Mediastinitis and subcutaneous abscess complicated after EBUS-TBNA of 2R mediastinal lymph node.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUSTBNA) is a minimally invasive diagnostic tool used for the evaluation of mediastinal lymphadenopathy. It is a safe procedure, but complications such as bleeding and infection may occur. We report a case of a patient who developed a subcutaneous abscess abscess and mediastinitis after EBUSTBNA. A 75-year-old male with a history of right nephrectomy due to renal cell carcinoma and lung adenocarcinoma history underwent EBUS-TBNA for the evaluation of a right upper paratracheal lymph node. Two weeks after the procedure, the patient presented to the emergency department with skin induration and erythema on the right clavicular area. A non-contrast neck and thorax CT scan was performed, which revealed an extensive subcutaneous abscess on the right clavicular area, extending to the supraclavicular region. The patient was hospitalized, and empirical intravenous antibiotics were initiated due to deep neck infection. Repeated drainage of the subcutaneous abscess was performed. Bacteriologic examination revealed Streptococcus mitis. The patient showed improvement with antibiotic treatment, and a follow-up ultrasound showed a decrease in the size of the abscess and was discharged approximately four weeks after hospitalization. Although very rare, serious infectious complications may develop after EBUSTBNA, and our case report is an important example regarding its management process.

Could the Cerebral Involvement of COVID-19 Disease be Related to Microstructural Changes that are not Reflected in Conventional MRI Images?

In patients with COVID-19, neurodegeneration may develop before clinical symptoms appear. Diffusion-weighted (DW) MRI is an important technique for analyzing microstructural changes such as gliosis. In this study, a quantitative evaluation of microstructural changes in the brain with apparent diffusion coefficient (ADC) values in patients presenting with a headache after the COVID-19 disease was analyzed and compared. DW MR images of patients of 20 COVID-19 patients (13 females, 7 males) who required imaging due to headache; 20 controls (16 females, 4 males) were retrospectively reevaluated. ADC measurements were taken from 16 regions of the brain, including right and left symmetrical in patients with COVID-19 infections and control groups. All regions of interest (ROIs) were taken from the hypothalamus, parahippocampus, thalamus, corpus striatum, cingulate gyrus, occipital gyrus, dentate nucleus, and medulla oblongata posterior. ADC values in the dentate nucleus right (784.6 ± 75.7 vs. 717.25 ± 50.75), dentate nucleus left (768.05 ± 69.76 vs. 711.40 ± 52.99), right thalamus (731.15 ± 38.14 vs. 701.60 ± 43.65), left thalamus (744.05 ± 39.00 vs. 702.85 ± 28.88), right parahippocampus (789.10 ± 56.35 vs. 754.75 ± 33.78), right corpus striatum (710.00 ± 39.81 vs. 681.55 ± 39.84) were significantly higher than those in the control group. No significant changes were observed in other areas. A significant increase in ADC values at many levels in the brain in patients with COVID-19 disease and headache was observed. Thus, this study indicates that cerebral involvement in COVID-19 disease may be related to microstructural changes that are not reflected in conventional MRI images.

A Rare Hernia Mimicking Implant in a Patient with Rectal Adenocarcinoma: Internal Herniation.

Internal herniation may be seen more frequently in patients with intra-abdominal surgery and malignancy history. We presented a 58-year-old male patient diagnosed with rectal adenocarcinoma seven years ago with a history of surgery and pelvic radiotherapy. When the abdominal computed tomography (CT) image was taken during routine oncology follow-up, a lesion mimicking a serosal implant on the anterior abdominal wall was detected. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT imaging was performed the suspicion of recurrence. It was concluded that the lesion, which was evaluated as an implant in abdominal CT with 18F-FDG PET/CT imaging, was a spontaneously reducing internal herniation. 18F-FDG PET/CT imaging in cancer patients is crucial in illuminating the suspicion of recurrent lesions in these patients and sheds light on the course of the patients in oncology practice.

The Role of Diffusion-Weighted Imaging in the Evaluation of Treatment of Newly Diagnosed Type 2 Diabetic Patients.

INTRODUCTION: To compare the pre and post-treatment pancreatic apparent diffusion coefficient (ADC) values of type II diabetes patients with control subjects, and also to evaluate its effectiveness in evaluating the response to treatment. METHODS: The study included 35 newly diagnosed type 2 diabetic patients and 35 non-diabetic participants, matched for sex and age. Insulin and metformin treatment was given to the patients. Abdominal diffusion-weighted MR imaging was performed before and after the treatment. ADCs of the control group and patients pre and post-treatment were compared. In addition, the clinical parameters of the patients related to diabetes were recorded. RESULTS: There was a significant difference between the median pancreatic ADC values of the patients pre and post-treatment. While there was a significant difference between the median pancreatic ADC values of the patient and the control groups before the treatment, no significant difference after the treatment was observed. There was a positive correlation between mean pancreatic ADC values and age, as well as a negative correlation with Hb1Ac level and eGFR. CONCLUSION: Pancreatic ADC values of newly diagnosed type II diabetes patients can be used as a marker of pancreatic function in the evaluation of response to treatment and clinical decisions.

Predicting COVID-19 Outcomes: Machine Learning Predictions Across Diverse Datasets.

Background The COVID-19 infection has spread rapidly since its emergence and has affected a large part of the global population. With the increasing number of cases, researchers are trying to predict the prognosis of patients by using different data with artificial intelligence methods such as machine learning (ML). In this study, we aimed to predict mortality risk in COVID-19 patients using ML algorithms with different datasets. Methodology In this retrospective study, we evaluated the fever, oxygen saturation, laboratory results, thorax computed tomography (CT) findings, and comorbid diseases at admission to the hospital of 404 patients whose diagnosis was confirmed by the reverse transcription polymerase chain reaction test. Different datasets were created by combining the data. The Synthetic Minority Oversampling Technique was used to reduce the imbalance in the dataset. K-nearest neighbors, support vector machine, stochastic gradient descent, random forest, neural network, naive Bayes, logistic regression, gradient boosting, XGBoost, and AdaBoost models were used to create the ML algorithm, and the accuracy rates of mortality prediction were compared. Results When the dataset was created with CT parenchyma score, pulmonary artery and inferior vena cava diameters, and laboratory results, mortality was predicted with an accuracy of 98.4% with the gradient boosting model. Conclusions The study demonstrates that patient prognosis can be accurately predicted using simple measurements from thorax CT scans and laboratory findings.

How does the side of lumbar disc herniation influence the psoas muscle size at the L4-5 level in patients operated for unilateral hip arthroplasty?

Study Design: Retrospective studyObjection: There can be a relationship between degenerative diseases in the spine and hipSummary of Background Data: Degenerative diseases in the spine and hip may occur concomitantly. This study was done to investigate the cross-sectional area of psoas muscle size and incidence of lumbar disc herniation after unilateral hip arthroplasty.Methods: The data files of patients who were operated on for unilateral hip arthroplasty between January 2014- and 15 May 2021 at the Recep Tayyip Erdogan University Hospital were retrospectively analyzed for the relationship between the psoas muscle volume and the incidence of lumbar disc herniation. The patients were divided according to their operated sides.Results: The data files of 48 patients were retrospectively analyzed. The patients were divided into two groups according to the operated side of their hip joints. Gender and age differences were not significant, and the mean ages were 68,68 years old in the right hip arthroplasty group, and 69,39 in the left hip arthroplasty group.Conclusions: A complex interaction between the development of lumbar disc herniations and increased contralateral cross-sectional area of the psoas muscle at the L4-5 level was observed in patients operated for unilateral hip arthroplasty. This interaction can be a compensatory mechanism to counteract the spinal imbalance.

Asymmetric Cross Sectional Area Size of the Psoas Muscle Seems to be a Key Feature in Patients with L4-5 Lumbar Disc Herniations.

AIM: To determine the relationship between the occurrence of lumbar L4-5 disc herniation (LDH) and the size of psoas muscles. MATERIAL AND METHODS: The cross-sectional areas (CSAs) of the psoas muscles were measured at the L4-5 disc level on axial MRI of patients with LDH who were admitted to the hospital between 1 January 2020 and 1 June 2020. The patients were divided into three groups according to the involvement side of LDH as the patients without disc (Group I), right side disc (Group II), and left side disc (Group III). The relationship of ipsilateral and the opposite side of the CSA of PM in the control group and the patients with LDHs was analyzed. RESULTS: This retrospective study included 65 patients (ages between 20 and 70 years) whose mean age is 42, 12. The mean values of the right side cross-sectional area of PM were 12.09 cm2 in Group I (n=18), 12.84 cm2 in Group II (n=20), and 14.15 cm2 in Group III (n=27), The left side values were 12.08 cm2, 13.22 cm2, 14.00 cm2 in Group I, II, and III, respectively. The difference between right and left side CSA of PM is that values of patients with left-sided LDHs were higher than those of the control and right-sided LDH group, and the difference was statistically significant. A strong correlation was observed between the left and right side of the cross-sectional area of psoas muscle at the L4-5 level (p < 0.05). CONCLUSION: This study shows that there are reciprocal changes in the cross-sectional area of the psoas muscle in patients with L4-5 lumbar disc herniation.

Introducing a new possible predisposing risk factor for odontoid type 2 fractures after cervical trauma; Ponticulus posticus anomaly of C1 vertebra.

OBJECTIVE: Ponticulus posticus is an anomaly of the atlas. Odontoid fracture type 2 fracture occurs by hyperflexion, hyperextension, lateral flexion, and a combination of these movements. The presence of Ponticulus Posticus anomaly may affect the occurrence of odontoid fractures of the C2 vertebra. In this study, the relationship between the presence of PP anomaly and occurring of the odontoid type 2 fracture was investigated. PATIENTS AND METHODS: Cervical CTs of a total of 14 patients with odontoid type 2 fracture were retrospectively evaluated for PP, and compared with 13 patients with cervical trauma without odontoid type 2 fracture. RESULTS: Ponticulus posticus anomaly was noted in 7 of 14 patients with odontoid type 2 fractures on the upper cervical CT; therefore, the prevalence was 50.%, but only 3 cases (23.07%) were seen in 13 patients of the control group. In binominal regression analysis showed that the presence of PP anomaly increases 12,075 times to occur odontoid type 2 fracture after cervical trauma. CONCLUSION: Ponticulus posticus is often not recognized, but this study shows that ponticulus posticus is a risk factor for odontoid type 2 fracture after cervical trauma.

A rare form of persistent Mullerian duct syndrome: Transverse testicular ectopia with germ cell testis cancer and hernia uteri inguinalis.

Persistent Mullerian duct syndrome is a rare form disorder of sexual differentiation characterised by the persistence of Mullerian derivatives (fallopian tubes, uterus and the proximal vagina) in males with an XY karyotype and normal virilisation. We report a case of a 29-year-old man with right transverse testicular ectopia, mix germ cell cancer at ectopic right testis and left-sided obstructed inguinal hernia containing a uterus and fallopian tube. We performed orchiectomy and hysterectomy on the patient.

Percutaneous Cholecystostomy in High-risk Geriatric Patients with Acute Cholecystitis.

OBJECTIVE: To determine the results of high-risk geriatric patients treated with percutaneous cholecystostomy (PC) for acute cholecystitis (AC). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Interventional Radiology, Recep Tayyip Erdogan University Hospital, Rize, Turkey, from April 2015 to October 2020. METHODOLOGY: Seventy-four patients, who underwent PC with a diagnosis of AC, were divided into three groups according to their ages: 65-74 years as group I, 75-84 years as group II, and ≥85 years as group III. Groups were compared in terms of American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), technical success, clinical success, complications, need for cholecystectomy, duration of hospital stay, 30 and 90 days mortality, catheter removal time, and recurrent cholecystitis after catheter insertion. RESULTS: Technical success was 100% in all groups. Clinical success decreased with age. There was a positive correlation between the patients' ASA score and age (p <0.001). The duration of hospital stay increased with age (p = 0.049). ASA score was found to be an independent risk factor in predicting overall survival (HR: 4.748; 95% CI: 1.030-21.895; p = 0.046). The mean catheter removal time was the longest in group III, and there was a significant difference between the groups (p <0.001). A significant positive correlation was found between catheter removal time and CCI (p <0.001). There was no statistically significant difference between groups in terms of complications and recurrent cholecystitis.  Conclusion: PC can be considered as definitive treatment in advanced elderly patients and interval therapy in early old age. Key Words: Acute cholecystitis, Elderly, Percutaneous cholecystostomy.

COVID-19 infection produces subarachnoid hemorrhage; acting now to understand its cause: A short communication.

In the medical literature, some case reports on the association of the COVID-19 infection and occurrence of spontaneous subarachnoid hemorrhage (SAH)have been reported Aim of the present paper is to search the causes of this association The diagnosis of COVID-19 was based on the real-time reverse-transcription polymerase chain reaction (PCR) test and computed tomography (CT) of the chest. There were four patients, whose median ages were 46,758, ranged 36-54 years). In conclusion, Spontaneous SAH can occur in the early and late course of COVID-19 infection. Its early recognition of the patient with spontaneous SAH is imperative.

Increased Epicardial Adipose Tissue is Associated with the Extent of Aortic Dissection.

BACKGROUND: Epicardial adipose tissue (EAT) is a biologically active organ that has endocrine and paracrine functions. Endothelial dysfunction, systemic, and local inflammatory response, due to bio-active molecules produced by EAT, may affect aortic dissection propagation and extent. We investigated the association between EAT thickness and the extent of aortic dissection. METHODS: We retrospectively enrolled 78 patients with aortic dissection diagnosed by thoracoabdominal Computerized Tomography (CT). EAT was measured from the thickest part of the perpendicular plane between the pericardium and free wall of the right ventricle using CT. Aortic dissection length was measured from the beginning to the end of the dissection flap at sagittal images. RESULTS: We included 78 patients with the mean age of 63.9 ± 11.7 and 57 (73.5%) patients were male. Dissection length was correlated positively with EAT (r = 0.409, p < 0.001), body mass index (r = 0.408, p = 0.018), and admission systolic blood pressure (r = 0.830, p = 0.026) whereas an inverse correlation existed between age and dissection length (r = -0.318, p = 0.005). Multivariate analysis identified age and EAT as independent predictors of dissection length. CONCLUSION: Increased EAT was independently associated with the extent of aortic dissection. We think that either paracrine and endocrine functions of EAT might have contributed to the extent of aortic dissection.

PET-CT and MR Imaging in the Management of Axillary Nodes in Early Stage Breast Cancer.

OBJECTIVE: To discriminate between malignant or benign axillary lymph nodes in breast cancer using MRI, PET-CT, and sentinel lymph node biopsy. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of General Surgery, Recep Tayyip Erdogan University School of Medicine, from January 2014 to March 2019. METHODOLOGY: Sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) was carried out on 102 patients, who had locally advanced cases and had not previously received neoadjuvant therapy. Axillary lymph nodes pathology results were evaluated and compared with PET-CT and MRI findings. RESULTS: PET-CT specificity was 93.18%, MRI specificity was 93.75%, and combined PET-CT and MRI specificity was 97.67%. PET-CT sensitivity was 81.03%, MRI sensitivity was 68.57%, and combined PET-CT and MRI sensitivity was 83.05%. For detecting the presence of axillary lymph node metastasis, there was a good correlation between histopathological results and the combined evaluation with PET-CT and MRI (kappa: 0.785, p <0.001). In combined PET-CT and MRI, short diamater mean values of lymph nodes in 10 patients, which could not detect lymph node metastases, were determined to be 5.2 ±0.9 mm. CONCLUSION: Combining PET-CT and MRI is superior to PET-CT or MRI imaging alone in distinguishing benign and malignant axillary lymph node; and contributes to deciding the approach to axillary lymph node surgery. Lymph node size is also important for this imaging method to determine benign and malignant nodes correctly. Key Words: Breast cancer, PET-CT, MRI, Sentinel lymph node biopsy, Axilla.