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Introduction : In this study, we aimed to evaluate the effects of the development of aspiration pneumonia (AP) on the intensive care unit (ICU) requirements and in-hospital mortality of patients hospitalised in the neurology ward due to an acute cerebrovascular accident (CVA). Material and methods: Five hundred and three patients hospitalised in the neurology ward following an acute CVA were retrospectively analysed. The patients were divided into two groups: those with AP (group 1) and those without AP (group 2). Demographic characteristics and physical and radiological findings, including the localisation, lateralisation and aetiology of the infarction, in addition to ICU requirements and mortality, were evaluated. Results : Aspiration pneumonia was detected in 80 (15.9%) patients during the in-hospital stay. Transfer to the ICU for any reason was required in 37.5% of the patients in group 1 and 4.7% of those in group 2 (p < 0.001). In-hospital mortality occurred in 7.5% and 1.4% of the patients in group 1 and group 2, respectively (p = 0.006). The incidence of AP was highest in patients with an infarction of the medial cerebral artery (MCA) (p < 0.001). AP was associated with older age (p < 0.001), hypertension (p = 0.007), echocardiography findings (p = 0.032) and the modified Rankin Scale (mRS) score (p < 0.001). Conclusions : Our findings suggest that the requirement rate for transfer to the ICU and the mortality rate appear to be significantly higher in patients with a diagnosis of AP. Precautions should be taken, starting from the first day of hospitalisation, to decrease the incidence of AP in patients with acute CVA, focusing especially on older patients and those with a severe mRS score.

Objective Due to a lack of sufficient data, the treatment protocols for male breast cancer are usually the same as those used for female breast cancer. The aim of the current study was to present our clinical experience with male breast cancer. Materials and methods The records of 37 patients who were treated for male breast cancer in our hospital between 2004 and 2014 were reviewed retrospectively. The data of patients were recorded and analyzed. Results The mean age of the patients was 63.03±12.36 years. Thirty-three patients (89.2%) had invasive ductal carcinoma, two (5.4%) had ductal carcinoma in situ, and two had invasive lobular carcinoma (5.4%). The most common molecular subtype was luminal A (17 cases, 45.9%). Twenty-nine patients with male breast cancer underwent mastectomy and two underwent breast conserving surgery. Axillary lymph node dissection was performed in 25 patients. The most common surgical procedure was modified radical mastectomy. Distant metastases were present in 17 (45.9%) patients. Overall, the 5-year survival was 60%. The 5-year survival was 100% for those with stage 0-I disease, 87% for stage II, and 42% for stage III. The 3-year survival was 14% for stage IV. Conclusion Patients with male breast cancer presented at an older age, a later stage, and with earlier metastasis. Early metastasis and death increases with increasing stage. Poor prognosis correlates with late admission. Data from different centers should be compiled and reviewed in order to determine a specific treatment protocol for male breast cancer; each paper published reveals new data.

Because of the widespread use of breast screening mammography, the number of women diagnosed with ductal carcinoma in situ (DCIS) has increased dramatically in recent years. DCIS is a noninvasive form of breast cancer, accounting for up to 30% of breast cancers in screening populations and approximately 5% of breast carcinomas in symptomatic patients (1–3). DCIS has a variety of mammographic presentations, but the most common mammographic feature is microcalcification (4). Indeed 80%–90% of DCIS lesions present with microcalcifications only, without any accompanying mass lesions (4). Other findings such as masses, nodular abnormalities, dilated retroareolar ducts, architectural distortions, and developing densities have also been reported (5). Ultrasound-guided biopsy is often the method of choice for sonographically visible breast lesions as it provides easy access for biopsy. However, in cases when the abnormality seen on mammography is not visible on ultrasonography, stereotactic biopsy is the recommended sampling method. For microcalcification-only lesions with no accompanying mass, ultrasonography often fails to identify the site of the lesion; hence, stereotactic biopsy is used more frequently. In most breast units, stereotactic 14-gauge automated core biopsy has been replaced by stereotactic vacuum-assisted biopsy (SVAB) using 8- to 11-gauge needles (6). Large core SVAB allows larger samples to be obtained in a shorter period of time compared with samples obtained using automated core biopsy devices (7). Moreover, this technique has the advantage of a single insertion in the area of interest compared with automated core biopsy devices, which require repeated insertions. Several published articles have shown that SVAB decreased the rate of cancer underestimation and the rate of failure to retrieve breast microcalcifications (8). The management of noninvasive and invasive breast cancers is different and therefore, an accurate preoperative diagnosis is crucial for adequate surgical planning. Underestimation of DCIS lesions occurs when an invasive component is found after surgery, which had been missed at the initial preoperative sampling. The underestimation rate of stereotactic 14-gauge automated core biopsy in DCIS was reported as 16%–35% (9–11), while that of SVAB was 5%–29% (6, 9, 11–13). The purpose of this study was to determine the rate, causes, and predictive factors of underestimation of invasive carcinoma in patients diagnosed with DCIS following SVAB of microcalcification-only lesions.

Coexistence of idiopathic granulomatous mastitis and erythema nodosum is very unusual. In this paper, we present a patient with idiopathic granulomatous mastitis accompanied by erythema nodosum to highlight the diagnostic importance of erythema nodosum and its relationship with treatment response of breast lesion. A 39-year-old female with a breast lesion and erythema nodosum was started on treatment with corticosteroids before the results of her histopathological evaluation were obtained. The response to treatment was very quick. Erythema nodosum totally disappeared and the breast lesion regressed noticeably within a week. We think that erythema nodosum associated with a breast lesion may be a sign suggestive of idiopathic granulomatous mastitis and can be used for the evaluation of the response to corticosteroid treatment. More case reports are needed to justify the use of erythema nodosum as a sign suggestive of idiopathic granulomatous mastitis.

Background: Recently, the use of a surgical approach in injured patients has begun to be increasingly limited to unstable patients. Advances in imaging techniques and developments in intensive care have increased the applicability of non-operative treatment. Here, we aimed to present our clinical experience with different approaches in some patients. Method: Thirteen inpatients who had thoracoabdominal gunshot injuries but did not undergo emergency surgery between 2009 and 2014 were retrospectively evaluated. Results: Of the patients, nine (69.2%) were male and the mean age was 32.6 ± 9.7 years. The mean trauma-treatment interval was 51.2 ± 15.8 minutes. No surgical procedure was performed in 10 patients, four of whom had tangential injury. Diaphragmatic repair was performed in three patients after stabilization of solid organ injuries. The splenic and liver injuries were allowed to resolve itself through non-operative management, and there was no rush to repair the diaphragm until the splenic and liver recovery occurred. Four patients with tangential injury were shown not to have penetration of the abdominal cavity. Two pregnant patients, one with liver injury and the other with retroperitoneal injury, were successfully treated non-operatively. Conclusions: In centers that provide advanced conditions for emergency surgery, a conservative approach can be performed successfully in selected thoracoabdominal gunshot wound patients, including pregnant patients and those with splenic injuries. Tangential injuries can be managed non-operatively after penetration of cavities is ruled out. When diaphragmatic hernia is accompanied by liver or splenic injury, diaphragmatic repair can be delayed until these injures are restricted themselves. J Curr Surg. 2015;5(4):199-203 doi: http://dx.doi.org/10.14740/jcs281w

To evaluate the relationship between varicocele and ankylosing spondylitis (AS) via color duplex sonography (CDS).Thirty male patients (age range 18-40 years, mean age 30.27 years) with AS and 30 male healthy controls (age range 20-36 years, mean age 27.23 years) were evaluated for varicocele using CDS.Vein diameter in right and left pampiniform plexus (PP) in the AS group was significantly higher than in the control group (p0.001 and p = 0.003, respectively). The incidence of varicocele was observed as 33.3 % in the AS group and 10 % in the control group. However, the difference was statistically significant (p = 0.028). The rate of right, left, and bilateral varicocele was 3.3 % (1 patient), 23.3 % (7 patients), and 6.6 % (2 patients), respectively, in the AS group, versus 0, 10, and 0 % in the control group (p = 1.000, p = 0.166, and p = 0.492, respectively).The incidence of varicocele in AS patients is higher than in control subjects, and the difference is statistically significant. Therefore, varicocele must be taken into consideration and investigated in patients with AS.

Cecal diverticulitis is an unusual condition that presents clinically similar to appendicitis. Although it is usually asymptomatic, it may cause inflammation, bleeding, or perforation. The diagnosis is not always easy and in the majority of cases, the diagnosis is usually made at laparotomy. There have been various controversies in the literature regarding the optimal management of cecal diverticulitis. The aim of this study is a detailed description of this rare cause of acute abdomen. A 40-year-old female patient presenting with acute onset pain in the right lower abdominal quadrant, nausea and fever had mild leukocytosis. Abdominal ultrasonography and computed tomography revealed findings suggestive of plastron appendicitis. The diagnosis of cecal diverticulitis was established during the surgery. The patient underwent diverticulectomy and appendectomy operations. Cecal diverticulitis is rare clinical entity that should be considered in the differential diagnosis of emergency patients admitted with the complaint of pain in the right lower abdominal quadrant., Çekal divertikülit klinik olarak apandisite benzeyen nadir bir durumdur. Genellikle asemptomatik olmasına rağmen, inflamasyon, kanama ve perforasyona sebep olabilir. Vakaların çoğunluğunda tanı zordur ve genellikle laparatomide tanı konulur. Literatürde çekal divertikülitin tedavisi ile ilgili çeşitli tartışmalar mevcuttur. Bu yazının amacı akut karının nadir bir nedeni olan çekal divertiküliti detaylı bir şekilde incelemektir. Akut sağ alt kadran ağrısı, bulantı ve ateşi olan 40 yaşında kadın hastanın hafif lökositozu vardı. Abdominal ultraonografi ve tomografide plastrone apendisiti düşündüren bulgular mevcuttu. Çekal divertikülit tanısı operasyon esnasında konuldu. Hastaya divertikülektomi ve apendektomi yapıldı. Çekal divertikülit, sağ alt kadran ağrısı olan acil vakalarda ayrıcı tanıda düşünülmesi gereken nadir görülen bir durumdur

Adult intussusception is an uncommon disease requiring surgical intervention. The aim of this study is to discuss the surgical alternatives and share our experience in the treatment of adult patients with intussusceptions formed as a result of polyps. The retrospective study included 16 adult patients who underwent surgery after the diagnosis of intestinal invaginations resulting from polyps between the years 2000 and 2011. Sixteen patients (seven males and nine females; mean age, 48.18 years; range, 18 to 76 years) presented with intestinal intussusceptions. Although a preoperative diagnosis was carried out in 11 (68.75%) patients, the diagnosis was made intra-operatively in five patients (31.25%). Among the patients, seven (43.8%) had undergone emergency surgeries and nine (52.8) had elective surgery. The invagination in 12 patients (75%) was located in the small intestine, in two patients (12.5%) in the colon, and in a further two patients (12.5%), it was ileocecally located. Ten patients (62.5%) had segmental resection 1 anastomosis; three patients underwent (18.8%) segmental resection 1 enterostomy, and three (18.8%) received hemicolectomies. In adults, surgical treatment is always the primary option in intussusceptions resulting from polyps. Although the surgical method of choice in colonically located ones is en bloc resection without reduction, because the polyps located in the small intestine are usually of a benign nature, segmental resection with reduction should be performed in elective surgery and segmental resection without reduction should be performed in emergency cases.

Epilepsy is a common chronic disease characterized by spontaneous and recurrent seizures. Along with the increases in life expectancy, the prevalence of epilepsy in adults increased in parallel. 3.0-T MRI provides high signal/noise ratio and is an important tool in the determination of epileptic lesion in epilepsy patients. Our aim in this study was to research and compare 3.0-T MRI findings of Turkish epileptic patients that are resistant and non-resistant to medical treatment. 3.0-T MRI images from 264 consecutive patients, of which 150 were males and 114 were females (age range 18–82 years; mean age 31.3 years) were examined, retrospectively. Among those patients, 94 were resistant to medical treatment (DRE+) and 170 were non-resistant (DRE−). Epileptic lesion was determined in 119 of the patients. Epileptic lesion was determined in sixty-three patients who were resistant to medical treatment and in fifty-six patients who were non-resistant. Epileptic lesion was determined in approximately half of the adult epilepsy patients by using 3.0-T MRI. This study demonstrates a high prevalence of brain abnormalities in Turkish epileptic patients with DRE+. The lesion was determined in 67% of patients with medical treatment resistance, while the percentage for the other group was only 32.9%. The ratio of epileptic lesion determination by using 3.0-T MRI was quite higher in the medical treatment resistant group than the non-resistant group.

Objective The most common procedure to prevent seroma formation, a common complication after breast and axillary surgery, is to use prophylactic surgical drains. Ongoing discussions continue regarding the ideal time for removing drains after surgical procedures. In this study, we aimed to investigate factors that affect drain indwelling time (DIT). Materials and methods From 2014 to 2015, a total of 91 consecutive patients with breast cancer were included in the study. The demographic characteristics of the patients, treatment methods, histopathologic features of the tumor, size of removed breast tissue (BS), tumor size (TS), number of totally removed lymph nodes (TLN), and metastatic lymph nodes (MLN), whether they had neoadjuvant chemotherapy, and the DIT were retrospectively recorded from the hospital database. Results The mean age of the patients was 48.9 years, and the mean DIT was 4.8 days. The mean size of breast removed was 17.3 cm and tumor size was 4.7 cm, and the mean number of metastatic lymph nodes was 3.3, and mean total number of lymph nodes was 14.1. Patients who had neoadjuvant chemotherahpy had longer DIT. There was a positive correlation between the BS, TS, TLN, MLN, length of hospital stay, and DIT. Linear regresion analysis revealed that the BS, TLN, and history of neoadjuvant chemotherahpy were independent risk factors for DIT. Conclusion DIT primarily depends on BS, TLN, and history of neoadjuvant chemotherahpy. A policy for the management of removing drains to prevent seroma formation should thus be individualized.

Objective: This survey aims to elucidate patient and health system related factors leading to delayed diagnosis and treatment of breast cancer in Southeastern Anatolia. Methods: Hundred patients admitted to Department of General Surgery at Dicle University between December 2012 and July 2014, and diagnosed with breast cancer in preceding 6 months were included in the survey after their consent. The survey has 4 chapters (patient and health system related factors, demographic data, and assessment of cancer stage) and 25 questions. Results: Fifty-eight percent of patients visited a physician with a 3 months delay after realization of breast cancer symptoms. Only 8% of patients had regular check-ups. Nine percent of patients were suspicious of breast cancer due to the lesion in the breast. 86% of patients did not consider it to be a serious matter. Lack of female physicians cited by 2% as the reason for avoiding doctor’s visit. Seven percent cited lack of knowledge and 23% being scared. Seventy-seven percent were able to get a doctor’s appointment, 82% to get mammography, 78% underwent biopsy in a week. Women between the ages of 30-50 had higher concern about cancer (p

Introduction Injuries that develop secondary to minor traumas and cannot be detected via direct examination methods, but are detected via advanced imaging methods, such as magnetic resonance (MR) imaging, are called occult bone injuries or bone bruises. In such injuries, diagnostic arthroscopy usually does not reveal any pathology. MR imaging methods are quite beneficial for the diagnosis of such clinical conditions, which cause acute pain and restriction of motion. The present study aimed to assess occult bone injuries via MR imaging in patients who presented with minor knee trauma. Patients and Methods Twelve patients who presented with minor knee trauma were included in the study. Etiological factors in these patients included walking a long distance, falls, and minor trauma. All patients underwent physical examinations, direct radiological imaging, MR imaging, and diagnostic arthroscopy. Results Direct radiographs of the patients showed no pathological fracture. Bone marrow changes detected on the MR images were classified according to Lynch’s classification as Type I lesions in nine patients and Type II lesions in three patients. Conclusion We suggest that MR imaging methods should be the gold standard for the diagnosis of minor traumatic bruise injuries of the knee.

The aim of this study is to investigate the frequency of the SHC variations, and the distribution of the SP lengths in different age and sex groups using MDCT. MDCT scans were performed in 805 patients (401 males, 404 females). The patients were divided into six groups according to their ages. The length of the styloid process (SP) and its angulation on the transverse (TA) and sagittal (SA) planes were measured. Structural variations of the SHC were observed by means of three-dimensional (3D) and multiplanar reconstruction (MPR) images. Absence of the styloid process (n = 10), double proximal origin (n = 13), segmentation (n = 223), complete ossification (n = 24), and an SP with three proximal parts in one patient were among the anomalies detected. The mean length of the SP was greater in males than in females (33.2 ± 13.2 vs. 29.6 ± 10.5 mm, P < 0.001). Elongated SP (ESP) was observed in 56 % of the patients in the study group, and this ratio was the highest in Group 3 with 65.4 % (P < 0.05). TA and SA were 70.2° ± 4.1°, 69.9° ± 4.2° and 86.6° ± 6.5°, 88.3° ± 6.6° for the right and left sides, respectively. Besides, 3D and MPR images also present detailed and reliable data to radiologists and surgeons for the evaluation of the SHC. ESP has been detected in more than half of the patients, being more frequent in males and in individuals in the fifth decade of life. For an accurate diagnosis, clinicians should consider the ESP while evaluating the patients in this age group.

The aim of this study was to determine the frequency of anatomical variations of the colon associated with the kidney.A retrospective analysis was performed on 1000 consecutive abdominal computed tomography (CT) scans performed between July 2010 and September 2011. A line parallel to the horizontal plane was drawn through the posterior edge of each kidney at three renal levels: upper, middle and lower pole. The bowel between the psoas muscle and the kidney was determined as the interposition of the colon. The amount of perinephric fat was estimated and graded.The total number of patients undergoing CT scans was 1000 (male/female = 510/490). The mean age of patients was 42.2 years. Seventeen patients (1.7%) had retrorenal colon, of which 12 (1.2%) were on the left side, three (0.3%) on the right side and two (0.2%) were bilateral. Of these 17 cases, 11 were found at the lower, two at the middle and four at the upper pole of the kidney. There was grade I perirenal fat tissue in 13 and grade II in four cases. Interposition of the colon was detected in 32 (3.2%) patients, 30 (3%) on the right and two (0.2%) on the left. The grade of perirenal fat tissue in patients with colon interposition was as follows: 25 patients grade I, six patients grade II and one patient grade III.In accessing the lower pole of the kidney, especially on the left side, the risk of colonic injury should be taken into consideration during percutaneous procedures, regardless of the patient's age and gender.

Objectives: The aim of this study was to determine the frequency and clinical importance of anatomic variations of the colon. Materials and methods: Multi-detector computed tomography (MDCT) of the abdomen for various indications was performed in 1300 patients in radiology department between January 2010 and September 2011 were retrospectively analyzed to investigate the anatomic variations of colon. Results: The total number of patients undergoing MDCT scans was 1300, of which 640 were female and 660 male. The mean age of patients was 43.02 years (2-92). The number (%) of colons according to their position were as: 34 (% 2,6) anterior and 14 (% 0,9) posterior hepatodiafragmatic, 40 (% 3) interposition of colon between psoas and right kidney, 3 (% 0,2) interposition of colon between psoas and left kidney, 4 (% 0,3) right retrorenal, 16 (% 1,2) left retrorenal, 2 (%0,2) bilateral, 10 (% 0,8) pancreaticogastric, 5 (% 0,4) retrosplenic and 64 (% 4,9) high caecum. Conclusion: Knowledge of the anatomic variations of colon is important for surgical planning or interventional radiologic procedures. Multi-detector computed tomography allows detailed visualization of these variations., Giriş: Bu çalışmanın amacı kolonun anatomik varyasyonlarının sıklığını ve klinik önemini belirlemektir. Gereç ve yöntem: Ocak 2010-Eylül 2011 tarihleri arasında, radyoloji bölümünde, farklı nedenlerden dolayı abdomen çok kesitli bilgisayarlı tomografi (ÇKBT) çekilmiş, 1300 hasta retrospektif olarak, kolonun anatomik varyasyonları açısından incelendi. Bulgular: ÇKBT çekilmiş 1300 hastanın, 640\'ı kadın ve 660\'ı erkek idi. Ortalama yaş 43,02 yıl (2-92) idi. Kolon varyasyonlarının sayısı: 34 (% 2,6) anterior, 14 (% 0,9) posterior hepatodiyaframatik, 40 (% 3) sağ böbrek-psoas interpozisyonu, 3 (% 0,2) sol böbrek-psoas interpozisyonu, 4 (% 0,3) sağ retrorenal, 16 (% 1,2) sol retrorenal, 2 (%0,2) bilateral, 10 (% 0,8) pankreatikogastrik, 5 (% 0,4) retosplenik kolon ve 64 (% 4,9) yüksek yerleşimli çekum. Sonuç: Kolonun anatomik varyasyonlarının bilinmesi cerrahi ve girişimsel radyolojik işlemlerde önemlidir. ÇKBT bu varyasyonların ayrıntılı bir şekilde gösterilmesine olanak sağlamaktadır.

Aim To determine the need for a fine-needle or core biopsy in patients with clinically palpable breast abnormalities who have negative mammographic and sonographic findings. Method and materials Over a 12-year period, 251 patients with a palpable abnormality at presentation and who had a negative ultrasound and mammogram underwent clinically guided biopsy (CGB) by breast surgeons. This was 2.7% (251/9313) of all breast biopsies performed from January 1999 to December 2010. Physical findings were qualitatively categorized into five groups as clinically “normal”, “benign”, “probably benign”, “suspicious”, and “malignant” at the time of initial assessment. The number of biopsies for each category and biopsy results were analysed retrospectively. Results Three (1.2%) of the 251 CGBs were reported as malignant; two (0.8%) of which were invasive. Forty-six (18.3%) of the 251 cases were regarded as clinically suspicious or malignant while the remaining 215 examinations were categorized as benign or probably benign. All three malignancies were in the clinically suspicious or malignant group. Conclusion A negative ultrasound and mammogram in patients with a palpable abnormality does not exclude breast cancer; however, the likelihood is very low (1.2%). In this study, 81.7% of biopsies (205/251) could have been avoided if CGB was reserved for the clinically suspicious or malignant group only without missing any malignancies.

After surgery, the most common foreign bodies retained in the abdominal cavity are the surgical sponges. The aim of the present study was to emphasize the importance of gossypiboma, which is a serious and medicolegal problem. The records of 12 patients with a confirmed diagnosis of gossypiboma after abdominal surgery at Dicle University Hospital were retrospectively reviewed between January 1994 and December 2009. Eight of the 12 patients were females, and 4 were males. Previously, 7 patients had been operated on electively, and 5 had undergone operations on an emergency basis. Abdominal ultrasonography clearly demonstrated gossypibomas in 5 patients, and computed tomography demonstrated a more precise image of retained surgical sponges in 3 patients. One patient died because of ventricular fibrillation; the other 11 patients were discharged in good health. To eliminate the risk of gossypibomas, all sponges should be counted at least twice (once preoperatively and once postoperatively); use of small sponges should be avoided during laparotomy, and only sponges with radiopaque markers should be used. The surgeon should explore the abdomen before closure. In cases in which the sponge count is uncertain, an abdominal x-ray should be performed before closure.

This study aims to collect data by multidetector computed tomography (MDCT) on the diameter of the normal common bile duct (CBD) and the diameter of CBD after cholecystectomy. In this retrospective study, CBD measurements were performed on axial oblique images, perpendicular to the long axis of the distal CBD. The mean diameter of the normal CBD was measured in 604 patients without cholecystectomy. The patients were divided into 6 groups according to their age. Analysis of variance (ANOVA) was used to compare data obtained from the six age groups. The mean diameter of the CBD of 46 patients who had cholecystectomy was calculated. The results were compared with age matched control group by Student's t test. The largest diameter of CBD ranged from 1.8 to 11.8mm. The mean of the largest diameter of 604 subjects was 4.77 ± 1.81. The diameter of the CBD significantly increased with age. Mean largest CBD diameters of postcholecystectomy subjects (7.28 ± 2.37) were significantly greater than age matched control group. In conclusion the diameter of CBD shows a considerable increase with age. The largest diameter of the CBD is up to 6mm in most of the subjects. An upper limit of 8mm appears reasonable after the age of 50; and an upper limit of 10mm seems appropriate for cholescystectomized subjects.

Pulmonary Veins are one of the major structures of circulation. In the last decade, pulmonary veins have been known to play an important role as the triggering focus of the electrical activity in atrial fibrillation. Primary treatment method of AF is RF ablation of the focus. For the best ablation, the anatomy of PVs should be well established before the procedure. MATERIAL AND METHODS: In our radiology department, 783 patients underwent computed tomography angiography between January 2008 and May 2010. Patients were referred for coronary CTA because of known or suspected coronary artery disease or computed tomography pulmonary angiography (CTPA) because of known or suspect pulmonary embolism. All scanning was performed on Philips Brilliance 64 slice Multidetector CT. The group consisted of 402 male and 381 female patients with the average age of 48 (range 14–89). CT data of patients were retrospectively reviewed to identify the PV anatomy and to determine anatomic variants and anomalies. RESULTS: In the majority of cases, two pulmonary veins drain into the left atrium on each side. Eighteen and eight variations were found in the right and left sides, respectively. Most frequent combined variations were 2R-4L (32.3%) and 4L was the more frequent single variation type (76%). In addition to that one Situs inversus totalis (0.12%), two partial anomalous pulmonary venous returns (0.25%) and one scimitar syndrome (0.12%) were found. CONCLUSION: This study showed that multiple types of variations of PVs can be found with increasing patient number. Therefore, for the successful ablation and surgery without any complications, the anatomy of PVs should be known before the procedure. MDCT is a reliable imaging method for the detailed cross-sectional and 3D anatomy.

While diaphragmatic hydatid disease is a rare condition, subcutaneous extension of the disease is very rare. A 33-year-old female visited our clinic due to swelling on the right upper quadrant of the abdomen. Thoraco-abdominal CT scan and MRI revealed a hydatid cyst (110 x 98 x 78 mm) located in the costal part of the hemidiaphragm extending into the preperitoneal space and protruding intercostally to a subcutaneous area. Total pericyst resection without opening the cyst, including a margin of normal diaphragm, was performed. The patient was started on albendazole for three months. Hydatid cyst in the diaphragm should be considered in patients with preoperative imaging data indicating cystic lesions adjacent to the diaphragm, especially for cystic lesions encountered in patients who live in or who have come from endemic regions.

Neurofibromatosis type 1 (NF–1), is a common hereditary disease which often take the form of benign tumours. Spinal primitive neuroectodermal tumour (PNET) is very rare. Herein we report US, CT and MRI findings of a female patient with PNET involving the spinal epidural and paravertebral spaces with neurofibromatosis type 1. A 37-year-old woman has NF–1 presented with lower back pain and progressive weakness of the right lower extremities. US revealed a heterogenous well defined solid mass. CT and MRI revealed heterogenously enhanced mass originating from the right neural foramen at the level of L5–S1. Adjacent to the lesion, there was a large hernia sac, including bowel loops and mesentery, in the posterolateral abdominal wall. The definitive diagnosis was made by transabdominal percutaneous tru-cut biopsy. Although it is rare, the possibility of PNET should be kept in mind in assessing the spinal epidural lesions.

Our aim was to measure cerebellum volume (CV), sclerotic plaque numbers (PN), and plaque surface area (SA) in the parietal lobe, and to investigate the relationship between CV and PN or SA in the parietal lobe, and the clinical status of patients with multiple sclerosis (MS). MRIs were performed in 14 patients with relapsing-remitting MS (RRMS), 13 patients with secondary progressive MS (SPMS), and 26 healthy control participants. The Cavalieri method was used to measure CV and SA. The cerebellum volume was significantly reduced in MS patients compared to controls (p0.01). In all patients, CV was negatively correlated with the duration of the disease, relapse number, and Expanded Disability Status Scale (EDSS) scores (p0.01). CV was related to mean PN in both the right and left parietal lobes (p0.01) and mean SA (p0.05) in RRMS patients; CV was also correlated with mean PN (p0.01) and mean SA (p0.05) in SPMS patients. The progression index (Pi) values were 2.03 +/- 0.4 in RRMS patients and 0.83 +/- 0.2 in SPMS patients (p = 0.023, t = 2.612) (where Pi = EDSS/time from onset in years). We propose that atrophy begins both in the supratentorial and infratentorial areas simultaneously in the RR stage, and that the Cavalieri method can be used to predict SPMS among patients with RRMS.

typical trajectories of a gunshot wound can create surgical or medico-legal diagnostic problems. In patients with multiple gunshot wounds, rapid identification of the trajectory of each bullet is important to detect possible organ injuries and to determine the surgical strategy. However, in such patients, it can be difficult to identify the trajectory of the bullet. Additionally, a thoracoabdominal gunshot injury is sometimes critical due to the difficulty in determination of the damaged organs, and instant occurrence of massive bleeding [1]. Helical computed tomography (CT) is useful for determining a trajectory; however, with multiple trajectories, the accurate diagnosis is difficult. Therefore, gathering detailed information at the crime scene is important for the correct identification of multiple trajectories [1,2]. Herein, we have presented an unusual case of multiple thoracoabdominal gunshot injuries without penetration and reviewed atypical bullet trajectories in thoracoabdominal gunshot injuries in light of the current literature.

Background: Diffusion-weighted magnetic resonance imaging (DWI) is a widely-accepted diagnostic modality whose efficacy has been investigated by numerous past studies in the differentiation of malignant lesions from benign entities. Aims: The aim of this study was to evaluate the efficiency of diffusion-weighted magnetic resonance imaging in the characterization of renal lesions. Study Design: Diagnostic accuracy study. Methods: A total of 137 patients with renal lesions were included in this study. The median apparent diffusion coefficient (ADC) values as well as the b 800 and b 1600 signal intensities of normal kidneys, solid components of mixed renal masses, and total cystic lesions were evaluated. Results: There were significant differences between the ADC values of lesions and normal renal parenchyma, and between the ADC values of benign and malignant renal lesions on DWIs at b values of 800 and 1600 s/mm² (p

Idiopathic granulomatous mastitis (IGM) is a rare benign chronic inflammatory disease. Etiology is unknown, but an autoimmune mechanism is suspected. Erythema nodosum is rare extramammillary manifestation of IGM, and few cases have been reported in the literature. In this study, we presented 28-year-old female patient with IGM associated with erythema nodosum. IGM can be caused by autoimmune mechanism and treated with steroid or surgical treatment. J Clin Exp Invest 2015; 6 (1): 84-85 Key words: Idiopathic granulomatous mastitis, erythema nodosum, steroid, surgery

Objective: Idiopathic granulomatous mastitis, a rare, benign, chronic inflammatory condition of the breast, which usually mimics breast carcinoma. In this study, we report on the management of 49 cases of idiopathic granulomatous mastitis and their clinical presentation. Methods: The breast and anatomical databases of one center were reviewed from 2007 to 2012 to identify patients with histological diagnosis of idiopathic granulomatous mastitis. Clinical and demographic characteristics were retrieved and treatment modalities were were recorded. Results: The mean patient age was 37.71±7.1 years. There were no differences between the management groups about etiological and demographic factors. The rate of recurrence in group 1, group 2, and group 3 was 8.3%, 14.8% and 20%, respectively; there were no statistically significant difference among the groups. Conclusion: Steroids and surgical methods codified in idiopathic granulomatous mastitis may be preferred. We recommend steroid therapy as first-line treatment. However, prospective, randomized clinical trials are needed to determine the treatment algorithm. Key words: Idiopathic, granulomatous, mastitis, management, Amaç: İdiopatik granulomatöz mastit, nadir görülen, benign, kronik inflamatuar bir hastalık olup meme kanserini taklit eder. Bu çalışmada idiopatik mastitli 49 hastanın tedavisini ve kliniğini sunmayı amaçladık. Yöntemler: Hastane otomasyon sisteminde 2007-2012 yılları arasında histolojik olarak granulomatöz tanısı konulmuş hastalar incelendi. Hastalara ait klinik bulgular, demografik veriler ve tedavi yöntemleri kaydedildi. Bulgular: Ortalama yaş 37.71±7.1 idi. Tedavi gruplar arasında etiyolojik ve demografik açıdan istatistiksel fark yoktu. Nüks oranları grup 1, grup 2 ve grup 3’te sırasıyla %8,3, %14,8 %20 olup, gruplar arasında istatistiksel anlamlı farklılık yoktu. Sonuç: Steroid ve cerrahi tedavinin idiopatik granulomatöz mastitli hastalarda uygulanabileceğini, steroid tedavisinin ilk basamak tedavi olması gerektiği kanaatindeyiz. Bununla birlikte tedavi algoritması belirlenebilmesi için prospektif, randomize klinik çalışmalara ihtiyaç vardır

To present the results of our retrospective study on 49 totally implantable subcutaneous venous ports inserted in angiography unit under ultrasound and fluoroscopic guidance. Between January 2010 and November 2011, 49 subcutaneous venous chest ports were placed in 48 patients (mean age, 49.3±16.7 years). One patient underwent port implantation twice. All the ports had single lumen catheters. The procedures were performed under ultrasound and fluoroscopic guidance in angiography unit. All ports were placed on the anterior chest wall. The technical success rate was 100%. There was no procedure-related minor or major complication. Mean duration of catheter usage was 220 days (total, 100.180 catheter days; range, 15 to 420 catheter days). There was no early complication(in the first month). Late complications occurred at a rate of 8.3% (n=4). Among those four cases, two ports (4.1%) had to be removed due to thrombosis. One port was explanted due to treatment-resistant bacteremia and sepsis, the other due to catheter malposition. In patients with malignant diseases, radiological implantation of subcutaneous venous ports can be performed with similar or lower complication rates, as compared to the surgical literature, due to the obvious advantage of imaging guidance. Hence, port implantation with imaging guidance may become a more preferred implantation method in the future., Anjiyografi ünitesinde ultrason ve floroskopi altında 49 tamamen implante edilebilen subkutan venöz port retrospektif olarak incelendi. 49 subkutan venöz göğüs portu 48 hastada (ortalama yaş 49.3 ± 16.7 yıl ) yerleştirildi . Bir hastaya iki port implantasyonu uygulandı. Tüm portlar tek lümen kateterine sahipti. Prosedürler ultrason ve anjiyografi ünitesinde floroskopi altında yapıldı. Tüm portlar göğüs ön duvarına yerleştirildi. Teknik başarı oranı %100 idi . İşleme bağlı minör veya major komplikasyon gözlenmemiştir . Erken komplikasyon (birinci ay ) olmadı. Geç komplikasyonlar % 8.3 oranında oluştu (n: 4) . Cerrahi literatürde malign hastalıklarda, subkutan venöz portların radyolojik implantasyonu benzer veya daha düşük komplikasyon oranları ile tercihedilebilir. Bu nedenle, görüntüleme kılavuzluğunda port implantasyonu gelecekte daha çok tercih edilen implantasyon yöntemi olabilir

To review clinical, radiological and histopathological findings of adult intussusception and its management, 18 adult patients who had been treated surgically because of intussusception were reviewed. Of the patients, 5 (27.8%) had idiopathic intussusceptions, while the other 13 (72.2%) had a definable intraluminal pathology. The site of the intussusception was more common in the small bowel (83.3%) than the colon (16.7%). Ultrasonography and computed tomography were successful in demonstrating "target lesion" in 80% and 75% respectively. Patients with idiopathic intussusception were treated with simple reduction, while the others underwent segmental resection because of the possibility of malignant tumour. In contrast to intussusception in childhood, intussusception in adults usually has a definable lead point and resection of the involved bowel, rather than simple reduction, is indicated.

Background. Fascioliasis is a disease caused by the trematode Fasciola hepatica. Cholangitis is a common clinical manifestation. Although fascioliasis may show various radiological and clinical features, cases without biliary dilatation are rare. Case report. We present unique ultrasound (US) and magnetic resonance cholangiopancreatography (MRCP) findings of a biliary fascioliasis case which doesn’t have biliary obstruction or cholestasis. Radiologically, curvilinear parasites compatible with juvenile and mature Fasciola hepatica within the gallbladder and common bile duct were found. The parasites appear as bright echogenic structures with no acoustic shadow on US and hypo-intense curvilinear lesions on T2 weighted MRCP images. Conclusions. Imaging studies may significantly contribute to the diagnosis of patients with subtle clinical and laboratory findings, particularly in endemic regions.

Background A wandering spleen, defined as a spleen without peritoneal attachments, is a rare entity characterized by splenic hypermobility due to laxity or maldevelopment of the supporting splenic ligaments. Patients with a wandering spleen may be asymptomatic, or may present with a palpable mass in the abdomen, or with acute, chronic, or intermittent symptoms due to torsion of the wandering spleen. Because early clinical diagnosis is difficult, imaging modalities play an important role in the diagnosis. Treatment should be planned according to the vitality of the spleen. Case report A 22-year-old woman presented with an acute abdomen that was found to be due to a wandering spleen with 720° anti-clockwise torsion around the pedicle. Conclusions Splenectomy is advocated in the presence of torsion, splenic vein thrombosis, or splenic infarction. Conversely, when a viable wandering spleen is found at laparotomy, detorsion with splenopexy is preferred.

Pancreas cancer has increased morbidity and mortality. It generally result in biliary obstruction which life threatening importance. Main biliary drainage method is endoscopic retrograde cholangiopancreatography. When endoscopic retrograde cholangiopancreatography is not successful, second preferred method is percutaneous biliary drainage. Percutaneous biliary drainage has some complications which is an invasive procedure. A complication of percutaneous biliary drainage due to patient iatrogenity which was not ever reported in the literature biliary drainage according to our literature research. In these circumstances an alternative solution is indirect biliary drainage.

A case of adenomyomatous polyp (AP) causig acute urinary retention in postmenopausal period is presented. A 65-year-old, G8P8 women admitted to our clinic with the complaint of vaginal bleeding and vaginal mass was identified. During preoperative hospitalization she complained about not able to urinate. Serum urea and creatinine levels increased [66 mg/dL (range= 10-45) and 2,49 mg/dL (range= 0. 6-1.3) respectively]. Emergent abdominopelvic tomography showed vaginal mass and overdistended bladder. Mass was removed by vaginal route and abdominal hysterectomy was also performed. Pathologic examination revealed non-malignant AP with massive necrosis. A variety of female reproductive tract diseases can cause urinary obstruction. Treatment choice depends on reproductive expectance of the patient., Postmenapozal dönemde akut üriner retansiyona neden olan adenomyomatoz polip (AP) olgusu sunulmuştur. 65 yaşında G8P8 bayan hasta kliniğimize vaginal kanama şikayeti ile başvurdu ve vajende kitle varlığı saptandı. Peroperatif hazırlık için hospitalize edilen hastanın idrar yapamama şikayeti olduğu öğrenildi. Serum üre ve kreatinin değerlerinin yüksek olduğu saptandı [66 mg/dL (normal aralık= 10-45) ve 2,49 mg/dL (normal aralık = 0. 6-1. 3) sırasıyla]. Acil abdominopelvik tomografide vajinal kitle ve distandü mesane izlendi. Kitle vajinal yoldan çıkartıldı ve abdominal histerektomi uygulandı. Patolojik incelemede malign olmayan ve yoğun nekroz alanları içeren AP olduğu saptandı. Kadın genital sistem patolojilerinin bazıları uriner retansiyona neden olabilirler. Tedavi seçimi hastanın fertilite beklentisine bağlıdır.

Urethral stone is a rare entity in clinical practice. Primary urethral stone happening directly in urethra is even rare, and it usually occurs as a result frequent urinary infection, urethral stricture and trauma.While the application of clear intermittant catheterization reliably protects bladder function, in long term use, it may cause various complications.In this case, we discussed giant urethral stone in a patient who has been acting clean intermittent catheterization regularly and without problem fort he last five years and who has had total loss of sensation in this lower extremity as a result of falling from height. Considering that the urethral calibration, in the patient acting clean intermittent catheterization is interesting, the giant urethra stone as much as examined such a case has not been presented in literature.In the patient acting clean intermittent catheterization and having loss of urethral sensation and with neurogenic bladder, we call attention to urethral pathologies the symptoms of which were seeing late

Uretra tasi uroloji pratiginde nadir karsilasilan bir durum­dur. Dogrudan uretrada olusan primer uretra taslari ise daha da azdir ve genellikle sik uriner enfeksiyon, uretral darlik ve travmalara bagli olusur. Temiz aralikli kateterizasyon (TAK) uygulamasi mesane fonksiyonlarini guvenilir bir sekilde korurken uzun donem kullaniminda cesitli komplikasyona neden olabilir. Bu calismada, yuksekten dusme nedeniyle alt ekstremi­telerinde tam duyu kaybi olan, bes yildir duzenli ve so­runsuz TAK yapan bir hastada son 15 gundur semptom veren dev uretra tasi olgusunu sunarak literatur esliginde tartistik. Uretranin kalibrasyonu goz onune alindiginda TAK yapan hastamizdaki dev uretra tasi ilgi cekicidir ve incelenebildigi kadariyla literaturde benzer bir vaka sunu­mu yapilmamistir. Bu olgu nedeniyle TAK yapan ve uretral his kaybi olan norojen mesaneli hastalarda gec semptom veren uretra patolojilerine dikkat cekmek istedik.

Unilateral agenesis of the parotid gland is an extremelyrare disorder. Only a few cases have been reported in theliterature. Although this entity is usually asymptomatic,sometimes it may be important. For an example thenormal parotid gland can be thought like a tumor due tothe facial asymmetry. Accompanied by clinical and radiologicalfindings, we present a case of unilateral parotidgland agenesis without involvement of other major salivaryglands and together with a compensatory hypertrophyof the contralateral parotid gland. J Clin Exp Invest2010; 2(1): 88-90

Summary Aim To evaluate the blood flow in arteries of the orbit in patients with psoriasis. Methods In total, 30 patients with psoriasis and 30 healthy control subjects were recruited to the study. Standard ophthalmic evaluation, fundus examination and retrobulbar colour Doppler ultrasonography assessment were performed. The ophthalmic, posterior ciliary and central arteries were evaluated, and peak systolic blood flow velocity, end diastolic velocity, resistance index and pulsatility index were measured. Results of the measurements were compared between the two study groups. Results There were significant differences in blood flow parameters of the orbital arteries between the psoriasis group and the control group. Conclusions The haemodynamics of the orbit might be affected in patients with psoriasis.

Blue dye used for sentinel lymph node biopsy (SLNB) in breast cancer patients may cause prolonged skin discoloration at the site of injection. The aim of this study was to assess the duration of such skin discoloration.236 consecutive patients who had undergone breast conserving surgery and SLNB for breast cancer were reviewed prospectively from January 2007 to December 2009.Of the 236 patients, 2 had undergone bilateral surgery, and 41 had been examined in consecutive yearly reviews. Blue discoloration remained visible at the injection site after 12, 24, and36 months in 36.5, 23.6, and 8.6% of the patients, respectively.The use of patent blue for identification of the sentinel lymph node in patients undergoing breast cancer surgery may result in prolonged discoloration of the skin at the injection site.Hintergrund: Der für die Sentinel-Knoten-Biopsie bei Mammakarzinom-Patientinnen verwendete blaue Farbstoff kann längerfristige Hautverfärbungen im Injektionsbereich verursachen. Ziel dieser Studie war es, die Dauer derartiger Hautverfärbungen zu bestimmen. Patientinnen und Methoden: 236 aufeinanderfolgende Mammakarzinom-Patientinnen, bei denen eine brusterhaltende Operation und Sentinel-Knoten-Biopsie durchgeführt worden waren, wurden von Januar 2007 bis Dezember 2009 prospektiv untersucht. Ergebnisse: Bei 2 der 236 Patientinnen war eine bilaterale chirurgische Behandlung erfolgt, und 41 wurden im Rahmen jährlicher Nachuntersuchungen beurteilt. Blaue Verfärbungen im Injektionsbereich waren nach 12, 24 bzw.36 Monaten bei 36,5, 23,6 bzw. 8,6% der Patientinnen weiterhin sichtbar. Schlussfolgerung: Die Anwendung von Patentblau zur Identifikation des Sentinellymphknotens bei chirurgisch behandelten Mammakarzinom-Patientinnen kann zur längerfristigen Verfärbung der Haut im Injektionsbereich führen.

Introduction. This study aimed to investigate the currency of computerized tomography pulmonary angiography-based parameters as pulmonary artery obstruction index (PAOI), as well as right ventricular diameters for pulmonary embolism (PE) risk evaluation and prediction of mortality and intensive care unit (ICU) requirement.Materials and Methods. The study retrospectively enrolled 203 patients hospitalized with acute PE. PAOI was calculated according to Qanadli score.Results. Forty-three patients (23.9%) were hospitalized in the ICU. Nineteen patients (10.6%) died during the 30-day follow-up period. The optimal cutoff value of PAOI for PE 30th day mortality and ICU requirement were found as 36.5% in ROC curve analysis. The pulmonary artery systolic pressure had a significant positive correlation with right/left ventricular diameter ratio (r=0.531,P<0.001), PAOI (r=0.296,P<0.001), and pulmonary artery diameter (r=0.659,P<0.001). The patients with PAOI values higher than 36.5% have a 5.7-times increased risk of death.Conclusion. PAOI is a fast and promising parameter for risk assessment in patients with acute PE. With greater education of clinicians in this radiological scoring, a rapid assessment for diagnosis, clinical risk evaluation, and prognosis may be possible in emergency services without the need for echocardiography.

Purpose. The aim of this study is to determine the prevalence of lumbosacral transitional vertebra (LSTV) in a well-represented general population. Methods. For a retrospective cohort study, abdominal radiographs of adult subjects were queried with clear visibility of the vertebral body articulation of the last rib, all lumbar transverse processes, and complete sacral wings. Exclusion criteria included any radiologic evidence of previous lumbosacral surgery that would block our view. A total of 6200 abdominal films were reviewed, and 3607 were identified as being suitable for the measurement of the desired parameters. Results. A total of 3607 subjects were identified as eligible for the study, and 683 (18.9%) were classified as positive for a lumbosacral transitional vertebra. The prevalence of sacralization and lumbarization was found as 17.2% and 1.7%, respectively. The average age at the time of the study was years (18–86 years). Conclusions. As a result of different opinions, LSTV retains its controversial status. Our prevalence study of the general population will provide assistance for resolution of the controversy. Prevalence studies of the general population with a wide participation will shed light on comparative studies.

To determine if the specimen without calcification, as depicted on specimen radiography, made any contribution to the final histopathological diagnosis in comparison to the specimen with calcification. The records of 1312 stereotactic vacuum-assisted biopsies for breast microcalcifications between February 2000 and December 2010 were reviewed retrospectively. Following specimen x-ray the biopsy tissues with and without microcalcifications were sent in two separate pots (pot 1 and pot 2 respectively). The number of cores in each pot and the number of calcium specks within the cores were recorded. In 1135 of the 1312 (86%) cases the histopathological findings were similar for pot 1 and pot 2. In 165 cases (13%) the diagnosis was made solely on pot 1 while cores in pot 2 did not reveal any additional pathology. In 12 biopsies (1%) the significant pathology was only present in the specimen without any calcification. For "microcalcification only" breast lesions the specimen containing calcium will yield a correct diagnosis in 99% of cases. Cores containing no calcification rarely contribute to the diagnosis on their own, but in 87% of cases an accurate diagnosis would still have been made even if the targeted calcification had been missed.

PURPOSE: The purpose of this study was to identify the factors that may have an impact on upgrading atypical ductal hyperplasia (ADH) lesions to malignancy. MATERIALS AND METHODS: Between February 1999 and December 2010, the records of 150 ADH lesions that had been biopsied were retrospectively reviewed. The biopsy types included 11-gauge stereotactic vacuum-assisted biopsy (SVAB) (n=102) and ultrasonography (US)-guided 14-gauge automated biopsy (n=48). The patients were divided into two groups: those who had cancer in the final pathology and those who did not. Variables associated with underestimation of ADH lesions were compared between the groups. RESULTS: The underestimation rates according to the biopsy types were 41.7% (20/48) for the US-guided 14-gauge automated biopsy and 20.6% (21/102) for the 11-gauge SVAB (P = 0.007). The rate of underestimation was significantly higher in lesions greater than 7 mm than it was in smaller lesions, with both US-guided 14-gauge automated biopsy and 11-gauge SVAB (P = 0.024 and P = 0.042, respectively). The rate of underestimation was significantly higher with the 11-gauge SVAB (P = 0.025) in lesions that were suspicious (R4) and highly suggestive of malignancy (R5) than in those that were probably benign (R3). CONCLUSION: The underestimation rate in ADH lesions was significantly higher with US-guided 14-gauge automated biopsy compared to the 11-gauge SVAB. The underestimation rate was also significantly higher in lesions greater than 7 mm regardless of the biopsy type, and in lesions biopsied using SVAB that were regarded as suspicious (R4) or highly suggestive of malignancy (R5) on imaging.