The comparison of local tumor control after microwave ablation, surgical resection and combined treatment for colorectal liver metastases

Aim. We aimed to compare the local therapeutic efficiency of microwave ablation (MWA), surgical resection, and combined treatment, assess the outcomes, and identify predictive factors for local treatment response in colorectal liver metastases (CLMs). Methods. From March 2013 to September 2019, a total of 54 patients with 302 CLMs were enrolled in this retrospective study. Eleven patients (20.4%) were treated with MWA, 9 patients (16.7%) with surgery, and 34 patients (63%) with the combined method. Univariate and multivariate analyses were performed to investigate overall survival (OS) and hepatic progression-free survival (HPFS) using the Cox proportional hazard regression model. The logistic regression analysis was used to identify the predictive factors for the local treatment response. Results. Total treatment response was achieved in 46.3% (n=25) of the patients. Local tumor progression was seen in 7.4% (n=4) of the patients, and the rate of intrahepatic distal recurrence was 46.3% (n=25). There were no significant differences in HPFS and OS between the three groups (p=0.56 and 0.90, respectively). Younger age

Late-onset tethered cord syndrome in a patient with spina bifida: A case report

Tethered cord is a clinical syndrome associated with short and thick filum terminale. It can occur because of congenital or acquired reasons and can lead to progressive neurological deficits. A thorough medical history, physcial examination, imaging, and electrophysiological tests are heplful in its diagnosis. An 11-year-old patient with a prior diagnosis of spina bifida was operated for pes ekinovarus at the age of 1.5 years. The patient visited our physical medicine and rehabilitation polyclinic with complaints of pain and weakness in the left ankle and region around the knee. She had been suffering from walking disruption, thinning of leg muscles, and pain for past 1 year. After imaging, a diagnosis of tethered cord syndrome was made. Follow-up of patients diagnosed with spina bifida during growth period is important to prevent complications such as syringomyelia and tethered cord syndrome

Compression of the celiac artery by the median arcuate ligament: Multidetector computed tomography findings and characteristics

WOS: 000359964200011PubMed ID: 25896451Purpose: The prevalence of the celiac artery stenosis caused by median arcuate ligament (MAL) compression and its multidetector computed tomography (MDCT) characteristics were evaluated in patients who underwent abdominal MDCT procedures, retrospectively. Methods: Totally 1121 patients who had abdominal MDCT with arterial phase or MDCT angiography of the abdominal aorta for various indications were analyzed for celiac artery compression by the MAL. Results: Fifty (ie, 4.6%) patients showed typical MDCT features of MAL compression. Focal narrowing of the proximal celiac artery, a characteristic hooked appearance of the narrowed segment without calcification and atherosclerotic changes were diagnostic. Poststenotic dilatation was detected in 22 (44%) patients with MAL compression. The ratio of the stenosis of the celiac artery was between 35%-50% in 15 patients and 51%-80% in 35 patients. The gastroduodenal artery diameter of these patients was not significantly different from the asymptomatic control group. Conclusion: MALS is an uncommon entity but it should be kept in mind in the presence of unexplained gastrointestinal symptoms. MDCT is a minimally invasive and plays a dominant role in the diagnosis of MAL compression especially with reformatted and 3-D reconstructed images.Objet : Nous avons evalu e, de fac¸on r etrospective, le taux de pr evalence de la st enose du tronc cœliaque attribuable a une compression par le ligament arqu e m edian et les caract eristiques observ ees par tomodensitom etrie multibarrettes (TDM multibarrettes) chez des patients ayant subi des techniques d’imagerie abdominale par TDM multibarrettes. M ethodes : Au total, nous avons analys e le dossier de 1 121 patients ayant subi une TDM multibarrettes abdominale avec acquisition a la phase art erielle ou une angiographie par TDM multibarrettes de l’aorte abdominale pour divers motifs afin de d eceler une compression du tronc cœliaque par le ligament arqu e m edian. R esultats : Des caract eristiques evoquant une compression par le ligament arqu e m edian ont et e observ ees par TDM multibarrettes chez 50 patients (soit 4,6 % des patients). Le r etr ecissement focal de la partie proximale du tronc cœliaque, l’aspect recourb e caract eristique de ce tronc¸on et l’absence de calcification et de modifications ath eroscl ereuses ont permis d’ etablir le diagnostic. Une dilatation post-st enotique a et e d ecel ee chez 22 des 50 patients (44 %) qui pr esentaient une compression par le ligament arqu e m edian. Le degr e de st enose du tronc cœliaque etait de 35 a 50 % chez 15 patients, et de 51 a 80 % chez 35 patients. Chez ces patients, le diametre de l’artere gastroduod enale ne diff erait pas sur le plan statistique de celui du groupe t emoin asymptomatique. Conclusion : Le syndrome du ligament arqu e m edian n’est pas courant, mais il doit ^etre pris en consid eration en pr esence de sympt^omes gastro-intestinaux inexplicables. La TDM multibarrettes est une technique peu effractive et de premier plan pour etablir un diagnostic de compression du tronc cœliaque par le ligament arqu e m edian, notamment avec des techniques de reformatage et de reconstruction tridimensionnelle des images

Diagnostic value of elastography in the diagnosis of ıntermetatarsal neuroma

WOS: 000378071300006PubMed ID: 26964696The objective of the present study was to characterize the ultrasound and elastographic properties of intermetatarsal neuroma (interdigital neuroma) and their contribution to diagnosis. Eighteen patients with metatarsalgia, who had presented to an orthopedic clinic from April 2013 to February 2015, were diagnosed with 25 intermetatarsal neuromas (11 unilateral [61.11%], 7 bilateral [38.89%]). These patients underwent evaluation with ultrasonography and simultaneous ultrasound strain elastography to assess the elastographic properties of the tissues in the intermetatarsal space. The intermetatarsal neuroma diagnosis was confirmed by histopathologic inspection. The lesion contours, localization, dimensions, and vascularization were evaluated before surgical excision. The elasticity and strain ratio values were compared between the neuroma and adjacent healthy intermetatarsal space. Of the 25 intermetatarsal neuromas, 1 (4%) was not detected by ultrasonography (incidence of detection of 96%). The mean neuroma width was 6.35 (range 3.7 to 13) mm in the coronal plane, and the mean elasticity and strain ratio values were 3.44 (range 1.1 to 5.1) and 9.47 (range 2.3 to 19.3), respectively. The elasticity and strain ratio values were significantly greater in the presence of an interdigital neuroma than in the adjacent healthy intermetatarsal spaces (Z = - 3.964, p = .0001 and Z = -3.927, p = .0001, respectively). The diagnostic cutoff values were calculated as 2.52 for elasticity and 6.1 for the strain ratio. Four neuromas (16%) were not demarcated, and the elasticity and strain ratio values for these were lower than those for neuromas with demarcated contours but were greater than those for healthy intermetatarsal spaces (p < .006 and p < .005, respectively). Patients with clinically suspected intermetatarsal neuromas that do not show demarcation and with smaller lesions might benefit from the use of ultrasound elastography for diagnosis

Meandering right pulmonary vein associated with retrocaval ureter and vertebral fusion anomalies

WOS: 000391829500013PubMed ID: 25586445We present multimodality imaging of a meandering right pulmonary vein in a 29-year-old female patient. It was associated with right retrocaval ureter causing hydronephrosis and stone formation, vertebral fusion anomalies and corrected cardiac anomalies (patent ductus arteriosus and ventricular septal defect). To the best of our knowledge, only a few meandering right pulmonary vein have been presented in the literature until now and this is the first reported case that is associated with retrocaval ureter and vertebral fusion anomalies

The efficacy of percutaneous treatment methods in bile duct stones

We aimed to search for the efficacy of percutaneous transhepatic cholangiography-guided balloon sphincteroplasty, mechanical lithotripsy, and laser lithotripsy in the treatment of bile duct stones and share our experience in retrievable internal plastic biliary stents derived from drainage catheter. Twenty-nine patients, in whom endoscopic retrograde cholangiopancreatography was contraindicated or failed, were included in this retrospective study. Balloon sphincteroplasty and balloons were used as the first choice of percutaneous treatment for stone removal. In four patients (14%), combined treatment with balloon sphincteroplasty and laser lithotripsy was performed. Plastic internal biliary stent converted from drainage catheter was advanced in 14 patients (48%). In 18 (62%) patients, a single procedure was performed while two sessions were required for nine patients and three sessions for two patients. Complete stone removal was achieved in 86% of the patients, and small residual stones remained in the biliary duct in four patients (14%). Two patients (7%) had minor complications including pain and fever, and the symptoms were ameliorated with conservative management. Stent retromigration was encountered in one patient (3.4%). The median follow-up time of the study was 4 months (range 1-51 months). Percutaneous treatment choices in bile duct stones are low-cost and safe methods that can be used efficiently if indicated

Psödoanjiomatöz stromal hiperplazi bildirilen kitlenin mamo-sonografi ve elastografi bulguları

WOS: 000370841500011PubMed ID: 28331712Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign mesenchymal proliferative lesion of the breast. In this study, we aimed to show a case of PASH with mammographic and sonographic features, which fulfill the criteria for benign lesions and to define its recently discovered elastography findings. A 49-year-old premenopausal female presented with breast pain in our outpatient surgery clinic. In ultrasound images, a hypoechoic solid mass located at the 3 o'clock position in the periareolar region of the right breast was observed. Due to it was not detected on earlier mammographies, the patient underwent a tru-cut biopsy, although the mass fulfilled the criteria for benign lesions on mammography, ultrasound, and elastography. Elastography is a new technique differentiating between benign and malignant lesions. It is also useful to determine whether a biopsy is necessary or follow-up is sufficient.Psödoanjiomatöz stromal hiperplazi (PASH), memenin benign mezenkimal proliferatif hastalıklarındandır. Stromal miyofibroblastların proliferasyonu sonucu oluşur. Tipik olarak pre ve perimenapozal kadınlarda görülür. Memede ağrı şikayetiyle genel cerrahi polikliniğine başvuran kırk dokuz yaşındaki premenapozal kadın hastanın yapılan meme ultrasonografisinde (US) sağ meme saat 3 hizasında periareolar alanda düzgün sınırlı, cilde paralel uzanımlı, homojen hipoekoik solid kitle saptandı. Kitlenin mamografik ve sonografik özellikleri benign kriterler taşımasına rağmen önceki mamogramlarda izlenmemesi nedeniyle kalın iğne biyopsisi yapıldı. Patoloji sonucu PASH olarak bildirilen hastanın mevcut mamografi, sonografi bulgularını tekrar gözden geçirmeyi ve elastografi bulgularını sunmayı amaçladık

Flow diverter stents in the treatment of cerebral aneurysms less than 5 mm

AIM: To evaluate the safety and efficacy of flow diverter (FD) stents in the treatment of intracranial aneurysms less than 5 mm. MATERIAL and METHODS: We treated 66 aneurysms in 43 patients with aneurysms less than 5 mm. Of the patients, 29 were females and 14 males (mean age: 50.2 years). Headache was the most frequent symptom. In 8 patients, the aneurysms were recanalized and these had been treated with coils or stent-assisted coiling. All aneurysms were in the anterior circulation. In the treatment, one of the SILK, Pipeline, Derivo or FRED FD stents was used for each patient. Neurointerventional stent medication (double antiplatelet) was used. All patients were investigated for new ischemic lesions with diffusion-weighted imaging one day later. The first follow-up angiogram was planned 3-6 months later. RESULTS: The treatment was technically successful in all patients. Minor complications occurred in 3 patients (7%). In one patient, thrombus inside the SILK was seen and was relieved with tirofiban. The second patient bled from the right common femoral artery entrance, which was operated on. In the third patient, the complication was technical. All patients were discharged without any neurological deficit. The mean follow-up period was 26 (6-52) months. Of the aneurysms, 64 (97.0%) were completely closed. CONCLUSION: The FD treatment of cerebral, anterior circulation small aneurysms less than 5 mm is effective and safe

Evaluación de lesiones de mama benignas patológicamente confirmadas utilizando inteligencia artificial en las imágenes ecográficas

Objectives: It was aimed to use AI retrospectively to evaluate US images of pathologically confirmed benign inflammatory lesions, to compare the results of AI with our US reports, and to test the reliability of AI in itself. Methods: US images of 71 histopathologically confirmed benign inflammatory breast lesions were analysed by the FDA-approved AI programme (Koios Decision Support) using 2 orthogonal projections. The lesions' probability of malignancy based on AI and BI-RADS categories of the lesion based on initial US interpretations were recorded. Categories obtained by both systems were divided into 2 groups as unsuspicious and suspicious in terms of malignancy and compared statistically. Reliability of AI was also evaluated. Results: No statistically significant difference was found in the lesions' likelihood of malignancy based on the AI and initial US interpretations (P = .512). Additionally, a positive and substantial association (τ-b = 0.458, P < .001) between the levels of suspicion by AI and the initial US interpretation reports was discovered, as per Kendall-b correlation analysis. With a Cronbach alpha correlation coefficient of 0.727, the reliability was high for AI. Conclusions: Benign inflammatory breast lesions may show suspicious appearances in terms of malignancy with US and AI. Artificial intelligence produces results comparable to radiologists' US reports for benign inflammatory diseases

The comparison of local tumor control after microwave ablation, surgical resection and combined treatment for colorectal liver metastases

Aim. We aimed to compare the local therapeutic efficiency of microwave ablation (MWA), surgical resection, and combined treatment, assess the outcomes, and identify predictive factors for local treatment response in colorectal liver metastases (CLMs). Methods. From March 2013 to September 2019, a total of 54 patients with 302 CLMs were enrolled in this retrospective study. Eleven patients (20.4%) were treated with MWA, 9 patients (16.7%) with surgery, and 34 patients (63%) with the combined method. Univariate and multivariate analyses were performed to investigate overall survival (OS) and hepatic progression-free survival (HPFS) using the Cox proportional hazard regression model. The logistic regression analysis was used to identify the predictive factors for the local treatment response. Results. Total treatment response was achieved in 46.3% (n=25) of the patients. Local tumor progression was seen in 7.4% (n=4) of the patients, and the rate of intrahepatic distal recurrence was 46.3% (n=25). There were no significant differences in HPFS and OS between the three groups (p=0.56 and 0.90, respectively). Younger age (<60), smaller (<= 2 cm) or fewer (<= 3) liver metastases, and wild-type RAS were predictive for higher rates of local treatment response (OR 0.22, 95% CI 0.15-0.93, p=0.04; OR 1.12, 95% CI 0.54-2.12, p=0.029; OR 1.37, 95% CI 0.97-2.37, p=0.035; OR 0.23, 95% CI 0.10-0.85, p=0.028, respectively). Conclusions. The results of this study reveal that the use of MWA, alone or combined with resection, may achieve high local treatment response and similar survival rates compared to patients undergoing resection, suggesting that MWA could potentially be preferred over surgical procedures