Can computed tomography findings and radiomics analysis of mediastinal lymph nodes differentiate between sarcoidosis and lymphoma?

AIMS: To assess the ability of computed tomography (CT) findings and radiomics analysis to differentiate mediastinal lymphadenopathies as sarcoidosis versus lymphoma. MATERIALS AND METHODS: 94 patients with lymphoma and 97 patients with sarcoidosis, who had > 1cm mediastinal lymph node were included. Size, location of lymph nodes, and distribution of the largest lymph nodes in two groups were compared. A total of 636 lymphadenopathies in four different regions were segmented for radiomics. Lesion segmentation was semiautomatically performed with a dedicated commercial software package on chest CT images. 149 patients were grouped as a training cohort, while 42 patients who underwent CT in the oncology hospital were used for external validation. The least absolute shrinkage and selection operator (LASSO) analysis was used to perform feature selection. Using selected features, the classification performance of various data mining methods in separating groups of sarcoidosis and lymphoma was investigated. RESULTS: Distribution and size of lymphadenopathies were significantly different in sarcoidosis and lymphoma groups (<0.05). Radiomics and data mining methods showed excellent performance in differentiating lymph nodes of sarcoidosis and lymphoma according to both the largest lymphadenopathy and lymphadenopathies in four different mediastinal regions (AUC >0,95). CONCLUSIONS: Distribution and size of lymphadenopathies can help differential diagnosis in patients with sarcoidosis and lymphoma. CT radiomics analysis can discriminate the lymph nodes of sarcoidosis and lymphoma with great performance regardless of lymph node size and location and it can be used safely in the diagnosis of these diseases, which can sometimes be challenging to distinguish from each other.

Prognostic Utility of Hypokalemia in Cirrhotic Patients.

BACKGROUND AND AIM: We researched the relationships between serum potassium level and prognostic scores and complications of cirrhosis, and mortality. METHODS: This study was performed retrospectively in Turkish High Specialty Training and Research Hospital between 2009 and 2015. Patients who had missing patient files and electrolyte disorder for another reason, showed complications at the time of application and were using diuretics were excluded from the study. RESULTS: 218 patients were included in the study. During the follow-up period, 23.4% (n: 51) of the entire population passed away. Compared to the patients who survived, the patients who passed away had higher HCC and HES development rate, mean Child-Pugh and MELD score and lower mean blood potassium level. The stepwise multivariable Cox regression model which included significant independent predictors showed that ChildPugh score (HR: 1.29; p <0.001), MELD score (HR:1.13; p= 0.006), and potassium level (HR: 0.18; p< 0.001) were independent predictors of mortality. The cut off value for potassium level in predicting mortality was found to be ≤ 3.4 mmol/L with 80.4% sensitivity and 100% specificity. Compared to the patients with a potassium level > 3.4 mmol/L, the patients with a potassium level ≤ 3.4 mmol/L had higher mortality rate, HCC and HES development rate, mean Child-Pugh and mean MELD scores. CONCLUSION: Hypokalemia is an important prognostic factor in cirrhotic patients.

The effect of flurbiprofen oral spray and ibuprofen vs ibuprofen alone on postoperative tonsillectomy pain: An open, randomised, controlled trial.

OBJECTIVE: This prospective clinical study was carried out to evaluate the analgesic efficacy and safety of oral spray form of flurbiprofen in the treatment of postoperative pain in tonsillectomy patients. STUDY DESIGN: Open, randomised, controlled clinical study. SETTING: Tertiary care training and research hospital. PARTICIPANTS: One hundred (53 males, 47 females) with an age range of 18-53 years old (mean 27.4 ± 9.3 SD) undergoing tonsillectomy were enrolled in this prospective controlled study. MAIN OUTCOME MEASURES: Patients receiving oral ibuprofen and flurbiprofen as spray form were enrolled as study group (53), whereas patients receiving only oral ibuprofen were enrolled as control group (47) in postoperative period. Postoperative pain was evaluated through visual analogue scale on 12th hour, first, third and seventh days after surgery. RESULTS: The mean maximal pain score of patients who have received flurbiprofen spray and ibuprofen was 3.36 ± 1.93 SD that was statistically lower than the mean maximal pain score of patients who were medicated with only ibuprofen which was 4.06 ± 1.29 SD on postoperative seventh day (P = .013). CONCLUSION: This study revealed that addition of flurbiprofen spray to oral ibuprofen is effective in the management of postoperative pain in tonsillectomy patients with no notable complications.

Tp-e interval and Tp-e/QT ratio in patients with celiac disease.

OBJECTIVES: Celiac disease is a chronic immune-mediated disease of the small intestine. It has been known that dilated cardiomyopathy and ischemic coronary artery disease have become more frequent in patients with celiac disease. The aim of the study was to assess Tp-e interval and Tp-e/QT ratio in patients with celiac disease. MATERIAL AND METHODS: This study was conducted at a single center in collaboration with gastroenterology and cardiology clinics. Between January 2014 and June 2015, a total of 76 consecutive patients were enrolled (38 patients with celiac disease and 38 control subjects). Tp-e interval, Tp-e/QT and Tp-e/QTc ratio were measured from the 12-lead electrocardiogram. RESULTS: Tp-e interval (64.2±11.0 vs. 44.5±6.0; p<0.001), Tp-e/QT ratio (0.18±0.02 vs. 0.13±0.02; p<0.001) and Tp-e/QTc ratio (0.16±0.02 vs. 0.11±0.01; p<0.001) were significantly higher in patients with celiac disease than control subjects. There was a significant positive correlation between Tp-e/QTc ratio and disease duration in patients with celiac disease (r=0.480, p=0.003) and also there was a significant positive correlation between Tp-e/QTc ratio and erythrocyte sedimentation rate (r=0.434, p<0.001). CONCLUSIONS: Our study showed that Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were increased in patients with celiac disease. Whether these changes increase the risk of ventricular arrhythmia deserve further studies.

Diffuse nodular duodenitis in a woman presenting with dyspepsia and weight loss.

Duodenal nodularity is an uncommon endoscopic finding charac-trized by numerous visible mucosal nodules in the duodenum. It is important to consider giardiasis in patients with symptoms include abdominal pain, nausea, anorexia, diarrhea, vomiting, weight loss and abdominal distension. It is also important to remind giardiasis in patients with duodenal nodularity.

The effects of two different frequencies of whole-body vibration on knee extensors strength in healthy young volunteers: a randomized trial.

The aim of this study was to investigate the effects of two different frequencies of whole-body vibration (WBV) training on knee extensors muscle strength in healthy young volunteers. Twenty-two eligible healthy untrained young women aged 22-31 years were allocated randomly to the 30-Hz (n=11) and 50-Hz (n=11) groups. They participated in a supervised WBV training program that consisted of 24 sessions on a synchronous vertical vibration platform (peak-to-peak displacement: 2-4 mm; type of exercises: semi-squat, one-legged squat, and lunge positions on right leg; set numbers: 2-24) three times per week for 8 weeks. Isometric and dynamic strength of the knee extensors were measured prior to and at the end of the 8-week training. In the 30-Hz group, there was a significant increase in the maximal voluntary isometric contraction (p=0.039) and the concentric peak torque (p=0.018) of knee extensors and these changes were significant (p<0.05) compared with the 50-Hz group. In addition, the eccentric peak torque of knee extensors was increased significantly in both groups (p<0.05); however, there was no significant difference between the two groups (p=0.873). We concluded that 8 weeks WBV training in 30 Hz was more effective than 50 Hz to increase the isometric contraction and dynamic strength of knee extensors as measured using peak concentric torque and equally effective with 50 Hz in improving eccentric torque of knee extensors in healthy young untrained women.

Splenic abscess in ulcerative colitis under anti tumor necrosis factor treatment.

Splenic abscess are rare conditions. Since morbidity and mortality rates are high, immediate diagnosis should be required. Here we presented an ulcerative colitis patients who develops splenic abscess under anti tumor necrosis factor treatment.

Alpha lipoic acid attenuates inflammatory response during extracorporeal circulation.

AIM: Extracorporeal circulation (ECC) of blood during cardiopulmonary surgery has been shown to stimulate various proinflammatory molecules such as cytokines and chemokines. The biochemical oxidation/reduction pathways of α-lipoic acid suggest that it may have antioxidant properties. METHODS: In this study we aimed to evaluate only patients with coronary heart disease and those planned for coronary artery bypass graft operation. Blood samples were obtained from the patients before the operation (P1) and one (P2), four (P3), 24 (P4) and 48 hours (P5) after administration of α-lipoic acid (LA). The patients were divided into two groups, control and LA treatment group. Levels of interleukin- 6 (IL-6) and -8 (IL-8), complement 3 (C3) and 4 (C4), anti-streptolysin (ASO), C-reactive protein (CRP) and haptoglobin were assessed in the blood samples. RESULTS: Cytokine IL-6 and IL-8 levels were significantly higher after surgery. Compared with the control groups, LA significantly decreased IL-6 and IL-8 levels in a time-dependent manner. CRP levels did not show significant variation in the first three time periods. CRP levels were higher after surgery, especially in the later periods. These results demonstrate that CRP formation depends on cytokine release. C3 and C4 levels were significantly higher after surgery than in the pre-operative period. LA treatment decreased C3 and C4 levels. Therefore, LA administration may be useful for the treatment of diseases and processes where excessive cytokine release could cause oxidative damage. CONCLUSION: Our findings suggest a possible benefit of using LA during cardiac surgery to reduce cytokine levels.

Evaluation of pericardial sinuses and recesses with 2-, 4-, 16-, and 64-row multidetector CT.

PURPOSE: The aim of this study was to describe visualisation rate and appearance of all pericardial sinuses and recesses and to evaluate whether there is a significant difference between visualisation of these sinuses and recesses on 2-, 4-, 16- and 64-slice multidetector computed tomography (MDCT). MATERIALS AND METHODS: We retrospectively analysed 588 MDCT scans of the chest obtained with a protocol for pulmonary embolism. RESULTS: The visualisation rate of any pericardial recess was 85.2%. The rates on 2-, 4-, 16- and 64-slice MDCT were 74.7%, 90.6%, 90.3% and 88.7%, respectively. There was a statistically significant difference in visualisation rates of pericardial recesses between 2-slice MDCT and other MDCT systems (p<0.01). Age, and 4-, 16- and 64-slice MDCT versus 2-slice MDCT and the presence of pleural effusion appeared as significant predictors of the presence of any recess. CONCLUSIONS: Visualisation rates of pericardial recesses are higher with 4-, 16- and 64-slice MDCT than with 2-slice MDCT. Therefore, radiologists need to be familiar with the different appearances of pericardial recesses on MDCT to avoid misdiagnosis.

A dilemma: prophylaxis for pulmonary embolism after surgical or invasive interventions for hemodialysis.

AIM: This study was designed to investigate if it needs to do prophylaxis for pulmonary embolism in the patients treated with different kinds of dialysis or not, and if it is, to find a proper method for prophylaxis. METHODS: Ten numbers of patients with central venous catheters (CVC group), 13 numbers of patients with arteriovenous fistula (AVF group) were enrolled in this study. Eleven patients treated with peritoneal dialysis (PD group) were utilized as a control group. Clinical and laboratory examinations to exclude pulmonary embolism were carried out in both AVF and PD groups at the onset and after three months. Same examinations were performed in CVC group at the onset and after 3 weeks (mean: 21 days). Examinations to exclude pulmonary embolism consist of medical history, clinical examinations, d-dimer measures, chest x-ray, respiratory function tests, blood gas analyses, ventilation-perfusion scintigraphies. RESULTS: Neither clinical nor laboratory findings in any stages reflected any suspicion for pulmonary embolism. None of the patients in any groups was admitted with pulmonary embolism in any period of follow-up. There was not any statistically difference between the outcomes of all first examinations and of all second ones (P>0.005). Neither obvious nor subclinical pulmonary embolism was detected in any case. None of the patients had deep venous thrombosis in any stage of follow-up. CONCLUSIONS: Conventional techniques of haemodialysis do not lead to pulmonary embolism unless deep venous thrombosis due to any intervention occurs in the patients. Thus, prophylactic anticoagulant usage to prevent pulmonary embolism is not necessary in haemodialysis patients. To shorten the length of stay of central venous catheters is the most important factors for pulmonary embolism prophylaxis in haemodialysis patients.

Early postoperative candida colonization in alimentary canal in patients undergoing open heart surgery.

AIM: To examine the frequency and factors predisposing to candidiasis in the digestive tract in the early postoperative period after open heart surgery. METHODS: One hundred patients undergoing open heart surgery were enrolled in this study. Patients were divided into 2 groups in regard to Candida spp. colonization. Group A means increased Candida spp. colonization after open heart surgery (31/100). Group B indicates unchanged Candida spp. colonization after open heart surgery (69/100). Samples were obtained from both oral and anal mucosa in 3 different periods of operation: 1) preoperatively (stage 1), 2) at the end of the first hour in the intensive care unit (stage 2), 3) 24 hours after operation (stage 3). Findings were compared with both preoperative and intraoperative parameters. For fungal isolation Sabourauds dextrose agar and blood agar were used. RESULTS: In Group A (31), there was a significant relationship between the samples in stage 1 and 2 (p=0.031), and also a significance between stage 1 and 3 (p=0.048). Comparison between Candida positive and negative groups (Group A and B) did not reflect any statistical significance (p>0.05). CONCLUSIONS: Candida colonization in the alimentary canal in the early postoperative period after open heart surgery is due to individual preoperative features. However, early postoperative Candida colonization in the digestive tract is not a risk factor for sepsis unless the patient has an additional risk factor leading to prolongation of length of stay in the intensive care unit.

A case of bronchogenic carcinoma and concomitant Swyer-James syndrome.

A 46-yr-old male patient with the rare concomitance of Swyer-James syndrome in the left lung and small cell lung carcinoma in the right is presented in the light of pertinent literature.

Corneal iron ring after hyperopic photorefractive keratectomy.

PURPOSE: To report the incidence and course of corneal iron deposition after hyperopic photorefractive keratectomy (PRK). SETTING: Gazi University, Medical School, Department of Ophthalmology, Ankara, Turkey. METHODS: Between January 1995 and December 1997, 62 eyes had PRK to correct hyperopia. RESULTS: Nine eyes developed corneal iron ring 5 to 8 months (mean 6.25 months +/- 1.3 [SD]) after PRK for hyperopia. The rings persisted during the mean follow-up of 19 +/- 11.09 months. CONCLUSION: The ring-shaped iron deposition after PRK for hyperopia must be differentiated from the Fleischer ring. Our results suggest that the slitlamp findings of peripheral corneal iron deposition in hyperopic PRK patients correlate with achieved correction.