BioBERTurk: Exploring Turkish Biomedical Language Model Development Strategies in Low-Resource Setting.

Pretrained language models augmented with in-domain corpora show impressive results in biomedicine and clinical Natural Language Processing (NLP) tasks in English. However, there has been minimal work in low-resource languages. Although some pioneering works have shown promising results, many scenarios still need to be explored to engineer effective pretrained language models in biomedicine for low-resource settings. This study introduces the BioBERTurk family and four pretrained models in Turkish for biomedicine. To evaluate the models, we also introduced a labeled dataset to classify radiology reports of head CT examinations. Two parts of the reports, impressions and findings, are evaluated separately to observe the performance of models on longer and less informative text. We compared the models with the Turkish BERT (BERTurk) pretrained with general domain text, multilingual BERT (mBERT), and LSTM+attention-based baseline models. The first model initialized from BERTurk and then further pretrained with biomedical corpus performs statistically better than BERTurk, multilingual BERT, and baseline for both datasets. The second model continues to pretrain the BERTurk model by using only radiology Ph.D. theses to test the effect of task-related text. This model slightly outperformed all models on the impression dataset and showed that using only radiology-related data for continual pre-training could be effective. The third model continues to pretrain by adding radiology theses to the biomedical corpus but does not show a statistically meaningful difference for both datasets. The final model combines radiology and biomedicine corpora with the corpus of BERTurk and pretrains a BERT model from scratch. This model is the worst-performing model of the BioBERT family, even worse than BERTurk and multilingual BERT.

Prediction of malignancy upgrade rate in high-risk breast lesions using an artificial intelligence model: a retrospective study

PURPOSE: High-risk breast lesions (HRLs) are associated with future risk of breast cancer. Considering the pathological subtypes, malignancy upgrade rate differs according to each subtype and depends on various factors such as clinical and radiological features and biopsy method. Using artificial intelligence and machine learning models in breast imaging, evaluations can be made in terms of risk estimation in different research areas. This study aimed to develop a machine learning model to distinguish HRL cases requiring surgical excision from lesions with a low risk of accompanying malignancy. METHODS: A total of 94 patients who were diagnosed with HRL by image-guided biopsy between January 2008 and March 2020 were included in the study. A structured database was created with clinical and radiological characteristics and histopathological results. A machine learning prediction model was created to make binary classifications of lesions as malignant or benign. Random forest, decision tree, K-nearest neighbors, logistic regression, support vector machine (SVM), and multilayer perceptron machine learning algorithms were used. Among these algorithms, SVM was the most successful. The estimations of malignancy for each case detected by artificial intelligence were combined and statistical analyses were performed. RESULTS: Considering all cases, the malignancy upgrade rate was 24.5%. A significant association was observed between malignancy upgrade rate and lesion size (P = 0.004), presence of mammography findings (P = 0.022), and breast imaging-reporting and data system category (P = 0.001). A statistically significant association was also found between the artificial intelligence prediction model and malignancy upgrade rate (P < 0.001). With the SVM model, an 84% accuracy and 0.786 area-underthe- curve score were obtained in classifying the data as benign or malignant. CONCLUSION: Our artificial intelligence model (SVM) can predict HRLs that can be followed up with a lower risk of accompanying malignancy. Unnecessary surgeries can be reduced, or second line vacuum excisions can be performed in HRLs, which are mostly benign, by evaluating on a case-by-case basis, in line with radiology-pathology compatibility and by using an artificial intelligence model.

High chitotriosidase and AGE levels in acromegaly: a case-control study.

PURPOSE: Acromegaly is associated with oxidative stress and inflammation parameters. Chitotriosidase (CHITO) is a marker of macrophage activation and plays a pivotal role in the activation of inflammatory and immunological responses. Our study aimed to determine CHITO,YKL-40, advanced glycation end product (AGE), and high-sensitivity C-reactive protein (hsCRP) levels to investigate malondialdehyde (MDA), catalase, superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) activities and to evaluate any association of these parameters with carotid intima media thickness (cIMT) in patients with controlled acromegaly. METHODS: Thirty controlled acromegaly patients and 41 age- and sex-matched control cases were studied. We obtained demographic data, hormonal and metabolic parameters, and cIMT. CHITO activity was measured with the fluorometric method of Chamoles et al. YKL-40 and hsCRP levels were measured using ELISA. AGEs were measured based on spectrofluorimetric detection. GSH-Px activity was determined by a colorimetric assay. MDA, SOD, and catalase activities were determined in hemolysis. RESULTS: Higher CHITO, AGE, and hsCRP concentrations were observed in patients with acromegaly compared to controls. SOD levels were non-significantly higher in the acromegaly group, while catalase activities were lower in patients with acromegaly. Correlation analyses of CHITO, AGEs, YKL-40, hsCRP, MDA, catalase, GSH-Px, and SOD with metabolic, anthropometric, and laboratory parameters did not demonstrate any significant correlation (p > 0.05). There was no significant difference between groups with regard to cIMT levels. CONCLUSION: This is the first study investigating CHITO and AGE levels in patients with acromegaly. Serum CHITO, AGE, and hsCRP levels in acromegalic patients were significantly increased. It may be important to evaluate CHITO, AGE, and hsCRP levels in acromegalic patients who are already under cardiometabolic surveillance due to risk of developing cardiovascular disease.

Diagnostic performance rates of the ACR-TIRADS and EU-TIRADS based on histopathological evidence.

PURPOSE: In this study, we aimed to assess the effectiveness of malignancy stratification algorithms of the American College of Radiology (ACR) and European Thyroid Association (ETA) in the delineation of thyroid nodules using a database of nodules that were unequivocally diagnosed by means of histopathological examination and meticulously matched with the imaged nodules. METHODS: A total of 165 patients having 251 thyroid nodules with histopathologically proven definitive diagnoses during a 5-year period were included in this study. All patients had preoperatively undergone ultrasonography (US) examination, and US characteristics of the thyroid nodules were retrospectively analyzed and assigned in compliance with the thyroid imaging reporting and data system categories recommended by the ACR (ACR-TIRADS) and ETA (EU-TIRADS). The diagnostic effectiveness in the delineation of thyroid nodules and unnecessary fine-needle aspiration (FNAB) rates were evaluated. RESULTS: Overall, 189 nodules (75.30%) were diagnosed as benign, while 62 nodules (24.70%) were reported to be malignant based on histopathological assessment. Sensitivity and specificity rates were 71% and 75% for ACR-TIRADS and 73% and 80% for EU-TIRADS. The area under the curve values were 0.78 and 0.80 for ACR-TIRADS and EU-TIRADS, respectively. The unnecessary FNAB rates were 61% for ACR-TIRADS and 64% for EU-TIRADS as per the recommended criteria of each algorithm. CONCLUSION: The diagnostic performance of both malignancy stratification systems was signified to be moderate and sufficient in a cohort of nodules with definite histopathological diagnosis. In light of our results, we demonstrated the strengths and weaknesses of the ACR- and EU-TIRADS for physicians who should be familiar with them for optimal management of thyroid nodules.

Impact of the HEAD-US Scoring System for Observing the Protective Effect of Prophylaxis in Hemophilia Patients: A Prospective, Multicenter, Observational Study

Objective: This study aimed to observe the preventive effect of prophylactic treatment on joint health in people with hemophilia (PwH) and to investigate the importance of integration of ultrasonographic examination into clinical and radiological evaluation of the joints. Materials and Methods: This national, multicenter, prospective, observational study included male patients aged ≥6 years with the diagnosis of moderate or severe hemophilia A or B from 8 centers across Turkey between January 2017 and March 2019. Patients were followed for 1 year with 5 visits (baseline and 3th, 6th, 9th, and 12th month visits). The Hemophilia Joint Health Score (HJHS) was used for physical examination of joints, the Pettersson scoring system was used for radiological assessment, point-of-care (POC) ultrasonography was used for bilateral examinations of joints, and the Hemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) score was used for evaluation of ultrasonography results. Results: Seventy-three PwH, of whom 62 had hemophilia A and 11 had hemophilia B, were included and 24.7% had target joints at baseline. The HJHS and HEAD-US scores were significantly increased at the 12th month in all patients. These scores were also higher in the hemophilia A subgroup than the hemophilia B subgroup. However, in the childhood group, the increment of scores was not significant. The HEAD-US total score was significantly correlated with both the HJHS total score and Pettersson total score at baseline and at the 12th month. Conclusion: The HEAD-US and HJHS scoring systems are valuable tools during follow-up examinations of PwH and they complement each other. We suggest that POC ultrasonographic evaluation and the HEAD-US scoring system may be integrated into differential diagnosis of bleeding and long-term monitoring for joint health as a routine procedure.

COVID-19 radiology CT personnel management.

A new coronavirus outbreak called COVID-19 started in December 2019. In Turkey, the first case was reported on 10 March 2020. In this article, information will be given about the patient and staff management and organization that we have implemented in the Radiology Department of our hospital during the COVID-19 pandemic. The rules we followed were: 1- Performing the examinations of COVID-19 patients and suspects with a CT device isolated from other patients; 2- Reducing the unnecessary workload in imaging modalities other than CT, emergency radiography, and emergency ultrasonography; 3- Directing and managing patients and their relatives in accordance with the mask and distancing rules; 4- Disinfecting the device with an appropriate disinfectant after each patient in order to prevent cross-contamination; 5- Protecting the entire technician team from infection by employing one week work, two weeks off shifts of fixed teams; 6- Ensuring adequate ventilation of the gantry room. Adhering to the above rules, no infection spread was reported from the Radiology department and especially the COVID-19 CT unit.

Hepatic and splenic sonographic and sonoelastographic findings in pulmonary arterial hypertension.

PURPOSE: The aim of this study was to evaluate the associations of sonographic and sonoelastographic parameters with clinical cardiac parameters, as well as to assess their value in predicting survival in patients with pulmonary arterial hypertension (PAH). METHODS: Thirty-six patients with PAH and normal liver function were prospectively enrolled in this prospective study along with 26 healthy controls, all of whom underwent ultrasound and point shear wave elastography examinations. Additionally, the portal vein pulsatility index (PVPI), inferior vena cava collapsibility index, and clinical cardiac variables were obtained in PAH patients. The values of hepatic (LVs) and splenic shear wave velocity (SVs) were compared between PAH patients and controls. The relationships between all sonographic and clinical parameters in the PAH patients were analyzed. Furthermore, their prognostic value in predicting survival was investigated. RESULTS: LVs values in PAH patients (median, 1.62 m/s) were significantly higher than in controls (median, 0.99 m/s), while no significant difference was observed in SVs values. Patients with higher grades of tricuspid regurgitation (TR) had significantly different values of PVPI (P=0.010) and sonoelastographic parameters (P<0.001 for LVs and P=0.004 for SVs) compared to those with less severe TR. Tricuspid annular plane systolic excursion values were the only investigated parameter found to be associated with survival (hazard ratio, 0.814; 95% confidence interval, 0.694 to 0.954; P=0.011). CONCLUSION: Our results demonstrated a direct association between cardiac congestion (i.e., the severity of TR) and liver stiffness, which should be kept in mind during the assessment of fibrosis in patients with PAH.

[The Effects of Lithium on Calcium and Parathormone Levels: A Cross-sectional Study with Healthy Controls]. / Lityumun Kalsiyum ve Parathormon Düzeyi Üzerine Etkisi: Saglikli Kontrollerle Karsilastirmali Kesitsel Bir Çalisma.

OBJECTIVE: Despite lithium associated hyperparathyroidism (LAH) can lead to many complications, little notice has been paid to this sideeffect. The aim of this study was to investigate the effects of lithium on calcium and parathyroid hormone levels and the relation between lithium use and thyroid diseases. METHOD: This cross-sectional study was carried out with 87 lithiumtreated patients and 65 volunteers who had a similar age and gender distribution with the lithium group. Serum levels of corrected calcium, intact parathormone, phosphorus, magnesium, alkaline phosphatase, free thyroxine, thyroid stimulating hormone, thyroid autoantibodies and creatinine were assessed, and also, thyroid and parathyroid ultrasonography was conducted. Further detailed investigations were made depending on the elevation of the initially measured calcium and/ or parathormone levels. RESULTS: Median values of serum levels of the corrected calcium and the intact parathormone were significantly higher in the lithium group. Calcium levels had a mild correlation with the duration of lithium treatment. In the first assessment, while all control individuals had values within the normal reference range, 11 lithium-treated patients had corrected calcium and/or intact parathormone levels above the normal reference levels. All of the five patients, who were diagnosed with LAH after further investigation, were also diagnosed with a thyroid disorder. CONCLUSION: These results demonstrate that lithium treatment has a relationship with calcium and parathormone levels. The 5.7% prevalence of LAH and potential life-threatening conditions associated with LAH necessitates the use of available low-cost METHODS to monitor blood calcium levels of lithium-treated patients for early diagnosis.

Scintigraphic and Sonographic Findings of Subcapsular Cortical Necrosis in a Transplanted Kidney.

Renal transplant scintigraphy, performed in a 23-year-old man who had renal graft from a living donor, showed nearly normal perfusion and moderately low function of the graft. But the margins of the graft were blurred, and it was interestingly appearing enlarged late in the study. Ultrasound demonstrated a hypoechoic rim surrounding the whole kidney. Biopsy revealed necrosis besides normal cortical tissue. Necrosis was thought to be limited to the subcapsular cortical area. It should be considered that these scintigraphic findings could be due to greatly reduced and delayed perfusion of edematous subcapsular necrotic area of the graft even in normal perfusion images.

Thyroid Function and Ultrasonography Abnormalities in Lithium-Treated Bipolar Patients: A Cross-sectional Study with Healthy Controls.

INTRODUCTION: Lithium has many effects on thyroid physiology. Although these side effects have been known for a long time, large sample studies of lithium-treated patients using ultrasonography are lacking. The aim of this study is to investigate the detailed thyroid morphologies, hormone levels, and antibodies of lithium-treated patients compared with healthy controls. METHODS: This cross-sectional study involved 84 lithium-treated patients with bipolar disorder and 65 gender and age similar controls who had never been exposed to lithium. Subjects between 18 and 65 years of age were eligible for the study. Venous blood samples were acquired to determine the levels of free thyroxine (fT4), thyroid stimulating hormone (TSH), and thyroid antibodies; also, ultrasonographic examinations of the patients' thyroid glands were performed. RESULTS: There were no statistically significant differences in smoking habits, known thyroid disease, thyroid medication use, familial thyroid disease, fT4 level, autoimmunity, thyroid nodule presence, or Hashimoto's thyroiditis between the lithium and control groups. The median TSH level and thyroid volume were significantly higher in the lithium group. In the lithium group, 14 cases (16.7%) of hypothyroidism, seven cases (8.3%) of subclinical hypothyroidism, and one case (1.2%) of subclinical hyperthyroidism were defined; in the control group, seven cases (10.8%) of hypothyroidism and two cases (3.1%) of subclinical hyperthyroidism were defined. Thyroid dysfunction, goiter, parenchymal abnormality, ultrasonographically defined thyroid abnormality, and thyroid disorder were found to be more prevalent in the lithium group. 90% of patients with goiter and 74.3% of patients with ultrasonographic pathologies were euthyroid. CONCLUSION: It is important to note that 90% of the patients with goiter were euthyroid. This indicates that monitoring by blood test alone is insufficient. The prevalence rates of 47.6% for goiter and 83.3% for ultrasonographic pathology demonstrate that ultasonographic follow-up may be useful in lithium-treated patients. To determine whether routine ultrasonographic examination is necessary, large sample prospective studies are necessary due to the limitations of this study.

Variable sonographic spectrum of parathyroid adenoma with a novel ultrasound finding: dual concentric echo sign.

AIMS: To review the detailed gray-scale and Doppler ultrasonography features of histologically proven parathyroid adenomas (PAs) evaluated with high-end ultrasonography devices and to present a novel ultrasonography finding called the dual concentric echo sign in PA with histopathologic correlation which was encountered during detailed analysis. MATERIAL AND METHODS: Fifty-six PAs with histopathological result were enrolled. The longest dimension, shape, distance to skin surface, internal echo and Doppler US features obtained with high-end US devices were evaluated. RESULTS: PAs had variable range of shape including oval, irregular, fusiform, lobulated, crescent-shaped, and nodular configuration. In nine patients the lesions were shown to have cystic components and calcifications were seen in four cases. Dual concentric echo sign was detected in 18% PAs. Histological reevaluation of this subgroup demonstrated significantly increased edema (p<0.01), and ectatic vessels (p=0.02) in the central part of the lesion compared to the rest of the PAs. CONCLUSIONS: The results of the study led to the conclusion that PAs have variable gray-scale and Doppler findings. Typical sonographic features like ovoid shape, homogeneously hypoechoic pattern may not be present in all PAs. Dual concentric echo sign which is a novel sonographic pattern may be suggestive of a PA.

Evaluation of Renal Transplant Scintigraphy and Resistance Index Performed Within 2 Days After Transplantation in Predicting Long-Term Graft Function.

PURPOSE: Value of renal transplant scintigraphy and resistance index (RI) in the assessment of renal graft function is well known. The aim of this study was to evaluate the predictive value of renal transplant scintigraphy and RI for long-term graft function. MATERIALS AND METHODS: A total of 119 patients were analyzed retrospectively. Renal transplant scintigraphy with technetium Tc 99 m DTPA and color Doppler ultrasonography for RI were performed to each patient within 2 days after transplantation. Resistance index and the results of the tests in perfusion/renographic curve analysis of scintigraphy were compared with the serum creatinine (sCr) levels at 3 months, 1 year, and 5 years after transplantation. A sCr level of more than 1.5 mg/dL was considered abnormal. RESULTS: Differences of the mean values of T½ of graft washout (GW½), time difference between peak renal perfusion and arterial count ([INCREMENT]P), and accumulation index (R20/3) were significantly high in patients with high follow-up sCr (>1.5 mg/dL) (P < 0.01). The correlation of these tests with the follow-up sCr levels was significant (P < 0.01). The number of recipients with high perfusion curve grade was also significant in the follow-up groups with high sCr levels. However, difference of the mean value of RI was insignificant between the follow-up groups, and there was no correlation between the RI and sCr levels. CONCLUSION: Renal transplant scintigraphy performed within 2 days after transplantation is useful in the prediction of long-term graft function at 3 months, 1 year, and 5 years; and it is superior to resistance index.

Incidentally discovered thyroid nodules: frequency in an adult population during Doppler ultrasonographic evaluation of cervical vessels.

In this study, the frequency of thyroid nodules was searched in a population of consecutive patients undergoing routine cervical Doppler evaluation with the use of high-end color Doppler ultrasound units equipped with new technologies that increase nodule conspicuity. Three hundred and fifteen subjects, who had been referred for Doppler ultrasonography of cervical vessel examination, were enrolled in the study. During the examinations, the presence or absence of thyroid nodules, if present, their number (as "single" or "multiple"), the longest diameter, and internal echo pattern of the largest nodule were noted. As a result, one hundred and sixty-one subjects (51 %) were shown to have at least one thyroid nodule. In this subgroup, 54 cases had single and 107 cases had multiple nodules. Incidental thyroid nodules were detected in similar ratios in both men and women (p = 0.34). The results of the study led to the conclusion that half of the elder adult population had at least one thyroid nodule. Use of ultrasound technologies with increasing resolution seems to help significantly in detecting and also evaluating smaller and previously unknown nodules.

US findings in euthyroid patients with positive antithyroid autoantibody tests compared to normal and hypothyroid cases.

PURPOSE: We aimed to compare the ultrasonographic and laboratory parameters of euthyroid patients who have only positive antithyroid autoantibody test results with those of patients with a hypothyroid status of Hashimoto's thyroiditis (HT). MATERIALS AND METHODS: Thirty-five patients with newly diagnosed HT, 35 euthyroid patients who have autoantibodies against thyroid peroxidase (TPOAb) and/or thyroglobulin (TgAb), and 40 controls were enrolled in the study. Plasma free T3, free T4, thyroid stimulating hormone, TPOAb, and TgAb levels were obtained retrospectively. For gray-scale ultrasonography, each thyroid gland of all individuals graded with gray-scale grading (GSG), which was determined according to the gland size, parenchymal structure, echogenicity, micronodulation, contour irregularity, and existence of hyperechoic septa. For Doppler analysis, the peak systolic velocity (S), resistive index (RI), and pulsatility index (PI) values were obtained from the superior thyroid artery (STA) and intrathyroidal artery (ITA). The color pixel ratio (CPR), which was computationally evaluated from a power Doppler image of all individuals, was used for quantification of the intrathyroidal vascularity. RESULTS: Although the mean GSG values were higher in the HT and antibody-positive groups than they were in the control group, there was no significant difference between the HT and antibody-positive groups. The three study groups demonstrated no statistically significant difference with regard to the S, RI, or PI variables obtained from the STAs and ITAs. Although the CPR values were highest in the HT group, the difference between the HT and antibody-positive group did not reach statistical significance. CONCLUSION: The euthyroid antibody-positive group revealed gray-scale and Doppler ultrasonographic findings that were similar to those of the HT group.

Associations of triiodothyronine levels with carotid atherosclerosis and arterial stiffness in hemodialysis patients.

BACKGROUND AND OBJECTIVES: End-stage renal disease is linked to alterations in thyroid hormone levels and/or metabolism, resulting in a high prevalence of subclinical hypothyroidism and low triiodothyronine (T3) levels. These alterations are involved in endothelial damage, cardiac abnormalities, and inflammation, but the exact mechanisms are unclear. In this study, we investigated the relationship between serum free-T3 (fT3) and carotid artery atherosclerosis, arterial stiffness, and vascular calcification in prevalent patients on conventional hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: 137 patients were included. Thyroid-hormone levels were determined by chemiluminescent immunoassay, carotid artery-intima media thickness (CA-IMT) by Doppler ultrasonography, carotid-femoral pulse wave velocity (c-f PWV), and augmentation index by Sphygmocor device, and coronary artery calcification (CAC) scores by multi-slice computerized tomography. RESULTS: Mean fT3 level was 3.70 ± 1.23 pmol/L. Across decreasing fT3 tertiles, c-f PWV and CA-IMT values were incrementally higher, whereas CACs were not different. In adjusted ordinal logistic regression analysis, fT3 level (odds ratio, 0.81; 95% confidence interval, 0.68 to 0.97), age, and interdialytic weight gain were significantly associated with CA-IMT. fT3 level was associated with c-f PWV in nondiabetics but not in diabetics. In nondiabetics (n = 113), c-f PWV was positively associated with age and systolic BP but negatively with fT3 levels (odds ratio = 0.57, 95% confidence interval 0.39 to 0.83). CONCLUSIONS: fT3 levels are inversely associated with carotid atherosclerosis but not with CAC in hemodialysis patients. Also, fT3 levels are inversely associated with surrogates of arterial stiffness in nondiabetics.

Anterior segment ischemia and retinochoroidal vascular occlusion after intralesional steroid injection.

A 19-year-old woman was admitted with sudden severe pain and loss of light perception that began immediately after eyelid injection of the depot form of corticosteroid. Ecchymosis of the lower eyelid, corneal edema, and a fixed dilated pupil were noted. Fundus examination could not be performed because of corneal edema. Embolic material packed in the episcleral vessels was detected. With these findings, the diagnosis was anterior and posterior segment ischemia. Despite administration of an intravenous hyperosmotic agent, in addition to topical and systemic pulse corticosteroid (1.0 g/day), vision was not recovered. The most serious complication of intralesional injection of corticosteroid is vascular occlusion. This catastrophic complication after intralesional steroid injection should prompt immediate ophthalmoscopic fundus examination to allow early recognition of ischemic signs and immediate intervention.

False-positive I-131 accumulation in a hepatic hydatid cyst.

In this report, a case of differentiated thyroid carcinoma having false-positive I-131 accumulation due to a large hydatid cyst in the liver is presented. Abdominal sonographic examination of a 37-year-old patient with differentiated thyroid carcinoma demonstrated an ovoid, complex cystic mass containing cystic parts as well as solid-appearing components in the right lobe of liver, which is concordant with a type CE-3 hydatid cyst. The postablative whole-body scan obtained 10 days after 100 mCi I-131 therapy displayed intense and homogeneous uptake of radioiodine in the liver. Hepatic cystic mass was removed, and postoperative histologic evaluation confirmed hydatid disease. Some cystic lesions of the kidney and liver have been previously reported as causes of false-positive radioiodine accumulation.

What does peritoneal thickness in peritoneal dialysis patients tell us?

Loss of peritoneal function is a major factor leading to failure of treatment in peritoneal dialysis (PD). Although the precise biologic mechanisms responsible for these changes have not been defined, the general assumption is that alterations in peritoneal function are related to structural changes in the peritoneal membrane. The aim of the present study was to uncover the relationship between functional parameters of peritoneum and peritoneal thickness as measured by ultrasonography. We studied 43 prevalent patients who had been on PD for at least 12 months in the Ege University PD unit. We recorded body weight, height, age, sex, PD duration, episodes of peritonitis, and results of peritoneal equilibration tests. Parietal peritoneal thickness was measured from four abdominal quadrants at the mid-clavicular line. The peritoneal thickness measurement was determined as the mean of the four separate measurements. (In some cases, the measurement at one of the lower quadrants was excluded from the calculation if the peritoneal catheter was present near the area probed.) Mean peritoneal thickness in the patients was 446 +/- 164 microm (range: 250-930 microm), which was significantly correlated with mean body weight (r = 0.31, p < 0.05), height (r = 0.31, p < 0.05), end-to-initial ratio of dialysate glucose (r = -0.44, p < 0. 01), dialysate-to-plasma creatinine (r = 0.51, p < 0.01), and PD duration (r = 0.48, p < 0.01). Peritoneal thickness was positively correlated with time on dialysis, being a median of 370 microm [interquartile range (IQR): 283-400 microm] in patients who had been on PD for less than 24 months up and 660 microm (IQR: 483-733 microm) in patients who had undergone PD for more than 6 years. Ultrasound examination is a simple and noninvasive method of measuring peritoneal thickness in PD patients. It may be useful in the study of peritoneal structure and function. Sequential measurements over time may be useful for early diagnosis of encapsulating peritoneal sclerosis.

Bladder ultrasound in the evaluation of the efficacy of dextranomer/hyaluronic acid injection for treatment of vesicoureteral reflux.

PURPOSE: To determine whether sonographic examination of subureteral implants after endoscopic dextranomer/hyaluronic acid (DHA) injection would help to evaluate the efficacy of this method in the treatment of vesicoureteral reflux. MATERIALS AND METHODS: Thirty-six patients (49 ureters) who underwent endoscopic subureteral DHA injection were evaluated using voiding cystourethrography (VCUG) and bladder sonography for a mean duration of 2.1 years (range, 3 months to 6.5 years) after treatment. Patient records-including the results of VCUG, renal sonography, Dimercapto succinic acid (DMSA) scintigraphy, and periodic urinary analysis-were also reviewed to determine the outcome of treatment. RESULTS: Reflux was corrected in 43/49 (88%) ureters (complete cure in 38, downgrading of reflux in 5). No change was noted in 6 (12%) ureters on VCUG. The reflux was found to be corrected in 19/22 (86%) ureters, with the implants clearly identifiable on sonography. However, reflux was documented in only 3/27 (11%) ureters, around which no implant was seen on sonography. CONCLUSION: The identification of the implant in the subureteral region by bladder sonography correlated with resolution of reflux in the early postinjection period. On the other hand, the majority of the implants disappeared on sonography in the long term despite correction of reflux. Therefore, we believe that the use of bladder sonography is not useful in the evaluation of patients in long-term follow-up.