Results of a long-term performance and follow-up of Endovenous Laser Ablatıon procedures performed for treating great saphenous vein incompetence

Objective: To assess the value of endovenous laser ablation (EVLA) for treating great saphenous vein (GSV) incompetence. Methods: We reviewed the overall results of EVLA procedures performed on 554 patients in our clinic between March 2011 and December 2015. Evaluations were made concerning the situations of the great saphenous vein (GSV), the energy used in the treatments, and the results obtained. We also investigated if there was a possibility to detect failure of EVLA treatment at an early stage. Results: From a total of 657 GSVs that were subjected to EVLA treatment, the procedure was found to be successful for 611 GSVs and unsuccessful for 46 GSVs (success rate: 93%). In 38 of the 46 GSVs, a thrombus formation was detected by color Doppler ultrasonography (CDUS) at the postoperative first month (82.6%). Conclusion: EVLA is a reliable and successful method utilized for the treatment of GSV incompetence. It is concluded that the detection of a thrombus in the GSV tract during the first postoperative follow-up month is an indicator for revascularization. © 2018, Professional Medical Publications. All rights reserved

An unexpected cause of small bowel obstruction in an adult patient: Midgut volvulus

The most important complication of intestinal malrotation is midgut volvulus because it may lead to intestinal ischaemia and necrosis. A 29-year-old male patient was admitted to the emergency department with abdominal pain. Ultrasonography (US), colour Doppler ultrasonography (CDUS), CT and barium studies were carried out. On US and CDUS, twisting of intestinal segments around the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) and alteration of the SMA-SMV relationship were detected. CT demonstrated that the small intestine was making a rotation around the SMA and SMV, which amounted to more than 360°. The upper gastrointestinal barium series revealed a corkscrew appearance of the duodenum and proximal jejunum, which is a pathognomonic finding of midgut volvulus. Prior knowledge of characteristic imaging findings of midgut volvulus is essential in order to reach proper diagnosis and establish proper treatment before the development of intestinal ischaemia and necrosis. Copyright 2014 BMJ Publishing Group. All rights reserved

Evaluation of the Diagnostic Accuracy of Prenatal MRI in Predicting Placenta Accreta Spectrum (PAS) and Clinical Outcomes in Cases with Placenta Previa

INTRODUCTION: The purpose of this study is to investigate the predictive value of magnetic resonance imaging (MRI) parameters in predicting placenta accreta spectrum (PAS) and clinical outcomes of patients with placenta previa. METHODS: A total of 56 prenatal placental MRI examinations acquired via 1.5 and 3 Tesla scanners were retrospectively examined by 2 radiologists in consensus. Presence of T2 dark band, thinning of myometrium, abnormal vascularization, uterine bulging, heterogeneous placenta, placental protrusion, placenta recess and percretism findings were evaluated. While pathology and clinical intrapartum findings constituted the reference standard for placenta accreta spectrum (PAS), intrapartum/peripartum bleeding over 1000 mL and emergency hysterectomy were regarded as poor clinical outcomes. The values of MRI findings in predicting both PAS and clinical outcomes were analyzed. RESULTS: Age, platelet (PLT) value and gestational age were similar in patients with both groups. Signs of percretism had the best diagnostic test performance in predicting clinical worsening, followed by intraplacental abnormal vascularization and placental recession (respectively 80.6%, 76.4%, 73.6%). The most valuable finding in predicting PAS was percretism sign, placental recess, and myometrial thinning (respectively 85.0%, 81.3%, 79.4%). DISCUSSION AND CONCLUSION: Percretism and intraplacental abnormal vascularization are highly predictive of a possible poor clinical outcome

Investigation of the Interobserver Variability of the Prostate Imaging for Recurrence Reporting (PI-RR) Score in Evaluating Local Recurrence in Prostate Cancer After Radiotherapy: Are Tumor Size and Prostate-specific Antigen Important?

INTRODUCTION: The aim of the study was to investigate the interobserver variability of the newly developed Prostate Imaging for Relapse Reporting (PI-RR) to assess recurrence in patients with prostate cancer who received radiotherapy. METHODS: A total of 81 patients who underwent multiparametric magnetic resonance imaging (mpMRI) examination between January 2018 and November 2022 due to the suspicion of local recurrence were retrospectively evaluated. All the mpMRI images were independently reviewed by three radiologists. None of the observers were blinded to clinical and pathological data (including primary tumor location). It was examined whether interobserver agreement increased according to the prostate-specific antigen (PSA) cut-off value being taken as 0,5 or 0,6 (µg/L) and the size of the tissue with tumor suspicion being greater than 1 cm or 1,5 cm. RESULTS: The mean age of the patients was 68,3 +- 6,6 years. The mean PSA was 2,32 +- 2,95 (µg/L), and the mean tumor size was 1,23 +- 0,77 (cm). A very high level of agreement was detected between the gold standard and observers 1, 2, and 3 (κ: 0,921 / 0,873 / 0,825, respectively). The agreement between the observers and the gold standard was also increased in the evaluation of patients with a PSA value above 0,5 (µg/L). Furthermore, patients with a tumor size greater than 1 cm had a very high level of agreement between the gold standard and the observers. DISCUSSION AND CONCLUSION: PI-RR detection rate of relapse tissue and interobserver agreement were correlated with PSA level and size of relapse tissue

Contrast-Enhanced Computed Tomographic Findings of the Wandering Spleen: A Case Report

Wandering spleen is a rare entity that defines abnormal localization of spleen due to various causes. Wandering spleen is prone to rotate on its peduncular axis and finally torsion and infarction. Contrast-enhanced computed tomography can visualize the torsioned peduncle and non-enhanced parenchyma with contrast medium. A 60-year-old woman who had abdominal pain was admitted to ER. Contrast-enhanced computed tomography depicts the abnormal localization of spleen and absence of contrast medium in the parenchyma and peduncle. Diagnosis was torsioned wandering spleen. Contrast-enhanced computed tomography is very important useful modality for diagnosis of torsioned wandering spleen

The Value of Fibrosis Index in Discrimination of Chronic Hepatitis and Cirrhosis

Aim: To evaluate the value of Doppler ultrasonography (US) and fibrosis index in differentiating between chronic hepatitis and cirrhosis. Methods: Sixty-seven non-cirrhotic viral hepatitis B and C patients and 28 cirrhotic patients were included in this study. All patients were examined by liver Doppler US. Quantitative Doppler parameters were obtained and fibrosis index was calculated. The results were evaluated statistically and a cut-off value for fibrosis index was obtained to differentiate between chronic hepatitis and cirrhosis groups. Results: The mean fibrosis index value in chronic hepatitis group and cirrhotic patients was 3.23±0.85 and 5.40±1.8, respectively. The difference between the two groups was statistically significant (p<0.05). Taking a cut-off value of 4.57 for fibrosis index, a sensitivity of 97% and a specificity of 71% were obtained. Conclusion: Fibrosis index may be valuable in monitoring of patients with chronic hepatitis and may be helpful in selecting patients who require biopsy