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Living donor liver transplantation may complement cadaveric transplantation in acute liver failure (ALF) patients. Between 2008 and 2017, 89 patients were treated for ALF; 15 patients (17%) recovered with intensive care treatment; 31 (35%) died without transplant. The records of the remaining 43 patients (median (range) age: 14 (1–62)) who underwent transplantation were evaluated. The etiologic factors were toxic agents (10; mushrooms: 8; herbs: 2), hepatitis viruses (7; A: 1; B: 6), Wilson’s disease (7), autoimmune hepatitis (4), and Budd-Chiari syndrome (2); 13 cases were idiopathic. Cadaveric organs (whole, split, reduced) were transplanted to 32 patients; 11 patients underwent living donor transplantation. One patient (2%) died of septic shock on the second postoperative day. Bacterial infection was the most common early (< 3 months) complication in the remaining patients (31/42; 74%), followed by delirium (5/42; 12%) and acute rejection requiring steroid pulse (5/42; 12%). Seven other patients died during median (range) follow-up of 94 (14–142) months: various infections (5), leukemia (1), and acute myocardial infarction (1). The 1-, 5-, and 10-year survival rates were 100%, 96%, and 92% in children and 94%, 82%, and 65% in adults respectively. Cadaveric organ sharing and transplantation from living donors when appropriate yield a high survival rate, despite high early morbidity, in ALF patients whose conditions deteriorate despite intensive care treatment. Efforts to eliminate preventable causes of acute liver failure will lead to more efficient use of health care resources.

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.

Resumen Introduccion La enfermedad tiroidea nodular posee el potencial de desarrollar malignidad. El objetivo es evaluar la importancia de la resonancia magnetica ponderada por difusion cervical (IRM-DP) para la deteccion de nodulos tiroideos malignos. Metodo El grupo de estudio lo constituyen los pacientes intervenidos por enfermedad tiroidea, en los que preoperatoriamente se les realizo 3 metodos diagnosticos: biopsia guiada por PAAF, US e IRM-DP. El grupo de estudio total se dividio en 2 subgrupos, de acuerdo con la evaluacion postoperatoria patologica final de los nodulos en 2 grupos: «grupo benigno» y «grupo de malignidad». Se evaluaron 65 nodulos tiroideos operados, en 58 pacientes. Los parametros preoperatorios, (datos demograficos, los hallazgos ecograficos, los resultados de la biopsia por aspiracion con aguja fina y los valores del coeficiente de difusion aparente (CDA) de los nodulos en IRM-DP), se compararon con los resultados de los examenes patologicos postoperatorios. Resultados El «grupo benigno» lo constituyen 50 (76,9%) nodulos, mientras que 15 (23,1%) nodulos constituyeron el «grupo de malignidad». Los valores minimos, maximos y medios de CDA de los nodulos fueron significativamente mas bajos en el grupo con malignidad (p Conclusiones El valor de CDA detectado en IRM-DP cervical puede considerarse como un parametro predictivo para la deteccion de cancer de tiroides.

Nodular thyroid disease possesses the potential to harbor malignancy. Our aim was to evaluate the significance of cervical diffusion-weighted magnetic resonance imaging (DW-MRI) for the detection of malignant thyroid nodules.Sixty-five thyroid nodules from 58 patients who had undergone surgery were evaluated. Preoperative parameters, demographic data, ultrasound findings, fine-needle aspiration biopsy results and apparent diffusion coefficient (ADC) values of the nodules at DW-MRI were compared with the results from postoperative pathology examinations.The "benign group" included 50 (76.9%) nodules, while 15 (23.1%) nodules constituted the "malignancy group". Minimum, maximum and mean ADC values of the nodules were significantly lower in the malignancy group (p0.05). The best cutoff value for the mean ADC value was 1.33 × 10-3 mm2/s, with a sensitivity of 66.67%, a specifity of 89.13%, a positive predictive value of 53.63% and a negative predictive value of 89.13%. A mean ADC value equal to or lower than 1.33 × 10-3 mm2/s was associated with 9 times higher risk of malignancy (odds ratio: 9.111, 95% confidence interval: 2.49-33.21).The ADC value detected by cervical DW-MRI can be considered a predictive parameter for the detection of thyroid cancer.

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.

To investigate the nodular thyroid disease (NTD) and the natural course of thyroid nodules in patients with acromegaly. 138 patients with acromegaly (73 F/65 M), whose initial thyroid ultrasonography performed in our university hospital, were included in this study. The frequencies of NTD, papillary thyroid cancer (PTC) and associated factors on nodule formation were investigated at initial assessment. Patients who had NTD continued to follow-up (n = 56) were re-evaluated with a ultrasonography performed after a mean 7-years follow-up period. The nodule size changes were compared with the initial data and the factors affecting nodule growth were investigated. The frequency of NTD was found 69%. Patients with NTD were older (p = 0.05), with higher baseline IGF-1%ULN (upper limit of normal) (p = 0.01). In patients with NTD, the majority had similar nodule size (45%), decreased nodule size in 30% and nodule growth in 25%. In patients with active acromegaly at last visit, nodule growth was more significant (p

Background: In individuals with atherosclerotic risk factors, endothelial dysfunction (ED) appears as an early phase in the development of clinical symptoms. Recent studies indicate that adropin, a newly identified peptide, participates in cardiovascular health through the regulation of several metabolic events including angiogenesis and blood flow. In this study, we aimed to determine the relation of adropin with biochemical and radiologic parameters which reflect ED such as endothelial nitric oxide synthase (eNOS), endothelin 1 (ET-1), nitric oxide (NO) and flow-mediated dilatation (FMD) along with the routine biochemical measurements in patients recently diagnosed with metabolic syndrome (MetS). Methods: Fasting blood samples from 110 patients with MetS diagnosed according to the NCEP ATP III-2005 criteria were collected to measure the concentrations of adropin and other parameters including the lipid profile, insulin and glucose. Serum NOx concentrations were determined by measuring NO2 plus NO3. FMD test was performed by ultrasonography, and patients were stratified as FMD (+) or (–). Data were compared between these two subgroups and also with matching healthy controls (n=50). Biochemical data were evaluated using Student’s t or Mann-Whitney U tests. Results: Fifty-nine subjects had ED (+) and the remaining 101 subjects were ED (–). In the first group, adropin levels were significantly lower than the latter (2.13±1.05 vs. 3.41±1.63 ng/mL, respectively; p Conclusions: Low adropin level in circulation is related to ED and has a close association with FMD. Any alterations in its level may be of help in order to assess the development of ED before the occurrence of clinical symptoms in patients with metabolic syndrome.

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.

Background Retrosternal goiter incidence rates range between 0.2% and 45% of all goiters, and sternotomy is performed in some of patients. There is no consensus for selecting the patients on whom sternotomy should be performed. We aimed to determine the most important factor for predicting requirement of sternotomy. Methods This prospective study included 260 patients with retrosternal goiter. The clinical symptoms, history of previous thyroidectomy, presence of tracheal deviation, tracheal compression, site of mediastinal extension, thyroid tissue density, findings of intubation, type of surgical approach, histologic findings of thyroid, weight of thyroid, and postoperative complications were evaluated. Results Thyroid tissue density, posterior location, and subcarinal extension were found to be independent factors for predicting requirement of sternotomy. The risk for sternotomy increased 47-fold for patients with harder thyroid tissue density (OR: 47.3; 95% CI: 5.8–385.70), 20-fold for patients with subcarinal extension (OR: 20.5; 95% CI: 2.5–168), and 10-fold for patients with posterior location (OR: 10.5; 95% CI:1.8–60). Conclusion Thyroid tissue density was defined the strongest predictive factor for requirement of sternotomy. Preoperatively obtained information thyroid tissue density can be useful for surgical strategy.

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.

This study was done to determine mammographic, sonographic and magnetic resonance imaging (MRI) appearances of idiopathic granulomatous mastitis, an entity clinically and radiographically resembling breast carcinoma. A total of 36 women (mean age 37 years, range 21–51 years) with histopathological diagnosis of idiopathic granulomatous mastitis were enrolled in the study. The Breast Imaging Reporting and Data System (BI-RADS) was used to categorise the levels of suspicion of malignancy on mammography. Mammography findings were classified also according to density, margin, architectural distortion and number of lesions. Lesions were classified according to number, heterogeneity and echogenic features on sonography. Dynamic MRI findings were categorised as enhancing mass lesion, nonmass lesion or both mass lesions and nonmass lesions together. Subclassification criteria for MRI included lesion shape, margin, border and internal enhancement pattern. The most common mammographic finding was either focal or diffuse asymmetric density (n=15, 44%). The most common sonographic findings were solitary or multiple circumscribed heterogeneous hypoechoic masses (n=19, 52%). Among other sonographic findings were diffuse abscess formation with fistulae and massive parenchymal heterogeneity and hypoechogenicity in 12 (33%) and five (13%) women, respectively. On MRI, enhancing mass lesions were detected in 24 patients, whereas enhancing nonmass lesions were observed in 28. Sixteen patients had both enhancing mass lesions and nonmass lesions together. Although not characteristic for this entity, asymmetric density on mammography, solitary or multiple clustered heterogeneous hypoechogenicity with a tubular configuration on sonography and round, smooth-contoured masslike lesion with rim enhancement or segmental non-mass-like lesion on MRI are the most common features of the disease.

Visceral obesity is one of the main components of the metabolic syndrome (MetS). The retroperitoneal fat area (RFA) is part of the intraabdominal adipose mass. The aim of this clinical trial was to determine whether there is an association between the RFA measurement and MetS components in patients undergoing laparoscopic lateral transabdominal adrenalectomy. The study population consisted of 61 consecutive patients who underwent laparoscopic adrenalectomy between January 2007 and June 2010 at the Istanbul Faculty of Medicine. Anthropometric, demographic, and biochemical parameters as well as cardiometabolic risk factors were recorded. The RFA was calculated using computed tomography. The mean body mass index, waist circumference, and RFA in patients with MetS was significantly higher than that of the patients without MetS. There were positive correlations between RFA and central obesity (r = 0.675, p = 0.0001) and MetS (r = 0.894, p = 0.0001). The strongest correlation was observed between RFA and MetS. According to receiver operating characteristic analysis, RFA measurement correctly predicted MetS risk in 96% of patients and failed in only 4%. Our findings indicate that measurement of the RFA may provide a safe, easy assessment of its metabolic risk.

We present the mammographic and sonographic findings in a case of fibroadenomatosis involving both breasts and axillae in a renal transplant patient after 16 years of treatment with cyclosporin A. Awareness of the fact that cyclosporin A may induce the formation of fibroadenomas, including in accessory breast tissue, is important for correct diagnosis and preventing unnecessary intervention.

The purpose of this study was to investigate the efficiency of a radioguided occult lesion localization technique in reoperative thyroid and parathyroid procedures in patients who had undergone previous neck exploration for thyroid or parathyroid disease.Twenty-one consecutive patients who were scheduled for reoperative thyroid or parathyroid surgery were studied. The indication for reoperation was recurrent papillary thyroid cancer (PTC) in eight patients, completion thyroidectomy for PTC in eight patients who had previously undergone a bilateral subtotal thyroidectomy, recurrent goiter in two patients, primary hyperparathyroidism in two patients, and recurrent parathyroid cancer in one patient. Ninety minutes before surgery, 0.1 mL of Technetium-99m (0.2 mCi)-labeled macroaggregated albumin was injected directly into the lesion under ultrasonographic guidance. During surgery, a handheld gamma probe was used to localize and excise the lesions. The background and postexcisional site radioactivities were compared to confirm the completeness of each procedure. The radiation dose in the operating room environment, duration of surgery, and postoperative complication rates were evaluated in all patients. In patients with PTC, the change in serum thyroglobulin (Tg) following surgery was noted.Thirty lesions were marked and excised. The postexcisional bed gamma counts (610 ± 141) were markedly decreased compared with the pre-excisional site counts (21,415.8 ± 4993.4; p = 0.0001). The ratio of the postexcisional and background counts (4.6 ± 4.3) was significantly lower than the ratio of the pre-excisional and background counts (173.7 ± 156.4; p = 0.0001). The mean operation duration was 53.3 ± 7.5 minutes. The dose absorbed by the hands of the surgeon was estimated as 0.07 ± 0.02 and 0.15 ± 0.05 millisievert/h when one or three lesions were marked, respectively. One patient developed postoperative transient hypoparathyroidism. After surgery, serum Tg levels dropped to2 ng/mL in 86% (6/7) of the patients with PTC whose preoperative serum Tg was elevated.The radioguided occult lesion localization technique was efficient in the perioperative identification of thyroid and parathyroid tumors in patients who were undergoing reoperation for PTC and hyperparathyroidism.

Background Better follow-up of patients with papillary thyroid cancer (PTC) and more sensitive detection leads to detection of recurrences in the neck. Despite excellent outcomes, the major challenge is controlling locoregional recurrence. We aimed to investigate whether the radioguided excision of metastatic lymph nodes makes it possible to find the affected lymph nodes in patients with previously operated neck compartments. Method This prospective study included 46 patients with recurrent/persistent PTC who had previously undergone operation of the neck compartment. Prior to operation, the pathologic node was localized by ultrasound (US) and radiotracer ( 99m Tc-labeled rhenium colloid) was injected directly into the pathologic node. Careful dissection was carried out following the area of maximum radioactivity until the metastatic lymph node(s) were identified and excised. Result One affected lymph node was removed in 17 patients, and more than one lymph node (affected or additional nodes) was removed in 29 patients. The median count from the lesion was significantly higher than values from the lesion bed (background activity) (16,886 counts/ 20 s versus 52 counts/20 s; p \ 0.001). During follow-up, four patients were lost to follow-up and 27 patients had negative US and basal thyroglobulin (Tg). Five patients had suspicious lymph nodes on the operated side. Although the basal Tg level remained above the normal limit, moderately high in 8 patients, no metastases were detected in the neck. Conclusions Radio-guided excision of metastatic lymph nodes can be performed safely for the detection and excision of recurrent thyroid cancer in the central and lateral neck.

Background: Obesity and visceral fat are thought to be the most important factors influencing the technical difficulty during open and laparoscopic surgery. The authors aimed to investigate the effect of retroperitoneal fat mass on surgical outcomes in patients undergoing laparoscopic adrenalectomy. Patients and methods: This prospective study included 51 consecutive patients who underwent lateral transabdominal laparoscopic adrenalectomy. Body mass index (BMI) and retroperitoneal fat area (RFA)/adrenal mass area (AMA) ratio were calculated. Results: There was a positive correlation between BMI and operating time and postoperative complications and hospital stay. According to 2-way analysis of variance, only RFA/AMA ratio ( P = .0001) was found to significantly correlate with operating time, whereas BMI did not significantly correlate with operating time ( P = .51). In patients with high BMI, high RFA indicated longer operating time and higher complication rate, whereas low RFA was associated with significantly shorter operating time and decreased risk of complications. Conclusion: Retroperitoneal fat mass is a more useful parameter than BMI for predicting the surgical outcomes of laparoscopic adrenalectomy.

Purpose The aim of our study is to demonstrate the feasibility of body diffusion weighted (DW) MR imaging in the evaluation of pancreatic islet cell tumors (ICTs) and to define apparent diffusion coefficient (ADC) values for these tumors. Materials and methods 12 normal volunteers and 12 patients with histopathologically proven pancreatic ICT by surgery were included in the study. DW MR images were obtained by a body-phased array coil using a multisection single-shot echo planar sequence on the axial plane without breath holding. In addition, the routine abdominal imaging protocol for pancreas was applied in the patient group. We measured the ADC value within the normal pancreas in control group, pancreatic ICT, and surrounding pancreas parenchyma. Mann–Whitney U-test has been used to compare ADC values between tumoral tissues and normal pancreatic tissues of the volunteers. Wilcoxon Signed Ranks Test was preferred to compare ADC values between tumoral tissues and surrounding pancreatic parenchyma of the patients. Results In 11 patients out of 12, conventional MR sequences were able to demonstrate ICTs succesfully. In 1 patient an indistinct suspicious lesion was noted at the pancreatic tail. DW sequence was able to demonstrate the lesions in all of the 12 patients. On the DW images, all ICTs demonstrated high signal intensity relative to the surrounding pancreatic parenchyma. The mean and standard deviations of the ADC values (×10−3 mm2/s) were as follows: ICT (n = 12), 1.51 ± 0.35 (0.91–2.11), surrounding parenchyma (n = 11) 0.76 ± 0.15 (0.51–1.01) and normal pancreas in normal volunteers (n = 12), 0.80 ± 0.06 (0.72–0.90). ADC values of the ICT were significantly higher compared with those of surrounding parenchyma (p Conclusion DW MR imaging does not appear to provide significant contribution to routine MR imaging protocol in the evaluation of pancreatic islet cell tumors. But it can be added to MR imaging protocol to detect the lesion in a limited number of patients with clinical suspicion for pancreatic ICT with negative or suspicious imaging findings.

It is not clear whether nonfunctional adrenal incidentaloma (NFA) increases the risk of atherosclerosis and metabolic syndrome or whether this type of adrenal tumor has been found more frequently in patients with cardiometabolic risk factors. We aimed to determine the effects of NFA on cardiometabolic risk factors and endothelial function and to compare the patients with a 1:1 cardiometabolic risk factor matched control group. Thirty-five patients with NFA were studied, and 35 body mass index-, age-, and sex-matched subjects were regarded as group 2 controls. Thirty-five cardiometabolic risk factors–matched subjects were then regarded as group 3 controls. Patients with NFA had significantly lower flow-mediated dilation (FMD)—a parameter for endothelial function—measurements compared with groups 2 and 3 (7.1 ± 2.9% vs. 12.9 ± 3.8% and 13.5 ± 4.5%; P

This prospective study was approved by the local institutional ethics committee, and written informed consent was obtained from all patients. The aim of this study was to determine whether the oral administration of a polyethylene glycol (PEG)-electrolyte solution induces adequate luminal distention for magnetic resonance (MR) colonography to be performed and to assess patient acceptance of this procedure. Fifty-five patients (26 women, 29 men; mean age, 60.5 years +/- 14 [standard deviation]; age range, 40-75 years) who were referred for optical colonoscopy (OC) owing to symptoms and findings that included rectal bleeding, altered bowel habits, and positive fecal occult blood test results participated in this study. Standard bowel preparation was performed 1 day before the procedure. MR colonography was performed and followed by OC on the same day. Before undergoing MR colonography, the patients received 2.0-2.5 L of the PEG-electrolyte solution orally. Adequate distention of all colonic segments was achieved in 50-53 (91%-96%) of patients imaged in the supine position and in 51-53 (93%-96%) of patients imaged in the prone position. Oral administration of the solution yielded uniform luminal darkening and sufficient colonic distention for MR colonography in 91%-96% of patients.

The objective of this study was to evaluate the accuracy of the magnetic induction technique with a nonlinear tunable oscillator (the Tissue Resonance Interaction Method [TRIMprob]) in the diagnosis of prostate cancer (CaP). Overall, 148 men were split into two groups (patients at risk of CaP [Group 1] and controls [Group 2]) and evaluated with the TRIMprob. Group 1 consisted of 100 patients (mean age: 63.8 +/- 7.2 years) with elevated prostate-specific antigen (>4 ng/mL) levels and/or abnormal digital rectal examination. Eleven patients (Group 2a, mean age: 59.5 +/- 7.3) with previously biopsy-proven CaP served as positive controls. In addition, 37 voluntary men (Group 2b, mean age: 39.8 +/- 10.4) with normal prostate-specific antigen and digital rectal examination without lower urinary tract symptoms served as negative controls. Non-linear resonance was analyzed at 465 MHz and a cut-off value of 40 units was detected as the resonance value for the best threshold to distinguish benign conditions from CaP after transrectal ultrasonography-guided biopsy with a standard 10-12 core technique in Group 1. Mean resonance values (+/-standard deviation) with the TRIMprob examination for patients in Groups 1 and 2b were 36.72 +/- 22.35 and 73.64 +/- 10.06, respectively, whereas for patients in Group 2a, it was 13.73 +/- 12.12 (P < 0.01). Sensitivity, specificity, positive and negative predictive values of the TRIMprob using the study cohort of Group 1 were found as 76%, 61.3%, 39.6% and 88.5%, respectively. Despite some technical limitations, the non-invasive TRIMprob examination may have a role in screening protocols for CaP.

Background To investigate whether radioguided surgery (RGS) has any beneficial effects on the complication rates and the completeness of completion thyroidectomy (CT) in a center experienced in endocrine surgery. Methods Thirty-three patients scheduled for CT for thyroid carcinoma were randomly selected for 2 types of intervention. CT was performed by RGS following administration of 5 mCi technetium-99m in 15 patients (group 1) and with conventional surgical exploration without RGS in 18 patients (group 2). The duration of the CT, thyroid function tests, iodine-131 uptake at 24 hours at the third postoperative week, and complication rates were compared between groups 1 and 2. Results In groups 1 and 2, the duration of CT (63.3 ± 7.5 vs 65 ± 10.8 minutes, P = .7), postoperative serum thyrotropin-stimulating hormone (TSH) levels (43.9 ± 17.5 mIU/L vs 36.8 ± 8.6 mIU/L, P = .2), postoperative 131 I uptake at 24 hours (6.86 ± 1.7 vs 7.0 ± 1.3, P = .8), and complication rates (13.3% vs 5.6%, P = .6) showed no significant differences. Conclusion RGS during CT offers no benefit over conventional surgical exploration with respect to operation time, complication rates, or completeness of surgery in a center experienced in endocrine surgery. However, it might be helpful for general surgeons who are less familiar with re-operative thyroid surgery.

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.

Background Preoperative preparation of the patient with Graves' disease (GD) is crucial to avoid intraoperative or postoperative complications associated with anesthesia or surgery. We aimed to evaluate thyroid blood flow and microvessel density in patients with GD according to antithyroid drug (ATD) treatment, preoperatively. Method Forty-three patients were divided into two groups according to the ATD type. Patients in group 1 (n = 25) were treated with methimazole, whereas patients in group 2 (n = 18) were treated with propylthiouracil, preoperatively. Blood flow through the thyroid arteries was measured by color flow Doppler ultrasonography. The microvessel density (MVD) was assessed immunohistochemically and via Western blot analysis using the level of CD-34expression in thyroid tissue. Results There was a positive correlation between blood loss and thyroid volume (rs = 0.953, P = .0001) and blood flow (rs = 0.720, P = .0001) and CD-34 expression (rs = 0.331, P = .03) and MVD (rs = 0.442, P = .003). No correlation was observed between ATD type and thyroid vascularity. In patients with longer treatment duration before operation, thyroid vascularity was significantly lower relative to patients with shorter treatment durations. According to logistic regression analysis, longer treatment duration had a 142-fold decreased rate of intraoperative blood loss independent of ATD type. Conclusion Preoperative ATD treatment duration may predict intraoperative blood loss during thyroidectomy. Longer treatment duration might be useful in reducing intraoperative bleeding, allowing better visualization and preservation of the nerves and parathyroid glands.

Although the sensitivity of preoperative localization techniques is high for solitary parathyroid adenomas, negative imaging study results are inevitable. The weight and location of the parathyroid adenoma may contribute to the negative results. We aimed to study the impact of adenoma weight and ectopic location of the parathyroid adenoma on ultrasonography and sestamibi scan results. The patients were divided into two groups according to adenoma location. Group 1 consisted of 36 patients with ectopic location, and group 2 consisted of 149 patients with normal location. Parathyroid adenoma weight and the results of imaging studies were determined in all patients. Of 185 patients operated on for hyperparathyroidism, 36 (19.4%) had ectopic parathyroid glands. There was a positive correlation between adenoma weight and positive imaging studies, whereas ectopic location did not correlate with negative imaging study results. There was no significant difference between the ectopic adenoma ratio of patients with negative and positive imaging study results. The weight of the ectopic parathyroid adenoma was significantly lower in patients with negative imaging study results than in patients with positive imaging study results (p = 0.001). According to the analysis of variance, patients with higher-weight adenomas have positive imaging study results irrespective of ectopic location. For both normal and ectopic adenoma locations, adenoma weight was found only to be a factor that positively influences imaging study results.

Adrenal cysts are very rare lesions, usually asymptomatic or without characteristic symptoms. They are classified as pseudocysts, endothelial cysts, epithelial cysts or parasitic cysts. Although pseudocysts are reported to be the most common clinically recognized adrenal cysts in surgical series, endothelial cysts are more common in autopsy series. We studied 15 consecutive patients with adrenal cysts who underwent surgical resection at our institution from 1990 to 2005. Of 15 patients with adrenal cysts, 10 had pseudocysts, 3 epithelial cysts, 1 an endothelial cyst and 1 a parasitic cyst. In conclusion, a better understanding of cystic adrenal masses is necessary to recognize true adrenal cysts and differentiating them from adrenal carcinoma or adenoma by demonstrating the foci of cystic or degenerative changes.

Although the sensitivity of imaging studies is high in solitary parathyroid adenomas, negative results are inevitable. The aims of this prospective clinical study are to evaluate the impact of the presence of thyroid disease on the sensitivity and positive predictive value (PPV) of ultrasonography (US), sestamibi (MIBI), and parathyroid fine needle aspiration and parathormone assay (PTH-FNA).The patients were divided into 4 groups according to preoperative imaging studies: group A (n = 62) with US, group B (n = 62) with MIBI, group C (n = 62) with US + MIBI, and group D (n = 62) with PTH-FNA. These 4 groups were subdivided according to the presence (group 1) or absence (group 2) of thyroid nodule.In the overall patients, the sensitivity and PPV of PTH-FNA to localize parathyroid adenoma was higher compared with US, MIBI, and US + MIBI (100% and 100% versus 96% and 91% versus 92% and 87% versus 95% and 94%, respectively, P.05). The sensitivity and PPV of US, MIBI, and US + MIBI in the patients without thyroid nodule was higher compared with the patients with thyroid nodule (100% and 100%, 100% and 96%, 100% and 100% versus 93% and 84%, 85% and 80%, 96% and 86%, respectively, P.05). The sensitivity and PPV of the PTH-FNA was 100% in the patients with and without a thyroid nodule.PTH-FNA can be performed safely for the confirmation of parathyroid adenoma localized by preoperative imaging studies. In patients with a concomitant thyroid nodule, PTH-FNA was more accurate to detect the parathyroid adenoma than the other imaging studies.

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.

A 54-year-old woman who had undergone total abdominal hysterectomy and bilateral adnexial resection because of endometrial carcinosarcoma presented with thyrotoxicosis, rapidly enlarging neck mass, right cervical tenderness to the ears, palpitation, swelling and heat intolerance, 3 years after the operation. Her serum thyroid hormone levels confirmed hyperthyroidism. Triiodothyronine/thyroxine ratio was 18. The thyroid antibodies were markedly elevated. A thyroid scan showed a cold area corresponding to the thyroid nodule, with high radioiodine uptake in the remaining thyroid tissue. Antithyroid drugs were started to control the hyperthyroidism. In our patient, who had a history of malignancy, the rapidly enlarging neck mass was considered as metastasis to the thyroid gland. The patient underwent bilateral total thyroidectomy. Histopathological examination demonstrated findings compatible with Graves' disease on the left and a carcinosarcoma metastasis on the right thyroid lobe. We suggest that both destructive thyroiditis and Graves' disease contributed to our patient's thyrotoxicosis. Metastatic thyroid carcinoma and destructive thyroiditis should be considered in patients with rapidly enlarging neck mass and a prior history of visceral malignancy.

Objectives: Primary hyperparathyroidism (pHPT) is a common endocrine disease. The aim of this study was to assess the effect of the presence of thyroid nodules, adenoma weight, and ectopic localization on the sensitivity of different imaging studies in patients with hyperparathyroidism. Study Design: A series of 125 patients with pHPT who underwent low-frequency ultrasonography, high-frequency ultrasonography, Thallium-Technetium scintigraphy, sestamibi scintigraphy, and combined technique was reviewed retrospectively. Patients were divided in two groups depending on the presence or absence of thyroid nodules. Results: The overall sensitivity of low-frequency ultrasonography, high-frequency ultrasonography, Thallium-Technetium scintigraphy, sestamibi scintigraphy, and combined technique was 69%, 89%, 71%, 86%, and 98%, respectively. The sensitivity of these imaging studies was 94%, 100%, 94%, 96%, and 100%, respectively, in our patients with no thyroid nodules but decreased to 54%, 84%, 54%, 81%, and 79%, respectively, in the presence of thyroid nodules. The parathyroid adenoma weight in true-positive imaging studies was significantly higher than those in false-positive and false-negative imaging studies. The numbers of ectopic parathyroid adenomas were found to be higher in the group of parathyroid adenomas undetected with ultrasonography when compared with ultrasonographically detected adenomas. Conclusion: In patients with parathyroid adenoma, the sensitivity of imaging studies correlates with the presence of thyroid nodules, adenoma weight, and ectopic localization.

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.

We present the mammographic and sonographic findings in a case of fibroadenomatosis involving both breasts and axillae in a renal transplant patient after 16 years of treatment with cyclosporin A. Awareness of the fact that cyclosporin A may induce the formation of fibroadenomas, including in accessory breast tissue, is important for correct diagnosis and preventing unnecessary intervention.

A 38-year-old woman had a 4-week history of vaginal bleeding, heat intolerance and palpitations. Levels of beta-human chorionic gonadotropin and thyroid hormones were abnormally high. After ultrasound diagnosis of a molar pregnancy, evacuation of the mole was planned with preoperative treatment involving the use of antithyroid drugs and plasmapheresis. Plasmapheresis was used to prepare for surgery in our patient who needed more rapid hormonal control. In conclusion, early diagnosis of molar pregnancy results in decreased incidence of significant complications related to hyperthyroidism.

To investigate the rate of operative success in excision of nonpalpable lymph nodes with metastatic disease achieved with radioguided occult lesion localization (ROLL) and intraoperative ultrasonography (IOUS) in patients with papillary thyroid cancer (PTC).Twenty consecutive PTC patients with nonpalpable lymph nodes with metastatic disease localized in previously operated fields were randomized to receive ROLL (n = 11) or IOUS (n = 9). Nodes were excised along with adjacent soft tissue to accomplish a compartment-oriented dissection. The duration of operation, rate of postoperative complications, pre- and postoperative serum thyroglobulin (Tg) levels, and the findings of postoperative neck ultrasonography and postablation scan were recorded in all patients. Measures of operative success included a postoperative Tg level50% of preoperative Tg level and no abnormal lesions on postoperative imaging.Histopathologic examination confirmed the excision of all preoperatively identified metastatic nodes. Additional nodes also were excised (2.3 ± 3.3 per specimen in the ROLL group and 1.6 ± 1.8 per specimen in the IOUS group), 23% of which were metastatic. No postoperative complications occurred in either group. The duration of operation was similar in the 2 groups (P = .4). Postoperative imaging confirmed the clearance of suspicious nodes in all patients. The rate of operative success in ROLL and IOUS group were 100% and 89%, respectively.In patients with recurrent PTC, a high rate of operative success in excision of nonpalpable metastatic lymph nodes was achieved by both ROLL and IOUS. We recommend compartment-oriented dissection; this approach may maximize the removal of metastatic nodes not identified by preoperative imaging.