Alptekin Tosun

Role of preoperative sonography in predicting conversion from laparoscopic cholecystectomy to open surgery

BACKGROUND Laparoscopic cholecystectomy is the first step treatment in cholelithiasis. The purpose of this study was to establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery. METHODS This study included 176 patients who had undergone laparoscopic cholecystectomy. Preoperative ultrasonographic findings were assessed and we gave points to each finding according to results from correlation analysis. After the scoring we investigated the relationship between ultrasonographic findings and conversion from laparoscopic cholecystectomy to open surgery. RESULTS Scoring significantly predicted failure in laparoscopic approach (AUC=0.758, P=0.003,). Optimal cut off score was found to be 1.95 with 67% sensitivity and 78% specificity. Score>1.95 was a risk factor for failure in laparoscopic approach [odds ratio=7.1(95% CI,2-24.9, P=0.002)]. There were 8 subjects out of 36(22%) with high score underwent open surgery while 4 out of 128 (3%) subjects with low score needed open surgery (p=0.002). Negative predictive value of 128/132=97%. Mean score of whole study population was 1.28 (range 0-8.8) and mean score of subjects underwent open surgery was 3.6 while it was 1.1 in successful laparoscopic approach group (p<0.001). Mean Age and BMI were similar between groups (p>0.05). Sex of subjects did not affect the success of surgery (p>0.05). CONCLUSION The contribution of preoperative ultrasonography is emphasized in many studies. Our study suggests quantitative results on conversion from laparoscopic cholecystectomy to open surgery. We believe that radiologists have to indicate the risk of conversion in their ultrasonography reports.

Is B-Flow USG superior to Color Doppler USG for evaluating blood flow patterns in ovarian torsion?

OBJECTIVE Ovarian torsion is an uncommon gynecological emergency that most often affects women of reproductive age. Its signs and symptoms are similar to those of other abdominal conditions, which make its differential diagnosis challenging. Color Doppler (Doppler USG) and B-flow ultrasonography (B-flow USG) are used for the differential diagnosis of ovarian torsion, and in this study, we aimed to evaluate these two techniques, validate B-flow USG as the gold standard non invasive diagnostic tool in the early phase of an ovarian torsion, and show that the B-flow USG is superior to the color Doppler USG. MATERIALS AND METHODS Sixteen rabbits of the same age and weight were separated into 2 subgroups of 8. In Group I (sham group), right ovaries were fixated, and in Group II (torsion group), right ovaries underwent 720° torsion in a counterclockwise direction. At 1h and 2h of ischemia, both ovaries were measured by the two techniques, and an additional measurement was taken at 24h to determine any changes in the left ovary due to the right ovary ischemia. Volume flow, peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) measurements were taken both with color Doppler USG (using a 12MHz linear probe, General Electric Medical Systems Logic 7, Milwaukee, USA) and with B-flow USG. RESULTS The right Doppler RI and PI values at 1h were significantly higher than the right B-flow values (p<0.05). The difference between the left B-flow RI and PI values and the left Doppler values at 1h was not significant (p>0.05), nor was the difference between the right B-flow RI value at 2h and the right Doppler RI value at 2h (p>0.05). The right B-flow PI value at 2h was statistically different from the right Doppler PI value at 2h (p<0.05), although the differences between the left B-flow RI and PI values at 1h and 2h and the left Doppler RI and PI values were not (p>0.05). However, there was a significant difference between the RI values at 24h (p<0.05). CONCLUSIONS In this study, the decrease in blood reperfusion at 1h measured by B-flow USG was apparently higher than that measured by Doppler USG. However, by the end of 2h, the measurements were equal (see Fig. 3 and 4). In conclusion, B-flow USG reveals the decrease in the blood flow more distinctly in the early phase. Moreover, B-flow Doppler USG is more reliable and advantageous than color Doppler USG because it provides a more accurate preoperative evaluation of the unilateral and contralateral preoperative adnexial structures, and allows for a better assessment of blood flow in the ovarian torsion.

Myometrial elasticity determined by elastosonography to predict preterm labor

Abstract Aim: To determine the utility of elastosonography (ES) combined to cervical length measurement to predict preterm labor. Methods: One hundred twenty-seven women with pregnancies between 21 to 36 weeks of gestation without any risk factor for preterm labor were included in the study. All subjects underwent sonographic evaluation including fetal biometry, cervical length measurement and ES of uterine myometrium. Subcutaneous tissue was the reference point for ES evaluation. Tissue strain ratio values were obtained from all patients. Results: Cervical length was a significant predictor for preterm delivery (AUC = 0.958, p < 0.001). Optimal cut-off value was obtained at 30 mm with 92% sensitivity and 81% specificity. Elastosonographic strain ratio was also a significant predictor for preterm delivery (AUC = 0.827, p < 0.001). Optimal cut-off value was obtained at 4.7 with 79% sensitivity and 91% specificity. In linear regression analysis, strain ratio (R2 = 0.61, beta = 0.171, p = 0.03) and cervical length (R2 = 0.61, beta = −0.516, p < 0.001) were significantly associated with preterm delivery. Cervical length < 30 mm [39.1 (95 CI, 6.6–231.5, p < 0.001)] and strain ratio > 4.7 [24.5 (95 CI, 4.1–146.5, p < 0.001)] were the risk factors for preterm delivery. Conclusion: Elastosonographic evaluation of uterine myometrium was found to be significantly correlated with cervical length but cervical length measurement is a better predictor for preterm labor than ES.

Ultrasonographic endometrial thickness measurement is predictive for treatment response in simple endometrial hyperplasia without atypia

OBJECTIVE We sought to determine the predictors of treatment response in simple endometrial hyperplasia without atypia. MATERIAL AND METHODS We prospectively treated 67 women with simple endometrial hyperplasia without atypia who were administered cyclic oral medroxyprogesterone acetate 10 mg/day for 12 days of luteal phase for 3 months and underwent control endometrial sampling after treatment. All subjects were evaluated in terms of age, gravidity, parity, body mass index (BMI), menstrual cycle, endometrial thickness, uterine fibroids, ovarian cysts, serum CA 125 levels, systemic disorders and cigarette smoking. All parameters were used to predict treatment success. RESULTS Persistent hyperplasia was observed in 11 subjects. Endometrial thickness was significantly correlated with treatment failure (r=0.293, p=0.015). In ROC analysis, endometrial thickness was found to be predictive for persistent hyperplasia (area under curve: 0.724, P=0.019). Optimal cut off value was calculated to be 16.5 mm with 64% sensitivity, 72% specificity and 91% negative predictive value. The number of persistent hyperplasia in women with and without endometrial thickness greater than 16.5 mm was significantly different (7/23 vs. 4/45, p=0.029). Odds ratio of endometrial thickness higher than 16.5 mm for treatment failure was 4.4 (95% CI, 1.2-17.4, p=0.03). CONCLUSION Results of this study suggest treatment modification according to the baseline endometrial thickness in patients with simple endometrial hyperplasia without atypia.

Unfavorable lipid profile and higher frequency of hot flashes during perimenopausal years after fallopian tube ligation.

Abstract Aim: We sought to study the effect of tubal ligation on lipid profile, ovarian reserve and hot flashes during perimenopausal years. Methods: A total of 210 perimenopausal women complaining of abnormal vaginal bleeding were enrolled for the study. Subjects’ menstrual, reproductive and medical histories were recorded. Serum FSH, LH and estradiol levels were screened in all women to determine menopausal status. In order to rule out any gynecologic pathology, all subjects underwent transvaginal sonography. Women were divided into two groups according to presence (study group, n = 68) or absence (control group, n = 142) of tubal ligation history. Lipid profiles and ovarian reserve tests were compared between groups. Results: Mean age, parity, serum hemoglobin (Hb), high density lipoprotein (HDL-C), triglyceride, estradiol levels, endometrial thickness and frequency of hot flashes were significantly different between groups (p < 0.05). Mean age was 42.8 ± 1.9 years in women with tubal ligation and 45.9 ± 3.5 years in control group. Mean serum estradiol level was lower in group with tubal ligation (41.4 versus 92.5 pg/ml). Mean endometrial thickness was higher in control group (10.2 versus 7.5 mm). Age-adjusted serum Hb, HDL-C, triglyceride, estradiol, FSH level, endometrial thickness and frequency of hot flashes remained significantly different between groups (p < 0.05). Conclusion: Tubal ligation is associated with unfavorable lipid profile and higher frequency of hot flashes during perimenopausal years.

Giant Peroneal Ganglion Cyst: Imaging and Clinical Findings

A ganglion cyst is the cystic lesion originates from the joint capsule or tendon sheath. This lesion is the most common soft tissue tumors of hand, wrist, and foot, and frequently observed in women between 30-50 years. A peroneal ganglion cyst is an uncommon lesion and rarely composes peroneal neuropathic symptoms. We report a 37-year-old man with swelling at the lateral portion of knee below, foot pain, loss of sensation at the lateral portion of left inferior cruris. Ultrasound (US) and magnetic resonance imaging (MRI) findings demonstrated a large cystic lesion in the peroneal muscle, and preliminary diagnosis of peroneal ganglion cyst was proved by cytology. The patient was asymptomatic one month after surgery. There was no evidence of residue or recurrence on US imaging after 6 months.

Computer-assisted Joint Space Area Measurement: A New Technique in Patients With Knee Osteoarthritis

Objectives This study aims to assess the validity and reproducibility of computer-assisted joint space area measurement in knee roentgenograms of patients with knee osteoarthritis and compare it with a qualitative method in knee roentgenograms and quantitative and semi-quantitative methods in magnetic resonance imaging. Patients and methods The study included 40 knees of 40 patients diagnosed as osteoarthritis (14 males, 26 females; mean age 57.4±5.9 years; range 47 to 67 years). Only the patients who wrote consents for publication of their radiologic data, and with knee roentgenograms and magnetic resonance images of the same knees were selected. Computer-assisted measurements were applied to joint spaces by two blinded physicians, for two times with an interval of one week. Data were evaluated for intraobserver and interobserver consistency. Also, data were compared with qualitative (Kellgren-Lawrence classification), quantitative (joint space width, cartilage thickness, meniscal thickness in magnetic resonance images) and semi-quantitative methods (whole-organ magnetic resonance imaging score). Results Intraobserver consistency was evaluated for each physician, which revealed no differences. Interobserver consistency was evaluated by comparing the measurements of two blinded physicians and no differences were found (p>0.05). There was no significant correlation between the grade of Kellgren-Lawrence classification and other variables; such as grade of meniscus, meniscal thickness, cartilage thickness and computer- assisted joint space area measurements (p>0.05). While there was a positive correlation between computer-assisted joint space area measurement and other quantitative measurements, there was a negative correlation between computer-assisted joint space area measurement and whole-organ magnetic resonance imaging scores. Conclusion When compared with qualitative, quantitative, and semi-quantitative methods, computer-assisted joint space area measurement seems to be a useful, reproducible, and cost-effective quantitative method for evaluating knee osteoarthritis.

Magnetic resonance imaging findings in spinal hemangioblastoma case

A 70-year-old man presented to the neurosurgery clinic with low back pain. Four years previously, the patient had undergone surgery for cerebellar hemangioblastoma. T2-weighted magnetic resonance images of the thoracolumbar spinal region showed expansion with heterogeneous hyperintense signal changes. Irregularly dilated cystic cavities were also seen at this level (Fig. 1, Middle, Right). The lesion site was hypointense on a T1weighted image (Fig. 1, Left). T1-weighted contrastenhanced images showed marked enhancement in eccentrically located mural nodular lesions in the cranial portion of the cystic cavity (Fig. 2, Left, Right). Based on the imaging characteristics, the lesion was reported to be a spinal

Spontaneous rupture of multifocal hepatocellular carcinoma: case report

Hemoperitoneum due to nontraumatic liver rupture is rare. The most common cause of nontraumatic rupture of the liver is hepatocellular carcinoma (HCC). The other causes of nontraumatic liver ruptures are peliosis hepatis, polyarteritis nodosa, systemic lupus erythematosus, preeclampsia, metastatic carcinoma, and other primary liver tumors. In this report, we present the computed tomography findings of spontaneous liver rupture in a 52-year-old male patient due to multifocal HCC, with the diagnosis proven by surgical specimen.