Intraoperative and surgical specimen (ex vivo) ultrasound in the assessment of margins at partial nephrectomy.

PURPOSE: To correlate the accuracy of intraoperative and surgical specimen (ex vivo) ultrasound (US) with pathological margin status at partial nephrectomy. MATERIALS AND METHODS: Patients undergoing partial nephrectomy for T1 renal tumours in the period May 2010-January 2014 at a single institution who had intraoperative specimen US were included. PN was performed by standardised technique with intraoperative tumour localisation. Following excision, surgical specimen (ex vivo) US was performed and the margin status was compared to the final histopathological analysis. The specificity of US to identify margin status was calculated as was the correlation between the ultrasonographic and final pathological margin. RESULTS: Forty-five patients were included (median age 61 years). Mean tumour size was 28.1 ± 10 mm, and 89 % were renal cell carcinomas with the remainder being oncocytomas. Forty-four cases had negative surgical margins on pathological analysis, and US had a specificity of 100 %. There was a strong correlation between the margin as measured on US and final analysis (Pearson's r = 0.86, p < 0.001). CONCLUSION: Results show that intraoperative, surgical specimen (ex vivo) US control of resection margins in patients undergoing PN is feasible and efficient. It represents a promising tool to ensure margin negativity during PN.

Contrast ureteropyelography in theatre: standardised flowchart reporting.

INTRODUCTION: Urologists perform retrograde contrast studies of the ureters and pelvicalyceal systems in the operating theatre, both for diagnostic purposes and to guide instrumentation. We describe the development of a set of guidelines that aim to standardise the diagnostic quality of these studies and to reduce radiation dose to the patient and theatre staff. The guidelines incorporate a reporting template that allows a urologist's written report to be made available on the picture archiving and com- munication system (PACS) for subsequent multidisciplinary review. METHODS: Three cycles of audit were conducted to assess the implementation of the guidelines. An independent reviewer rated image quality and screening times. During the audit cycle, the presentation of the guidelines was honed. The end prod- uct is a flowchart and reporting template for use by urologists in the operating theatre. RESULTS: Phase 1 of the audit included 63 studies, phase 2 included 42 studies and phase 3 included 46 studies. The results demonstrate significant improvements in the number of good quality studies and in the recording of control, contrast and post-procedure images. The mean screening time decreased from 5.0 minutes in phase 1 to 3.2 minutes in phase 3. In phase 3, when in-theatre reporting of the studies by the urologist was added, the handwritten report was scanned in and made available on PACS in 43 of 46 cases (93%). CONCLUSIONS Introduction of guidelines improved retrograde contrast study quality and reduced screening times. A system has been developed to store appropriate pictures and a urologist's report of the study on PACS.

A simple tool for rapid access to a symptomatic breast clinic.

AIM: The introduction of a rapid referral system has led to an increase in the number of patients with benign disease using clinic appointments. This situation could delay those patients, who do have cancer but are not referred within these rapid referral guidelines. Existing guidelines fail to benefit those patients with lower risk symptoms. We reviewed prospective audit data from patients referred to a symptomatic breast unit with the aim of introducing a referral schema based upon symptoms, age and relative risk of cancer. METHOD: Demographic details, mode of referral, history and presenting symptoms were collected from each of the 2064 patients referred to the James Cook University Hospital (JCUH) breast unit from April 2001 to March 2002. RESULTS: Odds Ratios (OR) from eight dependent variables gave a 30% improvement in prediction accuracy of breast cancer. From these findings a breast referral schema is presented that is designed to expedite referral from primary care of those patients most at risk. CONCLUSIONS: Use of the schema within primary care could lead to an increase in the early referral of patients with breast cancer.

Sonographic findings in the anterior interosseous nerve syndrome.

This report details previously undescribed sonographic findings in the anterior interosseous nerve syndrome. Loss of muscle bulk, increased reflectivity, reduced perfusion on Doppler sonography, and lack of active contraction of the affected muscles were observed. These findings can aid in the localization of the pathologic process and in the exclusion of tendon rupture. Dynamic observation of muscle function and Doppler changes after exercise can also help identify the muscles involved. Both sonography and MRI may be useful in the evaluation of patients with the anterior interosseous nerve syndrome and other peripheral neuropathies.

Cutis marmorata telangiectatica congenita with hypoplasia of the right iliac and femoral veins.

We describe a 37-year-old woman with an extensive congenital reticulate vascular naevus affecting predominantly the right side of the body associated with a naevus anaemicus. Investigation of persistent ulceration and scarring of the lower legs revealed right-sided hypoplasia of the hemipelvis and underlying ipsilateral hypoplasia of the deep veins of the pelvis and leg. This association has not previously been reported and its implications for morbidity and management are discussed.

Acquired involution of the maxillary antrum.

Maxillary sinus shrinkage can occur secondary to acquired benign osteomeatal disease. This may be associated with an external deformity and sinus wall sclerosis.

Plasma osmolality, iodine concentration and urographic images following high and low osmolar contrast media.

Three contrast media (sodium iothalamate, iopamidol and sodium/methylglucamine ioxaglate) in a dose of 240 mg iodine per kilogram of body weight were compared in clinical urography. The ionic monomer sodium iothalamate was the only medium to significantly elevate the plasma osmolality though it returned to normal values within 4 min. All three media exhibited first order linear kinetics. When corrected for the effects of diuresis, sodium iothalamate was shown to give the highest urinary iodine concentrations. On visual scoring sodium iothalamate produced better nephrograms and overall urograms than either of the low osmolar agents.

Transfemoral digital subtraction aortography. Are diluted high osmolar contrast media acceptable?

The ionic monomer, sodium diatrizoate at 150 mg I/ml (726 mosmol/kg) and the non-ionic monomer, iopamidol, diluted to the same iodine concentration but at 324.3 mosmol/kg, were randomly allocated to patients undergoing transfemoral intra-arterial digital subtraction angiography for lower limb peripheral vascular disease. The agents produced images of comparable quality and diagnostic efficacy. There were no significant differences between the media regarding sensations of pain and warmth. Minor neurological symptoms (headache and dizziness) occurred 7 times more frequently with the ionic monomer. There was a slight but temporary rise in plasma potassium one hour after injection of the ionic monomer but no evidence of appreciable intravascular haemolysis. The non-ionic monomer caused a slight fall in haemoglobin and haematocrit one hour after injection which is attributed to osmotic haemodilution. It is concluded that a diluted high osmolar contrast agent is an acceptable alternative to a low osmolar agent in transfemoral digital subtraction lower limb aortography.

Gartner's duct associated with diverticulosis of the fallopian tubes.

Hysterosalpingography demonstrated unilateral opacification of Gartner's duct and bilateral diverticulosis (salpingitis isthmica nodosa) of the fallopian tubes. An association of two mesonephric abnormalities in the same patient is postulated. The case also serves as a reminder of the association of diverticulosis with tubal ectopic pregnancy and infertility.