Can Karaman

Surgical approaches to antrochoanal polyps in children

Antrochoanal polyps (ACP) represent 4-6% of all nasal polyps in the general population, but this proportion increases to 33% in the pediatric group. The aim of this study is to discuss clinical and radiological findings, and some different surgical approaches with their results in the pediatric patients. This study consists of eight children with ACP diagnosed by means of clinical examination, nasal endoscopy and computed tomography. One patient was treated only with simple polypectomy. In five patients, transcanine sinuscopy (TS) was added to functional endoscopic sinus surgery. Four of the patients underwent anterior ethmoidectomy and uncinectomy. Middle meatal antrostomy was applied to two of them. No recurrence was encountered within 5-30 months. The decision for the appropriate type of surgery for ACP is influenced by factors such as patients age, other accompanying sinus pathologies, recurrence after previous surgery, and the possibility of total excision. In patients carrying the risk of recurrence, it is especially important to remove the polyp completely and manage other sinus pathologies, as well as avoiding an unnecessarily expanded operation. In selected patients, we believe that TS may be adequate in totally removing ACP.

Assessment of some important anatomical variations and dangerous areas of the paranasal sinuses by computed tomography in children

The purpose of this study is to determine important variations and areas of risk for major complications in paranasal computed tomography (CT). We also made specific measurements for individual differences. This study consisted of 64 children (128 sides). Eleven participants had coronal and axial, and the remaining 53 only coronal CT. The distance of the anterior ethmoidal artery (AEA) and the lamina cribrosa to the inferior turbinate and the orbital roof, and the depth of the lamina cribrosa were measured. The percentages of some of the variations were as follows: upper attachment of uncinate process 25%, freely coursing AEA 43%, aerated anterior clinoids 8%, optic canal bulging 6% and extreme medially coursing carotid canal 3%. The frequencies of some of these variations and the existence of Onodi cells were significantly smaller than compared with adults. Specific measurements varied individually. In conclusion, children deserve more attention while evaluating CT, due to their tiny bony structures.

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.

Cutaneous basosquamous carcinoma infiltrating cerebral tissue.

Basosquamous carcinoma of the skin is a rare malignancy with specific histopathological features of both basal cell carcinoma and squamous cell carcinoma. Some authors believe that basosquamous carcinoma is a variant of basal cell carcinoma, while others suggest that this tumour may behave more aggressively.

Epididymoorchitis mimicking testicular torsion in Henoch-Schönlein purpura

Abstract. Henoch-Schönlein purpura, although being a systemic vasculitis, mostly involves skin, gastrointestinal system, joints, and kidneys. Testicular involvement is a rare occurrence. A 7-year-old boy with Henoch-Schönlein purpura developed acute scrotum and was referred to rule out testicular torsion. On gray-scale ultrasonography, the testes and epididymis were slightly enlarged, and had heterogeneous and hypoechoic echotexture. The scrotal wall was thickened as well. Color and power Doppler ultrasonography revealed increased vascularity in scrotal contents. Testicular torsion was excluded and the diagnosis of testicular involvement of Henoch-Schönlein purpura was established. Color Doppler US, together with gray-scale findings, can be useful in the evaluation of Henoch-Schönlein purpura with acute scrotum, excluding testicular torsion and preventing unnecessary surgery.

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.

Sonographic features of histopathologically benign solid breast lesions that have been classified as BI-RADS 4 on sonography

To describe the sonographic (US) features associated with ultrasonography BI‐RADS category 4 lesions that have a benign histopathological outcome.

Power Doppler ultrasonography for the evaluation of skin tumors other than malignant melanoma

Abstract. The purpose of this prospective study was to evaluate the value of power Doppler ultrasonography (PDUS) in assessing the vascularity of skin tumors other than malignant melanoma, and to investigate possible diagnostic criteria to help to distinguish malignant from benign tumors preoperatively. Seventy-one patients with the clinical diagnosis of a skin tumor were initially evaluated by ultrasonography. Then PDUS was performed and the presence and type of vascularity (peripheral or mixed) were investigated. Of the 19 benign and 52 malignant lesions, 3 could not be visualized with US. Forty-nine lesions were found to have vascularity (21 peripheral, 28 mixed-type) on PDUS. Of the malignant lesions, 26 showed mixed and 17 showed peripheral-type vascularity; for benign lesions these numbers were 2 and 4 respectively. The presence of vascularity correlated well with pathological behavior (malignant versus benign) (P=0.00002), width (P=0.0001), thickness (P=0.001), dermal disruption (P=0.0018), and subdermal extension (P=0.002) of the tumor; however, the type of vascularity correlated only with thickness (P=0.014). In relation to malignancy, the sensitivity of the presence of vascularity on PDUS was 88% and the specificity was 63%. These values were 93% and 40% respectively, for the mixed type of vascularity when it was accepted as a feature of malignancy. PDUS may help to distinguish malignant from benign skin tumors during preoperative evaluation.

The diagnostic value of intrarenal colour duplex Doppler ultrasonography in children with lower urinary tract infection.

AbstractBackground. The diagnostic value of Doppler US in infectious disease of the kidney is well documented. Previous studies have demonstrated high resistive indices, especially in tubulo-interstitial diseases. Objective. To evaluate the role of intrarenal colour duplex Doppler US in lower urinary tract infections (UTI). Materials and methods. This prospective study was carried out in 111 children (222 kidneys) (age range 1–180 months). Of the children, 78 were healthy while 33 presented with lower UTI. The resistive indices (RI) were measured from the spectral waveforms obtained from interlobar arteries. Results. No statistically significant difference was found between RI of right and left kidneys in both groups. The mean RI was 0.75 ± 0.07 in patients with lower UTI and 0.71 ± 0.1 in the control group (P < 0.05). In the control group there was an inverse correlation between age and RI (P < 0.05). Conclusions. High RI may be found in lower UTI.