Ahmet Bas

Posttraumatic nonischemic priapism treated with autologous blood clot embolization.

INTRODUCTION High-flow arterial priapism is rare and characterized by a prolonged nonpainful erection. Autologous clot embolization allows complete resolution of the problem in most of the cases. AIM To review our experience with superselective transcatheter embolization in the treatment of nonischemic priapism. MAIN OUTCOME MEASURES Advances in the understanding of the nonischemic priapism with the aid of newer techniques have altered the current management of nonischemic priapism. MATERIALS AND METHODS Between 2002 and 2006, 11 patients underwent superselective transcatheter embolization of nonischemic priapism with blunt trauma to the penis or perineum. All patients underwent diagnostic evaluation with color-flow Doppler ultrasound and superselective pudendal arteriography, revealing bilateral arteriocorporal fistula and pseudoaneurysm in two cases, bilateral arteriocorporal fistula in one case, unilateral arteriocorporal fistula in one case, and unilateral arteriocorporal fistula and pseudoaneurysm in seven cases. Autologous blood clot was used as an embolization agent in all cases combined with microcatheter guidance. RESULTS The procedure was technically successful in all cases. In three (27.2%) cases, a second embolization was required due to recurrence of priapism. In all patients, erectile function was restored within 6 weeks of the procedure. Follow-ups at 6 and 12 months after the last procedure revealed that full erectile capacity was restored in 10 of 11 patients, and these patients did not experience further recurrence of priapism. One patient reported a slight decrease in the quality of his penile erection. CONCLUSIONS Our experience revealed that superselective transcatheter embolization and transient occlusion of the fistula with autologous blood clot is an effective therapy for the treatment of nonischemic priapism. Furthermore, recovery of erectile function due to recanalization of the occluded vessel occurred weeks after the procedure.

An experimental model of traumatic nasoethmoidal cerebrospinal fluid fistula.

Cerebrospinal fluid fistula secondary to head trauma is a potentially dangerous problem and precise localization and radical treatment is mandatory. The diagnostic technique is either computed tomography cisternography or MR cisternography. For evaluating the safety of diagnostic modalities and efficacy of treatment especially in terms of surgery, animal studies demonstrating traumatic cerebrospinal fistula model are indispensable not only for neurosurgeons but also for neuroradiologists. The authors in this paper describe a traumatic cerebrospinal fistula in an animal model using rabbits. The cerebrospinal fluid leakage was demonstrated successfully in all eight rabbits and was verified by computed tomography cisternography. The results led us to conclude that rabbit model of traumatic cerebrospinal fluid fistula is safe and has low mortality and morbidity rates. Further studies including larger number of animals should be considered in order to verify safety more accurately.

Spontaneous Intracranial Hypotension Syndrome in a Patient With Marfan Syndrome and Autosomal Dominant Polycystic Kidney Disease

Intracranial hypotension is typically manifested by orthostatic headache. The most frequent underlying factor is cerebrospinal fluid leakage. It has been suggested that dural structural weakness in some connective tissue diseases may be responsible for dural tears and diverticula and consequently leakage. We present a case of spontaneous intracranial hypotension associated with Marfan syndrome and autosomal dominant polycystic kidney disease. The patient was treated successfully with epidural autologous blood patch. Dural involvements of these hereditary connective tissue diseases are also discussed.

Quadriceps fat-pad impingement syndrome: MRI findings

A 32-year-old man was referred to a radiology department for intermittent anterior knee pain and swelling for approximately 6 months. The patient denied any history of major trauma, fracture or infection. MRI was performed to diagnose the cause of knee pain. The axial view of MRI revealed increased patellofemoral joint effusion and the sagittal view of T1-weighted, and T2-weighted MRIs showed an oedema, increased intra-articular fluid and thickening of suprapatellar fat pad (figures 1 and 2). Also, oedema …

Changes in the elasticity of fibroadenoma during the menstrual cycle determined by real-time sonoelastography

OBJECTIVE Shear-wave elastography (SWE) presents quantitative data that thought to represent intrinsic features of the target tissue. Factors affecting the metabolism of the breast parenchyma as well as age, menstrual cycle, hormone levels, pregnancy and lactation, pre-compression artifact during the examination could affect these elastic intrinsic features. Aim of our study is to determine variation of fibroadenoma elasticity during the menstrual cycle (MC) by means of real-time shear-wave elastography (SWE) and identify the optimal time for SWE evaluation. METHODS Thirty volunteers (aged 20-40 years) who had biopsy-proven fibroadenoma greater than 1cm in diameter, with regular menstrual cycle and without contraceptive medication underwent SWE (ShearWave on Aixplorer, France) once weekly during MC. Statistical data were processed by using the software Statistical Package for the Social Sciences (SPSS) 19.0. A repeated measures analysis of variance was used for each lesion where the repeated factor was the elastographic measurements (premenstrual, menstrual and postmenstrual). Pillais trace test was used. Pairwise correlation was calculated using Bonferroni correction. Values of p<0.05 were considered statistically significant. RESULTS The mean elasticity value of fibroadenomas in mid-cycle was 28.49 ± 12.92 kPa, with the highest value obtained in the third week corresponding to the premenstrual stage (32.98 ± 13.35 kPa) and the lowest value obtained in the first week corresponding to the postmenstrual stage (25.39 ± 10.21 kPa). Differences between the elasticity values of fibroadenomas in premenstrual and postmenstrual periods were statistically significant (p<0.001). There were no significant differences in lesion size between the different phases of the menstrual cycle (p>0.05). CONCLUSION In this study, we found that there is significant difference between the elasticity values of fibroadenomas on premenstrual and postmenstrual period. We propose that one week after menstruation would be appropriate time to perform breast SWE.

Percutaneous Transcatheter Embolization of Gastrointestinal Bleeding in a Child with Polyarteritis Nodosa

Summary Background Polyarteritis nodosa is a form of necrotizing vasculitis of small and medium-sized arteries. Major gastrointestinal complications are ulceration, perforation, hemorrhage, and obstruction. Case Report We report on a clinical case of a 16-year-old female patient with massive hematemesis, who was successfully treated with embolization with a 1:2 dilution of N-butyl cyanoacrylate glue. Conclusions To the best of our knowledge, this is the youngest child reported on with massive GI bleeding secondary to PAN, treated with successful percutaneous transcatheter embolization under emergency conditions.

Pelvic haemophilic pseudotumour in a patient with haemophilia.

We report a 20-year-old male patient, with a history of haemophilia presented with a sudden onset of pain in the right gluteal region of 5 days duration. He is afebrile; there is no history of trauma. He developed painful swelling in his right gluteal region for nearly 1 week with difficulty in walking. Physical examination revealed tenderness at the same site. CT examination confirmed the presence of a …

Adult diagnosis of Swyer-James-Macleod syndrome

Swyer-James-Macleod syndrome (SJMS) is a rare, complex disease characterised by unilateral hyperlucent lung or lobe owing to loss of pulmonary vasculature and alveolar hyperdistention. Patients with SJMS may be asymptomatic at diagnosis, but its differential diagnosis with asthma is difficult. Almost all the reported cases of SJMS were managed by conservative therapy, comprising prevention and treatment of recurrent pulmonary infections.

Silent sinus syndrome: CT and MRI findings

A 27-year-old man presented with a chief complaint of right eye enophthalmos. He had no visual symptoms and detailed ophthalmic examination showed a right-sided enophthalmos with hypoglobus, giving a sunken sulcus appearance to the right upper lid. The clinical picture was inferior displacement of orbital floor without recent history of orbital trauma. The patient also had no recent history of sinusitis. A subsequent CT and MR scan of the orbits …

Occult bleeding of small bowel: endovascular embolization and literature review

Blackwell Publishing Asia Melbourne, Australia CDD hines Journal of Digestive Diseases 1443-9611 751-2980