Investor Presentaiton

IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC s66 Abstracts Abstracts she had severe chest pain, ST-segment depressions and was admit- ted again.MRI showed fluid in the pericardial sac with a maximum of 8 mm at the base, After 9 days she was discharged with a diagnosis of pericaridial effusion and CAS. Conclusions: Anginal pain and ST- segment changes are not always due to CAD. The possibility of CAS should be taken into account, especially when the patient is a wo- man with history of chest pain triggered by cold exposure, smoking, stress or some drugs. This young female presented with symptoms typical for coronary artery occlusion, which were caused by CAS.To- gether with Raynaud's phenomenon and a suspicion of glaucoma it can reflect a systemic vasospasm disorder.The prognosis for variant angina is good, although it can lead to myocardial infarction, serious arrhythmias and even death. 12 A Case Report Of 60 -Year-Old Man With Depression And Hypertension Diagnosed With Pheochromocytoma Kinga Brodzińska, Beata Rak Students' Scientific Group, Chair and Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Poland Background: Pheochromocytoma is an adrenal gland tumor, origi- nating in the chromaffin cells, which produces catecholamines. Characteristic for this tumor is the "rule of tens" (10% bilateral, 10% extraadrenal, 10% malignant). The classical triad of clinical symptoms consists of palpitations, headaches and excesive swea- ting. Other symptoms include: hypertension, anxiety, pallor, nausea, weakness. However, it can be asymptomatic. Because of unspecific symptoms the diagnosis of this rare neuroendocrine tumor can be missed or delayed. The differential diagnosis should consider: essen- tial hypertension, anxiety attack, hyperthyroidism, hypogonadism, hypoglycemia, renal artery stenosis, intracranial lesion, autonomic epilepsy, carcinoid syndrome, use of cocaine or amphetamine. The final diagnosis is based on biochemical testing of plasma or urine metanephrines and imaging studies (CT, MRI, 123 MIBG, scan, PET). There is a need to exclude causes of falsely elevation of metane- phrines like: withdrawal of lewodopa, symphaticomimetics, alfa/ beta blockers and tricyclic antidepressants. Case: This study reports the case of a 60- year- old man with a history of depression and stable hypertension who was admitted to the hospital because of a tumor (35 x 30mm) in the left adrenal gland found incidentally on abdominal ultrasound examination. The patient complained only of profuse sweating on exertion. There was no abnormalities on physi- cal examination. He has been treated for depression for 7 years with clomipramine (Anafranil) and mianserin (Lerivon); for hypertension with losartan (Cozaar) and doksazosin (Doxar). The work up revealed elevated level of urine metanephines and noradrenaline. As post surgery urine metanephrines normalized, but norepinephrine was still elevated it may suggest that elevation of norepinephrine is due to drugs influence. It should be however established as it may aslo suggest not complete excision of a tumor or extradrenal tumor (me- tastases/paraganglioma). To confirm the drug influence hypothesis antidepressives should be withdrawn but it is not possible because of patients condition. Conclusions: This case report suggest, that pheochromocytoma is not always easy to diagnose. False positive and negative results do occur. The interpretation of laboratory data needs to be done together with clinical picture, imaging studies and concurrent treatment. 13 Magnetic Resonance Enterography For Assessment of Intens- tinal Graft-Versus- Host Disease Weronika Jaremek, lek. spec. radiolog Joanna Podgórska, lek. Piotr Kacprzyk II Zakład Radiologii Klinicznej Centralny Szpital Kliniczny Warszawskiego Uniwersytetu Medycznego Klinika Chorób Wewnętrznych Hematologii i Onkologii Centralny Szpital Kliniczny Warszawskiego Uniwersytetu Medycznego Background: Graft-versus-host disease (GVHD) occurs as a main, se- vere and frequent complication after allogenic bone marrow trans- plantation (alloPBSCT). The process of GVHD develops when donor alive T lymphocytes cells damage recipient target organs, especially skin, liver, digestive tract and bone marrow. After SCT about 50% of patients suffer from clinically relevant GVHD what more 10-year survival rate is no more than 5% in acute GVHD. Currently the as- sessment of intestinal GVHD is mainly based on clinical symptoms and endoscopic examination of the upper and lower gastrointes- tinal tract together with multiple biopsies. Magnetic resonans en- terography (MRE) is a standard method for evaluation various in- testinal pathologies in Inflammatory Bowel Diseases particularly in Leśniowski-Crohn disease. MRE is really sensitive to identify active inflammation, wall thickening, stenosis, mural stratification, ascites and others. Thereupon it could be also good method in grading of gastrointestinal graft-versus-host disease GI GVHD after alloPBSCT. Case: 45 year men, GI GVHD after alloPBSCT owing to MCL (mantle cell lymphoma). Patient underwent MRE. The MRE findings showed inflammation changes of all small intestine with submucosal oede- ma and mesentery changes. Conclusions: Magnetic resonance ente- rography is new opportunity and really well alternative method for assessing clinical severity of GI GVHD. MRE precisely shows localiza- tions and types of pathological changes. What else, patients may have to undergo repeated MRE because it is non-invasive method due to that long control of disease or relapsing detection is relatively simple. In case of that It could be also really useful method for GVHD patients. 14 Papillary Thyroid Carcinoma, Primary Hyperparathyroidism And Idiopathic Hyperandrogenism In 35-Year-Old Obese Fe- male Patient Case Report Marta Muszel, Kamil Wocial Medical University of Warsaw, Department of Internal Medi- cine and Endocrinology, Students' Scientific Group "Endocri- nus" Background: Papillary thyroid carcinoma (PTC) is the most prevalent of all thyroid carcinomas. It is characterized by rather slow growth with lymphatic spreads, distant metastases occur rarely. Some studies suggest that there is a connection between prevalence of Hashimoto's thyroiditis and PTC. Primary hyperparathyroidism can appear as a part of multiple endocrine neoplasia (MEN) syndrome. Its occurrence in patients with PTC is rare. Case: 35-year-old obese woman with Hashimoto thyroiditis, hypertension was admitted to hospital due to hirsutism that was gradually escalating since pu- berty, she reported regular menstruations. On physical examination patient presented: • • second degree obesity (BMI- 36,3)- patient reported that she gained circa 30kg over 7 years hirsutism 10/36 points on Ferriman-Gallwey score features of acanthosis nigricans (AN) around neck and axi- llas features of acne on face and chest DHEAS, testosterone and 17(OH)-P serum concentrations were nor- mal. TV ultrasound revealed no ovary abnormalities. Diagnosis of idiopathic hyperandrogenism has been established on basis of these results along with regular menstruations. Oral glucose tolerance test indicated impaired fasting glycaemia. Basic laboratory tests revealed elevated serum ionized calcium level. Further tests indicated increa- sed plasma parathormone concentration and urinary calcium ex- cretion. Laboratory results suggested primary hyperparathyroidism. Bone densitometry result was within normal range. MIBI parathyroid scintigraphy demonstrated no signs of increased gathering of the marker, however it might have been due to Hashimoto's thyroiditis and levothyroxine treatment. Further diagnostic procedure excluded MEN1 and MEN2a. Thyroid ultrasound (US) performed 1 year prior to patient's admission showed hypoechoic nodule (8mm size). Present thyroid US demonstrated 3 nodules, one of them was non homo- geneously hypoechoic with microcalcifications present. Fine-needle aspiration biopsy indicated PTC. Surgical consultation was planned to schedule strumectomy and parathyroidectomy. Conclusions: In case of described patient three diseases- idiopathic hyperandrogenism, primary hyperparathyroidism and papillary thyroid carcinoma have occurred independently. Patients with nodular HT should be carefully monitored, because of possible connection between nodular HT and papillary thyroid carcinoma. Radical strumectomy and parathyroi- dectomy is the first choice treatment in case of described patient. 15 When gynecology meets pneumonology a rare cause of multiple pulmonary nodules Magdalena Chojnowska, Marta Maskey-Warzechowska MD, PhD, Renata Rubinsztajn MD, PhD Students' Scientific Group "Alveolus", Department Internal Medicine, Pneumonology and Allergology, Medical University of Warsaw Background: Multiple contrast enhanced nodular lesions in the lungs indicate a malignancy, however benign diseases should also be con- sidered. We present a 57-year old woman with a rare pulmonological manifestation of a common benign gynecological disorder. Case: A 57-year old woman with a history of hysterectomy due to uterine leiomyoma 15 years ago, was hospitalized due to multiple pulmo- nary nodules in both lungs. The lesions were revealed in a routinely performed chest radiogram. The patient had no symptoms, no ab- normalities were found on physical examination. Computed tomo- graphy of the chest revealed multiple, bilateral, well-defined, nodu- lar lesions which varied in size and showed contrast enhancement. A malignant disseminated neoplasm was suspected, but numerous imaging studies and cancer markers within the normal range failed to confirm this suspicion. 18 FDG PET-CT was negative. The patient underwent open lung biopsy; histopathological examination showed altered muscular cells and low grade stromal sarcoma was diag- nosed. However, the attending oncologist, taking into consideration the lack of the primary focus and the very good general state of the patient despite an interval of few months between the initial and final diagnosis decided to consult the histopathological specimens in two independent oncological centers: benign metastasizing leiomyo- matosis was diagnosed. The patient is under observation since 2012, she remains asymptomatic. In 2015 a new single nodular lesion was detected in the left lung, the appearance of the remaining nodules is stable. Conclusions: Bilateral multiple lung nodules with contrast enhancement in CT are typically associated with pulmonary metas- tases. However, differential diagnosis should also include benign le- sions. BML should be suspected especially in asymptomatic middle- aged women with a history of uterine leiomyoma, who present with pulmonary nodules. 16 A Fever Of Unknown Origin As A Sign Of Neoplastic Process In The Body. Case Report. Katarzyna Ożga, Karolina Borowska Jagiellonian University Medical College Background: Neoplastic process in the body, especially neoplasia of the lymphoid system, sometimes creates diagnostic difficulties. Lymphomas, including Hodgkin lymphoma, can be associated with paraneoplastic syndromes, which do not lead to appropriate diag- nosis. Hodgkin lymphoma is the most common neoplasm in young adults, but because of non-specific symptoms it's often detected in advanced stage. Case: The patient is a 29 year-old male who presen- ted fever episodes up to 39 °C, which repeatedly recurred during last 10 months. The medical history revealed ulcerative colitis treated with mesalazine. The fever episodes began in January 2014, when the patient presented to his family doctor. Firstly he was suspected to suffer from some infection but the treatment was unsuccessful. Apart from fever the patient complained of hematochezia. In October 2014 he was admitted to the Department of Allergy and Immunology JUMC where the diagnostic procedure was extended. On physical examination no abnormalities were detected. Laboratory tests revea- led elevated LDH level (720.0 U/L) and CRP level (on admission: 14.3 mg/L, during hospitalization: 29.8 mg/L), in immunology test PANCA antibodies were found, although they are often present in ulcerative colitis patients. During hospitalization several episodes of fever up to 39.2 °C occurred. In thorax computed tomography nodular densi- ties with air spaces in lungs were detected accompanied by interlo- bular septal thickening. Bronchoscopy disclosed reddened bronchial mucosa, but all cultures including tuberculosis were negative. The abdominal ultrasound showed hepatomegaly and mild splenome- galy. Abdominal and pelvis radiology scans confirmed hepatomegaly and uncovered enlarged paraaortic and internal iliac lymph nodes. Lymphadenopathy was also found in the hepatic hilum area. Colo- noscopy did not reveal any abnormalities. Because of abdominal and pelvic lymphadenopathy the patient was referred for a lymph node biopsy. Histopathological examination of the samples revealed Hodgkin lymphoma. Conclusions: Hodgkin lymphoma can have a lot of symptoms, but the most common is lymphadenopathy, which occurs in 95% of cases. Usually, there is painless lymphadenopathy in cervical and supraclavicular region, but isolated subdiaphragmatic lymphadenopathy is rare. That's why in those cases finding the ap- propriate diagnosis is long and difficult. 17 Budd-Chiari Syndrome Connected To Mutation Of Jak 2 - A Case Report Anna Skoczek Medical University of Warsaw, Radiology Department Background: Hepatic veins occlusion, also known as the Budd-Chiari syndrome is one of the causes of liver failure Two maior forms of the disease can be distinguished: a primary form with thrombosis of the hepatic veins and a secondary form, due to compression of the veins by adjacent structures. All forms can lead to serious hemodynamic consequences and severe liver damage from inten- se centrilobular congestion, with ischemia, pressure necrosis and loss of parenchymal cells in the center of the liver lobule. Hepatic vein thrombosis is most commonly associated with myeloprolife- rative syndromes, hypercoagulable states and cancer. Diagnose is confirmed by CT with angiography and ultrasonography. Treatment includes administration of anticoagulants, angioplasty of the occu- pied veins and liver transplantation. Case: A 31-year old woman was admitted to hospital because of Budd-Chiari syndrome with suspi- cion of essential thrombocythaemia (present mutation V617F of JAK- 2) and thrombosis of hepatic portal system. The patient presented ascites and peripheral edemas with signs of hepatic insufficiency. Angio-CT showed presence of fluid in both pleural cavities and pe- ricardial sac, advanced ascites, slightly enlarged liver with large 1st segment and uneven density, indicating perfusion abnormalities. The study showed occlusion of all hepatic veins, with exception of a small vein from the 1st segment, compression of vena cava sup. by the liver at the level of diaphragm and thrombosis of portal vein, v. mesenterica sup. and v. lienalis. Spleen and other organs of abdomi- nal cavity were unaltered. During hospitalization, through paracen- tesis 21 of fluid was obtained, the patient was also consulted by a hematologist. A gastroscopic banding of varices was performed. The edemas subsided through optimal diuretic treatment. Due to throm- bosis of portal vein system, which contraindicates hepatic trans- plantation, the patient was qualified for conservative treatment with anticoagulants. The patient was discharged from the hospital in good condition for further hematologic diagnostic. Conclusions: The Budd- Chiari syndrome caused by thrombocythaemia with JAK-2 mutation is a rare disease, often asymptomatic. In this case it was present with the whole classic clinical and imaging manifestation and also with coexisting thrombosis of portal vein's system, which makes this case unusual and interesting from didactic point of view. 18 Multiple Endocrine Neoplasia Type 1- Cancer Predisposition Syndrome Associated With Cerebral Palsy. A Case Report Radosław Pietrzak, Anna Pasierb Students Scientific Group Endocrinus, Department of Endo- crinology and Internal Medicine, Medical University of War- saw Background: Multiple endocrine neoplasia type 1 (MEN1) is a syn- drome of endocrine and non-endocrine tumors involving the pa- rathyroids, anterior pituitary and enteropancreatic neuroendocrine tissues, and is inherited in an autosomal dominant. Estimates of the prevalence of MEN1 is 1 per 30 000 in general population. Tumors can be benign or malignant and they can grow synchronous or metachro- INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC 567