Investigation of alterations in retrobulbar hemodynamics and their correlation with choroidal thickness after strabismus surgery.

BACKGROUND: To evaluate the changes in retrobulbar circulation after strabismus surgery and to assess the relationship of these changes with choroidal thickness (CT). METHODS: This prospective study included 26 eyes of 26 patients who underwent strabismus surgery and 15 eyes of 15 healthy individuals as control group. The patients who had single horizontal muscle surgery were included in Group 1 (n = 14); and those who had surgery on both horizontal muscles were included in Group 2 (n = 12). Peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) of ophthalmic artery (OA), posterior ciliary artery (PCA), and central retinal artery (CRA) were measured using Color Doppler Ultrasonography. Subfoveal CT was measured via Optical Coherence Tomography. All measurements were obtained preoperatively, at 1st week and 1st month after surgery. RESULTS: There were no differences regarding preoperative blood flow velocity parameters among the groups. OA RI increased significantly at 1st week and 1st month after surgery in Group 1 and 2 (P = 0.029 and P = 0.045, respectively). There was a significant increase in PCA PSV at 1st week in Group 1 (P = 0.002). There was no difference between the mean preoperative and postoperative CT among the 3 groups. A negative correlation between the percentage changes of CT and CRA EDV was found in Group 2 (P = 0.011). CONCLUSION: Single and double horizontal rectus muscle surgery have a measurable effect on retrobulbar hemodynamics but these changes do not correlate with CT.

Long Term Radiological and Clinical Outcome of Symptomatic Lumbar Intraspinal Synovial Cyst: A Retrospective 4-Year Study.

AIM: To examine the prevalence of symptomatic lumbar synovial facet cysts in lumbar spinal magnetic resonance imaging (MRI) of patients who admitted to neurosurgery clinic, retrospectively. Also, we aimed to report the clinic and radiologic outcome of patients with symptomatic spinal synovial cyst, who undergo conservative treatment. MATERIAL AND METHODS: One thousand two hundred forty-three patients who admitted to Ordu University Neurosurgery outpatient clinic between 2015-2019 and underwent lumbosacral MRI and lumbosacral computed tomography examinations were reviewed retrospectively. The disappearance of cysts during radiologic follow up was accepted as spontaneous complete resolution, besides reduction in cyst dimensions and/or contrast enhancement were considered as radiologic regression. Decrease in radiculopathy, back pain and neurologic deficit complaints were also considered as clinical improvement. RESULTS: Thirteen patients (8 men, 5 women) with lumbar synovial cysts who admitted to the neurosurgery outpatient clinic with low back and radicular pain complaints were included in the study. Nine patients (69.2%) had clinical and radiological improvement, 1 female patient (7.7%) was operated due to the leg pain, progressive motor deficit and lumbar disc hernia. Radiological spontaneous complete resolution was detected in 3 patients (23.1%). Spontaneous complete resolution period was determined between 3 months to 24 months. CONCLUSION: The symptomatic lumbosacral synovial cyst treatment algorithm has not been fully demonstrated. However, as in our series, spontaneous complete resolution of cysts and effectiveness of conservative treatment in symptomatic patients should not to be underestimated and immediate invasive procedures should be postponed.

White Blood Count Can Be a Practical Guide for the Differential Diagnosis of Breast Abscess and Idiopathic Granulomatous Mastitis.

Introduction and aim Idiopathic granulomatous mastitis (IGM) is an inflammatory disease of the breast and has the same symptoms and radiologic imaging as breast abscess (BA). The aim of this study is to evaluate the use of inflammatory markers as white blood count (WBC), C-reactive protein (CRP), and neutrophil to lymphocyte ratio (NLR) as a potentially useful tool for the differential diagnosis of BA and IGM. Methods In this retrospective study, we analyzed 31 patients with IGM and 47 patients with BA between January 2013 and April 2020. Age, symptoms, symptomatic breast side, microbiological culture, complete blood count, and C-reactive protein (CRP) values of patients were analyzed. Receiver operating characteristic (ROC) curve analysis was used to define the optimal cut-off for WBC, CRP, and NLR. Results WBC was significantly higher in the BA group compared to the IGM group (11.45 vs. 9.78; p=0.042), but no difference was found for CRP and NLR between these groups (p=0.146, p=0.081, respectively). In ROC analysis results in BA group, cut-off values, the best sensitivity and specificity for WBC, CRP, and NLR were 8.46 × 103/µL (81%-70%), 1.5 mg/dl (77-76%), and 2.93 (70-82%), respectively. For IGM group, cut-off values, the best sensitivity and specificity for WBC, CRP and NLR were 8.49 × 103/µL (74-70%), 1.5 mg/dl (61-76%) and 2.29 (64-72%), respectively. Conclusion This study showed that CRP and NLR cannot be used as a useful tool for differential diagnosis of IGM; furthermore, WBC is a parameter that can act as a practical guide for the differential diagnosis of BA and IGM.

The impact of intravitreal dexamethasone implant (Ozurdex®) on retrobulbar hemodynamics in patients with diabetic macular edema and retinal vein occlusions.

Objective: To evaluate the effect of single intravitreal dexamethasone implant (Ozurdex®) on ocular blood flow velocities in patients with diabetic macular oedema (DME) and retinal vein occlusions (RVO). Methods: This prospective non-randomized interventional study included injected and fellow eyes of 12 patients with DME and of 16 patients with RVO treated with intravitreal Ozurdex®. Colour Doppler Ultrasonography (CDU) measures of the central retinal artery (CRA), posterior ciliary artery (PCA), ophthalmic artery (OA) those are peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) were performed in both injected and uninjected eyes before injection, at one week, one month after injection, and prior to re-injection. Results: Inter-eye comparison of all the measured CDU data (baseline, first week, first month, reinjection) showed no statistically significant difference in both DME and RVO group. PSV and EDV values of the CRA, OA, and PCA showed a decreasing trend in the first week and first-month visits and then increased at reinjection time. RI and PI measures of the CRA, OA, and PCA measures showed minimal alterations in the follow-up. But all these differences were not statistically significant. Significant visual gain and anatomic recovery were obtained by the intravitreal dex-implant both in the DME and RVO group. Conclusions: Single intravitreal dex-implant did not alter ocular blood flow in the treatment of macular oedema due to RVO and diabetes.

Effects of nodule characteristics on sampling number and duration of thyroid fine-needle aspiration biopsy: size does not matter, but cystic degeneration ratio does.

Background Ultrasound-guided fine needle aspiration biopsy (FNAB) of thyroid nodules, though the most accurate method to rule out malignancy, still has an inherent risk of yielding non-diagnostic specimens despite immediate assessment of specimen adequacy by an on-site cytopathologist. Purpose To evaluate the effects of nodule volume and extent of cystic degeneration on total biopsy time and number of aspirations required for obtaining an adequate specimen. Material and Methods A total of 510 patients underwent FNAB by a single radiologist accompanied by a cytopathologist who immediately assessed each sample for specimen adequacy. All sampled nodules were single and had one maximum diameter > 10 mm. Nodule volumes and cystic degeneration ratios were calculated prior to the intervention. Aspirations were repeated until the cytological material was deemed adequate by the cytopathologist; the number of aspirations and total biopsy time were then recorded. Results Nodule volumes did not have significant effect on neither number of aspirations necessary for achieving specimen adequacy ( P > 0.05) nor total biopsy time (r = -0.148 with P = 0.001). Predominantly cystic nodules, compared to predominantly solid nodules, required more sampling per nodule (4.58 ± 1.11 vs. 3.44 ± 1.19 aspirations, P = 0.001) and longer total biopsy time (16.40 ± 6.19 vs. 11.15 ± 6.18 min, P = 0.001). Conclusion Predominantly cystic nodules require allocation of more time for biopsy. To ensure specimen adequacy when immediate specimen evaluation by an on-site cytopathologist is not possible, four samples from predominantly solid nodules and five passes through predominantly cystic nodules are required.

Outcomes of unconventional utilization of BI-RADS category 3 assessment at opportunistic screening.

Background An important difficulty regarding the Breast Imaging Reporting and Data System (BI-RADS) category 3 assessment is the need for extensive diagnostic workup and an additional 6-month follow-up study. Purpose To evaluate the feasibility of the BI-RADS category 3 assessments at opportunistic screening. Material and Methods Mammography charts of 9062 screening patients in a major teaching hospital situated in an urban setting of a developing country were evaluated retrospectively (1997-2010). BI-RADS category 3 patients, called for a 6-month follow-up, which comprised a single-view spot or magnification mammogram. The length of follow-up period, compliance to periodic mammographic surveillance, cancer detection rate, and negative predictive values of category 3 assessments were calculated. Results Of the screened population, 9.2% were assigned BI-RADS category 3, and 31.2% of these cases were lost to follow-up. The mean follow-up period for 606 patients was 36.9 months. The negative predictive values for 6-month, 12-month, and final control studies were 90.9%, 87.5%, and 100%, respectively. Patient compliance for 6 months, 12 months, and any control evaluations beyond 12 months was low (50.0%, 29.8%, and 47.5%, respectively). Cancer detection rate was 0.8%. Conclusion Results of the study supports the feasibility of the BI-RADS category 3 assessments at opportunistic screening without any additional diagnostic workup. The practice of category 3 assessment following screening mammograms may be a more cost-effective method for developing countries with high recall rates and low resources in eliminating the maximum risk with minimum cost within the limits of available resources.

Use of a Volume Navigation Technique for Combining Real-Time Ultrasound and Contrast-Enhanced MRI: Accuracy and Feasibility of a Novel Technique for Locating Breast Lesions.

OBJECTIVE: The objective of this study was to evaluate the accuracy of the volume navigation technique for combining real-time ultrasound and contrast-enhanced MRI (CE-MRI) of breast lesions. SUBJECTS AND METHODS: Thirty-eight women with single breast lesions underwent 3-T MRI. A 3.5-minute CE-MRI sequence was used, as was a flexible body coil. Patients underwent imaging in the supine position, with three markers placed on their breasts. Real-time sonographic images were coregistered to the preloaded breast CE-MRI volume by coupling skin markers, with the use of an electromagnetic transmitter positioned next to the subjects. The transmitter detected the spatial positions of the two electromagnetic sensors mounted on the transducer bracket. After this fusion process in 3D space was completed, divergences in the location of the center of each lesion on CE-MRI and ultrasound images were analyzed. RESULTS: The mean lesion size was 17.4 mm on ultrasound and 17.9 mm on MRI, whereas the mean (± SD) misalignment of the lesion centers on CE-MRI and ultrasound was 3.9 ± 2.5 mm on the x-axis (mediolateral view), 3.6 ± 2.7 mm on the y-axis (anteroposterior view), and 4.3 ± 2.6 mm on the z-axis (craniocaudal view). No lesion had a misalignment greater than 10 mm on any of three axes. The accuracy of volume navigation was independent of patient age and the lesion size, location, and histopathologic findings (p > 0.05). Intermediate lesions, which had a depth of center of 11-20 mm on ultrasound had a mean misalignment of 2.6 ± 1.9 mm, compared with 5.5 ± 2.2 mm for deep lesions, which had a depth of center greater than 20 mm (p = 0.049). CONCLUSION: The volume navigation technique is an accurate method for coregistration of CE-MRI and sonographic images, enabling lesion localization within a limited volume.