Image-Assisted Pleural Needle Biopsy or Medical Thoracoscopy: Which Method for Which Patient? - A Randomized Controlled Trial.

BACKGROUND: Image-guided or assisted needle biopsies and the increasing use of medical thoracoscopy (MT) have increased the diagnostic accuracy of pleural diseases significantly. However, no consensus exists regarding which patients with pleural effusion should undergo MT and which patients should undergo image-guided or assisted needle biopsy as the first procedure to ensure greater diagnostic accuracy. RESEARCH QUESTION: Which biopsy method is more appropriate for which patient to provide the highest diagnostic accuracy in the diagnosis of pleural effusion? STUDY DESIGN AND METHODS: This prospective, randomized, parallel study included 228 patients with undiagnosed exudative pleural effusion. Patients were divided into two groups based on CT scan findings. Group 1 included patients with pleural effusion only. Group 2 included patients with pleural thickening or lesion in addition to pleural effusion. Patients in each group were assigned randomly to an image-assisted Abrams needle biopsy (IA-ANPB) or MT arm. The diagnostic sensitivity, reliability, and safety were determined for both groups. RESULTS: The false-negative rate was 30.3% for the IA-ANPB arm and 3.1% for the MT arm in group 1. The same rates were 11.9% for IA-ANPB and 4.7% for MT in group 2. In group 1, the sensitivity for the IA-ANPB arm was 69.7%, and the negative likelihood ratio was 0.30. The same rates for the MT arm were 96.9% and 0.03 (P = .009). In group 2, these values were 88.1% and 0.12 for the IA-ANPB arm and 95.4% and 0.05 for the MT arm (P = .207). The rate of complications between the two biopsy methods was not different (8.5% and 15.8%, respectively; P = .107). INTERPRETATION: MT showed a high diagnostic success in all patients with pleural fluid. However, IA-ANPB showed similar diagnostic success as MT in patients with pleural effusion and associated pleural thickening or lesions. Therefore, in the latter case, IA-ANPB could be preferable to MT. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT05428891; URL: www. CLINICALTRIALS: gov.

[Segmentation of acute pulmonary embolism in computed tomography pulmonary angiography using the deep learning method]. / Derin ögrenme yöntemiyle akut pulmoner embolinin bilgisayarli tomografik pulmoner anjiografide segmentasyonu.

Introduction: Pulmonary embolism is a type of thromboembolism seen in the main pulmonary artery and its branches. This study aimed to diagnose acute pulmonary embolism using the deep learning method in computed tomographic pulmonary angiography (CTPA) and perform the segmentation of pulmonary embolism data. Materials and Methods: The CTPA images of patients diagnosed with pulmonary embolism who underwent scheduled imaging were retrospectively evaluated. After data collection, the areas that were diagnosed as embolisms in the axial section images were segmented. The dataset was divided into three parts: training, validation, and testing. The results were calculated by selecting 50% as the cut-off value for the intersection over the union. Result: Images were obtained from 1.550 patients. The mean age of the patients was 64.23 ± 15.45 years. A total of 2.339 axial computed tomography images obtained from the 1.550 patients were used. The PyTorch U-Net was used to train 400 epochs, and the best model, epoch 178, was recorded. In the testing group, the number of true positives was determined as 471, the number of false positives as 35, and 27 cases were not detected. The sensitivity of CTPA segmentation was 0.95, the precision value was 0.93, and the F1 score value was 0.94. The area under the curve value obtained in the receiver operating characteristic analysis was calculated as 0.88. Conclusions: In this study, the deep learning method was successfully employed for the segmentation of acute pulmonary embolism in CTPA, yielding positive outcomes.

Evaluation of the relationship of the T and M stage with the erector spinae muscle area in male lung cancer patients.

OBJECTIVES: Sarcopenia is very common due to cachexia and presents with a decrease in skeletal muscle mass. In this study, we aimed to investigate the relationship between the T, M category and the erector spinae muscle area (ESMa). MATERIAL AND METHODS: The initial first thorax and high-resolution computed tomography (CT) of patients with lung cancer between 2015 and 2019 were retrospectively screened. After exclusion criterias remaining 226 male patients constituted the study group. ESMa was measured manually in the section taken from the T12 vertebra spinous process level as previously described in the literature and its relationship with the T and M stage were evaluated. RESULTS: The mean ages of patients were 70 ± 9.57 years. The T stage was T1 in 34 (15%) patients, T2 in 46 (20.4%), T3 in 59 (26.1%), and T4 in 87 (38.5%). Metastasis was detected in 83 (36.7%) patients. The mean ESMa of the patients was 34.15 ± 7.21 mm2 and did not differ according to the T stage (p = .39). ESMa was lower in the metastatic group (mean 30.42 ± 6.38 mm2) than the non-metastatic group (mean 36.32 ± 6.78 mm2) (p = .0001). CONCLUSIONS: ESMa, one of the indicators of sarcopenia, is lower in patients with metastatic lung cancer than in nonmetastatic.

Segmentation of orbital and periorbital lesions detected in orbital magnetic resonance imaging by deep learning method.

Purpose: Magnetic resonance imaging (MRI) has a special place in the evaluation of orbital and periorbital lesions. Segmentation is one of the deep learning methods. In this study, we aimed to perform segmentation in orbital and periorbital lesions. Material and methods: Contrast-enhanced orbital MRIs performed between 2010 and 2019 were retrospectively screened, and 302 cross-sections of contrast-enhanced, fat-suppressed, T1-weighted, axial MRI images of 95 patients obtained using 3 T and 1.5 T devices were included in the study. The dataset was divided into 3: training, test, and validation. The number of training and validation data was increased 4 times by applying data augmentation (horizontal, vertical, and both). Pytorch UNet was used for training, with 100 epochs. The intersection over union (IOU) statistic (the Jaccard index) was selected as 50%, and the results were calculated. Results: The 77th epoch model provided the best results: true positives, 23; false positives, 4; and false negatives, 8. The pre-cision, sensitivity, and F1 score were determined as 0.85, 0.74, and 0.79, respectively. Conclusions: Our study proved to be successful in segmentation by deep learning method. It is one of the pioneering studies on this subject and will shed light on further segmentation studies to be performed in orbital MR images.

Investigation of the relationship of CO-RADS and CT patterns with laboratory parameters in COVID-19 patients and a new perspective on the total CT scoring system.

BACKGROUND: It is important to determine the correlation of the CO-RADS classification and computed tomography (CT) patterns of the lung with laboratory data. To investigate the relationship of CO-RADS categories and CT patterns with laboratory data in patients with a positive RT-PCR test. We also developed a structured total CT scoring system and investigated its correlation with the total CT scoring system. METHOD: The CT examinations of the patients were evaluated in terms of the CO-RADS classification, pattern groups and total CT score. Structured total CT score values were obtained by including the total CT score values and pattern values in a regression analysis. The CT data were compared according to the laboratory data. RESULTS: A total of 198 patients were evaluated. There were significant differences between the CO-RADS groups in terms of age, ICU transfer, oxygen saturation, creatinine, LDH, D-dimer, high-sensitivity cardiac troponin-T (hs-TnT), CRP, structured total CT score values, and total CT score values. A significant difference was also observed between the CT pattern groups and oxygen saturation, creatinine and CRP values. When the structured total CT score values and total CT score values were compared they were observed to be correlated. CONCLUSIONS: Creatinine can be considered as an important marker for the CO-RADS and pattern classifications in lung involvement. LDH can be considered as an important marker of parenchymal involvement, especially bilateral and diffuse involvement. The structured total CT scoring system is a new system that can be used as an alternative.

A Case of Intestinal Perforation Associated with Mesenteric Thrombosis Due to Post-COVID-19 Syndrome.

PURPOSE: We aimed to present a case who developed intestinal ischemia and associated perforation and abscess due to Superior Mesenteric Vein (SMV) thrombosis caused by post-COVID-19 syndrome and discuss the preoperative Computed Tomography (CT) imaging findings used in diagnosis. CASE PRESENTATION: A 58-year-old patient presented to our clinic with a complaint of acute abdominal pain. His CT examination revealed thrombosis in SMV, congestion in the mesenteric venous structures, contamination in the mesentery, and thickening and dilatation of the jejunal loops due to ischemia. The patient had a history of acute COVID-19 infection. He had typical COVID-19 pneumonia findings (peripheral ground-glass opacities in both lung parenchyma predominantly in the lower lobe) on the thorax CT at that time. He was followed up with anticoagulant therapy. During his follow-up, a thoracic and abdominal CT was performed due to recurrent acute abdominal findings. On thorax CT, there was a web-like filling defect consistent with pulmonary embolism, traction bronchiectasis consistent with late findings of COVID-19 pneumonia, and poorly circumscribed subpleural ground glass opacities. On abdominal CT, in addition to mesenteric ischemia findings, loss of wall integrity was observed in the jejunal loops due to perforation and collection areas containing air consistent with an abscess. He was treated with small bowel resection and abscess drainage. CONCLUSION: Patients with acute COVID-19 infection should be followed up for the early diagnosis of serious symptoms that may develop due to post-COVID-19 syndrome, and contrast-enhanced CT should be the imaging method of choice to detect possible mesenteric vascular thrombosis in patients with acute abdominal symptoms.

Correlation of Indeterminate Lesions of COVID-19 Pneumonia Detected on Computed Tomography with RT-PCR Results.

BACKGROUND: The typical findings of COVID-19 pneumonia include multilobar groundglass opacities and consolidation areas observed predominantly in the basal and peripheral parts of both lungs in computed tomography. OBJECTIVE: The current study aimed to correlate indeterminate lesions of COVID-19 pneumonia detected on computed tomography with the results of the reverse transcription-polymerase chain reaction (RT-PCR) test. METHODS: Patients with high-resolution computed tomography images that were reported to contain indeterminate lesions in terms of COVID-19 pneumonia were included retrospectively in the study. The lesions were categorized and the patterns were classified. The RT-PCR-positive and the RTPCR- negative patients were compared. P<0.05 was accepted as the statistical significance limit. RESULTS: The RT-PCR-positive patients exhibited a higher rate of peripheral lesions. Limited consolidation areas were not detected in the RT-PCR-positive patients. In the RT-PCR-negative patients, the rates of acinar nodules and the tree-in-bud pattern were significantly higher. The RTPCR- negative patients had higher nodular contour features and lesion coalescence. In the subgroup consisting of lesions with ground-glass opacities and/or ground-glass opacity around the nodule, the rate of nodular contour positivity was significantly higher in the RT-PCR- positive patients. CONCLUSION: COVID-19 pneumonia should be suspected when peripheral indeterminate lesions are detected. When indeterminate lesions, such as tree-in-bud pattern, acinar nodules and limited consolidation area are detected, alternative diagnoses should be considered first, even if there are ground glass opacities accompanying these lesions.

Contribution of artificial intelligence applications developed with the deep learning method to the diagnosis of COVID-19 pneumonia on computed tomography.

INTRODUCTION: Computed tomography (CT) is an auxiliary modality in the diagnosis of the novel Coronavirus (COVID-19) disease and can guide physicians in the presence of lung involvement. In this study, we aimed to investigate the contribution of deep learning to diagnosis in patients with typical COVID-19 pneumonia findings on CT. MATERIALS AND METHODS: This study retrospectively evaluated 690 lesions obtained from 35 patients diagnosed with COVID-19 pneumonia based on typical findings on non-contrast high-resolution CT (HRCT) in our hospital. The diagnoses of the patients were also confirmed by other necessary tests. HRCT images were assessed in the parenchymal window. In the images obtained, COVID-19 lesions were detected. For the deep Convolutional Neural Network (CNN) algorithm, the Confusion matrix was used based on a Tensorflow Framework in Python. RESULT: A total of 596 labeled lesions obtained from 224 sections of the images were used for the training of the algorithm, 89 labeled lesions from 27 sections were used in validation, and 67 labeled lesions from 25 images in testing. Fifty-six of the 67 lesions used in the testing stage were accurately detected by the algorithm while the remaining 11 were not recognized. There was no false positive. The Recall, Precision and F1 score values in the test group were 83.58, 1, and 91.06, respectively. CONCLUSIONS: We successfully detected the COVID-19 pneumonia lesions on CT images using the algorithms created with artificial intelligence. The integration of deep learning into the diagnostic stage in medicine is an important step for the diagnosis of diseases that can cause lung involvement in possible future pandemics.

Detection of Lung Cancer on Computed Tomography Using Artificial Intelligence Applications Developed by Deep Learning Methods and the Contribution of Deep Learning to the Classification of Lung Carcinoma.

BACKGROUND: Every year, lung cancer contributes to a high percentage deaths in the world. Early detection of lung cancer is important for its effective treatment, and non-invasive rapid methods are usually used for diagnosis. INTRODUCTION: In this study, we aimed to detect lung cancer using deep learning methods and determine the contribution of deep learning to the classification of lung carcinoma using a convolutional neural network (CNN). METHODS: A total of 301 patients diagnosed with lung carcinoma pathologies in our hospital were included in the study. In the thorax, Computed Tomography (CT) was performed for diagnostic purposes prior to the treatment. After tagging the section images, tumor detection, small and non-small cell lung carcinoma differentiation, adenocarcinoma-squamous cell lung carcinoma differentiation, and adenocarcinoma-squamous cell-small cell lung carcinoma differentiation were sequentially performed using deep CNN methods. RESULTS: In total, 301 lung carcinoma images were used to detect tumors, and the model obtained with the deep CNN system exhibited 0.93 sensitivity, 0.82 precision, and 0.87 F1 score in detecting lung carcinoma. In the differentiation of small cell-non-small cell lung carcinoma, the sensitivity, precision and F1 score of the CNN model at the test stage were 0.92, 0.65, and 0.76, respectively. In the adenocarcinoma-squamous cancer differentiation, the sensitivity, precision, and F1 score were 0.95, 0.80, and 0.86, respectively. The patients were finally grouped as small cell lung carcinoma, adenocarcinoma, and squamous cell lung carcinoma, and the CNN model was used to determine whether it could differentiate these groups. The sensitivity, specificity, and F1 score of this model were 0.90, 0.44, and 0.59, respectively, in this differentiation. CONCLUSION: In this study, we successfully detected tumors and differentiated between adenocarcinoma- squamous cell carcinoma groups with the deep learning method using the CNN model. Due to their non-invasive nature and the success of the deep learning methods, they should be integrated into radiology to diagnose lung carcinoma.

3.0 Tesla MRI scanner evaluation of supratentorial major white matter tracts and central core anatomical structures of postmortem human brain hemispheres fixed by Klingler method.

Background: As an advanced imaging technique for the human brain, the importance of magnetic resonance imaging technique (MRI) is indisputable. The study aims to contribute to the literature by imaging post-mortem human brain hemispheres fixed with the Klinger method through the a 3.0 Tesla MRI Scanner and by defining the supratentorial major white matter tracts and central core anatomical structures.Methods: In our study, 10 post-mortem human brain hemisphere specimens were placed in 10% formalin solution for at least two months according to the Klingler method. The images were obtained using a 3.0 Tesla MRI Scanner. Anatomical structures were described on the T1-T2 axial, coronal, and sagittal MRI sections and compared with control images obtained from healthy humans.Results: Our examination revealed major association fibers, the basal cores and nuclei were denser, and the connections between them were clearly visible. The basal nuclei particularly were visualized more clearly compared with the normal MRI examinations. The claustrum, putamen, lateral and medial part of globus pallidus, and the caudolenticular bridges of the caudate nucleus could be clearly distinguished. The optic radiation line toward the occipital area as well as the forceps major and minor were distinct in the axial sections. Meanwhile, the imaging emphasized the importance of temporal stem, and the fibers it contained were clearly observed in the coronal sections.Conclusion: The use of hemispheres fixed using the Klinger method in post-mortem MRI examinations on brain hemispheres showed a clear separation of white matter fibers and nuclear structures.

A comparative evaluation of the Eustachian tube cartilage between healthy and diseased ears using a 3 Tesla MRI.

PURPOSE: The purpose of this study was to prospectively assess the Eustachian tube (ET) cartilage using 3 Tesla (3T) magnetic resonance imaging (MRI) and compare the results between healthy ears and those with a middle ear disease. MATERIAL AND METHODS: The study included 56 ears with a middle ear disease as the patient group and 100 ears without a middle ear disease as the control group. The patients' age ranged from 18 to 65 years. The axial three-dimensional (3D) multiple echo recombined gradient echo (MERGE) sequence and oblique parasagittal planes were obtained. Visualisation of the ET cartilage was assessed on the MR images using a three-point numerical rating score. In the axial plane, the ET lumen's diameter was measured from the mid-portion of the cartilage. RESULTS: There was no significant difference between the patient group and the control group according to patients' age and gender, and the medial laminal thickness of the ET cartilage. In the patient group, the diameter of the ET cartilage was significantly smaller than in the control group. The ET lumen diameter was significantly lower according to each of the three scoring systems. CONCLUSIONS: 3T MRI provides an evaluation of the ET cartilage and isthmus level, which are small but important anatomical localisations and surgical landmarks. MR imaging has the potential to provide essential information on ET prior to new surgical treatments, such as balloon dilation for middle ear diseases.

Perioperative hypothermia in pediatric patients operated in a tertiary care center: Incidence and correlates.

BACKGROUND & OBJECTIVES: Hypothermia, described as temperature < 35°C, is a frequent condition encountered in patients operated under general anesthesia. It is associated with significant morbidity and mortality. We aimed to estimate its incidence and to investigate the conditions associated with hypothermia in pediatric patients. METHODS: This prospective clinical study was carried out in the operating theatre of a tertiary care center between August 2015 and September 2015. A total of 108 pediatric patients who underwent various surgical procedures that lasted for more than 30 minutes were enrolled. Baseline demographic data, types of surgical procedures, duration of operations, preoperative and perioperative body temperatures were recorded. The incidence of hypothermia and its possible correlates were sought. RESULTS: Our series consisted of 108 children (77 males, 71.3%; 31 females, 28.7%) with an average age of 6.08±5.09 years were included in the study. There was no case diagnosed with hypothermia in the preoperative, perioperative and postoperative periods. Patients in American Society of Anesthesiologists classification (ASA) three group had significantly higher preoperative body temperatures compared to those in ASA-1 and ASA-2 groups (p = 0.027). The postoperative body temperature in patients receiving intravenous fluid replacement was significantly lower (p=0.017). CONCLUSION: For pediatric patients scheduled for surgical interventions, we recommend close monitorization and follow-up of body temperature, implementation of preventive measures to avoid hypothermia and routine perioperative heating. Avoidance of hypothermia may prevent hazardous consequences of postoperative hypothermia.

Medical treatment of a symptomatic acute pulmonary vein stenosis following antral pulmonary vein isolation.

Pulmonary vein (PV) stenosis is a rare but serious complication of PV isolation. It usually develops 3-6 months after the procedure, but may rarely develop in the acute phase. We present a case of symptomatic PV stenosis within 48 hours after antral PV isolation. Following the initiation of medical treatment including a glucocorticoid, acute changes in the PV wall regressed and the patient's complaint of dyspnea at rest improved rapidly. In addition, long-term renin-angiotensin-aldosterone system (RAAS) blockers were given. The complaint did not recur during follow-up and PV stenosis was mild at 6 months.

Three Dimensional Printing and Biomaterials in the Repairment of Bone Defects; Hydroxyapatite PLA Filaments

Background/aim: Application fields of bone tissue engineering studies continue to expand. New biocompatible materials aimed to improve bone repairment and regeneration of implants are being discovered everyday by scientists, engineers, and surgeons. Our objective in this study is to combine polylactic acid which is a polymer with hydroxyapatite in the repairment of bone defects considering the increased need by medical application fields. Materials and methods: After 750 g of PLA with a diameter of 2.85 mm was granulated into minimum particles, these particles were homogenously mixed with hydroxyapatite prepared in laboratory environment. Using this mixture, HA-PLA filament with a diameter of 2.85 mm was prepared in the extrusion device in Kütahya Medical Sciences University Innovative Technology Laboratory. The temperature was 250 °C and the gearmotor speed was 9 rpm during extrusion. X-ray diffraction (XRD) analysis was made for crystal phase analyses of the produced hydroxyapatite powder, to determine the produced main phase and examine whether a minor phase occurred. Vickers microhardness test was applied on both samples to measure the endurance levels of the samples prepared with HA-PLA filament. A loading force of 10 kg was applied on the samples for 10 s. Results: Hydroxyapatite peaks in XRD spectrum of the sample presented in figures are concordant with Joint Committee on Powder Diffraction Standards, JCPDS - File Card No. 01-075-9526 and no significant minor phase was observed. For both samples, hardness value was observed to increase between 3 and 5 mm. Conclusion: Surfacing hydroxyapatite on metallic materials is possible. By similar logic, to increase durability with low cost, characteristics of biomaterials can be improved with combinations such as hydroxyapatite PLA. Thus, we found that while these materials have usage limitations due to present disadvantages when used alone, it is possible to increase their efficiency and availability through different combinations.

Importance of Three-Dimensional Modeling in Cranioplasty.

Cranioplasty is a reconstruction operation made to protect intracranial structures. It is applied for the closure of bone defects occurring due to causes such as trauma, tumor, infection, and infarct. Many different products changing from autologous bone grafts to synthetic materials are used for cranioplasty. Three-dimensional printers that are among the popular innovations of today are used gradually more in medical area as in every field of life and they make the surgical operation easier. When customizable materials are combined with technology, the authors come across successful results and less complications. The aim of the authors' study was to show a 3-dimensional modeling method in 2 patients the authors applied cranioplasty and the advantages provided by this method for the surgeon and the patient.

Enhanced recovery after surgery (ERAS) versus conventional postoperative care in patients undergoing abdominal hysterectomies.

OBJECTIVES: In the present study, we aimed to compare the postoperative compliance and complications between ERAS and conventional postoperative care in patients undergoing abdominal hysterectomies. MATERIAL AND METHODS: This is the prospective, randomized, controlled trial, which involved 62 patients, who underwent abdominal hysterectomy between December 2016 to February 2017. A total of 30 patients formed the ERAS group. A total of 32 patients who received conventional perioperative care and matched for age, body mass index (BMI) and American Society of Anesthesiologists score were assigned as a control group. Groups were compared in terms of patient characteristics [age, body mass index, ASA Score, parity, diagnosis, type of surgery, and perioperative intravenous fluids], postoperative compliance (postoperative intravenous fluids, time to first flatus, first defecation, ambulation, eating solid food, and postoperative hospital stay), and postoperative complications. RESULTS: Peri- and post-operative administrated intravenous fluids were significantly lower in the ERAS group (p < 0.001 for both). Time to first flatus (p = 0.001), time to first defecation (p < 0.001), and time to eating solid food (p < 0.001) were all significantly shorter in the ERAS group. Post-operative early mobilization on the first postoperative day was achieved in eight (26.7%) patients in the ERAS group. There were no significant differences in complications. One (3.3%) patient in the ERAS Group and 11 (34.4%) patients in the Conventional Group required hospital readmission after discharge (p = 0.002). CONCLUSION: The ERAS protocol seems to be a simple tool for reducing the incidence of postoperative complications and shortening hospitalization.

Application of lumbar drainage in vasospasm after spontaneous subarachnoid hemorrhage and prevention of late cerebral infarction.

Cerebral vasospasm, especially delayed cerebral ischemia following subarachnoid hemorrhage (SAH) is the most important complication that effects mortality and morbidity of patients with intracranial aneurysms. The presence of cerebral vasospasm has been correlated with an increase in mortality in the first 2 weeks after SAH. Despite clinical studies and research, the etiopathogenesis of cerebral vasospasm is not understood exactly and there is not yet an effective therapy. The aim of our study was to investigate the effect of application of lumber drainage on vasospasm and delayed cerebral infarction following SAH and to examine the incidence of complications. Patient groups were determined by retrospective screening of 70 patients who underwent a surgical operation at the Osmangazi University Medical Faculty Department of Neurosurgery between 2009 and 2013 after a diagnosis of ruptured aneurysmal SAH. After the application of lumbar drainage, the complications and mortality after aneurysm surgery was significantly decreased and correlated with the amount of hemorrhagic cerebrospinal fluid drainage.