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Introduction Behçet’s disease (BD) is a chronic inflammatory disease which can be limited to only mucocutaneous tissues or can affect different systems of the body. Aim To investigate the association of endothelial and erectile dysfunctions with BD, on the basis of comparative analysis between mucocutaneous and systemic BD. Material and methods Thirty-eight men diagnosed with BD were included in the present study. The patients were stratified into two groups as mucocutaneous BD (n = 20, MBD group), and systemic BD (n = 18, SBD group). Erectile dysfunction (ED) was assessed using the Erectile Function domain of the International Index of Erectile Function (IIEF-EF) questionnaire. The coronary flow reserve (CFR) assessment was done for analysing endothelial dysfunction (EnD), and CFR < 2 was defined as EnD. Penile Doppler ultrasonography (PDU) was performed for ED. The demographic and clinical parameters, IIEF-EF score ED classification, CFR and PDU test findings were compared between two groups. Results The median age was 34 (22–52) years in the overall population, and there was no difference between two groups (p = 0.558). Time from diagnosis was significantly longer (24 vs. 102 months, p = 0.021) and the use of immunosuppressive therapies was higher (0 vs. 70.6%, p < 0.001) in the SBD group. In overall, median CFR was 1.92 (1.1–5.96), and there was no difference between two groups (1.88 vs. 1.97, p = 0.812). The percentage of patients with CFR < 2 was similar in two groups (52.6% vs. 52.9%, p = 0.985). The ED status according to IIEF-EF was similar in two groups (45% vs. 27.8%, p = 0.538) as well as according to PDU analyses (10% vs. 16.7%, p = 0.544). Conclusions The increased risk of endothelial, and erectile dysfunctions should be considered in men who were diagnosed with mucocutaneous and systemic BD.

Objective: In this study, we aimed to predict the malignancy potential of a thyroid nodule based on ultrasonography (US) features. Material and Method: The data of 726 nodules in 619 patients who underwent thyroidectomy between 2005 and 2012 at Istanbul University, Istanbul Medical Faculty were retrospectively analyzed. US features of nodules were recorded and matched with pathology reports and each US feature was evaluated for diagnostic value. Results: The study group consisted of mainly female patients (86.9%) and the mean age was 46,3 years. Thyroid cancer was detected in 374 (51.7%) nodules and the most common type was papillary thyroid cancer 97% (n=341). Microcalcifications (p=0.0001), irregular margin (p=0.001) and hypoechogenicity (p=0.038) were correlated with malignancy. The absence of any of these suspicious US features significantly predicted benign disease (p=0.0001). An increasing number of suspicious features predicted malign disease with increasing specificity, positive predictive value, and likelihood ratio. Microcalcifications and irregular borders had high specificity (>80%) to predict thyroid cancer. Conclusion: The presence of microcalcifications, irregular margin, and hypoechogenicity in a thyroid nodule significantly correlates with malignant disease. Microcalcifications and irregular borders had high specificity to predict thyroid cancer. The probability of thyroid cancer increases with an increasing number of suspicious US features., Amaç: Bu çalışmada tiroid nodüllerindeki malignite olasılığını ultrasonografi (US) özelliklerinin öngörme seviyesini araştırmayı amaçladık. Gereç ve Yöntem: İstanbul Üniversitesi İstanbul Tıp Fakültesi’nde, 2005 ila 2012 yılları arasında total tiroidektomi ameliyatı olan 619 hastada 726 nodül geriye dönük olarak incelendi. Tiroid nodüllerinin US özellikleri kaydedildi, patoloji raporları ile karşılaştırılarak eşleştirildi ve US özelliklerin tanısal değeri hesaplandı. Bulgular: Çalışmaya alınan hastalarda kadın oranı (%86,9) olup, ortalama yaş 46,3 olarak hesaplandı. Tiroid kanseri 374 (%51,7) nodülde tespit edilirken, en sık kanser türü %97 (n=341) oranla papiller tiroid kanseriydi. Tiroid nodülünde mikrokalsifikasyon (p=0,0001), düzensiz sınır (p=0,001) ve hipoekojenite (p=0,038) varlığı malignite ile korelasyon gösterdi. Mikrokalsifikasyon ve düzensiz sınır özelliklerinin kanser öngörüsü bakımından özgüllüğü yüksek (>%80) bulundu. Nodülde bu şüpheli US özelliklerinden hiçbirinin olmaması selim hastalığı (p=0,0001) tahmin etti. Artan US şüpheli özelliklerin sayısı, artan özgüllük, pozitif prediktif değer ve olasılık oranı ile malign hastalığı öngördü. Mikro kalsifikasyonlar ve düzensiz sınır tiroid kanserini öngörmek için yüksek özgüllüğe (>%80) sahipti. Sonuç: Bir tiroid nodülünde mikrokalsifikasyon, düzensiz sınır ve hipoekojenite varlığında tiroid kanseri olasılığı anlamlı şekilde yüksektir. Malignite öngörüsü açısından özgüllüğü en yüksek bulgular mikrokalsifikasyon ve düzensiz sınırdır. Bir nodüldeki şüpheli US özelliklerinin sayısı arttıkça malignite olasılığı da paralel olarak anlamlı şekilde artar.

Background A thyroidectomy can be performed via a cervical incision in most patients with retrosternal goiter. Aims To investigate the correlation between the volume of the mediastinal portion of the thyroid gland and the need for an extra-cervical approach for retrosternal goiter. Study design Diagnostic accuracy study. Methods The measurement of craniocaudal length and the volume of the mediastinal component of the thyroid gland on computerised tomography images was performed in 47 patients with retrosternal goiter. Of these 47 patients, 8 (17%) required an extra-cervical approach and were classified as group 1, and 39 (83%) patients that required a cervical incision were classified as group 2. Receiver operating characteristic analysis was performed to determine the cut-off value for the craniocaudal length and the volume of the mediastinal thyroid mass, which significantly correlated with an extra-cervical approach for retrosternal goiter. Results Reoperative surgery was significantly more frequent in group 1 than in group 2 (50% vs 13%; p=0.03). The craniocaudal length of the mediastinal thyroid gland was significantly longer in group 1 than in group 2 (77±11 mm vs 31±21 mm, respectively; p=0.0001). The volume of the mediastinal component was significantly larger in group 1 compared to group 2 (264±106 cm3 vs 40±41 cm3, respectively; p=0.0001). The receiver operating characteristic curve of craniocaudal length and the volume of the mediastinal component identified ≥66 mm and ≥162 cm3 as the cut-off values with the maximum accuracy, respectively. The craniocaudal length of the thyroid mass below the thoracic inlet ≥66 mm or a volume of the mediastinal portion ≥162 cm3 were significantly associated with an extra-cervical approach (p=0.0001). For predicting an extra-cervical approach, the sensitivity, positive predictive value and negative predictive value of the cut-off value for craniocaudal length was 87.5%, 64% and 97%, respectively. For predicting an extra-cervical approach, the sensitivity, positive predictive value and negative predictive value of the cut-off values for the mediastinal volume were 100%, 89% and 100%, respectively. Conclusion A thyroid volume of ≥162 cm3 extending below the thoracic inlet was a significant determining factor for an extra-cervical approach, with a negative predictive value for the extra-cervical approach of 100% for retrosternal goiter with smaller volumes. Further studies with an increased number of patients are needed to determine the value of volumetric analysis of retrosternal goiter to predict the need for an extra-cervical approach in retrosternal goiter.

Background/aim: Vascular complications can be detected in liver transplant patients. Digital subtraction angiography has served as the gold standard to make this diagnosis; however, due to its invasive nature, ultrasonography is used for the preliminary evaluation. The purpose of this study was to evaluate the role of multislice computerized tomography angiography (MSCTA) in the detection of vascular complications of symptomatic and asymptomatic liver transplant patients and to compare the results with Doppler ultrasound (Doppler US) findings. Materials and methods: Fifty-three liver transplant patients (6 symptomatic, 47 asymptomatic) underwent Doppler US examination followed by an MSCTA. The findings in each modality were interpreted in a blinded fashion and then compared. Results: MSCTA detected 15 abnormalities, none of which were detected by Doppler US. There were hepatic and splenic artery aneu-rysms (n = 4) and various stenoses (n = 4), infrarenal aortic anastomosis (n = 4), vena cava inferior thrombosis (n = 1), arteriovenous malformation (n = 1), and esophageal varices (n = 1). Conclusion: MSCTA detected more lesions and we believe that it should be considered as a road map for Doppler US follow-ups as well as a routine screening modality for early detection of vascular complications in symptomatic and asymptomatic liver transplantation patients that may be missed by Doppler US.

Purpose We aimed to determine the feasibility and effectiveness of agent emission imaging - high mechanical index (AEI-High MI) mode ultrasonography (US) compared with gray-scale and color Doppler US, alone or in combination, for the diagnosis of urolithiasis with reference to unenhanced computed tomography (CT). Methods This prospective study included 72 consecutive patients (40 males, 32 females; mean age, 45.9±14.7 years) referred by the department of urology for acute or elective symptoms of urolithiasis and confirmed to have urinary calculi on unenhanced abdominal CT, between January 2015 and June 2015. Gray-scale, color Doppler, and AEI-High MI US were performed by two radiologists to determine the effectiveness of these methods in the diagnosis of urinary stones and to compare them with the reference modality. Results A total of 189 calculi were detected on CT examination. Gray-scale US had a sensitivity of 66.1% and positive predictive value (PPV) of 88.7% for detecting calculi, while twinkling artifact of color Doppler had a sensitivity of 70.4% and PPV of 94.3%. The scintillation artifact of AEI-High MI mode had a sensitivity of 75.1% and PPV of 95.9%. When all ultrasound-based modalities were combined, the sensitivity and PPV rose to 83.1% and 88.2%, respectively. When calculi were grouped according to their size ( 10 mm), AEI-High MI mode had a higher sensitivity (60%) compared with gray-scale (32.5%) and color Doppler (41.3%) for calculi Conclusion AEI-High MI mode had a higher sensitivity compared with gray-scale and color Doppler for the detection of calculi smaller than 5 mm, but it did not make a significant contribution to detection of larger calculi. The combined use of gray-scale US with AEI-High MI mode could increase the detection rate of calculi smaller than 5 mm and provide a method for verification of suspected calculi on gray-scale US.

OBJECTIVE: To describe magnetic resonance imaging (MRI) and ultrasonography findings of breast stromal fibrosis (SF) and compare apparent diffusion coefficient (ADC) stromal fibrosis values with breast cancer and normal parenchyma. METHODS: 45 patients (ages 22‒74) with histopathologically proven SF who underwent MRI were included in this study. Their MRI and ultrasonography features were examined and categorized. The mean ADC values for SF, contralateral normal parenchyma, and breast malignancy of the control group values were calculated and compared among each other. RESULTS: The vast majority of SF on sonography showed features suggestive of malignancy: (1) irregular in shape 25/45 (55%); (2) indistinct in margin 27/45 (60%); and (3) hypoechoic 39/45 (87%) with posterior acoustic shadowing 11/45 (24%). An SF MRI showed a mass in 12/45 (26%) and non-mass enhancement in 33/45 (74%), mostly with irregular (8/12; 67%) shape. Non-mass lesions showed heterogeneous (12/33), clumped (9/33), and homogenous (9/33) enhancement. The initial SF contrast uptake rate varied between slow (57%), rapid (22%), and medium (21%). Delayed SF enhancement may be persistent (66%) or plateau (34%). Small cysts were located around/near 21 (47%) of lesions. Ductal ectasia was found in 14 (31%) of all patients. Mean ADCs of parenchyma, SF, and malignancy were 1.32 ± 0.32, 1.23 ± 0.25, and 0.99 ± 0.24 × 10(–3 )mm(2) sec(–1), respectively. CONCLUSION: SF often mimics breast carcinoma on imaging and leads the radiology‒pathology disagreement. In terms of distinguishing SF from malignancy, ADC could be a significant and promising value in diffusion-weighted MRI along with conventional sequences. Slow initial uptake with delayed persistent contrast enhancement in a non-mass lesion with relatively higher ADC values are very helpful for differentiating SF from malignancy. The presence of small cysts and ductal ectasia were common findings around/near the SF. ADVANCES IN KNOWLEDGE: A quantitative analysis for measuring ADC values along with additional MRI features can be very helpful in distinguishing SF from malignant lesions.

Objective We retrospectively analyzed the magnetic resonance (MR) imaging features and diffusion-weighted imaging findings of the 12 masses of 10 patients with tubular carcinoma (TC), including mammography and sonography findings. Materials and Methods Mammographic, sonographic and magnetic resonance imaging features in 12 histopathologically confirmed masses diagnosed as TC of the breast within 10 patients were evaluated. Morphologic characteristics, enhancement features, apparent diffusion coefficient (ADC) values were reviewed. Results On mammography (n=5), TC appeared as high density masses with indistinct, spiculated or obscured margins. Sonographically, TC appeared as a hypoechoic appearance (n=12) with posterior acoustic shadowing in nine. On MR imaging, the margins of ten of twelve masses were irregular. Internal enhancement patterns were heterogeneous in 10 patients. Dynamic enhancement patterns illustrated plateau kinetics (n=8). On the T2-weighted images 4 masses were hypointense, and 8 were hyperintense; hypointense internal septation was found in seven of these. Tubular carcinoma appeared as hyperintense on diffusion-weighted imaging with ADC values of 0.85±0.16×10-3 mm2/s that was lower than the normal parenchyma of 1.25±0.25×10-3 mm2/s. Conclusion According to our study with a limited number of cases, tubular carcinomas can be described as hyperintense breast carcinomas with or without dark internal septation like appearance on T2-weighted images. Low ADC values from DW imaging can be used to differentiate TC from hyperintense benign breast lesions.

OZ Amac: Bu calismada tromboprofilaksi uygulanan yogun bakim hastalarinda venoz tromboembolizm prevalansi ve insidansi arastirildi. Ca­lis­ma­ pla­ni:­ Medikal-cerrahi yogun bakim unitesine kabul edilen ≥18 yasinda ve ≥72 saat yogun bakimda kalmasi planlanan 74 ardisik hasta (34 kadin, 40 erkek; (ort. yas 55.8±19.4 yil; dagilim 20-86 yil) calismaya dahil edildi. Demografik veriler, Akut Fizyolojik ve Kronik Saglik Degerlendirmesi II skoru, baslangic ve zaman bagimli derin ven trombozu (DVT) risk faktorleri kaydedildi. Iki tarafli alt ekstremite kompresyon ultrasonografi haftada iki kez ve yogun bakimdan ciktiktan bir hafta sonra uygulandi. Yogun bakim yatisi suresince DVT suphesi oldugunda, kompresyon ultrasonografi tekrarlandi. Hastalarin tumune dusuk molekul agirlikli heparin veya mekanik tromboprofilaksi uygulandi. Ayrica, her gun fizyoterapist tarafindan tum hastalara pasif ekstremite egzersizleri uygulandi. Bul gu lar: Ortalama Akut Fizyolojik ve Kronik Saglik Degerlendirmesi II skoru 17±6.1 idi. Yogun bakima kabulde DVT prevalansi %2.7 (CI %95; 3.3-9.42) idi. Hastalarin %89.1’ine dusuk molekul agirlikli heparin, %10.9’una mekanik tromboprofilaksi uygulandi. Yogun bakim yatisi suresince yeni DVT veya pulmoner emboli saptanmadi. So­nuc:­ Yogun bakim unitesinde DVT prevalansi %2.7 olmasina ragmen, uygun ve etkili tromboprofilaksi yogun bakim yatisi suresince yeni DVT gelisimini onledi. Anah­tar­soz­cuk­ler: Derin ven trombozu; yogun bakim unitesi; fizyoterapi; pulmoner emboli; tromboprofilaksi. ABSTRACT Background:­This study aims to investigate the prevalence and incidence of venous thromboembolism in intensive care unit (ICU) patients receiving thromboprophylaxis. Methods: Seventy-four consecutive patients (34 females, 40 males; mean age 55.8±19.4 years; range 20-86 years) admitted to the medical-surgical ICU, who were ≥18 years old and expected to stay in ICU for ≥72 hours, were included. Demographic data, Acute Physiology and Chronic Health Evaluation II scores, baseline and time-dependent deep vein thrombosis (DVT) risk factors were recorded. Bilateral lower extremity compression ultrasound was performed twice weekly, and one week after discharge from ICU. If DVT was suspected at any time during ICU stay, compression ultrasound was repeated. All patients were administered low molecular weight heparin or mechanical thromboprophylaxis. Also, passive extremity exercises were applied by physiotherapist to all patients every day. Results:­ Mean Acute Physiology and Chronic Health Evaluation II score was 17±6.1. The prevalence of DVT was 2.7% (CI 95% 3.3-9.42) on ICU admission. Of the patients, 89.1% were administered low molecular weight heparin, and 10.9% were administered mechanical thromboprophylaxis. We did not detect new DVT or pulmonary embolism during the ICU stay. Conclusion:­Although DVT prevalence in ICU was 2.7%, appropriate and effective thromboprophylaxis prevented the development of new DVT during ICU stay.

Background While administering medication through intramuscular injection, the ventrogluteal site must be used instead of the dorsogluteal site, and it is of great significance to locate the ventrogluteal site correctly. Objective To determine the reliability of two different methods used to determine the ventrogluteal site in intramuscular injection practice. Design A cross-sectional study. Settings A university hospital in Istanbul. Participants The study population comprised 120 randomly selected healthcare personnel at a university hospital. Methods The ventrogluteal site was determined using the geometric (G method) and V method and these sites were scrutinized under ultrasonography. It was investigated whether there was any anatomic vessels or neural structure present, and also determined the thickness of subcutaneous tissue, musculus gluteus medius, and musculus gluteus minimus. Results Of the participants, 65.8% were female and the average age was 32.30 years and body mass index was 25.31kg/m 2 . The results showed that G and V methods were statistically significant in terms of variables. It was also found that sex affects subcutaneous tissue thickness and the skin-bone margin in the G and V method, and that body mass index determines subcutaneous tissue, musculus gluteus medius thickness and skin-bone margin. Conclusion When the ventrogluteal site is used for intramuscular injection purposes, the site must be determined in line with the geometric method.

Alveolar hydatid disease or alveolar echinococcosis is a disease of the parasiteEchinococcus multilocularisthat is potentially fatal if left untreated. It primarily involves the liver but can be disseminated to other organs like the lungs and the brain by hematogenous route. Multiorgan involvement and the aggressive appearance of lesions make alveolar hydatid disease easy to confuse with a metastatic malignancy. For this reason, histopathological confirmation is essential for definite diagnosis. We present the imaging features of this disease in two patients in order to emphasize that these lesions can be easily misdiagnosed as malignancies.

To investigate the role of density value in computed tomography (CT) and twinkling artifact observed in color Doppler analysis for the prediction of the mineral composition of urinary stones.A total of 42 patients who were operated via percutaneous or endoscopic means and had undergone abdominal non-contrast CT and color Doppler ultrasonography examinations were included in the study. X-ray diffraction method was utilized to analyze a total of 86 stones, and the correlations between calculated density values and twinkling intensities with stone types were investigated for each stone.Analyses of extracted stones revealed the presence of 40 calcium oxalate monohydrate, 12 calcium oxalate dihydrate, 9 uric acid, 11 calcium phosphate, and 14 cystine stones. The density values were calculated as 1499±269 Hounsfield Units (HU) for calcium oxalate monohydrate, 1505±221 HU for calcium oxalate dihydrate, 348±67 HU for uric acid, 1106±219 HU for calcium phosphate, and 563±115 HU for cystine stones. The artifact intensities were determined as grade 0 in 15, grade 1 in 32, grade 2 in 24, and grade 3 in 15 stones.In case the density value of the stone is measured below 780 HU and grade 3 artifact intensity is determined, it can be inferred that the mineral composition of the stone tends to be cystine.

Summary Background Hydatid disease (HD) is endemic in many parts of the world. It may develop in almost any part of the body; the liver is the organ most frequently involved. HD in an unusual location may make differential diagnosis difficult. Isolated retroperitoneal HD is extremely rare. Case report We report herein a case of retroperitoneal HD mimicking retroperitoneal malignant tumor. Conclusions HD should be considered in the differential diagnosis of all cystic masses in all anatomic locations, especially in regions of the world where the disease is endemic.

Context: Although some endocrine surgeons administer Lugol solution to decrease thyroid gland vascularity, there is still not an agreement on its effectiveness. Objective: The aims of this clinical trial are to evaluate thyroid blood flow and microvessel density in patients with Graves’ disease who received Lugol solution treatment preoperatively. Design: This was a prospective clinical trial. Setting: This clinical trial took place at a tertiary referral center. Method: Thirty-six patients were randomly assigned to receive either preoperative treatment with Lugol solution (group 1, n = 17) or no preoperative treatment with Lugol solution (group 2, n = 19). Main Outcome Measures: Blood flow through the thyroid arteries of patients with Graves’ disease was measured by color flow Doppler ultrasonography. The microvessel density (MVD) was assessed by immunohistochemical and Western blot analysis of the level of expression of CD-34 in thyroid tissue. The weight and blood loss of the thyroid gland were measured in all patients. Results: The mean blood flow, MVD, CD-34 expression, and blood loss in group 1 patients were significantly lower than those in group 2 patients. There was a negative correlation between Lugol solution treatment and blood flow (rs = −0.629; P = 0.0001), blood loss (rs = −0.621; P = 0.0001), MVD (rs = −0.865; P = 0.0001), and CD-34 expression (rs = −0.865; P = 0.0001). According to logistic regression analysis, Lugol solution treatment resulted in a 9.33-fold decreased rate of intraoperative blood loss. Conclusion: Preoperative Lugol solution treatment decreased the rate of blood flow, thyroid vascularity, and intraoperative blood loss during thyroidectomy.

Purpose: To evaluate diffusion-weighted imaging (DWI) features and signal intensity values at T2-weighted magnetic resonance (MR) imaging for differential diagnosis of benign retroperitoneal fibrosis (RPF) and plaque-like retroperitoneal malignant neoplasms. Materials and Methods: Institutional review board approval and informed consent were obtained for this retrospective study. Fifty-one patients with plaque-like confluent retroperitoneal soft-tissue masses were divided into three groups: group I, 25 patients with malignant RPF and retroperitoneal malignant neoplasm; group II, 16 patients with chronic RPF; and group III, 10 patients with active RPF. On T1-weighted (unenhanced and contrast material-enhanced), T2-weighted, and DWI (b = 1000 sec/mm(2)) images, apparent diffusion coefficient (ADC) values and quotients of postcontrast signal intensities between lesions and psoas muscle were evaluated. The chi(2) test was used to compare categorical values; one-way analysis of variance and Kruskal-Wallis tests were used to compare groups. Results: Overall sensitivity, specificity, and positive and negative predictive values of DWI findings were 92% (23 of 25 patients), 62% (16 of 26 patients), 70% (23 of 33 patients), and 89% (16 of 18 patients), respectively. Mean ADC values were 0.79 +/- 0.19 in group I, 1.43 +/- 0.16 in group II, and 0.91 +/- 0.14 in group III. When comparing values, differences between groups I and II (ADC values, P < .0001; DWI quotients, P < .0001; postcontrast quotients, P = .001) and groups II and III (ADC values, P < .0001; DWI quotients, P = .016; postcontrast quotients, P = .04) were significant. There was no significant difference between groups I and III or between the three groups when T2-weighted values were compared. Conclusion: ADC of chronic RPF was higher than that for active RPF or malignant RPF and retroperitoneal malignant neoplasm. DWI can contribute to differential diagnosis of chronic RPF and malignant neoplasms with RPF morphology. Lesions in the malignant group and active RPF group had similar enhancement patterns, while those in the chronic RPF group demonstrated less enhancement. Signal intensity values on T2-weighted images were not useful for differentiating these conditions.

A 17-year-old girl without any history of considerable trauma or previous disease was admitted with weakness and wasting in the right forearm and hand, more marked on the thenar eminence (figure). EMG revealed unrecordable medial antebrachial cutaneous sensory and low-amplitude median motor responses (recorded from thenar muscles) along with chronic neurogenic changes in the hand muscles. MRI showed a fusiform focal expansion of the right T1 root (figure). Neurogenic thoracic outlet syndrome (NTOS) was diagnosed and surgically decompressed.1

Background. The purpose of this study was to assess the factors that affect the false-negative outcomes of fine-needle aspiration biopsies (FNABs) in thyroid nodules.Methods. Thyroid nodules that underwent FNAB and surgery between August 2005 and January 2012 were analyzed. FNABs were taken from the suspicious nodules regardless of nodule size.Results. Nodules were analyzed in 2 different groups: Group 1 was the false-negatives (n=81) and Group 2 was the remaining true-positives, true-negatives, and false-positives (n=649). A cytopathologist attended in 559 (77%) of FNAB procedures. There was a positive correlation between the nodule size and false-negative rates, and the absence of an interpreting cytopathologist for the examination of the FNAB procedure was the most significant parameter with a 76-fold increased risk of false-negative results.Conclusion. The contribution of cytopathologists extends the time of the procedure, and this could be a difficult practice in centres with high patient turnovers. We currently request the contribution of a cytopathologist for selected patients whom should be followed up without surgery.

BackgroundCurrent indications for adrenalectomy include functional adrenal tumors and potentially malignant tumors based on imaging studies. We evaluated the effectiveness of magnetic resonance imaging (MRI) in obtaining a correct preoperative diagnosis.MethodFifty-three patients with nonfunctional adrenal lesions were analyzed. Indications for adrenalectomy of nonfunctional adrenal lesions included >6 cm in size and ≤6 cm in size with atypical characteristics on MRI. Lesions with a size of >6 cm, local invasion, irregular margins, and chemical-shift imaging that demonstrated no loss of signal intensity on out-of-phase images were considered suspected of malignancy.ResultsAdrenal lesions of >6 cm in size exhibited an 80-fold increased prediction of malignancy (OR: 80; 95% CI 7.8–813), whereas irregular margins and local invasion exhibited a 45-fold (OR: 45; 95% CI 6.4–312.5) and a 12-fold (OR: 12; 95% CI 4.6–30.6) increased occurrence of malignancy, respectively. The loss of signal intensity did not affect the prediction of malignancy.ConclusionThe rate of unnecessary tumor resections that are

Objectives: This study investigated whether diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values provide specific information that allows the diagnosis of solid or predominantly solid gynaecological adnexial lesions, especially whether they can discriminate benign and malignant lesions. Methods: DWI was performed in 37 patients with histologically proven solid or predominantly solid adnexial lesions (22 malignant and 15 benign neoplasms). The lesions in our data set were divided into two groups, all adnexial lesions or lesions of ovarian origin, for evaluation. The areas of the highest signal intensity on DWI (b5800 s mm 22 ) and the lowest ADC values within the lesions were evaluated. Results: On DWI, high signal intensity was observed more often in malignant than in benign lesions (p,0.0001). There was no significant difference between the ADC values of the malignant and benign lesions in either the adnexial (0.88i0.16 vs 0.84i0.42; p50.96) or the ovarian (0.85i0.14 vs 1.05i0.2; p50.133) lesions. When signal intensities on DWI were compared, however, malignant lesions had higher values than the benign lesions in both the adnexial (0.69i0.21 vs 0.29i0.13; p,0.0001) and the ovarian lesions (0.75i0.14 vs 0.37i0.24; p50.003). Conclusion: On DWI, high signal intensity was observed more frequently with the malignant lesions.

We report our success with somatostatin and propranolol to treat small-for-size syndrome that occurred despite splenic artery ligation. A 48-year-old woman with cirrhosis due to autoimmune hepatitis underwent living-donor liver transplant; her graft-to-body weight ratio of the right lobe was 0.91%. After arterial reperfusion, portal pressure and flow were 24 cm H20 and 2.22 L/min (ie, 360 mL/100g graft/min), respectively. Following splenic artery ligation, the portal pressure decreased to 16 cm H20 and portal flow to 1.74 L/min (ie, 282 mL/100g graft/min). On the second postoperative day, small-for-size syndrome was diagnosed based on the marked prolongation of prothrombin time (international normalized ratio, 4.4), hyperbilirubinemia (359.1 micromol/L), rapid escalation of transaminases (alanine aminotransferase 2488 U/L, aspartate aminotransferase 1075 U/L) and very high portal flow rate (90 cm/sec). Oral propranolol (40 mg/day b.i.d.) and somatostatin infusion (250-microgram bolus followed by perfusion at a rate of 250 microgram/h for 5 days) were started. Prothrombin time and transaminase levels began to decrease the following day, although the bilirubin level increased to 495.9 micromol/L before returning to normal. The patient was discharged in excellent health 5 weeks after surgery. Despite reduction of portal pressure by splenic artery ligation, small-for-size syndrome may develop in patients with persistent high portal flow. To the best of our knowledge, this is the first report of the successful treatment of small-for-size syndrome by somatostatin and propranolol in the clinical setting.

Background Hypothyroidism is a risk factor for atherosclerotic cardiovascular disease. This study investigated the effects of l-thyroxine replacement therapy on lipid profile and endothelial function after thyroidectomy in patients with overt transient non-autoimmune hypothyroidism. Methods Twenty-two patients with non-toxic multinodular goitre treated by total or near-total thyroidectomy and 22 healthy individuals matched for age, sex and body mass index were studied. Lipid profile and endothelial function were determined in each patient at the euthyroid phase before thyroidectomy (stage 1), the hypothyroid phase 3 weeks after surgery (stage 2), and the euthyroid phase 3 months (stage 3) and 6 months (stage 4) after the start of thyroxine treatment. Results The lipid profile and endothelial function deteriorated between stage 1 and stages 2 and 3. Findings at stage 4 were similar to those at stage 1. There was a positive correlation between serum thyroid-stimulating hormone (TSH) and total cholesterol (rs = 0·588, P < 0·001), and a negative correlation between serum TSH and flow-mediated arterial dilatation (rs = 0·506, P < 0·001). Total cholesterol and TSH were independent determinants of endothelial function. Conclusion A 3-week hypothyroid period after thyroidectomy led to a more atherogenic lipid profile and impaired endothelial function that persisted for at least 3 months.

Hydatid cysts may be found in almost any part of the body, but most often they are found in the liver and lungs. Other organs that are occasionally affected include the brain, muscle, kidney, heart, pancreas, and adrenal and thyroid glands. We report a case of hydatid cyst of the adrenal gland.

Hypothesis: The detection of suspected malignant thyroid nodules by ultrasonography is associated with thyroid gland volume and tumor size. Design: Prospective clinical trial. Setting: A tertiary referral center. Patients: Three hundred sixty-five patients with a multinodular goiter with coexistent dominant nodules. Main Outcome Measures: The correlation between thyroid gland volume and tumor size and the detection of suspected malignant thyroid nodules by ultrasonography. The incidence of thyroid carcinoma inside and outside the dominant nodules and thyroid gland volume and tumor size in suspected or unsuspected malignant thyroid nodules by ultrasonography were determined. Receiver operating characteristic analysis was used to identify the cutoffs of the tumor size and thyroid gland volume. Results: One hundred thyroid carcinomas were found in 69 (18.9%) patients. Forty-one of these carcinomas were inside the dominant nodule, whereas 59 were outside the dominant nodule. Only 9 of the 59 thyroid carcinomas outside the dominant nodules were suspected of being malignant by ultrasonography. Thyroid gland volume less than 38 mL and tumor size larger than 7 mm had 48-fold (odds ratio, 48; P.001) and 21.5-fold (odds ratio, 21.5; P.001) increased rates, respectively, of detecting suspected malignant thyroid nodules by ultrasonography. Conclusions: Thyroid gland volume and tumor size were significantly associated with detection of suspected malignant thyroid nodules by ultrasonography. Small thyroid gland volume was associated with detection of suspected malignant thyroid nodules in multinodular goiters.

To assess the diagnostic value of dynamic contrast medium-enhanced magnetic resonance imaging (DCE-MRI) in detection of thyroid carcinoma compared with fine-needle aspiration biopsy and frozen section analysis in multinodular goiter.Prospective clinical study.University hospital.Thirty consecutive patients with nodular goiter without any clinical risk and symptoms associated with thyroid carcinoma were studied. Twenty-five patients had euthyroid multinodular goiter, and 5 had toxic nodular goiter. Scintigraphy, ultrasonography, and DCE-MRI were performed preoperatively in all patients, as well as fine-needle aspiration biopsy and frozen section analysis in 17 patients with dominant cold nodules.Contrast enhancement patterns on DCE-MRIs and histopathologic results of thyroidectomy specimens were correlated. The sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values of DCE-MRI and the results of fine-needle aspiration biopsy and preoperative frozen section analysis to detect thyroid carcinoma were compared.Thyroid carcinoma was found in 11 patients (36.7%), but was clinically significant in only 4 (13.3%). Delayed washout pattern of contrast enhancement significantly correlated with a histologic diagnosis of thyroid carcinoma (P.001). The conditional probability of thyroid cancer in a patient with multinodular goiter with a delayed washout pattern was 0.78. The sensitivity and diagnostic accuracy of DCE-MRI to detect thyroid carcinoma was higher compared with fine-needle aspiration biopsy and frozen section analysis (100% vs 50% and 85.7%, and 90% vs 70.6% and 87.5%, respectively). The negative predictive value of DCE- MRI was 100%, ruling out thyroid carcinoma in all patients with benign goiter.Dynamic contrast-enhanced magnetic resonance imaging is useful to detect or exclude thyroid carcinoma with high diagnostic accuracy in patients with multinodular goiter when results of other diagnostic methods are inconclusive.

Background Several methods have been recommended to detect parathyroid lesions in patients who have previously undergone neck surgeries, including radio-guided surgery or intraoperative ultrasounds. In this study, we aimed to investigate whether the radio-guided excision of pathologic parathyroid lesions allowed us to find affected lesions in patients who had previously undergone neck operations. Methods This prospective study included 18 patients with primary hyperparathyroidism who had previously undergone neck surgeries. The pathologic parathyroid lesions were localized by ultrasonography, and a radiotracer was injected directly into the lesions. Results Careful dissections were carried out by following the area of maximum radioactivity until the lesions were identified and excised. Eighteen parathyroid adenomas were removed in 18 patients. The median count from each lesion was significantly higher than the values measured from the adjacent tissues and the lesion beds (12550/20 s, 370/20 s, and 35/20 s, respectively; p Conclusion Radio-guided excision of parathyroid lesions can be performed safely for re-operative parathyroid surgery.