Small Bowel Adenocarcinoma of Ileal Ureter 40 Years After Ureteral Reconstructive Surgery.

Malignant neoplasm arising from ileal ureter used for ureteral reconstructive surgery is an exceedingly rare event. Ureteroileoplasty was being performed since the beginning of the last century, but it was described more extensively in literature during the 1950s.1,2 Recurrent urinary infections, chronic renal failure, urolithiasis, anastomotic stricture, metabolic acidosis, and chronic dilation of the graft had been described as late complications of ureteroileoplasty.3,4 Herein, we describe history, imaging and pathologic findings of a small bowel adenocarcinoma arising from ileal ureter in a woman of 78-year-old, subjected to ureteroileoplasty about 40 years earlier.

Solid Renal Tumors Isoenhancing to Kidneys on Contrast-Enhanced Sonography: Differentiation From Pseudomasses.

OBJECTIVES: To estimate the prevalence of solid renal tumors isoenhancing to kidneys in all vascular phases on contrast-enhanced sonography and to investigate whether they can be differentiated from pseudomasses. METHODS: A computer search of the databases of 3 institutions identified 31 patients with pseudomasses and 380 patients with solid tumors investigated with contrast-enhanced sonography. Nineteen of 380 (5%) patients had tumors isoenhancing in all phases. Images and clips of these 19 tumors and the 31 pseudomasses were blindly assessed by 2 radiologists. They were asked to differentiate tumors from pseudomasses based on echogenicity, vascular architecture, and the presence of the medulla. RESULTS: Isoenhancing tumors were clear cell carcinomas (n = 7), angiomyolipomas (n = 3), papillary tumors (n = 3), metastasis (n = 1), and oncocytoma (n = 1). In the 4 nonoperated tumors, the diagnosis was confirmed by progression during the follow-up. There were 3 markedly hyperechoic, 11 mildly hypo/hyperechoic, and 5 isoechoic masses. Most pseudomasses were isoechoic to kidneys (23 of 31), with the medulla identified in 22 of 31 and 15 of 31 by radiologists 1 and 2, respectively. One and 2 pseudomasses were considered tumors by radiologists 1 and 2, respectively. One isoechoic isoenhancing tumor was not identified on contrast-enhanced sonography. Isoenhancing tumors in all phases were differentiated from pseudomasses by combining grayscale and contrast-enhanced sonography (areas under the receiver operating characteristic curve, 0.997 for reader 1; 0.969 for reader 2), with very good inter-reader agreement (weighted κ = 0.81). CONCLUSIONS: In our retrospective study, 5% of solid renal lesions were isoenhancing to kidneys in all phases. Differentiation from pseudomasses was possible by looking at baseline sonographic features and vascular characteristics.

Percutaneous radiofrequency ablation of benign thyroid nodules assisted by a virtual needle tracking system.

Our aim was to assess the feasibility and outcome of ultrasound (US)-guided percutaneous radiofrequency (RF) ablation of benign thyroid nodules assisted by a real-time virtual needle tracking (VT) system. Forty-five patients (34 females, mean age ± standard deviation (SD): 44 ± 16 y, range: 29-68 y) with 45 benign non-functioning thyroid nodules (mean volume ± SD: 13.5 ± 6.7 mL, range: 12-22 mL) underwent VT-assisted US-guided RF ablation. Nodule volume was evaluated before treatment and during 6-mo of follow-up. Complication rates and patient satisfaction after treatment were also evaluated. By use of the VT system, the tip of the RF electrode was identified during all ablation procedures. The overall mean volume reduction and complication rate were 72.6 ± 11.3% and 2.5%, respectively. Overall satisfaction at the 6-mo follow-up was rated by patients as positive in 42 cases (93%). The VT system could be useful in thyroid nodule ablation procedures because it is able to track the RF electrode tip even when the tip is obscured by the bubbles produced by the ablative process. VT-assisted RF ablation can be a tolerable, non-surgical treatment for patients with benign non-functioning thyroid nodules.

How often do patients ask for the results of their radiological studies?

OBJECTIVES: To measure how often patients ask directly about their test results at the end of imaging studies. METHODS: A total of 1,171 outpatients underwent ultrasonography (384), CT (382) or MR of the extremities (405). Demographic features including age, sex, educational background, anxiety and type of examination (initial examination vs follow-up) were considered. Statistical analysis was carried out by means of the chi-square test. RESULTS: Of the 1,171 patients, 525 (45%) asked for information about the results of their studies. Only 88/382 (23%) patients asked after CT; 224/405 (55.3%) asked after MR, and 213/384 (55.5%) asked after US (CT vs US and vs MR p < 0.001). There was a highly significant trend regarding education (36.4% with elementary schooling; 41.5% with intermediate education; 55.1% with higher schooling or university degrees; p < 0.001). No other differences were noted. CONCLUSION: We believe these results show the importance of the direct doctor-patient relationship during radiological studies. Communication, time to talk and provision of information are probably the most important things patients want from their doctors. Our study suggests that this is also relevant in radiology and, when given the opportunity to meet the radiologist, patients appreciate the interaction.

Radiology of patients with vertical banded gastroplasty.

BACKGROUND: The authors evaluated the usefulness of routine traditional radiology in the management of patients submitted to VBG. METHODS: Radiological findings in 65 subjects who had undergone VBG were evaluated. Post-surgical clinical and radiological examinations were performed 3 days, 1, 4 and 12 months after surgery. Upper GI symptoms, gastroesophageal imaging and 80% solid meal pouch emptying time were recorded. RESULTS: The routine postoperative study, in the absence of clinical symptoms, showed no unsuspected complication in any patient, both in the early and in the late postoperative period. There was no significant correlation at 4 and 12 months between emptying time and duration of satiation, emptying time and percent excess weight loss (%EWL), and duration of satiation and %EWL. CONCLUSIONS: Traditional radiological studies can be safely omitted from both the immediate postoperative period and from the long-term follow-up in asymptomatic VBG patients. The studies were not helpful in understanding functional changes leading to weight loss after VBG.