Multiparametric MRI guidance in first-time prostate biopsies: what is the real benefit?

PURPOSEWith the increased recognition of the capabilities of prostate multiparametric (mp) magnetic resonance imaging (MRI), attempts are being made to incorporate MRI into routine prostate biopsies. In this study, we aimed to analyze the diagnostic yield via cognitive fusion, transrectal ultrasound (TRUS)-guided, and in-bore MRI-guided biopsies in biopsy-naive patients with positive findings for prostate cancer screening.METHODSCharts of 140 patients, who underwent transrectal prostate biopsy after the adaptation of mp-MRI into our routine clinical practice, were reviewed retrospectively. Patients with previous negative biopsies (n=24) and digital rectal examination findings suspicious for ≥cT3 prostate cancer (n=16) were excluded. T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging were included in mp-MRI. Cognitive fusion biopsies were performed after a review of mp-MRI data, whereas TRUS-guided biopsies were performed blinded to MRI information. In-bore biopsies were conducted by means of real-time targeting under MRI guidance. RESULTSBetween January 2012 and February 2014, a total of 100 patients fulfilling the inclusion criteria underwent TRUS-guided (n=37), cognitive fusion (n=49), and in-bore (n=14) biopsies. Mean age, serum prostate specific antigen level, and prostate size did not differ significantly among the study groups. In TRUS-guided biopsy group, 51.3% were diagnosed with prostate cancer, while the same ratio was 55.1% and 71.4% in cognitive fusion and in-bore biopsy groups, respectively (P = 0.429). Clinically significant prostate cancer detection rate was 69.1%, 70.3%, and 90% in TRUS-guided, cognitive fusion, and in-bore biopsy groups, respectively (P = 0.31). According to histopathologic variables in the prostatectomy specimen, significant prostate cancer was detected in 85.7%, 93.3%, and 100% of patients in TRUS-guided, cognitive fusion, and in-bore biopsy groups, respectively. CONCLUSIONIn the first set of transrectal prostate biopsies, mp-MRI guidance did not increase the diagnostic yield significantly

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An effective alternative in the palliative treatment of massive hemoptysis: Endovascular intervention

Bu çalışmada, sınırlı akciğer rezervi nedeniyle cerrahi tedavi uygulanamayan ve endovasküler tedavi yapılmak üzere bölümümüze gönderilen 23 masif hemoptizi olgusu irdelenerek, tecrübelerimizin değerlendirilmesi ve karşılaşılan problemlerin analizi amaçlanmıştır. Ocak 1997-Ağustos 2000 tarihleri arasında yaşları 27-71 arasında değişen 23 olguda (3 kadın, 20 erkek) masif hemoptizinin kontrolü amacıyla transkateter embolizasyon yapılmıştır. On yedi (%74) olguda bir seans uygulanan endovasküler tedavinin ardından ortalama 18.4 aylık (2 gün-38 ay) takip süresi içinde hemoptizi tekrarlamamıştır. Altı (%26) olguda ilk girişimden ortalama 3.6 (1-7) ay sonra yeniden masif hemoptizi şikayeti gelişmiştir. Bu olguların beşinde kanama kaynağı anjiyografik olarak saptanarak, embolize edilmiştir. Son embolizasyondan günümüze dek, bir olguda yedi günlük ve diğer olgularda ortalama 28 aylık (18-36 aylık) izleme sürecinde hemoptizi bildirilmemiştir. Bir olgu ise ilk endovasküler tedaviyi izleyen bir aylık semptomsuz dönemin ardından müdahale edilemeden, abondan kanama nedeniyle yaşamını yitirmiştir. Çalışma grubumuzda yer alan hiçbir olguda işleme bağlı majör komplikasyon izlenmemiştir. Endovasküler tedavi, cerrahi tedavi uygulanamayan masif hemoptizi olgularında etkin ve güvenli bir palyatif tedavi seçeneğini oluşturmaktadır.The aim of this study was the evaluation of 23 patients with massive haemoptysis, who could not be treated surgically due to limited lung capacity and were sent to our department for endovascular intervention, in the light of our past experience and the analysis of problems that were encountered. Twenty three patients (3 females and 20 males) aged 27-71 years underwent transcatheter embolization for control of massive hemoptysis between January 1997 and August 2000. No recurrent haemoptysis was noted after one session of endovascular therapy during an average follow up period of 18.4 months (range: 2 days-38 months) in 17 cases (74%). Massive haemoptysis has recurred in six cases (26%) after the first intervention (average follow up: 3.6 months, range: 1-7 months). No heamoptysis has been reported up to the present time during seven-day follow-up in one case and a mean follow-up period of 28 months in the others (range: 18-36 months). One case has died due to uncontrollable bleeding after a one month symptom-free period. No major procedure-related complications have been encountered in our study. Endovascular therapy provides a safe and effective form of alternative palliative treatment in cases of massive haemoptysis

Cystic echinococcal liver disease: New insights into an old disease and an algorithm for therapy planning

Human cystic echinococcosis (CE) continues to be a major health problem in developing countries. A review of current literature discloses four alternatives for the management of active CE, consisting of surgery, percutaneous treatment (PT), chemotherapy, and follow-up without intervention, but no clear guidelines for directing patients to the different management options. Palliation of symptoms or prevention of complications is the main rationale for the treatment of CE. Surgery has long been considered as the gold standard treatment. However, a meta-analysis comparing the clinical outcomes of patients treated with PT with those of a control group treated with surgery found PT to be more effective, safer, and cheaper. Medical therapy is considered to be ineffective when the criterion of success is defined as the disappearance of the lesion. However, medical therapy seems to be effective when the goal of therapy is defined as the prevention of complications in asymptomatic patients. We propose an algorithm for therapy planning in CE where the first line of therapy for patients with active lesions is PT. Patients with lesions unsuitable for PT are directed to surgery if they are symptomatic, have complicated lesions or have lesions that are prone to rupture. Asymptomatic patients with uncomplicated lesions are directed to medical therapy. Medical therapy failures are redirected to surgery

Endovascular Treatment of a Superior Mesenteric Artery Aneurysm Secondary to Behcet's Disease with Onyx (Ethylene Vinyl Alcohol Copolymer)

Behcet's disease is a complex multisystemic chronic inflammatory disease that is characterized by oral and genital aphtous ulcers and vasculitis. Aneurysms of major arteries are the most important cause of mortality in Behcet's disease. Four patients with superior mesenteric artery (SMA) aneurysms related to Behcet's disease have been reported in the literature. We report here the first successful endovascular treatment of a giant, wide-necked SMA aneurysm secondary to Behcet's disease. We performed a balloon-assisted embolization technique using ethylene vinyl alcohol copolymer (Onyx, ev3, Irvine, CA, USA). There were no signs of recurrence during 2-year follow-up

Aorta após endoprótese para aneurisma micótico

Endopróteses vasculares são atualmente utilizadas no tratamento de diferentes patologias da aorta. Podem salvar a vida de pacientes com comorbidades e virtualmente inoperáveis quando da utilização de técnicas convencionais. Esse manuscrito relata o caso de um paciente de 40 anos, que havia sido previamente tratado de um aneurisma micótico sacular no arco aórtico e que apresentou ruptura da aorta descendente no seguimento de médio prazo. O tratamento da ruptura da aorta descendente também foi realizado através de medidas endovasculares, com sucesso

Diffusion weighted MR imaging of pancreatic islet cell tumors

Purpose: The aim of our study is to demonstrate the feasibility of body diffusion weighted (DW) MR imaging in the evaluation of pancreatic islet cell tumors (ICTs) and to define apparent diffusion coefficient (ADC) values for these tumors