Effect of informed consent for intravascular contrast material on the level of anxiety: how much information should be given?

Purpose: To compare the effect of two different informed consent forms on patients' anxiety level prior to intravenous contrast material (IVCM) injection.

Material and Methods: Two different informed consent forms were randomly given to 265 consecutive patients referred for either intravenous pyelography or computed tomography requiring IVCM injections. Form 1 had brief information, including only the common risks and risk factors associated with IVCM, while Form 2 had more comprehensive information. Before being presented with the two different informed consent forms, 191 of the 265 patients filled out two other forms evaluating: 1: How they felt in that particular situation/moment (STAI-T); and 2: How they felt independently of the situation or condition at that moment (STAI-S). After the patients were informed, the STAI-T (measuring how they felt in that particular situation) was filled out once more to see if the anxiety level had changed.

Results: The anxiety level for 88 patients receiving Form 1 decreased after they were given the informed consent (P = 0.033). However, among the 103 patients receiving Form 2, the anxiety level showed a significant increase (P = 0.001) compared to the values obtained before Form 2 was given.

Conclusion: These results indicate that informed consent, including brief information about the risk factors and potential adverse reactions of IVCM, reduces anxiety level, while detailed information before the procedure increases the anxiety level.     

An evaluation of internal carotid artery and cerebral blood flow volume using color duplex sonography in patients with vertebral artery hypoplasia

INTRODUCTION: Vertebral artery hypoplasia (VAH) may be defined as VA flow volume below approximately 30-40 mL/min using color duplex sonography. The aim of this study was to evaluate the effect of VAH on internal carotid artery (ICA) flow volume and cerebral blood flow (CBF) volume. MATERIAL AND METHODS: In this study, 17 patients with VAH and 20 control subjects with normal VA flow volume were enrolled. The patients and control subjects were 50-75 years aged. The ICA and VA flow volumes were determined by using color duplex sonography. The ICA and CBF volumes of patients with VAH were compared with control group flow volumes. RESULTS: There was no statistically significant difference in flow volumes of right, left and sum of both ICA between VAH and control group. However, CBF volume was lower in patient with VAH than control group. CONCLUSIONS: Evaluation of CBF using color duplex sonography is noninvasive and easily applicable to all patients and provides valuable diagnostic data. To the best of our knowledge, this is the first study demonstrating lower CBFV and normal ICA flow volume in patients with VAH.     

Agenesis of sphenoid sinus: three cases

Paranasal sinus agenesis is an unusual clinical condition. The frontal sinus agenesis is more frequently seen, whereas agenesis of the sphenoid sinus is extremely rare. This report presents three new cases of sphenoid sinus agenesis. The absence of the sphenoid sinus was demonstrated by computed tomography (CT) in all cases.     

Renal sinus histiocytosis

A 26-year-old woman had an infiltrative renal lesion accompanied by massive regional lymphadenopathy. Biopsy of the renal mass and a coexistent orbital mass revealed identical histologic evidence of sinus histiocytosis. This unusual benign entity is uncommon in the kidney, but radiographically, it may closely simulate an infiltrative renal neoplasm, especially a lymphoma or leukemia or even renal cell carcinoma.     

Focal segmental necrotizing glomerulonephritis in rheumatoid arthritis

We report ten patients with rheumatoid arthritis (RA) who developed a focal segmental necrotizing glomerulonephritis (FSNGN) and extracapillary proliferation typical of vasculitic glomerulonephritis. Five patients also had extrarenal vasculitis. Renal presentation was with renal impairment (n = 9) (median creatinine 726 mumol/l, range 230- 1592 mumol/l), microscopic haematuria (n = 8) and proteinuria (n = 10). Nine patients were seropositive for rheumatoid factor and nine had bone erosions. Serum from four of five patients tested by indirect immunofluorescence was positive for antineutrophil cytoplasmic antibody (ANCA) with perinuclear staining. Only three patients had penicillamine or gold therapy. Treatment was with prednisolone and cyclophosphamide (six patients, two of whom were also plasma-exchanged), prednisolone and azathioprine (two patients) and prednisolone alone (two patients). There was a marked improvement in renal function in eight patients. Two patients with dialysis-dependent renal failure recovered renal function, although in one patient this was transient and she required further dialysis 4 months later. Two other patients progressed to dialysis at 3 months and 1 year respectively. Four patients died, one remains dialysis-dependent, and four continue to have good renal function at 5 year follow-up (median creatinine 148.5 mumol/l, range 120-193 mumol/l). One patient was lost to follow-up at 5 years. FSNGN should be considered in all patients with RA and renal impairment, proteinuria and/or microscopic haematuria. This diagnosis appears to be more likely in patients with clinical extrarenal vasculitis, bone erosions or who are seropositive. In these cases, an urgent renal biopsy is indicated.      

Prenatal diagnosis of a fetal intracranial immature teratoma

Congenital intracranial teratoma is a rare disease. A fetus with a congenital intracranial teratoma presenting with a hydrocephalus at 27 weeks' gestation is presented. Prenatal ultrasonography and fetal magnetic resonance imaging demonstrated a huge, heterogeneous intracranial mass including the infra- and supratentorial region and polyhydramnios. At 28 weeks' gestation, a cesarean section was performed to avoid divisive operation during delivery. The infant died after 10 min from respiratory failure. Histological examination revealed the diagnosis of immature teratoma. Early detection of congenital intracranial tumors is crucial. The prognosis is poor with death usually occurring shortly after birth.