Nuclear protein in testis (NUT) midline carcinoma of the larynx: A rare case report of a paediatric patient and literature review.

Nuclear protein in testis (NUT) carcinoma is a rare neoplasm arising mainly from midline structures. It is an aggressive type of carcinoma associated with poor survival despite the use of multiple treatment modalities. Here, we present a case of a 17-year-old paediatric patient with NUT carcinoma of larynx, which is even rarer among all reported cases. The patient underwent surgery followed by radiotherapy and systemic treatment and he died 15 months after the diagnosis. The management of this rare disease requires further investigation.

The efficacy of artificial intelligence (AI) in detecting interval cancers in the national screening program of a middle-income country.

AIM: We aimed to investigate the efficiency and accuracy of an artificial intelligence (AI) algorithm for detecting interval cancers in a middle-income country's national screening program. MATERIAL AND METHODS: A total of 2,129,486 mammograms reported as BIRADS 1 and 2 were matched with the national cancer registry for interval cancers (IC). The IC group consisted of 442 cases, of which 36 were excluded due to having mammograms incompatible with the AI system. A control group of 446 women with two negative consequent mammograms was defined as time-proven normal and constituted the normal group. The cancer risk scores of both groups were determined from 1 to 10 with the AI system. The sensitivity and specificity values of the AI system were defined in terms of IC detection. The IC group was divided into subgroups with six-month intervals according to their time from screening to diagnosis: 0-6 months, 6-12 months, 12-18 months, and 18-24 months. The diagnostic performance of the AI system for all patients was evaluated using receiver operating characteristics (ROC) curve analysis. The diagnostic performance of the AI system for major and minor findings that expert readers determined was re-evaluated. RESULTS: AI labeled 53% of ICs with the highest score of 10. The sensitivity of AI in detecting ICs was 53.7% and 38.5% at specificities of 90% and 95%, respectively. Area under the curve (AUC) of AI in detecting major signs was 0.93 (95% CI: 0.90-0.95) with a sensitivity of 81.6% and 72.4% at specificities of 90% and 95%, respectively (95% CI: 0.73-0.88 and 95% CI: 0.60-0.82 respectively) and minor signs was 0.87 (95% CI: 0.87-0.92) with a sensitivity of 70% and 53% at a specificity of 90% and 95%, respectively (95% CI: 0.65-0.82 and 95% CI: 0.52-0.71 respectively). In subgroup analysis for time to diagnosis, the AUC value of the AI system was higher in the 0-6 month period than in later periods. CONCLUSION: This study showed the potential of AI in detecting ICs in initial mammograms and reducing human errors and undetected cancers.

Effect of an oral anxiolytic medication and heart rate variability on image quality of 64-slice MDCT coronary angiography.

PURPOSE: The aim of the study was to investigate the relationship between image quality in 64-slice multidetector computed tomography (MDCT) and patients' preimaging anxiety status and heart rate variability (HRV), and to evaluate the efficacy of an orally administered anxiolytic medication on HRV and image quality. MATERIALS AND METHODS: Sixty patients [14 women, 46 men; mean age 52.53 ± 10.55 (SD), range 33-78 years] were studied. Anxiety levels were assessed with the State-Trait Anxiety Inventory 60 min before the procedure. The participating patients were randomly assigned to one of the two study groups: a control group (no medication administered for anxiety reduction) and an anxiolytic medication group, with 30 patients in each group. The presence of motion artefacts and image quality for each coronary artery segment were evaluated using a four-point grading system. To estimate HRV, the duration of each heartbeat during MDCT data acquisition was measured in each patient. RESULTS: A moderate correlation was found between HRV during MDCT scanning and the mean image quality for all coronary segments (r=0.47, p<0.01). There was an association between HRV and state anxiety scores in all cases (r=0.370, p<0.01). HRV in the patients who received alprazolam was statistically significantly lower than in controls (p<0.05). The average image quality in patients who used alprazolam was also statistically significantly higher than in controls (p<0.05). CONCLUSIONS: The most important finding in our study is that oral premedication to reduce anxiety is also effective in decreasing HRV and improves image quality. Therefore, we suggest that using alprazolam in addition to a ß-blocker may improve image quality in patients undergoing MDCT coronary angiography (MDCT-CA). Anxiolytic usage may improve image quality by lowering the HRV in selected cases where administration of a ß-blocker is contraindicated. We also suggest that further studies in larger series are required to validate this finding.

Correlation between breast density in mammography and background enhancement in MR mammography.

PURPOSE: We aimed to analyse the influence of mammographic breast density on background enhancement (BE) at magnetic resonance (MR) mammography in pre- and postmenopausal women. In addition, we questioned predictability of contrast-enhancement dynamics of normal fibroglandular tissue (NFT) at MR mammography according to mammographic breast density. MATERIALS AND METHODS: Twenty-six patients (mean age 51.54+/-11.5 years; range 37-79 years) who underwent both MR mammography and conventional mammography were included in this retrospective study. Fourteen patients were premenopausal and 12 were postmenopausal. The ethics committee of our institution approved the study. The mammograms were retrospectively reviewed for overall breast density according to the four-point scale (I-IV) of the Breast Imaging Reporting and Data System (BI-RADS) classification. Two radiologists, who were unaware of the clinical data, separately assessed the MR mammography images. Images were assessed for enhancement kinetic features (enhancement kinetic curve and the early-phase enhancement rate) and BE. MR mammography and conventional mammography findings were compared according to BI-RADS breast density category and menopausal status. RESULTS: Percentage of increased signal intensity values during the first minute did not change according to mammographic breast density, and the mean early-phase enhancement rate scores were similar among breast density groups (p=0.942). There was no significant difference between pre- and postmenopausal groups. Enhancement kinetic features of the different groups based on BI-RADS breast density category and menopausal status were similar. There was no correlation between breast density and BE in either premenopausal (p=0.211) or in postmenopausal (p=0.735) groups. CONCLUSIONS: We determined no correlation between mammographic breast density and so-called BE in MR mammography in either premenopausal or postmenopausal women. NFT at MR mammography cannot be predicted on the basis of mammographic breast density.

Effects of supplemental L-carnitine in drinking water on performance and egg quality of laying hens exposed to a high ambient temperature.

The present study was conducted to investigate effects of L-carnitine supplied with drinking water on performance and egg quality of laying hens under high environmental temperature. In the study, 47-week-old laying hens (Brown hisex) were divided into two groups (control and treatment) and fed with a standard layer diet. Treatment group was received 50 p.p.m L-carnitine with drinking water for an 8-week period. Throughout the study, 8 h hot (35-37 degrees C) and 16 h thermoneutral (20-22 degrees C) environmental temperature regime was employed daily. The results showed that L-carnitine supplementation affected some egg quality characteristics of layers under high environmental temperature. Relative albumen weight and height were increased (p < 0.05) by supplemental L-carnitine. Live weight gain, feed intake, egg mass, egg weight, yolk weight, shell weight, yolk index, egg-shape index, yolk colour score and shell thickness were not affected (p < 0.05) by L-carnitine. It is concluded that L-carnitine supplementation in laying hens could have potential to improve albumen quality under high environmental temperature.

Comparison of sedation requirements for cataract surgery under topical anesthesia or retrobulbar block.

PURPOSE: Topical anesthesia is increasingly being used for cataract surgery. However, it is believed that topical anesthesia causes an increased risk of intraoperative complications from unrestricted eye movement and insufficient pain control and more need for sedation. It is difficult to compare pain and anxiety experienced by individual patients; therefore, the authors used the method of patient-controlled sedation to determine whether there is a difference in sedation requirements under topical or retrobulbar anesthesia. METHODS: In this prospective study, patients received either topical anesthesia (n=87) or retrobulbar block (n=104) and self-administered a mixture of midazolam (0.5 mg) and fentanyl (25 g) in increments using a patient controlled analgesia infuser to achieve sedation. At the end of surgery, patients rated their pain on a 10-point numerical rating scale and their comfort on a 5-point scale. The number of demands and deliveries were noted from the patient controlled analgesia infuser display. RESULTS: Pain scores were between 0 and 2 in 95.4% in the topical and in 94.2% in the retrobulbar group (p>0.05). Patient comfort was equal in both groups with 2.94 0.92 in the topical group and 2.92 0.99 in the retrobulbar group (p>0.05). Mean sedation requirements were similar in both groups: 26.4% of patients in the topical group and 19.2% in the retrobulbar group did not request any sedation (not significant, p>0.05). CONCLUSIONS: Sedation requirements were similar for cataract surgery under topical and retrobulbar anesthesia. (Eur J Ophthalmol 2004; 14: #-7).

Comparison of sedation requirements for cataract surgery under topical anesthesia or retrobulbar block.

PURPOSE: Topical anesthesia is increasingly being used for cataract surgery. However, it is believed that topical anesthesia causes an increased risk of intraoperative complications from unrestricted eye movement and insufficient pain control and more need for sedation. It is difficult to compare pain and anxiety experienced by individual patients; therefore, the authors used the method of patient-controlled sedation to determine whether there is a difference in sedation requirements under topical or retrobulbar anesthesia. METHODS: In this prospective study, patients received either topical anesthesia (n=87) or retrobulbar block (n=104) and self-administered a mixture of midazolam (0.5 mg) and fentanyl (25 microg) in increments using a patient controlled analgesia infuser to achieve sedation. At the end of surgery, patients rated their pain on a 10-point numerical rating scale and their comfort on a 5-point scale. The number of demands and deliveries were noted from the patient controlled analgesia infuser display. RESULTS: Pain scores were between 0 and 2 in 95.4% in the topical and in 94.2% in the retrobulbar group (p>0.05). Patient comfort was equal in both groups with 2.94+/-0.92 in the topical group and 2.92+/-0.99 in the retrobulbar group (p>0.05). Mean sedation requirements were similar in both groups: 26.4% of patients in the topical group and 19.2% in the retrobulbar group did not request any sedation (not significant, p>0.05). CONCLUSIONS: Sedation requirements were similar for cataract surgery under topical and retrobulbar anesthesia.

Effects of L-carnitine and niacin supplied by drinking water on fattening performance, carcass quality and plasma L-carnitine concentration of broiler chicks.

The present study was initiated to determine whether dietary supplemental L-carnitine and niacin affect growth performance, carcass yield, abdominal fat and plasma L-carnitine concentration of broiler chicks. One-day-old broiler chicks (COB500) were used in the experiment. A two by two factorial arrangement was employed with two levels (0 and 50 mg/l) of supplemental L-carnitine and two levels (0 or 50 mg/l) of supplemental niacin in drinking water as main effects. Body weight gain was significantly improved by L-carnitine, or L-carnitine + niacin supplementation during the first 3 weeks. However, supplemental L-carnitine and niacin did not change body weight gain during the last 3 weeks of the experimental period. Supplemental L-carnitine significantly improved feed intake during the first 3 weeks. Supplemental L-carnitine or niacin did not influence carcass weight, carcass yield and abdominal fat weight. L-carnitine content in the plasma was significantly higher in the groups receiving supplemental L-carnitine and L-carnitine + niacin. It is concluded that dietary supplemental L-carnitine or L-carnitine + niacin could have positive effects on body weight gain and feed intake during the early stages of growing. However, supplemental L-carnitine or L-carnitine + niacin were not of benefit regarding the complete growth period.

Effects of dietary supplemental L-carnitine and ascorbic acid on performance, carcass composition and plasma L-carnitine concentration of broiler chicks reared under different temperature.

The present study was initiated to determine whether dietary supplemental L-carnitine and ascorbic acid affect growth performance, carcass yield and composition, abdominal fat and plasma L-carnitine concentration of broiler chicks reared under normal and high temperature. During the experiment, two temperature regimes were employed in two experimental rooms, which were identical but different in environmental temperature. The regimes were thermoneutral (20-22 degrees C for 24 h) or recycling hot (34-36 degrees C for 8 h and 20-22 degrees C for 16 h). One-day-old broiler chicks (ROSS) were used in the experiment. A 2 x 2 x 2 factorial arrangement was employed with two levels (0 and 50 mg/kg) of supplemental L-carnitine and two levels (0 or 500 mg/kg) of supplemental ascorbic acid in drinking water under thermoneutral or high temperature regimes. Body weight gain was affected by high temperature. However, body weight gain was significantly improved in animals receiving supplemental L-carnitine, ascorbic acid or L-carnitine + ascorbic acid compared to animals receiving unsupplemented diet under high temperature. On the other hand, supplemental L-carnitine or L-carnitine + ascorbic acid reduced body weight gain under thermoneutral condition. Supplemental ascorbic acid significantly improved feed conversion efficiency, the improvement was relatively greater under high temperature. The L-carnitine content in the plasma was higher in the groups receiving supplemental L-carnitine and ascorbic acid under high temperature, while broilers fed supplemental L-carnitine and ascorbic acid had a decreased level of plasma L-carnitine concentration under normal temperature. It is concluded that dietary supplemental L-carnitine or L-carnitine + ascorbic acid may have positive effects on body weight gain, carcass weight under high temperature conditions.

Marking of nonpalpable breast lesions using a custom carbon suspension.

PURPOSE: To review results of carbon marking in non-palpable breast lesions using a different type of a carbon suspension containing 0.5% polyoxyethylene sorbitan monooleate (PSM). MATERIAL AND METHODS: Sixteen lesions of 16 patients with indeterminate or suspicious mammographic findings underwent stereotaxic carbon marking. With the aid of tracing of the carbon stains surgery was then performed. RESULTS: Pathology revealed malignancy in 26% of the cases and the missed rate by carbon marking was 6% (1 lesion). Carbon marking is an easier application compared to hook-wire systems in localizing occult breast lesions. PSM added to a 4% carbon suspension results in a more homogeneous suspension, prevents early precipitation and eases injection. Animal studies have shown that no local or peripheral tissue reactions are elicited with either pure PSM or in a mixture with carbon. CONCLUSION: We recommend addition of PSM to carbon marking suspensions.

Magnetic resonance imaging findings in patients with severe neonatal indirect hyperbilirubinemia.

The aim of this study was to document the magnetic resonance imaging (MRI) findings of cases with a history of severe neonatal indirect hyperbilirubinemia. Ten cases (eight cases with neurologic findings, two normal cases) with a history of severe neonatal indirect hyperbilirubinemia were studied. Neurologic findings and MRI results were described and correlated. Seven of eight cases with neurologic findings demonstrated symmetric and uniform increased T2 signal changes limited to globus pallidi. MRI scans of two cases without neurologic findings showed no abnormality. Severe neonatal indirect hyperbilirubinemia should be considered in the differential diagnosis of bilateral symmetric hyperintense signal changes in the globus pallidus on MRI. However, high levels of unconjugated bilirubin concentrations in the neonatal period may not always cause such lesions of globus pallidus on MRI despite the presence of neurologic findings.

Pitfalls in the diagnosis of complicated pulmonary hydatid disease.

The aim of this study was to present the pitfalls in the diagnosis of complicated pulmonary hydatid disease and to discuss the unusual radiological presentations of this endemic disorder in Turkey. We retrospectively evaluated 34 patients (12 females) aged between 8 and 64 years, who were operated on at our centre between 1991 and 1998 and diagnosed with complicated pulmonary hydatid cyst histopathologically. Computerized tomography (CT) scans of these patients were reviewed double-blind by two radiologists. The patients were then divided into two groups: group 1: initial radiological impression is pulmonary hydatid cyst and group 2: initial radiological impression is not pulmonary hydatid disease. These two groups were evaluated in terms of symptoms, radiographical presentation and laboratory tests. The presence of cystic appearance, water-lily sign, ring enhancement concomitant with intact cysts unanimously led the radiologists to the diagnosis of complicated pulmonary hydatid cyst, whereas solid appearance and presence of bronchial obliteration made the diagnosis unlikely. In such circumstances patient history, laboratory findings and bronchoscopic evaluation helped the diagnosis. In conclusion, in endemic regions like Turkey, atypical radiological presentation of complicated pulmonary hydatid disease should be considered in the differential diagnosis of solid pulmonary lesions.

An unusual localization of massive portasystemic collaterals: CT angiographic demonstration.

This article presents a patient with portal hypertension in whom an unusual localization for portosystemic collaterals have incidentally been found. Upper abdominal sonography revealed tubular structures filling the whole perirenal and partially the perihepatic area, and their venous nature was demonstrated with duplex Doppler sonography. Spiral CT angiography identified the right-sided retroperitoneal location and mesenteric-lumbar route of the collaterals. Upper gastrointestinal endoscopy with antral biopsy and percutaneous liver biopsy were performed. Laboratory results and specimen evaluation revealed chronic active hepatitis due to hepatitis-B infection. Attention is drawn to the abnormal location of these vessels, together with the noninvasive nature and competence of CT angiography in demonstrating vascular pathologies.

Microcatheter CSA in a young woman with Fontan repair undergoing elective sterilization.

We present the case of a 28-yr-old woman with Fontan anastomosis undergoing elective sterilization. Because of concerns about laparoscopic surgery with capnoperitoneum and positive-pressure ventilation, a mini-laparotomy was performed in microcatheter spinal anaesthesia. Tiration of small doses of plain bupivacaine 0.5% supplemented with 5 microg sufentanil provided high cardiocirculatory and respiratory perioperative stability in this patient.

CT in lobar atrophy of the liver caused by alveolar echinococcosis.

We reviewed the CT findings of 13 patients with histologically proved alveolar echinococcosis of the liver. Seven of these patients had hilar involvement, which caused dilatation of intrahepatic bile ducts and invasion of the portal vein or portal branches. In two of these patients we found marked atrophy of the right lobe and in one patient marked atrophy of the left lobe in addition to various CT findings previously reported for alveolar echinococcosis of the liver. The occurrence of lobar atrophy of the liver caused by alveolar echinococcosis has not been previously reported. We concluded that, when a mass lesion with hilar infiltration causing lobar atrophy is found in endemic areas, alveolar echinococcosis should be considered in the differential diagnosis in addition to malignant neoplasms.

Purely cystic hydatid disease of the liver: treatment with percutaneous aspiration and injection of hypertonic saline.

Percutaneous aspiration of purely cystic liver lesions was performed in 15 patients aged 11-56 years. After aspiration under guidance with computed tomography (CT) in 12 patients, a membrane that is diagnostic for hydatid disease was visible in the lumen of the cyst on CT scans. Hypertonic saline was injected in the cystic cavities of these patients as a scolecidal agent. No major complications occurred during or after the procedures. In the follow-up period of 6-16 months, control CT and ultrasound scans revealed a progressive decrease in the size of the lesions and no evidence of peritoneal seeding. It is concluded that percutaneous aspiration and hypertonic saline injection for purely cystic hydatid disease of the liver seem to be an effective form of treatment and may eventually prove to be an alternative to surgical intervention.

Preoperative CT staging of colon carcinoma (excluding the recto-sigmoid region).

Twenty-eight patients with colon carcinoma (excluding the recto-sigmoid region) underwent preoperative staging with computed tomography (CT). The CT had a sensitivity and a specificity of 60 and 67% for detection of extramural invasion, 75% sensitivity and specificity for lymph node metastases and a sensitivity of 87% and specificity of 95% for liver metastases. Compared with the modified Dukes classification, CT correctly staged 50% of the patients with Dukes A lesions; 40% with Dukes B; 75% with Dukes C and 85% with Dukes D lesions. The data presented in this study showed that CT has limitations in the sensitivity and accuracy of staging local colonic carcinoma. However, we recommend its use for patients who are clinically suspected of having extensive disease.