Differentiation of Malignancy and Idiopathic Granulomatous Mastitis Presenting as Non-mass Lesions on MRI: Radiological, Clinical, Radiomics, and Clinical-Radiomics Models.

RATIONALE AND OBJECTIVES: To investigate the effectiveness of machine learning-based clinical, radiomics, and combined models in differentiating idiopathic granulomatous mastitis (IGM) from malignancy, both presenting as non-mass enhancement (NME) lesions on magnetic resonance imaging (MRI), and to compare these models with radiological evaluation. MATERIAL AND METHODS: A total of 178 patients (69 IGM and 109 breast cancer patients) with NME on breast MRI evaluated between March 2018 and April 2022, were included in this two-center study. Age, skin changes, presence of fistula, and abscess were recorded from hospital records. Two experienced radiologists evaluated MRI images according to the breast imaging reporting and data system 2013 lexicon. Lesions were segmented independently on T2-weighted, apparent diffusion coefficient, and post-contrast-T1-weighted sequences. Data were split into training and external testing sets. Machine learning models were built using Light GBM (light gradient-boosting machine). Radiological, clinical, radiomics, and clinical-radiomics models were created and compared. Decision curve analysis was performed. Quality of reporting and that of methodology were evaluated using CLEAR and METRICS tools. RESULTS: IGM group was younger (p = 0.014). Abscesses (p < 0.001), fistulas (p < 0.001), and skin changes (p < 0.001) were significantly more common in the IGM group. No significant difference was detected in terms of lesion size (p = 0.213). In the evaluation of NME, the lowest performance belonged to the radiologists' evaluation (AUC for training, 0.740; for testing, 0.737), while the highest AUC was achieved by the model developed by combined clinical and radiomics features (AUC for training, 0.979; for testing, 0.942). CONCLUSION: Our study has shown that the machine learning-based clinical-radiomics model might have the potential to accurately discriminate IGM and malignant lesions in evaluating NME areas.

Prediction of Molecular Subtypes Using Superb Microvascular Imaging and Shear Wave Elastography in Invasive Breast Carcinomas.

RATIONALE AND OBJECTIVES: To investigate the efficacy of the advanced imaging methods, superb microvascular imaging (SMI) and shear wave elastography (SWE) in predicting molecular subtypes in invasive breast carcinomas. MATERIALS AND METHODS: A total of 210 biopsy-proven breast carcinomas in 200 patients who underwent ultrasound (US) imaging with SMI and SWE were included in this study. Quantitative analyses were performed using mean elasticity (Emean) score by SWE and vascular index (VI) by SMI. For qualitative assessment of microvascularity, first, lesions were graded according to Adler's classification in four types. Then, a new morphological model was used to classify the microvascular architecture into six patterns: type one, no signal; type two, penetrant; type three, rim-like; type four, dot-like/linear/regional; type five, wheel-like and type six, irregular signals. The correlation between these variables and molecular subtypes, nuclear grade, the Ki-67 levels and axillary status was investigated. RESULTS: The average VI and Emean values were relatively higher in non-luminal subtypes (VI, p = 0.002; Emean, p > 0.05). The two microvascularisation models were significantly able to differentiate the molecular subtypes according to the Kruskal Wallis test (p < 0.05). Rim-like, penetrant and regional patterns were primarily observed in luminal subtypes. The dominant pattern in non-luminal subtypes was wheel-like pattern. VI, Emean, Adler's classification and morphological vascularisation model were not significantly correlated with the nuclear grade, Ki-67 index or axillary status. CONCLUSION: The proposed microvascular categorization model may be more valuable in predicting molecular subtypes of breast carcinomas compared to VI and Emean and may contribute to the management of breast carcinomas as a non-invasive variable.

How Long does Denervation Take in Poliomyelitis? Or is it a Lifetime?"

BACKGROUND AND OBJECTIVE: This study aims to determine the period of reinnervation in patients with poliomyelitis. This research was conducted to identify the appearance of denervation potentials in patients with poliomyelitis as indicators for reinnervation. MATERIALS AND METHODS: A total of 246 male patients with poliomyelitis were assessed electrophysiologically between 1988 and 2007. The mean age was 22.8 (18-42). It has been an average of 19.9 ± 4.9 years since the beginning of complaints from the patients. RESULTS: The patients had no complaints of newly developing muscle weakness, fatigue, muscle and joint pain, and difficulties in breathing and swallowing. Neurological examinations revealed the absence of myotomal pain and sensory loss. Upon assessment of the patients' limbs, the following findings were revealed: two patients had left upper and lower limb involvement, two patients had left upper and right lower limb involvement, 6 patients had left upper limb involvement, 12 patients had both lower limb involvement, 105 patients had left lower limb involvement, 1 patient had both upper limb involvement, 2 patients had right lower and upper limb involvement, 12 patients had right upper limb involvement, 6 patients had both lower limb involvement, 95 patients had right lower limb involvement, and 3 had all the three extremities affected. The needle electromyography revealed the presence of denervation potentials in 25.2% (62) of the patients. CONCLUSION: When poliovirus attacks the motor neuron, this neuron may be completely destroyed, damaged, or unaffected. Reinnervation occurs when nearby functioning motor units send out terminal axon sprouts to reinnervate the damaged muscle fibers. As a consequence of poliomyelitis, several muscle fibers become atrophic and fibrotic, but others continue to survive. This study showed that patients with a history of poliomyelitis experienced denervation with subsequent reinnervation for many years.

P-wave dispersion doesn't increase in patients with epilepsy.

AIM: Epileptic seizures have occasionally been associated with cardiac conditions as atrioventricular blocks, long QT syndrome etc. P-wave dispersion (PWD), which is the difference between the longest (P max) and shortest P-wave duration (P min), is considered as a forerunner of atrial fibrillation. In this study, we investigated P-wave dispersion (PWD) in epileptic patients; based on the hypothesis that microthromboembolism may occur in atrial fibrillation. METHODS: Seventy five patients with mixed types of epilepsy and 50 age and sex matched healthy individuals were included into the study. P max, P min and PWD values were calculated for each subject from an ECG. RESULTS: The mean age of subjects in the epilepsy group and control group were similar (p>0.05). P max in patients with epilepsy was 125.1±0.7 ms, P min was 67.3±10.3 ms, and PWD was 57.6±8.3 ms while these values in the control group were 116.8±11.0 ms, 66.5±5.5 ms and 46.8±7.1 ms, respectively. There were no statistically significant difference between two groups (p>0.05). CONCLUSIONS: PWD does not increase in patients with mixed types of epilepsy. Therefore we believe that microthromboembolism due to atrial fibrillation can't cause epileptic seizures in patients with no structural heart disease.

Serum asymmetric dimethylarginine levels in diabetic patients with neuropathy.

OBJECTIVE: The goal of our study was to evaluate the role of asymmetric dimethylarginine (ADMA) in patients with diabetic neuropathy. MATERIALS AND METHODS: In this study, 58 diabetic patients and 26 healthy volunteers were included. In both groups ADMA measurements were performed together with other biochemical examinations. Nerve conduction studies and Neuropathy Symptom Score (NSS) were administered to the diabetic patients. RESULTS: ADMA levels were found significantly higher in diabetic patients compared to the control group (p = 0.0001). However, ADMA levels were not statistically significant between diabetic patients with neuropathy and without neuropathy (p = 0.86 and p = 0.47). CONCLUSION: These results demonstrate that there is not any significant relationship between ADMA and diabetic neuropathy.

Elastic characteristics of aorta in patients with epilepsy.

AIM: To investigate elastic characteristics of the aorta in patients with epilepsy. METHODS: Seventy five patients with a diagnosis of epilepsy through clinical and EEG findings and age and sex matched, 50 healthy controls were included. Systolic and diastolic blood pressures plus systolic and diastolic diameter of the aortic root was measured. Aortic strain (AS) and aortic distensibility (AD) and aortic distensibility index (BSI) were calculated. RESULTS: The average age of the epilepsy group was 23.8.8 +/- 8.2 years, and of the control group it was 24.1 +/- 6.2 years (p > 0.05). AS and AD were lower in the epileptic group while the aortic stiffness index was higher (10.4 +/- 4.2 vs 16.9 +/- 0.2, p: 0.001, for AS; 8.7 +/- 4.0 vs 17.2 +/- 0.1, p: 0.001, for AD and 20.1 +/- 0.1 vs 3.5 +/- 1.2, p: 0.001 for BSI). CONCLUSION: Elastic characteristics of the aorta change in epileptic patients, with a decrease of the distensibility of the aorta and an increase of the stiffness. After this preliminary study, new controlled studies are needed.

The effect of obesity on the assessment of diabetic peripheral neuropathy: a comparison of Michigan patient version test and Michigan physical assessment.

OBJECTIVE: Nerve conduction studies (NCS) and Michigan Neuropathy Screening Instrument (MNSI) are commonly used to make the diagnosis of diabetic peripheral neuropathy. The objective of this study was to compare the diagnostic values of MNSI patient version test and physical test for the assessment of the diabetic peripheral neuropathy in obese vs. non-obese patients. METHOD: This study was conducted on 70 type 2 diabetic patients. We carried out the MNSI patient version test and MNSI physical assessment test. Nerve conduction studies were performed for the diagnosis of the diabetic peripheral neuropathy. RESULTS: In diabetic peripheral neuropathy (DPN) determined by NCS, the independent prediction of peripheral neuropathy was the score of Michigan physical assessment (odds 2.0; CI: 1.3-3.0). In BMI (body mass index) ≥ 30 diabetic patients who have peripheral neuropathy, Michigan patient version test is not significant. But the score of Michigan physical assessment is significantly increased in these patients compared to patients without peripheral neuropathy. In BMI<30 diabetic patients who have peripheral neuropathy, scores of both Michigan patient version and physical assessment instruments are significantly increased. CONCLUSION: To screen diabetic peripheral neuropathy, Michigan physical assessment may be more useful instrument than Michigan patient version test in obese diabetic patients.

Crohn disease and chronic inflammatory demyelinating polyneuropathy; a case report.

BACKGROUND: The neurological manifestations of Crohn's disease are rare, dominated by multiple mononeuropathies, peripheral neuropathies (PN) of axonal and demyelinating types, myopathies and the abnormalities of the white matter. In our study, we aimed to report electrophysiological follow-up of a patient with chronic polyradiculoneuritis associated with newly diagnosed active Crohn's disease. CASE: A 32-year-old male patient was admitted with the complaints of abdominal pain and diarrhea for three years and an ascending weakness of all four extremities since two years. On his medical history he did not have any other disease and none of the members of his family had similar complaints. The neurological examination revealed a weakness of the especially distal muscles (2-3/5) with areflexia, hypotonia and distal atrophia in all extremities. He also had a glove and stocking hypoestesia. Routine biochemical and hematological examination were in normal ranges except C-reactive protein. The analysis of the cerebrospinal fluid showed an albumino-cytological dissociation. CONCLUSION: Our results suggest that peripheral neurological findings could be regarded as a possible extraintestinal manifestation of Crohn's disease. It is important to remember that inflammatory bowel diseases may be a reason for a newly diagnosed polyneuropathy (acute or chronic demyelinated polyneuropathy) and therefore detailed examinations are needed if the patients do not have the commonly observed reasons for the development of polyneuropathy and be careful in inflammatory disease patient to develop polyneuropathy.

Role of anti-GQ1B antibody in differential diagnosis of acute ophthalmoparesis.

Miller Fisher syndrome (MFS) is a triad of total external ophthalmoplegia, ataxia, and areflexia, while botulism has the usual clinical presentation of involvement of cranial muscles and palsies with blurred vision, diplopia, ptosis, dilated pupils, and facial paralysis, caused by a bacterial neurotoxin which attacks proteins involved in presynaptic vesicle release. In this report, we needed to make the differential diagnosis between MFS and botulism in a patient who presented with acute ophthalmoparesis and a history of diarrhea three days before, which started two days after consuming tinned food. Routine laboratory, neurophysiologic, and imaging investigations were normal. A clinical diagnosis of Miller Fisher syndrome was reached by anti-ganglioside GQ1B and GM1 Ig G and M antibody investigations which proved positive. The patient was treated with intravenous immunoglobulin two weeks after (in the late period) the symptoms started and he has recovered completely. Systemic autoimmune diseases should be considered in patients with bilateral ophthalmoparesis. As in the present patient, the evaluation of specific antibodies helps in the diagnosis and thus early effective treatment is possible.

A sledgehammer on the brachial plexus: thoracic outlet syndrome, subclavius posticus muscle, and traction in aggregate.

Reported here is a 30-year-old man who was seen because of pain and weakness in the upper extremities after a tractional injury. Physical examination revealed significant atrophy in the left deltoid and right intrinsic hand muscles, generalized hypoesthesia, decreased deep tendon reflexes bilaterally, and decreased strength in various muscle groups. Roos (right) and hyperabduction (bilateral) tests were positive. Electrodiagnostic studies were consistent with bilateral brachial plexopathy. Cervical radiographs showed long transverse process of C7 on the right side and a small rudimentary rib articulating with C7 on the left side. Brachial plexus magnetic resonance imaging demonstrated an aberrant muscle and compressive brachial plexus injury on the left side. Surgery via transaxillary approach was performed on the left side. The occurrence of traumatic brachial plexopathy in the presence of underlying thoracic outlet syndrome and subclavius posticus muscle is discussed for the first time in the literature.

Alpha1-acid glycoprotein for the early diagnosis of neonatal sepsis.

OBJECTIVE: We aimed to evaluate the diagnostic value of C-reactive protein (CRP) and alpha1-acid glycoprotein (alpha1AG) in the early diagnosis of neonatal sepsis. DESIGN: The study was prospectively conducted among newborns hospitalized for 'rule out sepsis' to neonatal intensive care unit (NICU). SETTING AND SUBJECTS: A total of 97 children [16 with confirmed sepsis (Group I), 34 with clinical sepsis (Group II), and 47 in control group (Group III)] were enrolled in the study. On admission to NICU, blood was sampled for CRP, blood culture, and alpha1AG before starting antibiotherapy. Twenty-four hours later CRP and alpha1AG levels were detected for second tests in the study group. RESULTS: In Group I and II, while the 1st and 2nd tests CRP levels were not different, the 2nd test alpha1AG levels were significantly higher than the 1st test results (p<0.01). Second test CRP and alpha1AG levels were also statistically higher in Group I than Group II (p<0.05). CONCLUSION: It is shown that CRP has limited value in the early diagnosis of neonatal sepsis. A significant increase in alpha1AG levels was detected in neonatal sepsis but its high specificity was accompanied with low sensitivity. Since the 2nd test alpha1AG values resulted with high sensitivity, we suggest that serial alpha1AG tests may be used but a single test for alpha1AG has limited usefulness in the neonatal sepsis which requires rapid diagnosis.

The effect of male circumcision on pudendal evoked potentials and sexual satisfaction.

Circumcision is generally considered a simple, rapid operation with medical benefits which accrue throughout life. The influence of circumcision on sexual satisfaction has always been argued. In this study, the assessment of the pudendal evoked potentials (PEP) in adults before and at least 12 weeks after circumcision was done. Healthy males aged between 18-27 years, who were willing to undergo circumcision were included in the study. Before and after circumcision, sexual performance was evaluated with the Brief Male Sexual Function Inventory (BMSFI), consisting of sexual drive, erection, ejaculation, problem assessment, and overall satisfaction sections. Forty-three adult males were enrolled in the study. Mean PEP latency was 41.97 +/- 0.25 (39.90-44.50) ms and 44.73 +/- 0.33 (40.90-47.60) ms before and after circumcision, respectively. Mean difference between pre- and postoperative PEP values was 2.76 ms which was statistically significant (p < 0.001). Mean ejaculatory latency time was significantly longer after circumcision (p < 0.001). In the light of our findings, we conclude that circumcision may contribute to sexual satisfaction by prolonging PEP latency but further studies are warranted also regarding the other dimensions of circumcision.

Use of sonography in carpal tunnel syndrome surgery. A prospective study.

The diagnosis of carpal tunnel syndrome (CTS) is mainly based on the characteristic symptoms and confirmed with nerve conduction studies. Sonography can provide measurements of the increased cross-sectional area of median nerve. The use of sonography was evaluated for the diagnosis and postoperative follow up of 48 wrists in 26 consecutive patients with CTS. Clinical evaluation and sonography were effective for the diagnosis in 40 wrists. Nerve conduction studies were needed in eight wrists, because of the decrease in cross-sectional area of the nerve as a result of degenerative changes. After 3 months, sonography detected statistically significant decreases in the cross-sectional areas of the median nerves. The sonographic studies were well tolerated by all patients. Sonography was both time-saving and cost-effective.

Incidence of ischemic brain lesions in hyperbaric chamber inside attendants.

Concern is growing about the negative long-term effects of hyperbaric exposure on the central nervous system of divers. This study was conducted with magnetic resonance imaging (MRI) to evaluate attendants that work inside hyperbaric chambers (known as inside attendants) for hyperintense brain lesions. Ten inside attendants and 10 healthy nondiving subjects were included in the study. A questionnaire was used to obtain information about subjects' medical history, hyperbaric exposure history, alcohol intake, and smoking habits. T1-weighted, T2-weighted, and fluid-attenuated inversion recovery images were acquired with a 1.5-T MRI device. A lesion was included in the count if it was hyperintense on both T2-weighted and fluid-attenuated inversion recovery images. Although MRI revealed 3 hyperintense brain lesions in 2 of 10 inside attendants and in none of the controls, the differences between groups were not statistically significant (P=.147). The number of brain lesions counted did not correlate with the age of the inside attendants (r=0.007; P=.978), the number of hyperbaric exposures (r=-0.203; P=.574), or the duration of work as an inside attendant (r=0.051; P=.890). Investigators found a correlation, however, between the number of cigarettes smoked in a day and the number of brain lesions identified (r=0.779; P<.01). An increased incidence of hyperintense brain lesions was not observed in inside attendants who had never experienced decompression sickness compared with nondiving controls. Additional multicenter epidemiologic studies are needed if the occupational safety of inside attendants is to be enhanced.

Cough headache: frequency, characteristics and the relationship with the characteristics of cough.

Cough headache (CH) is a relatively rare, but an important complication of cough. The aim of this cross-sectional clinical study was to evaluate the frequency, characteristics and etiology of CH among the patients referred to our Outpatient Department with the complaint of cough, and to investigate the relationship between their cough and headache characteristics. We evaluated 96 females and 69 males, a total of 165 patients with cough. Among those, 57 patients (34.5%) had one or more cough complications and 32 patients (19.3%) were diagnosed as CH. Although it was known that most of the patients with CH had benign headache characteristics, the ratio of the symptomatic CH was not low (37.5% of the CH patients and 7% of patients with cough). Also, there was a significant correlation between the frequency of cough and the severity of headache. Logistic regression analysis showed that the incidence of CH was increased 0.4-fold, when frequency of cough increased. Age, sex, tobacco use ad the duration of cough were not found to be predictive factors for CH. Logistic regression analysis showed that the rate of cough complications increased 2.08-fold, when the duration of cough was longer than eight weeks (p=0.03) and 0.4-fold when the frequency of cough increased (p=0.02). In conclusion, CH is a relatively rare, but an important complication of cough and it commonly has an effective treatment available. Radiological work-up was crucial in ruling out other causes of headache and to confirm that the CH was truly benign.

[The role of electrophysiologic tests in the early diagnosis of posterior interosseous neuropathy in patients thought to have lateral epicondylitis]. / Lateral epikondilit öntanisi konan olgularda posterior interosseöz sinir nöropatisinin elektrofizyolojik testlerle arastirilmasi.

OBJECTIVES: We investigated the role of electrophysiologic tests in determining posterior interosseous neuropathy (PIN) in patients with a preliminary diagnosis of lateral epicondylitis. METHODS: Thirty-three patients (24 females, 9 males; mean age 49 years) with a preliminary diagnosis of lateral epicondylitis and 15 healthy controls (10 females, 5 males; mean age 48 years) underwent radial, median, and ulnar nerve conduction studies, electromyography (EMG) of some selected muscles, and measurements for grip strength. The duration of symptoms was less than a month in all the patients and no therapy was instituted. RESULTS: A diagnosis of PIN was made in 22 patients (66.7%). The mean ages of the patients with and without PIN were 45 and 51 years, respectively. The mean grip strengths did not differ significantly between the patients and controls, and between the right and left hands. All the patients responded well to conservative treatment. CONCLUSION: Electrophysiologic tests may be necessary and beneficial in the differential diagnosis of PIN in patients unresponsive to treatment for lateral epicondylitis of early stage.