THYROID DISORDERS PREVALENCE IN A COHORT OF KIDNEY TRANSPLANT RECIPIENTS.

CONTEXT: As the life expectancy prolongs, malignancy has become an important issue in renal transplant recipients (RTRs). Thyroid cancer is the most common endocrine malignancy with ongoing increase in incidence all over the world. OBJECTIVE AND DESIGN: This is a cross-sectional study that investigates the thyroid disorders and the prevalence of thyroid nodule and cancer in RTRs. SUBJECTS AND METHODS: 204 RTRs were evaluated for the thyroid diseases with ultrasonography, serum thyroid stimulating hormone, free T4, free T3 levels, anti-thyroglobulin antibody and anti-thyroid peroxidase antibody levels; FNAB was carried if required. RESULTS: 191 patients (94.1%) had normal thyroid function. Subclinical hypothyroidism was diagnosed in 11 patients, subclinical hyperthyroidism in 1 patient and low T3 syndrome in 4 patients. The FNAB was performed in 17 (27.9%) from 61 patients with thyroid nodule. The cytological examination of biopsy materials revealed that 2 (11.8%) nodules were suspicious for malignancy, 13 (76.5%) were benign, and 2 (11.8%) with non diagnostic cytology. Thyroid cancer prevalence was 0.2% in Turkey but we detected that 0.98% of RTRs had thyroid cancer. CONCLUSIONS: Screening the RTRs for thyroid disorders is necessary, so that early diagnosis and appropriate treatment of thyroid disease and cancer may improve the quality of life.

Is There a Long-Term Risk for Donors With Heterozygous MEFV Mutation After Kidney Donation?

BACKGROUND: Familial Mediterranean fever (FMF) is an autosomal-recessive autoinflammatory disorder manifested severely by systemic amyloidosis. It has been hypothesized that heterozygous carriers may also have susceptibility to certain symptoms or even diseases. Because the living kidney donors of patients with FMF are generally relatives of the kidney recipients, there is a high possibility that the donors will have a heterozygous mutation of the FMF gene. The goal of this study was to investigate the long-term kidney function of donors who are carriers of the Mediterranean fever (MEFV) gene. METHODS: The medium- to long-term outcomes of 12 asymptomatic donors were compared with MEFV gene carriers and 24 non-FMF recipients' donors. RESULTS: Heterozygous carriers and the control group were similar with respect to age, sex, and follow-up period. The preoperative estimated glomerular filtration rate and 24-hour urine proteinuria levels were similar in the MEFV carrier and control groups. Four years after the donation, both groups had similar estimated glomerular filtration rates, but the change in 24-hour urine protein was statistically higher in the MEFV carrier group, and no significant change was observed in the control group (P = .004). At the end of the follow-up period, neither overt proteinuria nor kidney failure was seen in either group. CONCLUSIONS: This study showed that the medium- to long-term results of the kidney donors who are carriers of the MEFV gene seem to be safe. However, there was more of a tendency for an increase in proteinuria in the MEFV gene carriers compared with control subjects, which necessitated further long-term care for these donors.

Preoperative assessment of myometrial and cervical invasion in endometrial carcinoma: comparison of multi-section dynamic MR imaging using a three dimensional FLASH technique and T2-weighted MR imaging.

INTRODUCTION: We aimed to show the diagnostic performance of magnetic resonance imaging by comparing T2-weighted images and dynamic 3D MR images in the assessment of myometrial and cervical invasion by endometrial carcinoma. METHODS: This prospective study included 53 women consecutively diagnosed with endometrial carcinoma. The subjects were evaluated by TSE T2-weighted images and 3D FLASH-VIBE dynamic MR images by two radiologists with a special training in gynecology. Sensitivity, specificity, negative and positive predictive values were calculated for each imaging modality with regard to assessment of myometrial and cervical invasion. RESULTS: The diagnostic accuracy of TSE T2-weighted and dynamic 3D FLASH-VIBE MR imaging for the identification of any myometrial invasion were estimated as 64% and 84%, respectively. In the differentiation of deep myometrial invasion from the superficial invasion, the diagnostic accuracy of TSE T2-weighted and dynamic 3D FLASH-VIBE MR images were 75.5%, and 88.7%, respectively. Additionally, in the determining of deep myometrial invasion the sensitivity, the specificity, PPV, and NPV were 76%, 75%, 50%, and 90.9% on T2-weighted images, respectively; 100%, 85%, 68.4%, and 100% on dynamic 3D MR images, respectively. The diagnostic accuracy of TSE T2-weighted and dynamic 3D FLASH-VIBE MR images for cervical invasion by endometrial carcinoma were 86%, and 92%, respectively. CONCLUSION: The multiplanar capabilities of MRI are invaluable to evaluate spreading and margins of an endometrial mass, and the 3D dynamic MR techniques offer the advantages of increased coverage and high spatial resolution. Three dimensional dynamic MR imaging may be recommended in the especially postmenopausal cases before performing potentially curative treatments.

Elastofibroma dorsi: typical radiological features.

Elastofibroma dorsi is a rare benign and slow-growing fibro-proliferative lesion. It has a characteristic location (periscapular region) and a specific imaging appearance (sonography, CT, MRI) allowing accurate prospective diagnosis. The recognition of this benign lesion avoids unnecessary biopsy and/or surgery. We report two cases of bilateral elastofibroma dorsi illustrating characteristic imaging features on ultrasound, CT and MRI.

Magnetic resonance imaging in Linburg-Comstock anomaly.

PURPOSE: To determine the usefulness of magnetic resonance imaging (MRI) in detecting the tendinous connection in Linburg-Comstock anomaly. MATERIAL AND METHODS: The study comprised 52 patients attending the orthopedic clinic for different hand problems. They were also examined for the presence of Linburg-Comstock anomaly, which was present in nine, and these patients were examined by MRI. RESULTS: The tendinous connection between flexor pollicis longus and flexor digitorum longus in all patients was shown by MRI. The connections were in the wrist, just proximal to the radiocarpal joint or distal forearm. CONCLUSION: MRI can show localization of the connection in this anomaly and helps the surgeon perform the operation with a limited incision. The operation time is therefore shorter and wound scarring less prominent.

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.

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.

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.