Determination of congenital absence of palmaris longus tendon with clinical examination and ultrasonography.

OBJECTIVES: The tendon of the palmaris longus is commonly used as a tendon graft in many reconstructive surgeries. Palmaris longus absence (PLA) was found in 15% among individuals worldwide. In this prospective study, we aimed to conduct an incidence study in which physical examination methods were confirmed by ultrasonography in PLA, and to evaluate the relationship of absence with age, gender, laterality and dominant hand. METHODS: The study included 490 cases. They were initially tested to evaluated by physical examination using the Schaeffer's and Hiz-Ediz test for the assessment of the palmaris longus tendon. Additional ultrasonography was performed to confirm its absence in 129 wrists of 78 cases whose tendons could not be visualized or palpated. RESULTS: The incidence of tendon absence was 13% by physical examination methods. According to the final results when we added ultrasonography to physical examination methods, the incidence of unilateral, bilateral and overall absence of the palmaris longus were 5%, 9% and 11% respectively. There was no statistically significant difference between individuals with and without PLA in terms of gender, side, age and dominant hand (p = 0.796, p = 0.622, p = 0.397 and p = 0.187, respectively). However, bilateral PLA was statistically significantly higher than unilateral in both genders (p = 0.011). CONCLUSIONS: We think that agenesis should be proven accurately by ultrasonographic examination for the final result before any surgical procedure with palmaris longus tendon. Furthermore measuring the diameter of the palmaris longus tendon by preoperative ultrasonography can be useful for surgeons who plan a procedure that requires specific measurements.

Is the presence of echo-rich periportal cuffing in the liver indicator for abdominal inflammation in pediatric patients?

AIMS: Hyperechoic/echo-rich periportal cuffing (ErPC) is defined as an increase in echogenicity relative to the adjacentliver parenchyma. Thickening in the periportal area may occur with proliferation of bile ducts, hemorrhage, oedema, fibrosis,inflammatory changes or a combination of these. The aim of this study is to determine which intraabdominal inflammatory diseases are associated with the presence of ErPC in the pediatric population and to calculate the sensitivity and specificity of this finding. MATERIAL AND METHODS: In this prospective study 200 consecutive children who underwent abdominal ultrasonography (US) were included: group 1, the patient group (100 children with appendicitis, gastroenteritis, mesenteric lymphadenitis, intestinal infection, terminal ileitis and invagination as cause of intra-abdominal inflammation) and group 2, the control group (100 children). RESULTS: The ErPC was positive in 74 (74%) cases in the patient group and in 3 (3%) in the control group. According to final diagnoses, we found ErPC in most of patients with gastroenteritis (16/17), perforated appendicitis (10/11), mesenteric lymphadenitis (5/6) and acute appendicitis (27/37). The sensitivity of ErPC in indicating intra-abdominal inflammation was 0.80 and its specificity was 0.87. No significant correlation between ErPC and age, gender and CRP was found but a moderate and significant positive correlation between ErPC and WBC (p=0,010; r=0.255) was detected. Very good concordance between observers in terms of the presence of ErPC on abdominal US was found (concordance 97% and kappa 0.93). CONCLUSIONS: We consider that the presence of ErPC in pediatric patients, when evaluated alongside clinical and laboratory findings, has a high sensitivity and specificity for inflammatory intra-abdominal pathology.

Clinicopathological features of metaplastic breast carcinoma.

BACKGROUND: Metaplastic carcinoma of the breast (MpBC) is defined as a group of heterogeneous malignant neoplasms that contain glandular and non-glandular components with mixed epithelial and mesenchymal differentiations. OBJECTIVES: The aim of this study was to research the clinical and pathological characteristics of MpBC determining its rank among all breast cancers. MATERIAL AND METHODS: Metaplastic carcinoma of the breast was found in 7 out of 1,164 patients who had been diagnosed with breast cancer within the period of 12 years in our hospital. Demographic and clinical characteristics of the patients were retrieved from the patient files, and their final status was verified by a phone call. Diagnoses of the patients were confirmed by examining hematohylen and eosin (H&E) preparations. They were stained immunohistochemically for estrogen receptor (ER), progesterone receptor (PR), C-erbB-2, CK5/6 (Sitokeratin5/6), and EGFR (epidermal growth factor receptor), and the subgroups were determined according to the WHO classification. RESULTS: All patients were female with a median age of 61 years (41-87 years). Three of them were diagnosed with stage IIB, 2 with IIIB and 1 with IV. Four patients had squamous type of metaplastic cell differentiation, 1 spindle, 1 adenosquamous, and 1 osteosarcomatous. In 6 out of 7 patients, ER, PR and C-erbB-2 expressions were negative immunohistochemically. In the case of squamous metaplasia, estrogen receptor was 10% and progesterone receptor was 5% positive. CK5/6 was positive in 5 cases. Epidermal growth factor was positive in all cases. CONCLUSIONS: Metaplastic carcinoma of the breast is relatively rare and, in our series, its incidence was 0.6%. According to its immunohistochemical characteristics, MpBC can be interpreted as a subgroup of triplenegative breast cancers (TNBC). Five of the presented patients resembled the subgroup of TNBC with a basaloid phenotype. The chemotherapy regimens suggested in the treatment of MpBC are platin in the epithelial subgroup and high-dose anthracycline in the mesenchymal subgroup. There is a need of new studies that evaluate different choices of treatment as MpBC has a bad prognosis and an aggressive nature.

Sentinel Lymph Node Detection by 3D Freehand Single-Photon Emission Computed Tomography in Early Stage Breast Cancer.

We herein present our first experience obtained by 3D freehand single-photon emission computed tomography (SPECT) (F-SPECT) guidance for sentinel lymph node detection (SLND) in two patients with early stage breast cancer. F-SPECT guidance was carried out using one-day protocol in one case and by the two-day protocol in the other one. SLND was performed successfully in both patients. Histopathologic evaluation showed that the excised nodes were tumor negative. Thus, patients underwent breast-conserving surgery alone.

Preoperative Evaluation of Axillary Lymph Nodes in Malignant Breast Lesions with Ultrasonography and Histopathologic Correlation.

PURPOSE: Our aim is to define the sonographic criteria for assessing involved axillary nodes and to evaluate the accuracy of axillary ultrasound in the staging workup of individuals with breast cancer. MATERIALS AND METHODS: Thirty-five patients with breast cancer were prospectively evaluated with preoperative ultrasonography (US) to determine the presence of axillary lymph node metastasis. We determined whether there was axillary lymph node metastasis after axillary lymph node dissection or sentinel lymph node biopsy. If metastasis was found, the number of metastatic lymph nodes was recorded and compared with preoperative axillary US findings using histopathological evaluation as a reference. RESULTS: Metastatic lymph node detection in sonographic evaluation was associated with echogenic hilus obliteration, complete hypoechoic or anechoic appearance of lymph nodes, and asymmetric/nodal or diffuse cortical thickening greater than 3.8 mm. The overall sensitivity, specificity, positive predictive value, and negative predictive value of US were calculated as (20/22) 91 percent, (10/13) 77 percent, (20/23) 87 percent, and (10/12) 83 percent, respectively. CONCLUSION: Ultrasonography examination is a valuable method for evaluating the axilla in newly diagnosed breast cancer patients and provides valuable information for planning proper breast cancer management.

Comparison of the results of ultrasonographic evaluation and arthroscopy in patients scheduled for surgery of the supraspinatus tendon rupture.

BACKGROUND AND OBJECTIVES: This study aims to compare the findings of the shoulder ultrasonography (US) of patients with a supraspinatus (SS) tendon rupture with those of the shoulder arthroscopy, to determine the reliability and diagnostic performance of the shoulder US in the algorithm of the SS tendon pathologic lesions and their secondary ultrasonographic findings. DESIGN AND SETTINGS: A prospective study conducted with patients scheduled for arthroscopy of the shoulder due to an SS tendon rupture in Yildirm Beyazit Education and Research Center and Gazi University, Ankara, Turkey. MATERIALS AND METHODS: Fifty patients scheduled for an arthroscopy of the shoulder due to an SS tendon rupture were evaluated by shoulder US 1 week before the surgery. SS tendon pathologic lesions (tendinosis, partial tears, and full-thickness tears) and humeral degeneration were recorded, and the results of shoulder US were compared with those of arthroscopy. RESULTS: With reference to the arthroscopic data, the sensitivity of the ultrasonographic evaluation for the diagnosis of a full-thickness SS tendon rupture was 91%, with a specificity of 88%; the sensitivity for the diagnosis of a partial-thickness rupture was 86%, with a specificity of 82%; and the sensitivity for the diagnosis of a tendinosis was 98%, with a specificity of 71%. With reference to the arthroscopic data, the sensitivity of US for the diagnosis of humeral degeneration was 93%, with a specificity of 91%. CONCLUSION: The high sensitivity and specificity rates of US in detecting SS tendon rupture and its secondary imaging findings make it an efficient and reliable diagnostic modality, which should be preferred to other more expensive and more invasive methods in the algorithm.

Long-term follow-up of the percutaneous treatment of hydatid cyst in the adrenal gland: a case report and review of the literature.

Although the most involved organs are liver and lung, hydatid cysts occur in adrenal glands, rarely, and constitute only 0.5% of hydatid cysts. Herein, we demonstrate and discuss, for the first time in the literature to the best of our knowledge, the radiological features of adrenal hydatid disease and evaluate the long-term results (57 months of follow-up) of the percutaneous treatment of hydatid cyst in the adrenal gland in a patient.

Ultrasonographic evaluation and morphometric measurements of the suprascapular notch.

BACKGROUND: The aim of this study was to define the sonographic evaluation and morphometric measurements of the suprascapular notch. METHODS: The suprascapular notch was evaluated by ultrasound on both sides in 50 volunteers (25 males, 25 females). By means of ultrasound, the notch width, the notch depth and the distance between the skin and the notch base (skin-notch base interval) were measured and imaging of the superior transverse scapular ligament was attempted. Furthermore, imaging of the suprascapular artery and vein was performed by Doppler ultrasound. RESULTS: On the measurements performed, the notch was found to be deeper in men than in women on both the right (P = 0.022) and the left (P = 0.011) sides. Taking all volunteers into account without grouping sex, no differences were detected between the two sides with respect to the measurements of the notch width, notch depth and distance between the skin and the notch base. The superior transverse scapular ligament was demonstrated in 48 (96%) of 50 volunteers. On color Doppler ultrasound, the artery-vein complex was visualized in a total of 43 (86%) volunteers. CONCLUSIONS: Suprascapular notch measurements and the visualization of the anatomical neighborhood, which may be beneficial for the suprascapular nerve blockade procedure, can be successfully performed by the use of high-frequency ultrasound imaging.

Comparison of two periprostatic nerve blockade techniques for transrectal ultrasound-guided prostate biopsy: bilateral basal injection and single apical injection.

OBJECTIVES: To investigate the effectiveness of a periprostatic nerve blockade technique that relies on a single apical injection of lidocaine. We compared it with bilateral injections at the base of the prostate to determine the effectiveness of pain control and to compare the technical aspects during transrectal ultrasound-guided prostate biopsy. METHODS: The study included patients who had elected to undergo transrectal ultrasound-guided prostate needle biopsy. The patients were divided into 2 groups according to the anesthesia technique they would receive. In the bilateral basal injection group (n = 60), 2 injections of 5 mL lidocaine were administered just lateral to the junction between the base of the prostate and the seminal vesicles on both sides. In the single apical injection group (n = 57) 5 mL of lidocaine was injected at the apex of the prostate to provide the distribution of lidocaine toward the base of the prostate under Denonvilliers fascia. RESULTS: Both techniques were effective regarding pain control, with better results in the single apical injection group. The mean numeric rating scale score was 2.46 +/- 1.03 and 2.01 +/- 1.02 in the bilateral basal injection and single apical injection groups, respectively (P = .01). CONCLUSIONS: The results of this randomized prospective study suggest that both the single apical injection and the bilateral basal injection techniques are effective in terms of pain prevention during transrectal-ultrasound-guided prostate biopsy. The main advantage of the single apical injection technique is its ease of use and the requirement for one half the amount of local anesthetic agent.

Conventional galactography and MR contrast galactography for diagnosing nipple discharge: preliminary results.

OBJECTIVE: We wanted to compare the clinical usefulness of conventional galactography and MR contrast galactography for diagnosing patients with nipple discharge. MATERIALS AND METHODS: Both conventional galactography and MR contrast galactography were performed prospectively in 16 patients. Gadopentate dimeglumine (0.1 ml) was mixed with non-ionic contrast medium (0.9 ml) to obtain a resultant volume of 1 ml and this was used for both examinations. Following conventional galactography, MR contrast galactography was performed after direct injection of contrast media into the duct. RESULTS: Conventional galactography and MR contrast galactography were concordant in 13 (81%) of 16 patients; the results were normal in five, ductal dilatation was noted in four and intraductal filling defects were noted in four. The remaining three (19%) patients demonstrated discordant findings on the two examinations. While conventional galactography revealed filling defects, the MR contrast galactography results were normal in two patients. The third patient had kinks-stricture on conventional galactography and MR contrast galactography showed ductal dilatation. This suggested there were false positive results for the three patients' conventional galactography, and all the three patients with discordant results underwent surgery and the histopathologic evaluation showed fibrocystic changes. CONCLUSION: MR contrast galactography may be used as an alternative imaging modality for making the diagnosis of pathologic nipple discharge. However, statistically supported studies with large pools of subjects for comparing the galactography and MR contrast galactography results are needed to confirm our findings.

A simple method to decrease surgical trauma in wire localization procedures.

Minimally invasive breast biopsies of nonpalpable lesions are used for early diagnosis and treatment of breast cancer. This report describes a simple method to decrease surgical trauma in wire localization procedures. After wire localization with mammography or ultrasound, the course of the wire in the breast was marked on the skin to guide the surgeon. As a result, fewer tissue samples were taken and smaller hematomas occurred. This method is particularly useful in deep lesions and in large breasts, leading to shortened surgery time and improved cosmetic results. This technique can be used in any wire-guided procedure.

Doppler sonography in renal artery stenosis. An evaluation of intrarenal and extrarenal imaging parameters.

A prospective comparison of different direct and indirect Doppler parameters with angiography was performed to determine the most useful Doppler parameters and threshold values for the detection of significant (> or =60%) renal artery stenosis (RAS). The best combination of parameters was found to be the use of direct parameters of peak systolic velocity (PSV) greater than 180 or 200 cm/s and renal aortic ratio (RAR) greater than 3.0 with a sensitivity and specificity at 92% and 88%, respectively.