A Novel Treatment of Very Rare Anomaly; Breast Pseudoaneurysm Developed During Pregnancy

Pseudoaneurysms (PA) in the arterial supply of the breast are quite rare and mostly iatrogenic secondary to biopsies. Breast PAs after blunt trauma is even rarer. In this paper, a case of breast PAs secondary to blunt trauma and its percutaneous treatment using human thrombin injection and after N‐butyl cyanoacrylate is presented.     

Pigmented villonodular synovitis managed by Yttrium 90 after debulking surgery

The goal of this study was to evaluate outcome of patients with pigmented villonodular synovitis (PVNS) managed by Yttrium90 (90Y) after debulking surgery. Seven patients (3 males and 4 females) with PVNS were studied retrospectively. Mean follow-up was 47.8 months (range 24-97 months). Mean age was 44.8 years (range 20-68 years. Debulking surgeries via arthroscopic synovectomy were performed in 4 cases and in 3 cases via mini arthrotomy. After 90Y injection was applied. Magnetic resonance imaging (MRI) included measurement of synovial thickness in preoperative and at last control. Main musculoskeletal tumor society score was 26 (range, 23-29), main MTS rating was 70.4% (range, 38.5-86.2%). Mean preoperative synovial thickness was 14.9mm range 20-12mm. Synovial thickness was completely disappeared at last MRI examination. There was diffuse joint effusion preoperatively, decreasing at last control. No cases of PVNS recurrence were found. Although we had a small number of cases, we believe that combination of debulking surgery with intra-articular injection of 90Y for PVNS of knee joint is an effective and safe treatment method.     

Pazopanib: a novel treatment option for aggressive fibromatosis

Background

Aggressive fibromatosis (AF), also known as desmoid tumor, is an uncommon soft tissue neoplasm. AF does not metastasize, but it is locally invasive and its propensity for recurrence after conservative resection is well documented. No effective cytotoxic treatment has been reported, hence there is a need for novel treatment strategies.

Case presentation

We present the case of an AF successfully treated with an oral tyrosine kinase inhibitor, pazopanib, with mild side effects. As far as we know, this is the first case of AF with complete response to pazopanib.

Conclusion

Pazopanib might be an effective treatment option for AF.

     

Acceptability of Norplant at a well-woman clinic in Turkey.

OBJECTIVE: To make an assessment of the acceptability and cost of subdermal implants, a new method in Turkey, in a free-choice environment. METHODS: The records of women attending a university well-woman clinic in Istanbul, Turkey, were analyzed retrospectively. Among other contraceptives registered in the country, the women were offered subdermal contraceptive implants (Norplant) during counselling sessions. The women who chose implants were invited to attend for follow-up three times during the first 12 months and were advised to return annually thereafter. An estimation of cost was performed for Norplant, using the government price of the implant and the wage rates of public-sector staff. An estimation of cost was also performed for oral contraceptives. RESULTS: Among the 5650 women who applied to the Clinic for contraception between 1 January 1995 and 31 December 1998, 274 women decided to use implants, giving an initial acceptance rate of 5.1%. Continuation rates were 91.8%, 71.6% and 42.5% at 12 months, 24 months and 36 months, respectively. There were no pregnancies within the study period. The only demographic characteristic that was positively related to the acceptability of Norplant was younger age. The cost of contraception with Norplant was found to be lower than that for oral contraceptives. CONCLUSION: The high initial acceptance and continuation rates, combined with its high efficacy, make Norplant a valuable tool for Turkey's National Family Planning Program. Contraception with Norplant is also a cost-effective method, at least for the public sector.     

Psychometric Evaluation of the Wijma Delivery Expectancy/Experience Questionnaire Version B

Examining the fear of delivery after childbirth is important. The authors’ aim is to examine the overall psychometric quality of the Wijma Delivery Expectancy/Experience Questionnaire version B. Reliability and validity of the instrument were evaluated via reliability analysis, exploratory and confirmatory factor analyses, and multidimensional subscore estimation. A six-factor model was proposed to explain instrument results. Factors included concerns about labor pain, lack of positive behaviors, loneliness, lack of positive feelings, concerns about childbirth, and concerns about the baby. Researchers provide psychometric evidence about the quality of the questionnaire to measure fear of delivery after childbirth.     

Predictive value of elevated cystatin C in patients undergoing primary angioplasty for ST-elevation myocardial infarction

Objectives

The prognostic value of cystatin C (CysC) has been documented in patients with acute coronary syndrome without ST-segment elevation. However, its value in acute ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of this study was to evaluate the prognostic value of CysC in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).

Methods

We prospectively enrolled 475 consecutive STEMI patients (mean age 55.6 ± 12.4 years, 380 male, 95 female) undergoing primary PCI. The study population was divided into tertiles based on admission CysC values. The high CysC group (n = 159) was defined as a value in the third tertile (> 1.12 mg/L), and the low CysC group (n = 316) included those patients with a value in the lower two tertiles (≤ 1.12 mg/L). Clinical characteristics and in-hospital and one-month outcomes of primary PCI were analyzed.

Results

The patients of the high CysC group were older (mean age 62.8 ± 13.1 vs. 52.3±10.5, P < .001). Higher in-hospital and 1-month cardiovascular mortality rates were observed in the high CysC group (9.4% vs. 1.6%, P < .001 and 14.5% vs. 2.2%, P < .001, respectively). In Cox multivariate analysis; a high admission CysC value (> 1.12 mg/L) was found to be a powerful independent predictor of one-month cardiovascular mortality (odds ratio, 5.3; 95% confidence interval, 1.25-22.38; P = .02).

Conclusions

These results suggest that a high admission CysC level was associated with increased in-hospital and one-month cardiovascular mortality in patients with STEMI undergoing primary PCI.     

Cranial magnetic resonance imaging findings in patients with migraine

OBJECTIVE: To investigate the frequency of cranial magnetic resonance imaging abnormalities in patients with migraine and their relationship to type, duration, and frequency of migraine attacks. METHODS: Forty-five patients (43 women, 2 men) with migraine whose ages ranged between 19 and 53 years (mean, 40.91 [SD, 7.69]) were evaluated. Of the 45 patients, 20 had migraine with aura and 25 had migraine without aura, according to the diagnostic criteria of the International Headache Society. RESULTS: In 13 (28.8%) of 45 patients, white matter foci were present on magnetic resonance imaging. Eight of these patients (61.5%) had migraine with aura, and 5 patients (38.4%) had migraine without aura. The presence of white matter foci was significantly higher in the patients with aura (8 [40%] of 20) than in those without aura (5 [20%] of 25). It was found that as the frequency of attacks per month increased, the number of patients with white matter foci also increased. Although the mean duration of migraine was longer in patients with white matter foci (149.5 months [SD, 87.9]) than in those without white matter foci (134.1 months [SD, 88.3]), there was no significant difference (P >.05). CONCLUSION: Although there are no specific magnetic resonance imaging findings peculiar to migraine, detection of white matter foci should be taken into consideration in patients with migraine (especially migraine with aura). Frequency of attacks is an important indicator of existence of white matter foci.