Magnetic resonance imaging (MRI) was used to study vascular anatomy in 3 patients with the nutcracker syndrome and in 10 healthy volunteers. From these studies an abnormal branching of the superior mesenteric artery from the aorta was identified as being the cause of the nutcracker syndrome. Consequently, surgical transposition of the left renal vein to achieve an unobstructed renal venous backflow was performed successfully in 2 patients, while 1 underwent nephrectomy. In 1 patient adjuvant ureteral instrumentation became necessary to aid occlusion of persisting shunts between peripelvic venous varicosities and the urinary tract. Awareness of the pathophysiology of the nutcracker syndrome ensures an early diagnosis, which should be confirmed by a combination of diagnostic procedures, including MRI.

Introduction: EUS-guided ethanol ablation of insulinoma is a new method of treatment of this neuroendocrine tumour. Ablation is recommended in patients who are poor surgical candidates or refuse surgery. We present a case of an 81-year-old female with symptomatic insulinoma, treated successfully with EUS-guided alcoholic ablation, along with a literature review including 28 other previously described cases. The effectiveness, safety of the therapy, and technical procedure-related issues are summarised. To the best of our knowledge, this is the first described case of successful insulinoma EUS-guided ablation in Poland. Material and methods:We searched the PubMed/Medline database to identify cases of EUS-guided alcoholic ablation. Our analysis included 14 articles (case reports or case series), with a total of 27 patients and 31 tumours described, published before February 2017. Results: The described tumours were relatively small (mean 13 mm), and the most common location was pancreatic head. The mean ethanol volume injected to the tumour was 1.8 ml and the concentration of infused alcohol varied from 95% to 98%.Side effects were observed in six cases; apart from one, they were mild and self-limiting. There was only one severe adverse event, treated conservatively with success. The median follow-up was 14.4 months (2-55 months). In all described cases ablation led to improvement of the symptoms and normalisation of glycaemia. Conclusions:The EUS-guided alcoholic ablation of insulinoma is a safe and effective method of treatment in patients who are poor surgical candidates and/or refuse surgery. The adverse effects are rare and mild and were observed when the volume of injected ethanol was equal to or above 3.0 ml. However, the data is limited, the follow-up is relatively short, and prospective studies are needed to confirm the long-term effects of treatment. The study shows also that there are important procedural differences (concentration and volume of alcohol, needle gauge, number of sessions) between the endoscopists, which should be specified. (Endokrynol Pol 2017; 68 (4): 472-479)

We report on a 15-year-old girl referred to us for dyspnea. Investigations revealed multiple pulmonary emboli originating from iliac vein thrombosis. As under heparin therapy, d-dimers rose again and the thrombus grew significantly in size while platelet count decreased by >30%. A diagnosis of heparin-induced thrombocytopenia (HIT) type II was suspected, heparin-treatment was stopped and lepirudin therapy was started successfully at a doses of 0.15 mg/kg bw/hr.

Introduction: Intense pulsed-light (IPL) treatments are effective alternatives to ablative procedures for improving the appearance of photodamaged skin. Currently, there are multiple IPL sources to modulate photoaged skin, but there are no studies comparing the efficacy of or pain associated with 2 different PL sources. Therefore, we chose to compare patients' assessments of overall cutaneous rejuvenation and pain associated with a fluorescent PL source and a traditional IPL source. Materials and Methods: We performed a retrospective analysis of 24 patients who were treated with both a fluorescent PL source and a traditional IPL source. These patients completed questionnaire surveys that assessed (by a graded scale) pain during the procedure and overall satisfaction with each IPL source. The Wilcoxon signed-rank test for paired data as well as McNemar's test were used to compare overall facial rejuvenation and procedural pain between the 2 light sources. Results: For both light sources, most patients reported “fair” or better improvement in skin appearance. The patients did not report a significant difference in overall skin improvement between the treatments with each light source. In addition, most patients did not report having pain during recovery after procedures by either light source. However, patients did report significantly less pain during treatments with the fluorescent device compared with the traditional IPL source. Discussion: IPL sources provide safe and effective nonablative treatment for facial photorejuvenation. Patients are equally satisfied with the effects seen with both traditional and fluorescent PL source, but reported less pain with the fluorescent PL procedure during treatments.