Is Airway Management More Risky in Bariatric Surgery?

PURPOSE: Airway problems may be experienced more often during anesthesia management in bariatric surgery. In this prospective study, we aimed to compare the incidence of difficult ventilation and intubation between bariatric surgery and other surgeries. DESIGN: This was a case-control study. METHODS: Medical records of 156 patients over the age of 18 who were scheduled for bariatric (n = 68) and nonbariatric surgery (n = 88) under general anesthesia were evaluated. FINDINGS: The percentage of ASA III, diabetes mellitus, and obstructive sleep apnea syndrome (75%, 33.8%, and 16.2%, respectively) was significantly higher in bariatric surgery patients compared to nonbariatric patients (14.8%, 10.2%, and 3.4%, respectively). No significant difference was found in mean thyromental distance and history of difficult intubation, restriction of cervical extension, beard presence, tooth loss, mallampati, Cormack-Lehane score, intubation score, difficult ventilation, difficult intubation and intubation device used. An increase in neck circumference (>50 cm) rather than body mass index was a more significant indicator in predicting difficult intubation and difficult ventilation. CONCLUSIONS: The incidences of difficult ventilation and difficult intubation were similar in bariatric and nonbariatric surgeries in circumstances where the necessary equipment and experienced anesthesiologists are available.

Musculoskeletal symptoms and related factors in postacute COVID-19 patients.

AIM: There is a lack of an overview of the factors associated with postacute COVID-19 musculoskeletal symptoms. The aims of this study were as follows: 1- to evaluate the most frequent admission symptoms and the frequency of musculoskeletal symptoms in postacute COVID-19 patients; and 2- to determine the related factors with the postacute COVID-19 musculoskeletal symptoms. METHODS: A total of 280 postacute COVID-19 patients (183 females, 97 males) were enrolled and divided into two groups: 1- patients whose musculoskeletal symptoms initiated with or were aggravated by COVID-19 (n = 240); and 2- patients whose musculoskeletal symptoms did not change with COVID-19 (n = 40). The variables were demographic and treatment data, symptoms on admission, postacute COVID-19 symptoms, laboratory results (complete blood count, erythrocyte sedimentation rate, C-reactive protein, ferritin and d-dimer), chest computed tomography findings and symptoms during acute COVID-19. RESULTS: Most of the patients have fatigue (71.8%), spine pain (70.7%) and myalgia (60.7%). The most common pain region was the back (30.4%). The frequency of dyspnoea was 30%, cough 18.5% and chest pain 10.7%. Having any chronic disease (P = .031), the duration of hospital stay (P = .016), frequency of back pain during acute COVID-19 (P = .018), tomography findings and d-dimer (P = .035) levels were significantly higher, and lymphocyte (P = .024) levels were significantly lower in the patients whose symptoms began with or were aggravated by COVID-19. CONCLUSION: Back pain was the most frequent symptom on admission. The most common postacute COVID-19 musculoskeletal symptoms were fatigue, spine pain and myalgia. Lower lymphocyte and higher d-dimer levels, the presence of COVID-19 findings in tomography and back pain during acute COVID-19 infection, higher duration of hospital stay and having chronic diseases were related to post-COVID-19 musculoskeletal symptoms.

Effects of sleeve gastrectomy on neutrophil-lymphocyte ratio.

OBJECTIVES: Obesity and related diseases have become one of the most important health problems in the modern age. In addition to its clinical use in the treatment of obesity, bariatric surgery reduces obesity-induced inflammation. Neutrophil-lymphocyte ratio (NLR) is a cheap and easily attainable inflammatory marker. The purpose of this study is to show the effect of bariatric surgery on NLR at preoperative and postoperative 3rd, 6th, and 12th months after SG. METHODS: 298 patients, who underwent sleeve gastrectomy (SG) in general surgery clinic between 2015 and 2017, were included in the study. We excluded the patients younger than 18 years old, and did not have any inflammatory, infectious, hematological, and comorbide diseases such as diabetes mellitus, cardiovascular diseases, ischemic heart disease, hypertension, renal insufficiency, cancer, and respiratory problems like asthma, obstructive sleep apnea syndrome. We evaluated the levels of NLR at preoperative and postoperative 3rd, 6th, and 12th months visits. RESULTS: There were a total of 298 adult patients (age: mean 38.6, minimum 18, maximum 69 years old). Of whom 247 were female (82.9%) and 51 were male (17.1%). We found that NLR levels decreased significantly at 3rd, 6th, and 12th month visits after SG (p<0.001). CONCLUSIONS: We concluded that NLR levels decrease after surgery in a proportional reduction in adipose tissue. The decrease in NLR levels may also be associated with the protective effects of sleeve gastrectomy against low-grade inflammation-related diseases.

New Findings on Autoimmune Etiology of Idiopathic Granulomatous Mastitis: Serum IL-17, IL-22 and IL-23 Levels of Patients.

BACKGROUND: Idiopathic Granulomatous Mastitis (IGM) is a benign chronic inflammatory breast disease that mimics breast cancer, and the etiopathogenesis has not yet been fully evaluated. Autoimmunity has received the most focus as a possible etiology. Our aim in this prospective clinical study was to investigate the possible association between the cytokines, interleukin IL-17, IL-22, IL-23 and IGM. MATERIALS AND METHODS: The current study was conducted in 26 women with histopathologically diagnosed IGM, and 15 control women of reproductive age having no breast disease history. Blood samples were collected, and serum concentrations of IL-17, IL-22, and IL-23 were determined. RESULTS: In the analysis of variables, the patients with IGM and the control group had statistically significant differences between serum IL-22 titers (p = 0.0378) and IL-23 titers (p = 0.0469. No statistically significant difference was found between IGM patients and the control group in serum IL-17 titers (p = 0.9724). CONCLUSION: The results of the current study, especially pertaining to serum IL-22 and IL-23 levels, support the etiopathogenesis of IGM in favor of the autoinflammatory thesis. Nevertheless, this thesis should be supported by a large case number and prospective clinical studies.

Is it necessary to always resect elastofibroma dorsi?

BACKGROUND: Elastofibroma dorsi (ED) is a benign soft tissue tumour of the subscapular region of the chest wall. It is a frequent lesion, especially seen in females and in the elderly. It remains unclear whether the size or symptomatology of the tumour is important to make a resection decision. Our aim in this study is to reveal the results between asymptomatic or symptomatic ED cases, and to reveal which factors are important for making a resection decision. METHODS: Patients operated between January 2010 and December 2019 were included in the study, and divided into two groups as patients who were asymptomatic or with various symptoms. Patients were evaluated in terms of demographic and operational factors. RESULTS: The study included 57 patients with the average age of 56.1 ± 11.5 years. Whilst 31 (54.4%) of these patients were asymptomatic, 26 (45.6%) were symptomatic. There was a statistical significance between groups in terms of occupation (P < 0.001), comorbidity (P = 0.042) and the duration of complaints (P = 0.001). A statistically significant difference was analysed between comorbidity versus early and late complications (P = 0.011 and P = 0.002, respectively). CONCLUSION: ED probably occurs as a result of repeated trauma in the subcapular region in people who use their arms extensively. Regardless of the size of the lesion, surgery should be avoided as much as possible, especially in asymptomatic patients. However, in patients who are symptomatic, a precise surgical procedure can give satisfactory results. In these patients, who are generally elderly, early and late complications can be seen more, if they have comorbidity.

The role of platelet parameters in thrombosed hemorrhoids / O papel dos parâmetros plaquetários nas hemorróidas trombosadas

ABSTRACT Objectives: The most common disease of anus is hemorrhoids. The definition of external hemorrhoids suggests the acute phase, often characterized by thrombosis or edema. External thrombosed hemorrhoid is a specific complication. In this study, we aimed to investigate the effects of different platelet parameters in the presence of internal or external thrombosed hemorrhoids. Methods: Patients examined were divided into two groups: Group 1: Thrombosed hemorrhoids group (THG), Group 2: Hemorrhoidectomy group (HG). Demographic and clinical data were identified. In terms of laboratory findings, preoperative hemoglobin, hematocrit and all platelet parameters were recorded. Main results: Fifty-two patients in THG, and 75 patients in HG were included in the study. In female sex and young age group, the risk of developing thrombosed hemorrhoids was statistically significant (p= 0.029, p= 0.039, respectively). When the platelet parameters were evaluated; while PDW was higher in THG (p= 0.008), any significant difference could not found in all other values (p> 0.05). Thrombosed hemorrhoids were mostly (59.25%) found to be located in the left laterodorsal part of anus. Conclusion: Internal hemorrhoids are frequently seen in the ages of 45-65 with similar rates in both sexes, while external thrombosed hemorrhoids occur at a younger age (<45) and more often in women. Comparing in terms of platelet indexes, PDW value was found to be significantly higher in THG. In young people, thrombosed hemorrhoids may develop more frequently, as the connective tissue that forms the anal pads is not loose enough to form an internal hemorrhoid, as more seen in older patients.

RESUMO Objetivos: A doença anal mais comum são as hemorróidas. A definição de hemorróidas externas sugere a fase aguda, muitas vezes caracterizada por trombose ou edema. A hemorroida externa trombosada é uma complicação específica. Neste estudo, objetivamos investigar os efeitos de diferentes parâmetros plaquetários na presença de hemorróidas trombosadas internas ou externas. Métodos: Os pacientes examinados foram divididos em dois grupos: Grupo 1, Grupo de Hemorróidas Trombosadas (GHT); Grupo 2, Grupo de hemorroidectomia (GH). Os dados demográficos e clínicos foram identificados. Em termos de achados laboratoriais, a hemoglobina pré-operatória, o hematócrito e todos os parâmetros plaquetários foram registrados. Resultados principais: Cinquenta e dois pacientes em GHT e 75 pacientes em GH foram incluídos no estudo. No sexo feminino e na faixa etária jovem, o risco de desenvolver hemorróidas trombosadas foi estatisticamente significativo (p = 0,029, p = 0,039, respectivamente). Os parâmetros plaquetários avaliados mostraram que, enquanto a Amplitude de Distribuição de Plaquetas (PDW, do inglês platelet distribution width) foi maior no GHT (p = 0,008), nenhuma diferença significativa foi encontrada para todos os outros valores (p > 0,05). A maioria das hemorróidas trombosadas (59,25%) localizava-se na região lateral-dorsal esquerda do ânus. Conclusão: As hemorróidas internas são frequentemente vistas nas idades de 45 a 65 anos com taxas semelhantes em ambos os sexos, enquanto as hemorróidas externas trombosadas ocorrem em uma idade mais jovem (<45) e mais frequentemente em mulheres. Comparando em termos de índices de plaquetas, foi observado que o valor de PDW foi significativamente maior no GHT. Em pessoas jovens, as hemorróidas trombosadas podem se desenvolver com mais frequência, pois o tecido conjuntivo que forma as almofadas anais não é flácido o suficiente para formar uma hemorroida interna, como ocorre com mais frequência em pacientes mais velhos.

The role of the lactate level in determining the risk rates of small bowel resection in incarcerated hernias.

BACKGROUND: An incarcerated hernia is a part of the intestine or abdominal tissue that becomes trapped in the sac of a hernia. An increase in morbidity and mortality occurs after intestinal resections from strangulated hernias. This study aims to examine the markers that may be effective in determining the risk of small bowel resection due to incarcerated hernias. In particular, we aimed to investigate the effect s of blood lactate levels in determining this risk. METHODS: A cross-sectional retrospective study was designed. Patients, whose preoperative diagnosis were reported as incarcerated hernia and had essential information, were included in this study. They were divided into two groups according to whether they had resection or not. Age, gender, hernia type, hernia side, resection material, blood lactate level (BLL), white blood cell (WBC), neutrophil count (NE), lymphocyte count (LY), neutrophil/lymphocyte ratio (NLR), platelet count (PLT), lactate dehydrogenase (LDH), radiologic bowel obstruction sign and comorbidities were evaluated. RESULTS: Sixty-seven patients were included in this study. It was observed that 16 (23.9%) of these patients underwent small intestinal resection, 16 (23.9%) had an omentum resection, while no resection was performed on 35 (52.2%) patients. There was a statistically significant difference regarding radiologically intestinal obstruction (p=0.001), hernia type (p=0.005), BLL (p<0.001), WBC, NLR and LDH values (p<0.05). In incarcerated hernia patients with a lactate value ≥1.46 mg/dL, sensitivity was observed to be 84.0% and specificity 86.0% (p<0.001). CONCLUSION: In patients with a preliminary diagnosis of an incarcerated hernia, the risk of possible small bowel resection is the most important point in deciding for an operation. The presence of an intestinal obstruction in radiological examinations, and particularly the high levels of WBC, NLR, LDH and BLL, may indicate a necessity for possible small bowel resection. Concerning the risk associated with small bowel resection, blood lactate levels ≥1.46 mg/dL may be alerting.

Genetic variation in NOD1/CARD4 and NOD2/CARD15 immune sensors and risk of osteoporosis.

The present study was aimed to investigate the relationship between NOD1/CARD4 and NOD2/CARD15 gene polymorphisms and osteoporosis in the Turkish population. The first time we thought that the functional polymorphisms in NOD1/CARD4 and NOD2/CARD15 genes might have triggered the development of osteoporosis. The objective of our study was to determine the relationship between NOD1/CARD4 and NOD2/CARD15 SNPs and osteoporosis. The NOD1/CARD4 (rs5743336) and NOD2/CARD15 (rs2066847) SNPs were analyzed by PCR restriction fragment length polymorphism (PCR-RFLP) in 94 healthy controls and 164 subjects with osteoporosis. PCR products were digested with restriction enzymes AvaI for NOD1/CARD4 and ApaI for NOD2/CARD15. We found that NOD1/CARD4 genotype distribution of AA, GA and GG were 15, 44 and 41% for patients and 17, 46 and 37% for controls, respectively. NOD2/CARD15 mutation was found only in three patients (1.8%) as heterozygote. The results did not show any statistical difference between NOD1/CARD4 and NOD2/CARD15 genotype distribution of patients and healthy groups (χ2 = 1.740, P=0.187; χ2 = 1.311, P=0.519). However, the most frequent AG genotype (46%) of NOD1/CARD4 was observed in healthy controls, GG genotype (44%) of NOD1/CARD4 was observed as the most frequent in osteoporotic patients. NOD2/CARD15 WT/WT genotype, the most frequent genotype, was observed in both groups. Statistical analysis revealed that NOD1/CARD4 and NOD2/CARD15 polymorphisms are not associated with osteoporosis. However, a definite judgement is difficult to be made due to restricted number of patients and small size of control group. Further research is sorely warranted in this direction.

Electrochemical synthesis and corrosion protection of poly(3-aminophenylboronic acid-co-pyrrole) on mild steel.

Synthesis of poly(3-aminophenylboronic acid-co-pyrrole) (p(APBA-co-Py)) is carried out potentiodynamically on a pre-passivated mild steel (MS) surface in an oxalic acid solution containing 3-aminophenylboronic acid (APBA) and pyrrole (Py) monomers. The monomer feed ratio was determined using electrochemical impedance spectroscopy (EIS) and adhesion tests. The p(APBA-co-Py) coating is characterized by electrochemically and spectroscopically comparing with poly(3-aminophenylboronic acid) (p(APBA) and polypyrrole (p(Py) homopolymers. SERS, FTIR, XPS, scanning electron microscopy-wavelength dispersive X-ray and- energy dispersive X-ray spectroscopy results indicate the presence of both APBA and Py segments in the p(APBA-co-Py) backbone. The protective properties of the coating are investigated by Tafel and EIS measurements in a 0.50 M HCl solution. The corrosion resistance of p(APBA-co-Py)-coated MS (66.8 Ω cm2) is higher than that of p(APBA)- and p(Py)-coated, passivated, and uncoated MS. The p(APBA-co-Py) coating embodies the advantageous features of both homopolymers. Py units in p(APBA-co-Py) chains improve the protective property while APBA units carrying the -B(OH)2 group develop the adhesive property of the layer. EIS results show that the p(APBA-co-Py) coating, due to its homogeneous and compact distribution and the formation of a stable interface, enhanced corrosion resistance of MS by 87.4% for 10 hours in HCl corrosive medium.

Correlation of pelvic fractures and associated injuries: An analysis of 471 pelvic trauma patients.

BACKGROUND: In most respects, the vast majority of pelvic injuries is not of a life-threatening status, but co-presence of other injuries needs to be diagnosed. This study aims to evaluate associated pelvic and extra-pelvic visceral organ injuries of the patients with closed pelvic fractures. METHODS: This retrospective study was conducted with 471 adult patients who had been admitted to our Emergency Service with the diagnosis of pelvic fractures. Type of fractures, accompanying visceral organ injuries, the demographic data, type of operation, mortality rates were recorded and analysed statistically. RESULTS: The rate of operations carried out by the general surgery clinic or other surgical clinics in each type of fracture according to AO classification did not differ (p=0.118). In patients with A2, A3 and B1 types of fractures, the operation rate of general surgery clinic did not show a significant difference. However, most of the patients who had extrapelvic surgery were in the mild severity pelvic trauma, such as AO A2 and A3. A total of 31 patients were ex-patients, 17 of whom had AO-A2 type of fractures. The findings showed that there was a significant difference between abdominal ultrasonography outcome that was normal and non-orthopedic surgery types (p<0.001). There was no significant difference between the types of surgery performed and Abdominal CT outcome, which was normal (p=0.215). CONCLUSION: In the management of patients with pelvic fractures irrespective of its type or grade, the findings suggests that greater attention should be paid to not to overlook the associated injuries. Early blood and imaging tests are encouraged after the patient's hemodynamic status is stabilized.

The Effects of Monosodium Glutamate and Tannic Acid on Adult Rats.

BACKGROUND: Monosodium glutamate (MSG) is a widely-used flavor enhancer and stabilizer in ready-made or packaged foods. The excessive use of MSG has been shown to increase oxidative stress in different organ systems and causes glucose metabolism disorders, obesity, and coronary diseases. OBJECTIVES: In this study, the antioxidant activity of tannic acid was investigated experimentally with respect to its protective effects against overdosed MSG-induced oxidative stress in rats. The study took place in Turkey in August 2013. METHODS: Four groups (n = 7) of three- to four-month-old Sprague-Dawley female rats were used in this study. The first group was the control, who were administered saline. The second group received tannic acid (50 mg/kg, 3 days) intraperitoneally (i.p.). The third group received MSG (2 g/kg, 7 days) i.p., and the fourth group received both tannic acid (50 mg/kg, 3 days, pretreatment) and MSG (2 g/kg, 7 days) i.p. The animals were euthanized ten days later. Blood was collected for determining the hematological values and blood glucose levels. Superoxide dismutase (SOD) and malondialdehyde (MDA) levels were determined in the brain, liver, and kidney homogenates, and in the erythrocyte hemolysate. Histopathological examination of the brain, liver, and kidneys was conducted through hematoxylin-eosin staining. RESULTS: The data showed that the tannic acid treatment statistically decreased the MDA levels in the brain tissues of the group administered MSG and tannic acid (P < 0.001) when compared to the corresponding values of the control group. The SOD activities in the blood hemolysates of the MSG and tannic acid group increased when compared to the corresponding values for the MSG group (P < 0.01). Additionally, we found that pretreatment with tannic acid reduced blood glucose levels in comparison to the levels of the MSG group (P = 0.029). The results of our study show that tannic acid pretreatment in adult rats decreased blood glucose levels and oxidative stress. CONCLUSIONS: In the literature, it was observed that short-term MSG exposure does not cause significant histological changes in the kidneys, liver, or brain cortex. These findings should be re-evaluated in additional long-term studies.

The view of patients with Choronic Obstructive Pulmonary Disease (COPD) on Complementary and Alternative Medicine (CAM) in Eastern Turkey.

The purpose of this study was to examine the frequency of complementary and alternative medicine usage in Chronic Obstructive Pulmonary Disease (COPD) patients living in the eastern part of Turkey. In this study a descriptive design was used. The study was conducted with 216 patients who were present at the clinic. Data were gathered by the researchers in a comfortable setting through questionnaire method using the data collection form developed by the researcher. Individualised questionnaire-based interviews were also conducted among the 216 adult patients. The questionnaire included demographic information, clinical information, use of conventional therapies, and complementary and alternative therapy. According to the findings obtained in this research, the frequency of CAM use among Turkish COPD patients (72.1%) was close to the highest levels reported in the literature.

The role of flow cytometry in the diagnosis of non- Hodgkin's lymphoma, Hodgkin's lymphoma, granulomatous inflammation and reactive lymph node specimens.

PURPOSE: In this study we aimed to compare the flow cytometry (FC) results of patients with B cell lymphoma, T cell lymphoma, Hodgkin's lymphoma, granulomatous inflammation and reactive lymph node and investigate the role of FC in malignant or non malignant conditions. METHODS: Ninety patients were divided into 5 groups according to histopathology results. Patients were compared according to cytokeratin and positivity percentage of the following surface markers: CD45, CD19, CD5, CD19-CD5, CD4, CD8, CD3,CD16-CD56, CD10, CD10-CD19, CD23, CD20, CD4-CD8, CD3-CD16-56, CD30, CD38, kappa and lambda light chains, CD20-CD23. Patients were also compared according to the intensity of the expression (exp) of same markers. ROC curve analysis was performed for CD19+ cell percentage, CD38 exp, kappa/lambda and lambda/kappa ratios. RESULTS: 1) Kappa/lambda and lambda/kappa ratios can distinguish B cell lymphoma from T cell lymphoma, Hodgkin's lymphoma, granulomatous inflammation and reactive lymph node; 2) CD19+ cell percentage can distinguish T cell lymphoma from Hodgkin's lymphoma, granulomatous inflammation and reactive lymph node; 3) CD38 exp can partly distinguish B cell lymphoma from T cell lymphoma, Hodgkin's lymphoma, granulomatous inflammation and reactive lymph node and T cell lymphoma from granulomatous inflammation, T cell lymphoma from reactive lymph node, Hodgkin's lymphoma from reactive lymph node. CONCLUSION: Flow cytometry has a role in distinguishing lymphomas from non malignant lesions.

Differentiation of incidental intestinal activities at PET/CT examinations with a new sign: Peristaltic segment sign / Signo del segmento peristáltico: un nuevo signo del examen PET/TAC para el diagnóstico diferencial de las actividades intestinales incidentales

Purpose. The aim of this study was to present the effect of the peristaltic segment sign for the differential diagnosis between malignant, physiological and gastrointestinal focal fluorodeoxyglucose (FDG) uptakes as an alternative method to maximum standardized uptake value (SUVmax). Materials and methods. Gastrointestinal tract (GIT) sections of 823 FDG positron emission tomography/computed tomography (FDG-PET/CT) performed in our center were reviewed retrospectively. Images of these cases that have been reported for positive intestinal focal FDG uptake areas were included. Through the sectional images, any accompanying short segment expanded with air just after or before the uptake area was marked as “positive peristaltism sign”. The cases were confirmed with endoscopy plus biopsy (n:42), endoscopy (n:5), laparotomy (n:1), transabdominal biopsy (n:1), enteroclysis (n:1), CT-colonoscopy (n:5), rectal contrast enhanced CT (n:4). Distinguishing features of the sign were analyzed statistically compared to the conventional method for differentiation of malignity. Results. Localized FDG uptake was reported in 59 of 823 cases. A SUVmax greater than 2.5 with intestinal wall thickening allowed the diagnosis of malignity with sensitivity 33%, specificity 65%, positive predictive value 69% and negative predictive value 46%. The peristaltic segment sign, considered as a benign finding, increased the statistical values to 68%, 80%, 82% and 65%, respectively. Conclusion. In case of gastrointestinal increased focal FDG uptake, the new parameter of peristaltic segment sign may differentiate the physiologic uptakes from the malignant ones more accurately than the conventional SUVmax (AU)

Objetivo. El objetivo de este estudio fue presentar el efecto del signo del segmento peristáltico en el diagnóstico diferencial, maligno o fisiológico, de las captaciones focales de FDG detectadas en el tracto gastrointestinal (GIT) como un nuevo parámetro alternativo al SUVmax. Material y métodos. Se revisaron retrospectivamente las secciones del GIT de 823 estudios PET/TAC con FDG en los que se informaron la presencia de una captación focal intestinal de FDG. Se identificó como “signo peristáltico positivo” cualquier segmento intestinal que contenía aire antes o después del área de captación de FDG. Los casos se confirmaron por endoscopia con biopsia (42), endoscopia (5), laparotomía (1), biopsia transabdominal (1), enteroclisis (1), colonoscopia virtual (5) y TAC abdominal con contraste rectal (4). Los rasgos característicos del signo se analizaron estadísticamente comparados al método convencional para diferenciar malignidad. Resultados. La captación localizada de FDG se informó en 59 de los 823 casos. Un SUV mayor de 2.5 con engrosamiento de la pared intestinal permitió el diagnóstico diferencial de malignidad con sensibilidad 33%, especificidad 65%, valor predictivo positivo 69% y valor predictivo negativo 46%. El signo del segmento peristáltico, considerado como un hallazgo benigno, aumentó significativamente los valores a 68%, 80%, 82% y 65%, respectivamente. Conclusión. Cuando se detecta un aumento focal de captación de FDG en el GIT, el signo del segmento peristáltico, como un nuevo parámetro, puede diferenciar la captación fisiológica de la captación maligna de forma más exacta que el SUV (AU)

Differentiation of incidental intestinal activities at PET/CT examinations with a new sign: peristaltic segment sign.

PURPOSE: The aim of this study was to present the effect of the peristaltic segment sign for the differential diagnosis between malignant, physiological and gastrointestinal focal fluorodeoxyglucose (FDG) uptakes as an alternative method to maximum standardized uptake value (SUVmax). MATERIALS AND METHODS: Gastrointestinal tract (GIT) sections of 823 FDG positron emission tomography/computed tomography (FDG-PET/CT) performed in our center were reviewed retrospectively. Images of these cases that have been reported for positive intestinal focal FDG uptake areas were included. Through the sectional images, any accompanying short segment expanded with air just after or before the uptake area was marked as "positive peristaltism sign". The cases were confirmed with endoscopy plus biopsy (n:42), endoscopy (n:5), laparotomy (n:1), transabdominal biopsy (n:1), enteroclysis (n:1), CT-colonoscopy (n:5), rectal contrast enhanced CT (n:4). Distinguishing features of the sign were analyzed statistically compared to the conventional method for differentiation of malignity. RESULTS: Localized FDG uptake was reported in 59 of 823 cases. A SUVmax greater than 2.5 with intestinal wall thickening allowed the diagnosis of malignity with sensitivity 33%, specificity 65%, positive predictive value 69% and negative predictive value 46%. The peristaltic segment sign, considered as a benign finding, increased the statistical values to 68%, 80%, 82% and 65%, respectively. CONCLUSION: In case of gastrointestinal increased focal FDG uptake, the new parameter of peristaltic segment sign may differentiate the physiologic uptakes from the malignant ones more accurately than the conventional SUVmax.

Dynamic power Doppler ultrasonography of anterior abdominal wall hernias: confirmation of incarceration.

PURPOSE: Power Doppler ultrasonography (PD-US) is a motion-sensitive modality that can display flow characteristics regardless of the direction. This increased motion sensitivity can be used as a parameter to show the tissue motion on artificially generated fremitus images. This study aimed to confirm any signs of incarceration in abdominal wall hernias proven by herniorrhaphy by examination with dynamic PD-US (during manual compression-decompression maneuvers). METHODS: Twenty-seven patients with anterior abdominal wall hernia with a narrow neck (<1 cm in diameter) were examined firstly with gray-scale ultrasonography (GS-US), and then with dynamic PD-US. Two independent radiologists, who were blinded to the real-time images showing the orientation and motion of the hernia neck, completed the examinations. These images were evaluated for any signs of incarceration, as well as the orientation of the hernia neck. RESULTS: Orientations of the hernia neck were not described on GS-US images in 13 lesions and on dynamic PD-US images in 3 lesions. While the GS-US examination revealed incarcerated hernia in four of the patients, the dynamic PD-US examination revealed an additional seven patients with symptoms associated with incarceration. CONCLUSION: Dynamic PD-US may show the orientation of the hernia neck and any sign of incarceration more accurately and clearly than conventional GS-US. Being informed about these features preoperatively is of utmost importance. Thus, anterior abdominal wall hernias should be examined by dynamic PD-US.

The value of ultrasound elastography-guided fine-needle aspiration biopsy of thyroid nodules in reducing nondiagnostic results.

Fine-needle aspiration biopsy (FNAB) is an important tool for diagnosing thyroid nodules; however, nondiagnostic results are a problem with FNAB. We evaluated the optimal targeting area of thyroid nodules for FNAB by using ultrasound elastography (USE) to reduce nondiagnostic results. Between December 2008 and November 2010, 96 consecutive prospective subjects scheduled to undergo FNAB were included in the study. Initially, the dominant nodule was evaluated with ultrasound, after which USE was performed. FNABs were performed from both the red (hard foci) and the green (soft foci) color-coded areas using the same technique according to the USE maps. The cellularity of all the specimens was evaluated cytopathologically. Nondiagnostic results from the red and green color-coded areas were compared by Chi-square test. In the red color-coded regions on USE images, the diagnostic rate was 76.0 % and the nondiagnostic rate was 24.0 %. In the green color-coded regions on USE images, the diagnostic rate was 53.1 % and the nondiagnostic rate was 46.9 %. Seven nodules were malignant and 89 were benign. Nondiagnostic results were significantly fewer in red color-coded regions (P = 0.0001). USE can help to enhance the cellularity of biopsy of thyroid nodules to reduce the nondiagnostic results if the red color-coded (less elastic or hard) areas are preferred.

Ultrasound elastography for the differential diagnosis of nipple retraction.

PURPOSE: Nipple retraction is difficult to diagnose radiologically and extremely worrisome for patients. It occurs most commonly due to pathologies such as previous mastitis or an infiltrative malignancy. With this in mind, the goal of this study was to differentiate benign from malignant lesions of nipple retraction, using the differential characteristics of retroareolar area stiffness, observed by means of the new technological modality of ultrasound elastography (USE). MATERIALS AND METHODS: Nineteen unilateral nipple retraction cases, including five cases of mammary ductal carcinoma posteriorly infiltrated the areola, two cases of Paget disease, and 12 cases of mastitis, were investigated. Imaging findings [gray-scale ultrasound (US) and USE analyses of the breasts' nipple-areolar complex], pathological evaluation, and the results of 4 years of follow-up treatment were obtained. The recorded images were evaluated by two different radiologists, and all data were analyzed statistically. RESULTS: Statistical analysis showed that there was a strong correlation between the two radiologists' evaluations. The US images were not diagnostic for either the malignant or benign conditions. The correlation between the diagnosis using US and the final diagnosis was calculated as 0.436 (p = 0.006). However, the USE images were more informative since the correlation ratio between the USE results and the final diagnosis was found to be 0.723 (p < 0.001). While the area under the concentration curve (AUC) values that were used for the diagnostic determination of the US results were inconclusive at 0.274 (p < 0.021), the AUC values for USE were significant, with a diagnostic value of 0.866 for all cases (p < 0.01). CONCLUSION: The USE modality, which is not commonly used in routine practice, has the potential to solve the problem of differentiation of nipple retraction etiologies in the near future.

Clinical significance of reticulocyte hemoglobin content in the diagnosis of iron deficiency anemia.

OBJECTIVE: The aim of this study was to evaluate the clinical significance of reticulocyte hemoglobin content (CHr) in the diagnosis of iron deficiency anemia (IDA) and to compare it with other conventional iron parameters. MATERIALS AND METHODS: A total of 32 female patients with IDA (serum hemoglobin <120 g/L and serum ferritin <20 ng/ mL) and 18 female patients with iron deficiency (serum hemoglobin > 120 g/L and serum ferritin <20 ng/mL) were enrolled. RESULTS: CHr was 24.95±3.92 pg in female patients with IDA and 29.93±2.96 pg in female patients with iron deficiency. CHr showed a significant positive correlation with hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, serum iron, and transferrin saturation and a significant negative correlation with transferrin and total iron-binding capacity. The cut-off value of CHr for detecting IDA was 29 pg. CONCLUSION: Our data demonstrate that CHr is a useful parameter that can be confidently used in the diagnosis of IDA, and a CHr cut-off value of 29 pg predicts IDA. CONFLICT OF INTEREST: None declared.