Ali Ipek

Real-time sonoelastography of the Achilles tendon: pattern description in healthy subjects and patients with surgically repaired complete ruptures

ObjectiveThe purpose of this study is to describe the elastographic appearance of the Achilles tendon in healthy subjects and patients with surgically repaired complete ruptures.Materials and methodsNineteen Achilles tendons of 16 amateur footballers with surgically repaired complete ruptures and their contralateral asymptomatic Achilles tendons were assessed with ultrasound and real-time sonoelastography. Additionally, 40 asymptomatic Achilles tendons of 20 healthy amateur footballers were assessed. The Achilles tendons were divided into the distal, middle, and proximal thirds for elastographic image evaluation. Tendons were classified into three main types according to the elasticity features: type 1, blue (hardest tissue); type 2, blue/green (hard tissue); or type 3, green (intermediate tissue). In addition, three subtypes were determined: homogeneous, relatively homogeneous, and heterogeneous.ResultsMost of the Achilles tendons of the patients with surgically repaired complete ruptures were detected to have type 2 elasticity (64.9%), and the remaining had type 1 (35.1%). In contrast, most of the healthy tendons had type 2 (64.2%), and the remaining had either a type 3 (20.8%) or a type 1 (15%) elastographic pattern. All of the ruptured tendons had a heterogeneous structure, whereas all of the healthy Achilles tendons had a homogeneous or relatively homogeneous structure.ConclusionIn sonoelastography, the recognition of normal tendon structure will be useful in assessing pathologies of the Achilles tendon. Additionally, in patients with excellent American Orthopedic Foot and Ankle Society (AOFAS) scores and surgically repaired complete ruptures, a hard and heterogeneous pattern of tendon structure may be a natural consequence of tendon healing.

Platelet activity indices in patients with deep vein thrombosis.

Background: Extensive research has been performed regarding the association between platelet activity indices and various cardiovascular disorders. Less clear data, however, are present between these indices and deep vein thrombosis (DVT). Aim: The aim of this study was to investigate the association between platelet activity indices and DVT in a relatively large population. Methods: Mean platelet volume (MPV), mean platelet mass (MPM), and mean platelet component (MPC) were measured by an autoanalyzer in a total of 203 patients with DVT and the results were compared with 210 age- and sex-matched controls without DVT. Results: There were significant differences between the study and control groups in MPV (8.6 ± 1.3 fL vs 7.9 ± 0.5 fL [95% CI −0.82 to −0.44], P < .001, respectively), MPM (2.2 ± 0.3 pg vs 2.0 ± 0.1 pg [95% CI −0.20 to −0.11], P < .001, respectively), and MPC (24.9 ± 3.2 g/dL vs 26.3 ± 1.6 g/dL [95% CI 0.91 to 1.89], P < .001, respectively). These 3 platelet activity indices were also found to be significant predictors of the presence of DVT (all Ps < .001). Conclusion: In patients with DVT, the presence of DVT was closely associated with increased platelet activation. The MPV, MPM, and MPC may identify patients requiring aggressive antiplatelet treatment.

Irregular Yolk Sac Shape Is It Really Associated With an Increased Risk of Spontaneous Abortion

The yolk sac is the first conceptional structure that becomes sonographically visible within the gestational sac. Because the yolk sac is the primary route of exchange between the embryo and the mother, it is essential in early embryonic life. This study aimed to determine whether an irregular yolk sac shape is associated with an increased risk of spontaneous abortion.

Comparison of 21 and 27 gauge needles for determining sample adequacy in the aspiration biopsy of thyroid nodules.

PURPOSE To compare 21 and 27 gauge (G) needles used for fine-needle aspiration (FNA) of thyroid nodules to obtain better specimens for adequacy and cytological diagnosis. MATERIALS AND METHODS One hundred patients with thyroid nodules (100 nodules) were included in this study. Each nodule was aspirated with both 27 G and 21 G needles. The obtained aspirates were classified as adequate and inadequate by two separate cytopathologists. The results were analyzed by appropriate statistical methods. RESULTS There was no statistically significant difference between 21 G and 27 G needles in terms of adequacy, according to each pathologist (P > 0.05). After pathological evaluation with consensus, the adequacy prevalence was the same (84%) for both needle types in all study populations (P > 0.05). According to the ultrasound characteristics of nodules, the prevalence of inadequate samples in patients with hypoechoic or heterogeneous nodules was significantly higher compared with the prevalence of inadequate samples in patients with isoechoic or hyperechoic nodules for both types of needles (P < 0.05). However, according to the size of the needles, there was no significant difference between hypoechoic and heterogeneous nodules or between isoechoic and hyperechoic nodules with regard to the ability to yield adequate samples (P > 0.05). CONCLUSION The results of our study showed that FNA with 27 G needles can aspirate adequate material for cytopathological diagnosis. The probability of inadequate sample aspiration of hypoechoic and heterogeneous nodules is higher than that for other nodule types.

The utility of diffusion-weighted magnetic resonance imaging in differentiation of endometriomas from hemorrhagic ovarian cysts

The aim was to determine the utility of diffusion-weighted magnetic resonance imaging (DW MRI) and apparent diffusion coefficient (ADC) measurements in differentiation of endometrioma and hemorrhagic ovarian cyst. A total of 24 female patients who underwent pelvic MRI with an initial diagnosis of ovarian cyst were included in the study. The final diagnosis was endometrioma in 12 patients and hemorrhagic ovarian cyst in 12 patients. We observed significantly lower ADC values in endometriomas compared with hemorrhagic ovarian cysts in all b values. DW MRI with quantitative ADC measurements can be used for differentiation of endometrioma from hemorrhagic ovarian cysts.

Sonographic and sonoelastographic findings of a rarely seen soft tissue tumor: eccrine spiradenoma

Eccrine spiradenoma is a rare benign tumor originating from sweat glands. Its sonographic characteristics have been described in only a few reports, and there is no such report available that describes sonoelastographic findings of this tumor. In this case report, we aimed to define the sonographic and sonoelastographic findings of a benign eccrine spiradenoma.

The chorionic bump: Radiologic and pathologic correlation

Chorionic bump is a rare abnormal condition of the gestational sac seen in the first trimester of pregnancies, extending from the choriodecidual surface to the gestational sac. We report the sonographic and histopathologic findings in a case involving three “chorionic bumps” extending from the choriodecidual surface to the gestational sac. Chorionic bump can be associated with a poor prognosis for the pregnancy. Therefore, cases with chorionic bumps must be followed with serial ultrasound examinations throughout the first trimester.

Elastographic Findings of Achilles Tendons in Asymptomatic Professional Male Volleyball Players

Elastography is a new sonographic technique that evaluates the elasticity of different tissues such as the Achilles tendon. In this study, we aimed to investigate the elastographic findings of Achilles tendons in professional athletes in comparison with healthy volunteers.

B-mode and elastosonographic evaluation to determine the reference elastosonography values for cervical lymph nodes.

Background. It is crucial to differentiate between reactive and malignant lymphadenopathies. Elastosonography measures the elasticity of the tissue. Having a reference value for benign lymph nodes (LNs) is important in interpretation. The purpose of this study is to determine the reference elastosonography values of cervical LNs. Methods. 97 LNs were evaluated by B-mode and elastosonography. Depth, length, width, length to width ratio, hilar-cortical thickness, strain ratio, and elasticity scores were measured. Results. In 18.6% of the cervical LNs cortical thickness was less than the hilar thickness (group A) and in 81.4% it was equal or more (group B). 69.1% of LNs showed strain ratio (SR) less than 3 (group 1) and 30.9% equal to or more than 3 (group 2). 33% of LNs displayed elasticity score (ES) 1; 30.9% ES 2; 22.7% ES 3, and 13.4% ES 4. There was a significant correlation between thickness ratios and elasticity scores (P: 0.011). A significant correlation was also demonstrated between SR groups and elasticity scores. Conclusion. A simple, reproducible, noninvasive imaging technique for diagnosis of malignant LNs is necessary. Elastosonography can aid in the differentiation of benign versus malignant cervical LNs, thus help reduce the number of unnecessary biopsies for benign processes.

Real-time sonoelastography and ultrasound evaluation of the Achilles tendon in patients with diabetes with or without foot ulcers: a cross sectional study

BACKGROUND Diabetes mellitus (DM) is an endocrine disease characterized by metabolic abnormalities and long-term complications. The Achilles tendon (AT) plays an important role in foot biomechanics. We aimed to investigate the effect of DM on the Achilles tendon, which may contribute to long-term complications in the foot-ankle complex. METHODS Seventy-eight patients with diabetes, with (35 patients, group I) or without (43 patients, group II) foot ulcers were recruited from the endocrinology clinic. Thirty-three age-, gender-, and BMI-matched healthy individuals were selected as controls. All participants underwent ultrasonography and sonoelastography of their AT in order to evaluate Achilles tendon thickness (ATT) and stiffness (ATS). Each patient was also tested for fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1C) as a measure of diabetes control. Other chronic complications were also evaluated in all patients with diabetes. RESULTS The AT was significantly thicker in group I compared to group II and the controls. HbA1C, FPG, and duration of diabetes were higher in group I. We observed that ATT was positively correlated with neuropathy, retinopathy, nephropathy, peripheral arterial disease and coronary arterial disease in group II while this correlation was not detected in group I. ATS was reduced in group I more than group II and control groups. CONCLUSION Changes in the structure of the AT may precede foot ankle disorders in patients with diabetes. This is the first study that reported the results of sonoelastosonography of AT in patients with diabetes and revealed the correlation between ATT and other chronic complications of diabetes.