Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study.

PURPOSE: The clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions. METHODS: This retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson's chi-squared test, the Fisher-Freeman-Halton test, and Fisher's exact test were used for the statistical analyses. RESULTS: The overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes. CONCLUSION: ADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision.

Evaluation of the relationship between hallux valgus and foot measurements in radiographic images of adult female.

PURPOSE: In the present study, we aimed to determine the relationship of HV angle with angles and measurements obtained from lateral and anteroposterior (AP) radiological images of the foot in individuals with HV. METHODS: The present study had a retrospective design, and the participants consisted of 66 female patients between the ages of 19 and 64 who applied to Orthopedics and Traumatology and were diagnosed with Hallux valgus. Metatarsus adductus angle, metatarsus primus adductus angle, hallux valgus angle, hallux interphalangeal angle, metatarsal break angle, first metatarsal protrusion distance, metatarsal width, talocalcaneal angle, AP Meary's angle were measured on AP view and calcaneal inclination angle, talar declination angle, lateral talocalcaneal angle, first metatarsal declination angle, fifth metatarsal declination angle, navicular height, lateral Meary's angle, tibiotalar angle were measured on a lateral radiograph. The IBM SPSS 21.0. program was used for statistical analysis, and the level of significance was taken as p < 0.05. RESULTS: There were statistically significant differences between the right and left feet in MPA and AMA measurements. The results showed that HV angle (HVA) had a weak relationship with MAA and MW, as well as a moderately positive relationship with MPA. However, it had a moderately negative relationship with AMA and a weak negative relationship with HIPA. CONCLUSION: We believe that in addition to the HVA angle, MPA and AMA angles should be considered in the diagnosis of HV, especially as the HVA angle is moderately positively correlated with the MPA angle and moderately negatively correlated with the AMA angle.

Stature estimation from radiographic measurements in adult Anatolian population / Estimación de la estatura a partir de mediciones radiográficas en una población adulta de anatolia

SUMMARY: The purpose of the present study was to create a regression equation for measuring stature using measurements obtained from the long bone radiographs of adult individuals in Anatolian population. In this study, the maximum length measurements of the six long bones in the upper and lower limbs of 167 healthy individuals were determined from radiographic images. Single and multiple regression equations were created to predict the stature of the individuals from the maximum bone stature. From these equations, the standard error of estimate was determined in the range of 1.68-4.09 cm. As a result of this study, the obtained regression equations resulted in highly reliable and successful results in terms of predicting stature. These equations will provide convenient and predictive accuracy in the estimation of stature from skeletal remains obtained from societies that lived and living in Anatolia. Besides, we anticipate that it will guide researchers working in the fields of Forensic Anthropology, Forensic Medicine and Anatomy.

RESUMEN: El propósito del presente estudio fue crear una ecuación de regresión para medir la estatura utilizando medidas obtenidas de las radiografías de huesos largos de individuos adultos en la población de Anatolia. En este estudio, las medidas de longitud máxima de los seis huesos largos en los miembros superiores e inferiores de 167 individuos sanos se determinaron a partir de imágenes radiográficas. Se crearon ecuaciones de regresión única y múltiple para predecir la estatura de los individuos a partir de la estatura ósea máxima. A partir de estas ecuaciones, se determinó el error estándar de estimación en el rango de 1,68 a 4,09 cm. Como resultado de este estudio, las ecuaciones de regresión obtenidas dieron resultados altamente confiables y exitosos en términos de predecir la estatura. Estas ecuaciones proporcionarán una precisión conveniente y predictiva en la estimación de la estatura a partir de restos óseos obtenidos de sociedades que vivieron y viven en Anatolia. Además, anticipamos que guiará a los investigadores que trabajan en los campos de Antropología Forense, Medicina Forense y Anatomía.

Prenatal determination of the upper lesion level of spina bifida with three-dimensional ultrasound.

INTRODUCTION: To evaluate the role of three-dimensional (3D) sonography in the prenatal detection of the upper pole in fetuses with spina bifida. MATERIAL AND METHODS: Women admitted to a tertiary center with pregnancies with isolated open spina bifida were enrolled in the study. All fetuses had 3D sonography to predict the lesion level. The exact lesion level was ascertained using radiography and/or autopsy following the delivery at term or abortion. RESULTS: Forty-eight cases were eligible for this study. Twenty-eight fetuses were diagnosed in the second trimester and the lesion level was precisely predicted in 24 (86%) of them. In 14 (70%) of the 20 fetuses diagnosed in the last trimester, the level was accurately determined. The remaining 10 fetuses, from both the second and third trimesters, were found to have a lesion level that was within one segment of the predicted lesion level. The correct matching rate was 38/48 (79%), and agreement within one segment was achieved in all cases. DISCUSSION: According to our data, 3D ultrasound is useful for the prenatal determination of lesion level in spina bifida, which is an important prognostic factor.

Extrarenal pseudoaneurysm of the arterial anastomosis in a renal transplant: endovascular coil embolization with balloon remodeling technique.

Anastomotic pseudoaneurysms of transplanted kidneys are a very rare complication and encountered in less than 1% of such operations. They may be devastating and cause functional impairment and even loss of the graft. In this report, we present the first case of treatment of extrarenal pseudoaneurysm of arterial anastomosis in a renal transplant patient with endovascular coil embolization with the balloon remodeling technique. This method is mostly used in the treatment of wide-neck intracranial aneurysms.

Portal venous diameter in children: normal limits according to age, weight and height.

PURPOSE: To establish the normal limits of portal vein diameter according to age, height and weight. MATERIALS AND METHODS: One hundred and sixty-eight healthy children, ages ranging from 1 month to 15 years were examined by ultrasound. Portal vein diameters at hepatic port, weight and height were recorded. RESULTS: A range of normal limits for portal veneous diameter according to age, weight and height are obtained and presented in tables. CONCLUSION: Knowing the normals for portal venous diameter in every age group in children is mandatory in differentiating disease. The tables according to age, weight and height will definitely be helpful in the work-up process.

Estimation of the ratio of renal artery stenosis with magnetic resonance angiography using parallel imaging technique in suspected renovascular hypertension.

BACKGROUND: Renovascular hypertension, which may lead to end-stage renal failure, necessitates prompt diagnosis and medication. Although various diagnostic tools exist for evaluation of renal arteries, magnetic resonance angiography (MRA), with the improvement of hardware and software systems, has become a very promising technique in screening patients with suspected renal hypertension. In this study, we aimed to assess renal artery stenosis on MRA in patients with suspected renovascular disease using a parallel imaging technique which allows faster scanning with higher resolution. METHODS: Eighty-four patients with hypertension underwent MRA and digital angiography. RESULTS: MRA detected renal artery stenosis with a sensitivity rate ranging from 69.3 to 100% and specificity rate ranging from 85.7 to 96%. CONCLUSION: Contrast-enhanced MRA of renal arteries is very effective in the demonstration of renal artery stenoses and assessment of stenosis ratio. Furthermore, parallel imaging technology has improved this procedure by reducing the scan time. Renal MRA, as a diagnostic tool, can accurately direct patients with renovascular disease to intravascular treatment.

Cardiac mucormycosis in a child with severe aplastic anemia: a case report.

Mucormycosis is an uncommon, severe, life-threatening fungal infection in the immunocompromised host. Mucormycosis with aplastic anemia is seen rarely. Only a few cases of cardiac mucormycosis with aplastic anemia have been reported in the literature. The authors present a case with severe aplastic anemia that did not respond to classic and immunosuppressive treatment for disease and developing invasive cardiac mucormycosis despite empiric treatment for febrile neutropenia.

Risk of developing fibroadenoma with the use of cyclosporine A in renal transplant recipients.

To investigate the effect of cyclosporine A (Cyc A) on the development of fibroadenomas, 30 renal transplant patients and 20 chronic renal failure patients on dialysis were breast examined with ultrasonography and/or mammography. Of the renal transplant patients, 17 were receiving Cyc A-based combination therapy for immunosuppression. All patients were female with the age range of 29.7+/-9.2 years in the transplant group and 33.95+/-9.91 in the dialysis group. Eight of the 17 patients receiving Cyc A had fibroadenomas, 5 of them having bilateral lesions. None of the other patients, those on dialysis and on non-Cyc A combination therapy had fibroadenomas. A significant difference for fibroadenoma incidence in patients receiving Cyc A combination immunosuppression was found.

Renal vascular resistance in sickle cell painful crisis.

Vaso-occlusive painful crisis is one of the characteristic manifestations of sickle cell disease (SCD). We aimed to investigate the state of renal vascular resistance by means of Doppler ultrasonography during vaso-occlusive painful crisis in patients with SCD. The 60 patients with homozygous SCD who entered the study were divided into 2 groups. Group 1 included 45 patients who were living in steady-state conditions and had no history of transfusions within the 3 months before the initiation of the study. Group 2 consisted of 15 patients with signs of painful vaso-occlusive crisis during evaluation. Group 2 patients had significant reductions in 3 measures of flow velocity in both main renal arteries, compared with group 1 patients (P < .04, P < .001, and P < .01). Mean and end-diastolic velocities in the segmental arteries (P < .01, and P < .001, respectively) and end-diastolic velocities in the interlobar arteries (P < .04) were lower in group 2 patients than in group 1 patients. Analysis of resistive (RI) and pulsatile (PI) indices in the investigated arteries demonstrated that the RI of the renal (P < .001; P < .0001), segmental (P < .002; P < .0001) and interlobar (P < .001; P < .0001) arteries of both kidneys in group 2 < .0001; P < .0001) for both kidneys were markedly higher in group 2 patients than in group 1 patients and the healthy subjects, respectively. Our preliminary results suggest a reduction of renal blood flow and an increase in renal vascular resistance during painful crisis compared with steady-state SCD.

[Mediastinal hemangioma (case report)]. / Mediastinal hemanjiyom.

We present radiographic and computed tomographic findings of a mediastinal hemangioma, a very rare benign vascular tumor that comprises less than 0.5% of all mediastinal masses. Posteroanterior chest film showed a homogeneous opacity in the left upper zone that was contiguous with the mediastinum. Computed tomography demonstrated a mediastinal mass with inhomogeneous contrast enhancement and a small calcification.

The prevalence and variations of inferior right hepatic veins on contrast-enhanced helical CT scanning.

PURPOSE: To present the prevalence and variations of inferior right hepatic veins (IRHVs) on contrast-enhanced helical computed tomography (CEHCT) scans. MATERIALS AND METHODS: The routine abdominal CEHCT scans of 349 patients were reviewed. Three hundred and eight patients (88.2%) were included in the study. Of the 349 patients, 41 (11.8%) were excluded from the study because of improper opacification of hepatic veins and right hepatic lobe lesions which made difficult the optimal visualization and assessment of IRHVs. The mean age of 308 patients was 43 years (range 3-97 years). One hundred and forty-three patients (46.4%) were men and 165 (53.6%) women. Scans were examined whether the IRHVs were demonstrated or not and classified according to their numbers, levels, diameters, and joinings to inferior vena cava (IVC). RESULTS: Of the 308 patients, 65 (21.1%) had one or two IRHVs. Fifty-four patients (83.1%) had only one IRHV and 11 (16.9%) patients had two. More than two IRHVs were not seen in any patient. Eight (72.7%) of 11 double IRHVs joined the IVC at the same level and others (27.3%) did not. There was no truncal opening to the IVC. In five patients (7.7%) the IRHV were large (> or =0.5 cm). CONCLUSION: The presence of IRHVs is common and routine CEHCT scanning is efficacious in assessment of IRHVs.

[Unenhanced spiral CT in the diagnosis of acute appendicitis]. / Akut apandisit tanisinda kontrastsiz spiral BT'nin yeri.

PURPOSE: To evaluate the role of unenhanced spiral computed tomography (CT) in the work-up of patients with suspicious symptoms of acute appendicitis. MATERIALS AND METHODS: Sixty-five patients with suspected acute appendicitis (34 (52%) women and 31 (48%) men), were studied with spiral CT without administration of IV or oral contrast. From the upper L1 vertebral plate to the superior border of the iliac wings, slices of 10 mm collimation with 8 mm/sec table speed were taken, and from that level to the acetabular roof level, 5 mm thick slices were obtained with a table speed of 5 mm/sec and tube rotation time of 1.5 sec. The diagnosis of acute appendicitis was made by seeing a dilated appendix vermiformis greater than 6 mm in diameter and/or an appendicolith accompanied by periappendiceal inflammatory changes. The findings were compared with surgical and pathological results. Those patients who were not operated on were followed-up for 3 months. RESULTS: Acute appendicitis was diagnosed in 28 (43%) of the 65 patients. Of the 28 patients with a CT diagnosis of acute appendicitis, 25 (38%) had acute appendicitis proven by surgery and pathology. Twenty-one (32%) patients had a normal CT study and 16 (25%) patients had non-appendiceal pathologies. There were 25 true-positives, 35 true negatives, 3 false positives and 2 false negatives. Non-contrast helical CT had a sensitivity of 93%, specificity of 92%, accuracy of 95%, positive predictive value of 89% and negative predictive value of 95% in the diagnosis of acute appendicitis. CONCLUSION: Non-contrast CT is an accurate, reliable and efficacious method in the diagnosis of acute appendicitis. It also has the advantage of showing other pathologies mimicking the symptoms of acute appendicitis.

[Case report: Pedunculated leiomyosarcoma of the inferior vena cava]. / Inferior vena kavanin sapli leyomyosarkomu.

Leiomyosarcoma of the inferior vena cava is a rare mesenchymal tumor which originates from the smooth muscle cells of the vascular wall. Its radiographic presentation varies from that of intraluminal lesions resulting in obstruction of the inferior vena cava to those of giant retroperitoneal masses extending to the surrounding perivascular tissues although still with minimal intraluminal protrusion. In this report, we present one such case in which a 31-year-old woman had complaints of severe abdominal pain, abdominal distension and vomiting. Computed tomography demonstrated a giant well-defined right-sided retroperitoneal mass extending from the subhepatic region down to the pelvis. She was operated on and the tumor was discovered to be attached to the wall of the inferior vena cava with a peduncle, a leiomyosarcoma being proven histologically. CT features of this rare tumor are presented in this report.