Long-term evaluation of radioisotope synovectomy with Yttrium 90 for chronic synovitis in Turkish haemophiliacs: Izmir experience

Since 2001 we have performed 105 radioisotope synovectomy (RS) in 65 children and young adults, age ranging from 3 to 25 years with a average of 15 years in Ege University Hospital, Izmir, Turkey. One fourth of cases were below 10 years of age. All patients had severe haemophilia A and B. Ten patients (17 joints) had high responder inhibitor. We prefer to use Yttrium 90 for all joints (5 mCi for knees; 2 mCi for others). The knees were injected in 56 cases, elbows in 24 cases, ankles in 23 cases and shoulders in two cases. Steroid injections were not preferred as the principle drug of choice. Mean follow-up period after procedure was 2 years (range: 6 months to 3.5 years). All inhibitor patients had satisfactory results. The best results were obtained in elbows than knees and ankles. Excellent rates (no bleeding) were observed in grade-II synovitis 84% for knees, 93% for elbows and 50% for ankles. Because of the excellent and good response (bleeding reduction to 75%), rates were 100% for knees and elbows and 92% for ankles. In six cases, repeated injections were given at 6-month interval and all of them had good results. The grading of synovitis seems to be an important parameter than the age of the patient. Even in patients below 10 years of age, outcomes are not satisfactory in all joints with grade-III vs. grade-II synovitis (12% vs. 73%). No serious complications were observed during and after procedure except two cases. A mild and transient inflammatory reaction was observed in the ankle. There was a minimal radioisotope leakage to superficial skin in the elbow. RS seems to be a safe and effective treatment for chronic synovitis causing recurrent joint bleedings.

Effect of short-term finasteride therapy on peroperative bleeding in patients who were candidates for transurethral resection of the prostate (TUR-P): a randomized controlled study

In the present study we aimed to demonstrate the efficacy of short-term pretreatment with finasteride in patients undergoing transurethral resection of the prostate (TUR-P). For this purpose 40 patients with BPH, who were candidates for TUR-P, were randomized into two groups. The first group (n=20) received 5 mg finasteride/day for 4 weeks prior to surgery and the second group (n=20) remained as the control. Patients who underwent prior prostate or urethral surgery and had a diagnosis of prostate cancer or chronic renal failure, patients who received finasteride, aspirin, coumadin or similar anticoagulant drugs prior to surgery and patients who had capsule perforations or open sinuses during the surgery were excluded from the study. All patients had a normal digital rectal examination and PSA values less than 4 ng/ml. As we look at the results there was no statistically significant difference between the finasteride group and control group regarding age, IPSS, PSA, prostate volumes, preoperative serum hemoglobin, hematocrit values and mean operating times and used irrigating fluids. The total amount of bleeding and bleeding per gram resected tissue were significantly lower in the finasteride group regardless of prostate volume. Furthermore the decrease in the hemoglobin and hematocrit values was higher in the control group. As a conclusion four weeks of finasteride pretreatment provided a significant decrease in peroperative bleeding regardless of prostate volume without any major side effects.

Metastatic intramammary lymph nodes: mammographic and ultrasonographic features

OBJECTIVE

To evaluate the mammographic and ultrasonographic findings in patients with intramammary lymph node (IMLN) involvement in breast cancer.

MATERIALS AND METHODS

The mammograms of 1655 histopathologically proven breast cancer cases diagnosed during the last 10 years were retrospectively reviewed. There were 16 cases in which metastasis to intramammary lymph nodes was suspected mammographically and proven histopathologically. The clinical and radiological features of these 16 cases were evaluated.

RESULTS

On mammograms, the involved lymph nodes were all well circumscribed, homogeneous, oval or round opacities in the upper outer quadrant of the breast. They were all larger than 1 cm in size. On US, they were seen as well circumscribed, homogeneously hypoechoic masses with mild acoustic enhancement. In one case, besides enlargement, development of malignant microcalcifications was seen inside the node in the follow up period. In another case with IMLN metastasis, the primary focus of the breast cancer could not be detected either mammographically or histopathologically. So the case was accepted as occult breast carcinoma. All of the primary tumors detected were invasive histopathologically and their sizes varied between 1-6 cm (mean, 3 cm).

CONCLUSION

The involvement of the IMLN can be suspected with mammographic and ultrasonographic features. Metastatic disease from breast cancer to IMLN may be the first clinical and/or radiological sign of breast cancer.

Mammographic density changes during different postmenopausal hormone replacement therapies

OBJECTIVE

To determine the degree of change in mammographic breast densities during different types of postmenopausal hormone replacement therapies.

DESIGN

A retrospective study.

SETTING

Ege University Hospital.

PATIENT(S)

The mammographies of 216 women on various postmenopausal hormone replacement therapies were evaluated.

INTERVENTION(S)

Estrogen alone (n = 76) or estrogen in cyclic (n = 44) or continuous (n = 61) combination with progestin or tibolone-only (n = 35) replacement therapies were used. Mammographic density was quantified according to the Wolfe classification in patients with different hormone replacement regimens.

MAIN OUTCOME MEASURE(S)

Mammographic density changes were interpreted.

RESULT(S)

An increase in mammographic density was much more common among women receiving continuous combination hormone replacement therapy 31.1% (19 of 61) than among those receiving estrogen-only 3.9% (3 of 76) treatment. There were no significant mammographic breast density changes among women receiving cyclic continuous combination hormone replacement therapy or tibolone-only treatment. The increase in density was apparent already at first visit after the start of hormone replacement therapy. In continuous combined postmenopausal hormone replacement therapy with norethisterone acetate, the increase in mammographic density was 34.1% (15 of 44), followed by medroxyprogesterone acetate 23.5% (4 of 17).

CONCLUSION(S)

Our findings show that mammographic breast density changes related to postmenopausal hormone replacement therapy are dependent on the selected hormone regimen. The continuous administration of the progestin component of the combined-hormone replacement therapy seems to effect the breast density most.

Carotid steal: report of ten cases

The blood flow may be diverted from the external to the internal carotid artery via the carotid bulb in the absence of flow in the common carotid artery. We aimed to investigate the prevalence, hemodynamics, and clinical features of this condition. Reviewing the records of color duplex ultrasonographic examinations, we found carotid steal in 12 carotid arteries of 10 patients. In three patients flow in the ipsilateral external carotid artery was bidirectional. The steal had been demonstrated angiographically in six patients. The cause of the phenomenon was atherosclerosis, Takayasu arteritis, or trauma. Awareness of this pathway of collateral circulation may contribute to diagnostic work-up and expand management alternatives.

Effect of postnecrotic and alcoholic hepatic cirrhosis on development of benign prostatic hyperplasia

BACKGROUND

The object of this study was to investigate the effects of hepatic cirrhosis on the development of benign prostatic hyperplasia and consequent effects on prostatic volume, serum prostate-specific antigen (PSA), and prostatism symptoms.

METHODS

Sixty patients with postnecrotic cirrhosis and alcoholic cirrhosis at age 40 and over, and 20 voluntary subjects in the same age group with normal hepatic functions, were evaluated with prostatic volume calculation by transrectal ultrasound, symptom scoring according to American Urology Association (AUA) criteria, measurement of serum prostate-specific antigen (PSA), serum total testosterone (TT), free testosterone (FT), estradiol (E2), and calculation of E2/FT ratios, and the results were analyzed statistically by the Mann-Whitney U-test.

RESULTS

Serum FT and TT levels were significantly lower in the hepatic cirrhosis group compared to the control group (P = 0.0000 and P = 0000, respectively). Though mean serum E2 level was a little higher in cirrhotic patients compared to controls, the difference was not significant; however, the higher E2/FT ratio in the cirrhotic group was statistically significant (P = 0.27 and P = 0.0002, respectively). In the cirrhotic group, the decrease in FT and TT levels was greater, as the disease advanced. While E2 and E2/FT ratio increase, correlate with poor prognosis, no statistically significant differences were found. Mean prostatic volume, serum PSA level, and total symptom score were significantly higher in the control group, compared to the cirrhotic group (P = 0.0001, P = 0.0006, and P = 0.002, respectively). Prostatic volume decreased parallel to severity of disease in cirrhotic patients.

CONCLUSIONS

The main reason for the decrease in mean prostatic volume in cirrhotic patients compared to subjects in the same age group with normal hepatic functions was the decrease in serum FT and TT levels, and the secondary cause was the increase in E2/FT ratio, indicating estrogenic predominance.

Ultrasonographic detection of interpectoral (Rotter's) node involvement in breast cancer

Prospectively, ultrasonographic examination of the interpectoral space was performed in 185 patients with clinical and/or mammographic evidence/suspicion of breast carcinoma. Of these, 86 patients treated by modified radical mastectomy were included in the study. Interpectoral lymph node metastases were found histopathologically in 12 (14%) of patients. Ultrasonographic examination of the interpectoral space revealed enlarged Rotter's node in 4 (4.6%) of patients, and 33.3% of patients with involved interpectoral nodes. Therefore, one-third of interpectoral node involvement could be detected ultrasonographically in this group. This sonographic study represents the first report on the interpectoral region with special attention to Rotter's node.

Takayasu arteritis in Turkey

Takayasu arteritis is a non-specific inflammatory process of unknown etiology affecting the aorta and its branches. A retrospective study was done in 14 patients diagnosed as Takayasu arteritis. Eleven patients were female and three were male. Ages ranged from 12 to 30 years. Seven patients had type I arteritis, three patients type II arteritis, and four patients type III Takayasu arteritis. Successful angioplasty was performed in five cases.

A giant bladder stone: managed with osteotome

An unusual case of bladder stone is presented. The size of stone and the operation technique were exceptional in the urologic literature. The stone could be palpated on physical examination. The stone was removed by fragmentation with osteotome because of adherence of the stone to the bladder wall. The stone weighed 570 g.

Evaluation of impotent men with intracorporeal injection of papaverine and colour Doppler ultrasound

Fifty impotent patients have been evaluated with intracorporeal injection of papaverine and colour Doppler ultrasound. The papaverine tests were negative in 34 of 50 patients. Nineteen of 34 patients with negative papaverine results showed normal colour Doppler findings. In 14 of 16 patients with positive papaverine results the colour Doppler analysis revealed normal structure and functions. Correlation between intracorporeal papaverine injection and colour Doppler ultrasound results was found in 59% (p < 0.01). We concluded that intracorporeal papaverine injection is an effective, simple diagnostic test for beginning evaluation of impotent men. However, this screening test should be supported by colour Doppler ultrasound.

Image-directed and color Doppler ultrasonography in the diagnosis of postbiopsy arteriovenous fistulas of native kidneys

Using image-directed and color Doppler ultrasonography (ICDUS), we examined 65 patients with single kidney biopsy and diagnosed one arteriovenous fistula (AVF) in each of 8 kidneys. Three of them were associated with pseudoaneurysms. Three of the patients with AVF who presented with macrohematuria underwent angiography. Therapeutic percutaneous embolization was performed in 2 of them. The remaining 6 patients were followed up with ICDUS. All the lesions had disappeared at the end of a 6-month period. We conclude that ICDUS is an easy and noninvasive imaging technique in the diagnosis of postbiopsy native renal AVFs.

Image-directed color Doppler ultrasonography in the evaluation of superficial solid tumors

Image-directed color Doppler ultrasonography (ICDUS) studies of 86 patients with superficial solid masses yielded significantly lower resistive index (RI) values in acute inflammatory lesions, but no significant difference between the maximum systolic flow velocities (S) of the patient groups with malignant, benign, and acute inflammatory lesions. When analyzed separately, the malignant soft-tissue tumor subgroup was shown to have significantly higher mean RI compared to that of the malignant node subgroup. We conclude that RI may be useful in the differentiation of acute inflammatory masses from other pathological entities. Malignant soft-tissue tumors, especially sarcomas, may have different Doppler features from those of carcinomatous tumors.

Evaluation of palpable breast masses with 99Tcm-MIBI: a comparative study with mammography and ultrasonography

We evaluated the feasibility of 99Tcm-methoxyisobutylisonitrile (MIBI) as a tumour localizing agent in patients with palpable breast masses in comparison with mammography and ultrasonography (US). Forty-one patients with palpable masses were studied. An additional 12 women with no palpable breast anomaly also underwent 99Tcm-MIBI breast study. Multiple views were obtained and semiquantitative evaluation was applied. Mammography and US revealed all of the malignant breast masses but differential diagnosis of fibroadenomas could not be achieved. Twenty-five of 27 breast carcinomas were detected using 99Tcm-MIBI scintigraphy. Two patients with invasive lobular carcinoma showed absent MIBI accumulation. Eight of 14 axillary lymph-node metastases showed positive uptake (57%). Twelve of 14 patients with pathologically proven benign breast lesions did not demonstrate any MIBI accumulation. Focal MIBI uptake could be observed in two fibroadenomas. The sensitivity and the specificity of semiquantitative MIBI analysis were 93 and 86%, respectively. Subjective grading offered no additional help in the further differentiation of malignant breast masses. There was no significant difference between histopathological types of breast carcinomas and uptake grades. Our results indicate that 99Tcm-MIBI scintigraphy may provide additional information in the differentiation of malignant pathologies from benign lesions in patients with palpable breast anomalies.

Antispermatozoal antibody values after varicocelectomy

Although there are many causes of the production of antispermatozoal antibodies, there are still unknown aetiological factors. Antispermatozoal antibodies were investigated in the postoperative period in 25 infertile men with varicocele whose antispermatozoal antibody tests were negative in the preoperative period. Antispermatozoal antibodies were found in the serum in 4 of the 25 (16%) infertile men after varicocele operation. Postoperative genital infections were detected in 6 patients and antispermatozoal antibodies were present in only 2 of them. The correlation between these antibodies and varicocele has been demonstrated but there is no report on the association of antibodies with varicocelectomy in the literature to date.