Publications by authors named "Joanna Pilch-Kowalczyk"

34 Publications

Pancreatic neuroendocrine carcinoma metastasis to the skin.

Endokrynol Pol 2021 Mar 22. Epub 2021 Mar 22.

5Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland.

Opisujemy przypadek pacjentki z rozpoznaniem raka neuroendokrynnego trzustki z przerzutem do skóry. Pierwotnie, w badaniu fizykalnym stwierdzono jedynie powiększone węzły chłonne pachwinowe prawe. Pomimo wykonania wielu badań obrazowych i czynnościowych oraz przeprowadzenia licznych konsultacji specjalistycznych nie zlokalizowano ogniska pierwotnego. W wykonanych, w przebiegu choroby, kontrolnych badaniach obrazowych uwidoczniono ognisko pierwotne w trzustce. Pacjentkę zakwalifikowano do zabiegu resekcyjnego. Jednak przed planowanym zabiegiem pacjentka zauważyła szybkorosnącego guza przedramienia, który w badaniu histopatologicznym okazał się przerzutem raka neuroendokrynnego do skóry. Z powodu znacznej progresji guza trzustki odstąpiono od zabiegu operacyjnego. Pacjentkę skierowano do paliatywnego leczenia onkologicznego, którego ze względu na gwałtownie pogarszający się stan ogólny nie otrzymała. Zmarła po 6 miesiącach.
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http://dx.doi.org/10.5603/EP.a2021.0024DOI Listing
March 2021

Small Intestinal Intussusception Due to Complicated Giant Jejunal Diverticulosis.

Medicina (Kaunas) 2021 Jan 28;57(2). Epub 2021 Jan 28.

Department of Gastrointestinal Surgery, Medical University of Silesia, 40-752 Katowice, Poland.

: Jejunal diverticulosis and jejunal lipomatosis are uncommon conditions. Usually asymptomatic, they may cause severe complications in some cases. Intussusception is unusual in adults, but when diagnosed swiftly it can be treated surgically, usually with good outcome. : We present a 60-year-old female patient with a history of chronic malnutrition and anemia, complaining of acute abdominal pain, vomiting and diarrhea. Contrast-enhanced abdominal computed tomography (CT) showed intussusception, multiple giant jejunal diverticula and multiple lipomas. The patient underwent urgent surgery, but radical treatment was not possible due to the extent of the diseases. One month later, another surgery was needed due to ileostomy obstruction caused by lipomas. The patient's condition deteriorated due to malnutrition and concomitant metabolic disorders, which eventually led to her demise. : Radical treatment is not always possible in an extensive jejunal disease. Prolonged malnutrition impairs postoperative healing, and therefore surgical or nutritional treatment should be considered in jejunal diverticulosis before the onset of severe complications requiring urgent surgical intervention.
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http://dx.doi.org/10.3390/medicina57020116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910828PMC
January 2021

The new method, the old problem - role of contrast-enhanced spectral mammography in the diagnosis of breast cancer among Polish women.

Pol J Radiol 2020 27;85:e381-e386. Epub 2020 Jul 27.

Department of Radiology and Nuclear Medicine, Medical University of Silesia in Katowice, Poland.

Purpose: The aim of the study was to evaluate spectral mammography (CESM) in diagnosing breast cancer, which is based on sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Material And Methods: The study included a group of 547 women who underwent spectral mammography and histopathological verification of the lesion, previously seen in mammography and/or ultrasound. In the group of 547 women, 593 focal lesions were diagnosed. All CESM examinations were carried-out with a digital mammography device dedicated to performing dual-energy CESM acquisitions. An intravenous injection of 1.5 ml/kg of body mass of non-ionic contrast agent was performed.

Results: The analysis includes 593 breast lesions, in this group cancer was detected in 327 (55.14%) lesions, and in 256 (43.17%) cases benign lesions were confirmed by histopathological examination and at least 12 months of observation. The method shows differentiation of benign and malignant lesions in the breast: sensitivity of 97.86%, specificity of 59.4%, PPV - 74.76%, NPV - 95.76%.

Conclusions: Spectral mammography could be an ideal method to detect breast cancer. Thanks to the high NPV (95.76%), it facilitates the exclusion of cancer in situations where pathological contrast enhancement is not observed. The unsatisfactory specificity of the study (59.4%) would not make it safe to avoid a core needle biopsy of lesions that undergo contrast enhancement.
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http://dx.doi.org/10.5114/pjr.2020.97941DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7425219PMC
July 2020

Prospective Evaluation of the NETest as a Liquid Biopsy for Gastroenteropancreatic and Bronchopulmonary Neuroendocrine Tumors: An ENETS Center of Excellence Experience.

Neuroendocrinology 2021 24;111(4):304-319. Epub 2020 Apr 24.

Department of Endocrinology and Neuroendocrine Tumors, Medical University of Silesia, Katowice, Poland.

Background: There is a substantial unmet clinical need for an accurate and effective blood biomarker for neuroendocrine neoplasms (NEN). We therefore evaluated, under real-world conditions in an ENETS Center of Excellence (CoE), the clinical utility of the NETest as a liquid biopsy and compared its utility with chromogranin A (CgA) measurement.

Methods: The cohorts were: gastroenteropancreatic NEN (GEP-NEN; n = 253), bronchopulmonary NEN (BPNEN; n = 64), thymic NEN (n = 1), colon cancer (n = 37), non-small-cell lung cancer (NSCLC; n = 63), benign lung disease (n = 59), and controls (n = 86). In the GEPNEN group, 164 (65%) had image-positive disease (IPD, n = 135) or were image-negative but resection-margin/biopsy-positive (n = 29), and were graded as G1 (n = 106), G2 (n = 49), G3 (n = 7), or no data (n = 2). The remainder (n = 71) had no evidence of disease (NED). In the BPNEN group, 43/64 (67%) had IPD. Histology revealed typical carcinoids (TC, n = 14), atypical carcinoids (AC, n = 14), small-cell lung cancer (SCLC, n = 11), and large-cell neuroendocrine carcinoma (LCNEC, n = 4). Disease status (stable or progressive) was evaluated according to RECIST v1.1. Blood sampling involved NETest (n = 563) and NETest/CgA analysis matched samples (n = 178). NETest was performed by PCR (on a scale of 0-100), with a score ≥20 reflecting a disease-positive status and >40 reflecting progressive disease. CgA positivity was determined by ELISA. Samples were deidentified and measurements blinded. The Kruskal-Wallis, Mann-Whitney U, and McNemar tests, and the area under the curve (AUC) of the receiver-operating characteristics (ROC) were used in the statistical analysis.

Results: In the GEPNEN group, NETest was significantly higher (34.4 ± 1.8, p < 0.0001) in disease-positive patients than in patients with NED (10.5 ± 1, p < 0.0001), colon cancer patients (18 ± 4, p < 0.0004), and controls (7 ± 0.5, p < 0.0001). Sensitivity for detecting disease compared to controls was 89% and specificity was 94%. NETest levels were increased in G2 vs. G1 (39 ± 3 vs. 32 ± 2, p = 0.02) and correlated with stage (localized: 26 ± 2 vs. regional/distant: 40 ± 3, p = 0.0002) and progression (55 ± 5 vs. 34 ± 2 in stable disease, p = 0.0005). In the BPNEN group, diagnostic sensitivity was 100% and levels were significantly higher in patients with bronchopulmonary carcinoids (BPC; 30 ± 1.3) who had IPD than in controls (7 ± 0.5, p < 0.0001), patients with NED (24.1 ± 1.3, p < 0.005), and NSCLC patients (17 ± 3, p = 0.0001). NETest levels were higher in patients with poorly differentiated BPNEN (LCNEC + SCLC; 59 ± 7) than in those with BPC (30 ± 1.3, p = 0.0005) or progressive disease (57.8 ± 7), compared to those with stable disease (29.4 ± 1, p < 0.0001). The AUC for differentiating disease from controls was 0.87 in the GEPNEN group and 0.99 in BPC patients (p < 0.0001). Matched CgA analysis was performed in 178 patients. In the GEPNEN group (n = 135), NETest was significantly more accurate for detecting disease (99%) than CgA positivity (53%; McNemar test χ2 = 87, p < 0.0001). In the BPNEN group (n = 43), NETest was significantly more accurate for disease detection (100%) than CgA positivity (26%; McNemar's test χ2 = 30, p < 0.0001).

Conclusions: The NETest is an accurate diagnostic for GEPNEN and BPNEN. It exhibits tumor biology correlation with grading, staging, and progression. CgA as a biomarker is significantly less accurate than NETest. The NETest has substantial clinical utility that can facilitate patient management.
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http://dx.doi.org/10.1159/000508106DOI Listing
April 2020

NETest liquid biopsy is diagnostic of small intestine and pancreatic neuroendocrine tumors and correlates with imaging.

Endocr Connect 2019 Mar 1. Epub 2019 Mar 1.

B Kos-Kudła, Department of Endocrinology and Neuroendocrine Tumors, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland.

Introduction: Current monoanalyte biomarkers are ineffective in gastroenteropancreatic neuroendocrine tumors (GEP-NETs). NETest, a novel multianalyte signature, provides molecular information relevant to disease biology.

Aim(s): Independently validate NETest to diagnose GEP-NETs and identify progression in a tertiary referral center.

Materials And Methods: Cohorts: 67 pancreatic NET (PNETs), 44 small intestine NETs (SINETs), 63 controls. Well-differentiated (WD): PNETs, n=62, SINETs, all (n=44). Disease extent assessment at blood draw: anatomical (n=110)- CT(n=106), MRI(n=7) and/or functional- 68Ga-SSA-PET/CT(n=69) or 18F-FDG-PET/CT (n=8). Image positive disease (IPD) was defined as either CT/MRI or 68Ga-SSA-PET/CT/18F-FDG-PET/CT-positive. Both CT/MRI and 68Ga-SSA-PET/CT-negative in WD-NETs was considered image negative disease (IND). NETest (normal: 20): PCR (spotted plates).

Data: mean±SD.

Results: Diagnosis: NETest was significantly increased in NETs (n=111; 26±21) vs. controls (8±4, p<0.0001). 75 (42 PNET, 33 SINET) were image-positive. Eleven (8 PNET, 3 SINET; all WD) were IND. In IPD, NETest was significantly higher (36±22) vs. IND (8±7, p<0.0001). NETest accuracy, sensitivity, specificity: 97%, 99%, 95%. Concordance with imaging: NETest was 92% (101/110) concordant with anatomical imaging, 94% (65/69) with 68Ga-SSA-PET/CT, 96% (65/68) dual modality (CT/MRI and 68Ga-SSA-PET/CT). In 70 CT/MRI-positive, NETest was elevated in all (37±22). In 40 CT/MRI-negative, NETest was normal (11±10) in 31. In 56 68Ga-SSA-PET/CT-positive, NETest was elevated (36±22) in 55. In 13 68Ga-SSA-PET/CT-negative, NETest was normal (9±8) in 10. Disease status: NETest was significantly higher in progressive (61±26; n=11) vs. stable disease (29±14; n=64; p<0.0001) (RECIST 1.1).

Conclusion: NETest is an effective diagnostic for PNETs and SINETs. Elevated NETest is as effective as imaging in diagnosis and accurately identifies progression.
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http://dx.doi.org/10.1530/EC-19-0030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6479193PMC
March 2019

Pancreaticopleural and pancreaticomediastinal fistula extending to the cervical region, with dysphagia as initial symptom: A case report.

Medicine (Baltimore) 2019 Feb;98(5):e14233

Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland.

Rationale: Pancreaticopleural and pancreaticomediastinal fistulas are rare complications of pancreatitis. They are often misdiagnosed and there are no strict guidelines of treatment. In this study, we present a brief report of a combined pancreaticopleural and pancreaticomediastinal fistula extending to the cervical region, causing dysphagia and cervical swelling as initial symptoms.

Patient Concerns: A 36-year-old female with history of alcohol abuse and pancreatitis presented progressing dysphagia and mild dyspnea on admission.

Diagnosis: Chest X-ray and chest and abdominal computed tomography scan (CT) indicated pancreaticopleural fistula combined with pancreaticomediastinal fistula, a diagnosis confirmed by high amylase levels in pleural fluid.

Interventions: Conservative treatment was administered and ERCP was performed but pancreatic duct stenting was impossible. The patient presented rapid anterior cervical swelling with progressing dysphagia and dyspnea. CT showed fistula penetration to the cervical region. The patient underwent urgent surgery and pancreaticojejunal anastomosis was performed.

Outcomes: The surgery led to recovery. Six months later, the patient reported good health and weight gain.

Lessons: Coexistence of pancreaticopleural and pancreaticomediastinal fistula with cervical penetration is an extremely rare pancreatitis complication. It presents with dysphagia and anterior cervical swelling as initial symptoms. It is important to consider this complication in all patients with history of pancreatitis, presenting with dysphagia.
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http://dx.doi.org/10.1097/MD.0000000000014233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380760PMC
February 2019

Cystic pancreatic neuroendocrine tumours - a gastroenterologist's point of view.

Endokrynol Pol 2018 ;69(3):320-325

Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland, Poland.

Cystic pancreatic tumors are detected with increasing frequency and remain a clinical problem. Since they have different potential of malignancy the management and decision making process is a hard task. Guidelines, concerning pancreatic cystic tumors indicate the management with mucinous, serous cystic pancreatic neoplasms and solid pseudopappilary tumor, while the management with pancreatic cystic neuroendocrine tumors is not included into these standards. This review tries to answer the question are the cystic pancreatic neuroendocrine tumors different entity from solid tumors of neuroendocrine origin.The management and differential diagnosis of these neoplasms with special focus on features on imaging studies allowing preoperative diagnosis are discussed.
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http://dx.doi.org/10.5603/EP.2018.0034DOI Listing
October 2018

Primary neuroendocrine carcinoma of the breast - a report of four cases.

Endokrynol Pol 2017 7;68(5):597-602. Epub 2017 Sep 7.

Zakład Medycyny Nuklearnej i Diagnostyki Obrazowej Katedry Radiologii i Medycyny Nuklearnej SUM.

Breast neuroendocrine tumours are rare, accounting for up to 5% of all breasts tumours and approximately 1% of all neuroendocrine tumours. In most cases, breast neuroendocrine tumours are histologically and moderately well differentiated. Neuroendocrine breast tumours lack characteristic imaging patterns. The histopathological assessment of these tumours is difficult, and in most cases the correct diagnosis is made after proper examination of the postsurgical specimen.
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http://dx.doi.org/10.5603/EP.a2017.0049DOI Listing
September 2017

A case of a giant intraorbital aneurysm successfully treated surgically.

Neurol Neurochir Pol 2017 Nov - Dec;51(6):501-503. Epub 2017 Jul 11.

Department of Nuclear Medicine and Diagnostic Imaging in Katowice, Medical University of Silesia, Katowice, Poland.

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http://dx.doi.org/10.1016/j.pjnns.2017.07.003DOI Listing
March 2018

Diagnostic and therapeutic guidelines for gastro-entero-pancreatic neuroendocrine neoplasms (recommended by the Polish Network of Neuroendocrine Tumours).

Endokrynol Pol 2017 ;68(2):79-110

Klinika Endokrynologii i Nowotworów Neuroendokrynnych, Katedra Patofizjologii i Endokrynologii, Śląski Uniwersytet Medyczny.

Progress in the diagnostics and therapy of gastro-entero-pancreatic (GEP) neuroendocrine neoplasms (NEN), the published results of new randomised clinical trials, and the new guidelines issued by the European Neuroendocrine Tumour Society (ENETS) have led the Polish Network of Neuroendocrine Tumours to update the 2013 guidelines regarding management of these neoplasms. We present the general recommendations for the management of NENs, developed by experts during the Third Round Table Conference - Diagnostics and therapy of gastro-entero-pancreatic neuroendocrine neoplasms: Polish recommendations in view of current European recommenda-tions, which took place in December 2016 in Żelechów near Warsaw. Drawing from the extensive experience of centres dealing with this type of neoplasms, we hope that we have managed to develop the optimal management system, applying the most recent achievements in the field of medicine, for these patients, and that it can be implemented effectively in Poland. These management guidelines have been arranged in the following order: gastric and duodenal NENs (including gastrinoma); pancreatic NENs; NENs of the small intestine and appendix, and colorectal NENs.
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http://dx.doi.org/10.5603/EP.2017.0015DOI Listing
July 2017

Colorectal neuroendocrine neoplasms - management guidelines (recommended by the Polish Network of Neuroendocrine Tumours).

Endokrynol Pol 2017 ;68(2):250-260

Neuroendocrine neoplasms/tumours (NENs/NETs) of the large intestine are detected increasingly often, especially rectal tumours, which is probably associated with the widespread use of screening colonoscopy. There is a growing body of evidence supporting the thesis that the NENs of the rectum and the NENs of the colon are two different diseases. Rectal NENs are usually small lesions, of low to moderate histological malignancy, associated with good prognosis, and most may be treated endoscopically. NENs of the colon, however, are often aggressive, poorly differentiated, associated with a poor or uncer-tain prognosis, and require surgical treatment. The management guidelines regarding these groups of patients are constantly changing. On the basis of the recent literature data and conclusions reached by the working meeting of the Polish Network of Neuroendocrine Tumours (December 2016), this study completes and updates the data and management guidelines regarding colorectal NENs published in Endokrynologia Polska 2013; 64: 358-368.
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http://dx.doi.org/10.5603/EP.2017.0019DOI Listing
July 2017

Neuroendocrine neoplasms of the small intestine and appendix - management guidelines (recommended by the Polish Network of Neuroendocrine Tumours).

Endokrynol Pol 2017 ;68(2):223-236

This study presents the revised Polish guidelines regarding the management of patients suffering from neuroendocrine neoplasms (NENs) of the small intestine and appendix. The small intestine, especially the ileum, is the most common location for these neoplasms. Most are well differentiated and slow growing. Their symptoms may be atypical, which can result in delayed or accidental diagnosis. Appendicitis is usually the first manifestation of NEN in this location. Typical symptoms of carcinoid syndrome occur in approximately 20-30% of patients suffering from small intestinal NENs with distant metastases. The main cause of death in patients with carcinoid syndrome is carcinoid heart disease. The most useful laboratory test is the determination of chromogranin A, while concentration of 5-hydroxyindoleacetic acid is helpful in the diagnostics of carcinoid syndrome. For visualisation, ultrasound, computed tomography, magnetic resonance imaging, colonoscopy, video capsule endoscopy, double-balloon enteroscopy, and somatostatin receptor scintigraphy may be used. A detailed his-tological report is crucial for the proper diagnostics and therapy of NENs of the small intestine and appendix. The treatment of choice is surgical management, either radical or palliative. The pharmacological treatment of the hormonally active and non-active small intestinal NENs as well as NENs of the appendix is based on long-acting somatostatin analogues. In patients with generalised NENs of the small intestine in progress during the SSA treatment, with good expression of somatostatin receptors, the first-line treatment should be radio-isotope therapy, while targeted therapies, such as everolimus, should be considered afterwards. When the above therapies are exhausted, in certain cases chemotherapy may be considered.
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http://dx.doi.org/10.5603/EP.2017.0018DOI Listing
July 2017

Pancreatic neuroendocrine neoplasms - management guidelines (recommended by the Polish Network of Neuroendocrine Tumours).

Endokrynol Pol 2017 ;68(2):169-197

This article presents updated diagnostic and therapeutic guidelines for the management of pancreatic neuroendocrine tumours (PNEN), proposed by the Polish Network of Neuroendocrine Tumours. The guidelines contain new data received in the years 2013-2016, which confirm previous recommendations, and have led to modification of previous guidelines or have resulted in the formulation of new guidelines. Biochemical and imaging (anatomical and functional) tests are of great importance in diagnostics, as well as histopathological diagnosis to determine the management of PNEN patients, but they must be confirmed by an immunohistochemical examination. PNEN therapy requires collaboration among the members a multidisciplinary team of specialists experienced in the management of these neoplasms. Surgery is the basic form of treatment in many cases. Further therapy requires a multidirectional procedure; therefore, the rules of biotherapy, peptide receptor radionuclide therapy, molecular targeted therapy, and chemotherapy are discussed.
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http://dx.doi.org/10.5603/EP.2017.2016DOI Listing
July 2017

Gastroduodenal neuroendocrine neoplasms, including gastrinoma - management guidelines (recommended by the Polish Network of Neuroendocrine Tumours).

Endokrynol Pol 2017 ;68(2):138-153

This paper presents the updated Polish Neuroendocrine Tumour Network expert panel recommendations on the management of neuroendocrine neoplasms (NENs) of the stomach and duodenum, including gastrinoma. The recommendations discuss the epidemiology, pathogenesis, and clinical presentation of these tumours as well as their diagnosis, including biochemical, histopathological, and localisation diagnoses. The principles of treatment are discussed, including endoscopic, surgical, pharmacological, and radionuclide treatments. Finally, there are also recommendations on patient monitoring.
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http://dx.doi.org/10.5603/EP.2017.0016DOI Listing
July 2017

Traumatic basal subarachnoid haemorrhage or ruptured brain aneurysm in 16-year-old boy? - case report

Arch Med Sadowej Kryminol 2016 ;66(1):32-40

Chair and Department of Forensic Medicine and Forensic Toxicology, Medical University of Silesia, Katowice, Poland.

Traumatic basal subarachnoid haemorrhage (TBSAH) represents only 1.8% of all subarachnoid haemorrhage cases diagnosed during autopsy. This report presents such a case from the current practice of the authors. Sixteen-year-old boy was beaten by the aggressors. Suddenly he lost his consciousness and fall after he received a single blow in the neck. He was resuscitated immediately, but died at the scene. During the external examination we did not find any significant external injuries. Autopsy revealed large contusion of right sternocleidomastoid muscle. In the cranial cavity we found extensive subarachnoid haemorrhage, located mainly on brain basis, in the posterior cranial fossa and covering the subtentorial structures. During the preparation of blood vessels we noticed a slight change of morphology suggesting damaged vessel or aneurysm, or vascular malformation located in the basilar artery bifurcation, which was taken to detailed microscopic evaluation using the special stainings. Histological examination showed vital interruption of the basilar artery wall with massive haemorrhage, without the presence of general microscopic pathology. From the medico-legal viewpoint, to determine traumatic background of haemorrhage it is necessary to find the coexistence of the following circumstances: a sustained trauma, post-mortem findings consistent with a time of injury, the presence of temporal relationship between injury and death, and morphological vital injury of the brain vessel, as well as the absence of prior vascular malformations. For this purpose Verhoeff-van Gieson's, Masson's, Turnbull's and Gomori' histological stainings may be successfully used.
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http://dx.doi.org/10.5114/amsik.2016.62333DOI Listing
March 2017

Portal vein thrombosis in cirrhosis is not associated with intestinal barrier disruption or increased platelet aggregability.

Clin Res Hepatol Gastroenterol 2016 Dec 6;40(6):722-729. Epub 2016 May 6.

Department of Hematology and Bone Marrow Transplantation, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.

Objective: Portal vein thrombosis (PVT) is a common complication of cirrhosis, but its pathogenesis is unclear. We tested the hypotheses that PVT is the result of platelet hyperactivity or intestinal barrier disruption.

Methods: This study included 49 patients with cirrhosis (15 females) of mixed etiology. Based on spiral computed-tomography, the patients were divided into two groups: with PVT (n=16) and without PVT (n=33). Serum biomarkers of intestinal barrier integrity were endotoxins and zonulin, and platelet activity was assessed with multiple electrode aggregometry.

Results: The levels of endotoxin (43.5±18.3ng/ml vs. 36.9±7.5ng/ml; P=0.19) and zonulin (56.3±31.1ng/ml vs. 69.3±63.1ng/ml; P=0.69) were not different between the patients with and without PVT. Moreover, endotoxin and zonulin did not correlate with the coagulation and platelet parameters. The platelet aggregability measured with the TRAP and the ADP tests was decreased in PVT patients. In the logistic regression analysis the PVT incidence was related to the levels of D-dimer and bilirubin as well as the TRAP test results. Patients with PVT presented with significantly higher levels of D-dimer (4.45±2.59 vs. 3.03±2.97mg/l; P<0.05) and prothrombin levels (175±98.8μg/ml vs. 115±72.9μg/ml; P<0.05) than patients without thrombosis. PVT could be excluded with a 90% negative predictive value when the D-dimer level was below 1.82mg/l.

Conclusions: Endotoxemia and platelet activity are not determinants of PVT in patients with cirrhosis. The D-dimer measurement has diagnostic significance for PVT in patients with liver cirrhosis.
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http://dx.doi.org/10.1016/j.clinre.2016.03.008DOI Listing
December 2016

Large pancreatic lipoma in a 69-year-old diabetic woman: diagnostic considerations.

Prz Gastroenterol 2014 26;9(3):168-71. Epub 2014 Jun 26.

Department of Pathomorphology, Medical University of Silesia, Katowice, Poland.

Pancreatic mesenchymal neoplasms are very rare pancreatic tumours. One of them is pancreatic lipoma, often diagnosed incidentally. We herein report a case of a large lipoma of the pancreatic head, diagnosed by computed tomography and magnetic resonance imaging and confirmed by ultrasound-guided fine needle biopsy (FNA) biopsy. Regarding its benign character, silent clinical course and excellent prognosis of invasive surgical removal was avoided. We propose here the diagnostic and therapeutic management of these rare pancreatic tumours. Computed tomography is the most accurate method to diagnose pancreatic lipoma. Nevertheless large tumours may need confirmation by FNA in differential diagnosis of liposarcoma.
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http://dx.doi.org/10.5114/pg.2014.43579DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110364PMC
August 2014

Pancreatic neuroendocrine neoplasms - management guidelines (recommended by the Polish Network of Neuroendocrine Tumours).

Endokrynol Pol 2013 ;64(6):459-79

Division of Endocrinology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland.

We present revised diagnostic and therapeutic guidelines for the management of pancreatic neuroendocrine neoplasms (PNENs) proposed by the Polish Network of Neuroendocrine Tumours.These guidelines refer to biochemical (determination of specific and nonspecific neuroendocrine markers) and imaging diagnostics (EUS, CT, MR, and radioisotope examination with a 68Ga or 99Tc labelled somatostatin analogue).A histopathological diagnostic, which determines the further management of patients with PNENs, must be necessarily confirmed by immunohistochemical tests. PNENs therapy requires collaboration between a multidisciplinary team of specialists experienced in the management of these neoplasms. Surgery is the basic form of treatment. Medical therapy requires a multidirectional procedure, and therefore the rules of biotherapy, peptide receptor radionuclide therapy, chemotherapy and molecular targeted therapy are discussed.
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http://dx.doi.org/10.5603/EP.2013.0031DOI Listing
September 2015

Gastroduodenal neuroendocrine neoplasms including gastrinoma - management guidelines (recommended by the Polish Network of Neuroendocrine Tumours).

Endokrynol Pol 2013 ;64(6):444-58

Division of Endocrinology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland.

This paper presents the updated Polish Neuroendocrine Tumour Network expert panel recommendations on the management of neuroendocrine neoplasms (NENs) of the stomach and duodenum, including gastrinoma. The recommendations discuss the epidemiology, pathogenesis and clinical presentation of these tumours as well as their diagnosis, including biochemical, histopathological and localisation diagnosis. The principles of treatment are discussed, including endoscopic, surgical, pharmacological and radionuclide treatment. Finally, recommendations on patient monitoring are given.
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http://dx.doi.org/10.5603/EP.2013.0030DOI Listing
September 2015

A duodenal duplication cyst manifested by duodenojejunal intussusception and chronic pancreatitis.

Surgery 2014 Sep 15;156(3):742-4. Epub 2013 Jun 15.

Department of Gastrointestinal Surgery, Medical University of Silesia, Medykow, Poland.

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http://dx.doi.org/10.1016/j.surg.2013.02.013DOI Listing
September 2014

Spontaneous rupture of aneurysm of the right colic artery.

Dig Liver Dis 2013 Apr 5;45(4):e6. Epub 2012 Nov 5.

Department of Digestive Tract Surgery, Medical University of Silesia, Katowice, Poland.

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http://dx.doi.org/10.1016/j.dld.2012.09.016DOI Listing
April 2013

Detection of cerebral artery fenestrations by computed tomography angiography.

Neurol Neurochir Pol 2012 May-Jun;46(3):239-44

SP Szpital Kliniczny nr 1 w Zabrzu SUM, Zakład Radiologii, 41-800 Zabrze.

Background And Purpose: Cerebral artery fenestrations (CAF) are rare congenital variations usually diagnosed by digital subtraction angiography (DSA). The aim of this study was to examine the frequency of occurrence of fenestrations in cerebral arteries and their coexistence with cerebral aneurysms in computed tomography angiography (CTA).

Material And Methods: All reports of cerebral CTA (1140) performed in one institution from March 2005 to December 2007 were analysed. We found 40 patients with single fenestrations of the intracranial arteries. All 40 examinations were retrospectively reviewed for location of vascular malformations and presence of aneurysms or subarachnoid haemorrhage (SAH). Medical histories of those patients were then analysed for evidence of SAH and referral reasons for CTA.

Results: Forty fenestrated arteries were found in CTA: 18 basilar arteries (45%), 16 anterior cerebral arteries (40%), 4 anterior communicating arteries (10%) and one middle cerebral artery (2.5%). Only one vertebral artery fenestration was found due to the technique of the examination. Six patients (15%) with fenestrated arteries had a total of 8 aneurysms, although only one aneurysm was ipsilateral to the fenestration. In 8 cases of SAH, two were with no evidence of vascular malformation. The coexistence of CAF and aneurysms in CTA amounted to 15% (6/40), but the incidence of ipsilateral aneurysm was only 2.5% (1/40) and it affected the anterior cerebral artery.

Conclusions: Basilar artery fenestration is the most frequent observed fenestration in CTA, followed by anterior cerebral artery and anterior communicating artery fenestrations. Coexistence of fenestration and aneurysm is uncommon in CTA examination.
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http://dx.doi.org/10.5114/ninp.2012.29132DOI Listing
September 2012

Gastrointestinal image: a true giant transverse colon diverticulum.

J Gastrointest Surg 2011 Jul 15;15(7):1289-91. Epub 2011 Mar 15.

Department of Digestive Tract Surgery, Medical University of Silesia, Medyków 14 St, 40-752 Katowice, Poland.

Unlabelled: Giant colonic diverticulum is an extremely rare condition in colonic diverticular disease. More than 90% of giant colonic diverticula are found in the sigmoid colon. Inflammatory and pseudodiverticula are the most frequent. Only one case of a true diverticulum of the transverse colon has been reported in the literature.

Case Report: We report a case of a 22-year-old woman presenting with constipation and meteorism from childhood. A plain abdominal X-ray showed a round radiolucent air-filled cyst. Barium enema revealed a single, large diverticulum of the transverse colon. An extended right hemicolectomy with primary end-to-end anastomosis was performed. The postoperative course was uneventful, and she was discharged in 1 week without any complications. Histopathology showed a true diverticulum containing all layers of the colon.
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http://dx.doi.org/10.1007/s11605-011-1462-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116123PMC
July 2011

Extracolonic findings at CT colonography - additional advantage of the method.

Med Sci Monit 2004 Jun;10 Suppl 3:22-5

Department of Radiology SUSM, Katowice, Poland.

Background: In virtual colonoscopy (VC) we are capable to assess all organs located between a diaphragm and pelvic bottom. This report provides a breakdown of extracolonic pathological findings in VC performed in standard indications.

Material/methods: We reviewed 71 consecutive VC (29 men and 42 women) performed using double-slice scanner General Electric High Speed NX/I Pro. Pathological findings were presented in a tabular form illustrated by sample images.

Results: Extracolonic findings were found in 53 cases (74.6%), and were equally frequent in subgroups with pathological colon and free from colon lesions. Renal cysts occurred most often. In 15 cases the extracolonic pathologies were clinically important, most of them tumors.

Conclusions: VC is found to be a very useful tool in the detection and evaluation of extracolonic pathologies.
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June 2004

[Role of perfusion imaging in computed tomography in diagnostics of cerebral gliomas].

Neurol Neurochir Pol 2006 Jan-Feb;40(1):51-6

HELIMED Slaskie Centrum Diagnostyki Obrazowej, ul. Panewnicka 65, 40-760 Katowice.

CT perfusion is a new diagnostic method which enables imaging of the hemodynamics of tissues and organs. Until now most of the publications have been focused on the use of this technique to assess acute stroke. The aim of the presented work is to show the role of CT perfusion in the diagnosis of cerebral gliomas. These tumors are characterized by intensive vascularity which results in an increased blood volume (CBV), blood flow (CBF) and permeability surface (PS) values in perfusion CT examination. A correlation has been reported between perfusion parameters and the histopathological tumor grade. CT perfusion provides morphological and functional information which is useful in the diagnosis, planning treatment strategies and monitoring of the therapeutic effect in cerebral gliomas.
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June 2006

[Melkersson-Rosenthal syndrome as a rare cause of recurrent facial nerve palsy].

Neurol Neurochir Pol 2005 Jul-Aug;39(4):335-8

Department of Neurology, Aging, Degenerative and Cerebrovascular Diseases, Silesian Medical Academy, Central University Hospital, ul. Medyków 14, 40-752 Katowice, Poland.

Melkersson-Rosenthal syndrome is a rare cause of recurrent facial nerve palsy. The syndrome is classically characterized by a triad of signs consisting of facial edema, recurrent peripheral facial nerve paralysis, and congenital fissured tongue, although it may also present in a mono- or oligosymptomatic form. The paper presents a 24-year-old woman with right-sided peripheral facial nerve palsy and a history of left-sided episodes of facial nerve palsy. Magnetic resonance angiography of the cerebral vessels suggested compression of the right seventh and eighth cranial nerves by a vascular loop. The authors describe the patient with a complete picture of Melkersson-Rosenthal syndrome and discuss the diagnosing process and treatment.
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May 2006

Haemobilia causing acute pancreatitis after percutaneous liver biopsy.

J Hepatol 2005 Aug 7;43(2):366. Epub 2004 Dec 7.

Department of Gastroenterology, Silesian Medical School, ul. Medyków 14, 40-752 Katowice, Poland.

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http://dx.doi.org/10.1016/j.jhep.2004.09.025DOI Listing
August 2005