Results of surgical treatment of anterior abdominal wall desmoid tumours : 13 cases reviewed with literature.

BACKGROUND: We retrospectively evaluated the results of surgical treatment for anterior abdominal wall -desmoid tumours. METHODS: Records for 13 patients operated on for desmoid tumours from 1997-2013 were searched for age, gender, abdominal/pelvic surgical history, pregnancy, Gardner's syndrome, pre-operative radiological examinations, tumour size, multifocality, surgical procedure, tumour presence at surgical margins, recurrence, morbidity, and mortality. Local recurrence-free survival probabilities were estimated by the Kaplan-Meier method and stratified by various clinicopathological variables. RESULTS: There were 11 female (84,6%) and 2 male (15,4%) patients with a median age of 36 years. Seven (53,8%) -patients had previous abdominal/pelvic surgery, five (38,5%) had a history of pregnancy, and one (7,6%) had Gardner's Syndrome. Two (15,3%) patients had multifocality on their pre-operative radiological examinations. Mean tumour -diameter was 4,6 cm (SD 3,2 cm ; range 2-12 cm). After the excision of the masses in five (38,5%) patients, synthetic materials were used to close the abdominal wall defects. Two (15,3%) patients with positive surgical margins after -surgery were re-operated. Three (23%) patients required a second surgical intervention after the mass excisions were performed. Mean follow-up time was 56,7 months. Recurrence was observed in three patients during follow-up. Increased tumour size, history of previous abdominal/pelvic surgery, and the presence of multifocality had a negative effect on local recurrence-free survival. There was no mortality during follow-up. CONCLUSIONS: Desmoid tumours are characterized by high recurrence, even after proper surgical excisions. Preoperative differential diagnoses of these tumours should be done and a post-operative follow-up protocol should be followed.

Effect of ultrasound-guided intercostal nerve block on postoperative pain after percutaneous nephrolithotomy : prospective randomized controlled study.

BACKGROUND: The aim of the study was to investigate the effect of preoperative ultrasound-guided (US) intercostal nerve block (ICNB) in the 11th and 12th intercostal spaces on postoperative pain control and tramadol consumption in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS: After obtaining ethical committee approval and written informed patient consent, 40 patients were randomly allocated to the ICNB group or the control group. For the ICNB group US-guided ICNB was performed with 0.5 % bupivacaine and 1/200,000 epinephrine at the 11th and 12th intercostal spaces after premedication. A sham block was performed for the control group and postoperative pain and tramadol consumption were recorded by anesthesiologists blinded to the treatment. RESULTS: Postoperative visual analog scale scores at all follow-up times were found to be significantly lower in the ICNB group than in the control group (p < 0.05). The mean 24 h intravenous tramadol consumption was 97.5 ± 39.5 mg for the ICNB group which was significantly lower than the 199.7 ± 77.6 mg recorded for the control group (p < 0.05). CONCLUSION: In PCNL with nephrostomy tube placement US-guided ICNB performed at the 11th and 12th intercostal spaces provided effective analgesia.

Ischemia modified albumin levels cannot predict stress induced ischemia shown by myocardial perfusion scintigraphy.

PURPOSE: Ischemia modified albumin (IMA) is a new marker of ischemia which is used in especially emergency room. Aim of this study is showing the association of IMA with stress induced ischemia on Tc-99m 2-methoxyisobutyl-nitrate (MIBI) myocardial perfusion scintigraphy (MPS). METHODS: 56 patients (23 F, 33 M; 56.04 ± 8.45 years old) were included in our study. Stress-rest two days protocol Tc-99m MIBI MPS single photon emission tomography (SPECT) was performed to all patients. IMA levels from the blood samples which were taken before and after the treadmill test were measured. Thirty patients additionally underwent coronary angiography. RESULTS: The difference of IMA levels of ischemia between positive and negative groups was not statistically significant. Also, there was not statistically significant difference between IMA levels of patients who have narrowing in the coronary arteries and not. CONCLUSION: Although IMA is an important marker of ischemia, probably because of other ischemic process during stress; it cannot reflect stress induced ischemic changes on MPS.

Morgagni hernia: diagnosis with multidetector computed tomography and treatment.

PURPOSE: We aimed to retrospectively evaluate morbidity, mortality and treatment outcomes in 12 cases of Morgagni hernia diagnosed with multidetector computed tomography (MDCT) and treated appropriately. METHODS: This is a retrospective study and data on the demographics, presenting symptoms, MDCT images, operative approach, morbidity and mortality were collected from hospital records. RESULTS: Of 12 patients with a mean age of 60 years, ten were female. The diagnosis was made with MDCT before surgery. All hernias were unilateral and located in the right part of the thorax. The contents of the hernias were omentum and colon in the majority of the patients, and the contents of the hernia as diagnosed with CT was confirmed at surgery. Six patients had surgery. Of these, one had emergency surgery for hernia, two laparoscopic hernia repair, three transabdominal repair and one transthoracic repair. CONCLUSIONS: MDCT is a good imaging technique to be used before surgery in that it is fast and non-invasive, helps to make an accurate diagnosis of Morgagni hernias and provides detailed information about the contents of the hernia and accompanying complications. Modern surgical techniques, including laparoscopy, help to achieve the repair of Morgagni hernias safely with short hospital stay and with little morbidity and mortality.

Gastrointestinal stromal tumours: CT findings.

The aim of this study was to identify the predictors of malignancy and to demonstrate the uncommon radiological features of gastrointestinal stromal tumours (GIST) using CT. 30 patients participated in this retrospective study. CT findings were evaluated by two radiologists, and categorical variables were compared using chi(2) or Fisher's exact tests. These tests were used to assess any possible relationships between mitotic index and (i) tumour location, size, contour and growth status, (ii) presence of calcifications, necrosis or lymphadenopathy, (iii) enhancement pattern, (iv) metastasis to the liver or other distant sites and (v) invasion of the mesentery or adjacent organs. Tumours were located in the stomach (n = 22), small bowel (n = 6) and colon (n = 2). The size, localization, enhancement pattern, metastasis to the liver or other distant sites and the cystic-necrotic component of the tumours were all associated with a high mitotic index in statistical analyses (p<0.05). Uncommon radiological findings seen on CT were saccular aneurysmal dilatation, malignant lymphadenopathy and satellite nodules. In conclusion, CT features of GISTs were helpful in identifying predictors of malignant behaviour.

Milk of calcium collection in the differential diagnosis of giant renal calculus.

A 29-year-old man presented with milk of calcium that completely filled the right-sided renal collecting system and ureter and was thought to be a giant renal calculus. Plain radiographs and computed tomographic findings of this rarity, which has not been reported previously, are reviewed.

Radiological findings of primary retroperitoneal Ewing sarcoma.

Ewing sarcomas are most commonly located in bone, while extraskeletal involvement of the retroperitoneum is extremely rare. We describe the radiologic and pathological findings in an adult patient with retroperitoneal extraskeletal Ewing sarcoma.

Symptomatic interrupted inferior vena cava: report of a case presenting with haematochezia.

Interrupted inferior vena cava (IVC) is a rare developmental defect. IVC interruption is usually accompanied with azygos and hemiazygos continuation, and is asymptomatic. Here, we report the imaging findings of a patient with an interrupted IVC with diffuse collaterals between the infrarenal IVC and large renal veins, left gonadal, and perirectal haemorrhoidal-portal collateral veins with associated haematochezia. Depending on the haemodynamic changes, interrupted IVC may cause possible different clinical findings as presented here.

Double retroaortic left renal veins as a possible cause of pelvic congestion syndrome: imaging findings in two patients.

Pelvic congestion syndrome is characterized by chronic pelvic pain and varicose veins around the uterus and ovaries. We report two cases of double retroaortic left renal vein, associated with left-sided pelvic congestion syndrome, diagnosed by CT and confirmed by clinical findings and colour Doppler ultrasound. Double retroaortic left renal veins may be a contributing factor for the development of left pelvic congestion syndrome. This is the first report of double retroaortic left renal vein and associated pelvic congestion syndrome.