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Background: Acute peripheral arterial ischemia is a rapidly developing loss of perfusion, resulting in ischemic clinical manifestations. This study aimed to assess the incidence of cardiovascular mortality in patients with acute peripheral arterial ischemia and either atrial fibrillation (AF) or sinus rhythm (SR). Methods: This observational study involved patients with acute peripheral ischemia treated surgically. Patients were followed-up to assess cardiovascular mortality and its predictors. Results: The study group included 200 patients with acute peripheral arterial ischemia and either AF (n = 67) or SR (n = 133). No cardiovascular mortality differences between the AF and SR groups were observed. AF patients who died of cardiovascular causes had a higher prevalence of peripheral arterial disease (58.3% vs. 31.6%, p = 0.048) and hypercholesterolemia (31.2% vs. 5.3%, p = 0.028) than those who did not die of such causes. Patients with SR who died of cardiovascular causes more frequently had a GFR

Due to a great number of endovascular interventions, conducted over the last decades, a huge percentage of obese patients and administration of double antiplatelet therapy, manual compression (MC) is more and more frequently replaced by a vascular closure device of which the most common is Angio-Seal. The study presents a case of a 63-year old female patient with recurrent hemorrhages of the common femoral artery (CFA), originally closed after an endovascular intervention of a popliteal artery aneurysm with the use of Angio-Seal VIP. After around 3 weeks following the original surgery, the patient at first developed a pseudoaneurysm and then septic inflammation of the femoral artery, manifested with recurrent hemorrhages from the groin. The patient was operated on many times and an implantation of an ilio-femoral bypass from the femoral vein turned out to be an effective solution. Staphylococcus epidermidis MRSA was cultured in the femoral artery wall and a histopathological examination confirmed infectious arteritis. The presented case of a rare septic complication after the application of a closure device shows that it is essential to carefully monitor surgical approach areas in patients who are quickly discharged from hospital after surgical interventions, to select treatment methods tailored for individual patients as well as implement particular surgical management.

Introduction: In recent years, ultrasonography has been used in an increasing number of fields, such as dermatology, aesthetic medicine and cosmetology. For skin imaging, research has shown the usefulness of both classic scanners equipped with linear transducers, and high-frequency scanners with mechanical transducers. An increasing number of reports indicating high usefulness of Doppler sonography have been published recently. The aim of this study was to assess the usefulness of high-frequency Doppler imaging in the diagnosis of vascular complications after aesthetic procedures using tissue fillers. Materials and methods: A total of 12 women aged 19–48 years (mean age 36.08 years) who had undergone hyaluronic acid treatment were included in the study group. Ultrasound scans were performed using standard ultrasound scanners, i.e. Philips Epiq 5 with a linear transducer and Samsung RS85 with linear transducers and Doppler Microflow Imaging option. Ultrasound scans were performed to assess the presence of blood flow using Color Power Doppler (CPA). Pulsed- Wave Doppler was used only for arteries. If no blood flow was recorded with Color Power Doppler, Microflow Imaging was used. Results: Doppler ultrasound showed normal blood flow despite reported symptoms in 3 cases. Vascular stenosis was found in 2 patients. In the other 7 patients, Doppler ultrasound showed no blood flow at the sites where complications developed. Conclusions: Skin ultrasound with Doppler options is a useful tool in the diagnosis of aesthetic medicine complications.

Introduction: Lipodermatosclerosis is a symptom of severe venous insufficiency, the diagnosis of which is based on the clinical picture. Although the histopathology of the skin and the subcutaneous tissue allows for the most reliable diagnosis, it is not recommended due to healing disorders. Aim: The aim of this study was to assess the usefulness of high-frequency ultrasound in the diagnosis of lipodermatosclerosis. Materials and methods: The study included 10 patients with lipodermatosclerosis who underwent Duplex Doppler ultrasound of lower limb veins, high-frequency ultrasound of the tibial skin, and radiography of the lower leg, all of which were analyzed in correlation with clinical symptoms. Results: The study group included 9 women and 1 man aged 39–81 years. Manifestations of lipodermatosclerosis were detected in 14 limbs. High-frequency ultrasound showed that the mean dermis thickness at the affected sites was 2.63 mm, and was significantly thicker compared to healthy skin (1.45 mm) (p = 0.00002). Higher echogenicity was detected in the affected body regions in 85.7% of cases for the skin and 92.9% of cases for the subcutaneous tissue. Subcutaneous and vascular wall calcifications were detected in 92.9% and 78.6% of cases, respectively. Fibrosis was observed in all limbs, and compression sonoelastography showed that the compliance of the subcutaneous tissue was lower than that of muscles. The border between the skin and the subcutaneous tissue was blurred in 57.1% of cases. Radiography revealed thickening of the affected skin regions in all limbs, with calcifications detected in 85.7% of cases. A blurred border between the skin and the subcutaneous tissue was observed in 35.7% of limbs. Conclusion: High-frequency ultrasonography of the skin and the subcutaneous tissue in the lower legs supported with radiological findings is highly useful in the diagnosis of lipodermatosclerosis.

Retained neuroprotection filter after carotid stenting (CAS) is an extremely rare complication. We report the case of a 61-year old patient with an accidentally retained neuroprotection filter after urgent CAS. The patient did not consent to open surgical removal of the retained basket. We did not observe any flow disturbances in the filter and the patient remains asymptomatic in ten years follow-up. In some cases, the neuroprotection filter left in the internal carotid artery may not cause cerebral flow disturbances or occlusion of the stent. In case of the poor neurological or general condition of the patient, we can wait for its improvement or stenting.

Carotid endarterectomy (CEA) is safe and effective in reducing the risk of stroke in symptomatic severe carotid artery stenosis. Having information about cross-clamping (CC) intolerance before surgery may reduce the complication rate. The purpose of this study was to assess the usefulness of magnetic resonance angiography (MRA) and magnetic resonance angiography perfusion (P-MR) in determining the risk of CC intolerance during CEA. Material and methods: 40 patients after CEA with CC intolerance were included in Group I, and 15 with CC tolerance in Group II. All patients underwent MRA of the circle of Willis (CoW), P-MR with or without Acetazolamide, P(A)-MR in the postoperative period. Results: CoW was normal in the MRA in three cases (7.5%) in Group I, and in eight (53%) in Group II. We found P-MR abnormalities in all patients from Group I and in 40% from Group II. Using a calculated cut-off point of 0.322, the patients were classified as CC tolerant with 100% sensitivity or as CC intolerant with 95% specificity. After evaluating P-MR or MRA alone, the percentage of false negative results significantly increased. Conclusion: The highest value in predicting cross-clamping intolerance is achieved by using analysis of P(A)-MR and MRA of the CoW in combination.

Introduction: Many women consider local fat deposits unacceptable for aesthetic reasons as they have negative impact on appearance and thus, contribute to reduced self-esteem. Injection lipolysis (intralipotherapy) may be an alternative for conventional liposuction in reducing fat deposits. Aim: The aim of this paper was to assess the efficacy of high-frequency ultrasound-guided injection of deoxycholic acid (intralipotherapy) to remove fat deposits on the inner side of knees. Materials and methods: The procedure was performed in 7 women (14 inner sides of knees). The formulation was administered under high-frequency ultrasound guidance. The procedure was performed twice at 4-week intervals in each patient. Highfrequency ultrasound guidance was used to monitor such parameters as the thickness of the dermis (DermaMed, Dramiński S.A.) or the subcutaneous tissue (Philips Epiq 5, USA). Ultrasound was performed both before and after treatment. Additionally, anthropometric measurements were taken, a questionnaire was performed, and a photographic documentation was recorded. Results: Reduction in knee circumference and subcutaneous tissue occurred in 71.42% of patients. Conclusions: Intralipolysis with deoxycholic acid formulation is an effective method for reducing fat deposits on the inner part of the knees. Ultrasonography proved to be a useful method to monitor the procedure (correct administration of the preparation) and to assess treatment outcomes. A small sample size was a limitation of our study; therefore further studies are needed.

Introduction: As the average lifespan becomes longer, the number of cases of chronic shin ulcers is rising, which is slowly becoming a societal problem. Currently, there no methods for objective evaluation of ulcer healing process. Aim of the study: The aim of the study was to assess the use of high-frequency ultrasound to monitor the healing of shin ulcers subjected to laser biostimulation. Material and methods: The study included 8 patients (4 men and 4 women) aged from 46 to 81 years with 9 shin ulcers in whom the healing process did not progress within 8 weeks despite effective causal treatment. The ulcers were subjected to laser biostimulation. The induced changes were monitored using high-frequency ultrasound and photographic records. Ultrasound examination was used to assess the depth of ulceration and the thickness of granulation tissue, migrating epidermis, subepidermal low-echogenic band (SLEB) and epidermis in the immediate vicinity. The wound severity index and ulcer vascularity were also assessed. Results: As a result of laser therapy, in 7 out of 9 cases the ulcers healed completely and in the remaining 2 cases ulcer size was reduced. During the ulcer healing process induced by laser therapy, ultrasound examination revealed decreasing ulcer depth, wound severity index and SLEB thickness. Granulation tissue increased in thickness and there was an epidermal formation effect (newly formed epidermis was much thicker than the one surrounding the wound and became thicker as a result of laser therapy sessions). During the healing of ulcers induced by laser therapy no significant changes were observed in ulcer vascularity and thickness of the surrounding epidermis. Conclusions: High-frequency ultrasound is a useful technique for the imaging of leg ulcers. It allows one to monitor their healing process induced by laser biostimulation. Further research on the subject needs to be pursued.

BACKGROUND Renal insufficiency and allergy to iodine contrast are relative contraindications to carotid artery stenting (CAS). The primary aim of this pilot study was to evaluate the feasibility and safety of the CAS assisted by 3D fusion of previously performed computed tomography (CTA) and magnetic resonance angiography (MRA) images and DynaCT, the secondary aim was to determine if 3D fusion decreases radiation exposure and the amount of contrast needed during the procedure. METHODS Retrospective review of patients who underwent CAS between October 1st, 2012 and November 30th, 2014 was performed. CTA-assisted fusion was used in group A (CAS/CTA), MRA-assisted fusion in group B (CAS/MRA) and group C (control group) underwent CAS without fusion. No patient in the study had renal dysfunction, risk factors of contrast-induced nephropathy or insulin-dependent diabetes. Primary outcome was perioperative stroke or death, secondary outcome included technical success, radiation dose, exposure time and volume of contrast used. Statistical analysis was performed with Student's t-test, using the permutation methods. Level of significance was set at P

The study investigated whether the application of dressings with autologous platelet-rich plasma (PRP) would reduce the healing time in patients with chronic venous leg ulcers. This is a prospective observational study that included 100 patients diagnosed with lower extremity venous insufficiency complicated by ulceration of a leg or foot, who had been after angioplasty of stenotic artery. Patients were divided into two groups of 50 each: treated with PRP (study group) and treated with conventional hydrocolloid dressings (control group). We followed the wound changes at Day 10, Day 20, and Day 30 of treatment and compared them with the baseline appearance at Day 0. We evaluated the appearance, area, and depths of wounds with ultrasound. The granulation process was examined histologically to document skin formation and wound tissue neovascularization. The findings were that treatment with PRP dressings resulted in a significant progressive reduction in ulcer size, irrespective of the ulcer's initial size, compared to treatment with conventional dressings. Further, the best effect of PRP was noticed in the category of largest wounds. After a month of treatment with PRP dressings, more than 50% of all ulcers were completely healed. The young epidermis appeared together with the granulation tissue, and the formation of dermis took shape after 20 days of treatment. We conclude that the use of PRP dressings is a safe, nonsurgical adjunctive procedure for treating chronic venous leg ulcers. The potential benefit of PRP dressings over conventional ulcer treatment requires further in-depth exploration.

Introduction: Thermal ablation techniques have gradually replaced Babcock procedure in varicose vein treatment. Aim: A comparative quantitative–qualitative analysis of complications and failure of endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in a 5-year follow-up. Materials and Methods: One hundred ten adult participants with varicose veins clinical grade C2 to C6, treated for isolated great saphenous vein (GSV) or small saphenous vein (SSV) insufficiency in a single lower extremity in 2009 to 2010, were enrolled and subdivided into EVLA (n = 56) and RFA (n = 54) groups. Both groups were compared for demography, disease stage, affected veins, perioperative, and postoperative complications as well as treatment efficacy. Results: The perioperative and postoperative complications were statistically insignificant. Treatment efficacy, expressed as the number of participants with recurrent varicosity and recanalization, was comparable in both groups. The clinically significant recanalization rate was 3.6% and 5.6% in EVLA and RFA groups, respectively. Conclusion: Endovenous laser ablation and RFA for the management of lower extremity varicose vein offer comparable efficacy and safety in a 5-year follow-up.

The study investigated whether the application of dressings with autologous platelet-rich plasma (PRP) would reduce the healing time in patients with chronic venous leg ulcers. This is a prospective observational study that included 100 patients diagnosed with lower extremity venous insufficiency complicated by ulceration of a leg or foot, who had been after angioplasty of stenotic artery. Patients were divided into two groups of 50 each: treated with PRP (study group) and treated with conventional hydrocolloid dressings (control group). We followed the wound changes at Day 10, Day 20, and Day 30 of treatment and compared them with the baseline appearance at Day 0. We evaluated the appearance, area, and depths of wounds with ultrasound. The granulation process was examined histologically to document skin formation and wound tissue neovascularization. The findings were that treatment with PRP dressings resulted in a significant progressive reduction in ulcer size, irrespective of the ulcer’s initial size, compared to treatment with conventional dressings. Further, the best effect of PRP was noticed in the category of largest wounds. After a month of treatment with PRP dressings, more than 50% of all ulcers were completely healed. The young epidermis appeared together with the granulation tissue, and the formation of dermis took shape after 20 days of treatment. We conclude that the use of PRP dressings is a safe, nonsurgical adjunctive procedure for treating chronic venous leg ulcers. The potential benefit of PRP dressings over conventional ulcer treatment requires further in-depth exploration.

Background To compare efficacy and safety of segmental and monopolar radiofrequency ablation in the management of lower extremity varicose veins. Methods A total of 193 patients were treated with segmental RF ablation (Venefit; N.=97) or monopolar RF ablation (EVRF; N.=96) for lower extremity varicose veins from 2010 to 2012. A single extremity of each patient with isolated GSV or SSV insufficiency was enrolled. The differences between the two groups in demographic parameters, disease severity, treated veins, peri- and postoperative complications, and treatment efficacy indicators (VCSS) were evaluated. Results Based on Kaplan-Meier's analysis, the occlusion rate after 5 years was 87.6% in Venefit group and 87.8% in EVFR group (P>0.05). Varicose vein recurrence rates were 10.3% and 12.9% in the Venefit and EVFR groups, respectively (P>0.05). The VCSS reduction was comparable between the two groups (P Conclusions Venefit and EVRF systems can be considered equivalent in terms of efficacy and safety in the management of lower extremity varicose veins.

Background Lipomas are very common benign neoplasms, which constitute 99% of all adipose-derived tumors. Main treatment option includes surgical excision, which is unacceptable for a number of patients seeking ways to improve esthetic appearance of their skin. Therefore, alternative treatment options are being sought. Objective The aim of the present study was to assess the efficacy of lipoma removal using a Class III CE-marked device (Aqualyx™) administered as a high-frequency ultrasound-guided injection (intralipotherapy). Methods A total of 17 lipomas were treated. The procedure involved a high-frequency ultrasound-guided injection. A maximum of 3 injections per a lipoma were performed. High-frequency ultrasound was used for assessing the size of lipomas and monitoring treatment-induced changes to the lipomas and adjacent tissue. Results Response to treatment was achieved in all cases. A complete removal was achieved in 70.59% of lipomas. The remaining 29.41% of lipomas were not completely removed, yet significantly reduced in size. Conclusion An injection of Aqualyx™, a CE-marked drug, is a good noninvasive treatment of lipomas. Ultrasound guided procedure is recommended, as it ensures appropriate technique and enables monitoring treatment-induced changes. Considering a low number of published reports of such treatment, it is crucial to continue this research.

Microbial colonisation of chronic venous ulcers and synergism between bacterial species slow down the healing process. The study aimed at performing qualitative analysis of microbial flora in venous leg ulcers treated with platelet rich plasma (PRP). Twenty two women and twelve men aged 47–90 years were treated with PRP at our department between 2012 and 2015. Ulcer cultures collected before and after PRP therapy yielded 83 and 110 microbial isolates, respectively, of Gram positive, Gram negative bacteria and candida. Pseudomonas aueruginosa and Staphylococcus aureus were the most common pre- and post-treatment isolates. PRP therapy and increased the variety of microbial flora.

Objectives: The aim of this study was to evaluate the feasibility, safety and early results of mechanochemical ablation of incompetent varicose veins using a special catheter: the Phlebogriffe. Material and methods: The design of this catheter is based on a typical diagnostic catheter. Into this catheter a metal shank, attached to which are 5 thin, curved, springy wires with sharpened ends, is introduced. After being pushed out of the catheter, these wires deploy into a cat’s claw pattern. When the whole device – the catheter and shank with open claws – is being pulled out, sclerosing foam is administered. In this pilot study, which was performed in the years 2011-2013, we evaluated 40 patients with varicose veins. Efficacy of the procedure, defined as closure of the treated vein, and clinical result evaluated using the Venous Clinical Severity Score (VCSS) were assessed after 1, 3, 6 and 12 months. Results: Efficacy of the procedure after 1, 3, 6 and 12 months was 97.4%, 94.9%, 89.7% and 89.7%, respectively. Statistical analysis of the VCSS before the procedure and after 12 months revealed statistically significant improvements regarding pain, presence of varicose veins, oedema, number and size of active ulcers, their duration, size of active ulcers and the use of compression therapy. The average improvement in VCSS scores was 3.56 points. Conclusions: The Phlebogriffe is a device that offers new opportunities for safe and efficient treatment of varicose veins associated with incompetence of saphenous veins.

Introduction: For the last 10 years, endovenous thermal ablation methods have gradually predominated over the classic Babcock procedure in varicose vein treatment. Steam vein sclerosis is the newest thermal ablation technique. Aim: To assess the efficacy and safety of steam vein sclerosis as compared to the Babcock procedure in lower extrem- ity varicose vein treatment. Material and methods: One hundred and two adult subjects with varicose veins of clinical grade C2 to C6 according to the CEAP classification, treated with varicose vein surgery between 2010 and 2012, were enrolled in the study. These were subdivided into two groups: the study group of 52 patients treated with endovenous steam vein sclerosis and the control group of 50 patients treated with the Babcock procedure. A single lower extremity with isolated great or small saphenous vein insufficiency was operated on in each subject. The groups were compared for demography, disease severity, involved veins, potential perioperative and postoperative complications, as well as treatment effica- cy based on the VCSS score reduction. Results: There were no statistically significant differences between the groups in terms of demography, disease severity, involved veins, or perioperative and postoperative complications. The treatment efficacy of both methods, assessed based on the recurrence rate and the quantitative VCSS score reduction, was similar. Clinically significant recanalisation was observed in 1 (1.9%) patient in the study group. Conclusions: The efficacy and safety analysis shows that steam vein sclerosis is a safe, simple method which can be recommended as effective varicose vein treatment.

The genuine destruction of a synthetic prosthesis wall, as a late complication of vascular surgery, is extremely rare. We report a case of a 64-year-old male who had his 12-year-old femoropopliteal synthetic graft explanted due to two large pseudoaneurysms in the middle section of the graft. Microscopic evaluation demonstrated the areas of focal thinning along the entire prosthesis wall, with “foreign body” type reaction in the adjacent connective tissue. Transmission electron microscopy showed longitudinal fractures of Dacron fibers interposed with cellular structures, suggesting that destruction must have taken place significantly earlier. The problems of limited graft durability and graft surveillance are discussed.

A 50-year-old woman was admitted to the Gastroenterology Department for macrocytic anaemia. The patient had attacks of strong abdominal pain. On ultrasonography an approximately 15 cm long intestinal loop with loss of haustrations was visualised medially to the ascending colon. An abdominal X-ray was obtained and visualised oval opacifications with calcium saturated halos within the small pelvis. These opacifications were located within the lumen of the small bowel. The X-ray demonstrated the presence of isolated fluid levels within the small bowel. A colonoscopic examination was performed, where the image of the ascending colon and caecum mucosa suggested Crohn’s disease. Gastroscopy revealed two healing ulcers within the duodenal ampulla, with signs of unspecific inflammations on the histopathological examination of the biopsy specimens. During the hospitalisation severe pain and features of gastrointestinal subobstruction occurred. The surgery revealed two intestinal loops adhering side to side 30 cm from the caecum. Their close adherence caused intestinal obstruction. Numerous stones were palpable. Segmental resection of the ileum along with the intestinal conglomerate was performed. Continuity of the gastrointestinal tract was recreated by stapling the intestinal endings side to side. A developing fistula was found between intestinal loops. Histopathological examination revealed changes characteristic of Crohn’s disease. Streszczenie Kobieta 50-letnia zostala przyjeta do Kliniki Gastroenterologii z powodu niedokrwistości. Pacjentka od lat cierpiala na nawracające silne ataki bolow brzucha. W badaniu ultrasonograficznym jamy brzusznej przyśrodkowo od wstepnicy uwidoczniono petle jelita o pogrubialych ścianach o dlugości okolo 15 cm. Wykonano badanie rentgenograficzne przeglądowe jamy brzu sznej, w ktorym w obrebie miednicy malej stwierdzono owalne zacienienia z otoczkami o wysyceniu wapniowym. Lokalizowaly sie one w świetle jelita cienkiego. W badaniu wykazano takze obecnośc pojedynczych poziomow plynu w obrebie jelita cienkiego. Wykonano badanie kolonoskopowe, w ktorym obraz śluzowki wstepnicy i kątnicy nasuwal podejrzenia choroby Leśniowskiego-Crohna. W gastroskopii uwidoczniono dwa owrzodzenia w opuszce dwunastnicy. W czasie hospitalizacji pojawily sie silne bole brzucha oraz wymioty i cechy podniedrozności przewodu pokarmowego. W trakcie operacji stwierdzono dwie petle jelita cienkiego zrośniete bok do boku w odleglości 30 cm od kątnicy. Ich ścisle polączenie powodowalo niedroznośc. Powyzej konglomeratu wyczuwalne byly liczne kamienie. Wykonano odcinkową resekcje jelita kretego wraz z konglomeratem jelitowym. Ciąglośc przewodu pokarmowego odtworzono, zespalając konce jelita bok do boku staplerowo. Miedzy petlami jelitowymi stwierdzono tworzącą sie przetoke. W badaniu histopatologicznym usunietego fragmentu jelita cienkiego uwidoczniono charakterystyczne zmiany dla choroby Leśniowskiego-Crohna.

Background: Unlike other solid tumors (i.e. pancreas, gallbladder, stomach), an ovarian cancer is responsive to a systemic treatment with platinum derivates in 80% of patients. This apparent chemosensitivity justifies a broader surgical approach. A cytoreductive, ”tumor-debulking” surgery is defined as an attempt to remove in a maximum degree all visible and detect­able lesions. Despite treatment, the advancement of the disease very often leads to complications defined as “surgical” and life-threatening. Objectives: The aim was to evaluate the efficacy and safety of palliative surgery in advanced ovarian cancer implicating acute surgical diseases of the abdominal cavity. Material and methods: Between years 2005 and 2014 were operated 118 patients with an advanced ovarian cancer (FIGO III-IV) implicating acute and directly life-threatening diseases of the abdominal cavity, involving 132 surgical operations. The causes of these operations were: obstruction of the gastrointestinal tract — 91 patients; perforation of the gastrointestinal tract — 15; gastrointestinal bleeding — 9; intussusceptions — 3. Results: Retrospective data for the 118 patients were analyzed. Safety and the perioperative mortality rate were assessed. Serious postoperative complications were recorded in 31 patients (anastomotic stoma — 9; bleeding requiring repeated surgery —3; recurring gastrointestinal obstruction — 16; liver failure after partial hepatic resection — 3). Systemic compli­cations in the form of respiratory failure and cardiovascular disorders requiring cardiological treatment — 21. All patients required clinical nutrition, both parenteral and enteral. Deaths recorded — 3. 39 patients were rehospitalized within 30 days of surgery. 7 deaths were recorded in this group. Conclusions: Combining lifesaving surgery with cytoreduction allows further adjuvant treatment. Early rehospitalization occurring within less than 30 days is linked to increased mortality.

Background Sclerotherapy is a widely used method for the obliteration of blood vessels. Hyperpigmentation is a frequent complication that results from haemosiderin (FeO) accumulation. Hyperpigmentation and changes in the skin can be observed with ultrasound. Objective The aim of this study was to evaluate the efficacy of hyperpigmentation elimination using an intense pulse light generator (IPL) equipped with radio waves (RF) under ultrasonography (US) control. Methods Twenty-one women with permanent hyperpigmentation (after sclerotherapy or crossectomy combined with sclerotherapy) underwent a hyperpigmentation eliminating therapy with the use of IPL + RF and were monitored by using US. The thicknesses of the dermis and the subcutaneous tissue as well as the echogenicities of each layer were assessed. Results As a result of the therapy, a complete regression of hyperpigmentation was achieved in 90.48% of the women, and in 9.52% of the women, the therapy led to a reduction in hyperpigmentation but did not cause its complete disappearance. An increase in dermal echogenicity and a decrease in subcutaneous tissue echogenicity were observed, but there was no change in their thicknesses. After the therapy, the ultrasound images of areas of previous hyperpigmentation corresponded with images that were characteristic of healthy skin. Conclusion IPL + RF therapy is effective for eliminating permanent skin hyperpigmentation after sclerotherapy. US is also useful in this therapeutic method.

Background Cellulite affects nearly 85% of the female population. Given the size of the phenomenon, we are continuously looking for effective ways to reduce cellulite. Reliable monitoring of anticellulite treatment remains a problem. Objective The main aim of the study was to evaluate the effectiveness of anticellulite treatment carried out using radiofrequency (RF), which was monitored by classical and high-frequency ultrasound. Methods Twenty-eight women underwent anticellulite treatment using RF, 17 women were in the placebo group. The therapy was monitored by classical and high-frequency ultrasound. The examinations evaluated the thickness of the epidermal echo, dermis thickness, dermis echogenicity, the length of the subcutaneous tissue bands growing into the dermis, the presence or absence of oedema, the thickness of subcutaneous tissue as well as thigh circumference and the stage of cellulite (according to the Nurnberger–Muller scale). Results Cellulite was reduced in 89.286% of the women who underwent RF treatment. After the therapy, the following observations were made: a decrease in the thickness of the dermis and subcutaneous tissue, an increase in echogenicity reflecting on the increase in the number of collagen fibres, decreased subcutaneous tissue growing into bands in the dermis, and the reduction of oedema. In the placebo group, no statistically significant changes of the above parameters were observed. Conclusion Radiofrequency enables cellulite reduction. A crucial aspect is proper monitoring of the progress of such therapy, which ultrasound allows.

A rare case of a 56-year-old man with posttraumatic false aneurysm of the right subclavian artery is presented. He was admitted to hospital due to pain in the shoulder. The diagnosis was made upon ultrasonography and computed tomography (CT) results. With ultrasound guidance, the aneurysm was punctured and injected with bovine thrombin (Biotrombina 400u, Biomed). During the injection, the aneurysm neck was occluded by an endovascular balloon placed in the subclavian artery. Complete aneurysm embolisation was confirmed by ultrasound and CT studies. The postoperative course was complicated by Horner's syndrome which resolved completely within 3 weeks. The procedure technique is described in detail.

The anlage of the subarachnoid space is seen in embryos at stage 14 (33 days) in the innermost zone of the primary meninx as irregular spaces on the ventral surface of the spinal cord. At first this space is only on the ventral surface of the spinal cord. From stage 18 (44 days) on, when the dura mater proper is formed, the reticular tissue of the primary meninx and spaces are around the circumference of the spinal cord. These spaces gradually coalesce and contain many blood vessels.

The study was conducted on 15 embryos aged 5 weeks. The primordium of Meckel's cartilage appears at stage 13 (32 days) as a rounded structure composed of fusiform and polygonal cells, which blend with other cells of the mandibular process. At stages 14 and 15 (33 and 36 days) Meckel's cartilage forms a well delineated core of small densely packed cells.

A study was made of human embryos at the end of 8 weeks and foetuses aged 9 weeks. It was shown that at the beginning of the foetal period the cortical plate, which is the primordium of the neocortex, covers the whole surface of the cerebral hemisphere. The plate consists of 8-12 rows of densely packed cells. Below the cortical plate is the subplate.

The epidural space is seen in embryos at stage 17 (41 days) on the periphery of the primary meninx. During stage 18 (44 days) the dura mater proper appears and the epidural space is located between this meninx and the perichondrium and contains blood vessels. During the last week of the embryonic period (stages 20-23) the epidural space is evident around the circumference of the spinal cord. On the posterior surface it is found between the dura mater and the mesoderm of the dorsal body wall.

In foetuses of 9 and 10 weeks the articular disc presents a more cellular structure with bands of connective tissue fibres. It is connected with the articular capsule and lateral pterygoid muscle. During weeks 11 and 12 there is an increase in collagenous fibres and fusiform cells are located mainly close to the surface of the disc.

It was found that the ductus arteriosus is a muscular channel and resembles the muscular artery in structure. The diameter of the ductus is equal throughout its length. At the orifice of the ductus to the aorta the cells of its wall blend with those of the aorta. The primordia of the tunica media of the aorta and the pulmonary trunk consist of regularly arranged, circular layers which are more evident than the layers forming the wall of the dutcus arteriosus.

The aim of the study is to describe the differentiation of the cortical plate in human foetuses aged 9-11 weeks. Histological sections showed that in this early period of development the cortical plate is differentiated into two zones. The external zone is composed of vertical columns of cells, which are perpendicular to the cortical surface. The internal zone is wider and consists of irregularly arranged clusters of cells.

The development of the cervical part of the vagus nerve was studied by electron microscopy in 17 human embryos and fetuses from 18 to 220 mm crown-rump (CR) length, approximately 7–23 postovulatory weeks old. By the end of the embryonic period proper, processes of neurolemmocytes are beginning to invade the nerve bundles of the vagus. Early in the fetal period, the nerve fibres become more regularly arranged, the lemmocyte/axon ratio is diminishing, the neurolemmocytes are dividing, and the connective tissue elements are becoming differentiated. By 14 postovulatory weeks (120 mm CR), examples of a 1:1 lemmocyte/axon ratio are observed, and the spiral development characteristic of myelination is beginning. By 17 weeks, myelinated fibres at varying phases of myelinogenesis are apparent, and desmosome-like junctions in the opposed plasma membranes are seen where lemmocyte processes form a mesaxon. By 23 postovulatory weeks, the diameter of the axons varies from 0.2 to 3.5 µm, and the vagus shows its mature structure, although nerve fibres at the beginning of myelin formation are still visible.

The hypoglossal nerve with its communicating branches between the hypoglossal canal and its terminal rami was removed in toto from 11 human fetuses varying from 63 to 342 mm C.R. length. Serial sections were stained with luxol fast blue or impregnated with silver nitrate or protargol according to Bodian's method. The total number of nerve cells varied from 10 to 82 on the right side and from 6 to 60 on the left. Morphologically these cells resembled the cells in the inferior ganglion of the vagus nerve and they were always observed within the communicating rami between this ganglion and the hypoglossal nerve. The possibility of migration of these cells from the inferior ganglion of the vagus to the hypoglossal nerve and their relationship to the proprioceptive innervation of the tongue are discussed.

summary Aim. the aim of the study was to present preliminary results of the palliative treatment of strictures and obstruction of the gastrointestinal tract in stage iV cancers with the use of self-expanding stents. Material and methods. Within a one-year period, from october 2008 to september 2009, stent implantation in the gastrointestinal tract was performed in 32 patients. eligibility for palliative treatment was determined on the basis of a clinical examination and diagnostic tests to assess cancer stage. local advancement of cancer with infiltration of other tissues, such as metastases to the liver, distant lymph nodes or other organs, determined the choice of palliative treatment. the procedures were performed using a c-arm x-ray system and endoscope. Results. a total of 33 stents were implanted in 32 patients. Problems with stent placement occurred in one patient. during im

Utilization of the reaction of nucleophilic reagents with 1 allows for the simple preparation of methylenecyclopropane derivatives 3 via elimination-addition routes.