Alparslan Ünsal

Sclerosing adenosis of the breast: radiologic appearance and efficiency of core needle biopsy.

PURPOSE To examine the mammography and ultrasonography findings of patients who have a final histopathological diagnosis of sclerosing adenosis after breast biopsy, and to evaluate the follow-up results of patients who underwent core needle biopsies. MATERIALS AND METHODS Seventy-six of the 723 patients who underwent breast biopsy in our institution were diagnosed with sclerosing adenosis on histopathological examination. Mammography and ultrasonography findings from these 76 lesions were analyzed retrospectively. Thirty-seven of these lesions were sampled by image-guided core needle biopsy; the remaining lesions were excised surgically. Mammograms and ultrasound images of the lesions were re-evaluated, and the post-biopsy medical records of these patients were evaluated. RESULTS Sclerosing adenosis was the main diagnosis in 41 patients and the complementary diagnosis in 35 patients. Among the first 41 lesions in which sclerosing adenosis was the main diagnosis, there were 18 (44%) mass lesions, 16 (39%) microcalcification clusters, two (5%) lesions with asymmetrical opacity, three (7%) lesions with architectural distortion, and two (5%) lesions with focal acoustical shadowing that was only detected by ultrasonography. No alterations suggesting malignancy were noted during the follow-up examinations of 35 patients who underwent core needle biopsy. CONCLUSION Sclerosing adenosis is a benign proliferative disease of the breast that can be confused with malignancy on clinical, radiological, and even histopathological examination. There is no typical radiological criterion for diagnosis. Core needle biopsy or excisional biopsy can be used, depending on the lesions characteristics. Core needle biopsy can be the first step in the diagnosis of sclerosing adenosis.

Relapse of brucellosis simulating testis tumor

Abstract  We report on a case of a 32‐year‐old man referred for evaluation of a painless left testicular mass suggesting a testicular tumor. Previous history was uneventful except for a 3‐year history of systemic brucellosis without epididymo‐orchitis. Radical inguinal orchidectomy was performed. Clinical and histopathological findings indicated a brucellar abscess of the left testis. Even in the absence of systemic symptoms, the possible relapse of brucellosis as an abscess formation in the testis should be considered as a rare cause of testicular mass in patients who live in endemic regions.

The role of accompanying sinonasal abnormalities in the outcome of endonasal dacryocystorhinostomy.

Background Acquired nasolacrimal duct obstruction may occur simultaneously and possibly as a consequence of sinonasal disease, because the nasolacrimal system is anatomically related to important nasal and sinus structures. Methods Thirty-seven patients with nasolacrimal canal obstruction (42 eyes) were evaluated with paranasal sinus computerized tomography (CT) to determine the presence of sinonasal abnormalities if any. All of the patients underwent endoscopic dacryocystorhinostomy (end-DCR) and accompanying sinonasal pathology was treated also in the same session. Results Paranasal sinus CT examinations revealed one or more sinonasal abnormalities in 26 (73.3%) patients. The postoperative success rate of end-DCR procedure in patients with sinonasal abnormalities was 82.8%, whereas this figure increased to 92.3% in patients without additional sinonasal disease. However, additional rhinological surgery did not affect the success rate of end-DCR procedure significantly (p = 0.640). Conclusion These data establish a positive correlation between sinonasal abnormalities and the presence of nasolacrimal outflow obstruction, but the additional rhinological surgery does not significantly affect the results of the end-DCR procedure.

The impact of pre-procedural waiting period and anxiety level on pain perception in patients undergoing transrectal ultrasound-guided prostate biopsy.

PURPOSE To investigate the effect of pre-procedural waiting period and anxiety level on pain perception during transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS Sixty patients who had undergone transrectal ultrasound-guided prostate biopsy were enrolled in this prospective study. The subjects were asked to fill out the State-Trait Anxiety Inventory Scale-1 to measure the level of state anxiety at three times: 1) at the time of the procedure request, 2) before the procedure, and 3) before getting the result. Just after biopsy, the patients were asked to fill out a visual analog scale to evaluate pain perception resulting from the biopsy. RESULTS The mean pre-procedural level of state anxiety score was well correlated with the visual analog scale score (r=0.498; P < 0.001). The mean level of state anxiety scores before biopsy (39.7±9.4) and before getting the result (39.9±8.4) were significantly higher than the mean level of state anxiety score when the procedure was requested (31.4±7.9) (P < 0.001 for both). The patient group was divided into two subgroups according to the waiting time between the request and the procedure itself; the cut-off value between the short and long groups was 10 days. The difference between the mean visual analog scale scores from transrectal ultrasound-guided prostate biopsy patients with the short (n=23, 1.49±0.95) and long (n=37, 2.35±1.12) waiting periods was statistically significant (P = 0.003). CONCLUSION In conclusion, performing the transrectal ultrasound-guided prostate biopsy procedure as soon as possible and using more effective anesthetic methods, especially for patients with high level of state anxiety scores, may have a positive impact on patient tolerance.

The diagnostic efficiency of ultrasound guided imaging algorithm in evaluation of patients with hematuria

PURPOSE To assess the efficiency of the following imaging algorithm, including intravenous urography (IVU) or computed tomography urography (CTU) based on ultrasonographic (US) selection, in the radiological management of hematuria. MATERIALS AND METHODS One hundred and forty-one patients with hematuria were prospectively evaluated. Group 1 included 106 cases with normal or nearly normal US result and then they were examined with IVU. Group 2 was composed of the remaining 35 cases which had any urinary tract abnormality, and they were directed to CTU. Radiological results were compared with clinical diagnosis. RESULTS Ultrasonography and IVU results of 97 cases were congruent in group 1. Eight simple cysts were detected with US and 1 non-obstructing ureter stone was detected with IVU in remaining 9 patients. The only discordant case in clinical comparison was found to have urinary bladder cancer on conventional cystoscopy. Ultrasonography and CTU results were congruent in 30 cases. Additional lesions were detected with CTU (3 ureter stones, 1 ureter TCC, 1 advanced RCC) in remaining 5 patients. Ultrasonography+CTU combination results were all concordant with clinical diagnosis. Except 1 case, radio-clinical agreement was achieved. CONCLUSION Cross-sectional imaging modalities are preferred in evaluation of hematuria. CTU is the method of choice; however the limitations preclude using CTU as first line or screening test. Ultrasonography is now being accepted as a first line imaging modality with the increased sensitivity in mass detection compared to IVU. The US guided imaging algorithm can be used effectively in radiological approach to hematuria.

Unilateral Idiopathic Hydrocele Has a Substantial Effect on the Ipsilateral Testicular Geometry and Resistivity Indices

Objective. The purpose of this study was to determine whether hydrocele has any effect on the volume and shape of the ipsilateral testis and can be implicated as a cause of testicular ischemia. Methods. Group 1 consisted of 23 patients with unilateral idiopathic hydrocele, whereas 30 healthy men constituted group 2. All patients underwent scrotal ultrasonography by which testicular dimensions in craniocaudal (Dcc), anteroposterior (Dap), and mediolateral axes were measured, followed by calculation of the Dcc/Dap ratio and testicular volume. By color Doppler analysis, the resistivity index of the subcapsular artery (RIsc) and the resistivity index of the intratesticular artery were determined. Results. The mean Dcc/Dap ratio ± SD for group 1 was 1.7 ± 0.3 (range, 1.1–2.3), significantly lower than that of group 2, which was 1.9 ± 0.3 (range, 1.3–2.2) (P = .028). Mean testicular volume values of subjects having hydrocele for more than and less than 6 months were 13.4 ± 7.3 and 22.5 ± 5.1 cm3, respectively; the difference between the subgroups was significant (P = .003). For the ipsilateral testis, mean RIsc values were 0.70 ± 0.06 (range, 0.60–0.80) in group 1 and 0.65 ± 0.06 (range, 0.59–0.83) in group 2. The mean RIsc was significantly higher in group 1 (P = .006). Conclusions. Unilateral idiopathic hydrocele has a tendency for rounding rather than flattening the ipsilateral testis as well as elevating the RIsc on the affected side. To the best of our knowledge, no strict spectral Doppler analysis criteria have been proposed for testicular ischemia yet. Therefore, the impact of the difference of the RIsc should raise the suspicion for ischemia, and further research is needed to elucidate any effect on spermatogenesis.

Adenomatoid Ameloblastoma in the Mandible and Maxilla: Report of a Case

Ameloblastoma is an infrequent odontogenic neoplasm located in the mandible and/or infratemporal fossa extending into the maxilla. The authors report a patient who underwent a total of five operative interventions for recurrent lesions involving mandible and infratemporal fossa at other institutions before admission to our hospital. Radiographic imaging in our case demonstrated a solid/multicystic recurrent lesion of the right infratemporal fossa extending into the maxilla. Gross total excision of the tumour was done and the postoperative course was uneventful. In any case with a tumour located in this region, it is important to be aware of this condition because this lesion is unusual but serious pathology as illustrated in this report.

Coexistence of Multiple Endocrine Neoplasia Type 2B and Chilaiditi Sign: A Case Report

We present a 15-year-old female patient with medullary thyroid carcinoma, marfanoid habitus, and mucosal ganglioneuromatosis. Our case had a RET protooncogene mutation ser836 polymorphism in exon 14 and ser904 polymorphism in exon 15. Our patient is thought to be atypical MEN2B due to the absence of M918T or A883F mutations. Chilaiditi sign is an incidental radiographic finding of a usually asymptomatic condition in which a part of intestine is located between the liver and diaphragm; however, the term “Chilaiditi syndrome” is used for symptomatic hepatodiaphragmatic interposition. The patient had no symptoms as abdominal pain, constipation, diarrhea, or emesis. Incidentally, Chilaiditi sign was diagnosed with chest radiograph and thoracoabdominal CT. Our case is the first in the literature indicating the coexistence of Chilaiditi sign and MEN2B.

Review and management of breast lesions detected with breast tomosynthesis but not visible on mammography and ultrasonography

Background Breast tomosynthesis is more sensitive than mammography and can detect lesions that are not always visible with conventional methods such as digital mammography (MG) and ultrasonography (US). No standardized approach is available for the management of lesions that are detectable with tomosynthesis but are not visible on MG or US. Purpose To review suspicious breast lesions detected with tomosynthesis but not visible on two-dimensional (2D) MG or US and to determine the management options for these lesions. Material and Methods Ethical committee approval was obtained. The radiological records, biopsy or surgery results, and follow-up findings of 107 patients who had a tomosynthesis-positive but MG- or US-negative breast lesion between 2011 and 2016 were retrospectively evaluated. Results Of 107 lesions visible only with tomosynthesis, 74% were architectural distortions and 26% were asymmetrical opacities. All patients underwent magnetic resonance imaging (MRI) for further evaluation. Among the 48 (45%) MRI-negative lesions, none had a suspicious alteration during the follow-up period. Among the MRI-positive lesions, 28% of the 50 architectural distortions and 11% of the nine asymmetrical opacities were malignant. Conclusion Given the inherent high false-positive rate of breast tomosynthesis, breast MRI prior to biopsy may reduce the number of unnecessary biopsies for suspicious breast lesions that are tomosynthesis-positive only.

Acute kidney injury after near drowning: The way from the beach to hemodialysis

Acute kidney injury (AKI) occurs in many different situations and may have a variable prognosis influenced by clinical setting, underlying cause, and comorbidity. This is important because of the high mortality and morbidity risk affecting many people around the world. Near‐drowning related AKI requiring hemodialysis is very seldom reported in literature. Although cardiovascular and respiratory disorders are more frequently seen after this entity, we aimed to emphasize this rare but dangerous complication in near‐drowning patients.