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Key Clinical Message: Although retroperitoneal bleeding and massive hematuria are potential complications of angiomyolipoma (AML), the pulmonary embolism as a presenting symptom is extremely rare. It is important to be aware that benign AMLs can present with pulmonary fat embolism. [ABSTRACT FROM AUTHOR]

Purpose: Fusion transcripts are transcriptome‐mediated alterations involved in tumorigenesis and are considered as diagnostic, prognostic, and therapeutic biomarkers. In metastatic colorectal carcinoma (mCRC), fusion transcripts are rarely reported. The main challenge is to identify driver chimeras with a significant role in cancer progression. Methods: In the present study, 86 RNA sequencing data samples were analyzed to discover driver fusion transcripts. Functional assays included clonogenic cell survival, wound‐healing, and transwell cell invasion. Quantitative expression analysis of epithelial‐mesenchymal transition (EMT), apoptotic regulators, and metastatic markers were examined for the candidate fusion genes. Kaplan–Meier survival analysis was performed using patient overall survival (OS). Results: A variety of driver fusions were identified. Fourteen fusion genes (51% of mCRC), each at least found in two mCRC samples, were determined as oncogenic fusion transcripts by in silico analysis of their functions. Among them, two recurrent chimeric transcripts confirmed by Sanger sequencing were selected. Positive expression of ADAP1‐NOC4L was significantly associated with an increased risk of poor OS in mCRC patients. In vitro transforming potential for the chimera, resulting from the fusion of ADAP1 and NOC4L was assessed. Overexpression of this fusion gene increased cell proliferation and enhanced migration and invasion of CRC cells. In addition, it significantly upregulated EMT and anti‐apoptotic markers. Conclusions: ADAP1‐NOC4L transcript chimera, a driver chimera identified in this study, provides new insight into the underlying mechanisms involved in the development and spread of mCRC. It suggests the potential of RNA‐based alterations as novel targets for personalized medicine in clinical practice. [ABSTRACT FROM AUTHOR]

【Abstract】Horseshoe kidney is an uncommon anomaly of the urinary system with an increased risk of injury during penetrating and blunt abdominal traumas. Self-inflicted abdominal stab wound, a rare type of abdominal injury, accounts for only a small percentage of suicidal at-tempts and may be infrequently encountered by physicians in trauma centers. Psychiatric disorders and alcohol or drug abuse are common risk factors in cases of self-stabbing. Here we report a rare case of self-stabbing of a horseshoe kidney. The case was a 19-year-old man with self-inflicted abdominal stab wound who was referred to our department of radiology due to re-occurred gross hematuria three days after exploratory laparotomy and surgical repair of injured abdominal organs. A horseshoe kidney was incidentally found in the patient’s abdominal computed tomography. Renal angiography revealed active contrast extravasation from one of the segmental arteries. Selective transarterial embolization with a coil was successfully performed to con-trol the hematuria. Key words: Embolization, therapeutic; Kidney; Wounds, stab

Aim and Objective To evaluate the association between ultrasonographic findings of inflammation (effusion, synovitis) and clinical findings in patients with primary painful knee osteoarthritis. Method This cross-sectional study was performed on 142 patients with primary painful knee osteoarthritis (American College of Rheumatology criteria) in whom the visual analogue scale of pain was 30 or more. Clinical parameters were evaluated by a rheumatologist using Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC) score while the ultrasonographic examination was performed by a musculoskeletal radiologist in our center. Knee joint synovitis and effusion were defined as synovial thickness ≥ 4 mm and depth of fluid in the suprapatellar recess ≥ 4 mm, respectively. Results Sixty-eight (47.9%) patients demonstrated neither synovitis nor effusion, 37 (26.1%) had only effusion, 11 (7.7%) had only synovitis and 26 (18.3%) had both effusion and synovitis in the ultrasonographic examination. There was significant association between ultrasonographic knee arthritis (defined as presence of synovitis or effusion) and WOMAC pain sub-score, WOMAC physical function sub-score and WOMAC total score. No significant association was noted between sonographic signs of arthritis and WOMAC joint stiffness sub-score. We also found significant correlation between ultrasonographic synovitis and WOMAC pain sub-score ( P < 0.001), WOMAC physical function sub-score ( P < 0.001) and total WOMAC score ( P < 0.001). Conclusion This study revealed a positive correlation between ultrasonographic synovitis and total WOMAC score, WOMAC pain and physical function sub-score. There was no association between sonographic signs of arthritis and WOMAC joint stiffness sub-score. [ABSTRACT FROM AUTHOR]

Lung metastasis is a rare cause of hemoptysis. Bronchial artery embolization is an effective intervention for treatment of hemoptysis with various underlying etiologies. A 28-year-old man with a known history of malignant melanoma in the neck from 6 years ago and lung metastasis from 1 year ago referred to the Emergency Department of our teaching hospital with the chief complaint of hemoptysis. Chest x-ray and pulmonary CT-scan showed multiple pulmonary nodules with different sizes in both lung parenchyma. The patient's hemoptysis did not resolve completely in spite of appropriate medical treatment. The patient was then referred to the endovascular unit of the vascular department in our hospital and underwent bilateral bronchial artery embolization. With this procedure his symptoms resolved completely and he was discharged after a week. [ABSTRACT FROM AUTHOR]

Introduction: Despite presence of a body of evidence in support of high accuracy of cholecystokinin cholescintigraphy (CCK-CS) , for diagnosis of chronic cholecystitis(CC) , some authors have claimed that gallbladder ejection fraction (GBEF) has poor predictive diagnostic values. The purpose of this study was to determine if there is any difference in GBEF between normal individuals and patients with CC. Methods: In a prospective case-control study, we studied 36 subjects as control group who did not have any abdominal symptoms, or history of abdominal disease or gallstone. Patients group were 42 with established choronic calcalous cholecystitis(CCC) who complaining of chronic biliary-like pain and had gallstone on ultrasonography. All subjects underwent gallbladder scintigraphy and GBEF was calculated at 30 and 60 minutes after fatty meal (FM) ingestion. Results: In control group GBEF at 30-minute and at 60-minute after FM ingestion were 69.54%±21.04% and 84.26%±11.41% respectively while in patients group GBEF at 30-minute was 61.21%±16.0l% and at 60- minute was 80.22%±12.57%. No significant difference was noticed between control and patient groups. GBEF didn't show significant difference between different groups based on the number of gallbladder stone, severity of chronic inflammatory (lymphoplasma) cell infiltration, wall thickness and evidence of fibrosis in the gallbladder wall. Conclusion: Our data are against the diagnostic value of the GBEF as measured by FM-CS in the workup of patients with CC. Thus, interpretation of GBEF should take the proper clinical context into consideration. [ABSTRACT FROM AUTHOR]

Horseshoe kidney is an uncommon anomaly of the urinary system with an increased risk of injury during penetrating and blunt abdominal traumas. Self-inflicted abdominal stab wound, a rare type of abdominal injury, accounts for only a small percentage of suicidal attempts and may be infrequently encountered by physicians in trauma centers. Psychiatric disorders and alcohol or drug abuse are common risk factors in cases of self-stabbing. Here we report a rare case of self-stabbing of a horseshoe kidney. The case was a 19-year-old man with self-inflicted abdominal stab wound who was referred to our department of radiology due to re-occurred gross hematuria three days after exploratory laparotomy and surgical repair of injured abdominal organs. A horseshoe kidney was incidentally found in the patient's abdominal computed tomography. Renal angiography revealed active contrast extravasation from one of the segmental arteries. Selective transarterial embolization with a coil was successfully performed to control the hematuria. [ABSTRACT FROM AUTHOR]

Alveolar hydatid disease is a highly malignant form of echinococcosis caused by the larvae of the cestode echinococcus multilocularis. Alveolar hydatid disease always affects the liver and can metastasise to the lung and brain. Early diagnosis and precise evaluation of the localization as well as the extent of lesions are essential for treatment. In this report, we present ultrasound and computed tomography findings in a patient with hepatic alveolar ecninococcosis. The patient, who was presented with hepatomegaly, jaundice, and an infiltrative solid tumor, diagnosed by ultrasound and computed tomography. In contrast to hydatid cyst caused by echinococcus granulosus, this is a rare disease in Iran. [ABSTRACT FROM AUTHOR]

Background: Chronic pulmonary thromboembolism (CTEPH) is an unusual complication of acute pulmonary embolism (PE), which is now considered to be treatable. In modern multi-detector scanners, a detailed evaluation of pulmonary artery geometry is currently possible. This study aimed to evaluate the changes in pulmonary artery bifurcation angle (PABA) in the follow-up computed tomography angiography (CTA) of patients with acute PE., Methods: In this cross-sectional study, the records of two tertiary-level academic hospitals were gathered from 2012 to 2019. Pulmonary artery (PA) bifurcation angle and diameter were measured. Chi square test, independent samples t test, Mann-Whitney, and Pearson's tests were employed to compare data. To evaluate the cut-off point, we utilized receiver operating characteristic (ROC) curve analysis. The accuracy, sensitivity, and specificity of pulmonary artery bifurcation angle changes were calculated. A P value <0.05 was considered to be significant., Results: Forty-six patients were included in the study. No significant differences were found between patients with and without CTEPH, and PABA in the dimeters of PA trunk, right PA, and left PA in the first CTA images (P values of 0.151, 0.142, 0.891, and 0.483, respectively), while in the secondary CTA, the mean PABA was significantly smaller in patients with CTEPH (P=0.011). In the receiver operating characteristic (ROC) analysis, delta angle revealed an area under the curve of 0.745 and an optimal cutoff of 0, leading to a sensitivity of 64%, specificity of 87%, and accuracy of 76% for diagnosing CTEPH., Conclusion: We showed a significant decrease in PABA in patients developing CTEPH. This parameter can be easily measured in lung CTA., (Copyright: © Iranian Journal of Medical Sciences.)

Background: The normal range of kidney size is a controversial issue among different populations given to its impressibility by multiple factors, therefore, this study aimed to provide valid reference ranges for kidney dimensions in the adult population of Mashhad. Also, we assessed the association of kidney size characteristics with some personal predisposing factors., Methods: This cross-sectional study was conducted on 938 healthy individuals. Ultrasound measurement, physical examination, and laboratory analysis were performed. Demographic, dietary, and anthropometric data were obtained. The variables were categorized into 5 groups each, and data analysis were performed using the following statistical tests: Pearson correlation test, variance analysis, t-test, and chi-square test. A value of p<0.05 was considered statistically significant., Results: Weight had the most association with kidney size followed to a lesser extent by height and age. Even after adjustment for other confounding variables, weight remained as an independent factor, while this effect was resolved for height and age. Also, all values for renal function, body bio-impedance, blood pressure components, and water intake were notably correlated with kidney size., Conclusion: This study determined the normal kidney size in healthy adults. We also declared the normal range of kidney size is a dynamic concept and should be assessed for each individual separately according to their personal determinative factors., Competing Interests: The authors declare that there is no conflict of interest.

BACKGROUND One of the earliest diagnostic signs of hepatorenal syndrome in patients suffering from liver cirrhosis is an increase in the renal vascular resistive index (RI). In this study, the impact of propranolol on decreasing this index and to postpone the probability of hepatorenal syndrome has been investigated. METHODS In the current research, 30 patients with liver cirrhosis with different age and sexes have been enrolled. Demographic data and complete medical history have been collected using a specific questionnaire. At first, renal artery Doppler ultrasonography was performed to determine the RI. The patients were then treated with propranolol, and under supervision, the dose of the drug was increased gradually every 3 to 5 days to reach the target of 25% decrease in resting heart rate. One month after reaching the target dose of the medicine, Doppler ultrasonography was repeated for the patients and the second RI was compared with the pretreatment ones. RESULTS According to our results after treatment with propranolol, a significant decrease of RI was observed ( p < 0.01). However, there was no significant difference in the glomerular filtration rate (GFR) before and after treatment with propranolol ( p = 0.290). In our study, we found that administering propranolol was associated with significant changes in RI and GFR between the patients with compensated and decompensated cirrhosis (mean change: -0.005 ± 0.017 vs. -0.058 ± 0.045; p < 0.01 for RI and -4.226 ± 17.440 vs. 13.486 ± 12.047; p < 0.01 for GFR in patients with compensated and decompensated cirrhosis, respectively). CONCLUSION Propranolol reduces renal vascular RI in patients with cirrhosis. The response rates in the patients with decompensating cirrhosis were significantly higher than the patients with compensating cirrhosis., Competing Interests: CONFLICT OF INTEREST The authors declare no conflict of interest related to this work.

Objective: Cancer represents the second cause of mortality in the world. Saffron as a medicinal plant is known for its anti-cancer and anti-depressant properties. In this randomized double blind clinical trial, the effects of saffron on response to treatment in patients suffering from liver metastasis were evaluated., Materials and Methods: Thirteen patients suffering from liver metastases who referred to Ghaem and Imam Reza hospital, Mashhad, Iran were included in this study and then divided into two different groups. Both groups received chemotherapy regimen. Patients in group one were treated with saffron capsule (50 mg, twice daily) during chemotherapy periods whereas patients in group two received placebo. A sum of the longest diameter were calculated and compared for all lesions in IV contrast CT scan before and after the treatment., Results: from 13 patients included in this study, six patients quit and seven continued until the end. In saffron-treated group, two patients showed partial and complete response (50%) whereas in placebo group, no response was seen. Also, two deaths in placebo and one in saffron group occurred., Conclusion: This research suggests that saffron might be useful in patients suffering from liver metastasis. However, further investigations with larger sample size are required.

Objective: To evaluate the efficacy and safety of intravenous and catheter directed thrombolysis by recombinant tissue plasminogen activator (Alteplase) in the patients with non-traumatic acute limb ischemia (ALI)., Methods: This was a randomized clinical trial being performed between 2009 and 2011 in Mashhad University of Medical Sciences. We included those patients who were<75 years, with symptoms of less than 14 days duration, ALI of grade IIa and IIb (according to Rutherford classification) and absence of distal run off. Baseline assessment of peripheral circulation performed in all the patients. Patients were randomly assigned to undergo intravenous (n=18) or catheter directed thrombolysis (n=20) with Alteplase. The primary endpoint of the study was improvement of clinical status measured by Rutherford classification, ankle brachial index (ABI), visual analogue scale (VAS) score measured at 1, 3 and 6 months. The secondary endpoint of the study was complete or near complete recanalization of the occluded artery., Results: A total number of 38 patients with mean age of 54.13±13.5 years were included in the study. There were 23 (60.5%) men and 15 (39.5%) women among the patients. Overall 3 (7.9%) patients had upper and 35 (92.1%) lower extremity ischemia. There was no significant difference between two study groups. None of the patients experienced major therapeutic side effects. Both ABI and VAS score improved in patients who have received first dose of t-PA within 24-hourof ALI. There was no significant difference between two study groups regarding the 6-month clinical grade (p=0.088), VAS score (p=0.316) and ABI (p=0.360). The angiographic improvement was significantly higher in CDT group (p<0.001)., Conclusion: Intravenous and catheter directed thrombolysis with t-PA is a safe and effective method in treatment of acute arteriolar ischemia of extremities. However there both intravenous thrombolysis and CDT are comparable regarding the clinical outcome.

Background: Traumatic events are one of the major causes of arterial injuries. Physical examination is not a good predictor of the extent of injuries and arteriography is considered as the gold standard for this purpose. In the recent years, noninvasive modalities are increasingly replacing diagnostic arteriography. Color Doppler ultrasonography (USG) is an excellent method to investigate arterial diseases., Objectives: The present study aimed to evaluate the diagnostic value of color Doppler USG compared to conventional angiography in traumatic arterial injuries of extremities., Patients and Methods: Seventy-five patients with extremity trauma suspicious for arterial injury were examined by color Doppler USG just before angiography. Doppler pattern and flow states were assessed, then angiography was performed. The results of duplex USG were compared with angiography., Results: Color Doppler USG had a sensitivity of 95% and specificity of 98% in diagnosis of arterial injury. Positive and negative predictive values of Doppler USG were 92.5% and 94.2%, respectively., Conclusions: Color Doppler USG can be used as a reliable modality with acceptable sensitivity and specificity values to screen hemodynamically stable patients with limb trauma suspicious for arterial injury.

Purpose: Hemodialysis access-induced distal ischemia (HAIDI) is an uncommon but potentially devastating complication. HAIDI is classified as acute, subacute and chronic based upon the time of onset. The aim of this study was to determine the prevalence, severity, patients' characteristics and the underlying etiologic mechanism of chronic HAIDI using color Doppler ultrasonography (CDUS)., Methods: Between June and August 2010, 676 hemodialysis patients with arteriovenous access (AVA) were evaluated for clinical evidence of chronic HAIDI. In the case-control part of the study, CDUS findings were compared between ischemic patients and asymptomatic matched controls. Also, patients with chronic HAIDI were followed up until February 2014, access ligation, kidney transplantation or death., Results: Eighteen chronic HAIDI patients were diagnosed (2.66%). Cold hand and cold sensation were the most common signs and symptoms of hand ischemia, respectively. Fifteen patients were classified in stage 1. Patients with proximal autogenous arteriovenous fistula, younger age, more previous AVAs and less access age were more likely to develop chronic HAIDI. Excessive fistula flow was found in the majority of ischemic patients (83.3%). The mean fistula flow was significantly higher in cases compared to controls (p=0.001). Eleven patients with chronic HAIDI were successfully treated by conservative measures alone until the end of follow-up (n=3), kidney transplantation (n=4) or death (n=4)., Conclusions: CDUS is a useful adjunctive diagnostic tool to determine the etiology of chronic HAIDI. Conservative measures combined with close follow-up can be used as the first step in the management of chronic HAIDI patients with mild symptoms.

Aim: To assess and compare the image quality of 4% sorbitol and diluted iodine 2% (positive oral contrast agent) in abdomino-pelvic multi-detector computed tomography., Methods: Two-hundred patients, referred to the Radiology Department of a central educational hospital for multi-detector row abdominal-pelvic computed tomography, were randomly divided into two groups: the first group received 1500 mL of 4% sorbitol solution as a neutral contrast agent, while in the second group 1500 mL of meglumin solution as a positive contrast agent was administered in a one-way randomized prospective study. The results were independently reviewed by two radiologists. Luminal distension and mural thickness and mucosal enhancement were compared between the two groups. Statistical analysis of the results was performed by Statistical Package for the Social Sciences software version 16 and the Mann-Whitney test at a confidence level of 95%., Results: Use of neutral oral contrast agent significantly improved visualization of the small bowel wall thickness and mural appearance in comparison with administration of positive contrast agent (P < 0.01). In patients who received sorbitol, the small bowel showed better distention compared with those who received iodine solution as a positive contrast agent (P < 0.05)., Conclusion: The results of the study demonstrated that oral administration of sorbitol solution allows better luminal distention and visualization of mural features than iodine solution as a positive contrast agent.

Objective: To compare the conventional angiographic findings in extremity trauma patients with or without runoff., Methods: This was cross-sectional study including all the patients with extremity trauma who underwent conventional angiography during the 2 year period from 2011 to 2013 in Angiography departments of Mashhad University of Medical Sciences. Mechanism of trauma, type of injury and angiographic findings were recorded in a questionnaire for each patient. After completion of treatment and discharge, the treatment type was added. The characteristics as well as clinical findings were compared between those who were diagnosed to have arterial runoff ad those who did not., Results: One hundred and forty eight traumatic patients including 15 female with age range of 11-82 years and 133 men ranging from 25 to 40 years were enrolled. Abnormal angiographic findings were provided in 99 (66.9%) patients including cutoff with distal runoff (n=60, 60.6% of abnormalities), cut off without distal runoff (n=21, 21.2%) and spasm (n=14, 14.1%) and other findings (n=4, 4%). Fifty one cases were treated under open surgery and amputation of traumatic limb was done for 13 patients. Amputation rate was higher in patients with cutoff and without runoff than those with cutoff and runoff (33.3% vs. 6.78%; p=0.002)., Conclusion: Causes and types of traumatic arterial injury in our study were different with other reports. It was shown that angiographic findings were less important in prognosis and management of patients. Patients with spasm in angiographic findings had a better prognosis than other patients and mostly did not need any vascular surgery. The presence or absence of a distal run off in primary angiographic findings can have a predictive value in the final amputation rate.