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Red cell distribution width (RDW) is an inflammatory marker that is associated with CAD presence and prognosis. We aimed to evaluate the relationship between RDW value, coronary atherosclerosis, coronary plaque burden and morphology in diabetic patients.147 DM patients who were evaluated with 128-slice dual-source coronary computed tomography angiography (CCTA) for suspected CAD were included in the study. The study population was divided into two groups [a CAD group (Group I) and non-CAD group (Group II)]. The plaque characteristics were analyzed on a per-segment. RDW values were obtained from the automated complete blood count.RDW values were found to be significantly higher among diabetic patients with CAD compared to those without CAD (14.6±1.4% vs 13.3±1.6%, p<0.001). In the correlation analysis, RDW value showed significant positive correlation with hs-CRP (r=0.523, p<0.001), total plaque burden (r=0.379, p<0.001), mixed plaques (r=0.253, p=0.018) and non calcified plaques (r=0.413, p<0.001). Also, multivariate logistic regression analysis revealed RDW as a significant and independent predictor of the presence of CAD in patients with DM .(OR=1.659, 95% CI:1.257-2.190; p<0.001).In our study we have determined that RDW value is an independent predictor among diabetic patients for the presence of CAD. Moreover, RDW values showed significant correlation with total plaque burden, and the number of non-calcified and mixed plaques. [ABSTRACT FROM AUTHOR]

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Copyright of Marmara Medical Journal is the property of Marmara Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Surgery / Ulusal Cerrahi Dergisi is the property of Turkish Surgery Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents a case study of a 44-year-old female with complaints of heartburn and chest pain, who was later diagnosed with double aortic arch associated with tracheal and esophageal compression.

Objectives: Computed tomography-guided core needle biopsy has an important role in the accurate histopathological diagnosis of lung masses. The present study aims to share our results of computed tomography-guided percutaneous core needle biopsy of lung masses., Methods: A total of 117 patients had computed tomography-guided percutaneous core needle biopsy for lung masses between January 2017-September 2019 in our institution. In this study, these patients' post-procedural complications, diagnostic-yield-rates and radiological-histopathological correlations were evaluated retrospectively., Results: Complications occurred in 23 (20%) patients (20 (17%) of pneumothorax; 3 (3%) of hemorrhage). Chest-tube-drainage was needed in five (4%) of all patients. No significant difference was found between complication rates and patient gender/age, tumor volume/localization or needle-path-length (p>0.05). In 77 of the 85 (91%) primary-lung-cancer-cases radiological and pathological diagnostic results were correlated., Conclusion: Computed tomography-guided core needle biopsy has a high diagnostic yield rate with acceptable complication rates in the diagnosis of lung masses., Competing Interests: Conflict of Interest: None declared., (Copyright: © 2020 by The Medical Bulletin of Sisli Etfal Hospital.)

Purpose: This study evaluated the accuracy of phased-array magnetic resonance imaging (MRI) for preoperative local tumor staging in primary rectal cancer and emphasized the importance of the preoperative differentiation of T2 tumors from T3 tumors so the appropriate treatment can be applied., Materials and Methods: Twenty-four patients with primary rectal cancer were examined preoperatively using 1.5 T MRI with a phased-array coil. Multiplanar T2-weighted images were obtained. Rectum anatomy, depth of tumor invasion, mesorectal involvement and lymph nodes were assessed. All patients underwent radical surgery. The histological sections were evaluated microscopically. The correlation of magnetic resonance imaging and histopathology was assessed using the kappa statistic. Overstaging with MRI was compared with Fischer's exact test., Results: Histopathological examination of the tumors revealed adenocarcinoma. When the tumors were staged, there was one patient with a pT1 tumor, six patients with pT2 tumors, and 17 patients with pT3 tumors. Using MRI, four patients with pT2 were overstaged as T3, and one patient with pT3 was overstaged as T4. In the remaining cases (one pT1, two pT2, and 16 pT3), MRI correctly assessed the stage of transmural invasion. The accuracy of T staging and metastatic lymph node detection with MRI was calculated as 79.2% and 58.5%, respectively., Conclusion: Phased-array MRI is a valuable technique for the preoperative staging of rectal cancer, especially in the differentiation of T2 and T3 tumors.

Background/aims: Currently, the diagnostic sensitivity of malignant liver mass biopsies is an important problem in the definitive diagnosis. In this study, we aimed to investigate the role of selective peripheral approach to lesion biopsies for diagnostic sensitivity of liver masses., Materials and Methods: Between June 2007 and March 2011, totally 88 patients (50 male, 38 female), referred to our Interventional Radiology Department for sonographically guided Tru-cut biopsies for liver lesions, were examined.All biopsies were performed by an experienced radiologist with an 18-gauge Tru-cut biopsy needle with a spring-loaded biopsy gun under sonographic guidance. We describe two locations (peripheral and central) for liver lesions, with the inner 2/3 part of the mass as central and the outer 1/3 part as peripheral. We obtained biopsy from both of these locations, and samples were transferred to the Pathology Department separately., Results: According to pathological and immunohistochemistry studies, there were 42 hepatocellular carcinomas and 46 metastases. All of the metastatic tumors were stained by cytokeratin (10 lung adenocarcinoma, 15 breast adenocarcinoma, 16 gastrointestinal tract, 4 prostate, and 1 malignant melanoma of these 46 metastases were reported as primary). According to histopathological results, diagnostic sensitivity was 97.7% in peripherally located biopsies and 86.3% in biopsies taken from the center of the masses (p=0.0063)., Conclusions: Selective peripheral biopsy approach in Tru-cut biopsies of liver lesions has better sensitivity rates for histopathologic diagnosis compared to the centrally located and random biopsies.

Background: Reduction of intussusception under ultrasound guidance by saline has become popular in recent years. However, methods, duration of the procedure and causes of failure are not defined. In this study, we reviewed the patients who underwent ultrasound (US) guided saline reduction and compared them with those who were previously managed by operative intervention., Methods: Patients with severe peritonitis or perforation, those over 3 years or younger than 1 month were excluded. Saline was applied by anus. Entry of saline into the ileum was the main indicator for successful reduction. Dramatic improvement in the clinical findings was considered as an additional sign of successful reduction. No limit was imposed on duration of the procedure., Results: Hydrostatic reduction was successful in 41 out of 51 patients with intussusception. In three patients with partial resolution, hydrostatic reduction was attempted later and total reduction was achieved. No perforation or other complications were seen. In ten cases with reduction failure, one had an ileal lymphoma and another one had a duplication cyst as lead points., Conclusion: US guided hydrostatic reduction for childhood ileocolic intussusception is safe and, painless, has a high success rate and avoids radiation exposure risk. Presence of ultrasonographic and clinical changes is the best indicator of a successful reduction. In some cases, a second attempt may be necessary for reduction.

Epiploic appendagitis is a rare condition resulting from an acute inflammation of an appendix epiploica. Epiploic appendagitis is frequently misdiagnosed as either acute appendicitis or acute diverticulitis, and the diagnosis is usually made during surgery. Epiploic appendagitis is a rare, self-limiting condition, which can be easily diagnosed with computed tomography (CT). Imaging with CT may suggest the diagnosis thus preventing unnecessary surgery. Medical management of symptoms is usually sufficient. Herein, we present CT findings of an epiploic appendagitis case that developed in a left inguinal hernia, which is a very rare entity.

Purpose: To assess tear function in radiologists., Materials and Methods: The study included 71 volunteers divided into 2 groups; 36 radiologists (Group 1) and 35 non-radiologist controls (Group 2). The noted ophthalmologic symptoms in both groups were burning, stinging, redness, sensation of a foreign body, photophobia, and blurred vision. Schirmer's 1 and tear break-up time tests were used to assess tear function., Results: The distribution of eye symptoms in Group 1 was as follows: 16 radiologists (44.4%) presented with burning and stinging, 17 (47.2%) with the sensation of a foreign body, 23 (63.8%) with redness, 11 (30.5%) with blurred vision, and 5 (13.8%) with photophobia. As for Group 2, the following symptoms were noted: burning and stinging in 8 (22.8%), sensation of a foreign body in 5 (14.2%), redness in 6 (17.1%), blurred vision in 3 (8.5%), and photophobia in 1 control volunteer (2.8%). Tear break-up time test scores were 8.4 for Group 1 and 15.4 for Group 2, whereas Schirmer's 1 test scores were 9.1 and 16.1 for Groups 1 and 2, respectively., Conclusion: As a conclusion, dry eye syndrome occurs significantly more frequently in radiologists compared to non-radiologist. The working conditions and circumstances, including air-conditioned rooms, use of negatoscopes, and exposure to diagnostic radiation may be possible causative factors of this statistical outcome.

Objective: The uncinate process (UP) is an important anatomic landmark in frontal recess surgery. Its superior attachment shows great anatomic variability. The agger nasi (AN) cell is another important structure that affects frontal recess anatomy and there is a close neighborhood between them. The aim of this study was to investigate the relationship between superior attachment type of UP and the presence of AN cell., Study Design: A retrospective anatomical study., Method: Computed tomography scans were evaluated of 486 sides of 243 patients who had had paranasal sinus. In 125 (26%) sides, the superior attachment of the UP could not be identified. In the remaining 361 (74%) sides, the prevalence of superior attachment of UP types and the presence of AN cell in each side were recorded. The results were evaluated with chi2 test., Results: The AN cell was found in 290 (80.3%) of 361 sides. The prevalence of AN cell according to superior attachment of UP types were 79.6% for type 1/2, 90.1% for type 3, 71.4% for type 4, 86.5% for type 5, and 83.3% for type 6. The presence of AN cell according to superior attachment types of UP was not statistically significant (chi2= 3.54, P = 0.315)., Conclusions: The AN cell was found to be present in 80.3% of the cases. However, the relationship between the presence of the AN cell and the superior attachment types of UP was not statistically significant.

Purpose: To investigate the diagnostic accuracy of spiral CT angiography (CTA) in detection of cerebral aneurysms in cases with acute subarachnoid hemorrhage (SAH)., Materials and Methods: Spiral CT angiography and DSA examinations were performed in 32 cases due to non-traumatic SAH. CTA data were obtained by maximum intensity projection (MIP) method. CTA and DSA findings were evaluated and compared in terms of existence of aneurysm, size and location., Results: In 32 patients, DSA detected 34 aneurysms with diameters ranging from 3 to 13 mm while four cases were free of aneurysms. With CTA, an aneurysm at anterior communicating artery location could not be demonstrated. In all other cases CTA correlated well with DSA in detecting the site, size and orientation of the aneurysms. It was found that CTA sensitivity was 97% and specificity was 100% in diagnosis of intracranial aneurysms., Conclusion: Spiral CTA is a highly accurate, cheap and non-invasive imaging method in diagnosis of intracranial aneurysms in cases with SAH and can be used as a safe alternative method to DSA when emergency surgery is needed.

Objective: To evaluate the relationship between frontal sinusitis and the localization of the frontal sinus outflow tract medial or lateral to the superior attachment of the uncinate process (UP)., Design: A retrospective anatomical and clinical study., Setting: An ear, nose, and throat clinic in işli Etfal Teaching and Research Hospital, Istanbul, Turkey., Patients: Paranasal sinus computed tomographic scans of 486 sides of the frontal sinuses (hereafter referred to as sides) of 243 patients who had chronic sinusitis were evaluated. In 125 sides (26%), the superior attachment of the UP could not be identified. In the remaining 361 sides (74%), the prevalence of superior attachment of UP types and the presence of frontal sinusitis in each side were recorded. Localization of the frontal sinus outflow tract was determined according to the superior attachment of the UP. Drainage of the frontal sinus to the middle meatus (medial to the superior attachment of the UP [types 1-3]) was classified as group 1, and drainage of the frontal sinus to the ethmoid infundibulum (lateral to the superior attachment of the UP [types 4-6]) was classified as group 2., Results: Frontal sinusitis was found in 125 (35%) of 361 sides. The distribution of frontal sinusitis was 97 (41%) of 237 in group 1 and 28 (23%) of 124 in group 2. Group 1 drainage had a statistically significant presence of frontal sinusitis (chi(2) = 12.11; P<.001). The prevalence of superior attachment of UP types was 63% for type 1/2, 3% for type 3, 12% for type 4, 14% for type 5, and 8% for type 6., Conclusions: Frontal sinus outflow tract, which is medial to the superior attachment of the UP, is more common than the lateral one. There is a statistically significant relation between the presence of frontal sinusitis and the frontal sinus outflow tract, which is medial to the superior attachment of the UP.

Objectives: We evaluated the diagnostic value of palpation, ultrasonography (US), and computed tomography (CT) in detecting neck metastasis in head and neck cancers., Patients and Methods: The study included 35 patients (34 men, 1 woman; mean age 59 years; range 35 to 72 years) with laryngeal carcinoma. In addition to neck palpation, 17 patients and 27 patients had neck examinations by US and CT, respectively. Histopathologic results of the neck specimens were compared with those obtained from palpation, US, and CT., Results: The accuracy of CT, US, and palpation in the evaluation of lymph nodes of the neck were 85%, 65%, and 80%, respectively. Ultrasonography was found to have the highest sensitivity (100%), but the least specificity (33%). The highest false positive and false negative results were obtained by US (42%) and palpation (10%), respectively., Conclusion: Computed tomography proved superior to palpation and US in the evaluation of neck metastasis in patients with head and neck tumors.

Background: The ligamentum flavum is the anatomic plane between the epidural and laminar-extralaminar spaces, which should be meticulously preserved for a possible reoperation. Preservation of the ligamentum flavum together with other epidural anatomic structures, such as epidural fat tissue and venous plexuses, and limited removal of the lamina are important components in preventing epidural fibrosis that may be the cause of failed back surgery syndrome., Methods: One thousand five hundred patients underwent microdiskectomy with preservation of the ligamentum flavum over an 8-year period. This technique was performed with a small incision using an 18 mm-width mini Taylor retractor. The ligamentum flavum was released and preserved as a 3-sided flap. The disk content was totally removed and a pediculated fat graft was used to cover the root at the end. Four hundred patients operated on with the ligamentum flavum preserving technique were randomly selected for this study (Group 1). Their results were compared with those of 200 patients who were operated on with the standard microdiskectomy (Group 2). Standard microdiskectomy technique was performed with fenestration and foraminotomy and the ligamentum flavum was partially or totally excised. Early clinical outcome was classified as excellent, good, fair, poor, or failure. The clinical mean follow-up period in Group 1 was 36.8 months and in Group 2 it was 32.4 months. One hundred patients from each group had computed tomographic scans with contrast administration performed at least one year after the operation to examine late epidural fibrosis. A questionnaire was given to all patients at least 3 times during the late follow-up period. The questionnaire required patients to describe their relief of pain, job performance, and abstinence from narcotic analgesic use., Results: Early clinical outcome (fourth postoperative week) in Group 1 was satisfactory in 96.75% of the patients, whereas it was satisfactory in only 81.5% in Group 2 (p < 0.001). The radiological examinations revealed fibrosis in 18% of the patients in Group 1 and 37% in Group 2 (p < 0.001). None of the patients in Group 1 were readmitted because of fibrosis-related symptoms. The reoperation rate in Group 1 was 4.5%. The recurrence rate was 1.75% and disc at another level was 2.5%. One patient was reoperated because of a suture granuloma. In Group 2, the reoperation rate was 9% (p < 0.05). The recurrence rate was 4.5%, disc at another level was 3.5% and extensive epidural fibrosis was 1%. Two patients who underwent surgery for epidural fibrosis in this group had disappointing outcomes. Overall success rate based on the questionnaire was 91% in Group 1 and 76% in Group 2 (p < 0.001)., Conclusions: The ligamentum flavum preserving technique is useful in achieving a favorable long-term outcome, and reoperation, if necessary, is easier and safer.