Amaç: Bu çalışmanın amacı meme kitlelerindeki vaskülariteyi değerlendirmek için, Renkli Doppler Görüntüleme (RDG), Power Doppler Görüntüleme (PDG) ve Süperb Mikrovasküler Görüntüleme (SMG) yaparak elde ettiğimiz bulguları, histopatolojik sonuçlar ile karşılaştırıp tanısal etkinliklerini değerlendirmektir.
Yöntem: Belirtilen tarih aralığında, dahil etme kriterlerine uygun 46 hastaya gri skala USG, RDG, PDG ve SMG yapıldı. Her bir kitlenin vaskülarite özellikleri kaydedildi ve karşılaştırıldı.
Bulgular: Kırk altı meme lezyonundan 26’sı benign ve 20’si maligndi. 26 benign lezyondan 19 tanesi fibroadenom, 5 tanesi granülomatöz mastit ve 2 tanesi sklerozan adenozis iken 20 malign lezyonun tamamı invaziv duktal karsinomdu. Benign lezyonlarda ortalama boyut 21,5± 9,6mm, malign lezyonlarda 12,4± 5,8mm idi. Renkli SMG (rSMG) ile malign lezyonlarda benign lezyonlardan daha fazla penetran damar (PV) tespit edilmiş olup malign lezyonlar için rSMG tarafınca tespit edilen PV sayısı, RDG ve PDG tarafınca tespit edilenden daha fazladır. Benign lezyonlarda rSMG ve RDG ile, PDG’ye kıyasla daha az PV tespit edildi. PV varlığı malignite tanısı için bir kriter olarak kullanıldığında, rSMG’nin duyarlılık, özgüllük, pozitif prediktif değer (PPD), negatif prediktif değer (NPD) ve tanısal doğruluğu, RDG ve PDG'ninkinden daha yüksekti. RDG ve PDG ile karşılaştırıldığında, rSMG ile daha fazla akım sinyali ve damar morfolojisi tespit edildi. Meme lezyonlarındaki vasküler paternlere göre farklı görüntüleme modalitelerinin tanısal etkinliğinde rSMG’nin duyarlılık, PPD, NPD ve tanısal doğruluğu, RDG ve PDG’ninkinden daha yüksekken, özgüllüğü daha düşüktü.
Sonuç: rSMG, RDG ve PDG’den daha fazla vasküler dallanma detayı göstermekte olup benign-malign meme lezyonunun ayırt edilmesinde uygulanabilir bir yöntemdir.
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Objective: To determine the patency rates and reasons for failure using different access routes for tunneled hemodialysis catheters.Methods: The records of patients who underwent insertion of 14 French tunnelled hemodialysis catheters were retrospectively analyzed. Catheterpatency survival was demonstrated using Kaplan-Meier survival curve. Catheter failure and exchange reasons were evaluated.Results: One hundred and six patients underwent 474 catheter exchanges (mean/patient 4.47±1.62). Access was via right internal jugular vein (IJV)n=40, left IJV n=23, right femoral vein (FV) n=18, left FV n=11 and transhepatic vein n=14. The causes of catheter failure and exchange were:catheter-associated infection, catheter thrombosis, fibrin sheath and catheter tip malposition. Mean primary and cumulative catheter patency time(721 and 1276 days, respectively) was higher in the right IJV group compared with the others (p<0.001). The same parameters were lowest in thetranshepatic group, being 118 and 466 days, for primary and cumulative patency, respectively (p<0.001). The incidence of catheter-related infectionswas higher in the left FV (0.42/100 patient-days) and catheter tip malposition was higher in the transhepatic (0.38/100 patient-days) and in the leftIJV (0.32/100 patient-days).Conclusion: The use of right IJV should be the first option for hemodialysis access route. Based on our findings, if right IJV is unavailable theoptimal access routes in order would be left IJV, right FV, left FV and finally transhepatic vein
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İsa ÇAM ,
Kurtulus KARAUZUM ,
Irem KARAUZUM ,
Törehan ÖZER ,
Ahmet YALNIZ ,
ÖZGÜR ÇAKIR ,
Hakan CEBECİ ,
Başak ERDEMLİ GÜRSEL ,
Oğuz OMAY ,
Ercüment ÇİFTÇİ ,
Tayfun ŞAHİN ,
YONCA ANIK
Introduction: Cardiac involvement is rare in hydatid cystdisease, which accounted for 0.5%-2% of all hydatidosis cases.Cardiac cysts usually occur as part of a wider infestation withextracardiac involvement. This study aimed to describe thegeneral characteristics, imaging findings, and range of organinvolvement in cases of cardiac hydatid disease.Methods: Retrospective assessment of cardiac hydatid diseaserecords, between 2007 and 2019, was undertaken to identifypatients with cardiac hydatidosis. Hydatid cysts were assessedby transthoracic echocardiography, magnetic resonanceimaging, and computed tomography. Clinical symptoms,treatment modalities, and follow-up were also evaluated.Results: Over the study period, 22 (13 males: 59.1%; meanage: 43.1 years; range: 12-63 years) patients with 24 cardiachydatid cysts were identified. The most common symptomwas chest pain, which occurred in 13 (59.1%) patients. Cardiaccysts were located in the left ventricle (n=10, 41.7%), rightventricle (n=5, 20.8%), interventricular septum (n=5, 20.8%),and pericardium (n=4, 16.7%). Extracardiac involvement waspresent in 14 (63.6%) patients, most commonly affecting theliver (n=10, 45.4%), but in 8 (36.3%) patients, there was noextracardiac organ involvement. Cardiac hydatid cysts weresurgically removed in 20 (90.9%) patients.Conclusion: Cardiac hydatid disease is very uncommon, withthe left ventricle as the most commonly affected structure in thisseries. Chest pain was the most common presenting symptom.Extracardiac involvement is common, so patients with cardiachydatid cysts should be investigated for involvement of otherorgans.
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Objective: The accuracy of biopsy technique and pathological reports from supraclavicular lymphadenopathy (ScLAP) biopsies in adults were evaluated. Methods: Five hundred sixty-four lymph node excisions or aspiration biopsies because of lymphadenopathy from all cervical regions were retrospectively assessed. Demographic and clinical data collected included gender, age, preoperative diagnosis, biopsy or cytology type, location of ScLAP, and biopsy diagnosis. Results: After exclusions for a variety of clinical and diagnostic reasons, the final analysis included 156 patients, of whom 34 (21.8%) underwent fine-needle aspiration (FNA), 69 (44.2%) core needle biopsy (CNB), and 53 (34%) excisional biopsies. In this study, 52 (33.3%) benign and 93 (59.6%) malignant diagnoses were reported. Totally, 11 of the 34 (32.3%) FNAs were insufficient for diagnosis. The size of the ScLAP (<10, 11-20, 21-30, >30 mm) did not affect malignancy risk. Patients aged > 55 years had a significantly greater likelihood of malignancy than younger patients. Logistic regression analysis showed that malignancy risk assessed by odds ratio (OR) was increased by male gender (P = .004; OR = 1.428; 95% CI 1.106-1.842), left side (P = .003; OR = 1.502; 95% CI 1.125-2.005) and age > 55 years (P = .007; OR = 2.631; 95%CI 1.275-5.431). Conclusion: Regardless of size, biopsy or cytology should be performed in all appropriate masses. Although the size of the lymph node had no effect on malignancy risk, male gender, older age, and left side were associated with a significant increase in the likelihood of malignancy. Keywords:Clinicopathology
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Amaç: Ultrason (US) eşliğinde perkütan karaciğer biyopsisi, halen kronik karaciğer hastalığı ve karaciğer kitleleri yönetiminde halen altın standartyöntemdir. Çalışmamızda, Kocaeli Üniversitesi Tıp Fakültesi Girişimsel Radyoloji kliniğinde US eşliğinde son beş yılda yapılan karaciğerbiyopsilerinin endikasyonları, kullanılan iğne özellikleri, hastaya ait diğer hastalıkları ve demografik verilerin değerlendirilmesi çalışmamızınamacını oluşturmaktadır.Yöntem: Ocak 2015-Mayıs 2020 arasında hastanemizde perkütan karaciğer biyopsisi yapılan hastaların endikasyonları, komplikasyonları, histolojikbulguları değerlendirilmiştir.Bulgular: Perkütan karaciğer biyopsi 264 hastada yapılmıştır. Karaciğer biyopsi endikasyonları içerisinde hepatit B(HBV) (%29,2) en sıkendikasyon olup diğer endikasyonları sırasıyla malign kitleler (%22), non-alkolik yağlı karaciğer hastalığı (NAYKH) (%11,7), ilaca bağlı karaciğerhastalığı (İKH) (%11,4), Alkol (%9,5), hepatit C (HCV) (%9,5), Oto immun hepatit (%6,8)’dir.Sonuç: US eşliğinde perkütan karaciğer biyopsi, hastanede yatan ve ayaktan başvuran hastalarda başarı ile uygulanan hızlı, güvenli, etkili veminimal invaziv bir biyopsi işlemidir.
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Background/aim: To compare the subjective level of pain in patients who underwent an ultrasound-guided percutaneous liver biopsy (PLB) after either pericapsular anesthesia (PA) or subcapsular anesthesia (SA), based on the numeric rating scale (NRS). Materials and methods: A total of 323 patients, mean age 51, range 21–82 years; 160 (49.5%) male, referred to the Interventional Radiology Clinic of Kocaeli University Faculty of Medicine for image-guided PLB, between June 2019 and May 2020 were included and randomized into two groups by anesthetic type; the first (n = 171) consisted of patients undergoing SA while the second (n = 152) included patients undergoing PA. The intensity of pain at 0, 1, and 6 h after PLB was evaluated between the groups using NRS. Results: At hours 0, 1, and 6, the median [range] NRS scores in the subcapsular and pericapsular groups were 2 [1–2] versus 3 [2–4] (P < 0.001), 1 [0–1] versus 1 [1–2] (P < 0.001), and 0 [0–0] versus 1 [0–1] (P < 0.001), respectively. Subgroup analysis revealed that the patients who underwent the subcostal procedure with subcapsular anesthesia reported the lowest pain scores and intercostal procedure with pericapsular anesthesia reported the worst pain scores for each time point: 0 h 1 [1–2] versus 3 [3–4], P < 0.001; 1 h 1 [0–1] versus 1 [1–2], P < 0.001; and 6 h 0 [0–0] versus 0 [0–1], P < 0.001, respectively. Conclusion: Subcapsular anesthesia is a well-tolerated procedure compared to a pericapsular procedure. Furthermore, the application of a subcapsular anesthetic with a subcostal approach was reported to result in the lowest pain and greatest patient comfort. Key words: Biopsy, liver, pain, local anesthesia
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İngilizce Özet A 16-year-old female patient sufferingfrom a palpable mass in her right breast for 4 monthsattended to our outpatient clinic. A 7 cm mobile, soft,nontender mass was palpated in her right breast.Mammographic examination results of the mass wasinitially considered as a breast hamartoma indifferential diagnosis. Breast magnetic resonanceimaging (MRI) reported a 6 x 4 cm mass that isheterogenous in T1 and T2 sequences, with lipoidcomponent inside, highly contrasted and showingcontrasted areas in late stages which mostly lookedlike a hamartoma. During surgery we detected that theexcised mass was bilobulated, 6 x 5 cm in diameterhaving regular surface, yellowish in colour andcapsulated macroscopically. After the pathologicalexamination the lesion was reported as afibroadenoma. Herein, we report a patient with abreast mass. The mass was radiologically consideredas a hamartoma but histopathologically it wasreported as a fibroadenoma.
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İnce bağırsak volvulusu, ince barsağın bir segmentininmezenteriyle birlikte aksiyal rotasyonuyla karakterize birdurumudur. Altmış üç yaşında erkek hasta 2 gündürgöbek etrafında yaygın ağrı, gaz-gaita çıkışı olmamasışikayetleriyle acil servise başvurdu. Acil şartlardayapılan laparotomik eksplorasyonda ince bağırsaksegmentlerinin mezolarından bridlerle sarılaraktorsiyone olduğu izlendi. İnce bağırsak rezeksiyonuyapılmadan bridektomi ile operasyon sonlandırıldı. İncebağırsak volvulusunda mortalite riskini iki katına çıkarangangrenöz komplikasyonlar açısından erken cerrahizorunludur. Akut karın ile başvuran tüm hastalardamutlaka akla getirilmelidir.
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