarachnoid haemorrhage and 2 aneurysms of the cerebral arteries were diagnosed during multidetector 64-row computed tomography and angiography. An asymmetrical fenestration of the proximal part of the basilar artery was also observed. The bleeding aneurysm locating at anterior communicating artery was diagnosed and clipped surgically by right fronto-parietal craniotomy. The second aneurysm was located just after the junction of the vertebral arteries on the wall of the basilar artery. The presented case firstly illustrates the asymmetric fenestration of the proximal part of the basilar artery coexisting with subarachnoid haemorrhage and 2 aneurysms of brain arteries. Such observation should increase diagnostic attention in the detection of possible associated aneurysms and can help in preventing complications during all endovascular treatment procedures.
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Grzelak P, Domzalski M, Majos A, Podgórski M, Stefanczyk L, Krochmalski M, Polguj M. Thickening of the knee joint cartilage in elite weightlifters as a potential adaptation mechanism. Clin Anat 2014; 27:920-8. [PMID: 24648385 DOI: 10.1002/ca.22393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 02/03/2014] [Accepted: 02/20/2014] [Indexed: 01/17/2023]
Abstract
Thickening and increase of area of cartilage have been proposed as two alternative mechanisms of cartilage functional adaptation. The latter has been reported in endurance sportsmen. In weightlifters, extreme strain applied to the articular surfaces can result in other forms of adaptation. The aim of this research is to determine whether cartilage thickness is greater in elite weightlifters than in physically inactive men. Weightlifters (13) and 20 controls [age and body mass index (BMI) matched] underwent knee Magnetic Resonance Imaging (MRI). A single sagittal slice of the knee was taken and cartilage thickness was measured in five and six regions of the medial and lateral femoral condyles, respectively. The analyzed segments represented weight-bearing and nonweight-bearing regions. The tibia cartilage in the weight-bearing area was also measured. The time of training onset and its duration in the weightlifter group were recorded. The cartilage was found to be significantly thicker in weightlifters in most of the analyzed regions. The distribution of cartilage thickness on the medial and lateral femoral condyles was similar in both groups. The duration of training was not associated with cartilage thickness, but the time of training onset correlated inversely with cartilage thickness. It is possible that in high-strain sports, joint cartilage can undergo functional adaptation by thickening. Thus, mechanical loading history could exert a postnatal influence on cartilage morphology.
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Stefańczyk L, Majos M, Majos A, Polguj M. Duplication of the inferior vena cava and retroaortic left renal vein in a patient with large abdominal aortic aneurysm. Vasc Med 2014; 19:144-145. [PMID: 24503488 DOI: 10.1177/1358863x14521891] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bryszewski B, Tybor K, Ormezowska EA, Jaskólski DJ, Majos A. Rearrangement of motor centers and its relationship to the neurological status of low-grade glioma examined on pre- and postoperative fMRI. Clin Neurol Neurosurg 2013; 115:2464-70. [DOI: 10.1016/j.clineuro.2013.09.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 08/06/2013] [Accepted: 09/28/2013] [Indexed: 10/26/2022]
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Kośla K, Majos M, Polguj M, Antosik-Biernacka A, Stefańczyk L, Majos A. Prenatal diagnosis of a vein of Galen aneurysmal malformation with MR imaging - report of two cases. Pol J Radiol 2013; 78:88-92. [PMID: 24505230 PMCID: PMC3908515 DOI: 10.12659/pjr.889613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 08/19/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Vein of Galen malformations (VGMs) are rare congenital defects of cerebral vessels. They are formed between the 6(th) and 11(th) week of gestation. The background of this defect involves presence of one or more arterovenous fistulas directing bloodflow toward a persistent, dilated, proximal part of median prosencephalic vein (MProsV). Ultrasound examination is a basic test for diagnosis of VGMs. It has now become possible to acquire images of diagnostic value using magnetic resonance (MR) techniques. CASE REPORT This work presents two cases of vein of Galen aneurysms diagnosed prenatally with magnetic resonance imaging. In both patients fetal CNS malformations were diagnosed in ultrasound examinations. MR imaging of the fetal head was performed for further diagnostics. CONCLUSIONS Because of the ability to precisely determine the size of the ventricular system, presence of raised intraventricular pressure and topographic relationships between pathologically changed vessels and particular cerebral structures as well as the presence of ischemic areas MR examination is currently not only complementary to ultrasonography, but is becoming an independent examination method in the diagnostics of vein of Galen malformations.
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Pajak M, Majos MA, Szubert W, Stefanczyk L, Majos A. Acute brain ischemia as a complication of the Ehlers-Danlos syndrome, the case series. Vascular 2013; 22:341-5. [PMID: 24081809 DOI: 10.1177/1708538113505519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vascular type of Ehlers-Danlos syndrome involves many severe complications leading not only to organ-specific symptoms but often ends in a sudden death. The aim of this paper was to present a diagnostic possibilities and its efficiency rate in patients with vascular complications of Ehlers-Danlos syndrome who suffered from artery dissection resulting in acute brain or limb ischemia. We analysed three patients with diagnosed Ehlers-Danlos syndrome who were referred to radiology department for diagnostic imaging of affected vascular beds, each experienced brain ischemia. The paper also aims at offering some general recommendations for patients suffering from possible complications of type IV Ehlers-Danlos syndrome basing on our own experience and available literature data.
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Szymczyk K, Polguj M, Szymczyk E, Majos A, Grzelak P, Stefańczyk L. Persistent left superior vena cava with an absent right superior vena cava in a 72-year-old male with multivessel coronary artery disease. Folia Morphol (Warsz) 2013; 72:271-3. [PMID: 24068691 DOI: 10.5603/fm.2013.0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/18/2013] [Indexed: 11/25/2022]
Abstract
Congenital anomalies of systemic veins are usually asymptomatic and found incidentally during ultrasonography, computed tomography (CT) or magnetic resonance examinations performed for other clinical indications. Persistent left superior vena cava (PLSVC) with absent right superior vena cava (RSVC) is the congenital aberration in the thoracic venous system which occurs in only 0.09%to 0.13% of patients who have congenital heart defects. In this paper, we present the extremely rare case of a 72-year-old male with PLSVC associated with an absence of RSVC, referred for coronary CT angiography. Multidetector CT angiography is a powerful tool for the detection of venous anomalies, which is essential before invasive procedures such as the implantation of pacemakers.
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Polguj M, Jędrzejewski K, Podgórski M, Majos A, Topol M. A proposal for classification of the superior transverse scapular ligament: variable morphology and its potential influence on suprascapular nerve entrapment. J Shoulder Elbow Surg 2013; 22:1265-73. [PMID: 23375880 DOI: 10.1016/j.jse.2012.11.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 11/12/2012] [Accepted: 11/21/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND The suprascapular region is the most common site of suprascapular nerve entrapment. The aim of the present study was to determine the morphologic variation of the superior transverse scapular ligament (STSL) and measure the reduction in size of the suprascapular opening. Other structures that might be potentially significant during open and arthroscopic procedures in this region are also described. MATERIALS AND METHODS The study used 86 randomized formalin-fixed human cadaveric shoulders. After dissection of the suprascapular region, the following measurements were defined and collected for every STSL: length, proximal width, distal width, and thickness at the proximal and distal ends. Measurements were also taken of the area of the suprascapular opening (aSSO) and the middle width of the suprascapular opening (mwSSO). RESULTS Three types of STSL may be distinguished: a fan-shaped type (54.6%), a band-shaped type (41.9%), and a bifid type (3.5%). Statistically significant differences between the specimens with fan-shaped and band-shaped types of STSL were observed in aSSO and mwSSO of the suprascapular opening. Anterior coracoscapular ligaments (ACSL) were present in 44 of 86 shoulders. The aSSO and mwSSO were smaller in specimens with an ACSL than in those without; however, this difference was only significant in the band-shaped type of STSL. CONCLUSION Knowledge of the morphologic variations of STSL presented in this study is important for better understanding the possible anatomic conditions that can promote suprascapular nerve entrapment and should be taken into particular consideration during surgical and arthroscopic procedures around the suprascapular notch.
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Polguj M, Bliźniewska K, Jędrzejewski K, Majos A, Topol M. Morphological study of linea aspera variations - proposal of classification and sexual dimorphism. Folia Morphol (Warsz) 2013; 72:72-7. [PMID: 23749715 DOI: 10.5603/fm.2013.0012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 11/12/2012] [Accepted: 11/12/2012] [Indexed: 11/25/2022]
Abstract
The linea aspera is a roughened, longitudinally-oriented irregular crest composed of two lips located on the posterior surface of the femoral shaft. The purpose of this research was to investigate the morphological variations of the linea aspera in humans. The study was carried out on 90 femurs. Osteometric measurements of the bones were taken using two complementary methods: classical osteometry and a new one based on the analysis of digital photographic documentation of the femur using MultiScanBase v.18.03 software. The analysis allowed four types of the linea aspera to be determined: parallel (type I - 27.2%), concave (type II - 25.7%), convex (type III - 5.7%) and variform (type IV - 41.4%). The frequency of the each type in female and male was also described. Better knowledge of the anatomical variations of the linea aspera may be helpful in Orthopaedy and Radiology to distinguish pathological from normal anatomical variations.
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Grzelak P, Augsburg Ł, Majos A, Stefańczyk L, Górski P, Piotrowski W, Antczak A. Diagnostic Potential of Contrast-Enhanced Ultrasound (CEUS) In the Assessment of Spleen and Liver Granulomas in the Course of Sarcoidosis. Adv Respir Med 2013. [DOI: 10.5603/arm.35517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction: The aim of this study was to analyze the diagnostic potential of contrast enhanced ultrasound (CEUS) for the recognition of focal lesions of the spleen and liver in patients suffering from sarcoidosis. Material and methods: We analyzed the outcome of diagnostic imaging in a group of 21 patients treated for pulmonary sarcoidosis, searching for the systemic infiltration of the liver and/or spleen. All the participants are patients with inactive disease, who are monitored every 6 months at the Pulmonology Clinic. Apart from the check-up high-resolution computed tomography (HR-CT)—every 2 years, patients underwent an initial ultrasound examination (US) and if there was a suspicion of systemic infiltration, abdominal CT and/or magnetic resonance imaging (MRI) and CEUS were performed. Results: In 18 patients suffering from pulmonary sarcoidosis diagnostic imaging revealed no systemic infiltration. In three patients, the use of CEUS exposed the presence of lesions in the parenchymal organs. In all cases, the images from CEUS were consistent with those from CT/MRI. Conclusions: CEUS has the potential to become a reliable and safe screening tool for systemic infiltration in patients with sarcoidosis. It may also be an important method of monitoring the effects of therapy.
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Polguj M, Sibiński M, Grzegorzewski A, Grzelak P, Majos A, Topol M. Variation in morphology of suprascapular notch as a factor of suprascapular nerve entrapment. INTERNATIONAL ORTHOPAEDICS 2013; 37:2185-92. [PMID: 23892466 PMCID: PMC3824898 DOI: 10.1007/s00264-013-2005-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 06/23/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The shape and size of the suprascapular notch (SSN) is one of the most important risk factors in suprascapular nerve entrapment. The aim of the study was to perform a morphological study of SSN variations. METHODS A total of 616 computer tomography scans of scapulae were retrospectively analysed in 308 patients. The examination focused on the suprascapular region. The type of suprascapular notch was determined by using a classification based on three geometrical measurements: maximal depth (MD), superior (STD) and middle (MTD) transverse diameters. RESULTS In the scans, five types of SSN were noted. In type I (24.18%) maximal depth was greater than superior transverse diameter. Type II (1.95%) has equal MD, STD and MTD. In type III (56.16%) the superior transverse diameter was greater than the maximal depth. Scapulae with bony foramen were classified as type IV (4.72%). In type V a discrete notch (12.99 %) was found. Additionally, types I and III were divided into three subtypes: A, B and C. The frequency of type I and IV was lower in females than in males, but type III was more common in females than males. Distribution of other types of SSN in both groups was similar. CONCLUSION Knowledge of the anatomical variations of the suprascapular notch described in this study should be helpful in endoscopic and open procedures of the suprascapular region and also may increase the safety of operative decompression of the suprascapular nerve.
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Wilmanska D, Antosik-Biernacka A, Przewratil P, Szubert W, Stefanczyk L, Majos A. The role of MRI in diagnostic algorithm of cervicofacial vascular anomalies in children. Pol J Radiol 2013; 78:7-14. [PMID: 23807878 PMCID: PMC3693840 DOI: 10.12659/pjr.883941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/28/2013] [Indexed: 11/30/2022] Open
Abstract
Background: Vascular anomalies are usually diagnosed through their clinical picture and history. The purpose of this study was to assess the role of MR imaging in initial assessment of cervicofacial vascular anomalies in children. Material/Methods: Twenty pediatric patients with vascular anomalies located in the cervicofacial region underwent MRI examination in our department. Images were evaluated for lesion detectability and its signal characteristics (on T1w, T2w images with fat suppression and contrast enhanced T1w sequences); the extent of the lesions and surrounding tissue involvement were also assessed. Results: In the studied group MR images revealed all anomalies and provided information of their anatomic extent and invasion of surrounding anatomic structures. Nine hemangiomas and six venous malformations were found among studied patients. Two children had multiloculated lesions corresponding to lymphatic malformations. One examination visualized a lesion consisting mainly of dilated vascular channels with an apparent feeding artery, which was consistent with arteriovenous malformation. Two remaining lesions were mixed malformations. Nine patients had lesions limited to subcutaneous tissue. Two masses infiltrated bone structures. There was muscle involvement found in nine cases. Conclusions: MR imaging is a well-established method for detection and monitoring of vascular anomalies in children. With ultrasound used mostly for initial diagnosis and additional flow assessment, angiography viewed as an invasive therapeutic method and computed tomography used only in specific situations due to its high irradiation dose, magnetic resonance is the best imaging method used in differential diagnosis and topographical characterization of vascular malformations and tumors of cervicofacial area in pediatric patients. Noninvasively and without irradiation, it enables evaluation of the extent and characteristics of lesions and planning proper therapeutic strategy.
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Lipiec P, Płońska-Gościniak E, Kuśmierek J, Płachcińska A, Stefańczyk L, Majos A, Peruga JZ, Szymański P, Kępka C, Kasprzak JD. [Safety of non-invasive cardiovascular imaging techniques. Expert consensus statement of the Polish Clinical Forum for Cardiovascular Imaging]. Kardiol Pol 2013; 71:301-7. [PMID: 23575791 DOI: 10.5603/kp.2013.0048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Indexed: 11/25/2022]
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Polguj M, Podgórski M, Jędrzejewski K, Topol M, Majos A. Fenestration and duplication of the vertebral artery: the anatomical and clinical points of view. Clin Anat 2013; 26:933-43. [PMID: 23553773 DOI: 10.1002/ca.22231] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/20/2012] [Accepted: 01/17/2013] [Indexed: 11/07/2022]
Abstract
The vertebral artery (VA) acts as a foundation for the posterior circulation of the head and neck. It presents a number of anomalies that can be easily visualized thanks to modern imaging techniques, such as MR and CT angiography or color Doppler ulrasonography. Determining the appropriate terminology for those anomalies can be sometimes more challenging than their recognition. One particular challenge concerns the differentiation between VA fenestration and duplication. Because of the different clinical prognoses associated with those anomalies, confusion should be avoided. Knowledge of the morphological anomalies associated with the VA is important for both radiologists and head and neck surgeons, because any injury to the VA can result in a threat to the vascular supply of the brain stem, the cerebral or cerebellar hemispheres, the thalamus, cervical nerve roots and particularly the lateral medulla (Wallenberg's syndrome). This article analyses world literature concerning the issue of VA fenestration and duplication to facilitate a differential diagnosis.
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