Computed tomography analysis of the infraorbital canal and adjacent anatomical structures.

This study aimed to investigate the incidence of infraorbital canal (IOC) protrusion into the maxillary sinus via computed tomography (CT) and classify its variations. Additionally, it sought to identify nearby sinonasal variations that might elevate the risk of iatrogenic injury. Paranasal sinus CT of 500 patients was evaluated retrospectively. The IOC types were categorized. The length of the IOC, septum, the distance between the maxillary ostium and IOC (dOI), the presence of Haller cells, IOC-related intra-sinus opacity, and IOC dehiscence were investigated. The prevalence of type 3 IOC was 12%, of which 9.2% were type 3c. The maximum length of the IOC was positively correlated with type 3 IOC. A significant difference was found between IOC types in terms of dOI only on the left side. On both sides, the incidence of Haller cells was greater in patients with type 2 IOC than in those with type 1 and in patients with type 3 IOC than in those with type 2. IOC-related opacity and IOC dehiscence were more common in types 2 and 3 IOCs. The assessment of preoperative IOC types and neighboring anatomical structures by CT imaging is of great significance in preventing iatrogenic damage.

Prediction of mortality in COVID-19 through combing CT severity score with NEWS, qSOFA, or peripheral perfusion index.

INTRODUCTION: The assessment of disease severity and the prediction of clinical outcomes at early disease stages can contribute to decreased mortality in patients with Coronavirus disease 2019 (COVID-19). This study was conducted to develop and validate a multivariable risk prediction model for mortality with using a combination of computed tomography severity score (CT-SS), national early warning score (NEWS), and quick sequential (sepsis-related) organ failure assessment (qSOFA) in COVID-19 patients. METHODS: We retrospectively collected medical data from 655 adult COVID-19 patients admitted to our hospital between July and November 2020. Data on demographics, clinical characteristics, and laboratory and radiological findings measured as part of standard care at admission were used to calculate NEWS, qSOFA score, CT-SS, peripheral perfusion index (PPI) and shock index (SI). Logistic regression and Cox proportional hazard models were used to predict mortality, which was our primary outcome. The predictive accuracy of distinct scoring systems was evaluated by the receiver-operating characteristic (ROC) curve analysis. RESULTS: The median age was 50.0 years [333 males (50.8%), 322 females (49.2%)]. Higher NEWS and SI was associated with time-to-death within 90-days, whereas higher age, CT-SS and lower PPI were significantly associated with time-to-death within both 14 days and 90 days in the adjusted Cox regression model. The CT-SS predicted different mortality risk levels within each stratum of NEWS and qSOFA and improved the discrimination of mortality prediction models. Combining CT-SS with NEWS score yielded more accurate 14 days (DBA: -0.048, p = 0.002) and 90 days (DBA: -0.066, p < 0.001) mortality prediction. CONCLUSION: Combining severity tools such as CT-SS, NEWS and qSOFA improves the accuracy of predicting mortality in patients with COVID-19. Inclusion of these tools in decision strategies might provide early detection of high-risk groups, avoid delayed medical attention, and improve patient outcomes.

The Relationship between Chondromalacia Patella, Medial Meniscal Tear and Medial Periarticular Bursitis in Patients with Osteoarthritis.

BACKGROUND: This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa) in osteoarthritis, chondromalacia patella and medial meniscal tears. PATIENTS AND METHODS: Radiological findings of 100 patients undergoing magnetic resonance imaging with a preliminary diagnosis of knee pain were retrospectively evaluated by two radiologists. The first radiologist assessed all patients in terms of osteoarthritis, chondromalacia patella and medial meniscal tear. The second radiologist was blinded to these results and assessed the presence of bursitis in all patients. RESULTS: Mild osteoarthritis (grade I and II) was determined in 55 patients and severe osteoarthritis (grade III and IV) in 45 cases. At retropatellar cartilage evaluation, 25 patients were assessed as normal, while 29 patients were diagnosed with mild chondromalacia patella (grade I and II) and 46 with severe chondromalacia patella (grade III and IV). Medial meniscus tear was determined in 51 patients. Severe osteoarthritis and chondromalacia patella were positively correlated with meniscal tear (p < 0.001 and p = 0.018, respectively). Significant correlation was observed between medial meniscal tear and bursitis in the medial compartment (p = 0.038). Presence of medial periarticular bursitis was positively correlated with severity of osteoarthritis but exhibited no correlation with chondromalacia patella (p = 0.023 and p = 0.479, respectively). Evaluation of lateral compartment bursae revealed lateral collateral ligament bursitis in 2 patients and iliotibial bursitis in 5 patients. CONCLUSIONS: We observed a greater prevalence of bursitis in the medial compartment of the knee in patients with severe osteoarthritis and medial meniscus tear.

The association of urolithiasis and androgenetic alopecia.

OBJECTIVES: The objective of this study is to investigate whether patients with androgenetic alopecia were at risk in terms of urinary system stone disease. PATIENTS AND METHODS: Patients with no baldness (Hamilton-Norwood Scala [HNS] stage I) were categorized as Group I, those with hair loss in the frontal region (HNS stages II, III, IIIa, and IVa) as Group II, those with hair loss in the vertex region (HNS stage III-vertex, V) as Group III and those with hair loss in both vertex and frontal regions (HNS stages IV, Va, VI, and VII) as Group IV. Patients in all groups were compared in terms of presence of stone, and the presence of any association between alopecia and urolithiasis, with common etiological risk factors, was investigated. RESULTS: Three hundred and two male patients were included in the study. The presence of urolithiasis was detected in 28.9% of patients in Group I; 26.5% of Group II; 36.9% of Group III; and 44.4% of Group IV (p = 0.085). Among patients aged under 60, urinary stone disease was detected in 30.8% of patients in Group I; 26.4% of Group II; 41.2% of Group III; and 53.8% of Group IV (p = 0.001). In patients aged over 60, urolithiasis was detected in 12.5% of patients in Group I; 26.9% of Group II; 32.2% of Group III; and 37.8% of Group IV (p = 0.371). CONCLUSIONS: We determined a significant correlation between vertex pattern and total alopecia with urolithiasis in patients younger than 60 years old.

Subcapsular and Perirenal Hematoma after Ureteroscopy and Pneumatic Lithotripsy.

Subcapsular or perirenal hematoma is an unusual complication after semirigid ureteroscopy using pneumatic lithotripsy to treat ureteral stones. We present a patient who developed a large subcapsular and perirenal hematoma following ureteroscopy administered to a stone in the right ureter.

Association of congenital left renal vein anomalies and unexplained hematuria: multidetector computed tomography findings.

OBJECTIVES: To investigate whether congenital renal vein anomalies are involved in the etiology of hematuria by analyzing abdominal multidetector computed tomography (MDCT) results. METHODS: Six hundred and eighty patients undergoing MDCT for various abdominal pathologies in whom possible causes of hematuria were excluded were retrospectively assessed in terms of left renal vein anomalies, such as circumaortic left renal vein (CLRV), retroaortic left renal vein (RLRV) and multiple renal vein (MRV). Patients with CLRV, RLRV or MRV and patients with normal left renal veins were compared in terms of the presence of hematuria. RESULTS: Left renal vein anomalies were detected in 100 patients (14.7%). RLRV, CLRV and MRV were identified in 5.4, 2.5 and 6.8% of patients, respectively. Hematuria was determined in 8.1% of patients with an RLRV anomaly and in 10.5% of patients with no RLRV anomaly (p=0.633). Hematuria was detected in 23.5% of patients with a CLRV anomaly and 10.1% of those without (p=0.074), and in 21.7% of patients with an MRV anomaly and 9.6% of those without (p=0.009). CONCLUSIONS: In addition to increasing risk of complication during retroperitoneal surgery, numeric congenital renal vein anomalies are also significant in terms of leading to clinical symptoms such as hematuria.

Accuracy of unenhanced computerized tomography interpretation by urologists in patients with acute flank pain.

PURPOSE: The aim was to compare the findings of non-contrast computerized tomography (NCCT) evaluated by urology specialists with the findings of experienced radiologists, who are accepted as a standard reference for patients who present with acute flank pain. MATERIALS AND METHODS: Five hundred patients evaluated with NCCT were included in the study. The NCCT images of these patients were evaluated by both radiologists and urology specialists in terms of the presence of calculus, size of calculus, the location of calculus, the presence of hydronephrosis, and pathologies other than calculus, and the results were compared. RESULTS: The evaluations of urology specialists and standard reference radiology specialists are consistent with each other in terms of the presence of calculus (kappa [κ]: 0.904), categorical stone size (κ: 0.81), the location of calculus (κ: 0.88), and hydronephrosis (κ: 0.94). However, the evaluations of urology specialists in detecting pathologies other than calculus, which may cause acute flank pain or accompany renal colic, were found to be inadequate (κ: 0.37). The false-negative rate of detecting pathologies outside of the urinary system by the urology specialists is calculated as 0.86. CONCLUSION: Although the urology specialists can evaluate the findings related to calculus sufficiently with NCCT, they may not discover pathologies outside of the urinary system.

Do Hypertension, diabetes mellitus and obesity increase the risk of severity of nephrolithiasis?

OBJECTIVE: In this study we planned to investigate the relationship between presence of kidney stones and stone burden with hypertension (HT), diabetes mellitus (DM) and body mass index (BMI). METHODS: A total of 574 patients were included in the study. None of the patients had a history of stones. The 121 patients with kidney stone identified on ultrasound evaluation and the 453 patients with no stones were compared in terms of HT, BMI and DM. The stone burden of 121 patients with diagnosed stones was compared in terms of the same variables. RESULTS: Of the 121 patients with kidney stones 30 (24.7%) had HT, while 66 (14.5%) of the 453 patients without stones had HT (p=0.007). BMI values of those with and without stones were 27.2 ± 4.93 kg/m(2) and 25.29 ± 4.12 kg/m(2), respectively (p<0.001). Twenty-five (20.6%) of the patients with stones diagnosed by ultrasound had DM, while 49 (10.8%) of those without stones had DM (p=0.004). When comparing patients with and without kidney stones, logistic regression analysis revealed that DM (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.17 to 3.63, p=0.013) and BMI (OR 1.08, CI 1.03 to 1.13, p=0.003) were independently associated with presence of stones. No significant relationship was found between the same variables and cumulative stone diameter (CSD) and stone surface area (SA) evaluated for stone burden. CONCLUSIONS: While diabetes mellitus, Hypertension and increased Body Mass Index may add to the possibility of stone formation, they did not affect stone burden.

Association between mean platelet volume and bone mineral density in patients with ankylosing spondylitis and diagnostic value of diffusion-weighted magnetic resonance imaging.

[Purpose] The aim this study was to assess the relation between bone mineral density (BMD) and mean platelet volume (MPV) in ankylosing spondylitis (AS) patients, and evaluate the diagnostic role of the diffusion-weighted magnetic resonance imaging (MRI). [Subjects and Methods] Fifty patients diagnosed with AS were divided into two groups on the basis of BMD, a normal group (n=30) and an osteopenic (n=20) group. [Results] Duration of disease in the group with a normal BMD was 10.3±7.0 years, while it was 16.7±12.2 years in the osteopenia group. MPV was high in the osteopenia group, while no significant differences were observed between the groups in terms of apparent diffusion coefficient (ADC) and platelet distribution width (PDW). There was a positive correlation between MPV and duration of disease. Correlations between ADC value and the lumbar T score, femoral neck T score, and duration of disease were insignificant. A negative correlation was observed between BMD and disease duration. [Conclusion] Diffusion-weighted imaging provides valuable results in osteoporosis but is not a suitable technique for evaluating BMD in patients with AS because of the local and systemic inflammatory effects in the musculoskeletal system. The common pathophysiology of atherosclerosis and osteoporosis plays an important role in the negative correlation observed between MPV and BMD in patients with AS.

Intraperitoneal stone migration during percutaneos nephrolithotomy.

Percutaneos nephrolithotomy (PNL) is the standard care for renal stones larger than 2 cm. The procedure has some major and minor complications. Renal pelvis laceration and stone migration to the retroperitoneum is one of the rare condition. We report the first case of intraperitoneal stone migration during PNL.

Evaluation of the pathologic results of prostate biopsies in terms of age, Gleason score and PSA level: our experience and review of the literature.

OBJECTIVE: To evaluate the pathologic and clinic results of our large series of transrectal prostate biopsies in relation to Gleason score, age and PSA level. MATERIALS AND METHODS: We reviewed the pathologic results of transrectal prostate biopsies performed because of high PSA levels and abnormal digital rectal examination findings between January 2008 and February 2012. RESULTS: The pathologic result of 835 prostate biopsies was benign in 82.2% and malign in 17.8%. Furthermore in 3.7% high grade PIN (Prostatic Intraepitelial Neoplasia) or ASAP (Atypical Small Acinar Proliferation) was shown. In the interval of total PSA values between 4 and 10 ng/dl, that is thw so-called grey zone, cancer detection rate was 12.4%. There was a significant relationship between cancer detection and cancer stage at all high levels of PSA also in the grey zone. The most common Gleason score observed was 3 + 3 wirh a rate of 7.4% whereas the second most commonly observed scare was 3 + 4 with a rate of 2.5%. In the patients with abnormal digital rectal examination findings but normal PSA levels according to age the cancer detection rate was 8.7%, in patients with only high PSA levels the rate was 41.2% and in the patients with both high PSA levels and abnormal digital rectal examination findings. the rate was 49.3%. CONCLUSION: Our study underlines the relationship between age, PSA level and pathologic stage of prostate cancer and also the importance of digital rectal examination.

Comparison of individuals consuming natural spring water and tap water in terms of urinary tract stone disease.

OBJECTIVES: To compare individuals consuming natural spring water and tap water in terms of presence of urinary tract stone disease. PATIENTS AND METHODS: Patients were divided into two groups on the basis of the type of water: tap water (Group I) vs natural spring water consumers (Group II). The two groups were compared in terms of presence of urolithiasis. In addition to the type of water consumed, participants were investigated in terms of age, sex, occupation, body mass index (BMI) and presence of hypertension (HT) and diabetes mellitus in order to evaluate if they constituted a risk factor for urolithiasis. RESULTS: Two hundred fifty-nine patients consuming tap water and 254 consuming natural spring water were included in this study. Presence of urinary stone disease was determined in 27% of patients in Group I and 26% of Group II (p = 0.794). At multivariate analysis involving all variables that might be correlated with the presence of urolithiasis; male gender, high BMI and presence of HT emerged as being significantly associated with urolithiasis. CONCLUSIONS: Although we showed that male gender, presence of HT and high BMI affect stone formation, no difference was demonstated in terms of presence of stone among patients consuming tap or natural spring water.

Frequency and Clinical Significance of Incidental Findings Detected in Internal Acoustic Canal Magnetic Resonance Imaging of Patients with Audiovestibular Symptoms.

Objectives: Retrocochlear pathology associated with audiovestibular symptoms is detected in very few of the patients, and most of the internal acoustic canal magnetic resonance imaging examinations (IAC-MRIs) are either completely normal or include accompanying incidental findings (IFs). The aim of our study is to reveal the presence and frequency of IFs in IAC-MRIs, together with retrocochlear lesions. In addition, we intend to emphasize the clinical importance of these IFs. Methods: A retrospective analysis of 374 serial IAC-MRI scans. Results: Gender distribution: 201 males and 173 females. Age range: 2-82 years. Seventy-two scans (19.25%) were totally normal. Fifteen scans (4.01%) demonstrated only pontocerebellar angle findings (PCAFs). The presence of PCAF and IF was together in 57 scans (15.24%). In 230 (61.50%) of the scans, only IFs were present. The incidence of IFs in all IAC-MRIs was 76.74% (287 of 374). Critical findings that may require clinical further evaluation and examination were present in 34 scans (9.09%). IFs that did not require further examination were observed in 253 scans (67.65%). Conclusion: Various IFs can be detected with IAC-MRI that may cause similar symptoms with PCAF. And unfortunately, some of these IFs may be of very high clinical importance. All referral clinicians should know well that these audiovestibular symptoms can appear as IFs anywhere in the auditory pathway, and how they should be followed in their clinical approach.

Prognostic significance of hydronephrosis in bladder cancer treated by radical cystectomy.

OBJECTIVES: Hydronephrosis is a common finding in patients with bladder cancer. This study aims at an analysis of the association between hydronephrosis, pathologic characteristics of bladder cancer and cancer-specific survival rate after radical cystectomy. METHODS: Clinical data of 241 patients who underwent radical cystectomy between 1990 and 2007 for invasive bladder cancer were analyzed retrospectively. The significance of the relation between the clinical and pathological findings were determined by the chi(2) test. The Kaplan-Meier test was used for the estimation of disease-specific survival obtained according to hydronephrosis, and the differences were examined by the log-rank test. Multivariate analysis was performed by the Cox regression model. RESULTS: Of 241 patients, 39 (16.2%) had unilateral and 13 (5.4%) bilateral hydronephrosis. Five-year cancer-specific survival rates were reported as 63.4% in non-hydronephrotic and 11.57% in hydronephrotic patients (log-rank test, p < 0.001). The presence of hydronephrosis was associated with advanced pT stage, higher tumor grade and lymph node metastases (p < 0.001, p < 0.001 and p < 0.001, respectively). Multivariate analysis showed that hydronephrosis is an important factor directly affecting cancer-specific survival (0.0264). CONCLUSIONS: The presence of hydronephrosis prior to radical cystectomy is a significant prognostic parameter, associated with poor cancer-specific survival and advanced disease stage.

Neglected areas on thorax computed tomography evaluation in patients with chronic obstructive pulmonary disease: Paravertebral muscles and para-aortic adipose tissue.

INTRODUCTION: This study, investigated the para-aortic adipose tissue cross-sectional area, a novel predictor of cardiovascular diseases and degenerative changes in the paravertebral muscles, in patients with chronic obstructive pulmonary disease (COPD). METHOD: One hundred cases diagnosed as COPD and 50 healthy individuals with similar demographic characteristics were evaluated. Para-aortic adipose tissue cross-sectional area (mm2 ), subcutaneous adipose tissue thickness (mm), paravertebral muscle area (mm2 ) and fat deposition in muscle tissue were assessed radiologically. RESULTS: Paravertebral muscle mass was lower in the patient group compared to the healthy individuals (471.41 ± 157.71 mm2 and 561.58 + 151.03 mm2 , respectively; P = 0.001). Paravertebral muscle attenuation values were also lower in the patient group, and the grade of deposition increased (P = 0.012 and P = 0.045, respectively). Although subcutaneous adipose tissue thicknesses were similar in the patient and control groups, para-aortic adipose tissue cross-sectional area was higher in the patients with COPD than in the control group (439.34 ± 267.17 mm2 and 333.82 ± 165.23 mm2 , respectively, P = 0.012). The correlation between subcutaneous adipose tissue and para-aortic adipose tissue observed in the healthy group was not present in the subjects with COPD. CONCLUSION: Chronic obstructive pulmonary disease causes morphological changes in paravertebral muscles and para-aortic adipose tissue. Degenerative changes in the paravertebral muscles occur secondary to systemic inflammation, comorbidity and drugs used in COPD. Factors such as insulin resistance and steroid use result in an increase in para-aortic adipose tissue mass.

Thorax Computed Tomography Findings in Patients with Erectile Dysfunction.

OBJECTIVE: Diabetes mellitus, smoking, dyslipidemia, and obesity play an important role in the etiology of erectile dysfunction, particularly in cases with vascular insufficiency. These risk factors also target the lungs due to their systemic effects. MATERIALS AND METHODS: Patients with penile vascular insufficiency determined at Doppler ultrasonography and undergoing thoracic computerized tomography for various reasons were included in this study. A history of acute thoracic trauma, pneumonic consolidation, or pelvic surgery and trauma were regarded as exclusion criteria. RESULTS: Thirty-seven male patients with identified vascular insufficiency (age 54.48 ± 13.62 years) were enrolled. Mass lesions with a malignant morphology were present in two patients. The most common mediastinal/vascular pathology was atherosclerosis, while the most common parenchymal lesion was emphysematous aeration. Other findings included parenchymal fibrotic bands, atelectasis, interstitial thickening, bronchiectasis, air trapping, aortic aneurysm, a dilated pulmonary artery, hiatal hernia, and pericardial effusion. CONCLUSION: Erectile dysfunction may be an early sign of cardiovascular diseases. Care must be taken in terms of existing or potential pulmonary pathologies in these patients due to their sharing common risk factors with systemic effects.

Gaucher's disease in a patient presenting with hip and abdominal pain.

Gaucher's disease is characterized by glucocerebroside accumulation in the cells of the reticuloendothelial system. There are three subtypes. The most common is type 1, known as the non-neuropathic form. Pancytopenia, hepatosplenomegaly and bone lesions occur as a result of glucocerebroside accumulation in the liver, lung, spleen and bone marrow in these patients. Findings associated with liver, spleen or bone involvement may be seen at radiological analysis. Improvement in extraskeletal system findings is seen with enzyme replacement therapy. Support therapy is added in patients developing infection, anemia or pain. We describe a case of hepatosplenomegaly, splenic infarction, splenic nodules and femur fracture determined at radiological imaging in a patient under monitoring due to Gaucher's disease.

Amyand's hernia detected incidentally in two patients.

The appendix is rarely present inside the inguinal hernia sac. The risk of appendicitis increases in these patients since the blood supply to the appendix can be impaired. The condition is frequently asymptomatic, and even if symptomatic it gives rise to non-specific symptoms. There is no specific laboratory finding. Diagnosis is frequently made with radiological imaging. We report two cases diagnosed as Amyand's hernia with CT.

Malignant fibrous histiocytoma in a patient presenting with urinary system symptoms.

Malignant fibrous histiocytoma is a rare tumor. It is most commonly seen in individuals between the fifth and seventh decades of life, in extremities, and less frequently in the retroperitoneum. Although its etiology is not clearly known, radiotherapy, chemical agents, previous history of surgery, trauma and fracture, and Hodgkin lymphoma have been blamed. Leiomyosarcoma, liposarcoma and rhabdomyosarcoma should be taken into account in differential diagnosis. It is seen on computed tomography as a mass lesion with irregular borders and density similar to that of the surrounding muscle tissue. Necrotic and hemorrhagic components in the mass are characterized as heterogeneous low density areas. Fluid-fluid levels can be detected by computed tomography and magnetic resonance imaging.