Diagnostic difficulties in polymyalgia rheumatica cases with normal erythrocyte sedimentation rate and C-reactive protein values.

Polymyalgia Rheumatica (PMR) is an inflammatory disease which does not have specific diagnostic tests or pathological symptoms and is identified based on clinical characteristics. Among acute phase reactants (APR), the erythrocyte sedimentation rate (ESR) and C-Reactive Protein (CRP) are laboratory findings used in diagnosis and follow-up. In this study, it was aimed to determine the incidence of normal ESH and CRP in patients diagnosed with PMR and identify the distinguishing characteristics of these patients. PMR patients who were clinically diagnosed at a single center were reviewed. After the presence of bursitis was demonstrated with ultrasonography in patients with normal ESR and CRP rates, they were accepted to have PMR. Among all 54 patients (63% female), ESR and CRP values were normal in 8 patients (14%), and serum amyloid A (SAA) was determined to be elevated in all these patients. In the comparisons of the groups with normal and high levels of ESR and CRP, it was found that the group with normal ESR and CRP values had a younger age of diagnosis (P = .027), a longer symptom duration (P < .001), and a lower comorbidity rate (P = .010). PMR patients can have normal ESR and CRP values at the time of their diagnosis. While bursitis can be demonstrated with ultrasonography in patients who are clinically evaluated to have PMR, APRs such as SAA other than ESR and CRP can also be used.

Analysis of free-fall bullet injury potential in the cranium via finite elements method.

The aim of this study is to analyze the injury potential of the free-falling bullet in the cranium, which is known as a tired bullet in the public, with the finite element method (FEM) In the study, as penetrant 9 × 19 mm FMJ bullets with vertical falling angle, adult human skull and brain tissue were discussed. The results of the analysis with the Finite element method, which is similar to the cases reported before, revealed that free-falling bullets as a result of shooting into the air can cause fatal injuries.

Correlation of brain segmental volume changes with clinical parameters: a longitudinal study in multiple sclerosis patients.

OBJECTIVE: To measure the cranial volume differences from 15 different parts in the follow-up of relapsing-remitting multiple sclerosis (RRMS) patients and correlate them with clinical parameters. METHODS: Forty-seven patients with RRMS were included in the study. Patients were grouped into two categories; low Expanded Disability Status Scale (EDSS) (< 3; group 1), and moderate-high EDSS (≥ 3; group 2). Patients were evaluated with Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MOCA), Symbol Digit Modalities Test (SDMT), Fatigue Severity Scale (FSS), and calculated Annualized Relapse Rate (ARR) scores. Magnetic resonance imaging (MRI) was performed with a 1.5T MRI device (Magnetom AERA, Siemens, Erlangen, Germany) twice in a 1-year period. Volumetric analysis was performed by a free, automated, online MRI brain volumetry software. The differences in volumetric values between the two MRI scans were calculated and correlated with the demographic and clinical parameters of the patients. RESULTS: The number of attacks, disease duration, BDI, and FSS scores were higher in group 2; SDMT was higher in group 1. As expected, volumetric analyses have shown volume loss in total cerebral white matter in follow-up patients (p < 0.001). In addition, putaminal volume loss was related to a higher number of attacks. Besides, a negative relation between FSS with total amygdala volumes, a link between atrophy of globus pallidus and ARR, and BDI scores was found with the aid of network analysis. CONCLUSIONS: Apart from a visual demonstration of volume loss, cranial MRI with volumetric analysis has a great potential for revealing covert links between segmental volume changes and clinical parameters.

OBJETIVO: Medir as diferenças de dominância craniana de 15 regiões diferentes no seguimento de pacientes com esclerose múltipla recorrente-remitente (EMRR) e correlacioná-las com parâmetros clínicos. MéTODOS: Quarenta e sete pacientes com EMRR foram incluídos no estudo. Os pacientes foram agrupados em duas categorias; EDSS baixo (< 3; grupo 1) e EDSS médio-alto (≥ 3; grupo 2). Os pacientes foram avaliados com o Inventário de Depressão de Beck (BDI, na sigla em inglês), Montreal Cognitive Assessment (MOCA, na sigla em inglês), Symbol Digit Modality Tests (SDMT, na sigla em inglês), Fatigue Severity Scale (FSS, na sigla em inglês) e taxa de ataque anual (ARR, na sigla em inglês). Duas ressonâncias magnéticas (RMs) foram feitas em um ano com um aparelho de imagem de 1,5 T MR (Magnetom AERA, Siemens, Erlangen, Alemanha). A análise de volume foi realizada com um software de medição mestre cerebral de RM gratuito e automatizado. As diferenças volumétricas entre os dois exames de RM foram calculadas e correlacionadas com os parâmetros demográficos e clínicos dos pacientes. RESULTADOS: Número de crises, duração da doença, escores BDI e FSS foram mais elevados no grupo 2; as pontuações do SDMT foram maiores no grupo 1. Como esperado, as análises volumétricas mostraram perda total de volume de substância branca no seguimento (p < 0,001). Além disso, a perda da dominância putaminal foi associada ao maior número de ataques. Além disso, uma relação negativa entre FSS e volume total da amígdala, e uma correlação entre ARR e BDI e atrofia do globo pálido foi determinada com a ajuda da análise de rede. CONCLUSõES: Além da demonstração visual da perda de volume, a RM com análise volumétrica tem grande potencial para revelar alterações segmentares dominantes e conexões ocultas entre parâmetros clínicos.

Diagnostic Efficacy of Ultrasonography, Doppler Ultrasonography and Elastography in the Evaluation of Suspected Malignant Lymph Nodes.

Aim: In this prospective study, the efficiency of imaging findings was investigated by comparing the histopathological results of lymph nodes with Doppler and ultrasound features and elasticity scores. Material and method: A total of 100 cervical or axillary lymph nodes with a suspected malignancy or whose size did not decrease after treatment were examined. In addition to the demographic data of the patients, B-mode ultrasound, Doppler ultrasound, and elastography features of the lymph nodes were evaluated prospectively. The irregular shape, increased size, pronounced hypoechogenicity, presence of micro/macro calcification, short axis/long axis ratio >2, increased size of the short axis, increased cortex thickness, obliterated hilus or increased cortex thickness >3.5 mm were evaluated on ultrasound. Resistivity index, pulsatility index, acceleration rate and time were evaluated for intranodal arterial structures on color. Doppler ultrasound, strain ratio value and elasticity score were recorded on ultrasound elastography. After sonographic examination, patients underwent ultrasound-guided fine needle aspiration cytology or tru-cutting needle biopsy. Histopathological examination results of the patients were compared with the B-mode ultrasound, Doppler ultrasound, and ultrasound elastography. Results: When the individual and combined effects of the ultrasound, Doppler ultrasound, and ultrasound elastography were evaluated, the combination of all three imaging methods was found to have the highest sensitivity and the highest overall accuracy (90.4% and 73.9%). As an individual method Doppler ultrasound had the highest specificity (77.8%). B-mode ultrasound was found to have the lowest accuracy (56.7%) both in individual and combined evaluations. Conclusion: Addition of ultrasound elastography to the combination of B-mode and Doppler ultrasound findings increases diagnostic sensitivity and accuracy in the differentiation of benign and malignant lymph nodes.

Is there a relationship between fall status, cognition and cerebellar lobule volume in patients with multiple sclerosis?

In this prospective case control study, relationship of detailed cerebellar volumetric data and cognition in patients with multiple sclerosis considering falling status using 3 D MRI and network analysis were evaluated. Participants consist of 106 adults with relapsing-remitting multiple sclerosis. Scores of Montreal cognitive assessment test, symbol digit modality Test, nine-hole peg test, berg balance scale test, timed up and go test, timed 25-foot walk test were worse in faller group than non faller group (p < 0.05 for all tests). There was no significant difference in terms of cerebellar lobule volumes between groups. But using artificial intelligence (AI) based network analysis, we brought a new perspective to interpreting the relationship between the cerebellum, cognition, gait, and balance. Overall, data from the study suggest a possible relationship between cerebellar volume changes and cognitive dysfunction through connectivity analysis in patients with multiple sclerosis. Further studies are needed to examine this issue by using connectivity analysis.

Correlation of brain segmental volume changes with clinical parameters: a longitudinal study in multiple sclerosis patients / Correlação das alterações do volume segmentar cerebral com parâmetros clínicos: um estudo longitudinal em pacientes com esclerose múltipla

Abstract Objective To measure the cranial volume differences from 15 different parts in the follow-up of relapsing-remitting multiple sclerosis (RRMS) patients and correlate them with clinical parameters. Methods Forty-seven patients with RRMS were included in the study. Patients were grouped into two categories; low Expanded Disability Status Scale (EDSS) (< 3; group 1), and moderate-high EDSS (≥ 3; group 2). Patients were evaluated with Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MOCA), Symbol Digit Modalities Test(SDMT), Fatigue Severity Scale (FSS), and calculated Annualized Relapse Rate (ARR) scores. Magnetic resonance imaging (MRI) was performed with a 1.5T MRI device (Magnetom AERA, Siemens, Erlangen, Germany) twice in a 1-year period. Volumetric analysis was performed by a free, automated, online MRI brain volumetry software. The differences in volumetric values between the two MRI scans were calculated and correlated with the demographic and clinical parameters of the patients. Results The number of attacks, disease duration, BDI, and FSS scores were higher in group 2; SDMT was higher in group 1. As expected, volumetric analyses have shown volume loss in total cerebral white matter in follow-up patients (p < 0.001). In addition, putaminal volume loss was related to a higher number of attacks. Besides, a negative relation between FSS with total amygdala volumes, a link between atrophy of globus pallidus and ARR, and BDI scores was found with the aid of network analysis. Conclusions Apart from a visual demonstration of volume loss, cranial MRI with volumetric analysis has a great potential for revealing covert links between segmental volume changes and clinical parameters.

Resumo Objetivo Medir as diferenças de dominância craniana de 15 regiões diferentes no seguimento de pacientes com esclerose múltipla recorrente-remitente (EMRR) e correlacioná-las com parâmetros clínicos. Métodos Quarenta e sete pacientes com EMRR foram incluídos no estudo. Os pacientes foram agrupados em duas categorias; EDSS baixo (< 3; grupo 1) e EDSS médio-alto (≥ 3; grupo 2). Os pacientes foram avaliados com o Inventário de Depressão de Beck (BDI, na sigla em inglês), Montreal Cognitive Assessment (MOCA, na sigla em inglês), Symbol Digit Modality Tests (SDMT, na sigla em inglês), Fatigue Severity Scale (FSS, na sigla em inglês) e taxa de ataque anual (ARR, na sigla em inglês). Duas ressonâncias magnéticas (RMs) foram feitas em um ano com um aparelho de imagem de 1,5 T MR (Magnetom AERA, Siemens, Erlangen, Alemanha). A análise de volume foi realizada com um software de medição mestre cerebral de RM gratuito e automatizado. As diferenças volumétricas entre os dois exames de RM foram calculadas e correlacionadas com os parâmetros demográficos e clínicos dos pacientes. Resultados Número de crises, duração da doença, escores BDI e FSS foram mais elevados no grupo 2; as pontuações do SDMT foram maiores no grupo 1. Como esperado, as análises volumétricas mostraram perda total de volume de substância branca no seguimento (p < 0,001). Além disso, a perda da dominância putaminal foi associada ao maior número de ataques. Além disso, uma relação negativa entre FSS e volume total da amígdala, e uma correlação entre ARR e BDI e atrofia do globo pálido foi determinada com a ajuda da análise de rede. Conclusões Além da demonstração visual da perda de volume, a RM com análise volumétrica tem grande potencial para revelar alterações segmentares dominantes e conexões ocultas entre parâmetros clínicos.

Portal hypertension in familial Mediterranean fever patients

Introduction: Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by polyserositis and arthritis attacks, which are mediated by increased plasma levels of cytokines. Our hypothesis was that the increase in specific cytokines can also lead to portal hypertension, even in the absence of overt hepatic steatosis.MethodsWe designed a comparative cross-sectional study with 41 patients and 30 healthy individuals to show if there is a relationship between portal hypertension and FMF. B mode ultrasound and Doppler ultrasound were utilized to evaluate liver echogenicity, portal vein diameter, peak portal blood flow velocity, and portal vein flow direction, which are important diagnostic criteria for portal hypertension.ResultsSpleen and liver sizes and portal vein diameters of the FMF patients and the healthy controls were not significantly different. Imaging of 4 patients revealed periportal cuffing and one patient with periportal cuffing also had a fine granular appearance of the liver. The peak portal blood flow velocity of the FMF patients was lower than that of the control group (p<0.007).ConclusionThe FMF group had significantly lower peak portal blood flow velocity than the control group, indicating the existence of portal hypertension. However, the differences between the other findings that correlate with portal hypertension were not significant. (AU)

Introducción: La fiebre mediterránea familiar (FMF) es una enfermedad autoinflamatoria caracterizada por poliserositis y ataques de artritis que están mediados por niveles plasmáticos elevados de citocinas. Nuestra hipótesis fue que el aumento de citocinas específicas también puede conducir a hipertensión portal, incluso en ausencia de esteatosis hepática manifiesta.MétodosDiseñamos un estudio transversal comparativo con 41 pacientes con FMF y 30 individuos sanos para mostrar si existe una relación entre la hipertensión portal y la FMF. La ecografía en modo B y la ecografía Doppler se utilizaron para evaluar la ecogenicidad hepática, el diámetro de la vena porta, la velocidad máxima del flujo sanguíneo portal y la dirección del flujo de la vena porta, que son criterios de diagnóstico importantes para la hipertensión portal.ResultadosEl tamaño del bazo y del hígado y los diámetros de la vena porta de los pacientes con FMF y los controles sanos no fueron significativamente diferentes. Las imágenes de 4 pacientes revelaron manguito periportal y un paciente con manguito periportal también tenía un aspecto granular fino del hígado. La velocidad máxima del flujo sanguíneo portal de los pacientes con FMF fue menor que en el grupo control (p<0,007).ConclusiónEl grupo de FMF tuvo una velocidad máxima del flujo sanguíneo portal significativamente menor que el grupo control, lo que indica la existencia de hipertensión portal. Sin embargo, las diferencias entre los otros hallazgos que se correlacionan con la hipertensión portal no fueron significativas. (AU)

Portal hypertension in familial Mediterranean fever patients.

INTRODUCTION: Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by polyserositis and arthritis attacks, which are mediated by increased plasma levels of cytokines. Our hypothesis was that the increase in specific cytokines can also lead to portal hypertension, even in the absence of overt hepatic steatosis. METHODS: We designed a comparative cross-sectional study with 41 patients and 30 healthy individuals to show if there is a relationship between portal hypertension and FMF. B mode ultrasound and Doppler ultrasound were utilized to evaluate liver echogenicity, portal vein diameter, peak portal blood flow velocity, and portal vein flow direction, which are important diagnostic criteria for portal hypertension. RESULTS: Spleen and liver sizes and portal vein diameters of the FMF patients and the healthy controls were not significantly different. Imaging of 4 patients revealed periportal cuffing and one patient with periportal cuffing also had a fine granular appearance of the liver. The peak portal blood flow velocity of the FMF patients was lower than that of the control group (p<0.007). CONCLUSION: The FMF group had significantly lower peak portal blood flow velocity than the control group, indicating the existence of portal hypertension. However, the differences between the other findings that correlate with portal hypertension were not significant.

Progressive Multifocal Leukoencephalopathy Among Ibrutinib Treatment In Chronic Lymphocytic Leukemia.

INTRODUCTION: Both chronic lymphocytic leukemia (CLL) itself and the drugs used for its treatment, pose a risk for progressive multifocal leukoencephalopathy (PML). Although the relationship between Rituximab and PML is well known, case reports that have been recently published, suggest that ibrutinib; which is used in the treatment of CLL, may increase the risk of PML. CASE REPORT: Here, we report a case of 64 year-old female patient with CLL who was previously treated with rituximab, fludarabine and bendamustin but developed PML after receiving monotherapy with ibrutinib. According to Naranjo's algorithm, the causality relationship with the drug is possible with a score of 3. The patient initially exhibited neurological symptoms. Magnetic resonance of the brain revealed a bilateral asymmetric hyperintensity in the white matter involving the parietal and occipital lobules, and there was no mass effect, edema, hemorrhagic or iscemic lesions. No enhancement of contrast media was observed. The findings were consistent with demyelination and suggestive of PML. MANAGEMENT AND OUTCOME: Mirtazapine treatment was initiated. However, neurological sympthoms continuously progressed over the following weeks and the patient, aged 64, died six weeks after diagnosis of PML. DISCUSSION: PML is a rare and often fatal demyelinating disease of the central nervous system (CNS) that is exclusively seen in immunocompromised patients and there is no specific agent to treat PML. The case discussed here, highlights that the use of ibrutinib in chronic lymphocytic leukemia (CLL) therapy may result in PML.

Horner's Syndrome and Vertebral Artery Occlusion Concomitant With Brachial Plexus Injury in a Patient With Anterior Approach Cervical Disc Herniation Surgery.

Horner's syndrome is one of the rare complications after anterior approach intervertebral disc herniation surgery. Here, we described a 35-year-old male patient with Horner's syndrome accompanied by brachial plexus injury at the upper trunk level and vertebral artery occlusion after anterior ipsilateral approach cervical discectomy and cervical disc prosthesis operation. We are not aware of a similar case of these complications after this operation in the literature. After the six-month follow-up period the patient's Horner's syndrome slightly improved and he partially gained right upper extremity muscle strength.

Optic Nerve Tortuosity in Neurofibromatosis Type 1: A Rare Case Report.

Optic nerve tortuosity is a benign and usually asymptomatic optic nerve abnormality documented on magnetic resonance imaging. This abnormality has rarely been defined in neurofibromatosis type 1 (NF1) cases. In this case report, we present incidental optic nerve tortuosity in a housewife with NF1 without any ocular involvement. Optic nerve tortuosity may occasionally be an incidental finding in patients with NF1. Therefore, clinicians should be aware of this rare coexistence.

Intraspecific Genetic Diversity of Cistus creticus L. and Evolutionary Relationships to Cistus albidus L. (Cistaceae): Meeting of the Generations?

Cistus (Cistaceae) comprises a number of white- and purple-flowering shrub species widely distributed in the Mediterranean basin. Within genus Cistus, many taxa are subject to various taxonomic uncertainties. Cistus creticus, a prominent member of the purple-flowered clade, is a prime case of the current taxonomic troubles. Floras and databases approve different species names and utilise different or additional/fewer synonyms. Various intraspecific classification systems based on subspecies or varieties are in use. The inconsistent determination of plant material makes it difficult to compare literature regarding the phytochemical diversity and biological activities of plant material and impedes a systematic utilization of the manifold medicinal properties of C. creticus. In the present investigation, we used DNA sequence data from one nuclear region (ITS) and two chloroplast regions (trnL-trnF, rpl32-trnL) to test the intraspecific genetic diversity of C. creticus and its evolutionary relationships to the closely related C. albidus. The combined DNA data confirmed C. creticus as a rather heterogeneous species that integrates two major evolutionary lineages with clearly different genetic characteristics. The 'Eastern Mediterranean clade' seems to represent old and ancestral characteristics. This lineage exhibits a close relationship to the geographically distant C. albidus, expressed by very closely related ribotypes and an interspecifically shared chlorotype. The 'Western Mediterranean clade' is characterized by a distinctive ITS polymorphism (co-occurring paralogous ribotypes) and more distantly related chlorotypes. The formation of the genetically complex 'Western Mediterranean clade' seems to have involved hybridization and recurrent formation or migration movements.

How did radiologists' diagnostic performance has changed in COVID-19 pneumonia: A single-centre retrospective study.

AIMS: Delay and false positivity in PCR test results have necessitated accurate chest CT reporting for the management of patients with COVID-19-suspected symptoms. Pandemic related workload and level of experience on covid-dedicated chest CT scans might have affected the diagnostic performance of on-call radiologists. The aim of this study was to reveal the interpretation errors (IEs) in chest CT reports of COVID-19-suspected patients admitted to the Emergency Room (ER). METHODS: Chest CT scans between March and June 2020 were re-evaluated and compared with the former reports and PCR test results. CT scan results were classified into four groups. Parenchymal involvement ratios, radiology departments' workload, COVID-19-related educational activities have been examined. RESULTS: Out of 5721 Chest CT scans, 783 CTs belonging to 664 patients (340 female, 324 male) were included in this study. PCR test was positive in 398; negative in 385 cases. PCR positivity was found to be highest in "normal" and "typical for covid" groups whereas lowest in "atypical for covid" and "not covid" groups. 5%-25% parenchymal involvement ratio was found in 84.2% of the cases. Regarding the number of chest CT scans performed, radiologists' workload has found to be increased six-folds. With the re-evaluation, a total of 145 IEs (18.5%) have been found. IEs were mostly precipitated in the first two months (88.3%) and mostly in the "not covid" class (60%) regardless of PCR positivity. COVID-19 and radiology entitled educational activities along with the ER admission rates within the first two months of the pandemic have seemed to be related to the decline of IEs within time. CONCLUSION: COVID-19 pandemic made a great impact on radiology departments with an inevitable burden of daily chest CT reporting. This workload and concomitant factors have effects on diagnostic challenges in COVID-19 pneumonia.

Impact of magnetic resonance on the decision of conservative surgery in advanced larynx cancer.

OBJECTIVE: To evaluate the utility of magnetic resonance images (MRI) in the selection of treatment procedures for intermediate-advanced laryngeal cancers. MATERIAL AND METHOD: This study included patients with histologically proven laryngeal squamous cell carcinoma defined as cT3 and T4a at our tertiary academic care hospital. All scans were evaluated by two radiologists experienced in head and neck cross-sectional studies. Signal patterns in MRI sections of laryngeal compartment subsites were delineated as T1w, T2w hyperintensity, and T2w intermediate signals, and were compared with the postoperative pathological results. Sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were calculated. RESULTS: The study included 51 patients with a mean age of 62.55 ± 9.14 (range, 45-80) years. Tumor was glottic in 12 (23.5%) patients, supraglottic in 19 (31.4%) patients, glottic-supraglottic in 11 (21.6%) patients, transglottic in 9 (27%) patients. The posterior paraglottic space had the strongest specificity of MRI according to tumor infiltration in the histologic analysis (specificity 96.9% and sensitivity 78.6%). The specificity of MRI was poor for tumor infiltration in thyroid cartilage (specificity 70.0%). Spearman's test demonstrated that there was a statistically significant correlation between the MRI-based prediction scores of all subunites and the findings of histopathologic analyses (mean±SD: 4.96±4.46-5.53±4.38, respectively, R2: 0.711, p<0.001). CONCLUSION: The high specificity values of the predictions, which were MRI-based in all subsites, indicated that MRI could provide an important contribution for defining tumor infiltration and the presurgical assessment of patients with tumors of the larynx.

Experimental study of butane adsorption on coconut based activated carbon for different gas concentrations, temperatures and relative humidities.

In this paper, the adsorption behaviour of activated carbon was investigated experimentally for changing butane concentration, temperature and relative humidity. Throughout the study, the coconut-based activated carbon was used. During the tests applied for butane concentration of 2, 4, 8, 20, 40 and 80 ppm, the temperature was taken as 15, 23 and 33°C for a relative humidity of 50, 70 and 90%. The results showed that butane concentration had a direct relationship with adsorption. However, temperature and adsorption were inversely proportional. As a result of the adsorption between activated carbon and butane, it led to physical adsorption as one of the most important types of adsorption due to Van der Waals forces among molecules. To create physical adsorption, lower temperature ranges were more convenient. The relative humidity of the air reduced the time to reach the maximum saturation rate. The increased relative humidity also reduced the amount of butane adsorbed. Also, 50% relative humidity range was an important turning point. Relative humidity affected the adsorption of butane at a relative humidity of 50%. However, the relative humidity at 70 and 90% significantly reduced butane adsorption; on the other hand, it considerably increased the adsorption of moisture.

Endoscopic Ultrasound-Guided Fine Needle Aspiration Using a 22-G Needle for Hepatic Lesions: Single-Center Experience.

BACKGROUND/AIMS: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has been accepted as a reliable tool in diagnosing and staging intra-abdominal tumors. In this study, we aimed to investigate the performance of EUS-FNA in the evaluation of liver masses and its impact on patient management and procedure-related complications retrospectively. METHODS: Data of patients who underwent EUS-FNA biopsies due to liver masses between November 2017 and July 2018 were retrieved retrospectively. Biopsies were performed using 22-G needles. The demographics, EUS-FNA results, sensitivity and specificity of the procedure, negative predictive value, positive predictive value, and specimen sufficiency rates were assessed. RESULTS: A total of 25 patients (10 females) were included in the study. The mean age was 62.73±15.2 years. The mean size of the masses was 34.50±16.04 mm. The technical success rate was 88%. During the EUS-FNA procedure, each patient had only one pass with 94.45% of aspirate sufficiency rate and 86.3% of biopsy sufficiency rate. The diagnostic accuracy rate was 86.3%. There were no complications. CONCLUSION: For the evaluation of liver masses, EUS-FNA using a 22-G needle with even one pass had high aspiration and biopsy success rates accompanied with high diagnostic accuracy rates.

Comparison of diagnostic accuracy of ACR-TIRADS, American Thyroid Association (ATA), and EU-TIRADS guidelines in detecting thyroid malignancy.

PURPOSE: This study aims to compare three guidelines according to their diagnostic accuracy in the management of thyroid nodules. METHODS: A total of 540 patients with 597 thyroid nodules were enrolled in this study. Sonographic images were classified and scored with the American Thyroid Association (ATA-2015), American College of Radiology (ACR), and European Thyroid Association (EU) Thyroid Imaging, Reporting, and Data Systems (ACR-TIRADS and EU-TIRADS) guidelines. Fine-needle aspiration biopsy (FNAB) was performed, and cytopathological results were reported with the Bethesda system. Outcomes of these three classification systems were then correlated with Bethesda results. RESULTS: FNAB procedures revealed a total of 447 benign and 45 malignant nodules. With guideline dedicated FNAB criteria; 38 malignant nodules could have been diagnosed with ATA-2015, which is followed by 34 nodules with ACR-TIRADS, and 31 nodules with EU-TIRADS. Nonetheless, 301 benign nodules would have been biopsied with ATA-2015, 143 benign nodules with ACR-TIRADS, 222 benign nodules with EU-TIRADS. The accuracy rate was found to be highest with ACR-TIRADS (59.93 %); while 55.20 % with ATA-2015 and 51.25 % with EU-TIRADS. The sensitivity and specificity ratios of these guidelines were as follows; ATA-2015 (82.22, 53.47), ACR-TIRADS (48.89, 60.63), and EU-TIRADS (86.67, 48.99). A total of 23 nodules (3.8 %) could not be classified with ATA-2015. CONCLUSION: Diagnostic strengths, unnecessary recommended FNAB rates, and categorization capabilities differ among various guidelines. Clinicians and interventional radiologists should keep in mind these features in the management of thyroid nodules.

Hydration status and blood pressure variability in primary hypertensive patients / Estado de hidratación y variabilidad en la presión arterial en pacientes con hipertensión primaria

BACKGROUND: Increased blood pressure variability (BPV) is associated with higher cardiovascular risk. The association between BPV and fluid status in hypertensive patients has not been investigated so far. The aim of the present study was to determine the contribution of fluid balance to BPV and impact on endothelial and cardiac functions among primary hypertensive patients. METHODS: This is a prospective interventional study conducted in primary hypertensive patients with one-year follow-up. Volume status measurements by a body composition monitor, ambulatory blood pressure (BP) monitoring, echocardiographic and carotid intima-media thickness (CIMT) measurements were performed at enrollment and at twelfth. Patients in one of the two groups were kept negative hydrated during trial with diuretic treatment. Patients in other group were positively hydrated (hypervolemic) at enrollment, antihypertensive drugs other than diuretics (vasodilator agents) were added or intensified according to the BP monitoring. Average real variability (ARV) index was used for establishing the prognostic significance of BPV. RESULTS: The study population consisted of 50 patients with a mean age of 54.5±8.8 years. At the end of one-year follow-up, patients in negative hydrated group were found to have significantly lower BP, CIMT, left ventricle mass index (LVMI) and systolic and diastolic ARV. More weight gain and higher systolic BP were major risk factors of high systolic ARV. Patients who have improvement in CIMT and LVMI were considered as target organ damage (TOD) recovery present. In negatively hydrated group, TOD significantly reduced during trial. In patients who have TOD recovery, BPV significantly more reduced like systolic and diastolic BP. Significant risk factors associated with the presence of TOD were 24h systolic BP and daytime and night time diastolic ARV and night time diastolic BP. CONCLUSION: Addition of diuretic to established treatment or intensified diuretic treatment and keeping patients in negative hydration status resulted in reduction in BPV at twelfth month of follow-up. More weight gain and higher systolic BP are major risk factors of high systolic ARV, but not hypervolemia. BPV, especially diastolic ARV, was significantly associated with TOD

ANTECEDENTES: El aumento en la variabilidad en la presión arterial (VPA) se asocia con un mayor riesgo cardiovascular. Hasta el momento no se ha investigado la asociación entre la VPA y el estado hidroelectrolítico en pacientes hipertensos. El objetivo del presente estudio fue determinar la contribución del equilibrio hidroelectrolítico a la VPA y el impacto en las funciones endoteliales y cardíacas entre los pacientes con hipertensión primaria. MÉTODOS: Se trata de un estudio intervencionista prospectivo realizado en pacientes con hipertensión primaria con seguimiento de un año. Se llevaron a cabo mediciones del estado volumétrico mediante un monitor de composición corporal, monitorización de presión arterial (PA) ambulatoria, mediciones ecocardiográficas y del grosor de la íntima-media de la carótida (GIMC) en la inclusión y en el duodécimo mes. En los pacientes de uno de los 2 grupos se mantuvo hidratación negativa durante el ensayo con tratamiento diurético. Los pacientes de otro grupo presentaban hidratación positiva (hipervolemia) en la inclusión, y se añadieron o se intensificaron los fármacos antihipertensivos distintos de los diuréticos (vasodilatadores) en función de la monitorización de la PA. Se utilizó el índice de variabilidad real promedio (VRP) para establecer la significación pronóstica de la VPA. RESULTADOS: La población del estudio consistió en 50 pacientes con una media de edad de 54,5±8,8 años. Al final del seguimiento, al cabo de un año, los pacientes del grupo con hidratación negativa presentaron una PA, un GIMC, un índice de masa del ventrículo izquierdo (IMVI) y una VRP sistólica y diastólica significativamente menores. El mayor aumento de peso y una PA sistólica superior fueron factores de riesgo importantes de la VRP sistólica alta. Los pacientes con mejoras en el GIMC y el IMVI se consideraron pacientes con recuperación del daño de órganos diana (DOD). En el grupo con hidratación negativa, el DOD se redujo significativamente durante el ensayo. En los pacientes con recuperación del DOD, la VPA se redujo significativamente en mayor medida, al igual que la PA sistólica y diastólica. Los factores de riesgo significativos asociados con la presencia de DOC fueron la PA sistólica de 24h, la VPA diastólica diurna y nocturna y la PA diastólica nocturna. CONCLUSIÓN: La adición de diuréticos al tratamiento establecido o la intensificación del tratamiento diurético y el mantenimiento de los pacientes en estado de hidratación negativa provocó la reducción de la VPA en el duodécimo mes de seguimiento. El mayor aumento de peso y una PA sistólica superior son factores de riesgo importantes de VRP sistólica alta, pero no así la hipervolemia. La VPA, en especial la VPA diastólica se asoció de forma significativa al DOD