Investor Presentaiton

IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC Abstracts Abstracts that Xanthogranulomatous osteomyelitis can present with variable densities such as osteolytic, sclerotic (as in our case) and mixed densities radiologically. Histopathological examination plays a vital role in diagnosis of Xanthogranulomatous osteomyelitis and hence helps in appropriate treatment plan of the case. 47 Valve-In-Valve Transcatheter Aortic Valve Implantation Via Common Carotid Artery Anna Wancerz, Mateusz Wondołkowski, Dominika Puchta, Wiktoria Ciechowska, Zenon Huczek, Janusz Kochman, Ro- muald Cichoń, Radosław Wilimski Students' Scientific Group by the Department of Cardiac Sur- gery at the 1st Department of Cardiology, Medical University of Warsaw Background: Transcatheter Aortic Valve Implantation (TAVI) is an al- ternative procedure to aortic valve replacement (AVR) in high-risk patients with severe aortic stenosis (AS). This innovative technique had primarily involved delivering the valve using the transfemoral approach however the alternative: direct aortic, trans-apical, sub- clavian and carotid approaches have emerged over time. Case: A 74-year-old female with prosthetic aortic valve stenosis (aortic valve area: 0.45 cm2, mean gradient: 37 mmHg) and many comorbidities such as thoraco-abdominal aneurysm, hypertension, chronic kidney disease and recently diagnosed early-stage operable colorectal can- cer was admitted to the Department of Cardiac Surgery at the 1st De- partment of Cardiology, Medical University of Warsaw due to severe functional status deterioration in the past 4 months with chest pain and dyspnea (from NYHA class I to III). The patient was previously treated for aortic stenosis with AVR combined with coronary artery bypass grafting (CABG) and reductive ascending aortoplasty. Due to the previously stated factors the Heart Team decided to perform a valve in valve TAVI procedure. Transcarotid access was chosen as the best alternative. Second prosthetic aortic valve Evolut R 23 mm, was carefully placed and deployed within the previously im- planted surgical prosthesis. Control angiography revealed good po- sitioning and no aortic regurgitation. The patient's brain function was monitored using cerebral oxymetry and transcranial Doppler ultrasonography. Clinical and radiological examination did not reveal any pathological changes in the central nervous system during and after the procedure. Other complications did not occur. The patient was discharged in the seventh post-operative day in good clinical condition. Conclusions: Considering known patient selection criteria: advanced age, generalized atherosclerotic disease, porcelain aorta, or previous cardiac surgery and the connection between etiology and risk factors it is wise to search alternative approaches for this patients cohort. Transcarotid approach offers straight delivery route and short distance from access site to annulus level, which results in excellent control during frame flaring with no need to reposition. Probability of cerebral ischemia requires rigorous monitoring of cere- bral perfusion. The chosen access enabled valve-in-valve placement improving valvular function and further surgical treatment of the patient's comorbidities. 48 Arm Graft Thrombosis After Endovascular Treatment of Pa- tient With Abdominal Aortic Aneurysm Marcin Kowalik, Agata Frączek, Magda Grodzieńska, Alek- sandra Grzelka, Anna Drelich-Zbroja, Małgorzata Szczerbo- Trojanowska Uniwersytet Medyczny w Lublinie Background: The implantation of stent grafts is an established te- chnique for the treatment of patients with abdominal aortic aneu- rysms. Unfortunately, this method entails the possibility of compli- cations. Complications after endovascular surgery can be divided into primary (up to 30 days after surgery) and secondary (over 30 days), due to the time elapsed since surgery. The most common complication of endovascular techniques is the so-called „endo- leak" to the aneurysm, which can lead to further expansion of the aneurysm, and consequently to its rupture. Other complications of endovascular treatment are narrowing of the arm of a stentgraft as a result of leg fracture caused by the meandering course of the iliac arteries, migration and thrombosis of the arm. Stentgraft arm thrombosis can lead to a dangerous narrowing of the prosthesis and, consequently, to the symptoms of chronic or acute ischemia of the lower limbs. An important role is played by periodic check- ups of patients after endovascular surgery, which serve the rapid detection of possible complications, both primary and secondary. "Golden standard" for monitoring patients after implantation of the stent graft is now computed tomography. Case: This paper discusses the case of a patient with abdominal aortic aneurysm, endovascu- lary treated using a stent graft, technically completed with success. Control angiography ending surgery, revealed normal patency of the graft and ruled out the presence of complications. The patient was then subjected to a routine check-up at 6 months after surgery. The patient control ultrasound after 6 months, detected left bundle graft thrombosis, which was confirmed by computed tomography. Con- clusions: Endovascular treatment of patients with abdominal aortic aneurysms is not without complications. One of them is thrombosis of the stent graft's arm. Ultrasound examination clearly allows the detection of such complications, without the need for Computerised tomography, which exposes the patient to radiation and nephrotoxic contrast agent administration. Accurate and systematic observation of patients after endovascular implantation of a stent graft allows immediate detection of complications. 49 Varicella -Zoster Virus Infection Of The Central Nervous Sys- tem In 28-Year-Old Man After Orthotopic Liver Transplanta- tion Due To Hbv Cirrhosis Marta Poręcka, Emil Bik, Radosław Pietrzak, Igor Ilasz Students Scientific Group, Department of General, Transplant and Liver Surgery, Medical University of Warsaw Background: Varicella, also known as "chicken pox", is a very com- mon and usually benign disease in the early stages of youth caused by varicella-zoster virus (VZV). Approximately 95% of the popula- tion becomes immune to chicken pox during their childhood due to vaccination or acquired immunity. Varicella is rare among adults, however, some factors may increase the risk of the disease,such as immunosuppression. The aim of this study is to describe the clini- cal presentation and outcome of patient suffering from meningitis and encephalitis caused by VZV reactivation after orthotopic liver transplantation (OLTX). Case: A 28-year-old man suffering from liver cirrhosis due to HBV was admitted to the Department for elective OLTX. After a 9-hour surgery patient was transported to Intensive Care Unit where he recovered full consciousness. First laboratory tests showed no abnormalities. Four days after OLTX patient started to complain about visual deficiency, which was followed by lost of consciousness and seizure. Meningeal signs did not occurred. After computed tomography of the head and neurological consultation, posterior reversible encephalopathy syndrome was diagnosed and the doctor recommended a modified scheme of immunosuppres- sion. Blood and cerebrospinal fluid (CSF) cultures did demonstrate neither bacterial nor fungal growth. Eight days after OLTX exploratory laparotomy with peritoneal lavage was performed due to suspicion of intraabdominal infection (leak of turbid fluid, high serum levels of proinflammatory agents: C-reactive protein 131,1 mg/L and pro- calcytonin 2,59 ng/ml). Unfortunately, patient's condition did not change. Two weeks after the transplantation magnetic resonance was taken and CSF was collected for viral testing. Polymerase chain reaction (PCR) was positive for VZV. This diagnosis finally allowed the application of antiviral therapy-3x 500 mg of Acyclovir. Patient in stable neurological state with a very good function of the transplant liver was transferred to Warsaw Hospital for Infectious Diseases for further treatment. Subsequently he was treated at neurological ward and intensively rehabilitated in order to make a full recovery. Con- clusions: Neuroinfections after solid organs transplanation are rather rare, however, any inexplicable conscious disturbances should arou- se suspicion of central nervous system infection and CSF in this particular group of patients shall be examined not only for bacteria and fungi, but also for viruses. 50 Gastrointestinal Bleeding In Patient With Suspicion of Neu- roendocrine Neoplasm In Ileum: A Case Report Magdalena Czerwińska Student Research of General Surgery and Transplantology "Kindley", Medical University of Warsaw Background: Neuroendocrine neoplasms (NENS) are rare and gene- rally slow-growing. They secrete various peptides and neuroami- nes. The annual incidence of NENS is approximately 40-50 cases per million. 70% of them are gastroenteropancreatic neuroendocri- ne tumors (GEP-NET), which usually investigated in small intestine. They account for 1%-2% of all gastrointestinal malignancies. The incidence of GEP-NET has increased, during the last 30 years. Its hor- monal activity may be associated with clinical symptoms, although the majority of NENS show no secretive activity in the early stage of the disease (85 %), resulting in delayed diagnosis. About 11% of cases of GEP-NET are recognized during surgical intervention per- formed because of obstruction or gastrointestinal bleeding. Case: 63 year-old female patient was admitted to the Department of General Surgery and Transplantology for right-sided hemicolectomy, becau- se of the diagnosis of polyp in distal part of ileum. Woman was in generally good health condition, without any specific symptoms. Physical examination showed soft abdomen, with no tenderness. Per rectum examination also resulted in no pathology. Patient history showed periodic lower gastrointestinal hemorrhage since 6 months, what triggered colonoscopy-submitted ileum polyp. There was no histopathological verification because of submucosal localization of the polyp. CT scan showed a focal change with diameter about 15mm, localized in the distal part of ileum about 4cm from Bauhin's valve. It was not extended beyond the external bowel outline. Adi- pose tissues in vicinity of the tumor was unchanged. In addition, round 12mm-in-diameter lesion was found above the Bauhin's valve, which was suspected of being metastasis to lymphatic node. Elective right-sided hemicolectomy was performed. Patient recovered well and was discharged on the seven postoperative day. Histopatho- logy report revealed well-differentiated neuroendocrine carcinoma of ileum, pT2N1. Patient was referred to oncological consultation to qualification for chemotherapy. Conclusions: Surgery, if feasible, is the only curative therapy of NENS. NENS are usually hormonally non- active, what results in non-symptomatic grown. Moreover, they are small-sized and dismissed in most radiological examination. There is a need to paying attention to the diagnostic possibility of NENS, to provide earlier diagnosis and more effective treatment. one of the reasons for BIH is stenosis of the brain venous sinuses. Contrast MR Venography of brain sinuses should be a part of the rou- tine BIH diagnosis. The present case is most likely the first in Poland in which transverse sinus stenting was effective. 52 Intracranial Pneumatocele Caused By Basal Cell Carcinoma Urszula Knych Department of Neurosurgery at Second Faculty of Medicine, Medical Uniwersity of Warsaw Background: Basal-cell carcinoma is a slow growing skin cancer that can infiltrate surrounding tissues. It is most commonly located in head and neck region and is usually excised before it can progress to cause serious damage. This case report presents a patient with se- verely neglected basal-cell carcinoma which infiltrated the cranium so deeply that it caused pneumatocele. Case: A 76 year old female patient was admitted to an emergency room after fall-induced head injury. The patient was conscious, confused but with good verbal contact, and dehydrated. There was an ulcerative, bleeding, suppu- rated, feculent lesion measuring 81 mm diameter on patient's left frontal area, which she claimed has been growing for more that 10 years. She denied having any other health problems and taking any medications. A CT brain scan showed a 30,4 mm width bone defect of the left frontal bone, and air collection, mostly surrounding the left frontal lobe. A smear was taken from the lesion and bacteriological culture have shown the growth of Proteus vulgaris. The patient was admitted to neurosurgical ward. Physical examination did not reveal any neurological deficits. After plastic surgeon's consult, the patient was qualified for surgery. During the surgery an external lesion was excised, but after extension of craniectomy caused by the bone des- truction, it turned out that the lesion was infiltrating the ceiling of the orbital cavity. This infiltration was not excised. The dura mater and the brain tissue were also infiltrated and therefore the excision was made to the margin of the visible lesion. The duroplasty was performed using a graft made from fascia late of the left thigh. The deficit of skin and bone was covered with rotated left temporal ar- tery pedunculated skin flap, and the deficit from this flap was cove- red with a skin graft from the left thigh. Intracranial smear showed infection with Morganella morganii, therefore therapy with cefotaxi- me was applied. The histopathology from the skin lesion revealed basal-cell carcinoma. Conclusions: Basal cell carcinoma of the head is rarely causing severe damage to the underlying tissues, but if ne- glected and growing for many years, it can cause intracranial lesions. Therefore it is crucial to order a CT scan before performing a surgery. 51 Gbenign Intracranial Hypertension Due To The Transverse Sinus Stenosis. Case Report Bartosz Sieradzki 53 Warsaw Medical University / Department of Neurosurgery Background: The aim of this study is to present a rare case of benign intracranial hypertension (BIH) caused by stenosis of the transver- se sinus. BIH is a neurological disorder that is characterized by an increased intracranial pressure in the absence of a tumor. The most important neurological symptom is papilloedema, which can lead to progressive optic nerve atrophy and blindness. Case: A 40-year-old overweight woman who had been treated with hormones because of menstrual disorders, has been admitted to Neurosurgery Department due to recurrent headaches for the past two years, and papilloedema detected on the ophthalmic examination. On admission, neurological examination was negative except for an exaggerated tendon reflexes on the left side and the presence of a Babinski sign. MRI revealed partially empty sella with no brain focal lesions. Veno-MR showed partial stenosis of the right transverse sinus, which has been confir- med by angiography. In the first stage of the treatment the patient underwent endovascular balloon angioplasty of the transverse sinus. Follow-upMR and ophthalmic examinationshowed persistent trans- verse sinus stenosis and papilloedema. Two month later, patient un- derwent stenting of the right transverse sinus by Leo + 5. 5 x35mm (stent), and further balloon sinuplasty by Eclipse 6x9mm without any complications. Four days after the second procedure, follow-up ophthalmic examination revealed partial papilloedema regression. Patient's headaches resolved and the improvement persists over a two-month follow-up. Conclusions: It should be remembered that Surgical Outcome Of A Primary Angle-Closure Glaucoma Treatment Case Report Katarzyna Wojewoda, Agnieszka Dłużniewska, Monika Pilec- ka Students' Scientific Association on the Ophthalmology De- partment of Medical University of Lublin Background: A primary angle-closure glaucoma (PACG) is a condition determined by the anatomy of the eye. Patients with an abnorma- lly narrow drainage angle are predisposed to develop symptoms of an acute angle-closure glaucoma (AACG). Another risk factors are: thinner ciliary bodies, thinner iris, thicker lens, especially situated anteriorly, shallower anterior chambers, smaller eyeballs and cor- nea, shorter axial length of the eyeball. Physiological, age-dependent thickening of lens results in further anterior chamber crowding. Di- latation of the iris causes pathological iris-lens apposition leading to a pupillary block. The aqueous flow is obstructed or blocked. The rising pressure in the posterior chamber pushes the iris forward that results in further narrowing and finally closure of the drainage angle and subsequent increase of the intraocular pressure (IOP). Case: In 2012 53-year-old woman was referred to an ophthalmologist due to a visual acuity (VA) decrease in the right eye (RE). Examination re- vealed VA RE = 0,25 C.C. + 1,75 DSph and VA in the left eye (LE) = 1,0 C.C. + 2,0 DSph. RE IOP was elevated 34 mmHg, LE IOP = 19 mmHg. The patient was given acetazolamid and ẞ-blocker. The gonioscopy revealed the iridocorneal angle in RE as grade 1, with a hooked angle, in LE - grade 2. The patient was diagnosed with RE PACG. RE $76 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 S77