A novel risk prediction tool for contrast-induced nephropathy in patients with chronic kidney disease who underwent diagnostic coronary angiography.

OBJECTIVE: The incidence of contrast-induced nephropathy (CIN) is higher than 20% in patients with chronic kidney disease. In this study, we sought to define the predictors of CIN and develop a risk prediction tool in patients with chronic kidney disease. PATIENTS AND METHODS: Patients aged 18 years and older who underwent invasive coronary angiography with an iodine-based contrast media between March 2014 and June 2017 were retrospectively analyzed. Independent predictors for CIN development were identified and a new risk prediction tool was created that included these predictors. RESULTS: In total, 283 patients included in the study were divided into those who developed CIN (n=39, 13.8%) and those who did not (n=244, 86.2%). Male gender (OR: 4.874, 95% CI: 2.044-11.621), LVEF (OR: 0.965, 95% CI: 0.936-0.995), diabetes mellitus (OR: 1.711, 95% CI: 1.094-2.677), and e-GFR (OR: 0.880, 95% CI: 0.845-0.917), were identified as independent predictors for the development of CIN in the multivariate analysis. A new scoring system has been designed that can score a minimum of 0 and a maximum of 8 points. Patients with a new scoring system score of ≥4 were at approximately 40 times higher risk of developing CIN than others (OR: 39.9, 95% CI: 5.4-295.3). The area under the curve value of CIN's new scoring system was 0.873 (95% CI, 0.821-0.925). CONCLUSIONS: We found that four easily accessible and routinely collected variables, including sex, diabetes status, e-GFR, and LVEF, were independently associated with the development of CIN. We believe that using this risk prediction tool in routine clinical practice may guide physicians to use preventive medications and techniques in high-risk patients for CIN.

Clinical value of metabolic PET parameters of primary vulvar carcinoma. / Valor clínico de los parámetros metabólicos de la PET en el carcinoma vulvar primario.

PURPOSE: We aim to establish the prognostic value of metabolic parameters of the primary tumor in patients diagnosed with vulvar squamous cell carcinoma (VSCC) who underwent a pretreatment 18F FDG PET/CT scan. MATERIALS AND METHODS: This retrospective study included 47 patients with a histopathologically confirmed diagnosis of VSCC, and who underwent a 18F FDG PET/CT scan prior to treatment. The disease stage and age at diagnosis, the maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) values of the primary tumor, based on a baseline PET scan, were recorded. The relationship between these factors, and progression-free survival (PFS) and overall survival (OS) was evaluated. RESULTS: The mean age of the 47 study patients was 69.6±1.9 years. Among the patients, 18 were in early stage of the disease and 29 were in the advanced stage. The age, and SUVmax, SUVmean, MTV and TLG values were statistically significantly associated with OS and PFS. Furthermore, it was noted that OS and PFS were significantly longer in the early stage patients than in the advanced stage patients, in patients with a tumor size <4cm than those with a tumor size ≥4cm, and in patients with a negative lymph node metastasis than those with a positive lymph node metastasis. CONCLUSION: Our findings suggest that PET parameters are prognostic factors for VSCC. To the best of our knowledge, this study is the first to investigate the prognostic value of the PET parameters of primary tumors in patients with VSCC, and as such, we believe it contributes to literature.

Los parámetros volumétricos de la PET pueden predecir la supervivencia global en el adenocarcinoma pulmonar avanzado / Volumetric PET parameters can predict overall survival in advanced lung adenocarcinoma

OBJETIVO: El presente estudio evalúa el valor pronóstico de los parámetros metabólicos relacionados con el tumor primario en el 18F-FDG PET/TC pretratamiento en pacientes con adenocarcinoma pulmonar en fase avanzada. MATERIALES Y MÉTODOS: Este estudio retrospectivo incluyó 258 pacientes con adenocarcinoma pulmonar en fase avanzada a los que se les realizó un escáner PET/TC del pretratamiento y para quienes estaba disponible el receptor del factor de crecimiento epidérmico (EGFR)/cinasa de linfoma anaplásico (ALK). Se registraron el valor máximo de captación estándar (SUVmáx), SUVmean, el volumen tumoral metabólico (MTV) y la glucólisis total de la lesión (TLG) relacionados con el tumor primario en la PET basal y diversos factores clínicos. Se evaluó la relación entre estos factores y la supervivencia global (OS) y la supervivencia libre de progresión (PFS). RESULTADOS: El estudio incluyó a 258 pacientes con adenocarcinoma pulmonar en fases IIIB-IV (72 mujeres, 186 hombres, de edad media 60,4 +/- 10,4 años), 210 de los cuales murieron y 243 progresaron en el momento del análisis. La OS y PFS media de los pacientes fue de 16 +/- 1,9 y 5 +/- 0,5 meses respectivamente. El presente estudio no reveló una relación significativa entre la OS o PFS y el sexo, el estatus de fumador, la presencia de metástasis a distancia, la edad y el tamaño del tumor. No hubo una diferencia significativa en la OS y PFS de los pacientes que dieron resultados negativos en mutaciones EGFR/reorganizaciones ALK y los que dieron resultados positivos para ambos o para las mutaciones EGFR o las reorganizaciones ALK. La OS fue significativamente más larga en pacientes con MTV bajo (p = 0,011) y en aquellos con TLG bajo (p = 0,012) que en los que los tenían altos. No obstante, no se encontró una relación significativa entre los valores SUVmáx y SUVmean y la OS, ni entre todos los parámetros del PET y la PFS. CONCLUSIÓN: Los MTV y TLG que reflejen la carga tumoral metabólica pueden predecir la OS en pacientes con adenocarcinoma pulmonar avanzado

OBJECTIVE: The present study evaluates the prognostic value of metabolic parameters related to the primary tumor on pretreatment 18F FDG PET/CT in patients with advanced stage lung adenocarcinoma. MATERIAL AND METHODS: This retrospective study included 258 patients with advanced stage lung adenocarcinoma who underwent pretreatment PET/CT scan, and for whom epidermal growth factor receptor (EGFR)/anaplastic lymphoma kinase (ALK) status was available. The maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) related to the primary tumor at the baseline PET and various clinical factors were recorded. The relation between these factors and overall survival (OS) and progression-free survival (PFS) was evaluated. RESULTS: The study included 258 patients with stage IIIB-IV lung adenocarcinoma (72 female, 186 male, mean age 60.4+/-10.4 years), 210 of which died and 243 of which progressed at the time of analysis. The median OS and PFS of the patients were 16+/-1.9 and 5+/-0.5 months, respectively. The present study revealed no significant relation between OS or PFS and gender, smoking status, presence of distant metastasis, age and tumor size. There was no significant difference in the OS and PFS of patients testing negative for EGFR mutations/ALK rearrangements and those testing positive for both or either of the EGFR mutations and ALK rearrangements. OS was significantly longer in patients with low MTV(p = 0.011) and those with low TLG(p = 0.012) than high ones. However, no significant relation was found between SUVmax and SUVmean values and OS, and between all PET parameters and PFS. CONCLUSION: MTV and TLG reflecting the metabolic tumor burden can predict OS in patients with advanced lung adenocarcinoma

Volumetric PET parameters can predict overall survival in advanced lung adenocarcinoma. / Los parámetros volumétricos de la PET pueden predecir la supervivencia global en el adenocarcinoma pulmonar avanzado.

OBJECTIVE: The present study evaluates the prognostic value of metabolic parameters related to the primary tumor on pretreatment 18F FDG PET/CT in patients with advanced stage lung adenocarcinoma. MATERIAL AND METHODS: This retrospective study included 258 patients with advanced stage lung adenocarcinoma who underwent pretreatment PET/CT scan, and for whom epidermal growth factor receptor (EGFR)/anaplastic lymphoma kinase (ALK) status was available. The maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) related to the primary tumor at the baseline PET and various clinical factors were recorded. The relation between these factors and overall survival (OS) and progression-free survival (PFS) was evaluated. RESULTS: The study included 258 patients with stage IIIB-IV lung adenocarcinoma (72 female, 186 male, mean age 60.4±10.4 years), 210 of which died and 243 of which progressed at the time of analysis. The median OS and PFS of the patients were 16±1.9 and 5±0.5 months, respectively. The present study revealed no significant relation between OS or PFS and gender, smoking status, presence of distant metastasis, age and tumor size. There was no significant difference in the OS and PFS of patients testing negative for EGFR mutations/ALK rearrangements and those testing positive for both or either of the EGFR mutations and ALK rearrangements. OS was significantly longer in patients with low MTV(p=0.011) and those with low TLG(p=0.012) than high ones. However, no significant relation was found between SUVmax and SUVmean values and OS, and between all PET parameters and PFS. CONCLUSION: MTV and TLG reflecting the metabolic tumor burden can predict OS in patients with advanced lung adenocarcinoma.

Multivariate Analyses of Heavy Metals in Surface Soil Around an Organized Industrial Area in Eskisehir, Turkey.

A total of 50 surface industrial area soil in Eskisehir, Turkey were collected and the concentrations of As, Cr, Cd, Co, Cu, Ni, Pb, Zn, Fe and Mg, at 11.34, 95.8, 1.37, 15.28, 33.06, 143.65, 14.34, 78.79 mg/kg, 188.80% and 78.70%, respectively. The EF values for As, Cu, Pb and Zn at a number of sampling sites were found to be the highest among metals. Igeo-index results show that the study area is moderately polluted with respect to As, Cd, Ni. According to guideline values of Turkey Environmental Quality Standard for Soils, there is no problem for Pb, but the Cd values are fairly high. However, Cr, Cu, Ni and Zn values mostly exceed the limits. Cluster analyses suggested that soil the contaminator values are homogenous in those sub classes. The prevention and remediation of the heavy metal soil pollution should focus on these high-risk areas in the future.

A mucormycosis case treated with a combination of caspofungin and amphotericin B.

Mucormycosis is a rare, invasive and fatal disease that occurs mainly in diabetes mellitus patients with uncontrolled blood glucose levels or in immunocompromised patients. The mortality rate of this disease is as high as 25 to 80%, despite aggressive surgical treatment and antifungal therapy. This high mortality requires alternative treatment approaches. The accepted treatment modality of invasive mucormycosis are amphotericin B lipid formulations. Although echinocandins generally show no activity against Mucorales, it was shown that Rhizopus oryzae expressed the target enzyme for echinocandins, 1,3-beta-glucan synthase. Additionally, there are some experimental studies in a diabetic mouse model and case reports regarding the effects of caspofungin. In this report, we present a rhinocerebral mucormycosis case treated with liposomal amphotericin B and caspofungin. There was regression of the patient's clinical and radiological condition with the addition of caspofungin, but she died due to discontinuation of her treatment and reasons other than mucormycosis.

Multistatic synthetic aperture radar image formation.

In this paper, we consider a multistatic synthetic aperture radar (SAR) imaging scenario where a swarm of airborne antennas, some of which are transmitting, receiving or both, are traversing arbitrary flight trajectories and transmitting arbitrary waveforms without any form of multiplexing. The received signal at each receiving antenna may be interfered by the scattered signal due to multiple transmitters and additive thermal noise at the receiver. In this scenario, standard bistatic SAR image reconstruction algorithms result in artifacts in reconstructed images due to these interferences. In this paper, we use microlocal analysis in a statistical setting to develop a filtered-backprojection (FBP) type analytic image formation method that suppresses artifacts due to interference while preserving the location and orientation of edges of the scene in the reconstructed image. Our FBP-type algorithm exploits the second-order statistics of the target and noise to suppress the artifacts due to interference in a mean-square sense. We present numerical simulations to demonstrate the performance of our multistatic SAR image formation algorithm with the FBP-type bistatic SAR image reconstruction algorithm. While we mainly focus on radar applications, our image formation method is also applicable to other problems arising in fields such as acoustic, geophysical and medical imaging.

Criteria for initiation and evaluation of minority donor programs and application to the example of donors of Turkish descent in Germany.

Minority donor programs aim to improve access to unrelated hematopoietic SCT for specific ethnic groups through directed donor recruitment. We have developed criteria for initiation and evaluation of such programs and applied them to the situation of donors of Turkish descent in Germany, as well as a program by DKMS German Bone Marrow Center that targets this group. Criteria for program initiation include the number of accessible minority donors, potential impact on the chances of finding matching donors, and general access to unrelated transplantation for patients of the targeted group. Success criteria comprise number and availability of recruited donors, the effect of these donors on the HLA phenotype distribution of a donor file, and the number of donations resulting from the program. More than 40 000 donors of Turkish descent have been recruited within the analyzed program to date. Recruited minority donors show more favorable demographic characteristics but lower availability rates than do German donors. Although HLA haplotype distributions of Turkish and German donors differ considerably, patients with common Turkish HLA phenotypes should benefit from the German donor pool even without a specific minority program. The analysis of donations from minority donors, however, shows specific benefits for patients with rare HLA phenotypes.

Pneumosinus dilatans of the ethmoid sinus presenting with exophthalmus: a case report and review of the literature.

Pneumosinus dilatans (PSD) is a rare condition of unknown aetiology in which there is enlargement of the paranasal sinuses by air, where the affected sinus expands beyond the normal boundaries of bone without thinning of its bony walls. The case of a 28 year old male with PSD, who had gradually increasing exophthalmus and diplopia, is presented and characteristics of this condition are reviewed with literature data.

Investigation of the effect of exhaust particles on ocular blood flow in highway toll collectors using color Doppler ultrasonography.

PURPOSE: To investigate the effect of exhaust particles on orbital blood flow velocity of the ophthalmic artery, central retinal artery, and posterior ciliary artery by color Doppler ultrasonography in highway toll collectors. MATERIAL AND METHODS: Color Doppler imaging was used to measure the peak-systolic and end-diastolic flow velocities and resistivity indices of the ophthalmic artery, central retinal artery, and posterior ciliary artery in 20 toll collectors and 20 controls. RESULTS: Both the peak-systolic and the end-diastolic flow velocities were decreased in the ophthalmic artery, central retinal artery, and posterior ciliary artery, and the resistivity index was increased in the central retinal artery in toll collectors when compared with control groups. Results were considered statistically significant if P<0.05. CONCLUSION: It was determined that the effect of exhaust particles reduced ocular blood flow velocity in toll collectors as measured by color duplex Doppler ultrasonography.

X-ray imaging optimization using virtual phantoms and computerized observer modelling.

This study develops and demonstrates a realistic x-ray imaging simulator with computerized observers to maximize lesion detectability and minimize patient exposure. A software package, ViPRIS, incorporating two computational patient phantoms, has been developed for simulating x-ray radiographic images. A tomographic phantom, VIP-Man, constructed from Visible Human anatomical colour images is used to simulate the scattered portion using the ESGnrc Monte Carlo code. The primary portion of an x-ray image is simulated using the projection ray-tracing method through the Visible Human CT data set. To produce a realistic image, the software simulates quantum noise, blurring effects, lesions, detector absorption efficiency and other imaging artefacts. The primary and scattered portions of an x-ray chest image are combined to form a final image for computerized observer studies and image quality analysis. Absorbed doses in organs and tissues of the segmented VIP-Man phantom were also obtained from the Monte Carlo simulations. Approximately 25,000 simulated images and 2,500,000 data files were analysed using computerized observers. Hotelling and Laguerre-Gauss Hotelling observers are used to perform various lesion detection tasks. Several model observer tasks were used including SKE/BKE, MAFC and SKEV. The energy levels and fluence at the minimum dose required to detect a small lesion were determined with respect to lesion size, location and system parameters.

Volvulated paraoesophageal gastric herniation with perforation into bursa omentalis: report of a case.

Although paraoesophageal hernias remain 30% asymptomatic, when diagnosed they have to be operated because of their fatal complications such as ischaemia, bleeding and perforation. The mortality rate increases to twenty times in emergency cases when it is compared with elective ones. Site of gastric perforation may be directed towards bursa omentalis as well as to peritoneal cavity. A case of a volvulated paraoesophageal gastric herniation ruptured to bursa omentalis is discussed with the review of the literature.

Scar formation after stereotactic vacuum-assisted core biopsy of benign breast lesions.

AIM: To evaluate scar formation of impalpable breast lesions with benign histological outcome using stereotactic 11-gauge vacuum-assisted core biopsy (VACB). MATERIALS AND METHODS: Two hundred and ten lesions with benign histology for which follow-up mammograms were available, were assessed for scar formation at the biopsy site. All biopsies were performed using stereotactic VACB with 11-gauge needle. The incidence of post-biopsy scar formation and the number of specimens removed were determined. RESULTS: In 4.3% (9/210) of the lesions for which a biopsy was performed with 11-gauge directional vacuum-assisted technique, the follow-up mammogram revealed a scar formation. Of these, six were minimal scars, two were moderate scars and one was a marked scar. Minimal and moderate scars were diagnosed on imaging only. However, the case with marked scar formation required tissue diagnosis to rule out malignancy. CONCLUSION: Although uncommon, scar formation can be seen in the follow-up mammograms after percutaneous breast biopsies. It is important that the radiologist interpreting follow-up mammograms is aware of the features of this lesion and its relationship to the biopsy procedure.

Effects of tibolone on blood flow resistance and intima-media thickness of the carotid arteries: effect of time since menopause.

OBJECTIVE: The aim of this prospective study was to evaluate the effects of tibolone on carotid atherosclerosis in healthy postmenopausal women. METHODS: Twenty-five healthy postmenopausal women were included in the study. Patients received tibolone 2.5 mg daily for 6 months. Resistance indices of the common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA) and vertebral arteries, and intima-media thickness of the CCA were measured both at baseline and at the end of the study with ultrasonography. RESULTS: No significant differences were observed in the resistance indices of the CCA, ICA, ECA and vertebral arteries, as well as intima-media thickness of CCA at 6 months in comparison with baseline. Tibolone significantly improved the intima-media thickness of the CCA of women who were less than 18 months since menopause. CONCLUSION: Overall, these results demonstrate no significant effects of tibolone on either intima-media thickness or blood flow resistance in the carotid arteries in postmenopausal women. However, the results suggest that tibolone may have a positive effect on the vascular system if commenced within 18 months since menopause; this warrants further investigation.

Hump-shaped corpus callosum.

Developmental anomalies of the corpus callosum are agenesis, hypogenesis, or hypoplasia. In this case, a hump-shaped anomaly was present in the body of the corpus callosum. The rostrum, genu, and splenium of the corpus callosum were normal. In addition, a split was present within this hump, connecting the lateral ventricles. No additional anomalies were present. This type of anomaly has not been previously reported in the literature.

Comparison of ambulatory blood pressure values in patients with glaucoma and ocular hypertension.

PURPOSE: To compare systemic arterial blood pressure (BP) and nocturnal hypotension in patients with normal-tension glaucoma (NTG), high-tension glaucoma (HTG), and ocular hypertension. METHODS: Systemic BP was recorded by a portable automated BP monitoring device every 20 min during the day and every 30 min at night in patients with NTG (n=18), HTG (n=22), and ocular hypertension (n=19). Mean systolic, diastolic, and mean arterial BPs were calculated for 24 h, during the day and at night. The mean and maximum nocturnal dip rates were determined for each patient. The number of readings that declined below 90 mmHg for systolic BP and below 60 and 50 mm Hg for diastolic BP was recorded for each group. Statistical significance was set at P<0.05. RESULTS: Minimum, maximum, and mean values of the systolic, diastolic, and mean arterial BPs were not significantly different among groups. There was no difference among groups in the nocturnal dip percentages of systolic and diastolic BPs. The number of systolic BP readings below 90 mmHg was significantly higher in the NTG group compared with the other groups (P<0.001, chi(2) test). CONCLUSION: There may not be any difference among NTG, HTG, and ocular hypertension patients in terms of mean ambulatory BP values. On the other hand, when each individual's ambulatory reading is reviewed, readings may reveal that excessive and repetitive nocturnal drops occur more frequently in some patients with NTG. These hypotensive episodes may be related to the development of glaucomatous damage.

Prediction of visual outcome after retinal detachment surgery using the Lotmar visometer.

AIM: To evaluate whether an achromatic interferometer, the Lotmar visometer, is useful in predicting postoperative visual outcome in patients with primary rhegmatogenous retinal detachment (RD) involving the macula. METHODS: This prospective study included 40 eyes of 40 non-consecutive patients with macula-off RD. The eyes were phakic or pseudophakic, had a clear optical media, and had a measurable potential vision on preoperative visometric examination. Preoperative variables included Snellen visual acuity, duration of macular detachment, extent of RD, and visometric potential acuity. Reattachment surgery consisted of radial scleral buckling in 33 patients, circumferential scleral buckling and encircling in seven patients, and subretinal fluid drainage in 10 patients. Retinal breaks were treated with cryotherapy or laser photocoagulation. Patients were followed up for at least 6 months after uncomplicated surgery. Best corrected visual acuity measured at any time during follow up was correlated with the preoperative variables. RESULTS: Preoperative visual acuity was less than 20/200 in 37 (93%) of 40 patients. Potential visual acuity of 20/200 or better was measured using the Lotmar visometer in 37 patients (93%). Postoperative visual acuity was correlated significantly with duration of macular detachment (r=0.55; p<0.001), and extent of RD approached statistical significance (r=0.31; p=0.05). There was a higher correlation between postoperative visual acuity and the visometric measurements (r=0.61; p<0.001). CONCLUSIONS: The Lotmar visometer may be a valuable method to estimate visual outcome after uncomplicated scleral buckling surgery in patients with RD involving the macula.

Lacrimal sac dacryoliths: predictive factors and clinical characteristics.

OBJECTIVE: Lacrimal sac dacryoliths are often diagnosed during dacryocystorhinostomy (DCR), although their cause is unclear. Several factors have been suggested to predispose to dacryolith formation. The clinical presentation of nasolacrimal duct obstruction (NLDO) may differ if associated with a dacryolith. Our study evaluated specific risk factors related to dacryolith formation and how the clinical presentation of patients with dacryoliths differs from patients with primary acquired NLDO who undergo DCR. DESIGN: Retrospective, comparative, interventional case series. PARTICIPANTS/INTERVENTION: One hundred thirty-eight consecutive patients with NLDO who underwent DCR (163 total DCR cases) between 1993 and 1998. MAIN OUTCOME MEASURES: We evaluated the frequency of dacryolith formation for all DCR cases. For 115 patients with primary acquired NLDO, we statistically compared the patients with dacryoliths (n = 12) to those without (n = 103) for several variables related to clinical history and presentation. RESULTS: The overall frequency of dacryoliths was 12 of 163 (7.4%) for all DCR cases and 12 of 138 (8.7%) for all patients. All patients with dacryoliths were in the subgroup of 115 patients with primary acquired NLDO, and the frequency in that subgroup was 12 of 115 (10.4%). There was no statistical difference between the group of patients with dacryoliths and those without dacryoliths for age, duration of epiphora, history of acute dacryocystitis, or previous use of antiglaucomatous topical medications. Male gender was more likely to be associated with dacryoliths (P = 0.004), as was initial presentation with lacrimal sac distension (P < 0.001). Partial nasolacrimal obstruction on lacrimal irrigation approached statistical significance for dacryolith formation (P = 0.08), as did a history of cigarette smoking (P = 0.09). CONCLUSIONS: In patients with primary acquired NLDO who require DCR, male gender and presence of sac distension are more frequently associated with dacryoliths. Partial NLDO and history of cigarette smoking may also be relative risk factors for dacryolith formation. These observations may be helpful in the evaluation and surgical planning for patients with lacrimal obstruction.

Giant cell angiofibroma of the nasolacrimal duct.

PURPOSE: To describe clinical and histologic features of the first case, to our knowledge, of giant cell angiofibroma located in the nasolacrimal duct region in a 28-year-old woman. METHODS: Interventional case report. A left nasolacrimal duct tumor was excised en bloc by lateral rhinotomy. Histopathologic examination was performed with the use of light microscopy. Immunohistochemical staining included S-100 protein, muscle-specific actin, desmin, myoglobin, vimentin, and CD34. RESULTS: The lesion was characterized by haphazardly arranged oval to spindled cells, a myxoid and collagenous stroma, multinucleated giant cells, prominent blood vessels, and pseudovascular spaces. Tumor cells were strongly positive for vimentin and CD34 and were negative for other antigens. After excision, there has been no recurrence over 4 years of follow-up. CONCLUSIONS: Originally described as an orbital tumor, giant cell angiofibroma also may occur in the nasolacrimal duct and lacrimal sac region. This mesenchymal neoplasm should be included in the differential diagnosis of lacrimal drainage system tumors.