Emel Alimoglu

Subintimal Recanalization of Long Superficial Femoral Artery Occlusions Through the Retrograde Popliteal Approach

AbstractPurpose: To investigate the value of the retrograde popliteal artery approach for the percutaneous intentional extraluminal recanalization (PIER) of long superficial femoral artery (SFA) occlusions. Methods: During a period of 17 months, PIER through ultrasound-guided retrograde popliteal artery puncture was performed for 39 long SFA occlusions in 37 patients. In six patients, six additional iliac artery stenoses were also treated via the popliteal approach. Results: The procedure was technically successful in 32 (82%) of 39 SFA occlusions; in 29, lesions were treated with balloon angioplasty alone, and in three, stents were also used. Cumulative patency rate was 66% at 6 months, 62% at 1 year, and 59% at 18 months. Additional iliac artery stenoses were successfully treated in the same session. Complications included two minor hematomas and two SFA ruptures, which required no treatment. Conclusion: PIER through retrograde popliteal puncture is a safe and effective method in the treatment of long femoropopliteal occlusions, with a high technical success, low complication rate and a reasonable short-term patency rate. The technique offers an alternative in cases where standard PIER is unsuccessful or contraindicated.

Hepatobiliary Fascioliasis: Sonographic and CT Findings in 87 Patients During the Initial Phase and Long-Term Follow-Up

OBJECTIVE The purpose of our study was to describe the initial and long-term imaging findings in hepatobiliary fascioliasis. CONCLUSION Most patients with fascioliasis have typical hepatobiliary imaging findings. It is important to know that residual fibrotic or necrotic foci may remain for years after cure. Long-term complications are rare in fascioliasis, and malignancy or cirrhosis related to the disease has not been observed.

Advantages of US in Percutaneous Dilatational Tracheostomy: Randomized Controlled Trial and Review of the Literature

PURPOSE To compare procedure times and complication rates of preincisional ultrasonographic (US) evaluation and perioperative US guidance in percutaneous dilatational tracheostomy ( PDT percutaneous dilatational tracheostomy ) with those of the current standard of care, PDT percutaneous dilatational tracheostomy performed without image guidance. MATERIALS AND METHODS Between December 2007 and January 2011, 341 patients were included in this institutional review board-approved study after informed consent was obtained from the patients or their relatives. The patients were divided randomly into two groups. In group A (n = 166), the possible causes of complications, such as aberrations of tracheal, thyroidal, and vascular structures, were determined with US, and tracheal measurements were performed by using US. The clinicians initial considerations at physical examination were compared with the US findings. PDT percutaneous dilatational tracheostomy was subsequently performed with US guidance in suitable cases. In group B (n = 175), PDT percutaneous dilatational tracheostomy was performed solely on the basis of physical landmarks. The procedure times and complication rates were compared across groups by using the Fisher exact test. RESULTS In group A, the puncture sites designated at the physical examination were reconsidered in 39 (23.8%) of 164 cases. The perioperative complication rates were slightly lower in group A (7.8% [12 of 154]) than in group B (15.0% [25 of 167]); however, the difference did not achieve statistical significance (P = .054). The mean procedure times for groups A and B were 24.09 minutes ± 8.05 (standard deviation) (range, 14-68 minutes) and 18.62 minutes ± 6.34 (range, 12-81 minutes), respectively (P = .001), and the numbers of patients in each group who required multiple puncture attempts were six (3.9%) of 154 and 23 (13.6%) of 169 (P = .003), respectively. CONCLUSION The use of US guidance before and during PDT percutaneous dilatational tracheostomy could render the procedure easier and safer, with fewer complications but a slightly longer procedure time.

Bi-RADS category 3 nonpalpable breast masses on sonography: long-term results of a prospective cohort study

To determine the frequency of BI‐RADS category 3 nonpalpable masses detected using only sonography (US) and the malignancy rate among these lesions. Second, to validate a proposed short‐term follow‐up regimen based on long‐term observational results.

An Effective Way to Solve Equivocal Mammography Findings: The Rolled Views.

Background: The aim of this study was to investigate the efficacy of the rolled views taken in craniocaudal (CC) and mediolateral oblique (MLO) projections in solving equivocal mammography findings. Patients and Methods: The rolled views were taken by changing the positioning of the breast but not the obliquity of the X-ray beams. The breast was rolled medially or laterally in the rolled CC view, and inferiorly or superiorly in the rolled MLO view to separate overlapping structures from each other. Results: We evaluated equivocal findings in 87 asymptomatic women undergoing either CC (n = 48, 55%) or MLO (n = 39, 45%) rolled views between 2001 and 2008. The rolled views were helpful in solving equivocal mammographic findings and making proper decisions on management in 85 of the 87 (97.7%) women. This technique was used for breast asymmetries in 55 of the 87 (63.2%) women, and was sufficient to directly show summation artifacts in 59 of 79 (74.6%) women. The rolled views revealed 4 intramammary lymph nodes, 2 circumscribed masses out of 6 obscured masses, 7 summation artifacts, and 2 circumscribed masses out of 9 questionable masses. Conclusions: The rolled view is an effective method of differentiating summation artifacts from real lesions on mammography in both the CC and the MLO view.

Correlation of right atrial pressure and blood flow velocities in the common femoral vein obtained by duplex Doppler sonography

The purpose of this study was to correlate the right atrial pressure with the blood flow velocity and pulsatility index (PI) values obtained with duplex Doppler sonography of the common femoral vein.

Mature cystic renal teratoma.

Teratomas are rare germline tumors that originate from one or more embryonic germ cell layers. Teratoma of the kidney is extremely rare, and less than 30 cases of primary intrarenal teratomas have been published to date. We report the main radiologic features of an unusual case of mature cystic teratoma arising from the left kidney in a two-year-old boy. A left-sided abdominal mass was detected on physical examination and B-Mod Ultrasound (US) examination revealed a heterogeneous mass with central cystic component. Computed tomography (CT) demonstrated a lobulated, heterogeneous, hypodense mass extending craniocaudally from the splenic hilum to the level of the left iliac fossa. Nephrectomy was performed and a large, fatty mass arising from the left kidney was excised. The final pathologic diagnosis was confirmed as cystic renal teratoma.

Breast involvement in visceral leishmaniasis.

Visceral leishmaniasis usually involves the bone marrow, lymph nodes, liver and spleen. Involvement of the eye or respiratory or gastrointestinal systems is very rare and usually occurs in immunodepressed patients. Only one case of breast involvement by protozoa has been reported in the literature. We report a case of a visceral leishmaniasis with a solid breast mass caused by leishmania and diagnosed by sonography‐guided core biopsy.