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1.
Neurocomputing (Amst) ; 488: 457-469, 2022 Jun 01.
Article in English | MEDLINE | ID: mdl-35345875

ABSTRACT

Detecting COVID-19 in computed tomography (CT) or radiography images has been proposed as a supplement to the RT-PCR test. We compare slice-based (2D) and volume-based (3D) approaches to this problem and propose a deep learning ensemble, called IST-CovNet, combining the best 2D and 3D systems with novel preprocessing and attention modules and the use of a bidirectional Long Short-Term Memory model for combining slice-level decisions. The proposed ensemble obtains 90.80% accuracy and 0.95 AUC score overall on the newly collected IST-C dataset in detecting COVID-19 among normal controls and other types of lung pathologies; and 93.69% accuracy and 0.99 AUC score on the publicly available MosMedData dataset that consists of COVID-19 scans and normal controls only. The system also obtains state-of-art results (90.16% accuracy and 0.94 AUC) on the COVID-CT-MD dataset which is only used for testing. The system is deployed at Istanbul University Cerrahpasa School of Medicine where it is used to automatically screen CT scans of patients, while waiting for RT-PCR tests or radiologist evaluation.

2.
J Surg Oncol ; 123(8): 1757-1763, 2021 May.
Article in English | MEDLINE | ID: mdl-33684252

ABSTRACT

BACKGROUND: This study evaluates the achievability of CT volumetry of pancreatic cancer and its correlation with pTNM stage and survival. METHODS: Tumor volume was measured from contrast enhanced CT images of 58 patients who undergo curative resection for pancreatic cancer using the Segment Editor module implemented in 3D-Slicer-a free open source software platform. Receiver operating characteristic (ROC) analysis was used to evaluate correlation between Tvol and pTNM staging. RESULTS: The preoperative images of 58 pancreatic adenocarcinoma patients were included. The mean Tvol of pancreatic cancer is an increasing trend with T stage (The mean T1vol = 1.75 cm3 , the mean T2vol = 11.43 cm3 , the mean T3vol = 14.98 cm3 , the mean T4vol = 19.6 cm3 ). There were statistical differences between volumes (p = .000). On ROC analysis, the area under the ROC curve (Az) of Tvol to differentiate T1 stage from ≥T2 stage was 0.966 (p = .000). At a cut-off value of 3.050 cm3 , sensitivity of 92.3%, and specificity of 83.3% were achieved. Az value of Tvol to differentiate ≤T2 from ≥T3 stage was 0.750 (p = .010). At a cut-off value of 10.250 cm3 , sensitivity of 72.7% and specificity of 66% were achieved. In addition Az value of Tvol to differentiate ≤T3 from ≥T4 stage was 0.652 and was not significant (p = .380). At a cut-off value of 11.2 cm3 , sensitivity of 66.7% and specificity of 63.6% were achieved. CONCLUSION: CT volumetry in pancreatic cancer is feasible with excellent reproducibility. It is one of the prognostic factors affecting survival in operated patients with pancreatic cancer.


Subject(s)
Adenocarcinoma/diagnosis , Adenocarcinoma/mortality , Cone-Beam Computed Tomography , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/mortality , Adenocarcinoma/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Neoplasm Staging , Pancreatectomy , Pancreatic Neoplasms/surgery , Predictive Value of Tests , ROC Curve , Reproducibility of Results , Retrospective Studies , Survival Rate
3.
Int J Clin Pract ; 75(7): e14264, 2021 Jul.
Article in English | MEDLINE | ID: mdl-33891784

ABSTRACT

BACKGROUND: To investigate the relationship between ureteral wall thickness (UWT) and other variables of patients who underwent extracorporeal shock wave lithotripsy (SWL) in the primary treatment of the ureteral stone above the iliac crest level. MATERIAL AND METHODS: A total of 147 patients aged 18 years and older, who underwent SWL in our clinic between December 2016 and December 2019 for the treatment of ureteral stones above the iliac crest level and had non-contrast enhanced abdominal computed tomography scans before the procedure were included in the clinical study. The results were evaluated at 3 months after SWL. The absence of residual fragments was considered as stone-free status, and the existence of any size residual fragment was considered as treatment failure. RESULTS: In our study, the mean age of the patients was 42.4 ± 12.8 years, and the stone-free rate was 92.5%. The median transverse stone size was 7.5 mm (min 2.8-max 15), and the median UWT was 4.2 mm (1-8.7). In the multivariate analysis, UWT (P = .002) and multiple stone presence (P = .027) were found to be independent factors affecting stone-free status. In the receiver operating characteristic curve analysis, the optimal threshold value for UWT was determined as 5.25 mm. CONCLUSIONS: We found that UWT was the most important independent variable associated with increased failure in SWL treatment. The presence of multiple stones was another independent factor that increased the failure rates. Using SWL technology through experience accumulated with the mechanical hardware of the machine, we can select patients who are more suitable for this treatment and improve treatment outcomes.


Subject(s)
Lithotripsy , Ureteral Calculi , Adult , Humans , Ilium , Middle Aged , Retrospective Studies , Tomography, X-Ray Computed , Treatment Outcome , Ureteral Calculi/diagnostic imaging , Ureteral Calculi/therapy
4.
Arch Gynecol Obstet ; 301(5): 1257-1265, 2020 05.
Article in English | MEDLINE | ID: mdl-32215718

ABSTRACT

PURPOSE: To compare automated breast volumetric scanning (ABVS) with hand-held bilateral whole breast ultrasound (HHUS) prospectively in regards to patient workflow, woman preference, efficacy in lesion detection, and characterization. MATERIALS AND METHODS: Supplemental screening was performed with both ABVS and HHUS to 345 women with dense breasts and negative mammograms. Acquisition and evaluation times were recorded. Lesions were classified according to BIRADS US criteria and compared one to one. Women were recalled for a secondary HHUS examination if ABVS showed any additional lesions. Findings were compared based on biopsy results and/or 36-48 months of follow-up. RESULTS: Findings could be compared for 340 women. There were two carcinomas which were detected by both methods, with no interval cancers in the follow-up period. Recall rate was 46/340 (13.05%) for ABVS and 4/340 (1.18%) for HHUS. ABVS recalls decreased with experience. HHUS had more true negative (BIRADS 1-2) results, while ABVS had more false positive ones (p < 0.001). Positive predictive value was 4.17% for ABVS and 50% for HHUS. ABVS overdiagnosed shadowings (p < 0.01), distortions (p < 0.034), and irregular nodules (p < 0.001) in comparison to HHUS. At ABVS, 10.6% of women experienced severe pain. 59.7% stated that they would choose HHUS if they had the chance. CONCLUSION: ABVS is as good as HHUS in lesion detection. However, the recall rate is higher and positive predictive value is lower with ABVS, which could result in more follow-ups, and more anxiety for the women. More than 50% women stated they would prefer HHUS if they were given the chance.


Subject(s)
Breast Neoplasms/diagnostic imaging , Breast/diagnostic imaging , Image Interpretation, Computer-Assisted/methods , Mammography/methods , Pattern Recognition, Automated/methods , Ultrasonography, Mammary/methods , Adult , Aged , Biopsy , Breast/pathology , Breast Density , Breast Neoplasms/pathology , Female , Humans , Image Enhancement/methods , Male , Mammography/instrumentation , Middle Aged , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity , Ultrasonography, Mammary/instrumentation
5.
Surg Radiol Anat ; 38(5): 615-7, 2016 Jul.
Article in English | MEDLINE | ID: mdl-26459136

ABSTRACT

Vein of foramen caecum has been classically described as a vein that connects nasal mucosa to the superior sagittal sinus in classic anatomy textbooks. However, its existence is controversial in literature. Herein, we demonstrated computed tomography and contrast enhanced magnetic resonance imaging findings of a tubular vascular structure extending to nasal mucosa and superior sagittal sinus.


Subject(s)
Anatomic Variation , Frontal Bone/abnormalities , Frontal Bone/blood supply , Superior Sagittal Sinus/abnormalities , Adult , Chronic Pain/diagnostic imaging , Contrast Media , Female , Frontal Bone/diagnostic imaging , Headache/diagnostic imaging , Humans , Magnetic Resonance Imaging , Nasal Mucosa/blood supply , Superior Sagittal Sinus/diagnostic imaging , Tomography, X-Ray Computed , Young Adult
6.
Pol J Radiol ; 80: 89-92, 2015.
Article in English | MEDLINE | ID: mdl-25745523

ABSTRACT

BACKGROUND: Intrathoracic splenosis is a rare condition resulting from concomitant rupture of the spleen and left hemidiaphragm after a traumatic event involving the spleen and the diaphragma and is defined as autotransplantation of splenic tissue in thorax. CASE REPORT: The aim of this study was to present a case report of a combined intrathoracic and subcutaneous splenosis in a patient 19 years after penetrating trauma. She has left dorsal side pain and routine chest roentgenogram shows pleural nodular masses. The patient was referred to us for radiologic work up. CONCLUSIONS: The MRI scans revealed the intrathoracic and subcutan masses as mainly hypointense on T1-weighted images and hyperintense on T2-weighted images and significant restriction in diffusion-weighted images. Scintigraphy revealed abnormal hot spots in subcutaneous tissue and diaphragmatic pleura of the left hemithorax.

7.
Pol J Radiol ; 80: 36-9, 2015.
Article in English | MEDLINE | ID: mdl-25624958

ABSTRACT

BACKGROUND: Intravascular papillary endothelial hyperplasia (IPEH), also known as masson tumour, is a lesion composed of proliferating endothelial cells. CASE REPORT: In this article we explained clinical, histological and radiological features of IPEH involving the scalp, localized on the left side of the skull and in the periauricular region. CONCLUSIONS: Radiologically, intravascular papillary endothelial hyperplasia could be misdiagnosed as malignant or benign vascular tumour. On cross-sectional imaging it is useful demonstrating the extremely vascular component of IPEH. But IPEH has no specific radiologic features that we can use to differentiate from the aforementioned lesions. Due to that, histopathological examinations are needed to diagnose IPEH.

8.
Pol J Radiol ; 80: 360-3, 2015.
Article in English | MEDLINE | ID: mdl-26236418

ABSTRACT

BACKGROUND: Unilateral invasion of the internal jugular vein (IJV) after subtotal thyroidectomy caused by local recurrence of papillary thyroid carcinoma is extremely rare. We report a case of papillary thyroid carcinoma which invades IJV with hypervascular tumor thrombus. CASE REPORT: We report a case of a 52-year-old woman with a history of previous thyroid operation who presented with a 2-month history of a painless, growing, hard, solitary mass on the left side of the neck. Clinical examination revealed also ipsilateral cervical lymphadenopathy. Radiological examination showed a necrotic and cystic mass arising from the operated area extending and invading the left jugular vein wall with hypervascular tumor thrombus. Cytological examination of the mass confirmed a papillary thyroid carcinoma (PTC) and enlarged metastatic lymph nodes. Therefore, total thyroidectomy with left neck dissection and segmental resection of the left internal jugular vein were performed, and the tumor thrombus was cleared successfully. CONCLUSIONS: Invasion of IJV with hypervascular tumor thrombosis is an extremely rare condition in papillary thyroid carcinoma. Thrombosis of IJV is probably underdiagnosed. Early-stage diagnosis is important for long-term survival rates.

9.
Eur Radiol ; 24(2): 434-40, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24220753

ABSTRACT

OBJECTIVES: To measure the median nerve (MN) stiffness by quantitative shear wave elastography (SWE) at the carpal tunnel inlet and to determine whether SWE can be used in the diagnosis of carpal tunnel syndrome (CTS). METHODS: The study included 37 consecutive patients (60 wrists) with a definitive diagnosis of CTS and 18 healthy volunteers (36 wrists). The MN cross-sectional area (CSA) by ultrasound and stiffness by SWE were studied. The difference between CTS patients and controls, and the difference among subgroups based on electrodiagnostic tests were studied by the Student's t test. Interobserver variability and ROC analysis were performed. RESULTS: The MN stiffness was significantly higher in the CTS group (66.7 kPa) when compared to controls (32.0 kPa) (P < 0.001), and higher in the severe or extreme severity group (101.4 kPa) than the mild or moderate severity group (55.1 kPa) (P < 0.001). A 40.4-kPa cut-off value on SWE revealed sensitivity, specificity, PPV, NPV and accuracy of 93.3%, 88.9%, 93.3%, 88.9% and 91.7%, respectively. Interobserver agreement was excellent for SWE measurements. CONCLUSIONS: Median nerve stiffness at the carpal tunnel inlet is significantly higher in patients with carpal tunnel syndrome, for whom shear wave elastography appears to be a highly reproducible diagnostic technique. KEY POINTS: • Clinical examination is important for diagnosis of carpal tunnel syndrome • Shear wave elastography (SWE) offers new clinical opportunities within diagnostic ultrasound • SWE is highly reproducible in evaluation of median nerve stiffness • Median nerve stiffness is significantly increased in carpal tunnel syndrome • Elastography could become useful in diagnosis of carpal tunnel syndrome.


Subject(s)
Carpal Tunnel Syndrome/diagnostic imaging , Elasticity Imaging Techniques/methods , Median Nerve/physiopathology , Adult , Aged , Carpal Tunnel Syndrome/physiopathology , Elasticity , Female , Humans , Male , Median Nerve/diagnostic imaging , Middle Aged , ROC Curve , Reproducibility of Results
10.
J Pediatr Gastroenterol Nutr ; 58(6): 750-5, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24552673

ABSTRACT

BACKGROUND: Shear-wave elastography (SWE) is a novel noninvasive method that involves application of local mechanical compression on soft tissue using focused ultrasonography and acquiring strain images that show tissue response. In this study, our goal was to assess the performance of SWE in the staging of liver fibrosis in children with chronic liver disease. METHODS: The study involved measuring SWE values in the right lobe of the liver in a patient group of 76 children with chronic liver disease and a control group of 50 healthy subjects. In the patient group, the shear elastic modulus values were correlated with biopsy results according to the Brunt scoring system (F0: portal fibrosis, F1: perisinusoidal or portal/periportal fibrosis, F2: both perisinusoidal and portal/periportal fibrosis, F3: bridging fibrosis, and F4: cirrhosis). Performance of SWE in estimating liver fibrosis in children was determined based on a receiver-operating characteristics (ROC) analysis. RESULTS: Mean SWE values of the control group and F0 group were not statistically significantly different (P = 0.106). The mean SWE values of the F1, F2, F3, and F4 groups were higher than that of the control group (all P < 0.001). Based on kiloPascal measurement values, the area under the ROC curve was 95.2% (95% confidence interval [CI] 92.1-99.5), with a sensitivity for diagnosing liver fibrosis of 91.5%, a specificity of 94.0%, a positive predictive value of 93.1%, and a negative predictive value of 92.6%. Based on meter-per-second measurement values, the area under the ROC curve was 96.3% (95% CI 92.7-99.8), with a sensitivity for diagnosing liver fibrosis of 93.2%, a specificity of 94.0%, a positive predictive value of 93.2%, and a negative predictive value of 94.0%. Mean SWE values for patients with nonalcoholic steatohepatitis were higher than those in the remainder of the study group. CONCLUSIONS: Although liver fibrosis can be detected using SWE, differentiation of fibrosis stages could not be achieved. The presence of steatosis significantly increased the mean SWE values on elastography and so care should be taken when assessing children with nonalcoholic steatohepatitis.


Subject(s)
Elasticity Imaging Techniques/methods , Liver Cirrhosis/pathology , Liver/pathology , Severity of Illness Index , Adolescent , Biopsy , Case-Control Studies , Child , Child, Preschool , Chronic Disease , Female , Fibrosis , Humans , Infant , Liver Diseases/pathology , Male , Non-alcoholic Fatty Liver Disease/pathology , ROC Curve
11.
Ren Fail ; 36(8): 1278-82, 2014 Sep.
Article in English | MEDLINE | ID: mdl-25019642

ABSTRACT

PURPOSE: Urinary stones are common and can be diagnosed with computed tomography (CT) easily. In this study, we aimed to specify the opacity characteristics of various types of calcified foci that develop through the urinary system by using an image analysis program. With this method, we try to differentiate the calculi from the non-calculous opacities and also we aimed to present how to identify the characteristic features of renal and ureteral calcules. MATERIALS AND METHODS: We obtained the CT studies of the subjects (n = 48, mean age = 41 years) by using a dual source CT imaging system. We grouped the calculi detected in the dual-energy CT sections as renal (n = 40) or ureteric (n = 45) based on their locations. Other radio-opaque structures that were identified outside but within close proximity of the urinary tract were recorded as calculi "mimickers". We used ImageJ program for morphological analysis. All the acquired data were analyzed statistically. RESULTS: According to thorough morphological parameters, there were statistically significant differences in the angle and Feret angle values between calculi and mimickers (p < 0.001). Multivariate logistical regression analysis showed that Minor Axis and Feret angle parameters can be used to distinguish between ureteric (p = 0.003) and kidney (p = 0.001) stones. CONCLUSIONS: Computer-based morphologic parameters can be used simply to differentiate between calcular and noncalcular densities on CT and also between renal and ureteric stones.


Subject(s)
Kidney Calculi/diagnosis , Tomography, X-Ray Computed , Ureteral Calculi/diagnosis , Adult , Diagnosis, Computer-Assisted/methods , Diagnosis, Differential , Female , Humans , Male , Middle Aged
12.
Scott Med J ; 59(1): e9-13, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24448402

ABSTRACT

Intussusception is the most frequent complication of Peutz-Jeghers Syndrome (PJS), but usually seen in child age. It is a predictable, but infrequent complication in adults with PJS. However, there is no report about intussusception in pregnancy period secondary to Peutz-Jeghers (PJ) polyps in the literature. In this paper, we present a rare intussusception case in a pregnant woman with PJS, which was diagnosed with magnetic resonance imaging, and discuss this condition with a brief literature review.


Subject(s)
Intussusception/etiology , Peutz-Jeghers Syndrome/complications , Pregnancy Complications , Female , Humans , Intestine, Small , Intussusception/diagnosis , Pregnancy , Pregnancy Complications/diagnosis , Young Adult
13.
J Laparoendosc Adv Surg Tech A ; 34(9): 808-813, 2024 Sep.
Article in English | MEDLINE | ID: mdl-38629770

ABSTRACT

Introduction: To evaluate by using 3D renal volumetric assessment and compare renal parenchymal preservation between patient who underwent open partial nephrectomy (OPN) and robot assisted laparoscopic partial nephrectomy (RALPN). Methods: We retrospectively reviewed the records of the patients to evaluate the effect of OPN (23 patients) or RALPN (19 patients) partial nephrectomy on renal parenchymal preservation. The CT or MRI were examined using 3D-Slicer image processing software. The tumor volume and preoperative and postoperative non-tumor bearing parenchymal volumes were evaluated with the segmentation. The preoperative and postoperative parenchymal volumes, serum creatinine levels, and estimated glomerular filtration rates (eGFRs) were compared between the surgical techniques. Results: The data of 42 patients were included in the final analysis. The patient and tumor characteristics were similar between the two groups. Postoperative renal parenchymal volumetric changes were seen similar between groups. Although the serum creatinine levels and eGFRs did not change postoperatively in the RALPN group (P = .145 and P = .085, respectively), creatinine increased while eGFR decreased in the OPN group (P = .003 and P = .002, respectively). Conclusions: Our analysis showed that RALPN could be considered similar to OPN in terms of parenchymal volume preservation, but the rate of parenchymal volume preservation was not associated with the change in functional parameters. These results should be supported by further research.


Subject(s)
Imaging, Three-Dimensional , Kidney Neoplasms , Kidney , Laparoscopy , Nephrectomy , Robotic Surgical Procedures , Humans , Nephrectomy/methods , Female , Retrospective Studies , Male , Middle Aged , Robotic Surgical Procedures/methods , Kidney Neoplasms/surgery , Kidney Neoplasms/pathology , Laparoscopy/methods , Kidney/surgery , Kidney/diagnostic imaging , Aged , Tomography, X-Ray Computed , Glomerular Filtration Rate , Organ Sparing Treatments/methods , Magnetic Resonance Imaging/methods , Creatinine/blood
14.
Ther Adv Med Oncol ; 16: 17588359241247023, 2024.
Article in English | MEDLINE | ID: mdl-38645422

ABSTRACT

This paper presents a patient with a novel Ig-like-III domain fibroblast growth factor receptor (FGFR2) alteration (W290_P307>C) along with CDKN2A/B alterations and a cadherin 1 (CDH1) alteration. Initial responsiveness to pazopanib monotherapy was encouraging, yet progression occurred after 7.5 months. Following progression, the molecular tumor board recommended a combination therapy approach comprising pazopanib, crizotinib, and palbociclib to target all of the changed pathways at the same time. Pazopanib was chosen to specifically target the FGFR2 alteration, while crizotinib was selected due to its potential synthetic lethality with the CDH1 alteration. In addition, the CDK4/6 inhibitor palbociclib was administered to address the CDKN2A/B alterations. The patient exhibited a remarkable and sustained response to this innovative combination. This case not only underscores the potential of tyrosine kinase inhibitors, exemplified by pazopanib, as a viable alternative for patients without access to pan-FGFR inhibitors, but it also emphasizes their efficacy beyond commonly detected point mutations and rearrangements. Notably, the outstanding response to combination therapy, including crizotinib, in a patient with a CDH1 alteration, further substantiates the preclinical evidence of synthetic lethality between crizotinib and CDH1 alterations. To our knowledge, this represents the first clinical evidence demonstrating the efficacy of crizotinib in a patient with a CDH1 alteration. Through careful dosage adjustments and consideration of individualized genomic information, this case exemplifies the power of personalized medicine in achieving favorable treatment outcomes.

15.
Ulus Travma Acil Cerrahi Derg ; 30(10): 722-728, 2024 Oct.
Article in English | MEDLINE | ID: mdl-39382365

ABSTRACT

BACKGROUND: Acute appendicitis is a common cause of acute abdominal pain necessitating surgical intervention. While the traditional treatment has been urgent appendectomy, recent studies suggest that an antibiotics-first approach can be safe for uncomplicated cases. Classifying appendicitis into uncomplicated and complicated categories is crucial for guiding treatment decisions and predicting patient outcomes. This study aims to evaluate the distinct imaging findings associated with uncomplicated appendicitis and its complicated subtypes-phlegmonous, gangrenous, and perforated appendicitis-to aid in differential diagnosis. METHODS: This retrospective observational study was conducted from January 2014 to December 2023 and included 1,250 patients (492 women, 758 men) who underwent an appendectomy with available pathology results. After excluding 56 patients with normal pathology, 52 with non-appendicitis pathologies, and 48 with inaccessible computed tomography (CT) images, 1,094 patients were analyzed. CT images were evaluated for appendiceal diameter, wall thickness, cecal wall thickness, periappendiceal fat stranding, effusion, lymphadenopathy, intraluminal and free periappendiceal air, mucosal hyperenhancement, and the presence of appendicolith. RESULTS: The diameter of the appendix, along with the presence of periappendiceal air, effusion, and intraluminal appendicolith, were significantly higher in the perforated appendicitis group compared to other groups (p<0.05). Periappendiceal fat stranding, evaluated as a binary variable, did not show significant differences among the groups. Appendiceal wall thickness was higher in the perforated group and lower in the non-perforated gangrenous group compared to the uncomplicated group (p<0.05). No significant correlation was found for mucosal hyperenhancement between the appendicitis subgroups. Intraluminal air, though normal in a healthy appendix, was a specific predictor of complicated appendicitis when combined with other findings. CONCLUSION: This study provides a detailed analysis of distinct imaging findings associated with uncomplicated and complicated appendicitis. Key differentiators such as appendiceal diameter, periappendiceal air, effusion, and intraluminal appendicolith are crucial for accurate diagnosis. The findings highlight the importance of these parameters in distinguishing various types of appendicitis, offering valuable insights for clinical practice. Future prospective studies and advanced imaging techniques are needed to validate these findings and enhance the diagnosis and management of acute appendicitis and its complications.


Subject(s)
Appendectomy , Appendicitis , Tomography, X-Ray Computed , Humans , Appendicitis/diagnostic imaging , Appendicitis/surgery , Appendicitis/pathology , Female , Male , Retrospective Studies , Adult , Middle Aged , Diagnosis, Differential , Adolescent , Young Adult , Appendix/diagnostic imaging , Appendix/pathology , Appendix/surgery , Aged , Acute Disease
16.
Oral Oncol ; 154: 106859, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38781626

ABSTRACT

Cancer patients living with HIV (CPLWH) may experience increased mortality risk. Furthermore, they have been historically excluded from clinical trials due to safety concerns. Our patient with squamous cell carcinoma of the lower lip received radiotherapy and platinum-based chemotherapy but declined by multiple centers due to his accidental HIV status. Genomic profiling revealed CDKN2A/B, PBRM1, TP53, and TERT alterations corresponding to UV signature, and high tumor mutational burden with positive PD-L1 staining. Accordingly, we report a durable radiologic and molecular complete response upon nivolumab plus IVC and antiretroviral therapy (ART). We demonstrated the safety and efficacy of ICIs, and feasibility of managing adverse events caused by antitumor, antiviral, and integrative therapies.


Subject(s)
HIV Infections , Nivolumab , Squamous Cell Carcinoma of Head and Neck , Humans , Nivolumab/therapeutic use , Male , HIV Infections/drug therapy , HIV Infections/complications , Squamous Cell Carcinoma of Head and Neck/drug therapy , Squamous Cell Carcinoma of Head and Neck/therapy , Squamous Cell Carcinoma of Head and Neck/diagnostic imaging , Middle Aged , Head and Neck Neoplasms/drug therapy
17.
J Med Ultrason (2001) ; 40(4): 429-35, 2013 Oct.
Article in English | MEDLINE | ID: mdl-27277457

ABSTRACT

PURPOSE: Nipple retraction is difficult to diagnose radiologically and extremely worrisome for patients. It occurs most commonly due to pathologies such as previous mastitis or an infiltrative malignancy. With this in mind, the goal of this study was to differentiate benign from malignant lesions of nipple retraction, using the differential characteristics of retroareolar area stiffness, observed by means of the new technological modality of ultrasound elastography (USE). MATERIALS AND METHODS: Nineteen unilateral nipple retraction cases, including five cases of mammary ductal carcinoma posteriorly infiltrated the areola, two cases of Paget disease, and 12 cases of mastitis, were investigated. Imaging findings [gray-scale ultrasound (US) and USE analyses of the breasts' nipple-areolar complex], pathological evaluation, and the results of 4 years of follow-up treatment were obtained. The recorded images were evaluated by two different radiologists, and all data were analyzed statistically. RESULTS: Statistical analysis showed that there was a strong correlation between the two radiologists' evaluations. The US images were not diagnostic for either the malignant or benign conditions. The correlation between the diagnosis using US and the final diagnosis was calculated as 0.436 (p = 0.006). However, the USE images were more informative since the correlation ratio between the USE results and the final diagnosis was found to be 0.723 (p < 0.001). While the area under the concentration curve (AUC) values that were used for the diagnostic determination of the US results were inconclusive at 0.274 (p < 0.021), the AUC values for USE were significant, with a diagnostic value of 0.866 for all cases (p < 0.01). CONCLUSION: The USE modality, which is not commonly used in routine practice, has the potential to solve the problem of differentiation of nipple retraction etiologies in the near future.

18.
Aktuelle Urol ; 54(1): 30-36, 2023 02.
Article in English | MEDLINE | ID: mdl-36702134

ABSTRACT

OBJECTIVES: To compare the efficacy of in-vivo and in-vitro stone attenuation in the prediction of stone composition using non-contrast-enhanced abdominal computed tomography (NCCT). METHODS: This study included a total of 104 patients with renal stones who received percutaneous nephrolithotomy treatment for renal stones between December 2016 and December 2019 and underwent NCCT before the procedure. Preoperative (in-vivo) and postoperative (in-vitro) kidney stone attenuations were compared using the NCCT images of the patients. Renal stone fragments were analysed with the infrared spectrophotometer method. RESULTS: The mean age of the 104 patients was 49.5 (interquartile range: 37-61) years. According to the receiver operating characteristics analysis, the cut-off values for the prediction of uric acid stones were determined to be 556 HU for the in-vivo and 774 HU for the in-vitro attenuation measurement. Sensitivity and specificity were 100% and 96.6%, respectively, for the in-vivo and 90.9 and 91%, respectively, for the in-vitro images. The cut-off values for the prediction of calcium stones were determined to be 824 HU and 1065 HU for the in-vivo and in-vitro attenuation measurements, respectively. Sensitivity and specificity were 97.3 and 96% for the in-vivo and 96 and 96% for the in-vitro images. CONCLUSIONS: In-vivo stone attenuation measurement in NCCT was slightly superior to in-vitro measurement due to the reduction in the composition and size of the stone. Our findings show that NCCT in-vivo stone attenuation might differentiate uric acid and calcium stones from the other stone types.


Subject(s)
Calcium , Kidney Calculi , Humans , Adult , Middle Aged , Uric Acid , Tomography, X-Ray Computed/methods , Kidney Calculi/diagnostic imaging , Kidney Calculi/surgery , Sensitivity and Specificity
19.
Aktuelle Urol ; 54(1): 37-43, 2023 02.
Article in English | MEDLINE | ID: mdl-36473485

ABSTRACT

PURPOSE: To examine the parameters affecting the need for additional procedures in the primary ureteroscopy treatment in patients with ureteral stones above the iliac crest level. METHODS: Seventy-one patients were included in the study who were ≥ 18 years old and had undergone ureteroscopy (URS) for ureteral stones above the iliac crest level between 2018-2020 and had a non-contrast-enhanced abdominal computed tomography before the procedures were included in the study. Patients and stone characteristics were prospectively collected. The results were evaluated six weeks after URS. The absence of any residual fragment was thought to indicate stone-free status. The patients with failure were referred for the additional procedures. RESULTS: The median patient age was 51 years [interquartile range (IQR): 18-66]. The median transverse stone diameter was 9.5 mm (IQR: 7.1-11.4), and the median ureteral wall thickness (UWT) was 5.8 mm (IQR: 4.3-6.5). In the univariate analysis, UWT (p < 0.001), presence of multiple stones (p = 0.008), and stone length (p = 0.022) affected stone-free status. The multivariate analysis revealed UWT as the only independent factor affecting the need for additional procedures after URS (p = 0.028). In the receiver operating characteristic curve analysis, the best threshold value for UWT according to the outcomes was identified as 5.8 mm. CONCLUSION: Ureteral wall thickness was the only independent parameter determining the need for additional procedures and affecting the treatment outcomes after the URS procedure.


Subject(s)
Lithotripsy , Ureter , Ureteral Calculi , Humans , Middle Aged , Adolescent , Ureteroscopy/methods , Ilium , Lithotripsy/methods , Ureter/surgery , Ureteral Calculi/diagnostic imaging , Ureteral Calculi/surgery , Treatment Outcome , Retrospective Studies
20.
Acta Biomed ; 91(4): e2020136, 2021 01 19.
Article in English | MEDLINE | ID: mdl-33525256

ABSTRACT

COVID-19 is an infectious disease caused by the virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and declared a pandemic on March 11, 2020, by the world health organization. In Turkey, the first cases began to appear on March 11, 2020. After the cases in China, the appearance of ground glass with or without consolidation in the posterior and periphery of the bilateral lung is determined as the main finding of COVID-19. In this article, we wanted to share the tomography findings of eight patients who were diagnosed with COVID-19 in our emergency department and who had lung involvement.


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , Adult , Aged , COVID-19/complications , Cohort Studies , Emergency Service, Hospital , Humans , Male , Middle Aged , Tomography, X-Ray Computed , Turkey
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