Stent plus balloon-assisted coiling with low-profile braided stents in the treatment of complex wide-necked intracranial bifurcation aneurysms.

INTRODUCTION: Wide-necked bifurcation aneurysms pose significant challenges for endovascular treatment. A recent innovation, the stent plus balloon-assisted coiling technique, combines a stent and a balloon to address these aneurysms effectively. PURPOSE: To evaluate the safety and efficacy of the stent plus balloon-assisted coiling for the treatment of wide-necked bifurcation aneurysms. METHODS: We conducted a retrospective review of our endovascular database to identify patients who were treated with this technique and had a satisfactory angiographic follow-up of at least 24 months. Technical success, initial clinical and angiographic outcomes, procedural complications, and follow-up results were analyzed. Angiographic and clinical outcomes were assessed using Modified Raymond-Roy Classification and Modified Rankin Scale, respectively. RESULTS: Our study included 37 aneurysms in 36 patients (26 females) with a mean age of 56.6 years. Mean aneurysm and neck sizes were 7.3 ± 3.5 mm and 3.7 ± 1.0 mm, respectively. Technical success reached 97.2%, with an immediate occlusion rate of 65.7%. At a mean follow-up of 36.5 ± 9.7 months, final angiographic follow-up showed a 91.9% complete occlusion rate. Three aneurysms did not achieve complete occlusion; however, none required retreatment. Complications developed in 32.4% of the procedures. Mortality and morbidity rates were 5.4% and 2.7%, respectively. A good clinical outcome was observed in 91.9% of patients. CONCLUSION: Our results showed that stent plus balloon-assisted coiling technique allows good angiographic outcomes for wide-necked bifurcation aneurysms. However, overall complication rate is high. Subgroup analysis indicated promising safety and efficacy for MCA bifurcation aneurysms, suggesting this technique could be a valuable option for select aneurysms.

Ultrasound-Guided Suprascapular Nerve Block at Suprascapular Notch-Do We Really Target Suprascapular Notch or Not? Where Is Our Real Target?

Ultrasound (US)-guided suprascapular nerve block (SSNB) is a widely used procedure and while describing the US-guided SSNB in the suprascapular notch, the suprascapular fossa is often visualized and injection is performed in that location. Although it can be done in both location, to inject the right area, the terminology should be settled and the visualization of these areas which are unclear and confusing in the literature should be clarified. In this sense, we showed the course of the nerve on a cadaver and briefly describe a protocol to correctly visualize the suprascapular notch with US.

Added value of coronal-T1W sequence to the lumbar MR imaging protocol for low back pain. / Valor de la secuencia coronal-T1W agregada al protocolo de imágenes de resonancia magnética en casos de dolor lumbar

INTRODUCTION: Magnetic resonance imaging (MRI) is the most appropriate imaging method to investigate low back pain. As low back pain is very common, a large number of MRI scans are performed. OBJECTIVE: To evaluate the extraspinal findings and clinical effect of the T1-weighted spin echo (T1W SE) coronal sequence added to the lumbar MRI protocol for low back pain. MATERIALS AND METHODS: In 2015, we added a T1-weighted (T1W) coronal sequence to our routine lumbar MRI protocol. We retrospectively evaluated 969 lumbar MRI images for low back pain performed with this protocol. The extraspinal MRI findings obtained from them were then grouped as associated with low back pain (Category 1) and not associated with low back pain (Category 2). We also evaluated whether the recorded incidental extraspinal findings could be detected on conventional sagittal and axial images. RESULTS: Ninety-six (63%) of the extraspinal findings were associated with low back pain (Category 1) and 56 (37%), Category 2. Seventy-eight percent of the extraspinal findings were detected only on coronal-T1W images and not on conventional images. CONCLUSION: Adding coronal-T1W sequence to the routine protocol of lumbar MRI can help to identify extraspinal findings and guide clinical treatment.

Introducción. La resonancia magnética (RM) es el método de imágenes diagnósticas más apropiado para investigar el dolor lumbar. Dado que este es muy común, son muchas las resonancias magnéticas de este tipo que se hacen. Objetivo. Analizar los hallazgos extraespinales que se pueden detectar al agregar la secuencia coronal T1W al protocolo de imágenes de RM para el dolor lumbar y evaluar su efecto clínico. Materiales y métodos. En el 2015 se agregó una secuencia coronal ponderada en T1W al protocolo de resonancia magnética lumbar de rutina de nuestro hospital. Se evaluaron retrospectivamente 969 imágenes solicitadas en casos de dolor lumbar y realizadas con este protocolo. Los hallazgos obtenidos a partir de dichas imágenes se agruparon luego como asociados con el dolor lumbar (categoría 1) y no asociados con el dolor lumbar (categoría 2). Se evaluó, asimismo, si los hallazgos extraespinales registrados podían detectarse en imágenes axiales y sagitales convencionales. Resultados. Noventa y seis (63 %) de los hallazgos extraespinales se asociaron con lumbalgia (categoría 1) y 56 (37 %) correspondieron a la categoría 2. El 78 % de los hallazgos extraespinales se detectaron solo en imágenes coronales-T1W y no en las convencionales. Conclusión. La secuencia coronal-T1W agregada al protocolo de rutina de la resonancia magnética lumbar puede ayudar a detectar afectaciones extraespinales y guiar el tratamiento clínico.

Added value of coronal-T1 W sequence to the lumbar MR imaging protocol for low back pain / Valor de la secuencia coronal-TIW agregada al protocolo de imágenes de resonancia magnética en casos de dolor lumbar

Introduction: Magnetic resonance imaging (MRI) is the most appropriate imaging method to investigate low back pain. As low back pain is very common, a large number of MRI scans are performed. Objective: To evaluate the extraspinal findings and clinical effect of the T1-weighted spin echo (T1 W SE) coronal sequence added to the lumbar MRI protocol for low back pain. Materials and methods: In 2015, we added a T1-weighted (T1W) coronal sequence to our routine lumbar MRI protocol. We retrospectively evaluated 969 lumbar MRI images for low back pain performed with this protocol. The extraspinal MRI findings obtained from them were then grouped as associated with low back pain (Category 1) and not associated with low back pain (Category 2). We also evaluated whether the recorded incidental extraspinal findings could be detected on conventional sagittal and axial images. Results: Ninety-six (63%) of the extraspinal findings were associated with low back pain (Category 1) and 56 (37%), Category 2. Seventy-eight percent of the extraspinal findings were detected only on coronal-T1W images and not on conventional images. Conclusion: Adding coronal-T1W sequence to the routine protocol of lumbar MRI can help to identify extraspinal findings and guide clinical treatment.

Introducción. La resonancia magnética (RM) es el método de imágenes diagnósticas más apropiado para investigar el dolor lumbar. Dado que este es muy común, son muchas las resonancias magnéticas de este tipo que se hacen. Objetivo. Analizar los hallazgos extra espinales que se pueden detectar al agregar la secuencia coronal T1 W al protocolo de imágenes de RM para el dolor lumbar y evaluar su efecto clínico. Materiales y métodos. En el 2015 se agregó una secuencia coronal ponderada en T1W al protocolo de resonancia magnética lumbar de rutina de nuestro hospital. Se evaluaron retrospectivamente 969 imágenes solicitadas en casos de dolor lumbar y realizadas con este protocolo. Los hallazgos obtenidos a partir de dichas imágenes se agruparon luego como asociados con el dolor lumbar (categoría 1) y no asociados con el dolor lumbar (categoría 2). Se evaluó, asimismo, si los hallazgos extra espinales registrados podían detectarse en imágenes axiales y sagitales convencionales. Resultados. Noventa y seis (63 %) de los hallazgos extra espinales se asociaron con lumbalgia (categoría 1) y 56 (37 %) correspondieron a la categoría 2. El 78 % de los hallazgos extra espinales se detectaron solo en imágenes coronales-T1W y no en las convencionales. Conclusión. La secuencia coronal-T1 W agregada al protocolo de rutina de la resonancia magnética lumbar puede ayudar a detectar afectaciones extra espinales y guiar el tratamiento clínico.

Pulmonary fibrotic-like changes on follow-up chest CT exam in patients recovering from COVID-19 pneumonia.

INTRODUCTION: To date, there is limited data on the long-term changes in the lungs of patients recovering from coronavirus (COVID-19) pneumonia. In order to evaluate pulmonary sequelae, it was planned to investigate fibrotic changes observed as sequelae in lung tissue in 3-6-month control thorax computerized tomography (CT) scans of moderate-to-severe COVID-19 pneumonia survivors. MATERIALS AND METHODS: A total of 84 patients (mean age: 67.3 years ±15) with moderate-to-severe pneumonia on chest tomography at the time of diagnosis were included in the study, of which 51 (61%) were males and 33 (39%) were females. Initial and follow-up CT scans averaged 8.3 days ± 2.2 and 112.1 days ± 14.6 after symptom onset, respectively. Participants were recorded in two groups as those with and without fibrotic-like changes such as traction bronchiectasis, fibrotic - parenchymal bands, honeycomb appearance according to 3-6 months follow-up CT scans. Differences between the groups were evaluated with a two-sampled t-test. Logistic regression analyzes were performed to determine independent predictive factors of fibrotic-like sequelae changes. RESULT: On follow-up CTs, fibrotic-like changes were observed in 29 (35%) of the 84 participants (Group 1), while the remaining 55 (65%) showed complete radiological recovery (Group 2). With logistic regression analysis, hospital stay of 22 days or longer (OR: 4.9; 95% CI: 20, 32; p< 0.05) and a CT score of 15 or more at diagnosis (OR: 2.2; 95% CI: 13.5, 18; p< 0.05) were found to be an independent predictor for sequelae fibrotic changes in lung tissue. CONCLUSIONS: More than one-third of patients who survived COVID-19 pneumonia had fibrotic-like sequelae changes in the lung parenchyma. These changes were found to be associated with the presence of severe pneumonia at the time of diagnosis and longer hospital stay.

Comparison of Two Different Methods of Fine Needle Aspiration Biopsy and Histopathology for Thyroid Nodules.

OBJECTIVE:  Two different methods for fine needle aspiration biopsy (FNAB) of thyroid nodules (multi-pass conventional smear, MPCS; single-pass liquid-based cytology, SPLBC) were evaluated regarding the magnitude of nondiagnostic/unsatisfactory sampling ratio, and basic demographic and ultrasonographic (USG) factors to predict such outcome. METHODS:  One thousand FNAB patients were retrospectively assessed. Of them, 517 nodules were evaluated with the conventional smear method, and the rest were evaluated with liquid-based cytology method using the Bethesda System for Reporting Thyroid Cytopathology. FNAB technique had certain procedural differences for both pathological methods. For conventional smear, a modified "needle-only" technique with three independent passes was performed, whereas a single pass was used for liquid-based cytology. The reduction of nondiagnostic/unsatisfactory results constituted the basis of this study. Pathological results, therefore, were subgrouped under "nondiagnostic/unsatisfactory" (Category I), "benign" (Category II), and "atypia/neoplasia/malignancy" (Category III-VI). RESULTS:  Both FNAB groups were not statistically different or only slightly different regarding size (P = 0.196), echogenicity (P = 0.014), and the presence of echogenic foci (P = 0.11), therefore considered to have equal USG properties. In MPCS method, the nondiagnostic/unsatisfactory rate (i.e., Category I) was 24%. Other cytological results were as follows: Category II (67.1%), Category III-VI (8.8%). In SPLBC method, the nondiagnostic/unsatisfactory rate (i.e., Category I) was 14.5%. Other cytological results were as follows: Category II (77.6%), Category III-VI (7.8%). A significant difference was found between two sampling methods regarding pathological results (Independent samples t-test, P < 0.0001). The demographic and USG factors, considered in this study, did not offer a successful prediction of nondiagnostic/unsatisfactory outcomes. CONCLUSION:  SPLBC has significantly lower (14.5% vs 24%) nondiagnostic rate than MPCS, and higher 77.6% vs 67.1%) Category II rate than MPCS. This may point to the possibility that MPCS method undercategorizes many benign (i.e., Category II) nodules under nondiagnostic/unsatisfactory category. The success of the former is due to the elimination of confounding material during the process. Single pass, also, increases patient comfort and compliance, and has additional advantages for the interventionalist, as it obviates the need to smear aspirates. This dramatically decreases the actual duration of the biopsy procedure and is free of interventionalist expertise for smearing.

Pulmonary Embolism and Giant Cavitary Lesion Developing After COVID-19 Pneumonia.

Introduction: The clinical manifestations of the worldwide pandemic, which began in mainland China in December 2019, were very similar to viral pneumonia and defined as Coronavirus disease 2019 (COVID-19). Complications such as acute respiratory distress syndrome (ARDS), acute cardiac tissue damage, secondary infections, isolated coagulopathy and pulmonary embolism have been reported with COVID-19 disease. Clinical Findings: A 79-year-old woman admitted to the emergency room (ER) had complaints of fever and cough. The patient was admitted to the ER with the suspicion of COVID-19. Samples were collected with a nasopharyngeal swab and confirmed as COVID-19. In addition, a chest CT examination was performed. In the first evaluation after admittance, the D-dimer value was measured as 450 µg/L. In the follow-up of the patient, on the 18th day, increased respiratory distress and high D-dimer level (7893 µg/L) were detected in the laboratory findings. Outcomes: A chest CT scan had ground-glass opacities compatible with COVID-19 pneumonia. A giant cavitary lesion was detected following the development of pulmonary embolism after COVID-19 disease. Conclusions: In rare cases of COVID-19 cavitation development may occur after pulmonary infarction. In addition, it should be remembered that emphysema, giant bulla and pneumothorax may develop in COVID-19 pneumonia cases undergoing HFNC oxygen therapy. We present a case of a giant cavitary lesion that developed following a COVID-19-related pulmonary embolism.