BackgroundInfection after transrectal ultrasound (TRUS) guided biopsy of the prostate is a major and potentially life-threatening problem. Using antibiotic premedication can not completely eliminate infection after biopsy.ObjectivesWe performed this study to determine the value of using povidone-iodine in prevention of post biopsy infection.Patients and MethodsTotally, 280 patients who were referred for TRUS guided biopsy of the prostate were divided randomly into two equal groups. The case group received an intrarectal mixture of povidone-iodine and lidocaine gel before performing biopsy, while the control group received only lidocaine gel. Patients were followed up for 30 days for possible signs of infection including fever, chills and dysuria.ResultsThe mean age in the case group was 68.7 ± 7 years and 68.1 ± 7 years in the control group (P = 0.78). Overall, there were signs and symptoms of infection in 78 patients (27.9%), of which 27 (19.3%) were in the case group, while 51 (36.4%) were in the control group (P = 0.001, OR = 2.4, 95% CI = 1.4-4.1).ConclusionSimple use of widely available povidone-iodine for cleaning the rectum before TRUS guided prostate biopsy can reduce the infection rate.

Computed tomography (CT)-guided percutaneous transthoracic biopsy of the lung is a well-established diagnostic technique, but it can pose complications to the patients. Air embolism is one of the rarest but potentially fatal complications of this procedure. The authors report a fatal case of systemic and massive air embolism to the coronary and cerebral arteries after the performance of lung biopsy. Careful reviewing of the obtained CT images during the procedure may avoid a missing systemic air embolism and can immediately provide an adequate therapy also in asymptomatic patients. This extremely rare complication is an inevitable event and may happen in spite of appropriate experience and meticulous care.

Background:Transrectal ultrasound guided biopsy of the prostate is the most common modality used to diagnose prostate cancer.Objectives:The aim of this study was to evaluate the optimal number of cores at prostate biopsy, which have the most diagnostic value with least adverse effects.Patients and Materials:Transrectal ultrasonography (TRUS) guided biopsy was performed in 180 patients suspicious for prostate cancer due to either abnormal rectal examination or elevated PSA. The patients were divided randomly into three groups of six-core, twelve-core and eighteen-core biopsies. The detection rate of prostate cancer in each group with the rate of post biopsy urinary infection and prostatitis were compared.Results:Prostate cancer was diagnosed in 8 (13.3%), 21 (35%) and 24 (40%) patients in six, twelve and eighteen core biopsy groups, respectively. Urinary tract infection and prostatitis occurred in 17 (28.3%), 23 (38.3%) and 35 (58.3%) patients in six, twelve and eighteen core biopsy groups, respectively. Considering the detection rate of prostate cancer, there was a significant difference between 6 and 12 core biopsy groups (P = 0.006) and 12-core biopsies detected more cases of prostate cancer, but there was no significant difference between 12 and 18 core biopsy groups (P = 0.572). Considering the infection rate, there was no significant difference between 6 and 12 core biopsy groups (P = 0.254), but there was a significant difference between 12 and 18 core biopsy groups (P = 0.028) and infectious complications occurred more frequently in 18-core biopsy group.Conclusions:The best balance between detection rate of prostate cancer and infectious complications of biopsies achieved in twelve-core biopsy protocol. Twelve-core biopsy enhances the rate of prostate cancer detection with minimum adverse effects.

Using mathematical functions and enhancing tools such as wavelet transform and other mathematical functions can improve the performance of CNN in any image processing task such as segmentation and classification.

Background:Cervical lymphadenopathy could be seen in several pathologic processes. An accurate differentiation between these conditions is of utmost importance to select an appropriate therapy and assess the prognosis. Gray scale and Doppler are appropriate sonographic techniques for evaluating internal and external features of lymph nodes. Although, various criteria have been proposed to differentiate metastatic lymph nodes from benign ones, the most valuable and specific sonographic features are still under dispute.Objectives:The present study was designed to determine valuable sonographic features for differentiating metastasis from benign nodes using gray scale and Doppler sonography.Patients and Methods:A prospective diagnostic study was performed on 63 patients with head and neck squamous cell carcinoma (SCC) treated and referred to surgery clinic of Hazrat Rasoul Akram hospital from November 2010 to June 2012 with complaint of palpable cervical lymph node. All patients’ necks were scanned multidirectionally by gray-scale and Doppler techniques. After sonography, lymph nodes were biopsied and investigated to find out whether they were metastatic or reactive. Finally, demographic, sonographic and pathologic data were statistically analyzed by SPSS ver. 16 software using t-test, a nonparametric test and ROC analysis. Ninety five percent confidence interval was considered for all parameters.Results:The study included 41 males and 22 females with a mean age of 57.56 ± 13.79 years. The number of metastatic lymph nodes was 47, while the remaining 16 were reactive. There were significant differences in length (P = 0.037), width (P = 0.001), resistance index (P < 0.001), pulsatility index (P < 0.001) and systolic velocity (P < 0.001) of metastatic and reactive lymph nodes. Cut points for resistive and pulsatility indexes and systolic velocity were calculated as 0.695, 1.35 and 16.5, respectively. The most valuable factor for defining a lymph node as metastatic was circulation pattern with accuracy, sensitivity and specificity of 94%, 85% and 93%, respectively.Conclusion:Gray scale sonography in combination with Doppler sonography could be a trustworthy technique in differentiating metastatic lymph nodes from reactive ones. Although, circulation pattern had a higher diagnostic accuracy in the present study, combination of sonographic characteristics could be more beneficial in differentiating metastatic cervical nodes from reactive ones.

Diphallia or duplication of the penis is an extremely rare but well-documented anomaly. According to the presence of one or two corpora cavernosa in each of the penises, diphallia is classified into two major groups of bifid phallus or true diphallia, respectively. We report a 5-year-old boy with duplication of the penis. Significant separation of the penises and their morphology made them appear as true complete phalluses, but MRI established the definitive diagnosis of bifid phallus by demonstrating the presence of one corpus cavernosum in each penis. MRI is a valuable method for achieving the accurate diagnosis of these anomalies and associated malformations. It also provides the appropriate knowledge regarding anatomical detail and assists the surgeon in decision making and preoperative planning for the optimal surgical approach.

Intracavernosal injection of a vasodilating agent, followed by color Doppler ultrasonography of the penis, is used to diagnose vascular impotence. The vasodilating agent is usually injected into one of the corpora cavernosa and the peak systolic velocity (PSV) of the cavernosal arteries is measured on both sides, presuming that the connection between the two cavernosal bodies will distribute the drug uniformly on both sides and will consequently affect the cavernosal arteries and sinusoids equally. According to our experience, the PSV of the injection side is higher than that of the contralateral side. This difference could affect the results of the evaluation. In this study, our objective was to compare the results of both-side injections with those of one-side injection. A total number of 60 patients with a normal Doppler study of the penis were enrolled in the study and were randomly divided into three groups. In the first and second group, 60 mg papaverine was injected into the right and left corpus cavernosa each. In the third group, half of the dose was injected into each side. The mean maximum PSV was measured and compared in each group. The mean maximum PSV in the group with the right-side injection was 47.7±10.8 and 40.3±9.2 on the right and left side, respectively. The mean maximum PSV in the group with the left side injection was 44.4 ± 7.1 and 51.4 ± 7.1 on the right and the left side, respectively. The mean maximum PSV in the group with bilateral injection was 47±9.9 on the right side and 46.7±10.7 on the left side. In the first two groups, there was significant difference between the mean maximum PSV of the right and left cavernosal arteries, but in the third group, there was no significant difference between the mean maximum PSV of both side cavernosal arteries. Injecting papaverine in only one corpus cavernosum, despite a perfect postinjection manipulation of the penis, will affect the sinusoids and cavernosal artery at the same side of the injection more than the contralateral side. This results in a higher increase in the blood flow and PSV on that side and results in an artifactual difference between the velocity of the right and left side, which could ultimately exaggerate or mask the actual difference between the two sides. Dividing the total dose of the vasodilating agent and injecting half of the dose into each corpus cavernosum separately prevents artifactual difference between blood flow and velocity on the right and left side.

Background:In prostate cancer, detection of seminal vesicle involvement is important because it influences the treatment planning and prognosis of the patients.Objectives:The objective of this study was to determine the value of prostate MRI with endorectal coil in the detection of seminal vesicle involvement in patients with prostate cancer.Patients and Methods:A total number of 238 biopsy-proven prostate cancer patients were examined by 1.5 Tesla MRI with a combination of pelvic and endorectal coils to detect seminal vesicle involvement. After radical prostatectomy, the MRI results were compared with pathology results.Results:Seminal vesicle involvement was detected in 67 (28.1%) patients. Pathology confirmed the involvement of seminal vesicles by prostate cancer in 63 patients. In two patients, seminal vesicle involvement was diagnosed by pathology but not detected by MRI. The sensitivity was 0.97 [95% confidence interval = 0.89-0.99], the specificity was 0.98 [95% confidence interval = 0.94-0.99], the positive predictive value was 0.94 [95% confidence interval = 0.85-0.98], and the negative predictive value was 0.99 [95% confidence interval = 0.96-0.99].Conclusions:MRI with endorectal coil is a valuable imaging technique with suitable accuracy in detecting seminal vesicle involvement in prostate cancer.