Prediction of suboptimal cytoreduction of epithelial ovarian carcinoma by preoperative computed tomography.

In an aim to evaluate the diagnostic efficacy of preoperative abdominal-pelvic CT for the prediction of suboptimal cytoreduction of epithelial ovarian carcinoma (EOC) at primary surgery, CT scans of 48 patients who underwent primary surgery for EOC were retrospectively analyzed. The presence of at least one of the following CT findings: multiple implants > 1 cm in maximum diameter in the mesenteria of the small or large intestines, porta hepatis or intersegmental fissure or on the hepatic surface, diaphragmatic peritoneum, gastrohepatic or gastrosplenic ligaments or the extension of tumor infiltration > 2 cm on the omentum towards the spleen or stomach or the intestines encased by the tumor > 2 cm, diffuse peritoneal thickening or invasion of the lateral pelvic wall > 1 cm or multiple lymph nodes > 1 cm at the cardiophrenic and suprarenal levels were accepted as the critical markers for predicting suboptimal cytoreduction. Suboptimal surgery, defined as leaving a residual tumor mass > 1 cm, was determined in 18 (37.5%) patients. CT predicted suboptimal cytoreduction with 83.3% (15/18) sensitivity, 90% (27/30) specificity and 87.5% (42/48) accuracy. PPV and NPV values were 83.3% (15/18) and 90% (27/30), respectively. These results suggested that preoperative CT could successfully predict suboptimal surgery in patients with EOC.

Contribution of the amount of contrast media used in pulmonary CT angiography to assess the diagnostic value of CT venography; comparison of 100 and 150ml of contrast media.

AIM: To prospectively compare the vascular attenuation achieved with 100ml iohexol (350mgI/ml) 75% with that achieved with 150ml iohexol (350mgI/ml) 75% for computed tomography (CT) venography, which was performed after CT pulmonary angiography. MATERIALS AND METHODS: A total of 122 patients were included in the study. Group A, comprising 52 patients (mean age 64.8 years, mean body weight 70.8kg) received 150ml iohexol (350mgI/ml) contrast media. Group B, comprising 70 patients (mean age 61.2 years, mean body weight 71.4kg) received 100ml iohexol (350mgI/ml) contrast medium. RESULTS: Venous opacification values measured at all levels were significantly higher in group A than those in group B (p<0.001). In group B the mean HU values were between 87 and 115 and only three of the patients had HU values less than 60 at the level of femoral vein. Assuming a venous enhancement of 80HU as the cut-off value for accurate diagnosis of deep venous thrombosis, 22.8% (16/70) in group B and 7.6% (4/52; p=0.028) in group A had non-diagnostic CT venography of left femoral vein. CONCLUSION: One hundred millilitres of contrast medium with a concentration of 350mgI/ml may produce sufficient enhancement, but 150ml of contrast medium provides better accuracy for the diagnosis of deep venous thrombosis diagnosis. For better enhancement of lower extremity deep veins, the concentration of the contrast medium and the patient's body weight may also have significance.

Ruptured aneurysm of noncoronary sinus of Valsalva: demonstration with magnetic resonance imaging.

There are few published reports regarding imaging findings of sinus of Valsalva aneurysms (SVA) with magnetic resonance imaging (MRI). We present an unusual form of ruptured SVA, emphasizing the diagnostic importance of MRI among a range of imaging techniques. This case report describes a case of idiopathic (thought to be congenital in origin), acutely symptomatic ruptured noncoronary SVA diagnosed by MRI and confirmed with conventional angiography and surgery. MRI accurately showed aneurysm size, location, and rupture into the right atrium and provided valuable information about this rare lesion.

A case of late-onset primary hyperoxaluria.

Primary hyperoxaluria is a rare autosomal recessive disorder resulting in diffuse deposition of insoluble oxalate crystals in multiple organs. Two-thirds of patients have nephrolithiasis by 5 years of age and 80% die of renal failure by 20 years of age. Rarely, the disease will present in adulthood, with the onset of symptoms occurring as late as the sixth decade. Oxalosis is a condition in which the highly insoluble calcium oxalate crystals are deposited in extrarenal tissue. Pathologic involvement of bone is recognized as osteosclerosis on radiograph. Oxalosis should be considered in patients with osteosclerotic bone changes and chronic renal failure and should not be misinterpreted as renal osteodystrophy. We describe here a case of oxalosis in a 33-year-old man.

Renal replacement lipomatosis: multidetector-row computed tomography findings in one case.

Replacement lipomatosis of the kidney is the result of severe atrophy of the renal parenchyma often caused by chronic calculus disease with secondary marked benign proliferation of fibrofatty tissue replacing atrophied renal parenchyma. Different radiological modalities have been used to illustrate this entity, with magnetic resonance imaging, ultrasound, intravenous pyelogram, and computed tomography (CT) used most frequently. We report multidedector CT (MDCT) findings of replacement lipomatosis in a 50-year-old woman. We think that it accurately provides a complete one-step diagnostic workup and appropriate pre-surgical planning for patients for whom there is a suspicion of replacement lipomatosis.

Comparison of nitric oxide production by monocyte/macrophages in healthy subjects and patients with active pulmonary tuberculosis.

The aim of the present study was to determine the NO production by human cultured macrophages (m phi) and to compare the NO production between healthy subjects and patients with active pulmonary tuberculosis. The bioassay method was used for assessment of validation. Lipopolysaccharide (125 ng ml-1)-activated m phi from healthy and diseased subjects released a substantial amount of NO. NO synthase inhibitor, NG-nitro-L-arginine methyl ester, (0.1 mmol l-1) suppressed NO synthesis significantly in m phi of healthy subjects. Nitrite formation measured by the diazotization method in the supernatants taken from cultured m phi of tuberculous patients were significantly lower than the healthy subjects. The supernatants obtained in both subjects caused relaxation of guinea-pig aorta reversed by methylene blue (10 mumol l-1). There was a significant difference between relaxations of healthy and diseased supernatants. Nitrite formation measured by the bioassay method in the supernatants taken from cultured m phi of tuberculous patients was significantly higher than the healthy subjects. It was concluded that NO production appeared to be decreased in tuberculosis. The reason for decreased production of NO in tuberculosis may be related to the interaction of several cytokines and/or eicosanoids by means of the disease related induction of immune reactions.