Percutaneous radiofrequency rhizotomy of lumbar spinal facets: The results of 46 cases

The results of percutaneous radiofrequency rhizotomy of lumbar spinal facets in 46 patients followed at least three months (mean 15 months) are reported and compared with those reported previously. Satisfactory pain relief three months after the procedure was achieved in 36.4 percent of patients without operations and in 41.7 percent of patients with operations other than fusion.No patient had previously undergone fusion.Treatment of low-back pain by using radio-frequency thermocoagulation of spinal facets is a simple, safe, and well-tolerated procedure. It can be used to relief of pain in spite of decreasing rates of success within the follow-up period.     

Effects of different irrigation solutions on root dentine microhardness,smear layer removal and erosion

This study aimed to compare the effects of different irrigants on root dentine microhardness, erosion and smear layer removal. A total of 72 root dentine slices were divided into six groups, according to the final irrigants used: Group 1: 17% ethylenediamine tetra‐acetic acid (EDTA) + 2.5% NaOCl, Group 2: 7% maleic acid (MA) + 2.5% sodium hypochloride (NaOCl), Group 3: 1.3% NaOCl + mixture of tetracycline, acid and detergent (MTAD), Group 4: Smear Clear + 2.5% NaOCl, Group 5: 5% NaOCl, Group 6: saline. Vickers microhardness values were measured before and after treatment. In total, 42 root‐halves were prepared for scanning electron microscope to evaluate the amount of smear and erosion in the coronal, middle and apical thirds. Data were analysed using two‐way anova , Duncan and two‐proportion z‐tests. Maleic acid showed the greatest reduction in dentine microhardness (P < 0.05), followed by EDTA and MTAD. EDTA, maleic acid, MTAD and Smear Clear removed smear layer efficiently in the coronal and middle thirds of root canal. However, in the apical region, maleic acid showed more efficient removal of the smear layer than the other irrigants (P < 0.05).     

Percutaneous treatment of hepatic hydatid cyst in pregnancy

A 20 cm hepatic hydatid cyst with daughter cysts, was diagnosed in a primigravida in the fifteenth week of pregnancy and was managed percutaneously. No complications occurred and the patient subsequently gave birth to a healthy baby. Received: 25 February 1998 / Accepted: 28 August 1998     

Malignant pleural mesothelioma in a child: long-term survival with ICE-WAC chemotherapy regimen

Malignant mesothelioma is a very rare tumor in childhood. Presently, treatment of this disease continues to be frustrating and prognosis remains poor. We here report a pediatric case of malignant pleural mesothelioma who gave a complete response to ICE-VAC chemotherapy regimen and achieved a long-term survival. An eight-year-old girl underwent exploratory thoracotomy and decortication because of a unilateral loculated and multicystic pleural effusion. Histopathological diagnosis was sarcomatoid pleural malignant mesothelioma. After decortication, chemotherapy with ICE (ifosfamide, carboplatin, etoposide) - VAC (vincristine, adriamycin, cyclophosphamide) combination was started. Six courses of chemotherapy resulted in complete clinical and radiological tumor response. She did not receive any further therapy and remains disease-free three years after the first remission. ICE-VAC chemotherapy combination resulted in a complete tumor response and a long-term disease-free survival for the presented case. The efficacy of this chemotherapy regimen in malignant mesothelioma needs to be documented in future trials.     

The independent association of plateletcrit with long-term outcomes in patients undergoing primary percutaneous coronary intervention

Purpose

Platelets play a key role in the genesis of thrombosis. Plateletcrit (PCT) provides complete information on total platelet mass. The relationship between PCT values and long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary angioplasty is not known. We sought to determine the effect of PCT values on the outcomes of primary angioplasty for STEMI.

Methods

Overall, 2572 consecutive STEMI patients (mean age, 56.6 ± 11.8 years) undergoing primary percutaneous coronary intervention were enrolled retrospectively into the present study. Plateletcrit at admission was measured as part of the automated complete blood count. Patients were classified into 2 groups: high PCT (> 0.237, n = 852) and nonhigh PCT (< 0.237, n = 1720). Clinical characteristics and in-hospital and long-term (median, 21 months) outcomes of primary angioplasty were analyzed.

Results

A higher in-hospital shock rate was observed among patients with high PCT values compared with those with nonhigh PCT values (6.5 vs 3.8%, respectively; P = .003). The long-term cardiovascular prognosis was worse for patients with high PCT values (Kaplan-Meier, log-rank test; P = .007). We used Cox proportional hazard models to examine the association between PCT and adverse clinical outcomes. High PCT values were also an independent predictor of cardiovascular mortality (hazard ratio, 1.85; 95% confidence interval, 1.061-3.22; P = .03).

Conclusion

High PCT values on admission are independently associated with long-term adverse outcomes in patients with STEMI who undergo primary angioplasty.     

Circulating Thrombopoietin in Clonal Versus Reactive Thrombocytosis

Introduction: The aim of this study is to assess circulating thrombopoietin concentrations in patients with both clonal and reactive thrombocytosis (RT), which are two distinct categories of extreme platelet production circumstances. Investigation of the thrombopoietin levels in clonal versus reactive thrombocytosis may help us to understand the interactions of this key regulatory cytokine and the conditions in which abnormally increased platelet formation exist.

Materials and methods: Thrombopoietin levels were measured in patients with platelet counts greater than 500 × 10³ μl^?1 The study population consisted of 21 patients with RT (13 with iron deficiency anemia, and 8 with rheumatoid arthritis), 24 patients with clonal thrombocytosis (six with essential thrombocytosis, three with myelofibrosis, eight with chronic myelogenous leukemia, and seven with polycythemia vera (PV)) and 16 healthy subjects were used as controls.

Results: The median plasma thrombopoietin concentration was 100.5 pg ml^?1 in patients with RT, 467pg ml^?1 in patients with clonal thrombocytosis and 62.65pgml^?1 in the control group. The thrombopoietin concentration was found to be higher in the patients with primary thrombocytosis when compared to the control group (p = 0.001), as well as in patients with RT (p = 0.002). However, there was no statistically significant difference between the patients with RT and the control group (p = 0.14). There was no correlation between thrombopoietin levels and the platelet counts in patients with clonal thrombocytosis, including essential thrombo- cythemia (ET).

Conclusion: Increased levels of thrombopoietin were found in patients with clonal thrombocytosis versus patients with RT and control subjects as well. Defective clearance of thrombopoietin by megakaryocytes and platelets due to a reduced number of thrombopoietin receptors may be the causative mechanism behind this. These results indicate that plasma thrombopoietin levels may be helpful in distinguishing between clonal and reactive thrombocytosis.     

Pulmonary blastoma in a neonate: a lesion distinct from pleuropulmonary blastoma with unique cytogenetic features

Pulmonary blastoma is a rare malignant primary lung neoplasm typically seen in adults that accounts for 0.3–1.3% of lung malignancies. It has been categorized as a subtype of sarcomatoid carcinoma according to the current World Health Organization Classification of Lung Tumours and is distinct from the more common pediatric lung tumor pleuropulmonary blastoma. We report a case of neonatal pulmonary blastoma, illustrating the imaging characteristics of this rare tumor. The subject of pediatric lung masses is confusing because the terms pleuropulmonary blastoma and pulmonary blastoma have been used interchangeably in previously reported cases. We recommend use of the current WHO classification to differentiate these lesions as additional cases are described. Additionally, we discuss distinctive cytogenetic features of this case.     

Pediatric focal xanthogranulomatous pyelonephritis: dynamic contrast-enhanced MRI findings

Xanthogranulomatous pyelonephritis (XPN) is the result of chronic renal infection. It is very rare in childhood and the focal form, which is said to be more common in children, is often misdiagnosed as a renal tumor. We report a case of a focal XPN in a 14-year-old girl. The true preoperative diagnosis may be very hard in children especially in the focal form but it seems to be possible by the help of dynamic contrast-enhanced MRI.