Bilateral parapelvic cysts that mimic hydronephrosis in two imaging modalities: a case report

Parapelvic cysts are uncommon conditions that are usually found during autopsy. Their ultrasonographic appearance is similar to hydronephrosis. We report the case of a 46-year-old female with a 4-year history of vague flank pain and a previous history of bilateral moderate hydronephrosis. The patient was investigated by ultrasonography and non-enhanced CT scan, and finally diagnosed as bilateral parapelvic cysts by a contrast-enhanced CT scan. For any patient with hydronephrosis detected by sonography, the possibility of parapelvic cysts should be kept in mind, especially if no underlying cause is detected and other routine imaging is inconsistent with hydronephrosis. In such circumstances a CT scan with contrast enhancement should not be refused, and relying on sonographic signs, previously mentioned in literatures, can be misleading

Accuracy of 64-multidetector computed tomography in diagnosis of adnexal tumors

<p>Abstract</p> <p>Background</p> <p>Adnexal cancers are in fifth place among the tumors with the highest mortality in the female population. The aim of the present study was to evaluate the accuracy of Multi-detector computed tomography (MDCT) on a 64-multislice CT scanner in the detection and differentiation of adnexal masses stages.</p> <p>Methods</p> <p>During the present prospective study, 95 women with a primary diagnosis of ovarian mass in base of clinical examination and ultrasonographic findings underwent preoperative evaluation by a 64-slice MDCT with a section thickness of 0.6 mm, 50% overlap and reconstructed images. Afterward, results of MDCT were compared with surgical and histopathological findings, and the sensitivity, specificity, positive and negative predictive value and accuracy were determined.</p> <p>Results</p> <p>The mean age of patients was 48.63 ± 13.93 years. MDCT diagnosed 25 (26.3%) masses to be benign and 70 (73.7%) to be malignant (sensitivity, specificity, positive and negative predictive value and accuracy were 92.8%, 88.0%, 95.5%, 81.4% and 91.5% respectively). The sensitivity and specificity of MDCT in determining local extension was 72.2% and 93.4% respectively. And the sensitivity and specificity of MDCT in determining peritoneal seeding and liver extension was 81.8% and 93% respectively. Estimated stage was significantly agreed with the surgical (Cohen's Kappa (κ) = 0.891) and histopathological findings (κ = 0.858).</p> <p>Conclusion</p> <p>MDCT is a highly sensitive and specific diagnostic method in evaluation of adnexal masses and successfully stage the tumor in consistent with surgery and histopathology.</p

Nomograms of Iranian fetal middle cerebral artery Doppler waveforms and uniformity of their pattern with other populations' nomograms

<p>Abstract</p> <p>Background</p> <p>Doppler flow velocity waveform analysis of fetal vessels is one of the main methods for evaluating fetus health before labor. Doppler waves of middle cerebral artery (MCA) can predict most of the at risk fetuses in high risk pregnancies. In this study, we tried to obtain normal values and their nomograms during pregnancy for Doppler flow velocity indices of MCA in 20 – 40 weeks of normal pregnancies in Iranian population and compare their pattern with other countries' nomograms.</p> <p>Methods</p> <p>During present descriptive cross-sectional study, 1037 normal pregnant women with 20^th–40^thweek gestational age were underwent MCA Doppler study. All cases were studied by gray scale ultrasonography initially and Doppler of MCA afterward. Resistive Index (RI), Pulsative Index (PI), Systolic/Diastolic ratio (S/D ratio), and Peak Systolic Velocity (PSV) values of MCA were determined for all of the subjects.</p> <p>Results</p> <p>Results of present study showed that RI, PI, S/D ratio values of MCA decreased with parabolic pattern and PSV value increased with simple pattern, as gestational age progressed. These changes were statistically significant (P = 0.000 for all of indices) and more characteristic during late weeks of pregnancy.</p> <p>Conclusion</p> <p>Values of RI, PI and S/D ratio indices reduced toward the end of pregnancy, but PSV increased. Despite the trivial difference, nomograms of various Doppler indices in present study have similar pattern with other studies.</p

Long and Short-term Metformin Consumption as a Potential Therapy to Prevent Complications of COVID-19

Purpose: The aim of the study is to evaluate the effect of metformin in complication improvement of hospitalized patients with COVID-19. Methods: This was a randomized clinical trial that involved 189 patients with confirmed COVID-19 infection. Patients in the intervention group received metformin-500 mg twice daily. Patients who received metformin before admission were excluded from the control group. Patients who were discharged before taking at least 2000 mg of metformin were excluded from the study. Primary outcomes were vital signs, need for ICU admission, need for intubation, and mortality. Results: Data showed that patients with diabetes with previous metformin in their regimen had lower percentages of ICU admission and death in comparison with patients without diabetes (11.3% vs. 26.1% (P=0.014) and 4.9% vs. 23.9% (P≤0.001), respectively). Admission time characteristics were the same for both groups except for diabetes and hyperlipidemia, which were significantly different between the two groups. Observations of naproxen consumption on endpoints, duration of hospitalization, and the levels of spO2 did not show any significant differences between the intervention and the control group. The adjusted OR for intubation in the intervention group versus the control group was 0.21 [95% CI, 0.04-0.99 (P=0.047)]. Conclusion: In this trial, metformin consumption had no effect on mortality and ICU admission rates in non-diabetic patients. However, metformin improved COVID-19 complications in diabetic patients who had been receiving metformin prior to COVID-19 infection, and it significantly lowered the intubation rates

Laryngeal Ultrasonography Versus Cuff Leak Test in Predicting Postextubation Stridor

Introduction: Although cuff leak test has been proposed as a simple method of predicting the occurrence of postextubation stridor, cut-off point of cuff-leak volume substantially differs between previous studies. In addition, laryngeal ultrasonography including measurement of air column width could predict postextubation stridor. The aim of the present study was to evaluate the value of laryngeal ultrasonography versus cuff leak test in predicting postextubation stridor.Methods: In a prospective study, all patients intubated for a minimum of 24 h for acute respiratory failure, airway protection and other causes were included. Patients were evaluated for postextubation stridor and need for reintubation after extubation. The cuff leak volume was defined as a difference between expiratory tidal volumes with the cuff inflated and deflated. Laryngeal air column width was defined as the width of air passed through the vocal cords as determined by laryngeal ultrasonography. The air-column width difference was the width difference between balloon-cuff inflation and deflation.Results: Forty one intubated patients with the mean age of 57.16±20.07 years were included. Postextubation stridor was observed in 4 patients (9.75%). Cuff leak test (cut off point: 249 mL) showed sensitivity and specificity of 75% and 59%, respectively. In addition, laryngeal ultrasonography (cut off point for air column width: 10.95 mm) resulted in sensitivity and specificity of 50% and 54%, respectively. Positive predictive value of both methods were <20%.Conclusion: Both cuff leak test and laryngeal ultrasonography have low positive predictive value and sensitivity in predicting postextubation stridor and should be used with caution in this regard

Remnant kidney function and size in living unrelated kidney donors after nephrectomy

There are few published reports examining the extended outcome of donors after nephrectomy. The aim of present prospective study was to evaluate the changes of glomerular fil-tration rate (GFR) and ultrasonographic kidney size in unrelated living kidney donors during post-nephrectomy period. Thirty nine unrelated living kidney donors were prospectively followed after nephrectomy. Length, anterioposterior (AP) diameter, and cortical thickness of the kidney were determined before, one week and three months after nephrectomy. GFR and serum creatinine (Cr) level were assessed simultaneously. The mean age of participants was 25.41 &#177; 2.67 years with the male to female ratio of 29 to 10. Although GFR decreased 1 week after nephrectomy (P= 0.001), considering the pre-nephrectomy GFR as a result of both kidneys&#x2032; function and half of its value as a marker of the remnant kidney&#x2032;s function [(123.68 &#177; 17.99)/2], the calculated GFR for the remnant kidney increased about 63&#x0025; after one week and 91&#x0025;, after three months of nephrectomy (P= 0.003). Remnant kidney length, AP diameter, and cortical thickness were significantly in-creased during post-nephrectomy follow up (P&lt; 0.001, P&lt; 0.001, and P= 0.001, respectively). Results of present study showed that the GFR of remnant kidney was increased after nephrectomy, and serum Cr level was not changed, despite the mild increase at first post nephrectomy week. Also, remnant kidney size increased following nephrectomy in donors

Postnephrectomy Changes in Doppler Indexes of Remnant Kidney in Unrelated Kidney Donors

&lt;p&gt;&lt;strong&gt;Introduction:&lt;/strong&gt; We aimed to evaluate the intralobar renal arteries indexes using the Doppler ultrasonography indexes, which have become the established method of kidney monitoring, in living unrelated kidney donors during the postnephrectomy period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and Methods:&lt;/strong&gt; In this prospective study, we evaluated and followed up 34 living unrelated kidney donors. The Doppler ultrasonography indexes, including resistive index, pulsatility index, and peak systolic velocity, along with the grey-scale ultrasonographic indexes of cortical thickness, length, and anteroposterior diameter of the kidney were determined before nephrectomy, and then, 1 week and 3 months after nephrectomy. In addition, glomerular filtration rate were assessed simultaneously.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The resistive index and pulsatility index did not change 1 week and 3 months after nephrectomy (P = .66 and P = .38, respectively). The peak systolic velocity at 1 week was significantly higher than its prenephrectomy value (P = .02). Also, the peak systolic velocity at 3 months was significantly higher than that prior to nephrectomy (P &lt; .001). Indexes of the kidney size all increased during the follow-up period. The estimated glomerular filtration rate increased decreased 1 week after nephrectomy, but it reach to a level comparable with its preoperative values after 3 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Results of the present study showed an increased peak systolic velocity in association with unaltered resistive index and pulsatility index in the remnant kidney of donors, during the short-term follow-up. This finding indicates the increased blood flow and kidney size in the remnant kidney of donors, following nephrectomy.&lt;/p&gt