Regression of a melanoma brain metastasis that had appeared after immune checkpoint inhibitor discontinuation: a hypothesis-generating case.

We present the case of a 50-year-old woman previously treated with nivolumab-ipilimumab combination therapy for a metastatic melanoma. Despite premature discontinuation of these immune checkpoint inhibitors (ICIs) after 2 cycles due to severe immune-related hepatitis, the patient achieved a complete response. Nine months later, brain magnetic resonance imaging (MRI) showed progression of a single cerebral lesion, and the patient was referred for stereotactic radiosurgery. Unexpectedly, the brain MRI acquired one month later as part of radiosurgery planning showed a spontaneous regression of this lesion, allowing for radiosurgery cancellation. Follow-up imaging showed a sustained response, although the patient did not receive any other oncological treatment. We discuss here the potential immune mechanisms involved in this unusual course and the importance of better understanding the behaviour of tumours in the era of ICIs.

Ultrasonographic evaluation of abdominal wall fat index, carotid intima-media thickness and plaque score in obstructive sleep apnea syndrome.

AIMS: Obstructive sleep apnea syndrome (OSAS) is strongly related with increased risk of cardiovascular diseases andvisceral obesity. Abdominal wall fat index (AFI) is an indicator of visceral fat accumulation determined by ultrasonography(US). Carotid intima-media thickness (C-IMT) and carotid plaque score (C-PS) are the indicators of cardiovascular risk. Theaim of this study was to investigate the relation between OSAS and AFI, C-IMT or C-PS. MATERIALS AND METHODS: One-hundred and four subjects (31 females, 73 males) between 23-73year-old, candidate for polysomnography (PSG) with suspect of OSAS and without other atherosclerotic risk factor, were evaluated by US. AFI, C-IMTmean and C-PS values were determined and the subjects were grouped according to their apnea-hypopnea index (AHI) values as follows: no OSAS (<5), mild OSAS (5-15), moderate OSAS (15-30) and severe OSAS (>30). RESULTS: There was a statistically significant correlation between AFI and AHI (p=0.019). The C-IMTmean values of subjects with OSAS (AHI >5) were significantly higher than those without OSAS (AHI <5) (p=0.035). C-PS was not correlated with AHI (p=0.345) and also there was not a statistically significant difference between OSAS groups in terms of C-PS (p=0.775). CONCLUSIONS: This study revealed that AFI correlates with AHI and C-IMT increases in OSAS. The two parameters could be used as indicators of risk of metabolic disorders and atheroscleroticdiseases in subjects with sleep apnea in the future.

Evaluation of subclinical atherosclerosis in migraine patients by ultrasound radiofrequency data technology: preliminary results.

OBJECTIVES: Migraine is a headache disorder affecting approximately 12% of the population, predominantly female individuals. Migraine has been associated with vascular events such as stroke and cardiovascular disease. The close connection between these vascular disorders and atherosclerosis is well known. Carotid artery intima-media thickness (CAIMT) is a marker for detection of subclinical atherosclerosis. The present study is an analysis of the presence of subclinical atherosclerosis in migraine patients. METHODS: CAIMT was evaluated in 25 female migraine patients and 27 female controls using innovative ultrasound (US) radiofrequency (RF) data technology. Mann-Whitney U test was used to compare measurements in patient and control groups. RESULTS: There was a statistically significant difference between mean CAIMT of migraine patients and control group (p<0.005): mean CAIMT was 701±114 µm in migraine patients and 400±64 µm in control group. CONCLUSION: Migraine patients are more prone to atherosclerosis compared to healthy individuals. CAIMT measurement with sonography can be utilized in follow-up to detect subclinical atherosclerosis.

Evaluation of Clinical Alvarado Scoring System and CT Criteria in the Diagnosis of Acute Appendicitis.

Aim. The aim was to evaluate the clinical Alvarado scoring system and computed tomography (CT) criteria for the diagnosis of acute appendicitis. Material and Methods. 117 patients with acute abdominal pain who underwent abdominal CT were enrolled in this retrospective study. Patient demographics, clinical Alvarado scoring, CT images, and pathologic results of the patients were evaluated. Results. 39 of the 53 patients who were operated on had pathologically proven acute appendicitis. CT criteria of appendiceal diameter, presence of periappendiceal inflammation, fluid, appendicolith, and white blood cell (WBC) count were significantly correlated with the inflammation of the appendix. The best cut-off value for appendiceal diameter was 6.5 mm. The correlation between appendiceal diameter and WBC count was 80% (P = 0.01 < 0.05). The correlation between appendiceal diameter and Alvarado score was 78.7% (P = 0.01 < 0.05). Conclusion. Presence of CT criteria of appendiceal diameter above 6.5 mm, periappendiceal inflammation, fluid, and appendicolith should prompt the diagnosis of acute appendicitis. Since patients with acute appendicitis may not always show the typical signs and symptoms, CT is a helpful imaging modality for patients with relatively low Alvarado score and leukocytosis and when physical examination is confusing.

Percutaneous thrombin injection treatment of a femoral artery pseudoaneurysm with simultaneous arterial balloon occlusion: Case report and review of the literature.

Iatrogenic femoral artery pseudoaneurysm at the level of the hip joint in a 52-year-old patient was treated by ultrasound-guided percutaneous thrombin injection, while a balloon was inflated at the neck of the pseudoaneurysm under fluoroscopy, to prevent thrombin leakage to the arterial system.

The contribution of vacuum-assisted modified Menghini type needle to diagnosis of US-guided fine needle aspiration biopsy of the thyroid.

PURPOSE: We aimed to determine the contribution of vacuum-assisted modified Menghini type needle to diagnosis of ultrasound-guided fine needle aspiration biopsy (FNAB) of the thyroid evaluated by a pathologist at the bedside. METHODS: A total of 147 thyroid nodules in 138 patients (122 women, 16 men) were included in this prospective study. Sonographic features of nodules, number of aspirations, pain and pain severity during the process, hemorrhage, and presence of sample obtained for cell block analysis were recorded and analyzed with the results of aspiration biopsy. RESULTS: Using the 21G modified Menghini type needle, a diagnosis could not be reached in 14.3% of nodules. Adequate samples for cell block analysis were obtained in 47 nodules (32%), 17 of which contributed to the diagnosis. While the difference between diagnostic cytopathology results and the contribution of the cell block were statistically significant, obtainability of cell block samples was not significantly correlated with the number of aspirations or the presence of a cystic component in the nodule. CONCLUSION: FNAB with 21G vacuum-assisted modified Menghini type needle is a safe procedure with very low complication rates. In addition to the cytologic smear samples, microtissue fragments obtained with this method help pathologists in the diagnosis of thyroid nodules.

[The effect of clinical, laboratory and radiologic results on treatment decision and surgical results in patients admitted to the emergency department with blunt abdominal trauma due to traffic accident]. / Acil servise trafik kazasina bagli künt abdominal travma ile basvuran hastalarda klinik degerlendirme, laboratuvar parametreleri ve radyolojik sonuçlarin tedavi kararina ve cerrahi sonuçlarina etkisi.

BACKGROUND: The purpose of this study was to evaluate the effect of clinical, laboratory and radiological results on treatment decision and surgical results in patients with blunt abdominal trauma, who were admitted to the emergency department due to traffic accident. METHODS: Two hundred and twenty-two patients with blunt abdominal trauma were included into this retrospective study. Pearson chi square, Mann-Whitney U test and logistic regression methods were used for statistical analysis. RESULTS: All patients were analyzed by complete blood count and biochemistry and abdominal sonography. Eighty-two patients were also evaluated by CT. Twenty-three patients underwent surgery. Positive findings on physical examination, sonography and CT, increased white blood cell count and liver function tests, decreased hemoglobin were associated with the need for surgery. DISCUSSION: For the surgical evaluation of patients with blunt abdominal trauma, a reliable physical examination is not possible when the patients have concomitant injuries causing disturbing pain, or when the patients are unconscious. Laboratory tests should be interpreted with the clinical and radiologic analysis. Radiologic procedures play an important role in the management of patients with blunt abdominal trauma, especially for intubated patients.

The role of salivary gland elastosonography in Sjögren's syndrome: preliminary results.

AIM: There is a need for a reliable, noninvasive radiological method for the assessment of salivary gland changes in Sjögren's syndrome (SS). The aim of this study was to evaluate the role of elastosonography as a noninvasive, sonographic modality evaluating tissue stiffness for salivary gland involvement in SS. METHOD: We examined the stiffness in parotid and submandibular glands of 23 patients diagnosed with SS and 20 healthy volunteers. Elasticity scores of the salivary glands were classified into four groups according to the degree of the elasticity of the glands. RESULTS: The elasticity scores of the parotid and submandibular glands did not show a statistically significant difference between the patients with SS and the healthy volunteers. On the other hand, there was a significant relationship between the duration of the symptoms and the elasticity score of the parotid glands and left submandibular glands (P < 0.05). Patients with higher duration of symptoms had higher elasticity scores. CONCLUSION: The results might suggest that with the progression of the SS, the elasticity scores of the parotid glands increase gradually, indicating that ultrasonic elastosonography has the potential to demonstrate the progression of the disease. The utility of elastosonography in the follow-up of SS needs to be evaluated with larger studies.

Appropriateness of selection criteria for CT examinations performed at an emergency department.

In the diagnosis of traumatic and nontraumatic emergencies, computed tomography (CT) is the most frequently performed procedure. The aims of this study were to find out whether CT report results can be used as a reliable tool for the diagnosis and management of patients at an emergency department and to evaluate the appropriateness of the selection criteria for CT examinations. For this reason, we analysed the emergency CT procedures according to the diagnostic hypothesis written on CT request forms, the results of the CT reports and the final diagnosis of the patients. One thousand consecutive CT procedures in the emergency department of a research hospital were retrospectively analysed. When the CT reports and the final diagnosis were evaluated, the sensitivity and specifity of the CT were found to be 0.81 and 0.85. According to the analysis of the CT reports, 55.8 % of all the patients were reported to be normal. When the patient files were examined for the final diagnosis of the patients, 55.7 % of the patients did not receive a final diagnosis related to the diagnostic hypothesis. The lowest correlation was found between the diagnostic hypothesis, the CT reports and the final diagnosis of the patients who underwent cranial CT procedure for trauma. The results of the CT reports can be used as a reliable parameter for the diagnosis and management of the patients at emergency departments. On the other hand, a high negative rate of CT reports was noted especially for the cranial CT examinations. CT selection criteria for the head trauma patients should be reconsidered. Since CT is a procedure involving ionising radiation, it is important that it is performed with the correct indications and the relevant clinical information is specified on the CT request forms.

B-mode and elastosonographic evaluation to determine the reference elastosonography values for cervical lymph nodes.

Background. It is crucial to differentiate between reactive and malignant lymphadenopathies. Elastosonography measures the elasticity of the tissue. Having a reference value for benign lymph nodes (LNs) is important in interpretation. The purpose of this study is to determine the reference elastosonography values of cervical LNs. Methods. 97 LNs were evaluated by B-mode and elastosonography. Depth, length, width, length to width ratio, hilar-cortical thickness, strain ratio, and elasticity scores were measured. Results. In 18.6% of the cervical LNs cortical thickness was less than the hilar thickness (group A) and in 81.4% it was equal or more (group B). 69.1% of LNs showed strain ratio (SR) less than 3 (group 1) and 30.9% equal to or more than 3 (group 2). 33% of LNs displayed elasticity score (ES) 1; 30.9% ES 2; 22.7% ES 3, and 13.4% ES 4. There was a significant correlation between thickness ratios and elasticity scores (P: 0.011). A significant correlation was also demonstrated between SR groups and elasticity scores. Conclusion. A simple, reproducible, noninvasive imaging technique for diagnosis of malignant LNs is necessary. Elastosonography can aid in the differentiation of benign versus malignant cervical LNs, thus help reduce the number of unnecessary biopsies for benign processes.

High-resolution complementary spatial modulation of magnetization (CSPAMM) rat heart tagging on a 1.5 Tesla Clinical Magnetic Resonance System: a preliminary feasibility study.

The purpose of this study was to assess the feasibility of cardiac magnetic resonance (MR) tagging in rats on a standard clinical 1.5T MR system. Small animal models have been largely used as an experimental model in cardiovascular disease studies but mainly on high field systems (>4T) dedicated to research. Given the larger availability of routine clinical MR systems in centers with active cardiac research programs, it is of great interest to perform small animal imaging on whole-body MR systems of moderate field strength. The feasibility study was performed on 7 rats within 6 to 8 hours after myocardial infarction and 3 normal control rats. Myocardial strain was measured successfully in normal rats using the harmonic phase (ie, HARP) method, and a transmural gradient was demonstrated. In a rat model of acute occlusion/reperfusion, the myocardial circumferential strains were decreased, but the transmural strain gradient was preserved. This study demonstrated the feasibility of cardiac MR tagging in rats with a subendocardial resolution using a clinical 1.5T system.