Percutaneous Transcatheter Ethanol Sclerotherapy and Catheter Drainage of Postoperative Pelvic Lymphoceles

The aim of this study is to investigate the efficacy and long-term results of percutaneous transcatheter ethanol sclerotherapy (PTES) for postoperative pelvic lymphocele treatment. Fifty-two patients who were referred for lymphocele treatment were included in this study. Sixty lymphoceles of 52 patients were treated by percutaneous treatment with or without ethanol sclerotherapy. Lymphoceles developed in 47 and 5 patients, who underwent gynecologic malignancy operation (31 ovarian cancer, 6 cervix cancer, 10 endometrial cancer) and renal transplantation, respectively. Lymphoceles were catheterized by ultrasonography and fluoroscopy guidance using the Seldinger technique. Lymphoceles smaller than 150 mL underwent single-session ethanol sclerotherapy and the others were treated by multiple-session ethanol scleortherapy. In 10 patients, percutaneous ethanol sclerotherapy could not be performed and they were treated only by percutaneous catheter drainage. The mean lymphocele volume was 329 mL (15–2900 mL). The mean catheterization duration was 11.8 days (1–60 days). The mean follow up time was 25.8 months (2–64 months). The initial treatment was successful in 46 out of 50 (91%) lymphoceles treated with PTES and 7 out of 10 (70%) lymphoceles treated with percutaneous catheter drainage. Minor complications (secondary infection and catheter dislodgement) were noted in seven (11.6%) patients. Recurrence developed in four and three patients who were treated by PTES and percutaneous catheter drainage, respectively. Five of these patients were treated with PTES without further recurrence. Percutaneous transcatheter ethanol sclerotherapy is an effective and reliable method for the treatment of postoperative lymphoceles.     

Does 16-MDCT angiography scanning direction affect image quality of coronary artery bypass grafts and the native coronary arteries?

To assess the impact of scanning direction on the image quality of coronary artery bypass grafts (CABGs), native coronary arteries (NCAs) were examined by electrocardiographically (ECG) gated 16-row multidetector computed tomography (16-MDCT). Eighty-two patients with 209 grafts were studied by 16-MDCT. Forty-one patients with 111 grafts were scanned craniocaudally. Forty-one patients with 98 grafts were scanned caudocranially. CABG, native coronary arteries were examined in four (proximal, middle, distal, distal anastomoses), three (proximal, middle, distal) segments, respectively. Subjective image quality on a four-point scale was calculated for segments. Scores of groups were compared. Results Image quality scores of proximal, distal segments of the right coronary artery (RCA) were better in caudocranially scanned group (P<0.05). When we subgrouped patients according to initial heart rates (IHR) (group 1, <65 beats/min; group 2, ≥65 beats/min), there was no statistical significance between image quality scores of coronary arteries, CABG when IHR was <65 beats/min in groups regardless of scanning direction. Scores of anastomotic segment of CABG to RCA, middle segments of circumflex coronary artery, proximal and distal segments of RCA in caudocranially scanned group were better when the IHR is ≥65 beats/min compared with the craniocaudally scanned group. When the IHR of the patient is ≥65 beats/min, performing ECG-gated 16-MDCT angiography in the caudocranial direction provides better image quality for evaluation of coronary arteries and CABGs.     

Retroperitoneal vascular aberrations increase the risk of vascular injury during lymphadenectomy in gynecologic cancers

Purpose

To investigate the frequency of aberrations of retroperitoneal great vessels in patients with gynecologic cancers who were scheduled for pelvic and paraaortic lymphadenectomy, and to document the vascular complications which occurred during lymphadenectomy as well as the relationship of these vascular complications with vascular aberrations.

Methods

Patients with gynecologic cancers underwent a routine preoperative abdominal multi-detector computer tomography, and an intraoperative search for aberrations of the great vessels in the retroperitoneal region was undertaken. Intraoperative vascular complications were recorded and their relations to vascular aberrations were analyzed.

Results

The rate of vascular aberrations detected preoperatively by multi-detector computed tomography was 24.3?%. Vascular injuries occurred in six patients (16.2?%) during lymphadenectomy. Rate of intraoperative vascular injuries was significantly higher in patients who had vascular aberrations of retroperitoneal great vessels (44.4 vs. 7.1?%, p?=?0.022).

Conclusions

Aberrations of retroperitoneal vessels are not uncommon and may increase the risk of vascular complications during lymphadenectomy. The risk of these complications may be decreased if aberrations are detected preoperatively.     

Comparison of the efficacy of micronized progesterone and lynestrenol in treatment of simple endometrial hyperplasia without atypia

Purpose

To evaluate the treatment of simple endometrial hyperplasia without atypia with different gestagens.

Methods

Sixty premenopausal women with histologically documented endometrial hyperplasia without atypia were included in this prospective controlled study. Patients were randomized into two groups: Group I included 30 patients who received lynestrenol (LYN) in a dose of 15 mg/d, while Group II included 30 patients who received micronized progesterone (MP) 200 mg/d for 12 days per cycle for 3 months. Patients were reevaluated with endometrial curettage after treatment. MP and LYN regimens were compared to regression, resolution or persistence rates and metabolic parameters.

Results

After 3 months of treatment in both groups, none of the cases progressed. In LYN group, the rate of resolution was observed to be higher compared to MP group (p = 0.045). LYN was found more effective inducing resolution in patients more than 45 years compared to MP (p = 0.036). When we compare both groups after 3 months of treatment, there was no statistically significant difference in BMI, total cholesterol, HDL, LDL and fibrinogen level between two groups. The rate of patients without any side effects was found to be similar in both groups (p = 0.5).

Conclusion

LYN which is a synthetic progestin ensures better endometrial control compared to MP in simple hyperplasia without atypia in the patients of premenopausal age especially in ages more than 45 years.     

Fetal intraabdominal umbilical vein varix: antenatal diagnosis and management

Objective: Fetal intraabdominal vein varix (FIUVV) is a sonographic finding with unknown prevalence. We aimed to point out this particular abnormality and review possible associations and complications which may arise.

Method: We performed an unrestricted literature search via PubMed and included all cases diagnosed with FIUVV.

Case presentation: A 24-year-old, gravida 1 para 0 woman was referred to our clinic with possible diagnosis of FIUVV. We confirmed the diagnosis and detailed sonogram was normal. Beyond the gestational age of 32 weeks, intruterine growth restriction became evident. Close fetal surveillance was performed. We did not detect any thrombus formation within the varix or signs of cardiac decompansation during these visits. Delivery was planned after completion of 37 weeks. A healthy baby weighing 2100?g was delivered and discharged without any complications.

Conclusion: It is generally accepted that fetal anatomic survey is necessary after detection of FIUVV. Karyotyping could be performed for those cases associated with additional structural malformations. Close surveillance of fetal well being and growth is important. Possibility of thrombus formation within the varix should be kept in mind.     

MDCT angiography of the extremities in pediatric patients: initial experience

OBJECTIVE: We studied the feasibility of extremity MDCT angiography in pediatric patients with congenital anomalies, an extremity mass, and a suspected arterial occlusion. CONCLUSION: In pediatric patients, MDCT angiography of the extremities with a short imaging time and a low dose of contrast material is feasible and can be used as a noninvasive alternative to conventional angiography.     

Scrotal ultrasonography with emphasis on the extratesticular space: anatomy,embryology, and pathology

Sonography is the imaging modality of choice in detecting and characterizing pathologic conditions affecting the extratesticular space. Although most abnormalities are benign, many may simulate or represent malignant processes. Accurate diagnosis is therefore essential and must be based not only on the sonographic findings but also on accurate clinical history and physical examination findings. This article reviews the anatomy, embryologic development, and pathologic conditions affecting the extratesticular space.