Diagnostic value of strain elastography for differentiation between renal cell carcinoma and transitional cell carcinoma of kidney

Purpose

The objective of our study was to prospectively evaluate the diagnostic performance of strain elastography for differentiation between renal cell carcinomas (RCCs) and transitional cell carcinomas (TCCs) of kidney.

Methods

A total of 99 consecutive patients who were referred to our hospital because of a newly diagnosed solid renal mass suspicious for malignancy on radiological screenings were evaluated with sonography, including strain elastography. Strain elastography was used to compare the stiffness of the renal masses and renal cortex. The ratio of strain in a renal mass and nearby renal cortex was defined as the strain index value. Mean strain index values for RCCs and TCCs were compared, and mean strain index values between histological subtypes of RCC were also compared.

Results

Although TCCs were smaller than RCCs (p < 0.001), there were no significant differences in gender distribution and mean age of the patients, and mean probe-tumor distance between RCC and TCC. The mean strain index value ±SD for TCC (5.18 ± 1.12) was significantly higher than the value for RCC (4.04 ± 0.72; p < 0.001). Mean strain index value for papillary cell carcinomas (4.09 ± 0.45) was slightly higher than that for clear cell carcinomas (3.85 ± 0.78): however, the difference was not statistically significant (p = 0.51).

Conclusions

Strain elastography can be used as a valuable imaging technique for preoperative differentiation between RCC and TCC of kidney.

     

The effect of tianeptine in the prevention of radiation-induced neurocognitive impairment

Radiation-induced neurocognitive impairment is an undesirable radiation-induced toxicity and a common health problem in patients with primary or metastatic brain tumor. It greatly impairs quality of life for long-term brain tumor survivors. Hippocampus is the most important brain structure for neurocognitive functions. It has been shown that radiation affects the hippocampal neurogenesis due to either induce the apoptosis or reduce the precursor cell proliferation in the hippocampus. Radiation-induced microglial inflammatory response is also negative regulator of neurogenesis. Tianeptine is a clinically effective antidepressant that induces neurogenesis. It has also been shown that tianeptine is able to reduce apoptosis and cytoprotective against the effects of proinflammatory cytokines in the hippocampus. Given the putative role of impaired hippocampal neurogenesis in radiation-induced neurocognitive impairment we think that tianeptine can be effective for preventing radiation-induced neurocognitive impairment by increasing hippocampal neurogenesis.     

Probing for nasolacrimal duct obstruction using intranasal midazolam sedation as an alternative to general anesthesia

OBJECTIVE: To investigate the effectiveness of topical anesthesia with sedation using intranasal midazolam in patients with symptomatic congenital nasolacrimal duct obstruction undergoing probing. PATIENTS AND METHODS: In this prospective study, probing was performed with general anesthesia (30 cases) and with topical anesthesia using intranasal midazolam (0.3 mg/kg; 44 cases) in 74 patients who were divided into two groups, those 6 to 36 months old and those older than 36 months. The groups were compared after 12 to 48 months (mean, 18.2 months). RESULTS: For the patients 6 to 36 months old, the success rate was 80% in the group who received general anesthesia and 88.9% in the group who received topical anesthesia with intranasal midazolam; the difference between the two groups was not statistically significant (P > .05). For the patients older than 36 months, the success rate was 20% in the group who received general anesthesia and 25% in the group who received topical anesthesia with intranasal midazolam; there was no statistically significant difference between the two groups (P > .05). CONCLUSIONS: Probing with topical anesthesia in the office setting is usually recommended for patients younger than 8 months. Our results show that this is suitable for children until 4 years of age with the support of intranasal midazolam sedation. Probing under topical anesthesia with intranasal midazolam is cost-effective, safe, and comparable in efficacy to probing under general anesthesia but with less risk.     

Impact of Catheter Arteriography on the Serum Level of Asymmetric Dimethylarginine,an Endogenous Inhibitor of Nitric Oxide Synthase

The purpose of this study was to investigate the instantaneous impact of catheter arteriography on blood asymmetric dimethylarginine (ADMA) levels in accordance with patient- and procedure-related variables. Sixty-eight patients (16 women, 52 men; mean age, 45.6 ± 20.1 years; range, 20–79 years) referred for cerebral or peripheral catheter arteriography were recruited for the study. Pre- and postarteriography arterial blood ADMA levels were determined by high-performance liquid chromatographic technique. Type of nonionic iodinated contrast media used, duration of procedure, patient gender, and patient age were noted and evaluated as possible factors that could influence serum ADMA levels in arteriography procedures. Prearteriography ADMA levels decreased significantly after arteriography in general (pre, 1.16 ± 0.96 μmol/L; post, 1.08 ± 0.80 μmol/L; p = 0.002). Males tended to have lower postarteriography serum ADMA levels (p = 0.005). Serum ADMA levels tended to get lower after peripheral arteriography procedures (p = 0.005) and when iohexol, 350 mg I/ml, was used as the contrast agent (p = 0.017). In conclusion, ADMA level does not seem to be subject to acute elevation after catheter arteriography; on the contrary, its level may decrease in general. Moreover, a reduction in serum ADMA level may be expected, especially in male patients, in patients who undergo a peripheral arteriography procedure, or when iohexol, 350 mg I/ml, is used as the contrast agent.     

Intraoperative management of the thyroid gland in laryngeal cancer surgery.

OBJECTIVE: To determine if it is necessary to perform a hemithyroidectomy routinely with all total laryngectomies or if it should be reserved for selected cases. DESIGN: A retrospective analysis of 215 cases who had been operated on due to laryngeal cancer in our clinic between 1985 and 1999. SETTING: In only 182 cases, hemithyroidectomy and isthmectomy were performed together with laryngeal surgery. Of these, 98% were male. Their ages ranged between 42 and 70 years. The tumour was located in the supraglottic region in 93 (51%) and in the glottic region in 24 (13%) cases. In 65 cases (36%), the tumour was transglottic. Twenty cases of transglottic tumours (31%) and 3 cases of glottic tumours (12.5%) were found to have subglottic extension. METHODS: Total laryngectomy with unilateral or bilateral neck dissection and hemithyroidectomy on the tumour side plus isthmectomy were performed on all patients. On the pathologic specimens, subglottic extension was measured anteriorly and posteriorly from the free edges of the vocal cords. The specimens were stained with hematoxylin and eosin and examined under a light microscope. MAIN OUTCOME MEASURES: With glottic and transglottic carcinomas, the need for thyroidectomy may be based on the intraoperative assessment of the thyroid gland. In subglottic carcinomas, a hemithyroidectomy should routinely be performed. There may be no need to perform thyroidectomy in all total laryngectomy cases. RESULTS: The thyroid gland was invaded by squamous cell carcinoma in only 2 cases (1%). Both of these cases were transglottic tumours staged as T3 and T4 and had a subglottic extension more than 1 cm. CONCLUSIONS: We recommend routine hemithyroidectomy and isthmectomy during total laryngectomy only in cases with subglottic extensions more than 1 cm or thyroid cartilage invasion with tumour. In the other cases, assessment of extralaryngeal invasion and thyroid gland invasion by the tumour will determine whether thyroidectomy should be performed.     

RF-assisted cystectomy and pericystectomy: a new technique in the treatment of liver hydatid disease

BACKGROUND: Radiofrequency (RF) energy has been used for ablation and resection of liver tumors. Purpose: To present a new technique for the treatment of liver hydatid cyst disease. MATERIAL AND METHODS: Two patients with liver hydatid disease treated with RF energy cauterization and surgical resection are presented. Cystectomy was performed in a female patient aged 35 years and pericystectomy was carried out in another female patient aged 55 years using RF energy cauterization. Blood was not needed during the operation. RITA System (RITA Model 1500 RF Generator, RITA Medical Systems, Inc., USA) was used during the procedure. CONCLUSION: Cystectomy and pericystectomy in liver hydatid disease can be successfully performed with the assistance of RF energy.     

"Open y" technique in vessel diameter discrepancy

For the last 20 years, free tissue transfers have increasingly become the mainstay of plastic surgery. Size discrepancy between the vessels during tissue transfers are frequently encountered in clinical practice, and this may potentially be an important factor in the patency of anastomosis. In our clinic, we first studied a rat model and a fresh sheep cadaver to improve the diameter discrepancy in microvascular anastomosis with "open y" technique. At the end of our research, we progressed to success, and the open y technique was applied to nine patients in our clinic with a diameter discrepancy in microvascular anastomosis. After finding the bifurcation of vessels (artery, vein, or a vein graft) that are prepared for anastomosis, a distal cut of 2-3 mm was made for the anastomosis, which is considered to increase the diameter. Both legs of the resultant "y"-shaped vessel were united after inserting the microscissors from one leg and exiting from the other. Performing an end-to-end anastomosis between the vessels, we obtain an increase in the diameter. By using this method, we eliminated the diameter discrepancy in microvascular anastomosis in nine patients in our clinic. There was not any flap loss. To increase the usage of this technique, when we come across a problem of size discrepancy, it is important to use the open y technique, both to the recipient vessels, donor vessels, and to the vein grafts. Owing to its high prevalence and the ease of application, we are convinced that this is a suitable technique in appropriate cases.