Comparison of CT virtual cystoscopy of the contrast material-filled bladder with conventional cystoscopy in the diagnosis of bladder tumours.

AIM: To investigate the value of virtual cystoscopy using contrast material to fill the bladder during routine abdominopelvic computed tomography (CT) examinations for the detection of bladder tumours. MATERIALS AND METHODS: Thirty-three consecutive patients (25 men and eight women; are range 51-82 years; mean age+/-SD, 65+/-7 years) who had painless macroscopic haematuria and were suspected to have bladder neoplasms were prospectively evaluated with virtual cystoscopy. After intravenous injection of contrast medium, the contrast material-filled bladders were examined with single-detector helical CT with 2-mm section thicknesses. Source CT data were transferred to a workstation for interactive navigation using surface rendering. All the patients also underwent conventional cystoscopy. RESULTS: The results of virtual cystoscopy were compared with the findings from the conventional cystoscopy. Seventy-one of 78 bladder tumours detected with conventional cystoscopy in 28 patients were also shown on virtual images. The bladders of five patients appeared normal on both conventional cystoscopy and virtual cystoscopy. On virtual cystoscopy, seven of the 12 lesions that were < or =5 mm in diameter could be identified. The following statistical values for the identification of bladder lesions using virtual cystoscopy were calculated: sensitivity 94%, specificity 90%, positive predictive value 87%, negative predictive value 93%, and accuracy 93%. CONCLUSION: CT virtual cystoscopy is a noninvasive technique that can be used successfully for detection of bladder tumours >5 mm in selected cases during daily routine abdominopelvic work.

Partial priapism secondary to tamsulosin: a case report and review of the literature.

Partial priapism is also called partial segmental thrombosis of the corpus cavernosum. It is a rare pathology, and its aetiology, physiopathology and treatment are still not completely understood. To our knowledge, partial priapism due to alpha blockers has not been reported previously in the literature. In this study, a successfully treated case of partial priapism occurring after the usage of alpha blocker is presented and discussed in light of the related literature.

Bicornuate uterus with a pregnancy in one half.

Bicornuate uterus is one of the important causes of female infertility. Pregnancy was observed in a patient who was 28 years old nullipara with primary infertility of 6 years and had bicornuate uterus.

Lung hydatid cyst rupture and its surgery.

Hydatid cysts are common in Turkey. Authors have seen 248 cases of lung hydatid cysts; Fifty hydatid cyst of lung had ruptured. Their symptoms and detailed findings are reported. Rupture caused asphyxia in 3, haemoptysis in 20, lung abcess in 16, rupture in pleural cavity in 4 and anaphylactic reaction in one case.

Pulmonary embolism and hematologic outcome in cancer patients initiating chemotherapy.

Purpose: The aim of this study was to determine the relationship between chemotherapy use and the frequency of pulmonary embolism (PE) and associated mortality, clinical, and biochemical parameters. An additional aim was to analyze computed tomography pulmonary angiography findings. Materials and Methods: The study population comprised 65 of 368 consecutive patients diagnosed with PE who underwent chemotherapy in the Medical Oncology Department. The study population had cancer of various origins, including breast, colorectal, lung, gynecological, gastric and pancreatic, lymphatic, and other sites. The patients' clinical records were reviewed for leukocyte and platelet count, mean platelet volume (MPV), neutrophil to lymphocyte ratio, and level of mortality. As the parameters were normally distributed, the correlation coefficients and their significance were calculated using Pearson's test. One-way analysis of variance was used to compare the leukocyte counts among the cancer groups. A t-test was used to compare the means of the platelet and leukocyte counts between the patients. A Chi-square test was used to compare binary outcomes for categorical variables. Patients who died in the 1 st year and others (survivors and patients who died after the 1 st year) were compared using multinomial logistic regression analysis. Results: When the patients who died in the 1 st year and the survivors were compared, there was a statistically significant difference in the platelet count between the two groups. The platelet count, MPV, and leukocyte count of the patients with PE were significantly high. The leukocyte count was also significantly high in patients with breast, colorectal, lung, and gynecological cancers. Conclusion: Our results indicate that in cancer patients with PE who undergo chemotherapy, the platelet count, MPV, and leukocyte count are significantly high.

Uncommon locations of hydatid cysts.

Hydatid disease is endemic in many parts of the world. It may develop in almost any part of the body. The location is mostly hepatic (75%) and pulmonary (15%), and only 10% occur in the rest of the body. In this article, the various imaging findings of hydatid cysts in unusual localizations are reviewed, based on our experience. Findings in brain, cavernous sinus, submandibular gland, thyroid gland, heart, pleura, chest wall, retrocrural tissue, kidney, spleen, pancreas, peritoneal cavity and inguinal canal, breast, bone and soft tissue are discussed.

Fluoroscopy-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with ankylosing spondylitis.

PURPOSE: Our goal was to prospectively study the therapeutic efficacy of CT-marking and fluoroscopy-guided intraarticular corticosteroid instillation of inflamed sacroiliac joints in patients with ankylosing spondylitis. MATERIAL AND METHODS: A total of 22 fluoroscopy-guided intraarticular corticosteroid injections in the sacroiliac joints were performed in 17 patients with ankylosing spondylitis and severe low back pain. Needle puncture point, angle of intervention and distance of sacroiliac joint from the skin were determined by sacroiliac joint axial CT examination in prone position. 14 mg of betamethasone were instilled in each joint under fluoroscopy. RESULTS: Twenty of 22 joints (90.9%) reported good improvement during a month after corticosteroid injection of the sacroiliac joint. The remaining 2 joints reported fair improvement. CONCLUSION: CT-marking and fluoroscopy-guided intraarticular corticosteroid instillation in the sacroiliac joints may be regarded as an effective therapy. This technique was useful, rapid and safe.

Omental fibroma: CT and US findings.

The US, CT, and X-ray findings in a patient with omental fibroma of the lesser omentum are described. Ultrasound showed a solid mass with cystic areas in the central region. At CT the lesion showed peripheral enhancement and central hypodensity. On X-ray studies with barium, there was border distortion in the lesser curvature of the stomach. The mass was resected surgically. A pathologic diagnosis of fibroma was confirmed.

Pulmonary embolism due to cardiac hydatid disease: imaging findings of unusual complication of hydatid cyst.

We report two cases of primary cardiac hydatid cyst in which hydatid materials caused recurrent embolizations in pulmonary arteries and pulmonary parenchyma. Cardiac hydatid cysts may stay asymptomatic for a long time, until they reveal themselves being perforated into cardiac chambers and/or pulmonary artery or systemic circulation. The role of imaging techniques in diagnosis is discussed and the importance of dynamic enhanced CT, MR imaging, and enhanced MR angiography (MRA) is reported. Imaging findings were confirmed by surgery and pathology. Early diagnosis is essential because delayed treatment increases the morbidity and mortality rates.

Sonographic diagnosis of the ruptured hydatid cyst of the kidney.

The clinical and radiological features of one case of renal hydatid disease communicating with collecting system are described. Introduction of hydatid elements into the renal pelvis due to rupture was accompanied by six episodes of renal colic. Although the sonographic features of renal hydatid disease have been described extensively, direct demonstration by ultrasonography of hydatid cyst ruptured into the renal pelvis has not, to our knowledge, been previously reported. The diagnosis has also been confirmed at surgery.

Renal hydatid cysts and the evaluation of their radiologic images.

OBJECTIVE: We present our experience with the various sonographic and CT findings observed in patients with hydatid disease involving the kidney. The imaging characteristics of various echinococcal cysts were evaluated comparatively to offer a diagnostically better explanation for the radiologic images and to assist the urologist in defining the nature of the cyst and its content preoperatively. Renal involvement is extremely rare in patients with hydatid disease. METHODS: The clinical and radiological features in 17 patients with renal hydatid disease are described. Two patients (4 and 28 years old) had renal colic with passage of debris in urine (hydatiduria). Five males and twelve females were 4-61 years old (mean 37 years). Their histories, physical findings and imaging procedures were evaluated. Plain abdominal radiographs were taken in 17 patients. RESULTS: Plain film showed calcified mass compressing the pelvicalyceal system and/or ureter in 10 cases. Sonography showed typical features of echinococcal cysts in 14 cases, especially in the liver and spleen. CONCLUSIONS: Sonography demonstrates the internal cystic content better. When daughter cysts are present, CT establishes the diagnosis. CT scan provides further information on the affected organ and involvement of other organs, calcification of the cyst wall and density. The diagnosis was suggested preoperatively in all patients, and confirmed surgically in 12 patients. Eight total nephrectomies and four partial nephrectomies were performed. The others are being followed up.

Sonographically guided percutaneous treatment of hepatic hydatid cysts: long-term results.

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of sonographically guided percutaneous drainage and irrigation of hepatic hydatid cysts. METHODS: Sixty-one patients with 84 hepatic hydatid cysts were treated using the puncture, aspiration, injection, and reaspiration (PAIR) technique under sonographic guidance. Patients with cysts larger than 6 cm in diameter underwent PAIR followed by percutaneous drainage (PAIR-PD). The cysts were sterilized by the injection of 1 of 2 scolicidal agents, 20% hypertonic saline solution (38 patients) or 0.5% silver nitrate (23 patients). All patients underwent follow-up examinations for 1 month-6 years after aspiration. Clinical and radiologic examinations and laboratory analyses were performed every month for the first 6 months and then at 3-month intervals. RESULTS: Serial sonographic examinations revealed a heterogeneous echo pattern in 78 cysts (93%); a progressive decrease in diameter in 76 cysts (90%); calcification of the cyst wall, cystic contents, or both in 10 cysts (12%); and complete disappearance of 1 cyst (1%) in a patient who had been monitored for over 6 years. Five patients developed urticaria, and 6 developed fever. One patient developed a biliary fistula after the first aspiration attempt. Two patients developed infection of the cyst cavity after PAIR-PD and were successfully treated with oral antibiotics. An anaphylactic reaction developed in 2 patients and was successfully treated with antiallergenic medication. No recurrence of hydatid disease after PAIR or PAIR-PD was observed in any patient over the follow-up period of 72 months (mean, 26 +/- 27 months). CONCLUSIONS: Percutaneous drainage of hydatid cysts is a safe, effective, and reliable treatment. Antiallergenic medication is required before PAIR or PAIR-PD. Both sclerosing agents, hypertonic saline and silver nitrate solutions, gave excellent results.

The management of liver hydatid cysts by percutaneous drainage.

OBJECTIVE: To investigate the effect of percutaneous drainage on liver hydatid cysts. DESIGN: A retrospective case study. SETTING: Department of Surgery, Selçuk University, Konya, Turkey. PATIENTS: Forty-five patients with 83 liver hydatid cysts (types I and II according to the classification of Gharbi and colleagues) followed up for a mean of 30 months (range from 14 to 36 months). INTERVENTION: The cysts were drained percutaneously with ultrasonographic guidance and then irrigated with 0.05% silver nitrate solution through a fine needle. Albendazole was administered 48 hours before percutaneous drainage and for 2 months after the procedure to prevent the implantation of spilled scolices. MAIN OUTCOME MEASURES: Complications of the procedure, decrease in size of the cyst cavity, recurrence and dissemination of the cysts. RESULTS: All the cysts were treated successfully by percutaneous drainage. Anaphylactic shock developed in 1 (2.2 %) patient, and mild allergic reactions were observed in 2 (4.4 %) patients during the interventional procedure. Follow-up ultrasonography and CT demonstrated a statistically significant (p < 0.01) decrease in the mean cyst size. Recurrence and dissemination were not observed during the follow-up period. CONCLUSION: Percutaneous fine-needle aspiration and drainage is effective for managing cystic liver hydatid disease in selected cases.