Mandibular osteoma in the encephalocraniocutaneous lipomatosis.

INTRODUCTION: Encephalocraniocutaneous lipomatosis is a rare congenital disorder characterized by an abnormal development of adipose tissue, and is of unknown pathogenesis. Catherine Haberland and Maurice Perou first diagnosed this disorder in 1970. To our knowledge, approximately 25 patients have been reported with this diagnosis but so far, only 1 patient has been reported in Poland by Roszkowski and Dabrowski in 1997. At that time she was a 13-year-old girl, who was neurosurgically treated. CASE REPORT: The authors followed the same patient (now 21 years old), who was referred to the Department of Cranio-Maxillofacial Surgery of the Medical University of Lodz for osteoma of the mandible. Partial resection of the mandible was performed on account of the size of the lesion. The mandible was reconstructed by an iliac crest bone graft fixed by 2 titanium plates. The surgical procedure is described. CONCLUSION: Encephalocraniocutaneous lipomatosis is a very rare syndrome. Most of the cases described in the literature presented lipomas of the skin with neurological and ophthalmological disturbances. Only a few authors described jaw tumours and no information was found on such big osteomas to this syndrome.     

Decompressive hemicraniectomy in ischaemic stroke

Background and purposeHemispheric ischaemic stroke complicated by oedema is associated with high mortality. The results of randomized studies showed that decompressive hemicraniectomy performed in this group of patients could be beneficial. First experiences with implementation of hemicraniectomy in patients with brain infarct in our stroke centre are presented.Material and methodsBetween August 2007 and July 2008, four patients with hemispheric brain infarcts complicated by malignant oedema underwent decompressive hemicraniectomy within 72 hours from symptoms onset. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Clinical outcome was assessed 3, 6 and 12 months after the event using the modified Rankin scale (mRS).ResultsIn the first patient, the neurosurgical procedure included only decompressive hemicraniectomy, whereas in the other three duraplasty was performed additionally. The first patient died 23 days after the stroke onset due to acute respiratory failure. Another died at four months after the event, due to infectious complications. The remaining two patients presented severe functional disability 12 months after the procedure (mRS score 4).ConclusionsDecompressive surgery with duraplasty can be a life-saving procedure for patients with brain oedema. To our knowledge, the presented cases are among the first reported cases of hemispheric ischaemic stroke treated with decompressive hemicraniectomy in Poland. Extended follow-up with a larger group of patients is necessary to assess long-term outcome.     

Mono- and multislice computed tomography of the orbita injury

PURPOSE: To evaluate the reliability of the mono- (SCT) and multisliced CT (MSCT) imaging and their post-processing reconstructions in the cases of orbital trauma. MATERIAL AND METHODS: the spiral monoslice (n=20) and spiral multisliced (n=5) CT studies were performed in patients suffered from orbits' injuries. CT data were reconstructed in the 2D and 3D mode. The CT original images and the 2D and 3D reconstructions were evaluated according to the quality of visualization of a pathological lesions. Surgery was the method of reference. RESULTS: The reconstructed 3D images in 16 patients examined in SCT mode and in 5 patients examined in MSCT mode allowed to recognize properly the fracture. In the 13 patients SCT and in the 3 ones MSCT revealed the bone fragments and orbital soft tissues prolapse towards maxilla sinus; including the lower rectus muscle in 6 cases. In 1 patient evaluation of the 3D model allowed to exclude communication with intracranial space. The surgery correlated well with the source images and 2D/3D SCT and MSCT models. The diagnostic quality of the raw SCT vs MSCT images was evaluated as equal, but MSCT proved to be the better source for the post processing reconstruction, because of higher resolution and better smoothing. CONCLUSIONS: - Spiral CT 2D and 3D reconstructed images, especially generated from the MSCT, more clearly than the source data depict anatomical spatial relationships; - 2D/3D reconstructions revealed the position, course and displacement of a fractured fragments; thus it supports the surgery.     

Solid pseudopapillary tumor of the pancreas in a young woman--case report

We report a case of pancreatic solid pseudopapillary tumor that was diagnosed in a 36-year-old female patient. This neoplasm usually occurs in young women. Solid and cystic areas form a characteristic appearance of this tumor. Surgical resection is the mainstay of treatment and is possible in the majority of cases. Neoplasm is associated with a low-grade malignancy and a very good outlook.     

Intravenous thrombolysis in acute ischemic stroke after POLKARD: one center analysis of program impact on clinical practice

PurposeIntravenous thrombolysis in the acute ischemic stroke was initiated in Poland within the National Cardiovascular Disease Prevention and Treatment Program POLKARD in the years 2003–2008. Since 2009 the procedure has been reimbursed by the National Health Fund (Narodowy Fundusz Zdrowia – NFZ). The purpose of the presented study was to assess whether the change of financing institution was associated with the change in proportion of patients treated and with any of the clinical parameters or stroke outcomes.Patients and methodsWe reviewed the data of the 90 consecutive patients with acute ischemic stroke treated with intravenous thrombolysis within 3-hours from symptoms onset. The differences between the POLKARD period and the year 2009, regarding clinical parameters, time delays, death rates and functional outcomes on day 90 after the stroke were analyzed. The association of outcome measures with baseline characteristics of the patients was analyzed with binary logistic regression.ResultsIn 2009 there was a significant increase in the proportion of patients treated (7.6%, 95%CI 5.3–10.7%, vs. 4.3%, 95%CI 3.3-5.5% respectively, p=0.013). There were no differences in age, baseline neurological presentation, prevalence of stoke risk factors, treatment time delays or hemorrhagic complications. Higher, but not significantly, 90-day mortality was observed (32.1%, 95%CI 13.3-54.1% vs. 16.1%, 95%CI 6.4–29.7% respectively, p=0.101). Baseline neurological deficits and in-hospital treatment time delays were significant predictors of disability and death.ConclusionsAfter the Polish Ministry of Health program POLKARD termination and elimination of the reimbursement limits, higher proportion of ischemic stroke patients could be treated with the intravenous thrombolysis.