Single-session percutaneous ethanol sclerotherapy in simple renal cysts in children: long-term follow-up

Background: Simple renal cysts are rare in children and managed conservatively unless symptomatic. Objective: To demonstrate the efficacy and long-term results of single-session ethanol sclerotherapy in symptomatic simple renal cysts in children. Materials and methods: Three simple renal cysts in three children (age 1, 5 and 16 years) were included in the study. Indications for treatment were flank pain (n=1), hypertension (n=1), and increasing cyst size and urinary tract infection (n=1). The mean follow-up period was 5.5 years (range 3–7 years). The procedures were performed with the guidance of US and fluoroscopy and under IV sedation. After the cystogram, 95% ethanol with a volume of 40% of the cyst volume (but not more than 100 ml) was used as the sclerosing agent. Results: Two cysts disappeared completely, while the volume reduction was 99% for the third cyst at the end of the first year. CT demonstrated calcification of the cyst without an enhancing soft-tissue component in the third one 7 years after sclerotherapy. After the procedures, hypertension and pain resolved without any medication. There were no complications during the procedures or during follow-up. Cytological examination was unremarkable in all patients. Conclusions: Percutaneous treatment of symptomatic simple renal cysts in children with single-session ethanol sclerotherapy is a safe, effective and minimally invasive procedure. Calcification owing to sclerotherapy can be observed on follow-up.     

Familial high factor VIII level in a child with necrotizing fasciitis complicating primary varicella infection

This article describes an unusual association of familial high plasma factor VIII level and necrotizing fasciitis in a 4-year-old girl with primary varicella infection.     

Percutaneous management of parapneumonic effusions

Parapneumonic effusions continue to be a significant source of morbidity and mortality. Treatment at earlier stages before fibrous peel and loculations occur has a much better prognosis. Using image guidance, addition of intracavitary fibrinolytic instillation, close follow-up with drainage of residual or new collections are some of the other factors that improve prognosis. In this article, we discussed treatment strategies, percutaneous management of parapneumonic effusions, its alternatives and results.     

Efficacy of transvaginal contrast-enhanced MRI in the early staging of cervical carcinoma

The objective of this study was to evaluate the efficacy of transvaginal contrast for local staging of cervical carcinoma. Fifty patients diagnosed with cervical carcinoma prospectively underwent magnetic resonance (MR) imaging before and after vaginal opacification (VO) with a mixture of 25 ml saline and 25 ml barium. T2-weighted (T2W) TSE images in axial and sagittal planes were compared before and after vaginal opacification. Dynamic T1W images in sagittal and fat-suppressed T1W images in transverse planes were also evaluated after intravenous contrast administration. Involvement of vaginal wall, lumen, and fornices; parametrium; rectum; and bladder were noted. Changes in local tumor staging and in treatment planning were also assessed after vaginal opacification. MR results were later compared with surgical pathological findings. Twenty-eight patients who went through surgical staging were included in the study. VO did not change any of the MR interpretations in 14 patients (50%). Correct staging was achieved with T2W TSE images with and without VO (in sagittal and transverse planes) in 78.5% and 50% of the patients, respectively. VO correctly lowered staging in seven and increased it in three patients compared with sagittal standard T2W images. Treatment planning was also changed in four (14%) of these patients. When overall accuracy of MR staging to indicate the appropriate treatment was evaluated, patients would have received the proper treatment in 90% and 79% of the cases when only T2W sagittal images with and without VO were evaluated, respectively. Dynamic gradient-echo images in sagittal planes and postcontrast T1W images in transverse planes evaluated with T2W series after VO, accomplished correct staging in 23 (82%) of the patients. MRI staging in early cervical cancer may be difficult and overestimated, especially if the tumor is slightly extended into the proximal vagina. Use of vaginal contrast medium is an easy, well-tolerated, and effective method to better delineate the borders of the tumor. It increases the specificity and accuracy of MR staging by showing the exact relation of the tumor with the vaginal wall and beyond.     

Color Doppler ultrasound in ovarian fibrosarcoma

BACKGROUND: Primary ovarian fibrosarcoma is a very rare tumor. Its Doppler waveform characteristics have not been described before. CASE: A 35-year-old woman presented with a 5-cm solid ovarian mass. Intratumoral artery resistance index (RI) and pulsatility index (PI) were very low (0.19 and 0.21, respectively). Peak systolic velocity calculated by using transvaginal Doppler ultrasound was higher than expected (24.8 cm/s). Postoperatively, the histopathologic diagnosis was primary ovarian fibrosarcoma, stage Ia. CONCLUSIONS: Low vascular resistance can be encountered in ovarian fibrosarcomas. In young patients presenting with a solid adnexal mass, intratumoral Doppler waveform investigations might offer some help for earlier prediction of rare malignant tumors like fibrosarcomas.     

Electrocardiographic changes in patients with ischaemic stroke and their prognostic importance

We investigated prognostic importance of electrocardiographic (ECG) changes in ischaemic stroke patients without primary heart disease because of the limited evidence. This study consisted of 162 patients (92 male, age 64 +/- 14 years) with first ischaemic stroke presenting to hospital during 18 months. One-month mortality was analysed by means of ischaemia-like ECG changes, long QT and arrhythmia. Ischaemia-like ECG changes were observed in 79% of stroke patients and long QTc in 26% and arrhythmias in 44%. Early mortality rate was 27% (n = 44). Age, ST-segment change and abnormal U wave were univariate predictors of early mortality (each p < 0.05). In multivariate analysis, age > 65 years (OR = 1.4, p = 0.02) and presence of ST-segment change (OR = 2.6, p = 0.01) were only independent predictors. Although sensitivity and specificity of ST-segment change were relatively low to identify patients at risk of death, its negative predictive value was 82%. The ECG changes are frequently seen in selected patients with ischaemic stroke. Regardless of origin, ST-segment change can be a predictor of early mortality.     

Qt dispersion in soccer players during exercise testing

Screening for cardiac health should involve relevant parameters or indices that are easy and inexpensive to obtain. Various cardiac adaptation mechanisms develop during regular exercise that are affected by many factors, and these are reflected on a surface electrocardiogram. QT dispersion has been considered a surrogate for heterogeneity of repolarization, leading to ventricular arrhythmias. We compared QT parameters between athletes and sedentary subjects. A total of 225 men were assessed, comprising a group of professional soccer players and sedentaries. Each subject underwent supine 12-lead electrocardiographic examinations and exercise testing by ergospirometry. QT parameters were taken at rest and at peak exercise. Peak oxygen consumption was considerably higher in the athletes than in the controls (59.3 +/- 5.6 vs. 44.3 +/- 2.4 ml/kg/min, mean +/- SD, p < 0.001). QT parameters at rest: There were significant differences in heart-rate-corrected rest maximal QT duration (413.9 +/- 50.5 vs. 445.3 +/- 45.7 ms, p < 0.001) and in heart-rate-corrected rest minimum QT duration (380.5 +/- 51.2 vs. 409.5 +/- 46.7 ms, p < 0.001). QT parameters at peak exercise: maximal QT duration at peak exercise (253.9 +/- 20.8 vs. 261.7 +/- 26.2, p = 0.02), QT dispersion at peak exercise (25.2 +/- 9.1 vs. 29.5 +/- 15.8 ms, p = 0.04), heart-rate-corrected QT dispersion at peak exercise (44.6 +/- 16.4 vs. 52.6 +/- 28.3 ms, p = 0.03) differed significantly between professional soccer players and controls. QT dispersion and corrected QT dispersion at peak exercise are lower in athletes than in controls. Athletes and other subjects identified with a long QT interval should be examined at regular intervals.     

Combination of extremity computed tomography angiography and abdominal imaging in patients with musculoskeletal tumors

PURPOSE: To introduce a comprehensive computed tomography (CT) protocol for the evaluation of patients with musculoskeletal tumors by combining extremity CT angiography and abdomen CT in a dynamic multidetector CT study. METHODS: Single contrast bolus was used for each study in 4 patients with musculoskeletal tumors involving the lower extremities. Extremity CT angiography and abdominal CT were acquired sequentially by 4-channel multidetector CT. Technical parameters for extremity CT angiography were as follows: detector collimation, 4 mm x 1 mm; pitch, 1.75; slice thickness, 1.25 mm; reconstruction interval, 1 mm; coverage, 42 cm; and table speed, 14 mm/s. Thick and thin maximum intensity projections, volume renderings, and multiplanar reformats with or without bone subtraction were used to display vascular supply of the extremity mass and adjacent vascular structures. RESULTS: Satisfactory images of the extremity arterial system and abdomen were obtained in all patients. The mean delay time for CT angiography was 25 seconds. Extremity CT angiography demonstrated feeding arteries of a fibular giant cell tumor and a large lymphomatous mass. The same protocol was used for the evaluation of a distal tibial osteosarcoma and a fibular chondrosarcoma. In 2 patients, early venous return was noted, indicating vascularity of the tumors. In all patients, the relation of osseus masses to adjacent vascular structures was visualized as well as the bony anatomy. CONCLUSION: Extremity CT angiography and abdominal staging CT can be combined in a single dynamic multidetector CT protocol in patients with musculoskeletal tumors, resulting in a reduction of costs, acquisition time, and contrast dose as well as an improvement in patient management. The same protocol can also be used in trauma patients.     

Patient-controlled epidural analgesia after major urologic surgeries. A comparison of tramadol with or without bupivacaine

The efficiency and safety of patient-controlled epidural analgesia by using tramadol alone and combined with bupivacaine were investigated for postoperative pain treatment after major urological surgeries. For PCEA: in group I (n = 17) a loading dose of 20 mg tramadol with a continuous infusion of 1 mg/ml tramadol at a rate of 8 ml/h was given. In group II (n = 17), patients received an initial loading dose of 20 ml bupivacaine 0.125% and a supplemental continuous infusion of 8 ml/h. In group III (n = 17), a loading dose of 20 mg tramadol with 20 ml bupivacaine 0.125% were given and a supplemental infusion of 1 mg/ml tramadol in 20 ml bupivacaine 0.125% combination was begun with a rate of 8 ml/h. A demand epidural bolus dose of 5 ml with a lockout time of 30 min was also used in all patients. VAS for pain intensity, vital signs, sedation scale and side effects was monitored at 0, 15, 30 min and 1, 2, 3, 4, 8, 12, and 24 h of the postoperative period. Statistical significance was determined using Kruskal-Wallis, Fisher's exact, analysis of variance for repeated measurements and Tukey tests. The hemodynamic values and sedation scales were insignificantly different (p > 0.05). The adequate analgesia was provided in all patients. However VAS values were significantly lower in group III than in groups I and II at every measurement (p < 0.05). The incidence of side effects in all three groups was low (p > 0.05). In conclusion, we suggested that a combination of tramadol with bupivacaine can provide the most effective and safe postoperative analgesia with minimal risk for side effects.     

Pseudoaneurysms of the popliteal and tibioperoneal arteries after gunshot injuries

BACKGROUND: Pseudoaneurysms (PsAns) of the popliteal and tibioperoneal arteries are very rare and occur as a late complication after arterial injury. This study was undertaken to describe the management of PsAns of the popliteal and tibioperoneal arteries after gunshot injuries in a civilian vascular surgical unit with a large trauma workload. METHODS: A retrospective review of the records of nine patients treated between January 1998 and November 2001 at the Thoracic and Cardiovascular Surgery Department of Numune Education and Research Hospital was undertaken. RESULTS: Nine PsAns of the popliteal and tibioperoneal arteries after gunshot injuries were treated. The delay in diagnosis from the time of injury ranged from 15 days to 14 months, with a median delay of 75 days. One case with graft occlusion was noticed in a patient with a popliteal artery PsAn. In these cases, the early and late patency rate and limb salvage were 100%. CONCLUSION: Early diagnosis of popliteal and tibioperoneal PsAns is an important factor in successful surgical reconstruction. The operative procedures will be simple if the interval between injury and operation is short, and surgical treatment for PsAns includes reconstruction of both arterial and venous arteries.