Predicting difficult airway in morbidly obese patients using ultrasound.

Background/aim: Difficult mask ventilation and difficult intubation are more common in obese patients. Ultrasound is a reliable and noninvasive method for evaluating the airway. The aim of this study was to investigate the contribution and availability of anterior neck soft tissue (ANS) thickness at different levels, tongue volume (TV), hyomental distance (HMD), the ratio of preepiglottic distance to distance between the epiglottis and the midpoint of vocal cords (PE/E-VC) measured by ultrasonography in predicting difficult airway in morbidly obese patients. Materials and methods: Between March 2020 and November 2020, patients aged ≥18 years with a body mass index (BMI) of ≥40 kg/m2 who underwent elective surgery under general anesthesia were included in this prospective study at Firat University Hospital. During the preoperative evaluation of patients, ultrasound was used to measure and record TV, ANS thickness at different levels, HMD, and ratio of PE/E-VC. Patients with difficult intubation were identified using the Cormack-Lehane classification system. Patients whohad difficulties with balloon mask ventilation were recorded. Subsequently, the parameters of patients with easy and difficult intubation were compared. In addition, the parameters of patients with easy and difficult mask ventilation were also compared. Results: The preepiglottic ANS thickness at the level of the thyrohyoid membrane and the PE/E-VC value in obese patients with difficult intubation were significantly greater than in obese patients with easy intubation (p < 0.001). In addition, TV (p < 0.001), preepiglottic ANS thickness at the thyrohyoid membrane level (p < 0.001), ANS thickness at the thyroid isthmus level (p = 0.002), ANS-suprasternal notch thickness (p = 0.004), and PE/E-VC (p = 0.005) values were significantly greater in obese patients with difficult mask ventilation. Conclusion: Ultrasound may be a useful tool for predicting difficult airway and difficult mask ventilation. For this purpose, ANS thickness at different levels, PE/E-VC, and TV values measured by ultrasound can be used.

Evaluation of abdominal computed tomography findings in patients with COVID-19: a multicenter study

PURPOSE: To evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atherosclerosis score in the abdominal aorta. METHODS: This study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded. RESULTS: Ischemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-abdominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infiltration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 ± 13 vs. 10.4 ± 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations. CONCLUSION: Abdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19.

Median arcuate ligament syndrome noticed during pancreaticoduodenectomy.

Median arcuate ligament syndrome (MALS) occurs as a result of compression of the celiac artery by a fibrous band called the median ligament, which originates from the diaphragmatic crus. The prevalence of MALS has been reported as 10-24% among patients. The etiology is not clear. The components of the clinical triad are a chronic post-prandial pain, epigastric murmur and weight loss. Diagnosis is based on clinical and radiological findings. MALS has been reported in a small portion of patients undergoing pancreaticoduodenectomy. Most of the patients have been diagnosed prior to surgery.

Sonoelastrographic finding of Achilles tendon in patients with ankylosing spondylitis and acromegaly.

OBJECTIVES: Achilles tendinopathy can be noticed in both acromegaly and ankylosing spondylitis (AS). Acromegaly patients presenting with tendinopathy findings may be confused with AS findings. In this study, sonoelastrographic findings of Achilles tendon are explored in patients with AS and acromegaly. METHODS: 25 patients with AS, 30 patients with acromegaly, and 18 healthy controls were enrolled in the study. Achilles tendon was evaluated by sonoelastography in all the study participants. RESULTS: The thickness of Achilles tendon in neutral positions was higher in acromegaly patients than those in AS patients. The sonoelastography measurement of Achilles tendon was increased in acromegaly patients when compared to the control group and AS patients. CONCLUSION: The thickness of Achilles tendon can increase in patients with acromegaly and AS. However, the sonoelastographic features of Achilles tendon can be similar in patients with AS and acromegaly.

Percutaneous management of complicated parapneumonic effusion and empyema after surgical tube thoracostomy failure in children: a retrospective study.

PURPOSE: We aimed to evaluate the results of percutaneous management of complicated parapneumonic effusions (PPE) and empyema after surgical tube thoracostomy failure in children. METHODS: A total of 84 children treated percutaneously after surgical tube thoracostomy failure between 2004 and 2019 were included to this retrospective study. Technical success was defined as appropriate placement of the drainage catheter. Clinical success was defined as complete resolution of infection both clinically and radiologically. Management protocol included imaging-guided pigtail catheter insertion, fibrinolytic therapy, serial ultrasonographic evaluation, catheter manipulations as necessary (revision, exchange, or upsizing), and appropriate antibiotherapy. All patients were followed up at least 6 months. RESULTS: Technical success rate was 100%. Unilateral single, unilateral double, and bilateral catheter insertions were performed in 73, 9, and 2 patients, respectively. Inserted catheter sizes ranged from 8 F to 16 F. Streptokinase, urokinase, and tissue plasminogen activator were used as fibrinolytic agent in 29 (34%), 14 (17%), and 41 (49%) patients, respectively. In order to maintain effective drainage, 42 additional procedures (catheter exchange, revision, reposition, or additional catheter placement) were performed in 20 patients (24%). Clinical success was achieved in 83 of 84 patients (99%). Median catheter duration was 8 days (4-32 days). Median hospital stay during percutaneous management was 11.5 days (7-45 days). Factors affecting the median catheter duration were the presence of necrotizing pneumonia (p < 0.001) and bronchopleural fistulae (p < 0.001). CONCLUSION: Percutaneous imaging-guided catheterization with fibrinolytic therapy should be the method of choice in pediatric complicated PPE and empyema patients with surgical tube thoracostomy failure. Percutaneous treatment is useful in avoiding more aggressive surgical options.

Increased serum chemerin levels associated with carotid intima-media thickness.

BACKGROUND: Elevated levels of chemerin can predict future ischemic cerebrovascular disease. Although chemerin is thought to play a role in atherosclerotic inflammation, whether circulating chemerin levels are associated with the severity of atherosclerosis remains to be determined. OBJECTIVES: Through the use of carotid Doppler ultrasonography, our aim in this study was to investigate the relationships of serum chemerin levels with carotid intima-media thickness (CIMT) as an indicator of generalized atherosclerosis. METHODS: This study compared 40 patients with ischemic stroke and 40 healthy subjects. Measurements were made at end-diastole using color Doppler ultrasonography (CDUS) after a 5-min rest interval in a quiet and dark room. CIMT was defined as the distance between the innermost edge of the luminal echo to the innermost edge of the media/adventitia echo. CIMT was measured in the posterior wall of both common carotid arteries within 1 cm proximally to the bulbus. Three measurements were made on both sides and the average measurement was taken as the CIMT. Serum chemerin levels were determined in all patients and healthy subjects. RESULTS: Serum chemerin levels were significantly higher in the patient group than in the control group (p=0.004). Serum chemerin levels were positively correlated with CIMT (p<0.05). There was a significant difference between the groups with regard to CIMT (p<0.001). CONCLUSION: Elevated serum chemerin levels appear to be associated with CIMT, thus suggesting that a link exists between chemerin and atherosclerotic ischemic cerebrovascular disease.

Increased serum chemerin levels associated with carotid intima-media thickness / Aumento dos níveis séricos de chemerin associados à espessura das camadas intima-media carotídea

ABSTRACT Background: Elevated levels of chemerin can predict future ischemic cerebrovascular disease. Although chemerin is thought to play a role in atherosclerotic inflammation, whether circulating chemerin levels are associated with the severity of atherosclerosis remains to be determined. Objectives: Through the use of carotid Doppler ultrasonography, our aim in this study was to investigate the relationships of serum chemerin levels with carotid intima-media thickness (CIMT) as an indicator of generalized atherosclerosis. Methods: This study compared 40 patients with ischemic stroke and 40 healthy subjects. Measurements were made at end-diastole using color Doppler ultrasonography (CDUS) after a 5-min rest interval in a quiet and dark room. CIMT was defined as the distance between the innermost edge of the luminal echo to the innermost edge of the media/adventitia echo. CIMT was measured in the posterior wall of both common carotid arteries within 1 cm proximally to the bulbus. Three measurements were made on both sides and the average measurement was taken as the CIMT. Serum chemerin levels were determined in all patients and healthy subjects. Results: Serum chemerin levels were significantly higher in the patient group than in the control group (p=0.004). Serum chemerin levels were positively correlated with CIMT (p<0.05). There was a significant difference between the groups with regard to CIMT (p<0.001). Conclusion: Elevated serum chemerin levels appear to be associated with CIMT, thus suggesting that a link exists between chemerin and atherosclerotic ischemic cerebrovascular disease.

RESUMO Introdução: Níveis elevados de chemerin podem prever doenças cerebrovasculares isquêmicas futuras. Embora se acredite que a chemerin desempenhe um papel na inflamação aterosclerótica, ainda não foi determinado se os níveis circulantes de chemerin estão associados à gravidade da aterosclerose Objetivos: Por meio do uso da ultrassonografia Doppler da carótida, nosso objetivo neste estudo foi investigar as relações dos níveis séricos de chemerin com a espessura da íntima-média da carótida (EIMC) como um indicador de aterosclerose generalizada. Métodos: Este estudo comparou 40 pacientes com AVC isquêmico e 40 indivíduos saudáveis. As medidas foram feitas no final da diástole usando ultrassonografia Doppler em cores (USDC), após um intervalo de descanso de 5 minutos em um quarto silencioso e escuro. A EIMC foi definida como a distância entre a borda mais interna do eco luminal e a borda mais interna do eco da mídia/adventícia. EIMC foi medido na parede posterior de ambas as artérias carótidas comuns dentro de 1 cm proximalmente ao bulbo. Três medições foram feitas em ambos os lados e a medição média foi tomada como o EIMC. Os níveis séricos de chemerin foram determinados em todos os pacientes e indivíduos saudáveis. Resultados: Os níveis séricos de chemerin foram significativamente maiores no grupo de pacientes do que no grupo controle (p=0,004). Os níveis séricos de chemerin foram positivamente correlacionados com EIMC (p<0,05). Houve diferença significativa entre os grupos em relação à EIMC (p<0,001). Conclusão: Níveis séricos elevados de chemerin parecem estar associados com a EIMC, sugerindo que existe uma ligação entre chemerin e doença cerebrovascular isquêmica aterosclerótica.

A Case of Intrapancreatic Accessory Spleen Mimicking a Pancreatic Metastasis on the 18 F-FDG PET/CT Scan: A Case with Breast Cancer.

The accessory spleen is a focus of splenic tissue which is separated from the main of the spleen. Although accessory spleens are generally recognized on computed tomography (CT), intrapancreatic accessory spleen (IPAS) may be mistaken for other pancreatic tail lesions. We report a case of IPAS mimicking a pancreatic metastasis on the 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT). A 41-year-old with diagnosed breast cancer (invasive ductal carcinoma) woman patient underwent an 18 F-FDG PET/CT for metastasis screening and staging. 18 F-FDG PET/CT showed a focal uptake in the pancreatic tail. The patient underwent a contrast-enhanced CT and magnetic resonance imaging (MRI) for lesion characterization. The density and intensity of lesion were similar to spleen on all phases and all sequences. The lesion was evaluated as IPAS. The diagnosis was confirmed by endoscopic ultrasound (EUS) biopsy. A case of IPAS positive at 18 F-FDG PET/CT could not found in the literature. We present a case of IPAS mimicking a pancreatic metastasis positive at 18 F-FDG PET/CT.

Efficacy of Staple Line Reinforcement With Omentopexy During Laparoscopic Sleeve Gastrectomy on Postoperative Complications: Experience of a Single Center.

BACKGROUND: The aim of this study was to evaluate the protective effects of staple line reinforcement with omentopexy during laparoscopic sleeve gastrectomy on postoperative complications. MATERIALS AND METHODS: A total of 3942 laparoscopic sleeve gastrectomy cases were included in the study. All the patients were divided into 3 groups: No reinforcement (NoSLR), staple line reinforcement with fibrin glue (SLR-FG), and staple line reinforcement with omentopexy (SLR-O). Demographic data and perioperative characteristics of the groups were analyzed retrospectively. Among these, age, sex, preoperative comorbidities, American Society of Anesthesiologists scores, body mass index, duration of operation, reoperation, complications, and Clavien-Dindo classification scores were recorded. RESULTS: Age, sex, body mass index, comorbid diseases, American Society of Anesthesiologists, and Clavien-Dindo Classification scores were similar in all the groups. The overall complication rate was 3.0%. The overall minor and major complication rates were 1.7% and 1.3%, respectively. The mortality rate was 0.1% (4 patients). The most common postoperative complications were bleeding (0.9%) and leakage (0.5%). The incidence of leakage, bleeding, and twisted gastric sleeve rates were similar when compared between SLR-FG and NoSLR. In the SLR-O patients, the incidence of leakage, hemorrhage, and twist were significantly lower and the operation time was significantly longer when compared with the other groups. CONCLUSIONS: The SLR-O technique, especially when performed by experienced surgeons, is a promising method for the prevention of postoperative leakage, bleeding, and twist complications with an acceptable increase in the duration of operation. Considering the limited effects of the SLR-FG technique, it was predicted that it would lose its popularity over time.

Three-dimensional ultrasonographic evaluation of carotid artery plaque surface irregularity.

INTRODUCTION: The aim of this study was to evaluate 3-dimensional (3D) ultrasonography (US) in determining the surface irregularity of carotid artery plaques. MATERIAL AND METHODS: This study included 50 patients (20 females and 30 males) aged between 56 and 82 years with plaques in the carotid artery which were detected during routine neck ultrasound. Simultaneously these cases were evaluated in terms of plaque echogenicities and surface characteristics with 2D and 3D US. RESULTS: 3D imaging was successfully performed in 45 of the 50 cases and the technical success rate was 90%. A single plaque was detected in 64.4% of the patients, with the remaining 35.6% having more than one plaque. The lengths of the plaques ranged from 2 to 12 mm (mean: 3.98 ±1.70 mm); the widths ranged from 1.8 to 3.2 mm (mean: 2.11 ±0.37 mm). No significant difference was found between 2D and 3D plaque echo-structures (observer 1, p = 0.317; observer 2, p = 0.276), but there were significant differences between 2D and 3D plaque surface irregularities (observer 1, p = 0.002; observer 2, p = 0.004). The inter-observer agreement on 2D and 3D plaque echo-structure and surface irregularity was very good (k coefficients were 0.89 and 0.83, respectively, for echo-structure, and 0.91 and 0.95, respectively, for surface irregularity). CONCLUSIONS: The present study shows that 3D US examination is a valuable non-invasive method for investigation of surface irregularity of carotid artery plaques.

Imaging of sacroiliac joints in patients with acromegaly.

Acromegaly can lead to structural alterations of joints and bones. Patients with acromegaly may, therefore, have musculoskeletal complaints. In this study, sacroiliac joints are investigated in patients with acromegaly. 33 patients with acromegaly were enrolled. Sacroiliac joints were examined by X-ray and magnetic resonance imaging (MRI). In acromegaly, sacroiliac joints were abnormal in 36% of the patients by X-ray and 12.1% by MRI. When current axial spondylarthritis (SpA) classification criteria were taken into account, 6.1% of acromegaly patients could be classified as non-radiographic axial SpA and 2% as radiographic axial SpA. Sacroiliac joints are frequently affected in acromegaly and thus this disorder mimics the features of AS and SpA. Acromegaly should be kept in mind in the differential diagnosis of AS and SpA.

Grape seed extract supplement increases bone callus formation and mechanical strength: an animal study.

BACKGROUND: The positive effects of grape seed proanthocyanidin extract (GSPE) on bone health, which is a potent antioxidant, are known but its effects on fracture healing are not sufficiently covered in the literature. This study aims to investigate the effects of GSPE on fracture healing and biomechanics of healing bone. MATERIALS AND METHODS: Sixty-four adult Wistar-Albino male rats were divided into 8 groups of 8 animals in each group. Osteotomy was performed to the right femurs of all groups except the negative control (G1) and positive control (G2) groups, and intramedullary Kirchner wire was used for fixation. GSPE was given to half of the rats (G2-G4-G6-G8) 100 mg/kg/day by oral gavage. The rats were sacrificed on the tenth (G3-G4), twentieth (G5-G6), and thirtieth (G1-G2-G7-G8) days, respectively, and histopathological, radiological, and biomechanical examinations were performed. RESULTS: Histopathological examination of the specimens from the callus tissues revealed that bone healing was more prominent in the groups supplemented with GSPE (G4, G6, G8). There was a statistically significant improvement in radiological recovery scores and callus volumes in groups with GSPE. When biomechanical strengths were evaluated, it was found that GSPE increased bone strength not only in fracture groups but also in the positive control group (G2). CONCLUSIONS: As a result, this study showed that GSPE, a potent anti-oxidant, had a positive effect on bone healing and improved mechanical strength of the healing bone.

The investigation of incidence and multidetector computed tomography findings of median arcuate ligament syndrome

Background/aim: This study aims to evaluate the incidence and multidetector computed tomography (MDCT) findings of median arcuate ligament syndrome (MALS). Materials and methods: Between January 2010 and September 2016 a total of 4028 patients who underwent angiography for MDCT based on the clinical indications for abdominal pain were retrospectively analyzed. Results: The typical signs of MALS were identified in a total of 141 (3.5%) patients. Among all patients, 84 (59%) were male and 57 (41%) were female. The mean age was 42 years (range: 24 to 71 years). The incidence of celiac artery stenosis was 30% to 50% in 45 patients (32%) and 51% to 90% in 96 patients (68%). Poststenotic dilatation was reported in 74 patients (52%). Collateral vascular structures from the superior mesenteric artery were observed in 5 patients (3.5%). Twenty-one patients (14.9%) underwent laparoscopic surgery with significant stenosis. Conclusion: MALS is a rare vascular pathology. It is especially important to recognize the presence of MALS with an epigastric pain that increases with expiration in adults and also its etiology before interventional procedures. MDCT visualization made the diagnosis of MALS easy.

Median arcuate ligament syndrome during pancreaticoduodenectomy.

Median arcuate ligament syndrome is caused by the compression of the celiac artery by a fibrous band called the median ligament, which originates from the crus of diaphragm. The prevalence of Median arcuate ligament syndrome has been reported as 10%-24% among patients; however, the etiology is unclear. The components of the clinical triad include a chronic post-prandial pain, epigastric murmur, and weight loss. Diagnosis is based on clinical and radiological findings. Median arcuate ligament syndrome has been reported in a small portion of patients undergoing pancreaticoduodenectomy. Most patients have been diagnosed prior to surgery.

Hematological Indices in Portal Hypertension: Cirrhosis versus Noncirrhotic Portal Hypertension.

Portal hypertension (PHT) leads to several alterations on hematological indices (HI). The aim of the study is to investigate the differences in HI between cirrhotic subjects and subjects who have noncirrhotic PHT (NCPHT). This retrospective study included 328 patients with PHT (239 cirrhosis and 89 NCPHT). Demographic and clinical features, endoscopic and radiological findings, and HI including neutrophil to lymphocyte ratio (NLR) at the time of PHT diagnosis were recorded. Severity of cirrhosis was assessed according to the Child⁻Turcotte⁻Pugh (CTP) classification and Model for End-Stage Liver Disease (MELD) scores. Hematological abnormalities were found in 92.5% of cirrhotic patients and in 55.1% of patients with NCPHT (p < 0.001). While thrombocytopenia was the most common HI in patients with cirrhosis, anemia was the most prevalent HI in NCPHT group. In the cirrhotic group, the NLR was the only parameter to differentiate each CTP group from two others. The NLR value increased with the severity of cirrhosis (2.28 ± 0.14 in CTP-A, 2.85 ± 0.19 in CTP-B and 3.26 ± 0.37 in CTP-C). The AUROC of NLR was 0.692 for differentiating compensated cirrhotic patients from decompensated. Hematological abnormalities are more prevalent and more severe in cirrhotic patients compared to patients with NCPHT. NLR may be used to assess the severity of cirrhosis.

A Neglected Issue in Ulcerative Colitis: Mesenteric Lymph Nodes.

Data evaluating the presence and characteristics of mesenteric lymph nodes (LNs) in patients with ulcerative colitis (UC) are scarce. The aim of this study is to determine the presence and characteristics of LNs in UC. The LN characteristics in computed tomography (CT), including LN dimension and attenuation, were evaluated retrospectively in 100 patients with UC (61 active and 39 inactive cases). Clinical characteristics and laboratory parameters, including CBC, biochemical analysis, erythrocyte sedimentation rate (ESR), and C reactive protein (CRP) were also compared. Mesenteric LNs were evident in all patients with UC. The attenuation and dimension of mesenteric LNs did not differ between active and inactive patients with UC. No correlation was found among patients with UC in terms of LN dimension, attenuation, ESR, CRP, leucocyte, and albumin (all with p > 0.05). The current study suggested that inflammation results in the development of mesenteric LN in UC, similar to Crohn’s disease and other inflammatory disorders.

A Novel Candidate Molecule in the Pathological Grading of Gliomas: ELABELA.

AIM: To investigate the possible role of ELABELA (ELA) in the histopathological grading of gliomas. MATERIAL AND METHODS: We retrospectively assessed pathological specimens of patients who underwent surgery for intracranial space-occupying lesions. Only primary glioma specimens were included in this study. We enrolled 11 patients histologically diagnosed with low-grade glioma and 22 patients with high-grade glioma. The ELA antibody was applied to 4?6-?m-thick sections obtained from paraffin blocks. Histoscores were calculated using the distribution and intensity of staining immunoreactivity. An independent sample t-test was used for two-point inter-group assessments, whereas one-way analysis of variance was used for the other assessments. p < 0.05 was considered statistically significant. RESULTS: The histoscores of the control brain, low-grade glioma, and high-grade glioma tissues were found to be 0.08, 0.37, and 0.92, respectively. The difference in ELA immunoreactivity between the control brain tissue and glioma tissue was statistically significant (p < 0.05). In addition, a statistically significant increase was observed in ELA immunoreactivity in high-grade glioma tissues compared with that in low-grade glioma tissues (p < 0.05). CONCLUSION: ELA has an angiogenetic role in the progression of glial tumors. ELA, which is an endogenous ligand of the apelin receptor, activates the apelinergic system and causes the progression of glial tumors. Further studies with a large number of patients are necessary to investigate the angiogenetic role of ELA in glial tumors.

An unusual case of hematemesis and epistaxis caused by a pheochromocytoma.

Pheochromocytoma is a rare catecholamine-secreting neoplasm that is the cause of hypertension in <0.2% of patients with hypertension. We encountered an unusual case of pheochromocytoma involving hematemesis and epistaxis episodes with accompanying hypertensive attacks. Venous ectasia was detected in the esophagus. Abdominal magnetic resonance imaging revealed an adenoma in the left adrenal region. The present case illustrates that pheochromocytoma can mimic different clinical conditions.