A Retrospective Comparison of Computed Tomography and Fluoroscopic Guided Percutaneous Nephrostomy for Evaluating Radiation Exposure

Aim: The study aimed to compare the radiation doses absorbed by the patient in first-time percutaneous nephrostomy under computed tomography (CT) and nephrostomy replacement under fluoroscopy. Material and Methods: Eighty-nine hydronephrotic patients referred for nephrostomy were included in this retrospective study. Seventy-five of these patients had the nephrostomy for the first-time under CT- guidance. Fourteen patients had the nephrostomy replacement operation under fluoroscopy guidance. Absorbed radiation doses were compared between these operations. Results: The groups showed no statistically significant differences in means of demography (age, sex, and pathology) and operational parameters (intervention side and complications) except the absorbed radiation dose. The median effective radiation doses were 1.18 mSv and 1.68 mSv for CT and fluoroscopy, respectively. The first-time nephrostomy operations under CT were completed with radiation doses significantly lower than those in nephrostomy replacement under fluoroscopy (p < 0.001). Conclusion: Ultra-low-dose and fast-acting CT-guided nephrostomy is a safe, user-friendly procedure that leads patients to less radiation exposure than expected

Pain assessment of ultrasound-guided liver biopsy for diffuse parenchymal diseases: a randomized trial comparing intercostal and subcostal techniques

Objectives: Percutaneous liver biopsy is widely used in diffuse liver parenchymal diseases. Comparison ofthe severity of pain is not properly studied. In this randomized study, pain intensity between the intercostaland subcostal techniques of US-guided Tru-Cut liver biopsy in diffuse liver diseases was compared.Methods: Between March 2016 and May 2017, all potential study participants referred to the interventionalradiology department for ultrasound-guided liver biopsy (n = 245), were assessed for enrollment. The painintensity at 0, 2, and 4 h post-procedure was compared in two groups using a Numeric Rating Scale (NRS).Premedication was not used. After applying local anesthesia under US-guidance, 18-G automatic biopsy needlefree-hand US-guided biopsy was performed.Results: Immediately after the biopsy (p = 0.0024), and at the 2nd hour (p = 0.0298), NRS of the subcostalgroup was significantly less than the intercostal group. Furthermore, the need for oral (p = 0.0492) orintramuscular (p = 0.0094) analgesics after the biopsy in the subcostal group was significantly less than theintercostal group. At the evaluation of both groups together, 55.62% of the patients had a mild and 27.22%had a moderate pain score. NRS score decreased with time in each group.Conclusions: The pain intensity and the need for analgesics were less in the subcostal biopsies. Since intensepain and anxiety may be the cause of loss of the patients after the first biopsy, a subcostal biopsy could bepreferred primarily

Management of traumatic pneumothorax in isolated blunt chest trauma

Objectives: Pneumothorax is an important complication of blunt chest trauma. The aim of this study was toreport our experience in treatment strategy and outcomes of traumatic pneumothorax.Methods: A total of 78 patients who developed pneumothorax due to isolated blunt chest trauma were evaluatedin terms of age, gender, size of pneumothorax, treatment methods, complications and length of hospital stay.The size of pneumothorax was calculated with computer-aided volumetry.Results: Tube thoracostomy was performed for 48 patients while observation was undertaken for 30 cases.Chest tubes were inserted in 6 patients after 24 hours following the traumatic event. A total of 8 patients whodeveloped prolonged air leakage and hemothorax as complications underwent video-assisted thoracoscopicsurgery. None of the patients developed any mortality or morbidity.Conclusions: Traumatic pneumothorax demands prompt diagnosis and treatment. Monitoring all patients evenwith small sizes of traumatic pneumothorax for at least 24 hours onset of their initial assessment and applyingchest tubes for cases who have pneumothorax larger than 50% at first examination should be an appropriatemodality for treatment. Moreover, the minimally invasive approach of video-assisted thoracoscopic surgerybenefits to overcome the complications of thoracic trauma

Corpus callosum in schizophrenia with deficit and non-deficit syndrome: a statistical shape analysis

Background The corpus callosum (CC) is the most targeted region in the cerebrum that integrates cognitive data between homologous areas in the right and left hemispheres. Aims Our study used statistical analysis to determine whether there was a correlation between shape changes in the CC in patients with schizophrenia (SZ) (deficit syndrome (DS) and non-deficit syndrome (NDS)) and healthy control (HC) subjects. Methods This study consisted of 27 HC subjects and 50 schizophrenic patients (20 with DS and 30 with NDS). 3 patients with DS and 4 patients with NDS were excluded. Three-dimensional, sagittal, T1-spoiled, gradient-echo imaging was used. Standard anatomical landmarks were selected and marked on each image using specific software. Results As to comparing the Procrustes mean shapes of the CC, statistically significant differences were observed between HC and SZ (DS+NDS) (p=0.017, James's F-j=73.732), HC and DS (p<0.001, James's F-j=140.843), HC and NDS (p=0.006, James's F-j=89.178) and also DS and NDS (p<0.001, James's F-j=152.967). Shape variability in the form of CC was 0.131, 0.085, 0.082 and 0.086 in the HC, SZ (DS+NDS), DS and NDS groups, respectively. Conclusions This study reveals callosal shape variations in patients with SZ and their DS and NDS subgroups that take into account the CC's topographic distribution

Dose-dependent effects of adalimumab in neonatal rats with hypoxia/reoxygenation-induced intestinal damage

Tumor necrosis factor-alpha (TNF-α) has an important role in hypoxia/reoxygenation (H/R)-induced intestinal damage. It was shown that blocking TNF-α with infliximab has beneficial effects on experimental necrotizing enterocolitis and hypoxic intestinal injury. However, there is no data about the effect of adalimumab on H/R-induced intestinal damage. Therefore, we aimed to determine potential dose-dependent benefits of adalimumab in such damage in neonatal rats. Wistar albino rat pups were assigned to one of the four groups: control group, hypoxia group, low-dose adalimumab (5 mg/kg/day) treated group (LDAT), and high-dose adalimumab (50 mg/kg/day) treated group (HDAT). On the fourth day of the experiment, all rats except for the control group were exposed to H/R followed by euthanasia. Malondialdehyde (MDA), myeloperoxidase (MPO), TNF-α, total antioxidant capacity (TAC), and total oxidant capacity (TOC) were measured in intestinal tissue. TAC and TOC values were used to calculate the oxidative stress index (OSI). Histopathological injury scores (HIS) were also evaluated in the tissue samples. MDA levels were significantly lower in the LDAT and HDAT groups (p < 0.001). TNF-α levels were significantly lower in the LDAT group (p < 0.001). OSI was significantly higher in the H/R group than in the control and LDAT groups (p < 0.001). Mean HIS values in the LDAT group were significantly lower than those in the H/R and HDAT groups (p < 0.001). This experimental study showed that low-dose adalimumab appears to have a beneficial effect on intestinal injury induced with H/R in neonatal rats

Retrospective evaluation of changes in autoantibody levels after total thyroidectomy in patients with positive thyroid autoantibodies

Diferansiye tiroid kanserli hastaların en önemli izlem parametresi olan serum tiroglobulin düzeyinin güvenirliliği, anti-Tg pozitifliği olan hastalarda azalmaktadır. Total tiroidektomi sonrası anti-Tg seviyesinin azalarak negatifleşmesi beklenir. Çalışmamızda diferansiye tiroid kanserli hastaların postoperatif anti-Tg seviyesindeki azalmayı etkileyen faktörleri retrospektif olarak araştırdık. Çalışmamıza Ocak 2012-Ocak 2023 yılları arasında Bursa Uludağ Üniversitesi Tıp Fakültesi İç Hastalıkları Anabilim Dalı Endokrinoloji ve Metabolizma Hastalıkları Bilim Dalı polikliniğine başvuran, tiroid ektomiuygulanan, tiroid oto antikorlarından en az biri pozitif olan 93 hasta alındı. Hastaların demografik özellikleri, klinik, laboratuvar değerleri ve tedavi rejimleri incelendi. Hastaların %93,5’i (n=87) kadın, yaş ortalaması 48,2±13,8 yıldı. Hastaların izlemleri süresince anti-Tg pozitifliğinin negatifleşme oranı%56,8 ve negatifleşme medyan zamanı 17 ay bulundu. Negatifleşmeyi olumsuz etkileyen en önemli iki faktörün preoperatif anti-Tg seviyesi (p<0,001)ve lenf bezi metastazı varlığı olduğu saptandı (p=0,05). Operasyon sonrası hastaların çoğunda anti-Tg seviyelerinin hızla azaldığı, medyan 5 ay içerisinde yarılandığı saptandı. Anti-Tg seviyesinin yarılanma zamanını olumsuz etkileyen en önemli faktörün tümörün ekstra tiroidal yayılım özelliği olduğu görüldü (p=0,002). Nüks gelişen 5 (%5,6) hastanın çoğunda antikorseviyelerinin azalmadığı, bazılarında belirgin şekilde arttığı saptandı. Subtotal tiroidektomi sonrası tamamlayıcı tiroidektomi yapılanlarda antikor seviyesinin yüksek kaldığı ve bir hastamızda nüks gelişmesine rağmen antikor seviyesinin azalarak negatifleştiği görüldü. Sonuç olarak, anti-Tg pozitif diferansiye tiroid kanserli olgularda postoperatif antikor seviyesinin azalmaması tümör nüksüne işaret edebilir. Postoperatif anti-Tg seviyelerini etkileyen faktörler konusunda fikir birliğine varılamasa da total tiroidektominin ilk operasyon olarak yapılmaması, preoperatif anti-Tg seviyesinin yüksekliği, ekstra tiroidal yayılım veya lenf bezi metastazının varlığı anti-Tg seviyesinin azalmasını etkileyebilmektedir. Antikor seviyesi azalan hastalarda nadir de olsa nüks görülebileceği akılda tutulmalıdır.The reliability of serum thyroglobulin levels, which is the most important follow-up parameter for the patients with differentiated thyroid cancer, decreases in patients with anti-Tg positivity. After total thyroidectomy, the anti-Tg level is expected to decrease and become negative. In our study, we conducted a retrospective investigation to identify the factors influencing the decrease in postoperative anti-Tg levels in patients with differentiated thyroid cancer. Our study included 93 patients who underwent thyroidectomy and had at least one positive thyroid autoantibody, presenting to the outpatient clinic of the Department of Endocrinology and Metabolic Diseases, Division of Internal Medicine, Bursa Uludağ University Faculty of Medicine, between January 2012 and January 2023. The demographic characteristics, clinical and laboratory values, and treatment regimens of the patients were examined. In our study, 93.5% (n=87) of the patients were female, and the mean age was 48.2±13.8 years. During the follow-up period, the rate of anti-Tg positivity becomingnegative was 56.8%, with a median time of 17 months for the transition tonegative.. Preoperative anti-Tg level (p<0.001) and the presence of lymph node metastasis (p=0.05) were found to be the two most important factors negatively affecting negativization. It was found that anti-Tg levels decreased rapidly in most of the patients after the operation and were halved within a median of 5 months. It was observed that the most important factor negatively affecting the half-life of the anti-Tg level was the extrathyroidal spread of thetumor (p=0.002). The majority of the 5 (5.6%) patients who developed a recurrence were found to have no decrease in antibody levels, and in some of them, it was observed to increase significantly. Additionally, it was observed that the antibody level remained high in the patients who underwent completion thyroidectomy after subtotal thyroidectomy operation. Furthermore, despite the recurrence in one of our patients, the antibody level decreased and became negative. In conclusion, the absence of a decrease in postoperative antibody levels in patients with anti-Tg positive differentiated thyroid cancer may indicate tumor recurrence. Although there is no consensus on the factors affecting postoperative anti-Tg levels, not performing total thyroidectomy as the first operation, high preoperative anti-Tg levels, and the presence of extrathyroidal spread or lymph node metastasis may affect the decrease in anti-Tg levels. It should be kept in mind that, although rare, recurrence can be seen in patients with decreased antibody levels

Hypoplastic internal carotid artery ending as an ophthalmic artery with multiple cerebral aneurysms, fenestrated Acom and triple A2

A rare case of a hypoplastic internal carotid artery (ICA) terminating in the ophthalmic artery with multiple intracranial saccular aneurysms in the contralateral ICA, anterior communicating artery fenestration and triple A2 was identified. The aetiology and pathogenesis of ICA hypoplasia are subjected to certain hypotheses. Developing several collaterals to preserve the blood supply of the ipsilateral cerebral hemisphere could result in aneurysm formation due to flow overload on the contralateral vasculature, but it could also result in hemicranial hypoplasia, cerebral atrophy and deep watershed infarcts, as in our case.

Anterior choroidal artery aneurysms could have different symptoms, and outcomes: a report of 3 cases treated endovascularly

Anterior choroidal artery (AChoA) aneurysms are rare intracranial aneurysms, which are treated with endovascular techniques or surgical clipping procedures. AChoA aneurysm may have variable symptomatologies, clinical courses, and outcomes due to the eloquent territory of the artery. We have presented 3 cases of AChoA aneurysms, which differ from each other and literature by rare oculomotor nerve palsy, antiplatelet treatment complication and near-complete late resolution of the oculomotor nerve palsy. We have tried to share our AChoA case experiences to emphasize the importance of being flexible and adaptable in the diagnosis, treatment and follow up of this rare intracranial aneurysm type

A Retrospective Analysis of the Effectiveness of Extrapleural Autologous Blood Patch Injection on Pneumothorax and Intervention Need in CT-guided Lung Biopsy

Purpose: To assess the effect of extrapleural autologous blood injection (EPABI) technique on pneumothorax development before and after coaxial needle withdrawal (CNW) and intervention rate for pneumothorax. To analyze the risk factors of pneumothorax and parenchymal hemorrhage. Materials and Methods: The records of 288 patients who had lung biopsies were analyzed. Of these patients, 188 received EPABI (group-A) before penetrating the parietal pleura, and the remaining did not (group-B). Intraparenchymal autologous blood patch injection was applied at the end of the procedure. The pneumothorax rates before/after CNW and intervention requirement for pneumothorax were compared between groups. The risk factors of pneumothorax before/after CNW and parenchymal hemorrhage were assessed with stepwise logistic regression. Results: The pneumothorax rate before CNW was significantly lower in group-A (5.92%) than in group-B (19.10%) (p = 0.029). Pneumothorax risk before CNW was reduced if EPABI was applied and skin-to-pleura distance increased. The pneumothorax rate after CNW was similar between two groups (group-A: 6.94%, group-B: 8%), while emphysema grade along the needle path and procedure duration was the significant risk factor. The intervention requirement for pneumothorax was significantly lower in group-A (6.38%) than in group-B (16%) (p = 0.012). Needle aspiration requirement was significantly reduced in group-A. The rate of external drainage catheter and chest tube placement was similar in both groups. The risk factors of parenchymal hemorrhage were overall emphysema grade of the lung, target-to-pleura distance, and target size. Conclusion: Use of EPABI along with IAPBI significantly decreased the pneumothorax rate during biopsy procedure and the intervention rate compared to IAPBI-alone. © 2021, Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).The authors would like to thank Arindam Andy Bhattacharjee for proofreading the article. The study had no financial or industrial support

Novel Use of Extrapleural Autologous Blood Injection in CT-Guided Percutaneous Lung Biopsy and its Comparison to Intraparenchymal Autologous Blood Patch Injection: A Single-Center, Prospective, Randomized, and Controlled Clinical Trial

Purpose To evaluate the rate of iatrogenic pneumothorax and the need for intervention with extrapleural autologous blood injection (EPABI) along with intraparenchymal autologous blood patch injection (IABPI) or IABPI-only in CT-guided percutaneous lung biopsy. Materials and Methods One hundred and thirty-nine participants were referred for CT-guided percutaneous lung biopsy, and 81 were randomized into study (EPABI + IABPI,n = 40) and control (IABPI-only,n = 41) groups. In the study group, similar to 5 ml of autologous blood was injected into the extrapleural space before passing through the parietal and visceral pleura. The primary outcome was the incidence of pneumothorax in two cohorts within 2 weeks after the procedure. Results In the per-protocol population, pneumothorax rates were 5.9% and 25.7% in the study and control groups, respectively. The difference between the two groups was -19.8% (95% CI: -36.3%, 3.32%) (p = 0.025). On the other hand, in the population with no intraprocedural deviations, pneumothorax rates were 3.2% and 17.2% in the study and control groups, respectively. The difference between the two groups was -14.0% (95% CI: -29.1%, 1.07%) (p = 0.083). In the control group, 3.45% of the cases required aspiration, while no intervention was required in the study group. Conclusion The EPABI application along with IABPI is a promising method to decrease the incidence of pneumothorax following CT-guided percutaneous lung biopsy