Pressure ulcer development in patients treated for acute ischaemic stroke.

OBJECTIVE: The aim of this study was to determine the incidence of pressure ulcers (PUs) in patients treated for acute ischaemic stroke (AIS) and to evaluate comorbid/confounding factors. METHOD: The study included patients treated for AIS who were divided into three treatment groups: those receiving intravenous tissue plasminogen activator therapy (tPA); patients receiving mechanical thrombectomy (MT); and those receiving both tPA and MT. PUs were classified according to the international classification system and factors that may influence their development were investigated. RESULTS: A total of 242 patients were included in this study. The incidence of PUs in patients treated for AIS was 7.4%. Most PUs were located on the sacrum (3.7%), followed by the gluteus (3.3%) and trochanter (2.9%). With regards to PU classification: 29% were stage I; 34% were stage II; and the remainder were stage III. Age was not a significant factor in the development of PUs (p=0.172). Patients in the tPA group had a lower PU incidence (2.3%) than patients in the tPA+MT group (15.7%) and MT group (12.1%) (p=0.001). Patients with PUs had a longer period of hospitalisation (18.5±11.92 days) than patients without a PU (8.0±8.52 days) (p=0.000). National Institute of Health Stroke Scale (NIHSS) scores at admission were higher in patients with PUs than in patients without a PU (14.33±4.38 versus 11.08±5.68, respectively; p=0.010). The difference in presence of comorbidities between patients with and without PUs (p=0.922) and between treatment groups (p=0.677) were not statistically significant. The incidence of PUs was higher in patients requiring intensive care, but this difference was not statistically significant (p=0.089). CONCLUSION: In this study, patients treated for AIS with high NIHSS scores at admission and/or receiving MT were at higher risk for PUs, and so particular attention should be given to these patients in order to prevent PU development.

Minimally Invasive Excision of Breast Masses under Ultrasound Guidance: A Single Center's Five-Year Experience on the Breast Lesion Excision System.

Background: The purpose of this study was to investigate the feasibility of the percutaneous radiofrequency (RF) excision system (BLES) as a primary method of diagnosis and removal of small breast masses. Methods: Ninety-six lesions in 95 patients with 50.5 ± 8.4 years of age were treated in a five-year period by a single operator. Inclusion criteria were as follows: size (<20 mm), depth (>10 mm), and indeterminate or suspicious radiological features (74 BI-RADS 3 and 22 BI-RADS 4). The procedure was performed under ultrasound (US) guidance using 6 G retriever probes with 12-, 15-, and 20-mm baskets. Results: Lesions were between 5 and 20 (12.3 ± 3.8) mm in length. They were removed at the first attempt in all but one case. The technical success rate was 98.95%, and the diagnostic success rate was 100%. Ninety-one lesions were histologically benign and five were neoplastic. Two lesions that were previously classified as BI-RADS 3 were diagnosed as neoplasia (atypical lobular hyperplasia), and nineteen lesions that were previously classified as BI-RADS 4a were diagnosed as benign. The complete excision rate (presence of tumor-free negative surgical margin) was 40% in neoplastic lesions. There were no major complications. The minor complication rate was 1.58%. No recurrence was observed during 18 months of follow-up. Conclusion: BLES delivers surgical quality specimens for confident histopathological examination and is a safe alternative to surgical resection in lesions with suitable size.

Efficacy and safety of percutaneous endobilliary radiofrequency ablation with a novel temperature-controlled catheter in malignant biliary strictures.

Purpose: The purpose of this study is to evaluate the efficacy and safety of temperature-controlled endobilliary radio-frequency ablation (EB-RFA) followed by metal stent placement for nonresectable malignant biliary strictures. Material and methods: From May 2017 to March 2021, 18 patients with malignant biliary obstruction who had undergone percutaneous EB-RFA and stent placement (n = 9) or stent placement only (n = 9) were included in this retrospective study. Outcomes were stent patency, technical and clinical success, overall survival, and 30-day complication rate. Kaplan-Meier and Cox regression analyses were performed to examine the relationship of EB-RFA with stent patency and overall survival. Results: The clinical and technical success rate for each group was 100%. The median stent patency was 128 days (95% CI: 122.2-133.8) in the EB-RFA group and 86 days (95% CI: 1.2-170.7) in the control group. It was significantly longer in the study group (p = 0.012). The mean overall survival was 267.7 ± 68.5 days (95% CI: 133.3-402.2) in the study group and 239.6 ± 33.9 days (95% CI: 173.1-306.2) in the control group. Log-rank test showed there was not a statistically significant difference in overall survival rates (p = 0.302). There were no major complications and no statistically significant difference in cholangitis rates (p = 0.620). Conclusions: Percutaneous temperature-controlled EB-RFA combined with biliary stent placement for malignant biliary obstruction can be safe and feasible, and effectively increase stent patency.

Points to consider when evaluating three-dimensional digital subtraction angiography of intracranial aneurysms and their effects on treatment

Background/aim: In this study, we aimed to investigate what should be regarded as potential determinants of treatment strategies when evaluating 3D digital subtraction angiography (DSA) images. Material and methods: Our inclusion criteria were as follows: (1) presence of at least one intracranial aneurysm demonstrated by conventional angiography, (2) having both 2D and 3D images, and (3) being over 18 years old. First, two-dimensional (2D) and then 3D angiography images of 226 aneurysms of 150 patients were scanned. Morphological characteristics such as size, configurations, relationship with parent artery, baby counts, and other incidental findings were determined. Results: Of the 226 aneurysms, 11 (4.9%) were only detected on 3D images. Four of these 11 additional aneurysms were believed to be babies of other aneurysms seen in 2D images. Middle cerebral artery (MCA) M1 segment was the most common localization in terms of missed aneurysms. Of the 28 aneurysms located in the communicating segment of the internal carotid artery, the absolute locations of 7 (25%) could not be detected in 2D images or detected in the wrong location. Of the 24 aneurysms located in the ophthalmic segment, the origin of 8 (33%) could not be clearly identified in 2D images. Truncus relationships of MCAs bifurcation/trifurcation aneurysms were seen in 41 of 63 aneurysms (65%) on 2D images, whereas all were confirmed on 3D images. Fenestrations not seen in 2D images were identified in 3D images of 4 patients (3%). Conclusion: The superiority of 3D images compared to 2D images in determining the morphologic characteristics of intracranial aneurysms has been known for a long time. The contribution of 3D images to the treatment can be summarized as evaluating the parent artery relationship, revealing the number and shapes of aneurysm babies more clearly, detecting fenestrations, and shortening procedure time by finding the correct working angle.

Choosing the right artificial intelligence solutions for your radiology department: key factors to consider.

The rapid evolution of artificial intelligence (AI), particularly in deep learning, has significantly impacted radiology, introducing an array of AI solutions for interpretative tasks. This paper provides radiology departments with a practical guide for selecting and integrating AI solutions, focusing on interpretative tasks that require the active involvement of radiologists. Our approach is not to list available applications or review scientific evidence, as this information is readily available in previous studies; instead, we concentrate on the essential factors radiology departments must consider when choosing AI solutions. These factors include clinical relevance, performance and validation, implementation and integration, clinical usability, costs and return on investment, and regulations, security, and privacy. We illustrate each factor with hypothetical scenarios to provide a clearer understanding and practical relevance. Through our experience and literature review, we provide insights and a practical roadmap for radiologists to navigate the complex landscape of AI in radiology. We aim to assist in making informed decisions that enhance diagnostic precision, improve patient outcomes, and streamline workflows, thus contributing to the advancement of radiological practices and patient care.

Percutaneous treatment of simple renal cysts with 24-h-interval ethanol sclerotherapy.

Objective: To investigate the efficacy of 24-h interval multiple-session ethanol sclerotherapy for the treatment of simple renal cysts. Materials and Methods: The study sample included 58 patients (mean age, 65.37 ± 11.95 years). We included 76 simple renal cysts that were treated with percutaneous aspiration with a minimum of two sessions of 95% ethanol sclerotherapy in a 24-h interval between sessions. Patients were evaluated at 1, 3, and 6 months after the intervention for the efficacy of the treatment. Treatment success was defined as a complete regression of a cyst or a > 50% reduction in its volume, with no recurrence of symptoms. Results: The mean preprocedural cyst size was 72.98 ± 25.14 mm, and the mean preprocedural cyst volume was 205.76 ± 244.15 mL. The mean volume of ethanol used in the first sclerotherapy session was 62.76 ± 30.71 mL. The mean fluid accumulation in the cysts at the end of the first 24-h interval was 4.66 ± 7.13 mL. The mean quantity of ethanol used in the second sclerotherapy session was 26.48 ± 22.2 mL. A third sclerotherapy session was required in only 10 (13.2%) of the cysts. The mean follow-up period was 52.84 ± 37.83 months. The rate of complete regression was 97.4% for the whole sample at the end of the follow-up. Conclusion: Ethanol ablation with 24-h intervals is a safe and effective treatment option in the minimally invasive percutaneous treatment of simple renal cysts.

Objetivo: Demonstrar a eficácia da escleroterapia com etanol em sessões múltiplas em intervalos de 24 horas no tratamento de cistos renais simples. Materiais e Métodos: Foram avaliados 76 cistos renais simples de 58 pacientes (média de idade: 65,37 ± 11,95 anos) submetidos a aspiração percutânea e ao menos duas sessões de escleroterapia com etanol 95% num intervalo de 24 horas. Considerou- se sucesso de tratamento a regressão completa ou uma redução > 50% do volume do cisto, sem recorrência dos sintomas. Os pacientes foram reavaliados 1, 3 e 6 meses após o procedimento. Resultados: Antes do procedimento, a média do tamanho dos cistos foi de 72,98 ± 25,14 mm e a média do volume dos cistos foi de 205,76 ± 244,15 mL. A quantidade média de etanol utilizada na primeira sessão de escleroterapia foi de 62,76 ± 30,71 mL. A média de acúmulo de líquido ao final do intervalo de 24 horas foi de 4,66 ± 7,13 mL, sendo utilizada uma média de quantidade de etanol de 26,48 ± 22,2 mL na segunda sessão de escleroterapia. Uma terceira sessão de escleroterapia foi necessária em apenas 10 (13,2%) dos cistos. Na amostra geral, a taxa de regressão completa foi de 97,4%. O tempo médio de seguimento foi de 52,84 ± 37,83 meses. Conclusão: A ablação com etanol em intervalo de 24 horas é uma opção de tratamento segura, eficaz e minimamente invasiva no tratamento percutâneo de cistos renais simples.

Uncooled Microwave Ablation as a Treatment Option to Preserve Thyroid Function in Patients with Benign Thyroid Nodules.

Objective: The objective is to evaluate the long-term efficacy and safety of uncooled MWA for the treatment of benign thyroid nodules and its long-term effect on thyroid functions. Material and Methods: The study was conducted on 40 patients with 40 nodules. They were treated between September 2019 and December 2020. Nodules' volumes, thyroid functions (triiodothyronine, free thyroxine, thyrotropin) and anti-thyroid peroxidase and anti-thyroglobulin antibodies were measured before treatment and at 3rd, 6th and 12th month following the treatment. Volume reduction rates and changes in clinical findings were evaluated. Results: The mean volume reduction rate was 49.88, 65.3, and 79.06% at 3rd, 6th, and 12th month, respectively. Antibody levels and thyroid function tests have remained within normal limits and were not exhibited significant change during follow-ups (p > 0.05), except for a significant increase in free thyroxin level at 12th-month (p = 0.007). Subjective symptoms and cosmetic scores were significantly improved all follow-up (p < 0.0001). The only complication was a first-degree skin burn in a patient. Conclusion: In conclusion, uncooled microwave ablation is an effective and safe method for the treatment of benign thyroid nodules and preserves thyroid function.

Artery-first microwave ablation in the treatment of benign thyroid nodules.

BACKGROUND: Microwave ablation (MWA) is a safe and effective procedure for the treatment of benign thyroid nodules. The MWA causes progressive nodule shrinkage as well as the improvement of the symptoms and cosmesis. Some basic techniques have been described to further increase the efficacy and safety of this procedure. OBJECTIVES: To evaluate the efficacy of artery-first MWA as an advanced technique in the treatment of benign thyroid nodules. MATERIAL AND METHODS: A total of 40 patients treated with MWA were enrolled in the study. Nineteen patients who underwent artery-first MWA were selected for the study group and 21 patients who underwent MWA alone were included in the control group. Nodular vascularization was assessed using a new Doppler technique (Superb Microvascular Imaging (SMI)) and characterized using a 3-point scale. All patients were evaluated in terms of volume, symptoms, cosmetic scores, and laboratory findings before the procedure as well as 3 months (early-term follow-up) and 6 months (intermediate-term follow-up) after the procedure. RESULTS: Both groups were comparable with respect to the baseline volume (p = 0.135). Nevertheless, the nodular volume reduction rate was significantly different at 3-month follow-up (study group: 56.97 ±11.39%, control group: 47.07 ±7.93%; p = 0.003) and 6-month follow-up (study group: 78.38 ±8.91%, control group: 69.54 ±9.41%; p = 0.004). In both groups, cosmetic and symptom scores decreased progressively (p < 0.005) and there were no major complications. Thyroid hormones and antibodies were within normal limits before the procedure, and no significant change was observed during follow-up after the ablation. CONCLUSIONS: The artery-first MWA technique can be used in the treatment of benign thyroid nodules as a method of increasing the effectiveness of MWA.

Uncooled microwave ablation of osteoid osteoma: New approaches to an old problem.

OBJECTIVE: This study aims to evaluate the technical and clinical success of uncooled microwave ablation (MWA) in the treatment of osteoid osteoma with two-dimensional fluoroscopy guidance in the operating room. METHODS: The clinical and imaging data of 9 patients were retrospectively evaluated. Mean patient age was 14.55 years. The mean size and volume of the lesions were 17.2 × 10.8 × 8.0 mm and the mean nidus size was 6.86±2.05 mm on computed tomography. MWA was performed with uncooled probe in operating room and in sterile conditions. Numerical pain score was recorded before the procedure, the day after, and at 1, 3 months after the procedure. RESULTS: Clinical and technical success was achieved in 100% of patients. The mean volume of MWA-induced necrosis was 20.8 × 12.8 × 10.7 mm, peripheral scar thickness was 3.5±0.75 mm, and none of the patients had nidus enhancement on first month follow-up magnetic resonance imaging. Fluoroscopic guidance was conducted under digital c-arm. Patients received four to 12 spot films (mean: 6.6 kVp, 2.66 mAs) over the lower extremity. Mean radiation exposure to the skin due to imaging was 0.02 mGy per patient per procedure. The dose area product-the total amount of radiation deliverable to the patient was 0.75±0.32 Gy.cm2. CONCLUSION: This study demonstrated the effectiveness and the safety of the uncooled MWA in osteoid osteoma. The technique may effectively be used in operating room under c-arm fluoroscopy. Such hybrid approach may ensure sterility, anesthetic safety, and lower radiation dose to patients.

Total body height estimation using sacrum height in Anatolian Caucasians: multidetector computed tomography-based virtual anthropometry.

OBJECTIVE: Estimation of total body height is a major step when a subject has to be identified from his/her skeletal structures. In the presence of decomposed skeletons and missing bones, estimation is usually based on regression equation for intact long bones. If these bones are fragmented or missing, alternative structures must be used. In this study, the value of sacrum height (SH) in total body height (TBH) estimation was investigated in a contemporary population of adult Anatolian Caucasians. MATERIALS AND METHODS: Sixty-six men (41.6 ± 14.9 years) and 43 women (41.1 ± 14.2 years) were scanned with 64-row multidetector computed tomography (MDCT) to obtain high-resolution anthropometric data. SH of midsagittal sections was electronically measured. The technique and methodology were validated on a standard skeletal model. RESULTS: Sacrum height was 111.2 ± 12.6 mm (77-138 mm) in men and 104.7 ± 8.2 (89-125 mm) in women. The difference between the two sexes regarding SH was significant (p < 0.0001). SH did not significantly correlate with age in men, whereas the correlation was significant in women (p < 0.03). The correlation between SH and the stature was significant in men (r = 0.427, p < 0.0001) and was insignificant in women. For men the regression equation was [Formula: see text] (r = 0.54, SEE = 56.9, p < 0.0001). CONCLUSION: Sacrum height is not susceptible to sex, or to age in men. In the presence of incomplete male skeletons, SH helps to determine the stature. This study is also one of the initial applications of MDCT in virtual anthropometric research.

The reliability of low-dose chest CT for the initial imaging of COVID-19: comparison of structured findings, categorical diagnoses and dose levels.

PURPOSE: The widespread use of computed tomography (CT) in COVID-19 may cause adverse biological effects. Many recommend to minimize radiation dose while maintaining diagnostic quality. This study was designed to evaluate the difference between findings of COVID-19 pneumonia on standard and low-dose protocols to provide data on the utility of the latter during initial imaging of COVID-19. METHODS: Patients suspected of having COVID-19 were scanned with a 128-slices scanner using two consecutive protocols in the same session (standard-dose scan: 120 kV and 300 mA; low-dose scan: 80 kV and 40 mA). Dose data acquisition and analysis was performed using an automated software. High and low-dose examinations were anonymized, shuffled and read by two radiologist with consensus according to a highly structured reporting format that was primarily based on the consensus statement of the RSNA. Accordingly, 8 typical, 2 indeterminate, and 7 atypical findings were investigated. Cases were then assigned to one of the categories: (i) Cov19Typ, typical COVID-19; (ii) Cov19Ind, indeterminate COVID-19; (iii) Cov19Aty, atypical COVID-19; (iv) Cov19Neg, not COVID-19. McNemar test was used to analyze the number of disagreements between standard and low-dose scans regarding paired proportions of structured findings. Inter- test reliability was tested using kappa coefficient. RESULTS: The study included 740 patients with a mean age of 44.05±16.59 years. The median (minimum-maximum) dose level for standard protocol was 189.98 mGy•cm (98.20-493.54 mGy•cm) and for low-dose protocol was 15.59 mGy•cm (11.59-32.37 mGy•cm) differing by -80 and -254 mGy•cm from pan-European diagnostic reference levels. Only two findings for typical, one finding for indeterminate, and three findings for atypical categories were statistically similar (p > 0.05). The difference in other categories resulted in significantly different final diagnosis for COVID-19 (p < 0.001). Overall, 626 patients received matching diagnoses with the two protocols. According to intertest reliability analysis, kappa value was found to be 0.669 (p < 0.001) to indicate substantial match. CT with standard-dose had a sensitivity of 94% and a specificity of 72%, while CT with low-dose had a sensitivity of 90% and a specificity of 81%. CONCLUSION: Low kV and mA scans, as used in this study according to scanner manufacturer's global recommendations, may significantly lower exposure levels. However, these scans are significantly inferior in the detection of several individual CT findings of COVID-19 pneumonia, particularly the ones with GGO. Therefore, they should not be used as the protocol of choice in the initial imaging of COVID-19 patients during which higher sensitivity is required.

The antimicrobial efficacy of shielded ultraviolet germicidal irradiation in CT rooms with intense human circulation.

PURPOSE: Computed tomography (CT) premises are one of the strategic points in the spread of hospital-acquired infections. Ultraviolet germicidal irradiation (UVGI) is an effective method that could potentially be used to purify the ambient air in them. However, it cannot be directly used in the presence of humans and, therefore, it is not operationally suitable in such units with continuous human circulation. Newer devices have been developed to purify air with more efficient and shielded UV-C sources. This study aims to assess the microbial air contamination in CT scanning rooms and investigates the efficacy and technical considerations of shielded UV-C arrays. METHODS: Two shielded UVGI systems, each equipped with 15 Watt UV-C LED arrays, were tested in a very busy CT unit. Initially, a pilot study was performed to determine ambient microorganisms under routine conditions before UVGI installation, followed by three basic scenarios of UVGI use under normal and abnormal conditions: A, UVGI, with both air-conditioning (AC) and ventilation on; B, UVGI, with AC on and ventilation off; C, UVGI, with both AC and ventilation off. Ambient air was sampled in various time points before and after the initialization of UV irradiation and analyzed for colony formation. RESULTS: The mean total colony count in the pilot study was 1360±450 CFU/m3. Pre-UVGI colony count was 3510 CFU/m3 for Scenario A, ~10000 CFU/m3 for Scenario B and 990 CFU/m3 for Scenario C. Thirty minutes after UVGI, total colony counts in all three scenarios dropped to 30 to 70 CFU/m3. Under normal operating conditions and UVGI, the mean colony count was found as 21.4±13.5 CFU/m3 and the average efficacy of the UVGI was found as 99.39%. CONCLUSION: This study identified substantial microbial air contamination in CT scanning rooms during normal and abnormal operating conditions. UV-C LED arrays effectively eliminate these microbiological contaminants. This effect is also observed under abnormal operating conditions where no other means of ventilation or air conditioning exists.

Percutaneous cholecystostomy: An update for the 2020s.

Cholecystectomy is the standard treatment of acute cholecystitis. Surgery, however, poses significant risks for patients with advanced age and/or comorbid conditions. For such patients, percutaneous cholecystostomy (PC) is the only option. This interventional procedure does not have any absolute contraindications because of the life-threatening nature of the disease, in which other treatment options cannot be offered due to their risks. Nonetheless, these risk factors necessitate performing PC under urgent, rapid, and in many cases suboptimal conditions. In this article, PC was revisited in the light of our extensive experience in addition to the most current literature. Pre-procedural evaluation including the risk assessment and procedural steps was presented in detail. If conducted properly, PC provides significant clinical improvement in the short term and is life-saving, especially in the elderly and in patients with comorbid diseases or high surgical risk. It may also be the definitive treatment method for acute cholecystitis.

Initial experience with the CatchView thrombectomy device for acute ischemic stroke.

BACKGROUND: We report our initial experience with the CatchView (CV) thrombectomy device in patients with acute ischemic stroke (AIS). METHODS: A retrospective analysis of 53 of 284 AIS patients (mean age 66.6±14.8 years, range 37-94) treated with a CV device between January 2019 and February 2020 was performed. The baseline characteristics (gender, age, comorbidities, National Institutes of Health Stroke Scale (NIHSS) score, intravenous tissue plasminogen activator (IV-tPA) administration, and occlusion localization) of these subjects were recorded. Modified Thrombolysis in Cerebral Ischemia (mTICI) scores of 2b and 3 were considered to indicate successful recanalization, and subjects with a modified Rankin Scale score of ≤2 on day 90 was considered a good clinical outcomes. RESULTS: The mean NIHSS score was 12.3±3. Successful recanalization was achieved in 45 subjects (84.90%), and the rate of good clinical outcomes on day 90 was 43.39%. The secondary distal embolus rate was 5.66%. Symptomatic hemorrhage was observed in 3.77% of the subjects, and the mortality rate was 13.2%. CONCLUSIONS: Mechanical thrombectomy devices include a wide array of endovascular tools for removing clots in AIS patients. In terms of successful recanalization and good clinical outcomes on day 90, our initial experience with the CV devices was encouraging.

Clinical approach to patients admitted to the emergency room due to acute cholecystitis during the COVID-19 pandemic and percutaneous cholecystostomy experience.

BACKGROUND: Acute cholecystitis (AC), a common complication of gallstones, is responsible for a significant part of emergency applications, and cholecystectomy is the only definitive treatment method for AC. Early cholecystectomy has many reported advantages. Operation-related morbidity and mortality have increased during the COVID-19 pandemic. In this study, our aim is to present our general clinical approach to patients who were diagnosed with AC during the pandemic and our percutaneous cholecystostomy experience during this period. METHODS: This study included 72 patients who were presented to our hospital's emergency room between March 11 and May 31, 2020, with AC. Patients were divided into three groups based on their treatment: outpatients (Group 1), inpatients (Group 2) and patients undergoing percutaneous cholecystostomy (Group 3). These three groups were compared by their demographic and clinical characteristics. RESULTS: There were 36 (50%) patients in Group 1, 25 (34.7%) patients in Group 2, and 11 (15.3%) patients in Group 3. The demographic characteristics of the patients were similar. The CRP and WBC levels of the patients in Group 3 were significantly higher compared to the other groups. Moreover, the wall of the gallbladder was thicker and the size of the gallbladder was larger in Group 3. Patients had percutaneous cholecystostomy at the median of 3.5 days and the length of hospital stay was longer compared to Group 2 (3.9 days versus 9.2 days, p=0.00). The rate of re-hospitalization after discharge was similar in Group 2 and Group 3, but none of the patients in Group 1 required hospitalization. None of 72 patients developed an emergency condition requiring surgery, and there was no death. CONCLUSION: Although many publications emphasize that laparoscopic cholecystectomy (LC) can be performed with low morbidity at the first admission in acute cholecystitis, it is a clinical condition that can be delayed in the COVID-19 pandemic and other similar emergencies. Thus, percutaneous cholecystostomy should be effectively employed, and its indications should be extended if necessary (e.g., younger patients, patients with lower CCI or ASA). This approach may enable us to protect both patients and healthcare professionals that perform the operation from the risk of COVID-19.

Microstructural changes in uterine leiomyomas and myometrium: a diffusion-weighted magnetic resonance imaging study.

Although morphological and histopathological changes in uterine leiomyomas have been investigated in detail, the microstructural disruptions could not be studied in the living organism. Diffusion-weighted magnetic resonance imaging (DWI) is a novel tool to assess microstructural changes in vivo. The aim of this study was to investigate and characterize the diffusional property of leiomyomatous tissues with DWI. Sixteen females with a total of 21 leiomyomas were imaged with a 1.5-tesla clinical MR scanner. DWI images of leiomyomas, adjacent myometrial and myometrial tissues of healthy controls were obtained and quantified using apparent diffusion coefficient (ADC) maps. Mean ADC values of these groups were 1,201, 1,684, 1,661 mm(2)/s x 10(-6), respectively. ADC values in leiomyomas were significantly lower than those observed in the myometrium (p < 0.001). Cut-off values produced 91% sensitivity and 100% specificity. As ADC values implied the presence of cytotoxic edema in leiomyomas, the technique was found to be promising in observing temporal variations in leiomyomas and to monitor even the most subtle effects of therapeutic interventions.

Bilateral anterior inferior iliac spine avulsion in an adolescent soccer player: a typical imitator of malignant bone lesions.

Avulsion fractures are usually diagnosed easily in acutely presented cases. The diagnosis becomes definite if clinical and radiological follow up reflect the fracture's healing phase. A 13-year-old soccer player with bilateral anterior inferior iliac spine (AIIS) avulsion, who had been examined in other institutions with a prediagnosis of malignancy, is reported. Clinically, such cases display the importance of medical management of athletic injuries by specially trained physicians. From the perspective of preventive medicine, the high incidence of AIIS injuries during soccer games, and the bilateral nature of the damage mandate a review of the training programs and shooting techniques for adolescent players.

Diffusion-weighted imaging features of brain in obesity.

PURPOSE: Obesity is characterized by an altered distribution of body fluid. However, distribution of fluid (extracellular/intracellular) in brain tissues has not been studied in obese subjects yet. The purpose of this study was to detect possible brain diffusion changes especially in satiety and hunger related centers in obese subjects by diffusion weighted imaging (DWI). METHODS: Conventional MRI and DWI of the brain was obtained from 81 obese patients (obese=68, morbid obese=13) and 29 age-matched, nonobese. The apparent diffusion coefficient (ADC) values were calculated in hypothalamus; amygdala; hippocampal gyrus; thalamus; insula; cingulate gyrus; orbitofrontal, dorsomedial and dorsolateral frontal, middle temporal and occipital cortex; cerebellum; midbrain and corpus striatum. RESULTS: The ADC values of hypothalamus, hippocampal gyrus, amygdala, insula, cerebellum and midbrain were significantly increased in patients (n:81) when compared to nonobese subjects. The ADC values of thalamus, hippocampal gyrus, amygdala, orbitofrontal, occipital, dorsolateral and middle temporal cortex, insula and midbrain were significantly increased in morbid obese when compared to nonobese subjects. The ADC values of orbitofrontal and occipital cortex were significantly higher in morbid obese than the values in the obese. The body mass index positively correlated with ADC values of amygdala, insula, orbitofrontal and middle temporal cortex. CONCLUSION: We observed increased ADC values of distinct locations related to satiety and hunger that suggest altered fluid distribution and/or vasogenic edema in obese subjects. Awareness of this abnormalities in brain tissue composition/function in obesity may contribute to better understanding of the underlying mechanisms.

Magnetic resonance spectroscopy features of normal-appearing white matter in patients with acute brucellosis.

We aimed to evaluate whether the subtle metabolic cerebral changes are present in normal-appearing white matter on conventional MRI, in patients with acute brucellosis, by using MR spectroscopy (MRS). Sixteen patients with acute brucellosis and 13 healthy control subjects were investigated with conventional MRI and single-voxel MRS. Voxels were placed in normal-appearing parietal white matter (NAPWM). N-Acetyl aspartate (NAA)/creatine (Cr) and choline (Cho)/Cr ratios were calculated. There was no significant difference between the study subjects and the control group in NAA/Cr ratios obtained from NAPWM. However, the Cho/Cr ratios were significantly higher in patients with acute brucellosis compared to controls (p=0.01). MRS revealed metabolic changes in normal-appearing white matter of patients with brucellosis. Brucellosis may cause subtle cerebral alterations, which may only be discernible with MRS. Increased Cho/Cr ratio possibly represents an initial phase of inflammation and/or demyelination process of brucellosis.

Age-related changes in the incidence of pineal gland calcification in Turkey: A prospective multicenter CT study.

The goal of this cross-sectional observational study was to determine the incidence of pineal gland calcification (PGC), to investigate the interaction of PGC and aging, and to compare the incidence of PGC among the populations living in Turkey. In a prospective study the rate of PGC on CT scans of 1376 individuals in six referral centers from different regions of Turkey was investigated, with emphasis on effects of climatological parameters and aging on PGC. It was found that the incidence of PGC increased rapidly after first decade and the increase remains gradual thereafter, higher in males than in females for all age groups. There was a significant difference for incidence and degree of PGC between different clinics and between both sexes (p<0.001). In addition, there was a significant difference for the degree of PGC between the clinics in low altitude group and those in high altitude group (p<0.001 for each). Logistic regression analysis revealed that age, sex, altitude and intensity of sunlight exposure significantly affected the risk of PGC (odds ratios (OR) 1.335, 95% confidence intervals (CI) 1.261-1.414, p<0.001; OR 1.900, 95% CI 1.486-2.428, p<0.001; OR 0.715, 95% CI 0.517-0.990, p<0.05; OR 0.997, 95% CI 0.994-0.999, p<0.01, respectively). Furthermore, by multiple linear regression analysis, high altitude and increased intensity of sunlight exposure were found to affect the degree of PGC (beta=0.003, p<0.001). It is concluded that there is a close relationship between PGC and the aforementioned parameters, supporting a link between the development of PGC and these. This study provides some reference data for new clinical studies on the putative role of pineal gland in future.