An investigation of the efficacy of shear wave elastography in the characterization of benign and malignant liver lesions

Purpose: To investigate whether shear wave elastography (SWE) examination, which has recently been proposed as an accessory radiological examination technique, is effective in characterizing focal liver lesions (FLLs). Material and methods: A total of 105 patients, comprising 48 males and 57 females, underwent SWE examination. The mean age of the patients was 53.31 ± 1.59 (age range 5-87) years. The SWE measurements were obtained from FLLs that were approximately 2 to 8 cm in depth in a box that was approximately 0.5 × 1 cm wide on an ultra sonography (USG) screen from approximately 2 different locations. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic SWE values in the differentiation of benign and malignant lesions. Sensitivity, specificity, and positive predictive and negative predictive values were calculated in the presence of significant limit values. Results: The SWE values, in kPa and m/s, in the malignant lesions were significantly higher than those in the benign lesions (p = 0.006, p = 0.011). In the ROC curve analysis, the cut-off value was calculated as 9.005 kPa in the differ entiation of malignant lesions from benign lesions. The area under the ROC curve was calculated as 0.656 in the range of 0.551-0.761 with 95% reliability. Sensitivity was calculated as 64.2%, specificity as 61.5%, positive predictive value as 63%, and negative predictive value as 62.7%. Conclusions: In addition to providing little contribution to the differentiation of benign and malignant lesions, the SWE technique is thought to contribute to a certain extent, especially in suspected cases, during the diagnosis with cross sectional methods

Nörofibromatozis tip 1: Kraniyal MRG Bulguları

Amaç: Nörofibromatozis tip 1 NF1, von Recklinghausen hastalığı, periferal nörofibromatozis öncelikle nöral dokular olmak üzere birçok sistemi tutan nörokutanöz bir hastalıktır. Çocuklarda kanser yatkınlığını artırması sebebiyle bilinmesi ve tanı konması önem kazanan bir sendromdur. Amacımız kliniğimizde incelenen nörofibromatozis tip 1 hastalarının kraniyal MRG bulgularını tartışmak ve mevcut bulgular eşliğinde nörofibromatozis tip 1’in kraniyal tutulum şekillerini değerlendirmektir. Gereç ve yöntemler: Haziran 2011 ve Mart 2013 tarihleri arasında kliniğimizde Nörofibromatozis tip 1 tanısı olan ve en az 1 MRG incelemesi bulunan 21 hastanın 19’u değerlendirilmiştir. 6-32 yaş aralığında ortalama yaş 15,3 , 7 kız ve 12 erkek hastadan elde edilen kraniyal MRG incelemeleri retrospektif olarak taranmıştır. Çalışmaya dahil edilen olgulardaki lezyonların tipi ve lokalizasyonları farklı bir radyolog tarafından yeniden değerlendirilmiştir. Bulgular: Nörofibromatozis tip 1 tanısıyla takip edilen ve kraniyal MR görüntülemeleri değerlendirilen 19 hastanın 16’sında santral sinir sisteminde hamartomatöz lezyonlar, 5 hastada optik gliom ya da optik sinir kalınlaşması, 5 hastada pleksiform nörofibromlar ve 2 hastada nörofibrom odakları izlenmiştir. Sonuç: Birçok farklı tümör ve bulgu içermesi ve en sık kalıtılan santral sinir sistemi hastalığı olması Nörofibromatozis tip 1’in tanı kriterlerinin ve lezyonlarının bilinmesini ve akılda tutulmasını gerektirmektedir. Klinik bulguları Nörofibromatozis tip 1 kriterlerini karşılamayan, tanı kriterlerindeki lezyonlar gelişmeyen veya tanı konurken şüphede kalınan hastaların tanısı ve hastalığın tümöral oluşumların gelişmesine olan yatkınlığı sebebiyle Nörofibromatozis tip 1 hastalarında MR görüntüleme bulguları erken ve doğru tanı açısından önemlidi

A novel modified PAIR technique using a trocar catheter for percutaneous treatment of liver hydatid cysts: a six-year experience

PURPOSEWe aimed to demonstrate the success and reliability of a novel puncture, aspiration, injection, and reaspiration (PAIR) technique in liver hydatid cysts.METHODSPercutaneous treatment with ultrasonographic guidance was performed in 493 hepatic hydatid cysts in 374 patients. Patients were treated with a new PAIR technique by single puncture method using a 6F trocar catheter. The results of this novel technique were evaluated with regards to efficacy and safety of the procedure and complication rates.RESULTSOut of 493 cysts, 317 were Gharbi type I (WHO CE 1) and 176 were Gharbi type II (WHO CE 3A). Of all cysts, 13 were referred to surgery because of cystobiliary fistulization. Recurrence was observed in 11 cysts one month later. Therefore, the success rate of the PAIR technique was 97.7% (469/480). Minor complications (fever, urticaria-like reactions, biliary fistula) were seen in 44 treated patients (12%, 44/374); the only major complication was reversible anaphylactic shock which was observed in two patients (0.5%, 2/374).CONCLUSIONThis novel modified PAIR technique may be superior to catheterization by Seldinger technique due to its efficiency, easier application, lower severe complication rate, and lower cost. Further comparative studies are required to confirm our observations

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Belirgin alt ekstremite arter darlığı olan hastalarda renal arter darlığının sıklığı

Bu çalışmanın amacı, renal arter stenozu ile periferik arter hastalığı birlikteliğini değerlendirmek ve periferik arter hastalığı olan hastalarda insidental renal arter stenozu sıklığını saptamaktır. Bu çalışmaya alt ekstremite arterlerine yönelik DSA yapılan ve en az bir segmentinde %50 ve üzeri stenoz saptanan toplam 1502 hasta dahil edildi. Alt ekstremite arterleri aortoiliak, femoropop- liteal ve infrapopliteal olarak 3 segmente ayrılarak değerlendirildi. Segmentler tek segment ve multisegment tutulumu olarak sınıflandırıldı. Multisegmentler aortoiliakfemoropopliteal, aortoiliakinfrapopliteal, femoropoplitealinfrapopliteal ve aorto ilaikfemoropoplitealinfrapopliteal olarak isimlendirildi. En az bir segmentde %50 ve üzeri stenozu olanlar çalışmaya alındı. Segmental periferal arter hastalığı ve renal arter stenozu birlikteliğini karşılaştırmada ki-kare testi kullanıldı. Periferik vasküler hastalığı olan 1502 hastanın 228 inderenal arter stenozu saptandı. Renal arter stenozu sıklığı tek segment tutulumu olanlarda multi segment tutulumuna göre daha az bulundu (p0.03). Renal arter stenozu sıklığı tek segment tutulumunda %11,9 ve multi- segment tutulumunda %16,4 bulundu. Renal arter stenozu sıklığı diğerleriyle karşılaştırıldığında infrapopliteal tutulumda (%6) daha az bulundu (p0.027). Sağ, sol ve bilateral renal arter stenozuyla segment tutulumları karşılaştırıldığında segment grupları arasında fark bulunmadı (p0.086, p0.219). Kadınlarda renal arter stenozu sıklığı daha yüksek oranda bulundu (%23.6, p0.01). Renal arter stenozu periferal vasküler hastalığı olanlarda %15,2 sıklıkla görülmektedir. Renal arter stenozu infrapopliteal segment tutulumunda daha görüşmektedir. Multisegment tutulumu ile karşılaştırıldığında tek segment tutulumunda renal arter stenozu sıklığı kadınlarda erkeklere nazaran daha sıktır.The purpose of this study is to evaluate the unity of renal artery stenosis and peripheral vascular disease and to find the fre- quency of incidental renal artery stenosis in the patients with peripheral vascular disease. In this study,it was included 1502 patients that were sent from cardiovascular surgery department to radiology department to do lower extremity digital substrac- tion angiography and found on at least one segment 50% stenosis and more. The arteries of lower extremity were evaluated by dividing into three segments as aortoiliac, femoropopliteal and infrapopliteal. Segments were classified as unisegment and mul- tisegment. Multisegments were named aortoiliacfemoropopliteal, aortoiliacinfrapopliteal, femoropoplitealinfrapopliteal and aortoiliacfemoropopliteal infrapopliteal. Patients with 50% stenosis and more of renal artery are decided. The unity of renal artery stenosis and the segmental disease of peripheral artery were compared by using Chi-Square test. It was found evident renal artery stenosis in 228 (15.2%) of 1502 patients with peripheral vascular disease. The frequency of renal artery stenosis was found lesser at unisegment disease than multisegment disease (p0.03). The renal artery stenosis was found 11.9% unisegment and %16.4 at multisegment disease. The frequency of renal artery stenosis was appeared less at infrapopliteal (6%) disease compared to the others (p0.027). It was not found any difference between groups when the segmental groups of peripheral vascular disease was compared with right, left and bilateral renal artery stenosis (p0.086, p0.219). It was found higher rate of renal artery stenosis at women (23.6%, p0.01). The frequency of renal artery stenosis is %15,2 in the patients with peripheral vascular disease. Renal artery stenosis is less at infrapopliteal segment disease. Renal artery stenosis in women is more than men at multisegment disease compared to unisegment disease

The Amyand’s Hernia: A Rare Clinical Entity Diagnosed by Computed Tomography

Amyand’s hernia, named for the first person to describe an inguinal hernia containing the vermiform appendix, is an uncommon variant of an inguinal hernia. Amyand’s hernia is an extremely rare condition and is often misdiagnosed. Traditionally, these hernias have been diagnosed at surgery but are increasingly diagnosed by abdominal computed tomography (CT) scans. CT of the abdomen may help in guiding the diagnosis

Hepatosellüler karsinomda radyolojik algoritma ve görüntüleme yöntemleri

Radyolojik görüntülemenin amacı hepatosellüler karsinomu erken evrede tespit etmektir. Bunun amacı lezyonu küratif tedavi evre- sinde yakalayabilmektir. Son yıllarda özellikle küçük karsinomların erken tespit edilebilmesi için fazlaca çaba sarf edilmektedir. Bu derlemenin amacı hepatosellüler karsinomların tespiti ve tanımlanmasında ultrasonografi, bilgisayarlı tomografi, manyetik rezonans görüntüleme, radyonüklid görüntüleme, pozitron emisyon tomografi ve dijital subtraksiyon anjiografi gibi invaziv olmayan görüntü- leme yöntemlerinin etkinliğini belirlemekti

Radiological algorithm and imaging modalities in hepatocellular carcinoma

Radyolojik görüntülemenin amacı hepatosellüler karsinomu erken evrede tespit etmektir. Bunun amacı lezyonu küratif tedavi evre- sinde yakalayabilmektir. Son yıllarda özellikle küçük karsinomların erken tespit edilebilmesi için fazlaca çaba sarf edilmektedir. Bu derlemenin amacı hepatosellüler karsinomların tespiti ve tanımlanmasında ultrasonografi, bilgisayarlı tomografi, manyetik rezonans görüntüleme, radyonüklid görüntüleme, pozitron emisyon tomografi ve dijital subtraksiyon anjiografi gibi invaziv olmayan görüntü- leme yöntemlerinin etkinliğini belirlemektir.The purpose of diagnostic imaging is to detect HCC at an early stage, when curative options are available. In recent years, there have been many efforts to improve early detection of small HCC. The purpose of this review is to describe the pertinent findings of HCCs in non-invasive, diagnostic imaging, including ultrasound, computed tomography, magnetic resonance, radionuclide scanning, positron emission tomography and digital subtraction angiography imaging techniques

Detailed morphological analysis of axolotl sperm

The axolotl has extraordinary regeneration capacity compared to other vertebrates. This remarkable potential has been attributed to its life-long neoteny, characterized by the exhibition of embryonic characteristics at the adult stage. A recent study provided a detailed morphological analysis of the sperm morphology of the Ambystoma mexicanum using routine and detailed histological techniques. The primary purpose of the present study is to describe a simple and inexpensive method for evaluating the morphology of axolotl sperm. In this study, spermatophore structures were collected and spread on slides and air-dried. The slides were stained with periodic acid Schiff, toluidine blue, Masson's trichrome, Giemsa, Spermac, and Diff-Quik dye for a morphological examination. The slides were coated with gold/palladium for a scanning electron microscopy examination. The sperm of the axolotl consisted of an elongated head, a neck, and a flagellum covered with an undulating membrane. The lengths of the midpiece, tail, and head were 8.575 µm, 356.544 µm, and 103.661 µm, respectively. In the flagellum part, the wavy membrane structure, whose function has not been explained, surrounds the tail. The data obtained from this study will constitute an important step in designing future research on the reproductive and regeneration capacity of the axolotl

Böbrek yetmezlikli hastalarda FLAIR imajlarda subaraknoid aralık hiperintensitesi: Tanısal bir tuzak

Subaraknoid aralık SAA hiperintensitesi, manyetik rezonans görüntülemenin MRG FLAIR sekansında ayırıcı tanısı dikkatlice yapılması gereken önemli bir bulgudur. FLAIR sekansında SAA hiperintensitesinin subaraknoid kanama SAK , leptomeningeal karsinomatozis, menenjit gibi ciddi tedavi gerektiren birçok nedeni vardır. Kontrast madde, vasküler pulsasyonlar, beyin omurilik sıvısı BOS pulsasyonları ve hareket artefaktları sadece tuzak görüntülerdir, bu nedenle de tedavi gerektirmezler. Böbrek yetmezlikli hastalar için birçok komorbidite sebebi bulunmaktadır. Bunlardan bir tanesi serebrovasküler olaylardır. Nörolojik semptomlara sahip hastalarda MRG tanı için en iyi tercihtir. Fakat hastaya beyin MR tetkiki öncesinde kontrastlı başka bir MRG incelemesi uygulan- mışsa gadolinyumun SAA’da gecikmiş klirensi ve persistansı ortaya çıkar. Sonuçta bu durum ciddi patolojileri taklit edebilir. Bu olgu sunumunda daha önce kontrastlı boyun MRG uygulanan böbrek yetmezlikli olgunun SAA hiperintensitesine ait ilginç görüntülerini sunmayı amaçladı