Generalized cystic lymphangiomatosis incidentally recognized in an asymptomatic adult: Peroperative, CT, MRI, and histopathological findings of a very rare case.

Generalized cystic lymphangiomatosis is an uncommon congenital lymphatic malformation that may affect soft and hard tissues as well as organs. It is rarely seen in adult patients. Osseous lesions appear as well-defined cystic lesions with a sclerotic rim without periosteal reaction or a soft tissue component. A nonenhancing lesion in fluid density appears to be one of the most common characteristics of abdominal diseases, and clinical features are directly related to the extent of the disease. In this report, we present peroperative, computed tomography (CT), magnetic resonance imaging (MRI), and histopathological findings of a very rare case of generalized cystic lymphangiomatosis recognized in adulthood.

A novel report generation approach for medical applications: the SISDS methodology and its applications.

BACKGROUND: Despite exciting innovation in information system technologies, the medical reporting has remained static for a long time. Structured reporting was established to address the deficiencies in report content but has largely failed in its adoption due to concerns over workflow and productivity. The methods used in medical reporting are insufficient in providing with information for statistical processing and medical decision making as well as high quality healthcare. OBJECTIVE: The aim of this study is to introduce a novel method that enables professionals to efficiently produce medical reports that are less error-prone and can be used in decision support systems without extensive post-processing. METHODOLOGY: We first present the formal definition of the proposed method, called SISDS, that provides a clear separation between the data, logic and presentation layers. It allows free-text like structured data entry in a structured form, and reduces the cognitive effort by inline editing and dynamically controlling the information flow based on the entered data. Then, we validate the usability and reliability of the method on a real-world testbed in the field of radiology. For this purpose, a sample esophagus report was constructed by a focus group of radiologists and real patient data have been collected using a web-based prototype; these data are then used to build a decision support system with off-the-shelf tools. The usability of the method is assessed by evaluating its acceptability by the users and the accuracy of the resulting decision support system. For reliability, we conducted a controlled experiment comparing the performance of the method to that of transcriptionist-oriented systems in terms of the rate of successful diagnosis and the total time required to enter the data. RESULT: The most noticeable observation in the evaluation is that the rate of successful diagnosis improves significantly with the proposed method; in our case study, a success rate of 81.25% has been achieved by using the SISDS method compared to 43.75% for the transcriptionist-oriented system. In addition, the average time required to obtain the final approved reports decreased from 29 min to 14 min. Based on questionnaire responses, the acceptance rate of the SISDS methodology by users is also found to outperform the rates of the current methods. CONCLUSION: The empirical results show that the method can effectively help to reduce medical errors, increase data quality, and lead to more accurate decision support. In addition, the dynamic hierarchical data entry model proves to provide a good balance between cognitive load and structured data collection.

Accuracy and safety of percutaneous US-guided needle biopsies in specific focal liver lesions: comparison of large and small needles in 1300 patients.

AIM: The aim of this study was to compare small size aspiration needles with large size cutting needles in focal liver lesions for using small needles instead of large ones without on-site cytopathologist. METHODS: Percutaneous ultrasonography-guided liver biopsy was evaluated retrospectively in a biopsy cohort study of 1300 patients. In this series, 690 patients were biopsied with large size (<19G) cutting needles and 610 with small size (20G) aspiration needles. On-site cytopathologist was not present in the biopsy-room at any intervention. Needles were compared for diagnostic accuracy and safety for various focal liver diseases. RESULTS: We had diagnostic accuracy rate of 85.0% in small needle group vs. 96.9% in large needle group with metastasis (P<0.001). This rate was 85.5% in small needle group vs. 97.9% in large needle group with hepatocellular carcinoma (P=0.039). Accuracy rates of them were not different in hemangioma (P=0.277) and infection-inflammation (P=0.470). This rate was 75.0% in small needle group vs. 98.9% in large needle group with regenerative nodules (P=0.018). These rates were not different in focal steatosis (P=1.000). Sensitivity, specificity, and accuracy were 85.1%, 100%, and 89.2%, respectively. Only 2 (0.15%) major complications were found with small needles in uncooperative patients. Any major complication was not seen in hemangioma. CONCLUSION: In uncertain diagnosis with modern imaging, we propose that large size cutting needles should be used in suspected liver metastasis, hepatocellular carcinoma, and regenerative nodules if cytopathologist was not present. Small needles can be successfully used as well as large ones in focal steatosis, infection-inflammation, and hemangioma of liver in unclear diagnosis.

Imaging findings and clinical features of patients with multiple myeloma with the prognostic effect of bone marrow focal and diffuse infiltration patterns on spine MRI.

AIM: Aim of this study was to evaluate the prognostic effect of the magnetic resonance imaging (MRI) infiltration type as diffuse or focal patterns on spine magnetic resonance imaging (MRI), as well as other imaging and clinical features of patients with multiple myeloma. METHODS: A retrospective analysis of 35 patients with multiple myeloma was performed in this study. Patients were mean of 56.5 ± 12.4 year old, male/female ratio=1.3. Patients were at stage 2 and one at stage 3. Skeletal surveys were obtained in all patients, additionally bone scintigraphy (N.=25), CT (N.=22), and spine MRI (N.=16) were conducted. On imaging, lesion number, size and distribution and characteristics were assessed. On MRI, bone marrow involvements were assessed as focal and diffuse patterns (mild, moderate, and severe). All patients were followed-up with MRI for a median of 8.5 months (range, 1-105). Statistical analysis for bone marrow infiltration on MRI was performed using Kaplan-Meier survival test. RESULTS: Patients with diffuse infiltration pattern on MRI survived as median 13.0 months (range, 1-105), whereas cases with only focal pattern survived as median 3.5 months (range, 1-27). There was no difference between these groups (P=0.071). The disease-free survivals were not different, either (P=0.118). Scintigraphy, CT, and MRI detected more lesions in flat bones except for cranium where craniography was successful. CONCLUSION: It was not possible to find any further effect of the diffuse MRI infiltration type beyond focal infiltration on overall and disease-free survivals. Among typical findings of the radiography, spherical, punched-out lesions were seen, but lesion uniformity was not seen.

Percutaneous US-guided needle biopsies of solid renal masses.

Our objective was to examine the variables affecting diagnostic yield and complications in percutaneous ultrasonography-guided needle biopsies of solid renal masses. Percutaneous ultrasonography-guided needle biopsy of solid renal masses was performed in 172 patients with either large size (18G) cutting needles or small size (20G) aspiration needles. Retrospectively, 120 patients with diagnosis by percutaneous biopsy and follow-up data were included in this series. Age, gender, side, locations in kidneys, necrosis, calcification, maximum size, needle groups due to needle size and type (either 18G cutting needles or 20G aspiration needles), and needle pass were selected as variables. Their role was investigated in diagnostic yield. Two needle groups were divided and compared for diagnostic yield and safety. Also, change in treatment was evaluated. The mean maximum size of the masses was 8.8±4.9 cm. The only predictor affecting accuracy was side of kidney (p=0.002). Among patients, 15 (12.5%) and 105 (87.5%) had benign and malignant solid masses, respectively. Small and large needle groups did not differ in accuracy, 80.3% vs. 87.1% (p=1.000). Technical success was detected as 100%. No major complications neither tumor seeding was seen. Percutaneous ultrasonography-guided needle biopsy of solid renal masses is effective and safe method with large size cutting needles and small aspiration needles. Change in clinical management was significant at 63.3% rate. Diagnostic yield was low in left kidney relating to right kidney, 69.4 vs. 93.1, while upper lobe location did not lead to significant false result. Repeat biopsies can be taken under CT guidance after nondiagnostic diagnosis in solid tumors of left kidney. All the needles including large cutting type were found safe.

Fine-needle aspiration biopsy of cervical lymph nodes: factors in predicting malignant diagnosis.

The objective of the study was to determine the predicting factors in malignant diagnosis in ultrasonography guided fine-needle aspiration biopsy of cervical lymph nodes. Design is retrospective follow-up study. Ultrasonography guided fine-needle aspiration biopsies of cervical lymph nodes were performed in 290 patients. The mean age was 45.5 ± 14.4 years (range; 15-85). 207 (71.4%) and 83 (28.6%) were women and men, respectively. Cytopathologist was not present in any biopsy procedure. Factors in predicting malignancy were age, gender, presence of primary malignancy, localization (Level 1-6), hypoechogenicity with loss of echogenic hilum, microcalcification, cystic feature, minimum and maximum sizes, and index value (minimum size/maximum size). Factors were analyzed by univariate and multivariable tests. The mean minimum size and index value of the lymph nodes were 10.4 ± 5.5 mm and 0.58 ± 0.18, respectively. Age, gender, microcalcification, cystic feature, minimum size, and index value were poor predictors in malignancy. Predictors were presence of primary malignancy (p-< 0.001), the level of localization (p=0.001), and hypoechogenicity (p-< 0.001)- in malignancy. Microcalcification and cystic parts were specific US findings of metastasis of thyroid carcinoma; nevertheless cystic parts were seen more specific finding in the other malignancies. Malignant lymph nodes were often found in the presence of primary malignancy, mid neck and lower neck localizations as Level 3-6, and markedly hypoechoic lymph nodes. In 131 patients with a primary thyroid carcinoma, the predictors for malignancy were localization where the most often regions were Level 3, 4, and 6 and hypoechogenicity. Malignancy rate was relatively low in patients with thyroid malignancy than those with non thyroid malignancies in Level 5. Level 6 was the most difficult area for biopsy due to postoperative changes. Microcalcification was specific only in thyroid carcinoma, whereas cystic parts were more specific in the other malignancies

Astigmatism after superonasal and superotemporal clear corneal incisions in phacoemulsification.

PURPOSE: To determine the astigmatism outcomes after cataract surgery performed using superonasal and superotemporal clear corneal incisions. SETTING: Department of Ophthalmology, Kartal Training and Research Hospital, Istanbul, Turkey. METHODS: This prospective study includes consecutive 45 eyes of 34 patients having phacoemulsification with implantation of foldable acrylic intraocular lens through a corneal tunnel incision between January and April 2004. The right eye always had a superotemporal incision while the left eye a superonasal incision. Astigmatism was measured by keratometry readings before surgery and 3rd, 15th, and 45th days postoperatively. The surgically induced astigmatism (SIA) was calculated by the vector analysis using the Holladay-Cravy-Koch method at 3rd day, 2nd and 6th weeks postoperatively. RESULTS: The mean preoperative astigmatism was 0.74 +/- 0.45 diopter (D) in the temporal incision group and 0.69 +/- 0.39 D in the nasal incision group. Fifty-eight percent of eyes had against-the-rule (ATR) astigmatism, 26% had with-the-rule (WTR) astigmatism, and 16% were astigmatically neutral. At 6 weeks, 46% of eyes had ATR astigmatism and 35% had WTR astigmatism. The mean total astigmatism was lower in the temporal incision group than in the nasal incision group at all successive examinations postoperatively. Although the total astigmatism decreased at 6 weeks in both groups, temporal incisions yielded less total and surgically induced astigmatism (P < .05). CONCLUSIONS: Cataract surgery using superotemporal incision induced significantly less SIA in the early postoperative period.

Determination of the effect of a single hemodialysis session on retrobulbar blood hemodynamics by color Doppler ultrasonography.

BACKGROUND: Retrobulbar hemodynamic alterations can occur during hemodialysis sessions, and patients with chronic renal failure may experience visual problems. PURPOSE: To evaluate the effect of single-session hemodialysis on retrobulbar vessel hemodynamics by color Doppler ultrasonography. MATERIAL AND METHODS: Thirty-five patients were included in the study. Retrobulbar blood flows were examined before and after dialysis sessions. Doppler spectral patterns of retrobulbar blood flow were evaluated. The t test for paired samples and the Wilcoxon matched-pairs signed-rank test were used for comparing the flow values before and after dialysis. RESULTS: Systolic and diastolic blood flow velocities of the ophthalmic artery, central retinal artery, central retinal vein, nasal posterior ciliary artery, and temporal posterior ciliary artery were found to be decreased bilaterally after hemodialysis sessions. No significant change was observed in resistivity index values after hemodialysis sessions. CONCLUSION: Our findings reveal that retrobulbar circulation was disturbed after a single hemodialysis session.

Pulmonary function tests, high-resolution computed tomography findings and inflammatory bowel disease.

AIM: The association between inflammatory bowel disease and pulmonary involvement has not been clearly established. The aim of this prospective study was to define the features of pulmonary function tests and high resolution computed tomography in inflammatory bowel disease patients and the relation between these and disease activity. METHOD: Fifty-two patients with inflammatory bowel disease (20 with Crohn's disease and 32 with ulcerative colitis) were enrolled. The standard pulmonary function tests and thorax high resolution computed tomography findings were investigated with respect to inflammatory bowel disease activity. Crohn's disease activity index and the Rachmilewitz endoscopic activity index for ulcerative colitis were used to assess disease activity. Medications used and smoking status were also documented. RESULTS: Among the patients with ulcerative colitis, 6.25% had an obstructive and/or restrictive ventilatory defect compared with 25% of the patients with Crohn's disease. Fifty percent of the patients with ulcerative colitis and 60% of the patients with Crohn's disease showed abnormal findings in high resolution computed tomography. Pulmonary function tests and high resolution computed tomography abnormalities did not differ significantly between Crohn's disease and ulcerative colitis. No significant difference related to inflammatory bowel disease activity was found (P > 0.05). CONCLUSION: Findings of high resolution computed tomography and the pulmonary function tests did not differ between ulcerative colitis and Crohn's disease. Bowel disease activity did not seem to affect these measurements.

Implantation of novel small-diameter polyurethane vascular prostheses interposed in canine femoral and carotid arteries.

OBJECTIVES: The performance of small-diameter (3-5-mm) vascular grafts still poses a challenge in the field of vascular surgery. We present here our preliminary experience with implanting unique small-sized polycarbonate urethane vascular grafts in 7 dogs. MATERIAL AND METHODS: Each animal was implanted with 4 interposition grafts, 2 femoral and 2 carotid. No anti-thrombotic medication was administered. Doppler sonography was performed at 3-month intervals to examine for patency and flow characteristics. Animals were sacrificed electively at 3, 6 and 12 months. RESULTS: At 3 months, all grafts were patent. After 6 months, 3 grafts occluded and at 1 year a further 6 grafts occluded. Hence 9 of 28 grafts occluded (67.9% patency). During the study, no correlation could be established between flow velocity or resistance index and occlusion. Histopathology showed intimal hyperplasia to be the cause of occlusion. CONCLUSIONS: Compared to literature data on small-diameter grafts in the same position, ADIAM's Biomechanical grafts performed clearly better. Compliance data suggest a correlation between elastic compliance and patency.

Intermittent torsion of a wandering spleen in a child: the role of MRI in diagnosis.

Wandering spleen is a rare condition, particularly in children. We report a pediatric case of intermittent torsion of a wandering spleen. The preoperative diagnosis was made based on ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). A detailed description of MRI findings is presented and the role of MRI in diagnosis is explored.

The value of computed tomography in the diagnosis of acute necrotising pancreatitis in a renal transplant patient.

BACKGROUND: The incidence of acute pancreatitis after renal transplantation ranges around 1%, and the mortality rate is nearly 65%. Dynamic computed tomography (CT) scan and amylase levels are valuable in the diagnosis of this rare complication. CASE OUTLINE: A 29-year-old man was hospitalised with cytomegalovirus (CMV) pancreatitis after renal transplantation. An initial CT scan showed an enlarged pancreas with hypodense, heterogeneous consistency and with peripancreatic, perihepatic, mesenteric and pelvic fluid collections. After initial conservative management, follow-up CT revealed pancreatic necrosis and abscess formation. The patient underwent necrosectomy and repeated drainage of abscess facilitated by a Bogota bag, but he died 60 days after admission and five surgical procedures. DISCUSSION: CMV pancreatitis after renal transplantation is rare and frequently fatal. In the presence of an acute abdomen after renal transplantation, the diagnosis of pancreatitis should be considered. Dynamic CT scan and measurement of amylase levels are recommended.

Seroprevalence of hepatitis B and C in subjects admitted to a cardiology clinics in Turkey.

A seroepidemiological study was conducted to assess the seroprevalence of hepatitis B surface antigen (HBs Ag) and antibodies to hepatitis C virus (Anti-HCV) in 14,196 patients hospitalized in our cardiology clinics. Threehundred and fifty five (355) patients (2.43%) were found to be positive for HBs Ag, a hundred and sixty six (166) patients (1.09%) were positive for Anti-HCV and ten patients (0.07%) were positive for both. The presence of HBs Ag and Anti-HCV was similar in patients living in rural and urban areas. The presence of risk factors was greater in the patients with Anti-HCV. The prevalences of HBs Ag and Anti-HCV were found to be comparable with those reported in other mediterranean countries in Europe.

An unusual case of hydatid disease located in the erector spinae muscle.

We present a case of hydatid disease localized to the erector spinae muscle. A 60-year-old male was admitted to our hospital with back pain. The diagnosis was made preoperatively by US, CT, and MRI. They showed hydatid disease in erector spinae muscle. Cysts and some part of the erector spinae muscle were resected. Postoperatively pathology confirmed the diagnosis.

Value of computed tomography in addition to ultrasound for preoperative staging of gastric cancer.

AIM: The aim of this study was to assess the added value of computed tomography (CT) with ultrasound in identifying unresectable or incurable gastric cancer. METHODS: One hundred and eighteen patients with various types of gastric cancer were preoperatively staged with ultrasound and CT between January 1999 and October 2000. Each individual was evaluated for ascites, liver metastasis and peritoneal metastases. The observations were compared to findings at surgery. RESULTS: Both techniques were highly specific (93-99%) for all conditions except retroperitoneal invasion (85%). The sensitivities of ultrasound and CT were 64 and 36% for ascites, 50 and 62% for liver metastasis, 9 and 13% for peritoneal metastasis and 18 and 41% for retroperitoneal invasion. Ultrasonography was more sensitive than CT for detecting ascites, and CT was better for detecting retroperitoneal invasion. CONCLUSIONS: Both techniques allowed more accurate identification of liver metastasis and ascites than peritoneal metastasis and retroperitoneal invasion. In order to simplify scanning of patients with gastric cancer, we recommend that CT investigation should be done only in cases where the ultrasound findings are suspicious.

Association between mitral annular calcification and carotid atheroma.

Carotid artery atherosclerosis is a strong predictor of stroke and represents a potential source of cerebral emboli. The aim of this study was to investigate whether an association exists between mitral annular calcification and carotid atheroma. In addition, the characteristics of carotid atheromas were compared between patients with and without mitral annular calcification. The authors found that there was a significant association between the presence of mitral annular calcification and carotid atheroma. Mitral annular calcification in the elderly may be a form of atherosclerosis.

Postpartum follow-up of hepatic calcification detected by prenatal ultrasound.

The causes of parenchymal hepatic calcification are mostly transplacental infection of TORCH complex, ischaemic necrosis, or tumours of foetal liver including haemangioma, hamartoma, teratoma, hepatoma, and hemangioendothelioma. Vascular pathologies like hepatic artery aneurysm, haematoma, calcified thromboemboli of portal vein and hepatic veins can also cause hepatic calcification. We present a case of hepatic calcification which was first diagnosed by prenatal ultrasound. In the postpartum follow-up, we observed that the calcifications had decreased in number and size. The causes and results of hepatic calcification or underlying disease are discussed with analysis of the literature.

A clinical dilemma: cardiac and pericardiac echinococcosis.

BACKGROUND: Cardiac and pericardial echinococcosis as a life-threatening disease may present with a clear picture most of the time, however it may also become a clinical puzzle. METHODS: In the period between 1977 and 1998, 14 patients were operated on with the diagnosis of cardiac and pericardial echinococcosis. Nine patients were operated on with standard cardiopulmonary bypass (CPB) techniques, and the remaining 5 patients were operated on without CPB. Transesophageal echocardiography (TEE) or intraoperative surface echocardiography were used to plan and perform the operation for the late cases. RESULTS: One patient died during the postoperative period due to the rupture of interventricular septum. All other patients survived the perioperative period, received mebendazole treatment, and exhibited no recurrence during the follow-up. CONCLUSIONS: The definitive treatment is the surgical extraction of the cyst. Because the clinical picture may vary according to the number, size, and location of cysts, as well as complications, cardiac echinococcosis should be remembered and included in the differential diagnosis to achieve the treatment. Intraoperative surface echocardiography is of paramount value for diagnosis and planning the management of a successful surgery.

Carotid disease in patients scheduled for coronary artery bypass: analysis of 678 patients.

The purpose of this article is to investigate the frequency of carotid disease and to identify high-risk groups among patients scheduled for isolated coronary artery bypass grafting (CABG) procedures under nonemergent conditions. A total of 678 consecutive patients underwent preoperative carotid artery duplex scanning (CADS) before CABG procedures. Morphology of carotid artery was determined and five groups were formed. Age, sex, cervical bruit, diabetes mellitus (DM), hypertension, smoking, history of cerebrovascular event (CVE), peripheral vascular disease (PVD), and severity of coronary artery disease were investigated to describe the high-risk group for carotid artery disease. In 41% of patients carotid examination produced normal findings; 46.2% had less than 60% luminal stenoses, 7.1% had 60-79% stenoses, 4.6% had 80-99% stenoses, and 1.2% had total occlusion. Previous cerebral ischemic events (CVE) (p<0.05), hypertension (p < 0.01), smoking (p < 0.01), advanced age (p < 0.01), and female sex (p < 0.01) were identified as high-risk factors for carotid artery stenoses. There was a linear association between carotid disease and coronary disease (p < 0.05). Documentation of previous CVE, hypertension, smoking, advanced age, female sex, and severe coronary artery disease may be helpful in identifying patients at high risk for carotid artery stenoses.

Reconstruction of ureteral defects with a tubular skin graft secondarily prefabricated utilizing omentum as a carrier: an experimental study.

OBJECTIVES: This study was conducted to evaluate reconstruction of the ureter in dogs after resection of a 7-cm-long midlength segment with a vascularized tubular skin graft secondarily prefabricated utilizing omentum as a carrier. METHODS: Nine female mongrel dogs underwent surgery in which omental surface capabilities were used to create a vascularized prefabricated skin graft. After 4 weeks, all 9 dogs underwent the second surgical procedure, which included the resection of a 7-cm-long segment from the ureter and an interureteral anastomosis of the omentocutaneous cylindrical tube. At postoperative week 10, just before the third surgical procedure, intravenous urography was performed to evaluate the continuity of the treated ureter. Nephroureterectomy was also performed immediately after intravenous urography to obtain specimens for histologic analysis of the aforementioned tubular anastomosis. RESULTS: The continuity of the ureteral defect was restored with the help of the omentocutaneous cylindrical tube. There was no narrowing throughout the ureter and along the omentocutaneous cylindrical tube. Only minimal dilation occurred at the neoskin tube and at the ipsilateral collecting system. Histopathologically, there were capillary protrusions entering the skin graft from the omental vasculature. The columnar epithelium of the cutaneous cylindrical tube was completely preserved, and transitional ingrowth was present at the proximal and distal ends of the tube. CONCLUSIONS: The surgical procedure resulted in successful reconstruction of ureteral continuity by the use of a prefabricated omentocutaneous cylindrical tube in dogs.