Galinaitytė, Inesa

Kontrastinės medžiagos radiologijoje yra labai svarbios vaizdų diagnostiniam tikslumui. Jos naudojamos įvairiuose tyrimuose, tokiuose kaip kompiuterinė tomografija (KT), magnetinio rezonanso tomografija (MRT) ir ultragarsas (UG). Kontrastinės medžiagos, pvz., jodo junginiai KT tyrime ir gadolinio pagrindu pagaminti preparatai MRT tyrime, pagerina audinių ar organų vizualizaciją, keisdamos kontrastą tarp skirtingų struktūrų.

Introduction Adrenal tumors (AT) are commonly discovered incidentally on cross-sectional abdominal imaging performed for reasons unrelated to an adrenal mass (AM). AT affect around 4–10% of the general population, with the highest incidence occurring in the seventh decade of life1,2. In any patient with a newly discovered AM, determining whether it is malignant and whether it is hormonally active are equally important to guide optimal management3. All patients found to have an AT should undergo a detailed clinical, biochemical and radiological evaluation to select those requiring surgical management2. Modern image techniques play a central role in the diagnosis of AT. Unenhanced computed tomography (CT) attenuation is the preferred method for evaluating primary AT, as it helps differentiate between malignant and benign tumors4. CT radiographic characteristics of malignant AM include a tumor size > 4 cm, irregular margins, heterogeneous enhancement, and lesions exhibiting < 40% relative percentage washout (RPW) or < 60% absolute percentage washout (APW) of intravenous contrast5. AT can affect the synthesis of hormones produced by the adrenal glands (i.e. cortisol, aldosterone, and androgens) leading to hyperadrenalism from excess hormones or hypoadrenalism if non-functional6. In either case, the presence of an AT can significantly affect the levels of adrenal hormones, leading to various health symptoms. Aim To evaluate the distribution of different AT types, hormonal profiles, and radiological data of patients diagnosed with AT. Methods We retrospectively analyzed the medical documentation from database of the Hospital of LUHS KK of 80 patients (40 female, 40 male) who were diagnosed with AT in 2017-2018 using CT. Formal Bioethical Permit from regional legal body was obtained. Clinical and laboratory data, including hormone levels (DHEAS, testosterone, aldosterone, ACTH, cortisol, renin, metanephrine, normetanephrine), were recorded. CT features (tumor size, contrast enhancement) and hormone levels were analyzed, with statistical significance set at p<0.05 using "IBM SPSS Statistics 29.0." Results The most frequently occurring AT (42.5%) was adenoma, whereas aldosteronoma was the least common (3.8%). Analyzing the distribution of the AT types and blood hormone concentrations, it was found that the percent increase in metanephrine and noretanephrine was significantly higher in pheochromocytoma than in other tumors. There was a statistically significant difference in tumor sizes between adenomas and pheochromocytomas, with pheochromocytomas being notably larger. Additionally, pheochromocytomas showed significantly greater contrast enhancement compared to all other AT. Conclusions The most common AT type was adenoma. Pheochromocytomas showed significantly higher metanephrine and normetanephrine levels, larger tumor sizes, and greater contrast enhancement compared to other AT.

Aim: To evaluate the clinical, laboratory and radiological data of patients diagnosed with adrenal tumors. Methods: Analysis of medical histories of patients diagnosed with adrenal tumor in 2017-2018. 40 males and females with a mean age of 59.48 ± 12.45 and 63.83 ± 14.92, respectively. Results: 35% of the patients were overweight, and 41.3% - obese. Arterial blood pressure was elevated in 66 (82%) patients. The average heart rate in female patients was 77.48 ± 11.43 bpm, while in male – 78.53 ± 13 bpm. The most common: 1) complaint was high blood pressure (63,8%); 2) comorbidity - arterial hypertension (42,5%); 3) adrenal tumor - adenoma (42,5%); 4) tumor size - 3 cm (25%); and the least common adrenal tumor was aldosteronoma (3,8%). 37 tumors were enhanced according to the CT with a contrast enhancement. Males (30%) were more often diagnosed with bilateral tumors than females (5%). Finally, percental increase of metanephrine and noretanephrine was significantly higher in pheochromocytoma than in other tumors. Conclusions: 1) Differences between gender in BMI, blood pressure and heart rate were not significant. No significant differences were found between male and female complaint analysis. 2) The most common adrenal tumors were adenomas, and the changes in the hormone concentration of adenomas were not statistically significant. Pheochromocytomas were significantly larger than adenomas. Pheochromocytomas enhance statistically significantly more compared to other adrenal tumors. 3) In case of pheochromocytoma, the percentage of increase of metanephrine and normetanephrine is significantly higher than in other tumors.

Pagrindinis išeminio insulto diagnostikos metodas yra kompiuterinė tomografija (KT). Tobulėjant tyrimo meto­dams, vis dažniau praktikoje naudojamas magnetinio rezo­nanso tomografijos (MRT) tyrimas, kuris padeda nustatyti tikslesnį išemijos laiką ir parinkti tinkamiausią gydymo taktiką. Tyrimo tikslas − išanalizuoti ir apžvelgti įrodymais grįstoje mokslinėje literatūroje išeminio insulto diagnostiką MRT tyrimu.

Introduction: Intussusception is defined as an invagination of one part of the intestine into another section of the bowel. Case report: A 67-year-old woman presented to the ambulatory with pain in the lower right side of the abdomen and nausea lasting for 3 days. Past medical history revealed right ovariectomy because of a cyst. Physical examination revealed an abdominal tenderness in the lower right side of the abdomen. An abdominal ultrasound demonstrated a suspected small bowel intussusception into the cecum of about 2 cm. Radiographic bowel examination with a barium meal test was done, contrast material filled all large bowels. Colonoscopy has shown an edematous Bauhin's valve with small bruising, a biopsy was taken. Histopathological examination of the biopsy material has shown an active ulcerative colitis without tumorous changes. A computed tomography demonstrated small bowel intussusception into the cecumand a contrast filling defect 1.4 × 1.5 cm in the lumen of a terminal ileum. Lower laparotomy was performed. During the exploration there was no visible appendix in the right iliac fossa, but it was palpated in the cecum. In the terminal ileum, a soft subserosal tumor of about 2 cm in size was seen approximately 10 cm from the ileocecal junction. Ileocecal segment resection was performed. Histopathological postoperative examination has shown an intussusception of the appendix with chronic active ulcerative inflammation, hyperplastic/regenerative mucous membrane lesions, and low-grade intraepithelial neoplasia. Small bowel endometriosis was found.Conclusions: Intussusception of the appendix is a very rare condition with an incidence rate of 0.01% in a large surgical material study. It may clinically mimic acute/chronic abdominal diseases or can be asymptomatic. It is important to know about such a rare condition in order to avoid mistaking it with other abdominal diseases. However, diagnosis is rarely made preoperatively.

Introduction. Squamous cell carninoma of the sinonasal tract is relatively rare and morphologically and genetically heterogenous. Case report. A 65-year-old man complained of pain with pulsation in the right temple, insomnia, swelling of the right eye and cheek. Magnetic resonance imaging (MRI) revealed a tumor of the right maxillary sinus which spread to the retrobulbar space. A biopsy was taken during unilateral intranasal buccal antrostomy and showed poorly differentiated non-keratinizing squamous cell carcinoma (NK SCC) G3. After chemoradiotherapy, computed tomography (CT) revealed signs of tumor progression in the right buccal cavity, however a biopsy showed fibrosis without neoplastic changes. After 9 months, the patient complained of right cheek inflammation, rhinorrhea. Nasal endoscopy showed small remaining tumor tissue, predominantly in the maxilla. A biopsy revealed infiltrative SCC. MRI demonstrated progression of the oncological process. Biopsy taken from the walls of the buccal sinus and the palate, which showed infiltrative SCC. Right maxillectomy (type IIb according to Brown) was performed. A biopsy was taken from the hard palate indicating spread of SCC. Multidisciplinary team concluded to perform tumor excision with cytobiopsies. Palatoplasty with a temporal patch could be made only in the presence of a radical resection margin. Based on urgent histology, the scope of the operation was expanded to remove the tumour radically. 2 months after surgery the patient is in good condition and is able to eat, drink without sustenance entering the nose. Discussion. Transposition of the temporal muscle patch was performed through the formed channel under the zygomatic bone into the oral cavity. Plasty of the defect was performed by sewing the patch to its edges. Conclusions. We present a case of 65-year-old patient with SCC of the sinonasal tract. Treatment strategies consist of chemoradiotherapy, surgery or a combination of both.

Objective: To analyse symptoms of patients with adrenal tumors in one university center, and try to find any regularities, related to clinical data. The term ‘adrenal tumor’; describes benign and malignant mass of the adrenal gland. Materials and methods: This study includes 80 patients retrospectively with adrenal tumors at LUHS Kaunas Clinics Radiology Department. Statistical analysis was performed using SPSS 26.0. AIM: To elucidate the correlations between clinical signs and different adrenal tumors. Results: In this study involved 40 male (50%), 40 female (50%) patients with various types of adrenal tumors (aldosteronoma – 3,8%, pheochromocytoma – 21,3%, adenoma – 42,5%, others – 32,5%). The mean age of patients diagnosed with pheochromocytoma was statistically significantly lower compared to other types of adrenal tumors (52,5 years, p=0,01). Regardless of the type of adrenal tumor, 74 patients (92,5%) reported complaints and the most common were high BP (n=51, 63,8%), general weakness, fatigue (n=22, 27,5%). Patients diagnosed with aldosteroma (n=3) complained of increased arterial BP and 1 patient - heart rhythm disorder. Of those who diagnosed with pheochromocytoma (n=17) the most common symptoms were high BP (n=10, 58,8%), general weakness / fatigue / insomnia (n=9, 52,9%), headache / dizziness (n=7, 41,2%), abdominal pain (n=5, 29,4%). Patients diagnosed with adenoma (n=34), indicated high BP (n=23, 67,6%), general weakness / fatigue / insomnia (n=8, 23,5%), headache/ dizziness (n=7, 20,5%), abdominal pain (n=7, 20,5%), heart rhythm disorders (n=7, 20,5%). Other adrenal tumors (n=26) in patients manifested increased arterial BP (n=15, 57,7%), abdominal pain (n=6,23,1%), heart rhythm disorders (n=6, 23,1%), headache / dizziness (n=5, 19,2%), general weakness (n=5,19,2%). No significant difference was found between tumor type and symptoms p>0,05). It was found that other types of adrenal tumors occurred significantly more often in women than in men (p=0,02). Conclusions: Patients with an adrenal gland tumor may experience different clinical signs. No significant difference was found between tumor type and symptoms. However, it was found that other types of adrenal tumors occurred significantly more often in women than in men.

Background and objectives. A synthetic ACTH stimulation test is a gold standard to detect occult adrenal insufficiently. The advantages of the test are the ability to perform it at any time and well-known normal or pathological levels of cortisol during the test 30 or 60 minutes after the injection of synthetic ACTH. The aim. Of the work was to find out how often ACTH stimulation test was performed at the Kaunas Endocrinology Center in 2014-2017. Material and methods. Medical documentation of 1471 patients (764 - 52% - women, 707 - 48% - males) was performed for 3 main reasons: 1100 -for investigation of importance of DHEAS in males, 220 - for investigation of adrenal function in ENSAT study and 151 patients for the recent study of clinical expressions in the patients with adrenal tumors. Since cortisol is the most important vital hormone of the adrenal glands, we analyzed the conditions under which it was studied. Results. A suppression test of 1 mg of dexamethasone was usually performed. It was followed by small or high dose dexamethasone suppression tests. It was not possible to determine what time of day cortisol was tested. Of 1471 patients no patient could be found who underwent an ACTH stimulation test. [...].

Objective To analyse the radiological and clinical features of patients with adrenal tumours in one university center (Hospital of Lithuanian University of Health Sciences, Kauno klinikos) and to try to find any regularities, related to clinical data. Methods Medical documentation of 150 patients (53 women and 97 men), who had adrenal tumors diagnosed by CT or/and by MRI, were analysed. Essential clinical and laboratory (hormone assessment) data were documented. Age, height, weight, BMI, systolic and diastolic blood pressure, pulse were recorded together with results of investigation of DHEAS, testosterone, TTH, aldosterone, ACTH, fT4, cortisol, renin, metanefrine, normethanefrine, aldosterone/renin ratio. Results Age of women and men at the moment of AT diagnosis was the same (60,9 and 60,5 years respectively). No difference of systolic and diastolic blood pressure, pulse and BMI was detected between women and men. Concentration of aldosterone (around 70%), ACTH (around 40%), cortisol (around 70%), renin (around 60%), methanephrine and normethanephrine (around 65%) and aldosterone/renin ratio (around 25%) were investigated with the same frequency both in women and men. TTH, fT4 and DHEAS were assessed more frequently in female, than in male patients (48, 41 and 50% and 32, 28 and 40% respectively). Surprisingly, testosterone was assessed rarely both in women (7%) and men (8,25%). Without hormone investigations remained 5,5 % of women and 20,6% of men. Unilateral, as well as bilateral, adrenal tumours were detected with the same frequency (64,8% female vs 63,9% male, as well as 11,1% of female vs 16,5% of male patients). Minor visual changes of adrenals were detected with similar frequency in both genders (3,7% in females and 5,2% in males). Surgery was performed in 7,4% of female, and in 5,2% of male patients. In female patients all resections were unilateral, in male 3,1% of cases were unilateral. In case of bilateral AT, unilateral resection was performed more frequently in female, compared to male patients (5,6% vs 2,1%).ConclusionsTTH, fT4 and DHEAS were assessed more frequently in female, than in male patients. Surprisingly, testosterone was assessed rarely both sexes. Without hormone investigations remained 5,5 % of women and 20,6% of men. Unilateral, as well as bilateral, adrenal tumours were detected with the same frequency (female vs male patients). Minor visual changes of adrenals were detected with similar frequency in both genders, as well. In case of bilateral AT, unilateral resection was performed more frequently in female, compared to male patientsB rief description of the abstractAdrenal tumors are common a finding. Modern image techniques occupie a central place in the diagnosis of adrenal tumors. After diagnosis of an adrenal tumor, a multidisciplinary team clarifies the diagnosis and prescribes treatment for the patients. This is usually performed in tertiary hospital (university clinic in our case). We attempted to analyse retrospectively, how this system works in real life, and tried to find any regularities, related to clinical data and radiological findings.

Objective: To analyse the radiological and clinical features of patients with adrenal tumors in one university center, and to tr y to find any regularities, related to clinical data. Methods: Medical documentation of 53 women and 97 men, who had adrenal tumors diagnosed by CT or/and by MRI, were analysed. Essential clinical and laboratory data were documented. Age, height, weight, B MI, systolic and diastolic blood pressure, pulse were recorded together with results of investigation of DHEAS, testosterone, TTH, aldosterone, ACTH, fT4, cortisol, renin, metanefrine, normethanefrine, aldosterone/renin ratio. Results: Age of women and men at the time of AT diagnosis was the same. Concentration of aldosterone, ACTH, cortisol, renin, methanephrine and normethanephrine and aldosterone/renin ratio were investigated with the same frequency in both sexes. TTH, fT4 and DHEAS were assessed more fr equently in female, than in male patients (48, 41 and 50% and 32, 28 and 40% respectively). Surprisingly, testosterone was assessed rarely both in women and men. Without hormone investigations remained 5,5 % of women and 20,6% of men. Unilateral, as well a s bilateral, adrenal tumours were detected with the same frequency in both sexes. Surgery was performed in 7,4% of female, and in 5,2% of male patients. Conclusions: TTH, fT4 and DHEAS were assessed more frequently in female patients. Surprisingly, testos terone was assessed rarely in both sexes. Unilateral, as well as bilateral, adrenal tumours were detected with the same frequency (female vs male patients). In case of bilateral AT, unilateral resection was performed more frequently in female patients.