Hounsfield unit density in the characterisation of bile duct lesions

Purpose: To study the density of lesions in the lumens of extrahepatic bile ducts through computed tomography examinations, and to compare their characterisations with the results of pathology and/or endoscopic retrograde cholangiopancreatography (ERCP). Methods: The density of lesions along extrahepatic bile ducts were measured and compared with pathology and/or ERCP. The lesions were evaluated in two main groups: benign or malignant. The bile duct wall enhancement, intrahepatic bile ducts, and gallbladder were also evaluated. Results: The study was conducted with computed tomography scans of 197 cases (93 females, 104 males) who had optimal imaging. The results regarding density of extrahepatic intraductal lesions that were studied at BT were compared with pathology and magnetic resonance cholangiopancreatography results. Of 197 lesions, 125 (63.5%) were reported as benign and 72 (36.5%) were reported as malignant. The results for benign lesions showed an average density of 66.67 ± 17.30 Hounsfield units (HU), and for malignant lesions the average density was 82.38 ± 13.67 HU. Conclusion: Lesion density level (HU) gives valuable information for the differentiation between benign and malign lesions in intraluminal extrahepatic bile ducts

Serum Adipokine and Ghrelin Levels in Nonalcoholic Steatohepatitis

Adipokines and ghrelin play role in insulin resistance, the key pathophysiological abnormality in patients with nonalcoholic fatty liver diseases. In the present study, relationship between nonalcoholic steatohepatitis (NASH) and serum adipokine and ghrelin levels was investigated. Thirty seven patients with biopsy-proven NASH and 25 age- and sex-matched controls were enrolled. Ten of NASH patients (27%) had diabetes mellitus (n = 5) or impaired glucose tolerance (n = 5). Body mass index (BMI) was less than 30 kg/m(2) in 67.6% of patients, while in the remaining 32.4% it was more than 30 kg/m(2). Serum adiponectin, leptin, TNF-α, and ghrelin were determined. Serum leptin (15.49 ± 4.84 vs 10.31 ± 2.53) and TNF-α (12.1 ± 2.7 vs 10.31 ± 2.56) levels were significantly higher in the NASH group compared to in the control group (P < .001 for each). Nevertheless, adiponectin (11.1±2.1 vs 17.3±2.8) and ghrelin (6.46±1.1 vs 7.8±1.1) levels were lower in the NASH group than in the control group (P < .001 for each). Serum levels of the adipokines and ghrelin, however, were comparable in the subgroups of patients regardless of whether BMI was < 30 or > 30 or glucose tolerance was impaired or not (P > .05). Additionally, neither adipokines nor ghrelin was correlated with histopathological grade and stage (P > .05). In conclusion; there is a significant relationship between NASH and adipokines and ghrelin independent from BMI and status of the glucose metabolism. These cytokines that appear to have role in the pathogenesis of NASH, however, do not have any effect upon the severity of the histopathology

Duodenal varices diagnosed by endoscopic ultrasound: A case report

Portal hypertension and associated complications cause significant morbidity and mortality in cirrhotic patients. Variceal development is the most important portal hypertension related complication. Varices most commonly occur around the gastroesophageal junction, but ectopic varices may develop in many gastrointestinal and extra-gastrointestinal localizations. Duodenum is one of the most common localizations for ectopic varices. Diagnosis of duodenal varices is usually made by upper gastrointestinal endoscopy, but endoscopic appearance is not diagnostic and usually further investigations are required in order to make accurate diagnosis. Endoscopic ultrasound is the gold standard method for the examination of gastrointestinal submucosal lesions therefore it is alsouseful in the work up of suspected duodenal varices. Here we present a patient with cryptogenic liver cirrhosis followed in our clinic, whom duodenal lesions suspected of duodenal varices were noticed during upper gastrointestinal endoscopic examination and endoscopic ultrasound was used to confirm the presence of duodenal varices

What has changed in the last 25 years in osteosarcoma treatment? A single center experience

Background. Osteosarcoma is the most common type of primary malignant bone tumor in the extremities. The main purpose of this study was to determine clinical features, prognostic factors, and treatment results of patients with osteosarcoma at our center.Methods. We retrospectively analyzed the medical records of children with osteosarcoma between the years 1994-2020.Results. 79 patients were identified (54.4% male, 45.6% female). The most common primary site was the femur (62%). Twenty-six of them (32.9%) had lung metastasis at diagnosis. The patients were treated between 1995-2013 according to the Mayo Pilot II Study protocol, while the others were treated with the EURAMOS protocol between the years 2013-2020. Sixty-nine patients underwent limb salvage surgery as a local treatment, whereas seven underwent amputation. The median follow-up time was 53 months (2.5-265 months). The event-free survival (EFS) and overall survival (OS) rates at 5 years were 52.1% and 61.5%. The 5-year EFS and OS rates were 69.4% and 80% in females; 37.1% and 45.5% in males (p=0.008/p=0.001). The 5-year EFS and OS rates of the patients without metastasis were 63.2% and 66.3%; with metastasis 28.8% and 51.8% (p=0.002/p=0.05). For good-responders, the 5-year EFS and OS rates were 80.2% and 89.1%; while for poor-responders, 35% and 46.7% (p=0.001). Mifamurtide was used in addition to chemotherapy as of the year 2016 (n=16). The 5-year EFS and OS rates were 78.8% and 91.7%, respectively for the mifamurtide group; 55.1% and 45.9%, respectively for the non-mifamurtide group (p=0.015, p=0.027).Conclusions. Metastasis at diagnosis and poor response to preoperative chemotherapy were the most important predictors of survival. Females had a better outcome than males. In our study group, the mifamurtide group's survival rates were significantly higher. Further large studies are needed to validate the efficacy of mifamurtide

Portal Hypertension Due to Echinococcus Alveolaris: A Case Report

Infection of the liver with Echinococcus alveolaris (EA) contemplates with a fatal course though it is a rare condition. We present herein a patient with upper gastrointestinal bleeding due to portal hypertension caused by the involvement of the liver with EA

Case Report External Hemorrhage from a Portacaval Anastomosis in a Patient with Liver Cirrhosis

Variceal bleeding is the major complication of portal hypertension in patients with liver cirrhosis. Hemorrhage mainly occurs in gastrointestinal lumen. Extraluminal hemorrhages are quite rare, such as intraperitoneal hemorrhages. We aimed to present a variceal bleeding case from the anastomosis on the anterior abdominal wall, as an extraordinary bleeding location, in a patient with portal hypertension in whom there were no esophageal and gastric varices

External Hemorrhage from a Portacaval Anastomosis in a Patient with Liver Cirrhosis

Variceal bleeding is the major complication of portal hypertension in patients with liver cirrhosis. Hemorrhage mainly occurs in gastrointestinal lumen. Extraluminal hemorrhages are quite rare, such as intraperitoneal hemorrhages. We aimed to present a variceal bleeding case from the anastomosis on the anterior abdominal wall, as an extraordinary bleeding location, in a patient with portal hypertension in whom there were no esophageal and gastric varices