The Efficacy of Chest Computed Tomography in Pediatric Patients With Suspected COVID-19.

OBJECTIVE: The aim of the study was to investigate chest computed tomography (CT) findings and the value of CT in the diagnosis in children with suspected coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: Chest CT images of pediatric patients with suspected COVID-19 were retrospectively evaluated. Computed tomography findings were divided into 3 groups: normal, consistent, and inconsistent with COVID-19. The sensitivity and specificity of CT were calculated by reference to reverse transcriptase polymerase chain reaction. RESULTS: The study included patients with a mean age of 11.1 years (1 month-17 years). Of the patients, 43 (40.19%) had normal CT, 34 (31.77%) had CT findings consistent with COVID-19, and 30 (28.04%) had CT findings inconsistent with COVID-19. The sensitivity, specificity, positive predictive value, and negative predictive value of CT were 47.92%, 81.36%, 67.65%, and 65.75%, respectively. CONCLUSIONS: Because the sensitivity of CT in the pediatric age group is low, it should be used cautiously for the evaluation of COVID-19 in the pediatric age group.

Changes in renal Doppler ultrasonographic parameters in patients managed with rigid ureteroscopy.

BACKGROUND: There has been no study evaluating the intrarenal hemodynamic changes after ureteroscopy in the published literature. PURPOSE: To determine preoperative and postoperative intrarenal vascular parameters such as resistive index (RI), pulsatility index (PI), peak systolic velocity (PSV), end-diastolic velocity (EDV), measure changes on these values (ΔRI, ΔPI, ΔPSV, ΔEDV) after ureteroscopy (URS) and compare the outcomes with the results of normal contralateral kidneys, and finally investigate possible parameters that would affect renal vascular resistance changes. MATERIAL AND METHODS: We prospectively studied 47 patients who underwent rigid URS. Preoperative gray-scale and Doppler ultrasonography (CDUS) measurements were obtained 24 h before URS. Similarly, postoperative CDUS measurements were done 24 h after the operation. The degree of hydronephrosis and location of stones in the obstructed kidneys, diameters of both kidneys, and thickness of renal parenchyma were evaluated with gray-scale US followed by CDUS with calculation of the intrarenal RI, PI, PSV, and EDV values for each kidney. RESULTS: For the operated kidneys, statistically significant P values were noticed when RI and PI values were considered (P < 0.001). ΔRI and ΔPI of the operated kidneys were also significantly greater than the values for non-operated kidneys (P < 0.001). However, it was not the case for ΔPSV and ΔEDV values. In Spearman correlation coefficient analysis, ΔRI was found to be correlated with the parameters: "operative time" and "irrigation fluid volume". No significant relation was documented between ΔRI and the other parameters: age, gender, side of ureteroscopy, stone location, and degree of hydronephrosis. CONCLUSION: Significant changes in RI and PI values in patients treated with URS reveal that URS can cause a significant increase in renal vascular resistance. With the increase in operative time and irrigation fluid volume used during the operation, RI seems to be significantly increased.

The role of radiological subacromial distance measurements in the subacromial impingement syndrome.

Subacromial impingement is one of the most common causes of painful shoulder in the middle aged and elderly population. Since Neer's first description of the process, many investigators have researched this condition in an effort to gain a better understanding of the disease etiology. The aim of this study was to investigate the relationship between the radiological subacromial distance measurements and the subacromial impingement syndrome in a series of patients from our institution. For this purpose, 44 patients scheduled for a unilateral shoulder arthroscopy were investigated prospectively. The acromio-glenoid angle, supraspinatus-glenoid angle (from coronal MR images) and acromial index (from true anterior-posterior shoulder X-ray images) were measured as the implications of the subacromial distance, and the degree of subacromial impingement was graded according to intraoperative findings. Statistical data analysis revealed no significant correlations between the radiological measurements and the severity of subacromial impingement (p > 0.05). On the other hand, there was a significant correlation (p = 0.0049) between the patient age and subacromial impingement. These results suggest that the radiological subacromial distance measurements do not have enough clinical significance as predictive markers in the subacromial impingement syndrome.

Additive effectiveness of everolimus plus tamoxifen therapy in treatment of encapsulating peritoneal sclerosis.

Peritoneal dialysis (PD) is one of the commonly used choices of continuous renal replacement therapies. Peritoneal membrane is damaged by using solutions with lower biocompatibility, peritonitis episodes, and vintage of PD therapy. Encapsulating peritoneal sclerosis (EPS) is a rare complication of PD and is presented by progressive fibrosis of the peritoneum. Fibrous tissue entrapment of the intestine, leading to complete intestinal obstruction, is referred to as EPS, the most severe form of sclerosing peritonitis. EPS is irreversible fibrosis of the peritoneal membrane usually associated with high rates of morbidity and mortality. Preventive strategies are the best choice of treatment. Also there is no proven effective therapy for EPS; there are only small-sized trials. Herein we present a case of EPS who improved with everolimus plus tamoxifen therapy.

Should CT be used for the diagnosis of RT-PCR-negative suspected COVID-19 patients?

INTRODUCTION: The diagnosis of patients with Coronavirus disease 2019 (COVID-19) suspicion but negative reverse transcriptase-polymerase chain reaction (RT-PCR) test is challenging. OBJECTIVE: We aimed to investigate the diagnostic value of chest computed tomography (CT) in RT-PCR-negative patients with suspected COVID-19. MATERIALS AND METHODS: The study included patients who were admitted to our hospital with the suspicion of COVID-19 between 1 April 2020 and 30 April 2020 and tested negative after RT-PCR test, and underwent CT for further diagnosis. Initial CT findings were classified as typical, indeterminate, and atypical for COVID-19, and negative for pneumonia. Incidental findings on CT were noted. RESULTS: Of the 338 patients with a mean age of 57 years (min 18 years-max 96 years), 168 (49.70%) were male and 170 (50.29%) were female. The most common symptoms were cough (58.87%), fever (40.82%), and dyspnea (39.34%). The CT findings were typical for COVID-19 in 109 (32.24%) patients, indeterminate in 47 (13.90%) patients, and atypical in 77 (22.78%) patients. The CT findings of 105 (31.06%) patients were negative for pneumonia. Incidental lung nodules suspicious of malignancy were identified in seven patients. Seventy-seven patients (22.78%) had extrapulmonary incidental findings CONCLUSION: The diagnostic value of CT in RT-PCR-negative patients with suspected COVID-19 is not very high. Based on clinical, laboratory, and chest x-ray findings, it may be more appropriate to refer patients to CT after the first triage, when necessary.

Using texture analysis as a predictive factor of subtype, grade and stage of renal cell carcinoma.

OBJECTIVE: The aim of this study was to evaluate the correlation between the tissue texture analysis and the histological subtypes, grade and stage of the disease in patients with renal cell carcinoma (RCC). MATERIALS AND METHODS: Seventy-seven patients who underwent computed tomography due to renal mass and diagnosed with RCC as a result of pathological examination were retrospectively analyzed. In these analyses, the demographic characteristics, pathological and radiological findings of the patients were evaluated. The masses were introduced to the Radiomics extension of the software and the first- and second-order texture analysis parameters were obtained. The correlation of these parameters with histological subtype, Fuhrman grade and TNM stage was investigated. RESULTS: In the comparison of the Radiomics values by stages, "minimum", "Long Run Low Gray-level Emphasis" values were higher in the stage 1-2 group, while "Energy", "Total energy", "Range", "Joint Average", "Sum Average", "Gray-Level Non-Uniformity", "Short-Run High Gray-level Emphasis ", "Run Length Non-Uniformity "and "High Gray-Level Run Emphasis "values were higher in the stage 3-4 group. Of these parameters, only "Gray-Level Non-Uniformity" and "Run Length Non-Uniformity'' values were significantly lower in tumors with low Fuhrman grade (1-2) and low TNM stage (1-2). There was no statistically significant correlation between the parameters found to be significant in histological subtype differentiation and Fuhrman grade and TNM stage. CONCLUSION: This study demonstrates that "Gray-Level Non-Uniformity" and "Run Length Non-Uniformity "parameters in the texture analysis method can be used to evaluate the prognosis in patients with RCC.

Screening Mammography Findings in Women With Chronic Kidney Disease on a Renal Transplant Waiting List.

BACKGROUND: The incidence of breast cancer has been reported to be increased in people with chronic kidney disease (CKD). Thus, breast cancer screening is stated to be mandatory. However, it is as yet unclear what age group or what type of breast structure indicate a need for mammography. This study aimed to evaluate the effects of age and breast parenchymal density on mammography findings. The rate of detection of calcification from mammographies increased in dialysis patients with CKD. The associations of calcifications with comorbid pathologies were also evaluated. PATIENTS AND METHODS: Patients were divided into the two age groups of 40 to 49.9 years and ≥ 50 years. The patients were asked about smoking habits, hypertension, diabetes mellitus, the pathology that caused CKD, state of hemodialysis, and, if relevant, the type and duration of dialysis. RESULTS: The mean age of the 55 patients included in this study was 54.8 years, and 78.2% (n = 43) were ≥ 50 years old. The rate of malignancy across the entire group was 3.6%. No association was found between breast arterial calcification and cigarette smoking, hypertension, diabetes mellitus, state of dialysis, duration of dialysis, and breast parenchymal density in any age group. CONCLUSION: A pretransplantation evaluation of CKD patients may include a breast screening program for patients aged 40 to 49.9 and for the patients aged ≥ 50. Breast parenchymal density was demonstrated to have no effect on the findings, and no association was found between calcifications and comorbid pathologies.

The role of upper airway morphology in apnea versus hypopnea predominant obstructive sleep apnea patients: an exploratory study.

OBJECTIVE: The objective of this study was to investigate the association between upper airway morphology and apnea vs hypopnea predominance in patients with obstructive sleep apnea (OSA) syndrome. METHODS: A retrospective study on consecutively CT scans obtained from 54 OSA patients and 53 non-snoring controls. CT scans were measured to evaluate upper airway and surrounding structures' morphologic characteristics. OSA patients (matched for age, gender and body mass index) compared as two groups; apneic group: apnea ratio >50% and hypopneic group: hypopnea ratio >50%. Morphologic characteristics were analyzed using Kruskal-Wallis test and Pearson's correlation test. RESULTS: Apneic group (17 patients) showed 76.56% apnea rate and hypopneic group (37 patients) showed 78.46% hypopnea rate. Minimal lateral and anteroposterior dimensions of velopharynx in the apneic group (0.86 ± 0.73 and 0.21 ± 0.13 cm, respectively) was statistically lesser from that of the hypopneic group (1.2 ± 0.42 and 0.54 ± 0.22 cm, respectively). Minimum cross-sectional area of the velopharynx was also lesser in apneic group (0.21 ± 0.16 cm2) than that in hypopneic group (0.65 ± 0.38 cm2). Almost all upper airway parameters in both apneic and hypopneic groups were tended to be smaller than in controls. CONCLUSION: Decrease in airway volume does not signify the type of respiratory event, but significant narrowing of velopharynx in both dimensions; thus having the narrowest value below a certain level causes more apnea. Advances in knowledge: We did not find a similar study when we did a literature search, showing the relationship of apnea vs hypopnea predominance and upper airway parameters in CT in patients with OSA.

Can core biopsy be used instead of surgical biopsy in the diagnosis and prognostic factor analysis of breast carcinoma?

PURPOSE: The aim of this article was to investigate the efficacy of ultrasonography-guided core needle biopsy and prognostic factor analysis of breast cancer to plan overall treatment strategy. PATIENTS AND METHODS: A consecutive series of nonpalpable and palpable breast cancers constituted our study group (n= 201 lesions; mean size, 20.4 mm) Mean number of core samples was 3.4. Malignant lesions diagnosed with core biopsy underwent therapeutic surgical excision. Core biopsy and surgical excisions were compared for histologic type, grade, estrogen receptors (ERs), progesterone receptors (PgRs), and c-erbB2 levels. Cutoff values for ER, PgR, and c-erbB2 affecting the management strategy were selected as 10%, 10%, and 50%, respectively. RESULTS: Eighty-five lesions (42.3%) were malignant in core biopsy (mean size, 18.4 mm). Among these, 11 were inoperable and 13 were surgically excised at other institutions. In 61 lesions, core and surgical excision specimens were evaluated in the same institution (mean tumor size, 18.6 mm; range 6-60 mm). Concordance between the 2 biopsy methods was 85.2% (52 of 61) for histologic type of tumor, 68.8% (33 of 48) for tumor grade, 90% (27 of 30) for ER, 86.7% (26 of 30) for PgR, and 79.3% (23 of 29) for c-erbB2 levels. Appropriate site selection for sampling was indicated to be of paramount importance, especially in determining reliable ER, PgR, and c-erbB2 levels. CONCLUSION: Core needle biopsy of breast cancer is equally effective compared with surgical biopsy and can be used in overall treatment planning. However, appropriate site selection for sampling should be guaranteed using ultrasonographic guidance.

Mammography device use in Turkey, and quantity and quality analysis of mammography education.

PURPOSE: To evaluate in detail the ways and methods of mammography education, to survey currently used mammography devices, and to determine the quality of mammography examinations in Turkey in order to increase the quality of said examinations and to offer guidance to standardization studies in Turkey. MATERIALS AND METHODS: This study depended on the analysis of a questionnaire that was completed by volunteering medical centers. The questionnaire was mailed to all institutions in Turkey with a mammography device and which were registered with the Turkish Atomic Energy Commission and individual city health administration databases (n = 456). RESULTS: It was not possible to determine the exact number of mammography devices in Turkey. In all, 270 questionnaires were completed and returned from the registered centers. Among the mammography devices declared (n = 291), automatic exposure control (AEC), spot view, and magnification view were not used at 21%, 34%, and 43% of the centers, respectively. Preoperative wire localization was not practiced at 180 centers (62%) despite the ability to do so. At 16% of the centers, mammograms were not labeled and at 57% of the centers labeling was handwritten. At 23% of the centers only small cassettes were used, and at 58% the heat and at 94% the humidity of film storage areas were inappropriate or unknown. At 25% of the centers light and at 15% radiation exposure of the film was present. Mammography quality control tests were performed at 40%, and in 70% control records were not well kept. There were no thermometers in 49% of the centers, no phantom breast at 80%, no sensitometer at 93%, and no densitometer at 81%. At 50% of the centers, regular periodic maintenance was not performed. Second look was performed consistently at 12% of the centers and BI-RADS (Breast Imaging Reporting and Data System) categorization was used at 40%. CONCLUSION: The exact number of mammography devices is not officially known in Turkey, and it is apparent that registration of some devices was not made by the Turkish Atomic Energy Commission. Questionnaire responses about mammography education and procedures revealed that there was a serious lack of quality across regions. Education, accreditation, inspection, and sanctions are needed immediately to institute standardization and improve quality. This is a critical situation that should be addressed by the Turkish Society of Radiology.

Factors affecting executive functions in obstructive sleep apnea syndrome and volumetric changes in the prefrontal cortex.

PURPOSE: Obstructive sleep apnea syndrome (OSAS) is associated with cognitive changes and executive functions are among the cognitive domains most affected. However, it is not completely understood which of the factor(s) among hypoxemia, repeated arousal, and sleepiness affect the executive functions. This study aims to evaluate the possible relationship between the executive functions and nocturnal parameters, Epworth Sleepiness Scale (ESS) scores, and prefrontal cortex (PFC) volumes. PATIENTS AND METHODS: A total of 28 patients aged between 18 and 60 years who were newly diagnosed with OSAS were included in this study. The Wisconsin Card Sorting Test (WCST) and Stroop test which were used in the evaluation of executive functions were applied to all patients. Cranial magnetic resonance imaging (MRI) and volumetric measurements of the PFC were performed. Polysomnography (PSG), WCST, Stroop test, and cranial MRI were also applied to the control group which consisted of age- and education status-matched 15 healthy subjects. The correlation of WCST and Stroop tests and PFC volume, PSG parameters, and ESS scale was examined. RESULTS: The WCST-6 test scores were statistically significantly higher in the patient group (p = 0.022; p < 0.05). Additionally, the Stroop test 5 (p = 0.043) and Stroop test-5 correction (p = 0.005) measurements were statistically significantly higher in the patient group (p < 0.05). A negative and statistically significant correlation was found between the WCST-4 and WCST-10 and ESS measurements in the patient group (r -0.452; p 0.016; p < 0.05; r -0.437; p 0.020; p < 0.05). However, there was no correlation between the PSG parameters and WCST and Stroop test scores. No statistically significant differences in the MRI volumetric measurements of the PFC were found between the patient and control groups. CONCLUSIONS: Impairment in the attentive and executive functions in OSAS is evident. The most influential factor is excessive daytime sleepiness, rather than hypoxemia and severity of the disease.

The long-term incidence and predictors of radial artery occlusion following a transradial coronary procedure.

BACKGROUND: Radial artery occlusion (RAO) is an infrequent complication of transradial coronary procedures (TRA). To our knowledge, there is no satisfactory data regarding the late term incidence and predictors of RAO in the literature. Our aim was to establish the long-term incidence of radial artery occlusion and investigate its predictors. METHODS: This was a single center prospective study. A total number of 409 consecutive patients undergoing their first TRA were recruited. Clinical and procedural data were all recorded. Doppler ultrasound examination was performed at 6-15 months following the intervention. RESULTS: RAO was detected in 67 patients and 342 patients maintained radial artery patency. The overall RAO incidence was 16.4% at late term. Patients with RAO were younger than the patients with patent radial arteries (55.9 ± 9.7 vs. 59.1 ± 9.4 years, p = 0.014). The incidence of RAO in hypertensive patients (9.8%) was lower (p < 0.001) than the observed incidence (23%) in non-hypertensive patients. RAO group had higher rate (28%, p = 0.027) of post--procedural access site pain. Regression analysis revealed that hypertension was negative while post-procedural access site pain was positive independent predictors for RAO. In addition, the relative risk for RAO also increased significantly (p < 0.001) when the ratio of sheath/artery diameter (S/A) was > 1. CONCLUSIONS: The present study reveals that the long-term incidence of RAO is 16.4%. Hypertension, post-procedural access site pain and S/A ratio > 1 are independent predictors of RAO at late term.

The investigation of correlation between semen analysis parameters and intraparenchymal testicular spectral Doppler indices in patients with clinical varicocele.

OBJECTIVES: Our aim was to evaluate the effect of clinical varicocele on testicular microcirculation measured by spectral Doppler analysis and investigate the correlation between Doppler ultrasonographic findings and semen parameters. METHODS: Fifty patients who received a diagnosis of clinical varicocele in the Urology Department of our university hospital were enrolled in this prospective study. Varicocele grades were determined according to sonographic parameters, and a scrotal vein with a diameter of 2.5 mm or greater on color Doppler ultrasonography was included in the study. Spectral Doppler measurements of testicular arteries (peak systolic [PSV]/end-diastolic velocity [EDV], resistivity index [RI], pulsatility index [PI]) were measured from capsular and intratesticular branches of testicular arteries. All the patients were also assessed by semen analysis. RESULTS: Mean age was 29.08 ± 5.42 years (range, 18-45 years). Among the whole study population, 22 men had isolated left varicocele, and 28 had bilateral varicoceles. No statistically significant correlation was found between the Doppler parameters: RI, PI, and EDV, and semen analysis parameters: count, motility, volume, and morphology. On the other hand, both in unilateral and bilateral varicocele cases, PSV was found to be significantly correlated with sperm count (P < 0.05). CONCLUSIONS: Spectral Doppler analysis can provide valuable information as a noninvasive method to assess the hemodynamic changes and testicular microcirculation status in cases of clinical varicocele. However, RI, PI, and EDV values of capsular and intraparenchymal branches of testicular arteries may not be used as indicators of semen parameter deterioration. Hopefully, PSV measurement may give more conclusive data to predict sperm count. In addition, the cutoff value for this index has to be determined for future studies.

Evaluation of effects of Extracorporeal Shock Wave Lithotripsy on renal vasculature with Doppler ultrasonography.

OBJECTIVES: In this prospective study, we aimed to demonstrate the effects of Extracorporeal Shock Wave Lithotripsy (ESWL) on renal blood flow in patients treated for renal/ ureteral stones. MATERIAL AND METHODS: The study group comprised 41 patients (26 males, 15 females, aged between 18-63 years, mean age 45 years), 23 with renal and 18 with ureteral stones, who underwent ESWL between March 2010 and January 2011. Colour Doppler ultrasonography and pulsed wave spectral analysis was performed before, 1 hour, and 7 days after ESWL to both ipsilateral and contralateral kidneys in order to measure resistive index (RI), pulsatility index (PI) and acceleration time (AT) values. RESULTS: One hour after ESWL, RI and PI values showed significant increase from pre-ESWL values in both ipsilateral and contralateral kidneys. However, no significant change was found in AT values. Seven days after ESWL, PI in both ipsilateral and contralateral kidneys and RI in contralateral kidney returned to pre-ESWL values. But, 7 days after ESWL, RI in the ipsilateral kidney did not return to pre-ESWL values, although decrease in RI values were observed. CONCLUSION: Spectral Doppler analysis can provide valuable information as a non-invasive method to assess the hemodynamic changes and renal microcirculation status in cases managed with ESWL.

Can Hounsfield unit values of the cortex and papillae determined by computed tomography demonstrate the possibility of kidney stone formation?

PURPOSE: This study is aimed at measuring HU values of the renal cortex and papillae in patients with nephrolithiasis and demonstrating renal changes associated with nephrolithiasis. MATERIALS AND METHODS: Measurements were performed with regard to HU values of the cortex and papillae of 82 patients with unilateral nephrolithiasis and 81 patients in the control group at the level of the upper pole, middle region and lower pole of both kidneys. RESULTS: When the HU values obtained from the upper pole, middle region and lower pole of the kidney with calculi and unaffected kidney in patients with nephrolithiasis were compared with those for the control group, the difference among the groups were found to be significant (p<0.001). A comparison of the cortex and papillae densities of the affected and unaffected kidneys in patients with unilateral nephrolithiasis were compared with regard to the upper pole and middle region, no statistically significant difference was observed with regard to both the cortex and papillae densities of the upper pole, middle region. However, in those patients with calculi in the lower pole, the region with calculi has a higher papillae density as compared to the unaffected region. CONCLUSION: Both kidneys in patients with calculi have a comparatively high renal cortex and papillae densities. In the future, this information may be useful in predicting which patients may develop nephrolithiasis.

Diagnostic values of detrusor wall thickness, postvoid residual urine, and prostate volume to evaluate lower urinary tract symptoms in men.

PURPOSE: This prospective, controlled clinical study aimed to assess the diagnostic values of detrusor wall thickness (DWT), postvoid residual urine volume (PVR), and prostate volume in men with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: During an 18-month period, a total of 243 males were included in the study. Three groups were assessed due to their International Prostate Symptom Score (IPSS): men with normal lower urinary tracts (n = 51; control group), men with mild LUTS (n = 60; Group 1), and men with moderate to severe LUTS (n = 132; Group 2). DWT, bladder, and prostate volumes and PVR were measured by suprapubic ultrasonography. DWT was measured when the bladder was full (DWT-1) and when it was empty (DWT-2). RESULTS: The mean age for the study population was 60.0 ± 0.6 years, while the mean IPSS for the whole group was 8.0 ± 0.4. Both the bladder and prostate volumes in Group 2 were statistically significantly higher than the control group and Group 1. The mean DWT-1 values were significantly lower in the control group when compared to Groups 1 and 2. However, when study groups were compared with each other, no statistical significance was noticed (1.12 vs. 1.17 mm). In contrast, the mean PVR and DWT-2 values were significantly different in each group. There was a significant correlation between IPSS questionnaire results and all individual parameters. CONCLUSION: Suprapubic transabdominal ultrasonographic assessment of the lower urinary tract in a noninvasive manner allows the clinician to assess LUTS severity in men without morbidity. Additional studies are necessary to provide further conclusions regarding this clinical procedure.