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Objectives: We recently reported the first controlled Doppler ultrasonography (US) study demonstrating increased common femoral vein (CFV) thickness in Behçet's Disease (BD). Standard lower extremity venous Doppler US is performed in erect position. In order to confirm accuracy and applicability of method, we measured CFV thickness in both supine and standing positions in this study. Method: We included sex and age-matched 42 BD patients and 41 healthy controls (HCs). After routine visits, bilateral CFV thickness was measured with Doppler US both in supine and standing positions. Results: Bilateral CFV thickness was significantly higher in BD than in HC. There were no statistically significant differences in measurements of CFV wall thickness between standing and supine positions in both groups. Conclusions: CFV measurement by Doppler US is a new and non-invasive diagnostic tool for the diagnosis of BD. Our study confirmed that patient position does not affect CFV wall thickness measurement for diagnosis of BD. [ABSTRACT FROM AUTHOR]

The article evaluates the effectiveness of femoral vein wall thickness measurement in patients with suspected Behcet's disease. Topics mentioned the specificity and sensitivity of common femoral vein thickness, the need of immediate immunosuppressive treatment of patients with Behcet disease thrombosis, and the use of anticoagulants in the management of non-inflammatory thrombosis.

Backgrounds: Behçet's disease (BD) and Crohn's disease (CD) cannot be easily differentiated in young adults presenting with nonspecific gastrointestinal (GI) manifestations due to similar extraintestinal manifestations. We recently showed that increased common femoral vein (CFV) thickness is a distinctive feature of BD, rarely present in other inflammatory or vascular diseases with a specificity higher than 80% for the cutoff value of ≥ 0.5 mm. We suggest that CFV thickness measurement with ultrasonography (US) can be a diagnostic tool for BD. Aims: To assess the diagnostic performance of CFV thickness measurement in the differential diagnosis of BD and CD. Methods: Patients with BD (n = 69), CD (n = 38), and healthy controls (HC) (n = 38) were included in the study. Bilateral CFV thickness was measured with Doppler US. Results: Both right and left CFV thicknesses were significantly higher in BD compared to HC and CD (for right: 0.76 mm vs 0.33 mm, for left: 0.78 mm vs 0.35 mm, p < 0.001 for both). CFV thicknesses in CD were similar to HC (p > 0.05 for both). CFV thickness was also similar between BD patients with and without GI involvement (p = 0.367). The diagnostic cutoff values of ≥ 0.5 mm for CFV thickness performed well against to both CD and HCs for discrimination of BD. The sensitivity and specificity rates were > 85% for both HC and CD. Positive and negative predictive values in our tertiary clinical setting were > 90%. Conclusion: We found significantly lower CFV thickness in CD compared to BD. Our results suggest that CFV wall thickness measurement is a distinctive diagnostic tool for the differentiation of BD and CD and can be helpful in daily practice for the differentiation of two diseases. [ABSTRACT FROM AUTHOR]

Objectives Diagnosing Behçet's disease (BD) is a challenge, especially in countries with a low prevalence. Recently, venous wall thickness (VWT) in lower extremities has been shown to be increased in BD patients. In this study, we aimed to investigate the diagnostic performance of common femoral vein (CFV) thickness measurement in BD and whether it can be used as a diagnostic tool. Methods. Patients with BD (n  = 152), ankylosing spondylitis (n  = 27), systemic vasculitides (n  = 23), venous insufficiency (n  = 29), antiphospholipid syndrome (APS; n  = 43), deep vein thrombosis due to non-inflammatory causes (n  = 25) and healthy controls (n  = 51) were included in the study. Bilateral CFV thickness was measured with ultrasonography by a radiologist blinded to cases. Results Bilateral CFV thickness was significantly increased in BD compared with all control groups (P  < 0.001 for all). The area under the receiver operating characteristic curve for bilateral CFV thicknesses in all comparator groups was >0.95 for the cut-off value (0.5 mm). This cut-off value also performed well against all control groups with sensitivity rates >90%. The specificity rate was also >80% in all comparator groups except APS (positive predictive value: 79.2–76.5%, negative predictive value: 92–91.8% for right and left CFV, respectively). Conclusion Increased CFV thickness is a distinctive feature of BD and is rarely present in healthy and diseased controls, except APS. Our results suggest that CFV thickness measurement with ultrasonography, a non-invasive radiological modality, can be a diagnostic tool for BD with sensitivity and the specificity rates higher than 80% for the cut-off value ≥0.5 mm. [ABSTRACT FROM AUTHOR]

Vascular involvement, especially in young males, is seen in up to 40% of the patients with Behcet's disease (BD) and is a major cause of mortality and morbidity. In this study, we investigated vessel wall thickness (VWT) and dilatation in lower extremity veins with Doppler ultrasound (US) in male BD patients. Sixty-one male patients with BD, 37 healthy male controls (HC) and 27 male patients, with ankylosing spondylitis (AS), were included in the study. Venous Doppler US was performed by an experienced radiologist blinded to cases. Bilateral common femoral vein (CFV) wall thickness and great/small saphenous vein (SV) dilatations were assessed. All venous measurements were significantly higher in BD compared to AS and HC (p < 0.001 for all). Both right and left extremity CFV thicknesses had a high area under the ROC curve (> 0.8). Cut-off values for right and left CFV thicknesses for BD was 0.49 and 0.48 mm, respectively. High sensitivity and specificities are observed for both measurements (right CFV: sensitivity 81%, specificity 78.4%; left CFV: sensitivity 82.8%, specificity 81.1%). We found increased CFV thickness in BD patients independent of vascular involvement. As a similar change was not observed in controls, increased CFV thickness may be a specific sign of venous inflammation in BD. Our acceptable sensitivity and specificity values of CFV measurements suggest that assessment of femoral vein thickness with US may be a candidate diagnostic tool, especially in young males suspected of BD. [ABSTRACT FROM AUTHOR]

Amaç: Behçet hastalığında (BH) artmış common femoral ven (CFV) duvar kalınlığını gösteren kontrollü ultrason çalışması ilk defa tarafımızca bildirilmiştir. Artmış CFV duvar kalınlığının, BH'nin ayırt edici bir özelliği olduğu, diğer enflamatuvar/vasküler hastalıklarda nadiren görüldüğü ve ≥0,5 mm'lik cutoff değeri için özgüllüğün %80'den yüksek olduğu tarafımızca gösterilmiştir. CFV duvar kalınlığı ile hastalığa bağlı herhangi bir organ tutulumu, hastalık seyri, tedaviler arasında herhangi bir ilişki saptanamamıştır. Burada prospektif takip edilen BH'lerin, CFV duvar kalınlık ölçümünün uzun dönem seyrini ve prognostik değerini değerlendirmeyi amaçlanmıştır. Yöntem: Çalışmaya 195 BH alındı. Ultrasonografi ile bilateral CFV duvar kalınlığı ölçüldü. Hastalar prospektif olarak 3-6 aylık aralıklarla takip edildi. Bulgular: Hastaların %98,6'sının başlangıç CFV duvar kalınlığı ≥0,5 mm'lik cut-off'un üzerindedir. Tanı ve takiplerindeki klinik özellikler Tablo 1'dedir. Yüz doksan beş hastanın 139'unun ortalama 26,5 (16,9) aylık prospektif takip verileri mevcuttur. Otuz dokuz (%28) hastada tedavi değişikliğine yol açan yeni majör organ tutulumu ve/veya relaps görülmüştür. Başlangıçta sadece mukokutanöz hastalığı olan 36 hastanın 9'unda takip sırasında yeni majör organ tutulumu gelişmiştir. Bu dokuz hastanın bazal CFV duvar kalınlıkları, majör organ tutulumu olmayan hastalara kıyasla klinik anlamlılığa ulaşmasa da daha yüksek ölçülmüştür (sağ: 0,83 mm'ye 0,73 mm, sol: 0,80 mm'ye 0,73 mm). Kırk yedi hastada, ilk vizitten ortalama 19,8 ay sonra ikinci CFV kalınlığı ölçülmüştür. Her iki CFV'lerin birinci ve ikinci CFV duvar kalınlığı ölçümleri arasında anlamlı bir fark saptanmamıştır (sağ: birinci ve ikinci: 0,79 ve 0,76 mm, p=0,26; sol: 0,79 ve 0,75 mm, p=0,26). Tedavi modalitesi, yeni organ tutulumu ve relapslara bağlı CFV duvar kalınlığında herhangi bir değişiklik tespit edilmemiştir. Sonuç: BH için yeni bir non-invaziv tanı aracı olan ultrasonografi ile CFV duvar kalınlığı ölçümü, tedavi modalitesi, yeni organ tutulumu veya nükslerle anlamlı değişiklik göstermemektedir. Ayrıca ön sonuçlarımız daha yüksek CFV kalınlığına sahip mukokutanöz BH'de takipte majör organ tutulumu riskinin daha yüksek olabileceğini düşündürmektedir. [ABSTRACT FROM AUTHOR]

The histopathological data about vascular inflammation in Behçet's disease(BD) mainly comprises patients with arterial involvement. Inflammatory cell infiltration was mainly observed around the vasa vasorum and adventitial layer of the aneurysmatic vessels, and only a few cells were seen in the intimal layer during active arteritis. There is limited data for the histopathology of venous inflammation. We recently showed that increased common femoral vein(CFV) wall thickness is a specific sign of vein wall inflammation in BD. We aimed to investigate the different vein subsections measuring the whole wall and the intima-media thickness(IMT) of CFV with ultrasonography in BD. We found increased IMT of CFV compared to controls as well as CFV wall thickness. This study shows that there is a full layer venous wall inflammation in BD independent of vascular involvement. Our results suggest that venous endothelial inflammation may trigger the thickening of the vein wall and cause thrombotic tendency in BD. • We found increased intima-media thickness of CFV in BD compared to controls as well as whole wall thickness. • These results suggest a full layer venous wall inflammation in BD. • Endothelial inflammation may trigger the thickening of the vein wall and cause thrombotic tendency in BD. [ABSTRACT FROM AUTHOR]

Objective: Necrotizing enterocolitis (NEC) is one of the most common conditions requiring surgical intervention in the neonatal period. The decision for surgical intervention in NEC is difficult and the surgical procedures differ according to the condition of the patient. This study assesses the decision for surgical intervention in patients being followed with a preliminary diagnosis of NEC and the appropriate surgical procedure. Material and Method: The files of patients undergoing surgery with a diagnosis of NEC at the Marmara University Hospital Neonatal Intensive Care Unit between 15.07.2013- 15.07.2015 were studied retrospectively. Patients were evaluated for the following: gestational age, birth weight, gender, time of onset of symptoms, abdominal distention, tenderness, presence of abdominal erythema, hypotension, acidosis, thrombocytopenia, radiological findings, surgical timing and post-operative follow up. Results: A total of 10 neonates (7 boys, 3 girls) were treated surgically with an NEC diagnosis. The average gestational age of the patients was 27.6 weeks (22-37 weeks), and the median birth weight was 710 grams (400-3750). Average onset of symptoms was found to be 8.1 days (2-30) postnatally. Abdominal distention and tenderness (10), hypotension (4), and abdominal erythema (3) were observed in patients upon physical examination. Acidosis (7) and thrombocytopenia (6) were observed in patients in laboratory findings. Free fluid (4), thickening of the intestinal wall ans (3), pneumatosis intestinalis (1), portal venous gas (1) were observed in patients during the assessment of the abdominal ultrasonography (US). Three patients whose direct x-ray evaluations were grade III underwent peritoneal drainage. The drain site of one of these patients closed by itself, and there was no need for further surgery for the patient. Laparotomy was carried out a day after clinical stabilization was achieved. Our third patient, the lowest birth weight in our series, was lost immediately following the peritoneal drainage process. Peritoneal drainage was planned in two other grade III patients based on the radiological findings. However, due to the appearance of necrotic bowel segments from the incision site, they underwent bowel resection and ileostomy during a bedside laparotomy. One of these patients improved clinically, but the other patient was lost in the early stages. Due to the deterioration seen in the clinical findings of 5 patients who were radiologically grade II, the decision for laparotomy was made initially. All of these 5 patients were discharged after an uneventful postoperative period. Conclusion: In patients who are grade II radiologically, the decision for surgical intervention in an operating room can be made according to clinical deterioration. In infants who are grade III, and whose clinical condition is poor, bedside surgical intervention in the neonatal intensive care unit is preferable. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of our study was to determine apparent diffusion coefficients (ADCs) of focal liver lesions on the basis of respiratory triggered diffusion-weighted single-shot echo-planar MR imaging (DWI-SS-EPI) sequence and to evaluate whether ADC measurements can be used to characterize lesions. Patients and Methods: One hundred and eighteen patients with 134 focal liver lesions [35 cysts, 48 hemangiomas, 4 focal noduler hyperplasias (FNH), 31 metastases, 14 hepatocellular carsinomas (HCCs), 1 fibrolamellar carsinoma, 1 cholangiocellular carcinoma; mean size 18.4 mm; range 10-140 mm] were examined on a 1.5-T system using respiratory triggered DWI-SS-EPI (b-values: 50, 400, 800 s/mm2). Results: Results were correlated with characteristic MRI findings, histopathologic data and follow-up imagings. The ADCs of different lesion types were compared and lesion differentiation using optimal thresholds for ADCs was evaluated. Mean ADCs (x10-3 mm2/s) were 2.15, 1.57, 1.16, 1.08, 1.03 for cysts, hemangiomas, FNHs, metastases and HCCs, respectively. Mean ADCs differed significantly for all lesion types except metastases, HCCs and FNHs. Overall, 88.5% of lesions were correctly classified as benign or malignant using a treshold value of 1.20x10-3mm²/s. Conclusion: Measurements of the ADCs of focal liver lesions on the basis of a respiratory triggered DWI-SS-EPI sequence may constitute a useful supplementary method for lesion characterization. [ABSTRACT FROM AUTHOR]

Background: Liver fibrosis is an important prognostic determinant in patients with nonalcoholic steatohepatitis (NASH). Hepatic artery resistivity index (HARI) is a doppler ultrasonography (US) parameter that is used to follow up microcirculatory resistance in fatty liver. We aimed to asses whether it is possible to demonstrate significant fibrosis by means of doppler US in comparison with transient elastography (TE) and liver biopsy in NASH patients. Patients and methods: A total of 63 (mean age 47.1 ± 8.4 years, 39 male, 24 female) biopsy-proven NASH patients were enrolled in this prospective study. The study population was classified into two groups: significant and no-significant fibrosis patients. Doppler US and TE were performed in two groups. Results: HARI and TE values were significantly higher in significant fibrosis group (0.81 ± 0.05 vs. 0.63 ± 0.14, p < 0.0005; 15.9 ± 4.8 vs. 6.2 ± 2.6 kilopascals, p < 0.0005; respectively). Based on the ROC curve, the optimal cut-off value of HARI for a significant fibrosis was >0.75, which yielded a sensitivity of 78% and a specificity of 75%, with the area under the curve at 0.90. The optimal cut-off value of TE for a significant fibrosis was >9.8 kilopascals, which yielded a sensitivity of 90% and a specificity of 91%, with the area under the curve at 0.95. HARI values were moderately correlated with TE values ( r = 0.53, p < 0.001). Conclusion: Doppler US has moderate % sensitivity and % specificity, which is lower compared with TE for the diagnosis significant fibrosis. However, it may be used as an alternative method for the assessment of fibrosis in patients with NASH who are not good candidates for TE evaluation. [ABSTRACT FROM AUTHOR]

Amaç: Grubumuz Behçet hastalığında (BH) artmış ana femoral ven kalınlığını gösteren ilk kontrollü Doppler ultrasonografi (USG) çalışmasını yayınlamış ≥0,5 mm'lik cut-off değeri için %80'in üzerinde duyarlılık ve özgünlükle BH'nin ayırt edici bir özelliği olduğunu göstererek, BH için tanısal bir test olarak kullanılabileceğini önermişti. Daha önce yapılan tüm çalışmalarımızda, ana femoral ven duvar kalınlığı sırt üstü yatar pozisyonda ölçülmüştü. Standart alt ekstremite venöz Doppler USG uygulamalarının, venöz tromboz veya yetmezlik için dik pozisyonda yapıldığı bilindiğinden, bu çalışmada, bu ölçümün BH'de doğruluğunu ve uygulanabilirliğini teyit etmek için hem supin hem de dik pozisyonda Doppler USG ile ölçülen ana femoral ven duvar kalınlığının değerlendirilmesi amaçlanmıştır. Yöntem: Çalışmaya Marmara Üniversitesi Behçet Kliniği'nde BH tanısı almış 42 hasta [Erkek/kadın: 27/15, ortalama yaş: 39,8 (10,04) yıl] ve yaş ve cinsiyet açısından eşleştirilmiş 41 sağlıklı kontrol [Erkek/kadın: 21/18, ortalama yaş: 36,5 (8,4) yıl] dahil edilmiştir. Demografik ve klinik veriler rutin vizitleri sırasında kaydedilerek, bilateral ana femoral ven kalınlığı aynı gün deneyimli bir radyolog tarafından hem ayakta hem de supin pozisyonda Doppler USG ile ölçülmüştür. Bulgular: BH hastalarının klinik özellikleri Tablo 1'de verilmiştir. Bilateral ana femoral ven duvar kalınlığı BH'de sağlıklı kontrollere göre anlamlı olarak daha yüksekti (0,74 vs. 0,18 mm, sağ ana femoral ven, p<0,001, 0,74 vs. 0,19 mm, sol ana femoral ven, p<0,001). Hem BH hem de sağlıklı kontrol gruplarında ayakta ve supin ölçülen ana femoral ven duvar kalınlığı ölçümleri arasında istatistiksel olarak anlamlı bir fark yoktu (Resim 1). Sonuç: Doppler USG ile ana femoral ven duvar kalınlığı ölçümü, BH tanısı için yeni, kolay uygulanabilir ve non-invaziv bir tanı aracı olarak kullanılabilir. Alt ekstremite venöz Doppler USG, venöz tromboz veya yetersizliğin değerlendirilmesi için ayakta yapılmasına rağmen, çalışmamız BH'de hasta pozisyonunun ana femoral ven duvar kalınlığı ölçümünü etkilemediğini, her iki şekilde de ölçüm yapılabileceğini göstermiştir. [ABSTRACT FROM AUTHOR]

Amaç: Behçet hastalığının gastrointestinal tutulumu ile enflamatuvar barsak hastalığının (İBH) ayırt edilmesi günlük pratikte oldukça zor olabilmektedir. Daha önce yaptığımız bir çalışmada, Behçet hastalarında ana femoral ven kalınlığının (FVK) Crohn hastalarına göre anlamlı olarak daha yüksek olduğunu saptamıştık. Bu çalışmada ise hem Crohn hem de ülseratif kolit (ÜK) tanılı İBH hastalarında FVK ölçümünü Behçet hastalarıyla karşılaştırmayı amaçladık. Yöntem: Çalışmaya 117 Behçet hastası, 87 İBH hastası (53 Crohn, 34 ÜK) ve 85 yaş cinsiyet uyumlu sağlıklı kontrol dahil edildi. Hastalar rutin vizite geldikleri sırada FVK deneyimli radyologlar tarafından Doppler ultrasonografi ile ölçüldü, hastalık ilişkili veriler hasta dosyalarından kaydedildi. Bulgular: Hastaların ve kontrollerin demografik özellikleri Tablo 1'de verilmiştir. Behçet hastalarının 70'inde (%59,8) majör organ tutulumu [48 (%41,0) vasküler, 21 (%30,0) oküler, 11 (%15,7) gastrointestinal, 8 (%11,4) nörolojik] mevcuttu. Ortalama sağ FVK ölçümleri Behçet, İBH ve sağlıklı kontroller için sırasıyla; 0,75±0,21 mm, 0,32±0,08 mm, ve 0,28±0,13 mm idi. Ortalama sol FVK ölçümleri Behçet, İBH ve sağlıklı kontroller için sırasıyla; 0,76±0,21 mm, 0,32±0,09 mm, ve 0,28±0,13 mm idi. Behçet hastalarında sağ ve sol FVK ölçümleri, İBH hastaları ve sağlıklı kontrollere göre anlamlı olarak yüksek saptandı (p<0,001). Bilateral FVK ölçümleri sağlıklı kontroller ve İBH hastaları arasında benzer saptandı (p>0,05). Majör organ tutulumu olan ve olmayan Behçet hastaları karşılaştırıldığında, sağ ve sol FVK ölçümleri benzer saptandı (sırasıyla, p=0,53 ve p=0,21). FVK ölçümleri aynı zamanda gastrointestinal tutulumu olan ve olmayan Behçet hastaları arasında da benzer saptandı (sırasıyla, p=0,64 ve p=0,27). İBH hastaları içinde sağ ve sol FVK ölçümlerinde Crohn ve ÜK hastaları arasında anlamlı fark saptanmadı (sırasıyla, p=0,13 ve p=0,14). Sonuç: Behçet hastalarında FVK ölçümü hem Crohn hem de ÜK hastalarına göre anlamlı olarak yüksek saptandı. Bu sonuçlar günlük pratikte İBH ile Behçet hastalığı gastrointestinal tutulumunun ayırt edilmesinde FVK ölçümünün kullanılabileceğini göstermektedir. [ABSTRACT FROM AUTHOR]

Amaç: Behçet hastalığının vasküler tutulumunda, aktif arterit sırasında enflamatuvar hücrelerin özellikle adventita ve media tabakalarını infiltre ettiği, intima tabakasında çok az enflamatuvar hücre görüldüğü bildirilmiştir. Grubumuzun yaptığı çalışmada femoral ven duvar kalınlığının (FVK) 0,5 mm ve üzerinde olmasının %80'in üzerinde bir özgünlük ile Behçet hastalığının ayırt edici bir özelliği olduğu gösterilmişti. Bu çalışmada, Behçet hastalarında ven duvarındaki enflamasyonun yaygınlığının hem FVK hem de femoral ven intima media kalınlığının (İMK) ölçülerek araştırılması amaçlandı. Yöntem: Çalışmaya 42 Behçet hastası (27E/15K) ve yaş-cinsiyet uyumlu 35 sağlıklı kontrol (21E/14K) dahil edildi. Hastaların demografik ve klinik verileri rutin vizitler sırasında doldurulan dosyalarından elde edildi. FVK ve İMK deneyimli bir radyolog tarafından Doppler ultrasonografi ile ölçüldü. Bulgular: Behçet hastalarının yaş ortalaması 39,8±10,0 yıl, kontrol grubunun yaş ortalaması 36,8±7,9 yıl idi. Behçet hastalarının medyan hastalık süresi 72 (28,5-162,0) aydı ve hastaların %61,9'unda majör organ tutulumu mevcuttu. Majör organ tutulumları sıklık sırasıyla vasküler (%57,7), oküler (%34,6) ve nörolojik (%7,7) tutulum idi. Hastaların %66,7'si immünosüpresif tedavi almaktaydı. FVK ve İMK ölçümleri Tablo 1'de gösterilmiştir. Behçet hastalarında İMK-sağ ve İMK-sol ölçümleri sağlıklı kontrollere göre istatistiksel olarak anlamlı düzeyde yüksek saptandı (p<0,001). İMK-sağ ve CFV-sağ, İMK-sol ve CFV-sol ölçümleri arasında anlamlı pozitif ilişki saptandı (sırasıyla, p<0,001, r=0,918 ve p<0,001, r=0,907). Behçet hastaları içinde majör organ tutulumu olan ve olmayanlar arasında İMK-sağ ve İMK-sol ölçümleri arasında istatistiksel olarak anlamlı fark saptanmadı (her ikisi için p>0,05). Sonuç: Behçet hastalarında, sağlıklı kontrollere göre hem femoral ven duvar kalınlığı hem de femoral ven intima media kalınlığı artmış saptanmıştır. Bu bulgular, Behçet hastalarında vasküler tutulumdan bağımsız olarak, intima-media tabakası da dahil olmak üzere tüm damar duvarında artmış enflamasyon bulunduğunu düşündürmektedir. [ABSTRACT FROM AUTHOR]

Lung cancer is the most frequent cause of cancer deaths worldwide. In recent years through molecular studies and technological improvements, there have been important developments in tumour types and staging and so the chances of curative surgeries have increased. Radiology has an important role in identifying limited or diffuse disease. With the aid of imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI) and pozitron emission tomography (PET), tumor detection, staging, surveillance and postoperative complications can be reported accuratly and safely in patients with lung cancer. [ABSTRACT FROM AUTHOR]

Posteroanterior (PA) plain X-ray is the most commonly used imaging modality in chest imaging. The procedure requires simple yet important rules that should be followed to obtain an optimal image and correct diagnosis. Interpretation of a correctly obtained PA X-ray also requires discipline and caution in order to detect typical signs. The purpose of this paper is to emphasize the important points for optimal image quality and review the important signs used for diagnosis. [ABSTRACT FROM AUTHOR]

Amaç: Vasküler tutulum Behçet hastalığında (BH) %40'a varan oranda görülür ve özellikle erkek hastalarda önemli bir morta-lite ve morbidite nedenidir. Alt ekstremite derin venlerinde inf-lamasyona bağh tromboz vasküler tutulumun en sık görülen şeklidir. Yakın zamanda, venöz duvar kalınlığı ve dilatasyonu-nun ultrasonografi (US) ile değerlendirilmesinin venöz vasküler inflamasyon varlığını gösterebileceği bildirilmiştir. Bu çalışmada, vasküler tutulum açısından en riskli grup olan mukokutanöz tu tulumlu erkek Behçet hastalarında alt ekstremite venöz duvar kalınlıkları ve dilatasyonunun US ile değerlendirilmesi amaçlanmıştır. Yöntem: Çalışmaya Marmara Üniversitesi Romatoloji polikliniğinde BH tanısı ile takipli 29 erkek mukokutanöz BH, 30 vas-küler tutulumlu erkek BH, yaş eşleştirilmiş 27 erkek ankilozan spondilit (AS) hastası ve 24 erkek sağlıklı kontrol alınmıştır. Bilateral alt ekstremi te venöz dopler US, olgulara kör ve deneyimli bir radyolog (RE) tarafından yapılmıştır. Bilateral common femoral ven (CFV) duvar kalınlığı, bilateral büyük ve küçük safen ven dilatasyonu değerlendirilmiştir. Aktivite değerlendirilmesinde Behçet sendromu aktivite skoru (BSAS) kullanılmıştır. On olguda CFV duvar kalınlığı iki ayrı radyolog tarafından (RE, RA) "araştırıcı-arası (interobserver) güvenilirlik" değerlendirilmesi için aynı gün tekrarlanmış ve radyologlar arasında kuvvetli uyum saptanmıştır (r=0.765, pcO.OOl). Bulgular: Behçet grubunda ortalama hastalık süresi 9.1±6.3 yıl, ortalama BSAS 24±17 idi. Tüm venöz duvar ölçümleri BH'da sağlıklı kontrollere ve AS'li hastalara kıyasla anlamlı derecede yüksekti (hepsi için pcO.OOl, Tablo SS-28). Mukokutanöz ve vasküler tutulumlu BH kıyaslandığında, vasküler tutulumlu BH'larında tüm ölçümler yüksek olmakla beraber, yalnız sol CFV kalınlığı ve sağ büyük safen ven genişliği değerleri istatistiksel olarak anlamlıydı (pcO.OOl ve p=0.028, Şekil SS-28). Venöz duvar ölçümleri ile BSAS ve akut faz reaktanları arasında ise herhangi bir ilişki saptanmadı. Sonuç: Bu kesitsel çalışmada erkek Behçet hastalarında alt eks-tremite derin yenlerinde artmış duvar kalınlığı saptanmıştır. Saptanan artış damar tutulumundan bağımsızdır. Benzer artışın sağlıklı kontroller ve AS hastalarında olmaması, artmış venöz duvar kalınlığının BH'na özgü olduğunu düşündürmektedir. Özellikle tanısal açıdan sorun yaşanan erken şüpheli erkek Behçet hastalarında venöz duvar kalınlığı ölçümü non-invasif tanı-sal bir test olarak kullanılabilir. [ABSTRACT FROM AUTHOR]

CD55 deficiency with hyperactivation of complement, angiopathic thrombosis, and protein-losing enteropathy (CHAPLE) is an ultra-rare genetic disorder characterised by intestinal lymphatic damage, lymphangiectasia, and protein-losing enteropathy caused by overactivation of the complement system. We assessed the efficacy and safety of pozelimab, an antibody blocking complement component 5. This open-label, single-arm, historically controlled, multicentre phase 2 and 3 study evaluated ten patients with CHAPLE disease. This study was conducted at three hospitals in Thailand, Türkiye, and the USA. Patients aged 1 year or older with a clinical diagnosis of CHAPLE disease and a CD55 loss-of-function variant identified by genetic analysis and confirmed by flow cytometry or western blot of CD55 from peripheral blood cells were eligible for this study. Patients received a single intravenous loading dose of pozelimab 30 mg per kg of bodyweight, followed by a once-per-week subcutaneous dose over the treatment period based on bodyweight at a concentration of 200 mg/mL as either a single injection (<40 kg bodyweight) or two injections (≥40 kg bodyweight). The primary endpoint was proportion of patients with serum albumin normalisation with an improvement in active clinical outcomes and no worsening in inactive clinical outcomes (frequency of problematic abdominal pain, bowel movement frequency, facial oedema severity, and peripheral oedema severity) at week 24 compared with baseline, assessed in the full analysis set. This study is registered with ClinicalTrials.gov (NCT04209634) and is active but not recruiting. 11 patients were recruited between Jan 27, 2020, and May 12, 2021, ten of which were enrolled in the study and included in the analysis populations. The efficacy data corresponded to all patients completing the week 48 assessment and having at least 52 weeks of treatment exposure, and the safety data included an additional 90 days of follow-up and corresponded to all patients having at least 72 weeks of treatment. Patients were predominantly paediatric (with a median age of 8·5 years), and originated from Türkiye, Syria, Thailand, and Bolivia. Patients had markedly low weight-for-age and stature-for-age at baseline, and mean albumin at baseline was 2·2 g/dL, which was considerably less than the local laboratory reference range. After pozelimab treatment, all ten patients had serum albumin normalisation and improvement with no worsening in clinical outcomes. There was a complete inhibition of the total complement activity. Nine patients had adverse events; two were severe events, and one patient had an adverse event considered related to pozelimab. Pozelimab inhibits complement overactivation and resolves the clinical and laboratory manifestations of CHAPLE disease. Pozelimab is the only currently approved therapeutic drug for patients with this life-threatening, ultra-rare condition. In patients with protein-losing enteropathy where known causes have been excluded, testing for a CD55 deficiency should be contemplated. A diagnosis of CHAPLE disease should lead to early consideration of treatment with pozelimab. Regeneron Pharmaceuticals and the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health. [ABSTRACT FROM AUTHOR]

Aim: To determine the ability of ileocolic artery (ICA) and ileocolic vein (ICV) diameter measurements in the diagnosis of acute appendicitis. Material and Methods: ICA, ICV, abdominal aorta (AA) and inferior vena cava (IVC) diameters were recorded in 123 patients. Patients were grouped according to the presence of acute appendicitis clinically-radiologically. The receiver operating characteristic (ROC) curves were constructed to obtain the cutoff values in terms of differentiation of appendicitis and control groups. Results: ICA, ICV, ICA/AA and ICV/IVC measurements differed significantly between the appendicitis (n=75) and control (n=48) groups (p <0.001, p <0.001, p =0.003, p =0.006). The best cutoff values for ICA and ICV to differentiate appendicitis from the control group were 2.92 mm and 4.28 mm, respectively. The ICA, with a cut-off point based on the ROC curve, of 2.92 mm provided a sensitivity of 70.7%, and a specificity of 70.8%. Applying the cut-off point of 4.28 mm for ICV, generated a sensitivity of 80%, and a specificity of 72.9%. Conclusion: Measurements of the ICA and ICV diameter in computed tomography (CT) is a promising application for determining acute appendicitis. This preliminary study suggests ICA and ICV diameter measurements could contribute as an alternative parameter to major radiological evidence in the diagnosis of acute appendicitis. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer is a significant global health concern, ranking as the second most deadly and third most common cancer worldwide. Early detection and removal of precancerous lesions play a crucial role in preventing cancer development and reducing mortality. Since FDG uptake is not specific for malignancy, incidental increased FDG uptake in the gastrointestinal tract may be challenging to interpret and may require further colonoscopic examination. This study aimed to investigate the features associated with malignant and premalignant pathology in patients with incidental colonic FDG uptake and determine the necessity of colonoscopy for each FDG uptake. Methods: Retrospective analysis was performed on data from patients who underwent colonoscopies between January 2016 and December 2021. Patients with FDG uptake in known colorectal malignancy regions were excluded. The study included 56 patients with incidental colonic FDG uptake. PET/CT images were visually and quantitatively analyzed, and the corresponding colonoscopy and histopathological results were recorded. Statistical analyses were conducted to evaluate the relationship between FDG uptake patterns, SUVmax values, and histopathological diagnoses. Colonoscopic findings were categorized as malignancy, polyps, and non-neoplastic lesions. Results: Among the 56 patients with incidental colonic FDG uptake, 36 lesions were identified, and histopathology revealed malignancy in 10 (17.9%) patients and premalignant polyps in the 26 (46.4%) cases. Focal FDG uptake with corresponding wall thickening or soft tissue density on CT was associated with a higher likelihood of premalignant or malignant lesions. The SUVmax values demonstrated a significant difference between negative findings and polyps/malignancies. However, no significant difference was observed between malignant and premalignant lesions. A ROC curve analysis was made and assesed a cut-off value of 11.1 SUVmax (sensitivity: 83.3% and specificity: 90%) to distinguish premalignant or malignant lesions from non-malignant lesions. Conclusion: Incidental colonic FDG uptake with a focal pattern and corresponding CT findings were more likely to indicate premalignant or malignant lesions. SUVmax values were helpful in predicting the presence of pathological findings, but histopathological verification remains necessary for a definitive diagnosis. These findings contribute to our understanding of the clinical implications of incidental colonic FDG uptake and highlight the importance of follow-up colonoscopy for further evaluation. [ABSTRACT FROM AUTHOR]

The thyroid imaging reporting and data system (TI-RADS) and 2015 American Thyroid Association (ATA) guidelines are two well-known risk stratification systems for classifying thyroid nodules based on cancer risk. This study aims to evaluate the diagnostic efficacy of these two systems in predicting malignancy in patients undergoing thyroid surgery. We studied data on 120 individuals who were scheduled to undergo surgery for benign or malignant nodular diseases of the thyroid gland between October 2017 and October 2019. The TI-RADS category and ultrasound pattern based on ATA guidelines were assigned to dominant thyroid nodule categories by two experienced radiologists blinded to patients' previous thyroid ultrasonography and fine-needle aspiration biopsy results. A pathologist with experience in thyroid diseases blinded to patients' sonographic and clinical data reviewed the thyroidectomy specimens. A total of 120 patients, 88 women and 32 men, were included in our study. Final histopathological results were as follows: 50% (n=60) papillary thyroid carcinoma, 36.6% (n=44) benign nodular thyroid diseases, 4.1% (n=5) follicular adenoma, 2.5% (n=3) hurtle cell adenoma, 1.7% (n=2) follicular thyroid carcinoma, 1.7% (n=2) medullary thyroid carcinoma, 1.7% (n=2) hurtle cell carcinoma, and 1.7% (n=2) follicular tumor of uncertain malignancy potential. The sensitivity, specificity, positive predictive value, and negative predictive value for TI-RADS were 80%, 56%, 72%, and 67%, respectively, and that for ATA were 80%, 64%, 76%, and 69%, respectively. The TI-RADS and ATA showed similar rates of sensitivity, specificity, NPV, and PPV. Our observed risk of malignancy was higher than expected for the ACR TI-RADS 3–5 categories and the very low, low, and intermediate suspicion risk strata in the ATA guidelines. We found no difference between observed and expected malignancy risk for the ACR TI-RADS 2's and ATA's high suspicion categories. [ABSTRACT FROM AUTHOR]

OBJECTIVE This study is a comparison of contoured diagnostic images derived from computed tomography (CT) and magnetic resonance imaging (MRI) by both a radiation oncologist (RO) and a radiologist (R) using volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) techniques. METHODS CT and MRI sections of 16 patients were contoured by the RO and the R. Planning target volume (PTV) criteria assessed were conformity index (CI), homogeneity index (HI), volume covered by 98% isodose line (V 98%) and maximum dose (Dmax). In critical organs, 40 Gy organ area volume (V40), 65 Gy organ area volume ( V65), and Dmean criteria were evaluated. Paired samples t-test was used for statistical analysis. RESULTS PTV and critical organs were compared. MRI PTV and bladder volume drawn by R were lower. Comparison of CT images revealed IMRT plans were superior in terms of Dmax and CI, while V40 and Dmean values for rectum and bladder were lower in MRI-based VMAT plans. In MRI plans, IMRT was superior in terms of PTV, Dmax, CI, V65, and Dmean for critical organs; however, critical organs were well preserved with both planning techniques. CONCLUSION There was some difference between contouring of the R and the RO, which was reflected in the treatment plans. [ABSTRACT FROM AUTHOR]

To investigate the acute inflammatory and structural changes of sacroiliitis as auxiliary findings on magnetic resonance enterography (MRE) and their presence on closely timed conventional magnetic resonance imaging of the sacroiliac joint (SI joint MRI). We screened axial spondyloarthritis patients for the simultaneous presence of MREs and SI joint MRIs. Two blinded radiologists evaluated SI joint MRIs and MREs on two separate occasions. We used the Assessment of SpondyloArthritis International Society (ASAS)/Outcome Measures in Rheumatology Network (OMERACT) definitions for SI joint MRI. We implemented previously published standard definitions for osteitis, erosion, sclerosis, and fatty infiltration of SI joint in MREs that contain T1w and T1w post-gadolinium sequences. SI joint MRI and MRE images were present in 43 patients. The median time between the two modalities was 14 (0–89) days. Twelve patients had ASAS-defined positive SI joint MRI. Radiologist-1 and radiologist-2 detected osteitis on MRE in nine and eight out of these 12 patients, respectively. The two radiologists detected ankylosis and fatty metaplasia with a complete agreement and sclerosis with an almost perfect agreement. Both radiologists agreed on erosions on SI joint MRI in the same 10 cases. Radiologists did not identify acute inflammatory or structural changes on MRE in patients with a negative SI joint MRI for these lesions. Along with intestinal findings, additional reporting of acute inflammatory and structural changes of the SI joint on a MRE is valuable and may alert physicians to the presence of previously not diagnosed axial spondyloarthritis. • Acute inflammatory and structural changes of the SI joint may readily be available on MRE. • MRE may alert physicians to the presence of previously undiagnosed axial spondyloarthritis. • MRE reveals important radiologic data on the presence of sacroiliitis. [ABSTRACT FROM AUTHOR]

Background: Recent findings suggest that fluoroquinolones, most prescribed antibiotic to treat various infections, have increased abdominal aortic aneurysm formation. We aimed to investigate the relation of the development of abdominal aortic aneurysm and the duration of ciprofloxacin use. Methods: Male Sprague--Dawley rats were divided into 2 groups to administer saline to the control groups and CaCl2 to the aneurysm groups. These groups were then divided into 3 subgroups: intraperitoneal saline, ciprofloxacin for 2 weeks, and ciprofloxacin for 4 weeks. At the end of 4 weeks, the diameter of abdominal aorta was determined by ultrasonography and animals were sacrificed to obtain abdominal aorta specimens. Elastic fiber fracture, tunica media layer thickness, and aortic tissue damage were evaluated histologically. Results: Aortic diameter of control-saline (2.15 mm ± 0.06), control-2 weeks (2.25 mm ± 0.06), and control-4 weeks (3.31 mm ± 0.09) ciprofloxacin groups was significantly different (P < .0001). Also, aortic diameter of aneurysm-saline (2.07 mm ± 0.02), aneurysm-2 weeks ciprofloxacin (3.33 mm ± 0.64), and aneurysm-4 weeks ciprofloxacin (8.55 mm ± 1.70) groups showed significant increase in aortic diameter with increasing duration of ciprofloxacin use (P < .01). A significant difference was found between the control-saline (0.00 ± 0.00), control-2 weeks (1.50 ± 0.33), and control-4 weeks ciprofloxacin groups (1.57 ± 0.20) in the histological aneurysm scores (P < .001). Aortic tunica media thickness did not change between control-saline and control-ciprofloxaci in groups (P > .05). Conclusion: The study showed that ciprofloxacin caused injury in the aortic wall but not a significant change in the thickness of the aortic tunica media layer. The duration of cipro- floxacin use was important in the development of aneurysm and aneurysm severity. [ABSTRACT FROM AUTHOR]

Amaç: Özellikle tek majör organ tutulumu olmak üzere sınırlı organ bulguları ile başvuran hastalarda Behçet hastalığı (BH) tanısı koymak zorlayıcı olabilir. Grubumuz yakın zamanda, BH'de artmış ana femoral ven kalınlığını gösteren ilk kontrollü Doppler ultrasonografi (USG) çalışmasını yayınlamış, aynı zamanda, artmış ana femoral ven kalınlığının, ≥0,5 mm'lik cutoff değeri için %80'den yüksek bir özgüllükle BH'nin ayırt edici bir özelliği olduğunu göstermişti. Bu çalışmada, uzman görüşü ile "inkomplet Behçet hastalığı" tanısı almış hastalarda, Doppler USG ile ana femoral ven kalınlık ölçümünün tanısal performansını değerlendirmeyi amaçladık. Yöntem: Çalışmaya Marmara Üniversitesi Behçet Kliniği'nde inkomplet (26 erkek, 22 kadın) BH tanısı almış 48 hasta dahil edildi. Rutin ziyaretler sırasında demografik ve klinik özellikler ve tedavi verileri kaydedildi. Ana femoral ven duvar kalınlığı aynı gün deneyimli bir radyolog tarafından ölçüldü. Bulgular: Hastaların yaş ortalaması 39,1 (SS: 11,1), ortalama hastalık süresi 53,7 (SS: 51,4) ay olarak saptandı. Hastaların 40'ında (%83,3) majör organ tutulumu mevcuttu. Altı (%12,5) hastada paterji pozitifliği, 15 (%31,3) hastada ailesel BH izlendi. Hastaların 20, 8 ve 6'sında sırasıyla vasküler, oküler ve nörolojik tutulum vardı. Sağ ana femoral ven kalınlığı 0,72 (SS: 0,15) mm ve sol ana femoral ven kalınlığı 0,72 (SS: 0,15) mm saptandı. Sadece 2 (%4,2) hastada ana femoral ven kalınlık değeri ≥0,5 mm olan eşik değerinin altındaydı. Sonuç: Özellikle prevalansın düşük olduğu ülkelerde, tek majör bir organ tutulumu ile başvuran hastalarda BH teşhisi zor olabilir. Bu hastalara genellikle "uzman görüşü" ile "inkomplet" BH tanısı konur. Bu olguların bazılarında erken teşhis çok önemlidir. Sonuçlarımız, non-invaziv bir radyolojik modalite olan Doppler USG ile ana femoral ven kalınlık ölçümünün, özellikle majör organ tutulumu olan, inkomplet BH'de değerli bir tanı testi olduğunu göstermektedir. [ABSTRACT FROM AUTHOR]

Objective: US elastography is an emerging technique that can be used during breast US examination. The increasing awareness of breast cancer led to an increase in mammography and breast US examinations. The specificity of these techniques is not high enough to prevent unnecessary biopsies. There is still a need for a more specific technique that can overcome this problem. This study aimed to evaluate the value of strain elastography in breast lesions. Materials and Methods: In this study, 110 lesions of 96 patients were evaluated with strain elastography. Five score system was used for lesion scoring. The histopathologic results of lesions were obtained and were accepted as gold standard. The sensitivity, specificity, PPV and NPV of the technique were calculated. Histopathologic and strain elastography results were correlated. Results: The sensitivity of US strain elastography was calculated as 83%, the specificity as 89%, the positive predictive value as 79% and the negative predictive value as 91%.There were no score 1 lesions. All score 2 lesions were benign. Score 5 had the highest true positivity rate. Conclusion: We believe that ultrasound elastography is an effective imaging technique that can be used as an adjunct for differential diagnosis, prior to the decision to biopsy a lesion in certain cases. [ABSTRACT FROM AUTHOR]

Renal abscess, the accumulation of infected fluid in the kidney, is a rare condition seen in children as well as adults. It leads to long term hospital admission and antibiotic use. Early diagnosis is an important factor in the outcome of renal abscess because the management may differ. Urinalysis test results and radiologic imaging findings of the patients who are admitted to hospital with complaints of fever, vomiting, abdominal pain or flank pain are important for the early diagnosis. Undertreated cases have high risk for renal scar formation. In this paper, we aim to present three pediatric patients, who showed the complication of renal abscess and were treated with long term antibiotic use without a need for surgical drainage. [ABSTRACT FROM AUTHOR]

Background: Anti-angiogenic tyrosine kinase inhibitors, sunitinib and pazopanib, have proven efficacy in advanced renal cell carcinoma, with specific adverse events occurring during treatment process. Comorbidities can reflect functional status and have prognostic value in oncology patients. We aimed to assess the association of the Charlson Comorbidity Index with severe toxicities and mortality in renal cell carcinoma cases treated with front-line sunitinib or pazopanib. Methods: Files of locally advanced and metastatic renal cell carcinoma patients who received first-line sunitinib or pazopanib were retrospectively examined. Charlson Comorbidity Index of each patient was calculated. Patients were also stratified into Memorial Sloan-Kettering Cancer Center risk groups. Predictors of dose-limiting toxicity were evaluated with binomial logistic regression analysis. Univariate and multivariate Cox regression models were utilized to determine prognostic factors for survival. Results: The study included 102 patients, 64 were treated with first-line sunitinib and 38 with pazopanib. In 42 patients (41.9%), Charlson Comorbidity Index was 9 or more. Dose-limiting toxicities were significantly more frequent in Charlson Comorbidity Index ≥9 group (69% vs. 40%, p = 0.004), and Charlson Comorbidity Index independently predicted dose-limiting toxicity (Hazard ratio (HR) = 4.30, p = 0.002). After adjusting for other variables, a Charlson Comorbidity Index of ≥9 is also a significant prognostic factor for progression-free (HR = 1.76, p = 0.02) and overall survival (HR = 1.75, p = 0.03). Conclusions: Charlson Comorbidity Index may be a valuable method to estimate prognosis and optimize therapy in patients with advanced renal cell carcinoma receiving first-line sunitinib or pazopanib. [ABSTRACT FROM AUTHOR]

Introduction: Primary choriocarcinoma of the colon is an extremely rare neoplasm which has a poor prognosis. Only 18 cases have been previously reported in English medical literature. Here we present a case of primary rectal choriocarcinoma with a good response to chemotherapy and review the literature on this uncommon tumor. Case report: A 36-year-old woman presented with abdominal pain and vaginal bleeding. Abdominal magnetic resonance imaging revealed 6.9 × 5.3 × 6.4 cm hypervascular mass posterior to uterus very close to rectum. Beta-human chorionic gonadotropin (β-hCG) level was markedly elevated. Low anterior resection of the rectum with lymph node dissection and total abdominal hysterectomy with bilateral salpingo-oophorectomy were performed. Pathologic diagnosis was reported as colonic choriocarcinoma with a focal component of adenocarcinoma. Post-operative magnetic resonance imaging detected multiple metastatic lesions throughout the liver. The patient was treated with systemic chemotherapy using bleomycin, etoposide and cisplatin (BEP protocol). After three cycles, β-hCG level decreased to normal and magnetic resonance imaging showed regression of liver metastasis. However, the patient died of respiratory failure due to bleomycin toxicity and pneumonia accompanied by rapid disease progression. Discussion: This is an extremely rare case of primary rectal choriocarcinoma. Due to poor prognosis of the disease, it seems very important to start prompt treatment to improve patient's survival. [ABSTRACT FROM AUTHOR]

Giriş: Retrospektif olarak sakroiliyak eklemin (SIE) akut enflamatuvar ve yapısal değişikliklerinin manyetik rezonans enterografi (MRE) ile değerlendirilebileceği bildirilmiştir. Ancak eşzamanlı sakroiliyak eklem MR görüntüleme (SIE-MRG) ile doğrudan karşılaştırma yapılmamıştır. Amaç: MRE ile saptanan SIE'e ait akut enflamatuvar ve yapısal değişikliklerin standart SIE-MRG ile korelasyonunun değerlendirilmesi amaçlanmıştır. Yöntem: Son beş yıldır hastanemiz takipli tüm Spondiloartrit (SpA) hastalarının MRE'leri ve SIE-MR'ları tarandı. En fazla üç ay arayla her iki görüntülemesi olan hastalarda klinik ve demografik bilgilere kör iki deneyimli radyolog tarafından akut enflamatuvar ve yapısal SIE değişiklikleri değerlendirildi. Görüntüleme sonuçları McNemar testi, intra-reader ve inter-reader uyum değerlendirilesi ise Cohen'in kappa analizi ile değerlendirildi. Bulgular: Değerlendirilen 43 SpA hastasının %27,9'unda (n=12) SIE-MRG'de sakroiliit mevcuttu. İlk radyoloğun iki okuması arasındaki uyumu için kappa değerleri MRE'de 0,920 ile 1,000 arasında, SIE-MRG'de ise 0,831 ile 1,000 arasındaydı. İkinci radyolog için kappa değerleri MRE için 0,646 ile 1,000 arasında, SIE-MRG için 0,942 ile 1,000 arasındaydı. Her ilk radyolog için akut enflamatuvar ve yapısal değişikliklerin MRE ve SIE-MRG'de değerlendirilmesi arasında fark yoktu. Yanlızca ikinci radyolog için, erozyonu değerlendirmede her iki modalite arasında anlamlı fark vardı (p=0,002). Sonuç: MR enterografide SIE'in akut enflamatuvar ve yapısal değişikliklerinin saptanması teknik olarak mümkündür ve lezyon sıklığı standart SIE-MRG ile benzerdir. Bu MRE bulgularının radyolog tarafından raporlanması, enflamatuvar barsak hastalığı'nda (İBH) eşlik eden aksiyal SpA'nın değerlendirilmesinde yol gösterici olacaktır. [ABSTRACT FROM AUTHOR]

Giriş: Aksiyal spondiloartropati (aksSpA) hastalarında %60 orannda subklinik intestinal enflamasyon (Sİİ) tanımlanmıştır. Sİİ'nin klinik ve tedavi isle ilişkisi bilinmemektedir. Amaç: AksSpA hastalarında ishal sıklığının belirlenmesi ve Sİİ'nin radyolojik, histopatolojik ve klinik özellikler ile korelasyonunun belirlenmesidir. İkincil olarak Sİİ'nin biyolojik tedavi etkililik oranlarına etkisi değerlendirilecektir. Yöntem: Kasım 2020-Temmuz 2022 tarihleri arasında biyolojik ajanlar ile tedavi öncesi SpA dışı nedenler ile okolonoskopi endikasyonu olan hastalar standart anket ile kronik ishal ve karın ağrısı taraması sonrası ileokolonoskopi ve MR enterografi (MRE) ile değerlendirildi. İleum ve kolon segmentlerinden alınan multipl biyopsiler klinik bilgiye kör olarak akut ve kronik tipte enflamasyon için incelendi. MRE görüntüleri kliniğine kör olarak değerlendirildi. Bulgular: Çalışmaya alınan 60 hastanın klinik ve demografik özellikler Tablo 1'de, dahil edilme akış diyagramı Şekil 1'de özetlenmiştir. İshal %41,7 hastada saptandı. MRE ile değerlendirilen 49 hastadanın 39'unda ileokolonoskopik multipl biyopsiler alındı. Kolonoskopide makroskopik bulgu %28,6 oranında saptandı. Terminal ileumda aftöz ülser en sık kolonoskopik bulguydu (%18,4). MRE'de enflamasyon düşündüren bulgular (mezenterik vaskülarite artışı, uzun segment kontrastlanma ve duvar kalınlık artışı) %65,3 hastada mevcuttu. İntestinal enflamasyon hastaların %51,3'ünde saptandı (%17,9 akut, %48,7 kronik). MRE bulguları ve histopatolojik inceleme arasında anlamlı bir ilişki yoktu (p=0,280). Sonuç: AksSpA hastalarında saptanan %40 oranında ishal varlığına rağmen hiçbiri enflamatuvar barsak hastalığı (İBH) tanısı almadı. İBH'da iyi tanımlanmış radyolojik enflamasyon bulgularının aksSpA hastalarında yüksek oranda bulunduğu daha önce bildirilmemiştir. İntestinal enflamasyon ve/veya MRE bulgularının tedavi yanıtı ile ilişkisi takip edilmektedir. [ABSTRACT FROM AUTHOR]

Foreign body ingestion is a common problem in childhood. Sharp objects such as needles, toothpicks or open safety pins can also be ingested. A 13-month-old-boy was admitted to our pediatric emergency department with the suspicion of safety pin ingestion. The boy was taken to a private hospital and an abdominal X-ray was obtained. The open safety pin was seen in the pylorus and he was referred to a university hospital. When he arrived to our pediatric emergency department, an abdominal X-ray was retaken, and an open safety pin was seen in the first part of the duodenum. The patient was hospitalized for observation. After twenty hours, a control X-ray was taken; the open safety pin was seen in the ascending colon. The child was discharged from hospital, and instructions were given to the family for watching his stool closely. The day after, we called the family and learned that the open safety pin was eliminated spontaneously from stool. Infants and children with safety pin ingestion can be closely followed clinically without complication and there will be no need for an endoscopy and/or surgery. An open safety pin ingested small child was reported with the aim to draw attention to safety pin ingestion. [ABSTRACT FROM AUTHOR]

Objective Nonalcoholic fatty liver disease ( NAFLD) is associated with increased risk of cardiovascular disease and impaired left ventricular ( LV) function, yet the impact of NAFLD on right ventricular ( RV) function remains unclear. We investigate the RV functional properties in patients with NAFLD. Methods Ninety consecutive patients with the diagnosis of biopsy-proven NAFLD and 45 age- and sex-matched controls were included. All patients underwent an echocardiographic examination. RV function was evaluated by two-dimensional (2D) speckle-tracking echocardiography ( STE). Results Mean fibrosis stage and nonalcoholic steatohepatitis ( NASH) scores were 1.3 ± 1.1 and 5.2 ± 1.6, respectively. NAFLD patients displayed decreased RV function compared to controls. NAFLD patients with liver fibrosis (67 patients) had significantly lower RV function assessed by GLS (global longitudinal strain) compared to patients without liver fibrosis (18.9 ± 3.4% vs. 21.6 ± 2.3%, P < 0.001). NASH score ≥5 was associated with lower RV- GLS (18.9 ± 3.1% vs. 21.0 ± 3.4%, P = 0.006). NASH score inversely correlated with RV- GLS (r = −0.370, P < 0.001) such as patients with impaired RV- GLS (<19%) showed significantly higher NASH score compared to normal RV- GLS group (5.8 ± 1.4 vs. 4.8 ± 1.7, P = 0.009). Logistic regression analysis revealed that NASH score was an independent predictor of impaired RV function in patients with NAFLD. Conclusions Patients with NAFLD have impaired RV function. NASH score inversely correlates with RV- GLS and independently predicts impaired RV function in patients with NAFLD. [ABSTRACT FROM AUTHOR]

Objective : Non-alcoholic fatty liver disease (NAFLD) is associated with atherosclerosis and reduced vascular compliance. The purpose of this study was to examine the relationships between arterial stiffness measures, the histological severity of NAFLD, and epicardial fat thickness (EFT). Methods : A total of 100 patients with biopsy-proven NAFLD and 50 age- and sex-matched controls were enrolled. The histological severity was assessed in all NAFLD patients. Measurements of arterial stiffness [pulse-wave velocity (PWV) and augmentation index (AIx)] were carried out using a Mobil-O-Graph arteriograph system. EFT was assessed by means of echocardiography. Results : Compared with controls, NAFLD patients had significantly higher PWV and AIx values. Stepwise linear regression analysis demonstrated that the liver fibrosis score and EFT were independent predictors of both PWV and AIx values in NAFLD patients. Conclusions : Patients with NAFLD have an increased arterial stiffness, which reflects both the severity of liver fibrosis and increased EFT values. [ABSTRACT FROM AUTHOR]

Background: Noninvasive markers that purport to distinguish patients with non-alcoholic fatty liver disease (NAFLD) with fibrosis from those without must be evaluated rigorously for their classification accuracy. Herein, we seek to compare the diagnostic performances of three different noninvasive methods (FibroMeter™ NAFLD score, NAFLD Fibrosis score (NFSA), and Transient Elastrography [TE]) for the detection of liver fibrosis in NAFLD patients. Methods: A total of 88 patients with biopsy-proven NAFLD were included. The Kleiner system was used for grading fibrosis in liver biopsies. The FibroMeter™ NAFLD score was determined using a proprietary algorithm (regression score). The NFSA score was calculated based on age, hyperglycemia, body mass index, platelets, albumin and serum aminotransferase levels. TE was performed using the Fibroscan apparatus. Results: The sensitivities/specificities for the FibroMeter™ NAFLD score, NFSA, and TE for the diagnosis of significant fibrosis (F2 + F3 + F4 fibrosis) were 38.6%/86.4%, 52.3%/88.6%, and 75.0%/93.2%, respectively. The areas under the receiver operating characteristic curves of TE were significantly higher than those of both the FibroMeter™ NAFLD score and NFSA. No significant differences were found between the FibroMeter™ NAFLD score and NFSA for the detection of significant and severe fibrosis, although the diagnostic performance of the FibroMeter™ NAFLD score was higher than that of the NFSA score for cirrhosis. Conclusions: In summary, TE showed the best diagnostic performance for the noninvasive assessment of liver fibrosis in NAFLD patients. The diagnostic performances of the FibroMeter™ NAFLD score and NFSA did not differ significantly for the detection of both significant and severe fibrosis. [ABSTRACT FROM AUTHOR]

Objective. Measurements of controlled attenuation parameter (CAP) with transient elastography (FibroScan®; EcoSens SA, Paris, France) may provide an accurate noninvasive assessment of hepatic steatosis. Herein, we prospectively determined the accuracy of liver fat quantification with CAP values in patients with chronic liver diseases and compare the results with those of histological assessment of steatosis as reference standard. Materials and methods. We enrolled 50 Turkish patients with various forms of chronic liver diseases. All patients underwent both CAP assessment and ultrasonography-guided liver biopsy. Results. On liver biopsy, 16 (32%) patients had S0, 12 (24%) had S1, 9 (18%) had S2, and 13 (26%) had S3. The CAP values increased significantly ( p < 0.001) for each steatosis stage on liver biopsy: S0, 222 dB/m; S1, 250 dB/m; S2, 270 dB/m; and S3, 318 dB/m. A cutoff value of 257 dB/m could distinguish significant steatosis (S2-S3) from S0 (Sn 89%, Sp 83%, positive likelihood ratio 5.33, negative likelihood ratio 0.13, AUROC = 0.93). Multivariable analysis indicated that neither liver fibrosis ( p = 0.58) nor disease etiology ( p = 0.96) had a significant impact on the association between CAP and the stage of steatosis. Conclusion. The determination of CAP using transient elastography can represent an important step forward toward the goal of an 'imaging liver biopsy'. [ABSTRACT FROM AUTHOR]

Aims: Growing evidence suggests that not only type 2 diabetes (T2D) but also prediabetes (PD) is common in patients with non-alcoholic fatty liver disease (NAFLD). However, few data exist on how PD impacts the histological characteristics of NAFLD patients. In this exploratory study, we sought to investigate the associations of PD and T2D with the severity of the histological features in patients with NAFLD. Methods: The population consisted of 280 patients with biopsy-proven NAFLD. The associations of PD and T2D with the severity of histological features of NAFLD were analyzed using multiple logistic (or ordinal logistic) regression models after adjustment for confounding factors. Results: PD and T2D was noted in 102 (36.4%) and 92 (32.8%) of patients, respectively. Of the 92 patients with T2D, ten (10.9%) were diagnosed de novo after the OGTT. PD and T2D were significantly associated with more severe portal inflammation (P b 0.01); the adjusted odds ratios (ORs) of PD and T2D for having a higher grade of portal inflammation were 1.8 [95% CI, 1.1, 3.2] and 2.6 [95% CI, 1.3, 5.8]), respectively. A similar relationship was observed for liver fibrosis (P b 0.001); specifically, the adjusted ORs of PD and T2D for having a higher grade of hepatic fibrosis were 2.4 [95% CI, 1.3, 3.7] and 3.8 [95% CI, 1.9, 6.1]), respectively. Conclusion: Not only T2D but also PD is independently associated with portal inflammation and fibrosis in NAFLD patients. PD may be useful as a clinical indicator of patients who are likely to have already more severe histological findings. [ABSTRACT FROM AUTHOR]

Acute leukemias are the most common childhood cancer in all age groups. Acute myeloid leukemias (AML) constitute about 15-20% of acute leukemias. Fatigability, pallor, fever, and bleeding are the most common presenting symptoms of AML. Hepatosplenomegaly and lymphadenopathy are commonly encountered during physical examination. In rare instances eruptions due to skin involvement and localized tumor masses (myeloid sarcoma)may be found. Myeloid sarcoma is especially seen in AML-M2 subtype. By cytogenetic analysis, in AML-M2 subtype t(8;21) is often seen and it is more probable to find inversion 16 in AML-M4Eos subtype. Herein, we present a 15-year-old girl whose initial symptom was abdominal pain for three days and her pathological sign was a large abdominal mass which was verified by imaging studies and diagnosed as myeloid sarcoma by biopsy. On bone marrow examination, she had diagnosis of AML-M2 and by cytogenetic analysis inversion 16 was positive. She was treated with AML-BFM 2004 protocol and she is being followed up in remission on her ninth month of the maintenance therapy. [ABSTRACT FROM AUTHOR]

Amaç: Vasküler tutulum, Behçet hastalarının (Bil) yaklaşık üçte birinde görülmektedir,vakaların %80'inde alt ekstreıııite derin venöz trombozu (DVT) şeklindedir. Post-troıııbotik seıı-droııı (PTS) DVT sonrası gelişebilen majör komplikasyonlardan biridir. Bu çalışmada DVT öyküsü olan vasküler Bil (VBIiyiarında PTS varlığının, ciddiyetinin, risk faktörlerinin ve yaşam kalitesine etkisinin değerlendirilmesi amaçlandı. Yöntem: Çalışmaya Türkiye'deki 3 romatoloji kliniğinde ta-kipli DVT öyküsü olan 96 Behçet hastası (K/E: 18/78, ortalama yaş: 38.8±8.74) alındı. PTS varlığının saptanması için Villalta ölçeği kullanıldı. Bu ölçeğe göre;skor >4 ise PTS var; 5-9, 10-14, >14 sırasıyla hafif, orta ve ciddiPTS olarak değerlendirildi. Ciddi PTS'yi değerlendirmek için yapılan diğer skorlama CEAP (klinik, etiyolojik, anatomik, patofizyolojik) oldu, bu skorlamaya göre 4 ve üzerindeki skorlar ciddi PTS ile ilişkiliydi. Venöz Disabilite Skoru (VDS) ve Venöz Klinik Ciddiyet Skoru (VKCS) venöz hastalık şiddet değerlendirilmesinde kullanıldı. Bütün hastalara klinik değerlendirilmelerinden sonraki 1 hafta içerisinde deneyimli radyolog tarafından her iki alt eks-tremite Doppler ultrasonografi (US) yapıldı. Bulgular: Vasküler tutulum sırasında hastaların ortalama yaşı 32.7±8.65 idi. Venöz değerlendirme ilk vasküler tutulumdan ortanca 6 (0-34) yıl sonra yapıldı. Değerlendirme sırasmda ortanca hastalık süresi 9 (0-34) yıl idi. 80 (%84.2) hasta immunsupresif (IS) ve 13 hasta IS'lere ek olarak antikoagülan (AK) tedavi almaktaydı. 93 hastanın 57"sinde (%61.3) PTS mevcuttu ve 19 (%19.8)'unda da ciddi PTS vardı. PTS varlığı ile cinsiyet, yaş, antikoagülan kullanımı ve relaps varlığı arasında ilişki saptanmadı. CEAP skorla-masına göre 32 (%36) hastada ciddi PTS saptandı. DopplerUS incelemesinde lOhastada normal bulgular saptandı,ancak bu hastaların yarısmda klinik olarak PTS mevcuttu. Bilateral tutulum 31 (% 31-4), üst-alt bacak ven tutulumu 40 (%47.6) hastada mevcuttu. PTS varlığı ile doppler US bulguları arasında (bilateral, üst-alt bacak tutulumu, reflü tromboz varlığı) ilişki saptanmadı. Sonuç: Çalışmamızda değerlendirilen VBH'larımn yarısından fazlasında PTS varlığı saptadık. Bu hastaların da üçte birinde ciddi PTS mevcuttu. Ancak çalışmamızda PTS gelişimini pre-dikte eden bir faktör saptanmadı. VBH'larınm takibinde PTS, hastanın yaşam kalitesini etkileyen önemli bir problemdir ve standart klinik izlemde PTS değerlendirmesi de vasküler relaps sıklığı yanında dikkate alınmalıdır. [ABSTRACT FROM AUTHOR]