Diagnostic Yield of Transabdominal Ultrasound-Guided Core Needle Method in Biopsies of Pancreatic Lesions.

ABSTRACT: In this study, it was aimed to contribute to the selection of the method to perform pancreatic lesion biopsies.Data of patients, who had undergone a percutaneous biopsy because of pancreatic masses in our institution in the period between January 2015 and November 2019, were evaluated retrospectively. The percutaneous biopsy method, the type of needle used in the procedure, and periprocedural complications were listed. Pathology and cytology reports in the archive were reviewed, and biopsy results were divided into 3 groups as benign, malignant, and inadequate. Of 308 patients included in the study, the diagnostic accuracy was verified in 124 patients through the assessment of surgical outcomes, results of biopsies from metastatic lesions, or follow-up findings. The verified results were classified as true-positives and true-negatives.Of a total of 308 patients included in the study, 23 underwent a fine-needle aspiration biopsy (FNAB) and 285 underwent a core needle biopsy (CNB). No statistical differences were observed in sample acquisition success and complications between the groups.Of the lesions with a confirmed pathological diagnosis, 67.74% were malignant and 32.26% were benign. The diagnosis was correct in 107 of 112 CNB patients (95.54%) and 9 of 12 FNAB patients (75.00%). When the success of the 2 methods was compared, it was found that outcomes of CNB were statistically more successful compared with those of FNAB.A transabdominal ultrasound-guided percutaneous CNB is a safe method with a high diagnostic yield to perform a biopsy of the pancreas.

Liver Pseudolymphoma (Reactive Lymphoid Hyperplasia): Difficulty in Radiological and Pathological Diagnosis.

BACKGROUND: Pseudolymphoma of the liver (Reactive Lymphoid Hyperplasia) (RLH) is a rare condition. It is usually asymptomatic and detected incidentally on radiological imaging. Imaging features are similar to hepatic adenoma, hepatocellular carcinoma, cholangiocarcinoma, and malignant lymphoma and are not specific for pseudolymphoma of the liver. Percutaneous core biopsy is insufficient to distinguish pseudolymphoma of the liver from low-grade malignant lymphoma and extranodal marginal lymphomas. CASE DESCRIPTIONS: In this article, we present a case of hepatic RLH of a patient who was presented with a skin rash on the leg and was detected incidentally on radiological imaging. CONCLUSION: Preoperative definitive diagnosis of hepatic RLH using various imaging methods, including MRI with hepatocellular agents, is highly difficult.

Radiology guided antegrade GASTROSTOMY deployment of mushroom (pull type) catheters with classical and modified methods in patients with oropharyngeal, laryngeal carcinoma, and anesthesia risk.

OBJECTIVE: The aim of study is to evaluate the results of deployment of Percutaneous Radiological Gastrostomy (PRG), which is a good alternative to Surgical Gastrostomy (SG), with transoral approach in cases where Percutaneous Endoscopic Gastrostomy (PEG) is contraindicated, difficult or unsuccessful, in patients with high risk of American Society of Anesthesiologists with four scores. In addition, we aimed to demonstrate the advantages of mushroom pull type catheters over push type gastrostomy catheters. METHODS: This retrospective study included a total of 40 patients (18 females and 22 males) aged 21-92 years who underwent PRG with the antegrade transoral approach. PRG was performed by retrograde passing through the esophagus or snaring the guidewire from the stomach and taking out of the anterior abdominal wall. Patients' demographic data, indications for PRG, procedural outcomes and complications were screened and recorded. RESULTS: PRG was performed in 39 of 40 patients included in the study. Technical success rate was 97.5%. Procedure-dependent major complications such as death, aspiration, colon perforation, and deep abscess were not observed. Aspiration occurred in the first patient during the first feeding on the day after the procedure. Major complication rate was 2.5%. The total minor complication rate was 17.5% in 7 patients; parastomal leakage in 2 patients (5%), skin rash and infection in 3 (7.5%) patients, minor bleeding in 2 (5%) patients with oropharynx cancer, minimal bleeding from the gastrostomy catheter 1 week after the procedure in 1 (2.5%) patient. None of the cases had buried buffer. Tube functionality was preserved in all patients without any damage. CONCLUSION: Mushroom tip (pull type) gastrostomy catheter is a safe treatment method for patients requiring prolonged feeding because of wide diameter, endurance, long staying opening duration, less excessive dilatation and parastomal leakage, and no need for gastropexy. Lower cost and easier access are advantageous for mushroom tip pull type catheters compared to push type gastrostomy catheters in our country. The less invasive PRG is an alternative option in patients who are difficult to administer PEG, are at high anesthesia risk and cannot be sedated. ADVANCES IN KNOWLEDGE: This article is valuable in terms of its contribution to develop an alternative radiological method for the deployment of gastrostomy tubes in medical difficult patients. This method has shortened the duration of the procedure and increased the success rate in patients with difficulty in transition from the stomach to the esophagus or with difficulty in the upper gastrointestinal tract. Mushroom tip catheters can be placed successfully by radiological methods.

The effects of sevoflurane anesthesia on hemodynamics and cerebral artery diameters in endovascular treatment of intracranial aneurysm: A pilot study.

BACKGROUND: Cerebral autoregulation is a steady-state of cerebral blood flow despite major changes in arterial blood pressure. Inhalation anesthetics are cerebral vasodilators. In <1 MAC values, the net effect is a moderate decrease in cerebral blood flow and maintenance of responsiveness to carbon dioxide. This study aims to investigate the effects of steady-state sevoflurane anesthesia on hemodynamic and cerebral artery diameter measurements in patients undergoing flow diverter device placement under general anesthesia. METHODS: Forty-six patients aged 18-70 years who underwent flow diverter devices under general anesthesia were included in this study. Routine monitoring was performed on the patients. Mean arterial pressure (MAP) values were recorded. Internal carotid artery, middle cerebral artery and anterior cerebral artery diameter measurements were made from digital subtraction angiography (DSA) images of patients with anterior aneurysms. Baseline artery, right posterior cerebral artery and left posterior cerebral artery diameter measurements were made from DSA images of patients with posterior aneurysms. These measurements were recorded as preoperative measurements. The same measurements were made from the DSA images performed before the Flow diverter device placement procedure performed under steady-state sevoflurane anesthesia for the same patients. These measurements were recorded as peroperative measurements. RESULTS: The average age of the patients was 56.6±15.1. The MAP of the patients before induction was 76.28±5.13 mmHg, MAP after induction was 64.36±3.23 mmHg, and MAP during sevoflurane anesthesia was 68.26±4.30 mmHg, there was a statistically significant difference. There was a statistically significant difference between the preoperative and perioperative values of anterior cerebral artery diameters. There was a strong relationship between the MAP change percentage and the ICA diameter change percentage (p<0.001, p=-0.785) and a moderate relationship between the MCA diameter change percentage (p=0.033, p=-0.338). CONCLUSION: In patients undergoing flow diverter devices, <1 MAC sevoflurane has a hemodynamic effect and creates significant vasodilation in the cerebral artery diameters.

Ultra-mini Percutaneous Hepatolithotomy in Patients With Large and Multiple Hepatolithiasis.

BACKGROUND: In this study, we applied the ultra-mini percutaneous hepatolithotomy (UM-PHL) technique on hepatolithiasis patients with multiple and large stones on which other minimally invasive methods failed, and our aim was to report its results, sharing in series for the first time. MATERIALS AND METHODS: Preoperative and postoperative data, laboratory parameters, radiologic findings, and preoperative and postoperative details were recorded for a total of 14 patients for whom the UM-PHL technique was applied between April 2017 and December 2019. As all patients had multiple stones and extreme stone load and had bile duct surgery, they did not have a normal anatomy. All patients were radiologically confirmed to have had preprocedural magnetic retrograde cholangiopancreatography. RESULTS: Operation duration of the patients was 137.6±44.9 minutes, while intraoperative blood loss was 69.2±24.9 mL, drainage catheter removal time was 2.85±0.86 days, and the hospitalization time was 4.28±2.55 days. Intraoperative balloon dilation was applied to enlarge the stricture area in 5 patients (35.7%). On the basis of the Clavien-Dindo classification, grade 2 complication was observed in 2 patients (14.2%) due to postoperative cholangitis. Patients were followed up for an average of 15 months, and nonsymptomatic radiologic stone recurrence was detected in the 12th month control of 1 patient (7.1%). CONCLUSION: The UM-PHL technique is a successful method that facilitates stone clearance by providing minimal dilatation through percutaneous intervention and by using instruments with small diameter, and it can safely be applied with its low complication level, low recurrence ratio, and short hospitalization time.

Effectiveness of autologous blood injection in reducing the rate of pneumothorax after percutaneous lung core needle biopsy.

PURPOSE: To assess the effectiveness and safety of autologous intraparenchymal blood patch (IBP) application in reducing the frequency of pneumothorax (PTX) after percutaneous transthoracic pulmonary core needle biopsy. METHODS: The records of patients who underwent the transthoracic pulmonary core needle biopsy procedure under CT guidance between January 2015 and October 2018 were screened retrospectively. Patients whose traversed pulmonary parenchymal length was ≥20 mm during biopsy were included in the study irrespective of lesion size. The IBP procedure was made a department policy in November 2017; patients who underwent biopsy after this date comprised the IBP group, while those who underwent the procedure before this date comprised the control group. IBP recipients received 2-5 mL of autologous blood injection to the needle tract. Demographic data, procedural reports, tomography images, and the follow-up records of patients were assessed. RESULTS: A total of 262 patients were included in the study. Of the 91 patients that received an IBP, PTX developed in 13 (14.1%), with 7 (7.7%) requiring a thoracic tube. Of the 171 patients who did not receive an IBP, PTX developed in 45 (26.3%), with 19 (11.1%) requiring a thoracic tube. Patients who received an autologous IBP showed a significantly lower rate of PTX development versus those who did not (P = 0.01). Similarly, a significantly lower number of patients who received the blood patch required chest tube placement (P = 0.015). CONCLUSION: Autologous IBP is a safe, inexpensive and easy to use method that reduces the rate of PTX development and thoracic tube application after percutaneous core needle biopsies of the lung.

Hydatid Cyst Treatment and Management in Retroperitoneal Organs; Is Percutaneous Drainage an Option?

PURPOSE: To evaluate patients who cyst hydatid (CH) in their retroperitoneal space and organs in order to determine a standard treatment option for CH. MATERIALS AND METHODS: The files of 56 patients who were treated for CH in our clinic were evaluated retrospectively. All patients underwent either percutaneous drainage (PD) or surgery. Patients were divided into two groups as PD (Group one) and surgery groups (Group two). Preoperative and postoperative results were compared statistically. RESULTS: 31 of 56 patients were male. Mean age of the patient was 39.7 (10-85). 16 patients had been treated with PD and 40 with different surgical interventions such as total cystectomy, partial cystectomy, partial nephrectomy, total nephrectomy, surrenalectomy, and laparoscopic partial surrenalectomy. Patients' followed up was 18 months (6-38m). Relapse was seen in 1 patient who underwent PD. On comparing the results, hospitalization period was prolonged in the surgical group with enlarged cyst presence. CONCLUSION: CH presence in the retroperitoneal area is rare. PD, a minimally invasive method, has the potential to be the standard treatment option as it can be performed safely in selected patients. However, currently surgical treatment is considered as the first treatment option after CH diagnosis.

Endovascular treatment of intracranial aneurysms using the Woven EndoBridge (WEB) device: retrospective analysis of a single center experience.

INTRODUCTION: Woven EndoBridge (WEB) is an innovative device for the treatment of intracranial aneurysms especially wide-necked bifurcation aneurysms. Here we present our experience with the WEB device. MATERIAL AND METHODS: Patients treated using only the WEB device between September 2014 and November 2018 were included in the study. Follow up imaging studies and medical records of the patients were retrospectively reviewed. RESULTS: Forty-two aneurysm of 42 patients (27 female, 15 male; median age: 56, range: 32-76) were treated using the WEB device. The mean diameter of the aneurysms was 6.6 mm (range: 3-12 mm). The neck diameter was ≥4 mm in 57% of the aneurysms. The locations of the aneurysms were the middle cerebral artery bifurcation in 29 (69%), basilar tip in 5 (12%), anterior communicating artery in 5 (12%), internal carotid artery tip in 2 (5%), and M1 segment of the middle cerebral artery in 1 (2%) of the patients. Five patients had subarachnoid hemorrhage due to aneurysm rupture. The device could be successfully deployed in all of the cases. There were control imaging studies available for 36 patients who were followed up for a median of 7 months (range: 1-33 months). Adequate occlusion was observed in 35 of these 36 patients (97%). There was no treatment related morbidity or mortality. CONCLUSION: Although long term follow-up data are not available, WEB intrasaccular flow disruptor seems to be effective and safe for intracranial bifurcation aneurysm treatment in the mid-term follow up.

Ectopic Cushing's syndrome due to adrenocorticotropic hormone secreting atypical thymic carcinoid tumor.

Cushing's syndromes (CS) due to thymic carcinoids are rarely seen. In this text, a case with CS due to ectopic adrenocorticotropic hormone (ACTH) secreting atypical thymic carcinoid tumor is presented. A 50-year-old Turkish male patient was admitted to our emergency department with typical CS features. Basal hormone profile, low- and high-dose dexamethasone suppression tests, and inferior petrosal sinus sampling results were consistent with ectopic ACTH secretion. Thorax computerized tomography showed an upper mediastinal mass, and trans-thoracic biopsy showed atypical thymic carcinoid with positive ACTH staining. Since the vascular invasion was detected, tumor was accepted inoperable; somatostatine receptor analogs, chemotherapy, and radiotherapy were planned. Ectopic CS can be derived from atypical thymic carcinoid. In this case, ACTH staining was used to confirm ACTH secretion from thymic tissue, and positive staining was detected. ACTH staining routinely was not performed for extra hypophyseal tissue tumors. In suspicious and difficult cases, ACTH staining can be helpful to confirm the presence of ACTH in tumor tissues.

Effectiveness of Superb Microvascular Imaging for the differentiation of intraductal breast lesions.

AIMS: The aim of this study was to compare the diagnostic performance of superb microvascular imaging (SMI) and power Doppler imaging (PDI) for the differentiation of intraductal breast lesions. MATERIALS AND METHODS: A total of 54 intraductal breast lesions (39 benign, 10 atypical, and 5 malignant) in 53 patients were examined using B-mode ultrasonography, PDI, and SMI. Vascularity grading, distribution of microvessels, and penetrating vessels were evaluated using each Doppler technique. The diagnostic performances of both methods were compared. RESULTS: SMI was more efficient in detecting flow signals than PDI (p=0.004). The highest diagnostic accuracy rates were achieved with SMI using vascular grading. When hypervascularity was used as a cut-off value to differentiate malignant and atypical lesions from benign lesions, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 66.6%, 80.7%, 66.6%, 80.7%, and 75.6%for PDI, and 86.6%, 76.9%, 68.4%, 90.9%, and 80.4% for SMI, respectively. CONCLUSIONS: SMI is more sensitive than PDI for detecting subtle blood flow in intraductal breast lesions with statistical significance. This novel and promising vascular imaging technique may be helpful in B-mode ultrasonography to distinguish intraductal breast lesions.

Superb Microvascular Imaging of the Median Nerve in Carpal Tunnel Syndrome: An Electrodiagnostic and Ultrasonographic Study.

OBJECTIVE: To evaluate intraneural blood flow of the median nerve using superb microvascular imaging (SMI) and power Doppler ultrasonography (PDUS), and to examine their correlation with electroneuromyography in patients with carpal tunnel syndrome (CTS). METHODS: A cross-sectional survey was used, and the study was conducted in the research unit of a training and research hospital. Patients diagnosed with CTS according to electroneuromyography studies were included in the study. Ultrasound measurements were taken using an Aplio-500 (Toshiba Medical System Corporation, Tokyo, Japan) device and a linear multifrequency 14-MHz probe. The cross-sectional area of the median nerve at the carpal tunnel level was measured by the direct tracing method using electronic calipers. The power Doppler ultrasonography and superb microvascular imaging scores were recorded by grading the vascularity between 0 and 3. RESULTS: Evaluation was made of a total of 113 hands of 80 patients (18 men, 62 women) with a mean age of 34.67 ± 12.82 years. The mean duration of symptoms was 12.34 ± 6.66 months. When the patients were grouped as mild, moderate, and severe CTS, there was a statistically significant difference between the SMI and PDUS grades (P < .05). As the severity of CTS increased, an increase in SMI and PDUS scores was observed. There was a strong correlation between SMI scores and motor distal latency (r = .71/P = .026), amplitude of sensory action potential (r = -.77/P = .029), and sensory neurotransmission rate (r = .77/P = .029). CONCLUSION: SMI seems to be more sensitive than PDUS for evaluating the vascularity of the median nerve in patients with CTS, and SMI grading is correlated with the ENMG results.

Diagnostic Performance of Superb Microvascular Imaging and Other Sonographic Modalities in the Assessment of Lateral Epicondylosis.

OBJECTIVES: The aim of this study was to compare the diagnostic performance of different sonographic modalities for diagnosing lateral epicondylosis. METHODS: A total of 50 symptomatic and 50 asymptomatic common extensor tendons in 44 patients with lateral epicondylosis, and 25 healthy participants were prospectively examined by B-mode sonography, color Doppler imaging, power Doppler imaging, Superb Microvascular Imaging (SMI; Toshiba Medical Systems Corporation, Tokyo, Japan), and strain elastography. We evaluated blood flow in common extensor tendons by using a grading system with color Doppler imaging, power Doppler imaging, and SMI. The diagnostic performance of the modalities was compared. RESULTS: When a cutoff value of hypoechogenicity was used for the mean strain ratio, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rates were 92.0%, 94%.0, 93.9%, 92.2%, and 93.0%, respectively. When a cutoff point of grade 1 was used, the sensitivity, specificity, PPV, NPV, and accuracy rates were 26.0%, 10.0%, 10.0%, 57.5%, and 63.0, for color Doppler imaging; 40.0%, 10.0%, 10.0%, 62.5%, and 70.0% for power Doppler imaging; and 84.0%, 94.0%, 93.0%, 85.5%, and 89.0% for SMI. When a cutoff value of 3.94 was used for the mean strain ratio, the sensitivity, specificity, PPV, NPV, and accuracy rates were 78.0%, 92.0%, 90.7%, 80.7%, and 85.0%, respectively. A statistically significant correlation was detected between SMI, strain elastography, and visual analog scale scores (P < .001). CONCLUSIONS: The combination of SMI and B-mode sonography was found to have excellent diagnostic performance for lateral epicondylosis. Neovascularzation in patients' tendons with lateral epicondylosis was identified much better with SMI compared to color or power Doppler imaging.

Long-term results of percutaneously treated multiple hepatic and splenic hydatid cysts in a pregnant woman.

Hydatid disease is caused by Echinococcus granulosus, which is endemic worldwide. This parasitic tapeworm can produce cysts in almost every organ of the body; however, the liver and lungs are the most frequently targeted. 37­year-old multigravida woman with a 10-week pregnancy in whom multiple splenic and liver hydatid cysts were detected by ultrasound. All splenic and liver hydatid cysts were treated percutaneously under US guidance during the 14th week of pregnancy. The catheterization method was used in the treatment of all hydatid cysts. Alcohol was also used as scolicidal and sclerosing agent in all procedures. There were no major complications. A cystobiliary fistula developed in a hydatid cyst treated in the liver. A healthy baby was delivered vaginally at term.

Percutaneous treatment of hepatic cystic echinococcosis: the success of alcohol as a single endocavitary agent in PAIR, catheterization, and modified catheterization techniques.

OBJECTIVES: This retrospective study aims at demonstrating the success rate, effectiveness, and advantages of alcohol as a scolicidal and sclerosing agent for the percutaneous treatment of liver hydatid cysts. METHODS: A total of 554 liver hydatid cysts obtained from 347 patients admitted between January 2008 and February 2016 were retrospectively investigated. Of these, 435 (78.5%), 91 (16.4%), and 28 (5%) were classified as Gharbi type 1, 2, and 3, respectively. Type 1 and 2 cysts were treated using PAIR (puncture, aspiration, injection, respiration) and single puncture catheterization methods; type 3 lesions were treated using a modified catheterization technique. Alcohol was used as a scolicidal and sclerosing agent in all procedures. RESULTS: After excluding three lesions (0.5%) because of lack of parenchymal support during catheterization, 274 (49.7%), 250 (45.3%), and 27 (4.9%) of 551 lesions were treated with PAIR, single puncture catheterization, and modified catheterization techniques, respectively. Therefore, a 99.5% of technical success rate was obtained. Major complications in 2 patients (0.5%) and minor complications were observed in 36 patients (10.3%). Mean hospital stay was 1.55±2.3 days (range: 0-23 days). Patients were followed-up for mean 19.6 months (range: 6-83 months), during which recurrences were detected in 19 patients (5.4%). CONCLUSIONS: The use of alcohol as a scolicidal and sclerosing agent during the percutaneous treatment of liver hydatid cysts is associated with a high success rate and low rates of recurrence and complications, and should be considered an important alternative to surgical procedures.

New surgical technique applied with urological instruments in bilobar multiple hepatolithiasis: Ultra-mini percutaneous hepatolithotomy.

Intrahepatic bile duct stones may emerge with manifestations as chronic stomach ache, cholestasis, cholangitis, abscess, post-obstructive atrophy and liver cirrhosis presentation may occur. Thus the treatment of symptomatic hepatolithiasis patients should be provided. Different methods such as biliary decompression, endoscopic, percutaneous or open surgery are recommended for the treatment of patients with intrahepatic gallstones. The aim of the treatment is to extract the stones and regain biliary drainage. But the treatment regimen to be applied should be determined after examining the age, performance condition, general condition of the patient and location of the stone carefully. In this case, we presented a young female patient who had many unsuccessful surgical interventions due to coledochal cyst and congenital malformation in bile ducts, had large stones in right and left intrahepatic bile ducts and in whom we provided complete stone-free condition through Ultra-Mini Percutaneous Hepatolithotomy (UM-PHL) using urological instruments.

Successful percutaneous treatment of extrahepatic cystic echinococcosis through PAIR and single puncture catheter techniques.

PURPOSE: To demonstrate the successful percutaneous treatment of extrahepatic cystic echinococcosis as an alternative to surgical procedures. MATERIALS AND METHODS: A total of 27 extrahepatic hydatid cysts in 12 patients, the spleen in 8 patients, muscles and soft tissues in 3 patients each and right adrenal gland in 1 patient were treated with PAIR (puncture, aspiration, injection, respiration) or single puncture catheterization methods. As a scolicidal and sclerosing agent, alcohol was used in all patients. RESULTS: Of 27 extrahepatic lesions of hydatid cysts, 24 (88.9%) were Gharbi type 1 (WHO CE 1), and 3 (11.1%) were Gharbi type 2 (WHO CE 3A). Of hydatid cystic lesions, 20 with PAIR and 7 with single puncture catheterization methods were treated. No major complications developed in any patients. Abscesses were detected in two patients (16.6%). Mean total hospital stay was calculated between 1 and 14 days (mean 2.3 days). Follow-up periods ranged between 10 and 62 months (mean 22.3 months). CONCLUSION: Percutaneous treatment for extrahepatic hydatid cystic lesions is an important alternative to surgical procedures because of the high therapeutic success rate, lower rate of complications and shorter hospital stays.

Role of Different Treatment Modalities in Cavity Volume during the Treatment of Cystic Ecchinococcosis.

OBJECTIVE: Surgery and percutaneous aspiration-injection-re-aspiration (PAIR) are widely accepted treatment modalities for hepatic hydatid cysts. Endoscopic retrograde cholangiopancreaticography (ERCP) acts as a minimally invasive rescue method for the biliary complications of both the hydatid cysts and treatment modalities. The aim of this study was to identify the role of different treatment modalities in the obliteration of hydatid cysts. METHODS: Patients treated for hydatid cysts between January 2009 and December 2013 were evaluated in the study. Data were collected from hospital records. All cyst cavities were evaluated by ultrasonography or computed tomography. RESULTS: Ninety-five (40.4%) males and 140 (59.5%) females were included in the study. Before the procedures, the mean cyst diameter was 89.7±33.5 mm. At follow-up, the mean cyst diameter decreased to 53.2±30.1 mm. In the ERCP group, the mean diameter of the residual hydatid cyst cavity was significantly lower than that of the other groups (p=0.003). CONCLUSION: ERCP provides faster cyst shrinkage and even disappearance of the residual cavity in 50% of cases. Moreover, in hydatid cysts with biliary communication, ERCP+ES can be safely used for primary treatment.

(18)F-FDG PET/CT mean SUV and metabolic tumor volume for mean survival time in non-small cell lung cancer.

OBJECTIVE: The study was designed to determine the relationship between survival time of standardized uptake value (SUVmax and SUVmean) and metabolic tumor volume (MTV) in patients with non-small cell lung cancer (NSCLC), and examine the impact of demographic, clinical, and radiological data of these patients on survival. MATERIALS AND METHODS: We performed a retrospective analysis of the records of 79 patients with NSCLC who presented to our hospital between May 2010 and March 2013, received a final diagnosis, and underwent F-FDG PET/CT for staging. Clinical, radiological, and F-FDG PET/CT parameters with an impact on prognosis such as the SUVmax of the primary tumor as calculated by the volumetric region of interest in the F-FDG PET/CT scans during initial diagnosis, mean SUV of the tumor, and MTV obtained with a threshold of SUVmax greater than 2.5 were recorded and statistically analyzed. A statistical analysis was carried out based on the clinical, radiological, and PET/CT findings of the patients who were divided into 2 groups: survivors and nonsurvivors. RESULTS: Seventy patients (88.6%) were men, and 9 (11.4%) were women. The mean age was 63.65 ± 11.51 years in the nonsurvivor group (n = 40) versus 62.74 ± 10.60 years in the survivor group (n = 39) (Table 1). The mean survival time from diagnosis was 7.9 ± 6.52 months in the nonsurvivor group versus 14.09 ± 7.41 months in the survivor group. The mean survival time was 12.9 ± 7.9 months for those aged 60 or younger, whereas it was 9.9 ± 7.2 years for those aged 60 or older. According to the Cox regression analysis, higher MTV [relative risk (RR), 1.006; P = 0.03] and mean SUVmax (mSUV) (RR, 1.302; P = 0.03) had a significant impact on shortening of the mean survival time. However, no statistical significance was reached for SUVmax measurements (RR, 0.970; P = 0.39). Furthermore, there was a significant relationship between increased tumor size (<2 cm, 2-4 cm, and ≥4 cm) and shortened mean survival time (P = 0.03). CONCLUSION: The present study showed that MTV and mSUV of FDG PET/CT scans of the tumor, but not SUVmax, had a significant impact on survival time of patients with NSCLC. Based on this result, we believe that we might have more accurate information about the survival time of our patients if we also evaluate mSUV and MTV in combination with mSUV, which is frequently used for diagnosis and monitoring of patients with NSCLC during our daily practice.

Frequency of nodular goiter and autoimmune thyroid disease in patients with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS), and nodular and autoimmune thyroid diseases are frequently seen disorders. Previous studies reported conflicting results regarding possible association between PCOS and thyroid disorders. In this study, we investigated the frequency of autoimmune thyroid disease (AITD) and nodular goiter in patients with PCOS. Seventy-three PCOS patients and 60 age-matched controls were enrolled in the study. In PCOS group, body mass index values (27.45 ± 5.73 vs. 22.55 ± 3.78 kg/m(2), p < 0.001, respectively), systolic [110 mmHg (90-130) vs. 100 mmHg (90-140), p = 0.016, respectively] and diastolic (72.67 ± 6.52 vs. 66.42 ± 8.88 mmHg, p < 0.001, respectively) blood pressure, waist circumference (86.27 ± 14.41 vs. 78.78 ± 8.87 cm, p < 0.001, respectively), and homeostasis model assessment-insulin resistance (HOMA-IR) levels (2.96 ± 2.11 and 1.77 ± 0.83 p < 0.001, respectively) were higher than controls. However, thyroid nodule frequency was similar in both groups [22 (30.1 %) vs. 12 (20 %)], also thyroid gland volume was not significantly different [9.23 ml (3.08-32.40) vs. 8.52 ml (4.28-50.29)] among groups. The percentages of patients with thyroid parenchymal heterogeneity, positive anti-thyroid peroxidase, anti-thyroglobulin, and AITD were similar. Cases were reclassified according to the presence of thyroid nodule in which similar HOMA-IR levels were detected (median 2.39 and 1.89, p = 0.093, respectively) despite the fact that the group with nodules had higher mean age (26.5 (18-37) vs. 21 (18-34), p = 0.013, respectively). Similar ratios of thyroid nodule and AITD were found in patients with PCOS and controls.

Frequency of Thyroid Nodules among Patients with Colonic Polyps.

Aim. Colonic polyps and thyroid nodules are common diseases and their frequency increases with age. In the literature, there is no study investigating the coexistence of colonic polyps and thyroid nodules. Therefore, this study was designed to investigate thyroid nodule prevalence in patients with colonic polyps. Material and Methods. Sixty-six patients with colonic polyps and 146 patients without colonic polyps enrolled into the study. Age and sex matched control group was composed from patients without colonic polyps. Colonoscopic examinations, thyroid ultrasonographies were performed in all patients, and TSH were measured. Results. Male/female ratio in polyp and control groups were 40/26 versus 68/78, respectively (P = 0.058). Mean ages were similar in both groups (53.3 ± 11.4 versus, 51.8 ± 11.4, P = 0.373). Thyroid nodule was detected in 44 (66.7%) patients with polyps and in 61 (41.8%) controls (P = 0.001). Patients with adenomatous polyps had 5 or more thyroid nodules compared to patients with hyperplastic polyps (P = 0.03). Thyroid nodules were more prevalent among patients aged 50 or older compared to 50 years or less (P = 0.023). Conclusion. Thyroid nodules were detected more common in patients with colonic polyps. Further studies are needed to clarify this coexistence.