Comparing the Diagnostic Performance of Multiparametric Prostate MRI Versus 68Ga-PSMA PET-CT in the Evaluation Lymph Node Involvement and Extraprostatic Extension.

PURPOSE: Our research aims to compare the efficacy of PET and MRI for lymph node metastasis and extraprostatic extension in cases with newly diagnosed prostate cancer undergoing radical prostatectomy with extended pelvic lymph node dissection. METHODS: Thirty-nine cases who underwent radical prostatectomy with pelvic lymph node dissection between June 2015 and January 2020 were included in the study. Patients with gallium (ga-68 Prostate-specific membrane antigen (PSMA) PET) PSMA PET-CT and multiparametric (mp) prostate MRI performed according to PIRADS v2 criteria in our clinic were included. RESULTS: The extraprostatic extension was observed in 16 cases. The sensitivity of MR in detecting extracapsular invasion was calculated as 56.2%, specificity 82.6%, positive predictive value (PPV) 69.2%, negative predictive value (NPV) 73.0%. The sensitivity of PET was 62.5%, specificity 60.8%, PPV 52.6%, NPV 70%. Eleven lymph node metastases were observed in nine cases. The sensitivity, specificity, PPV and NPV of metastatic lymph node detection were; 36.3%, 99.6%, 57.1%, 99.0% for MRI and; 18.1%, 99.4%, 33.3%, 98.8% for PET CT, respectively. CONCLUSION: Mp prostate MRI showed low sensitivity and high specificity compared to PSMA PET CT in extracapsular invasion evaluation. The sensitivity of both modalities in the detection of metastatic lymph nodes was low.

Core outcome set for surgical trials in gastric cancer (GASTROS study): international patient and healthcare professional consensus.

BACKGROUND: Surgery is the primary treatment that can offer potential cure for gastric cancer, but is associated with significant risks. Identifying optimal surgical approaches should be based on comparing outcomes from well designed trials. Currently, trials report different outcomes, making synthesis of evidence difficult. To address this, the aim of this study was to develop a core outcome set (COS)-a standardized group of outcomes important to key international stakeholders-that should be reported by future trials in this field. METHODS: Stage 1 of the study involved identifying potentially important outcomes from previous trials and a series of patient interviews. Stage 2 involved patients and healthcare professionals prioritizing outcomes using a multilanguage international Delphi survey that informed an international consensus meeting at which the COS was finalized. RESULTS: Some 498 outcomes were identified from previously reported trials and patient interviews, and rationalized into 56 items presented in the Delphi survey. A total of 952 patients, surgeons, and nurses enrolled in round 1 of the survey, and 662 (70 per cent) completed round 2. Following the consensus meeting, eight outcomes were included in the COS: disease-free survival, disease-specific survival, surgery-related death, recurrence, completeness of tumour removal, overall quality of life, nutritional effects, and 'serious' adverse events. CONCLUSION: A COS for surgical trials in gastric cancer has been developed with international patients and healthcare professionals. This is a minimum set of outcomes that is recommended to be used in all future trials in this field to improve trial design and synthesis of evidence.

Comparison of MRI, PSMA PET/CT, and Fusion PSMA PET/MRI for Detection of Clinically Significant Prostate Cancer.

PURPOSE: The aim of our study is to compare the efficacy of positron emission tomography (PET) and magnetic resonance imaging (MRI) for detecting intraprostatic lesions in patients with clinically significant prostate cancer who underwent radical prostatectomy; additionally, investigate the benefits of rostate-specific membrane antigen (PSMA) PET-MR software fusion images to the diagnosis. METHODS: Thirty patients, who underwent radical prostatectomy between June 2015 and April 2018, were included in the study. Subjects with gallium PSMA PET-CT and multiparametric prostate MRI performed according to Prostate Imaging Reporting and Data System v2 criteria in our clinic were included in the study. 68Ga-PSMA PET-CT images were fused with MR sequences for analysis. RESULTS: The mean age of cases was 63.2 years (ranged from 45 to 79 years). Index lesions of 29 cases were detected by MRI and 22 of them by PET CT. Both modalities were found to be less sensitive for detection of bilaterality and multifocality (42.85% and 20% for MRI, 28.57% and 20% for PET CT, respectively). There was no statistically significant difference between modalities. It was observed that if a clinically significant tumor focus was not detected by MRI, it was small (6 mm or less) in diameter or had a low Gleason score. CONCLUSIONS: Software fusion PSMA PET-MRI increased the sensitivity of the index lesion identification compared with PSMA PET-CT and also increased the sensitivity of real lesion size identification compared with multiparametric prostate MRI.

Comparisons between the Dosimetric and Clinical Outcomes of Tomotherapy and 3D Conformal Radiotherapy in Gastric Cancer Treatment

Introduction: Previous studies comparing tomotherapy (TOMO) and three dimensional (3D) conformal radiotherapy (3DCRT) in gastric radiotherapy are limited and tend to be based on dosimetry. The aim of the present study was to evaluate the clinical outcomes of these two treatment modalities. Methods: A total of 51 patients diagnosed with gastric cancer who were treated with postoperative adjuvant chemoradiotherapy and had subtotal/total gastrectomy and D2 lymphatic dissection were recruited to the present study: 30 patients were treated with TOMO and 21 patients were treated with 3DCRT. Results: The 3DCRT and TOMO treatment regimens were compared. There was no difference in planning target volume (PTV) 95%, but TOMO was statistically significant in regard to PTV 105% (P<0.05). TOMO was also significantly different when compared with 3DCRT when evaluating liver mean dose, liver V40, right/left kidneys mean dose, right/left kidneys V20 and spinal cord mean dose values (P<0.05). Grade 2 acute side effects were more frequent (85.7%) following 3DCRT. In addition, the median overall survival time for TOMO treated patients was 62 months while in 3DCRT treated patients it was 22.05 months. The difference in disease free survival was also significantly increased in patients treated with TOMO (66.7% vs. 19.0%; P<0.05). Conclusion: TOMO treatment resulted in lower acute side effects with better patient survival following gastric cancer radiotherapy.

Left ventricular twist in hypertrophic cardiomyopathy : Predictor of nonsustained ventricular tachycardia.

BACKGROUND: We investigated the efficacy of clinical and classic echocardiographic parameters in predicting the occurrence of nonsustained ventricular tachycardia (NsVT) in patients with hypertrophic cardiomyopathy (HCM). METHODS: The study comprised 59 patients with HCM (47 male, [80%]; mean age, 48.48 ± 14.16 years). Clinical, electrocardiographic, as well as classic two-dimensional and speckle-tracking echocardiography (STE) data were collected. All patients had Holter monitoring within 24-72 h of the echocardiographic examination. NsVT was defined as three or more consecutive premature wide QRS complexes with a heart rate of > 100 bpm. The patient population was categorized into groups based on the occurrence or absence of NsVT on the 24-h Holter recordings. RESULTS: NsVT was observed in 17 patients (29%). In these patients, higher twist (14.4 ± 3.8 vs.18 ± 7.9; p = 0.02), higher apical rotation (8.7 ± 4.2 vs. 12.2 ± 7; p = 0.02), higher sudden cardiac death risk score (4.4 ± 2.2 vs. 7 ± 3.3; p = 0.007), and decreased global longitudinal peak strain (GLPS; -12.8 ± 3.1 vs. -10.6 ± 2.8; p = 0.014) were observed. In the multivariate logistic regression analysis, including GLPS and twist, GLPS (Odds Ratio [OR]: 1.406; 95% CI: 1.087-1.818; p = 0.009) and twist (OR: 1.236; 95% CI: 1.056-1.446; p = 0.008) were found to be independent predictors of NsVT. In the receiver operating characteristic curve analysis, GLPS < -11.9% predicted NsVT with 82% sensitivity and 60% specificity (area under the curve [AUC]: 0.70; p = 0.014) and twist > 15.2° predicted NsVT with 70% sensitivity and 58% specificity (AUC: 0.69; p = 0.027). CONCLUSION: Decreased GLPS and increased twist were predictive of NsVT in HCM patients. Parameters that can easily be measured with STE can help detect patients who may develop arrhythmia.

The effectiveness of the low-power laser and kinesiotaping in the treatment of carpal tunnel syndrome, a pilot study.

In mild and moderate cases of carpal tunnel syndrome (CTS), the conservative approach is suggested. The purpose of this study is to assess and compare the effect of low-power laser versus the combination of low-power laser and kinesiotaping on pain, muscle strength, functionality, and electrophysiologic parameters in the patients with CTS. The study was planned as single-blind, prospective, randomized control. 64 hands diagnosed with CTS were included in the study. The patients were randomly divided into three groups by closed envelope method. Low-power laser therapy was applied to Group 1 (21 hands), kinesiotaping and low-power laser therapy in group 2 (22 hands), sham laser therapy in Group 3 (21 hands). All patients were assessed by visual numeric pain scale (VNS), hand grip strength (HGS), finger pinch strength (FPS), the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), before treatment, after treatment (3rd week), and after (12th week) 3 months the treatment with the same physician. Motor and sensory nerve conduction studies were performed with electroneuromyography (ENMG) before the treatment (0th week) and at the end of the 12th week. Comparison of the group 1 with the group 3 showed significantly better improvement in the former in VNS, BCTSQ at 3rd week and 12th week compared to 0th week, and in FPS and HGS at 3rd week. Comparison of the group 2 with the group 3 showed significantly better improvement in the former VNS, BCTSQ, FPS and HGS at 3rd and 12th week compared to 0th week. When Group 1 and Group 2 were compared there was no statistically significant difference in any parameters in the 3rd week, but there was a statistically significant difference in favor of group 2 in FPS and HGS parameters at the 12th week. We have found that the kinesiotaping method applied with low-power laser treatment does not provide any additional benefit to the low-power laser treatment in the short term, however, in the long term, the increase in the HGS and FPS has occurred. In conclusion, low-power laser and kinesiotaping method in the treatment of CTS may be an effective and reliable treatment option in clinical parameters.

Thyroid nodules classified as atypia or follicular lesions of undetermined significance deserve further research: Analysis of 305 surgically confirmed nodules.

OBJECTIVE: The objective of the present study was to determine the malignancy risk for nodules categorised as atypia or follicular lesions of undetermined significance atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) and to investigate the predictors of malignancy. METHODS: All nodules diagnosed as AUS/FLUS on fine needle aspiration (FNAs) performed between January 2011 and December 2015 were retrospectively reviewed. Clinical data, ultrasonographic features, follow-up data and the final pathological results were recorded. After further exclusion, only nodules that underwent surgical excision were included in the final analysis. The malignancy rate and the range of malignancy rates were calculated. Clinical and ultrasound features were examined to determine the predictors of malignancy. RESULTS: During the study period, FNA was performed on 9938 nodules, and 1019 (10.2%) nodules were diagnosed as AUS/FLUS. After further exclusion, 976 nodules were evaluated. After the initial diagnosis of AUS/FLUS, 139 (14.2%) patients underwent surgery, 518 (53.1%) had repeated FNAs. A total of 305 (31%) had undergone surgical excision at different time points. For surgically confirmed nodules, the malignancy rate after the initial FNA was 34.5% (the lower and upper thresholds for the malignancy rate were 19.3% and 66.3%, respectively), and 37.9% after the repeated FNA. No ultrasound feature was determined as a predictor, whereas age (>55 years) was a predictor for malignancy. CONCLUSIONS: The overall malignancy rate for nodules diagnosed as AUS/FLUS and the malignancy rate for nodules that underwent repeated FNA after AUS/FLUS were higher than the expected malignancy rates of the National Cancer Institute. It is, therefore, suggested that the current recommendations should be reconsidered.

Evaluation of CR-POSSUM, original ACPGBI and new ACPGBI scoring systems for colorectal cancer surgery.

PURPOSE: To compare the Colorectal Physiological and Operative Score for enUmeration of Mortality and Morbidity (Cr-POSSUM) with the original Association of Coloproctology of Great Britain and Ireland (ACPGBI) and new ACPGBI scoring systems for their ability to predict mortality after colorectal cancer surgery. METHODS: We retrospectively calculated the Cr-POSSUM,original ACPBGI and new ACPGBI scores of 105 patients who underwent colorectal cancer surgery. Data were obtained from patients'€™ medical records and operative notes.Mortality was defined as death within 30 days of surgery.Scores were validated by assessing their calibration and discrimination. Calibration was assessed using the Hosmer-Leme show test and corresponding calibration curves. The discriminative capability of the models was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: The observed mortality rate was 4.8 %. The over all estimated risks of death of the Cr-POSSUM, original ACPGBI, and new ACPGBI scores were 9.92%, 7.35% and 4.20%, respectively. The results of areas under the curve(AUC) for Cr-POSSUM, original ACPGBI and new ACPGBI scores were 0.792, 0.844 and 0.801 respectively. CONCLUSIONS: The Cr-POSSUM, original ACPGBI and new ACPGBI scoring syStems are accurate in determining mortality rates and for predicting the risks of death in individual patients. The new and original ACPGBI scoring systems performed slightly better than the Cr-POSSUM scoring system.

Modification of the Bascom cleft lift procedure for chronic pilonidal sinus: results in 141 patients.

AIM: There is no definitive consensus on the best treatment for pilonidal sinus. The Bascom cleft lift technique has been reported to produce successful results. This study presents the results of a modified cleft lift procedure in which the sinus tissue was excised and the lower end of the incision was kept outside the intergluteal sulcus by extending the lower end of the incision laterally. METHOD: Between August 2010 and January 2012, 141 consecutive patients who presented with primary or recurrent pilonidal sinus disease were included in the study, which was conducted at a single tertiary academic medical centre. Prospectively collected data were recorded, including complications, pain score, satisfaction level, primary healing rate, length of hospital stay and early recurrence. RESULTS: The mean operating time was 30 min and the mean length of hospital stay was 1.2 days. The most common surgical-site complication was a collection followed by partial wound dehiscence and superficial infection. The primary healing rate was 88%, the mean time for functional recovery was 13 days and the mean follow-up time was 14 months. No recurrence was observed within this follow-up period. CONCLUSION: The modified Bascom cleft lift technique is effective and reliable. It is applicable to all pilonidal sinus cases and has low complication rates, high satisfaction scores, rapid early recovery and low recurrence rates.

Determining the influence of fibre post light transmission on polymerization depth and viscoelastic behaviour of dual-cured resin cement.

AIM: To evaluate the effect of quartz-fibre posts on the depth of polymerization of a dual-cure resin cement using Raman spectroscopy and to determine the physical properties of the polymerized cement using a dynamic mechanical analyzer (DMA). METHODOLOGY: Twenty-five fibre and 25 CrNi posts were used to evaluate depth of polymerization. Posts were cemented with dual-cure resin into root canals formed from silicone moulds, without using bonding or etching agents. After polymerization, resin layers on each sample were removed using a curette and cut into three equal parts (apical, middle and coronal). All resin specimens for every third were gathered and crushed. Resin powder samples were analysed using Dynamic Mechanical Analysis and Raman spectroscopy for each third. RESULTS: The numerical data revealed that the thermal transitions of the materials took place at higher temperatures from the apical to the coronal sections in both groups. C=C double bond intensity was lower in fibre post-resin cement samples when compared to their intensity in metal post-resin cement samples. CONCLUSION: Dual-cured resin cements had more rigid properties and better polymerization for fibre posts when compared with metal posts. Polymerization quantity was affected by position in the canal.

Parathyroid cyst: the forgotten diagnosis of a neck mass.

The differential diagnosis of cystic cervical masses includes cystic thyroid disease or some embryological diseases. Parathyroid cyst is one of the less common causes of the cervical masses. The Swedish anatomist Sandstrom reported the first description of parathyroid cyst in 1880. Up to date, only about 300 cases have been reported in the world literature. They may be functional or nonfunctional, depending on the presence or absence of the hyperparathyroidism and treatment options vary for both presentations. Particularly, nonfunctional cysts are often considered as thyroid cysts. Diagnosis is best made by monitoring serum calcium levels and sending cyst fluid for parathormone analysis. We herein report a patient diagnosed with a parathyroid cyst who had received the diagnosis of goitre at other institute; including a review of the literature.

Indications of Philadelphia collar in the treatment of upper cervical injuries.

The principles of the management of upper cervical injuries remain controversial. The specific anatomical conditions render upper cervical injuries more problematic than lower cervical injuries. Here we present and discuss our experiences with upper cervical injury, comparing them with other treatment modalities. The 24 patients admitted to our department with upper cervical injury were treated surgically or conservatively according to their neurological and radiological status. Five patients were treated surgically due to neurological abnormality associated with compression to neural structures observed in computerized tomography/magnetic resonance imaging (CT/MRI). Patients with no neural compression were managed conservatively, with the Philadelphia collar. All patients showed stable fracture healing and experienced no additional clinical disability on follow-up after a minimum of 3 months, except one who died due to cardiac and respiratory failure. Regardless of the type of injury, indication for surgery in many cases of upper cervical injury is neurological abnormality associated with radiologically observed neural compression. It is our belief that, in the absence of both neurological abnormality and compression to neural structures observed in CT/MRI, treatment with the Philadelphia collar alone is safe, cost-effective and easily applicable for many cases of upper cervical injury.

Injury caused by deeply penetrating knife blade lodged in infratemporal fossa.

Knife-inflicted, deeply penetrating head and neck trauma is an uncommon life-threatening injury and a challenging problem. An examination of the neurovascular and systemic physical status is a first requirement and the decision as to which approach to adopt for the removal of the blade is of critical importance. Here we report a rare case of a pre-auricular stab wound with the knife blade deeply lodged in the extracranial infratemporal fossa. Radiological investigations showed that the knife blade had entered from the temporomandibular joint and become lodged through the anterior margin of foremen magnum below the petrosal bone. Minimal left vocal cord paresis, left palatal weakness and a slight deviation of the tongue towards the left side were observed. The other neurological and systemic physical evaluations were normal. Simple withdrawal of the blade in the operating room did not cause serious neurovascular injury. Here we discuss and compare the expanded exposure of anatomical structures for blade removal and simple withdrawal in similar injuries.

Disability in ankylosing spondylitis.

PURPOSE: This study was designed to examine the functional loss in ankylosing spondylitis and explore the relationship between disability and various factors such as age, disease duration, disease activity, spinal mobility, chest expansion, peripheral joint involvement, radiological changes, and psychosocial well-being. METHOD: Forty-two patients were included in this cross-sectional study. RESULTS: The results showed that 37 patients had mild to moderate disability, two patients had severe disability, and three patients did not report any functional loss. Spearman correlation analyses showed that disability was strongly correlated with spinal mobility measures, disease activity measures, and disease duration. Also, patients with peripheral joint involvement had greater disability. When the predictive effect of five independent variables was studied by multiple regression analysis, it was found that the most powerful predictors of functional loss in AS patients were cervical rotation, modified Schober's test, and pain. CONCLUSIONS: These data suggest that functional consequences of AS are constituted by multiple impairments and each needs to be managed by an integrated physiatric approach.

The effect of epidural cooling on lipid peroxidation after experimental spinal cord injury.

STUDY DESIGN: The effect of epidural space perfusion with chilled saline solution (% 0.9 NaCl) on lipid peroxidation after experimental spinal cord injury in rats was evaluated. OBJECTIVES: The extent of lipid peroxidation is a useful parameter for evaluating the cellular disturbance caused by spinal cord trauma in experimental conditions. The protective effects of hypothermia against neurological injury resulting from trauma or ischemia both in experimental and clinical situations have been demonstrated. SETTING: Departments of Neurosurgery and Biochemistry, Cerrahpasa Medical School, Istanbul, Turkey. METHODS: Twenty-five female Wistar Albino rats were used. There were five rats in group I (sham-operated), seven rats in group II (trauma), and eight rats in group III (epidural cooling). The remaining five rats were used for the pilot study to determine the spinal cord and body temperature. A clip compression method was used to produce acute spinal cord injury. In group III, 30 min after the trauma the injured spinal cord was cooled by perfusion of the epidural space with chilled saline solution (% 0.9 NaCl) with a flow rate of 5 ml/min for 30 min. At 2 h after trauma, all rats other than the ones used in the pilot study, were sacrificed and the spinal cords were excised. The extent of lipid peroxidation in the spinal cord was assessed by measuring the tissue content of malonil dialdehyde (MDA). RESULTS: The tissue MDA contents were 1.58 micromol MDA/gram wet weight (gww) in group I (sham-operated), 2.58 micromol MDA/gww in group 2 (trauma), and 1.77 micromol/gww in group 3 (epidural cooling), the differences being statistically significant. CONCLUSION: The results indicated that epidural cooling of traumatized spinal cord is effective in preventing secondary damage due to the peroxidation of lipid membranes.

Intracranial tuberculoma mimicking metastasis from renal tumor--case report.

A 63-year-old female presented with intracranial tuberculoma manifesting as severe headache. Systemic examination found a mass in the left kidney. The histological diagnosis was tuberculoma after kidney biopsy. Cranial computed tomography found two lesions, in the right frontal and occipital lobes. The intracranial lesions were considered to be tuberculomas. Tuberculosis chemotherapy was continued for 15 months. Her neurological deficit was resolved. Cranial computed tomography showed the lesion in the frontal lobe had disappeared and the lesion in the occipital lobe was reduced in size.