Fuat Ozkan

The effects of sonographic and demographic features and needle size on obtaining adequate cytological material in sonography-guided fine-needle aspiration biopsy of thyroid nodules

The aim of this study is to investigate the effects of the sonographic characteristics of the nodule, demographic features of patient, and nodule size and needle size used for sampling, on obtaining adequate cytological material (CM) in thyroid fine-needle aspiration biopsy (FNAB). We performed 270 FNAB between September 2010 and June 2012. Size, echogenicity, and localization of all nodules were evaluated by ultrasonography (US) before the biopsy. Nodules were grouped as <1, 1–3, and >3xa0cm according to their size and as hypoechoic, isoechoic, hyperechoic, or heterogeneous according to their US characteristics. 20-, 22-, and 24-G needles were used for the biopsies. Different sonographic characteristics of the nodules did not affect the needle selection. All specimens were classified as adequate or inadequate CM by a cytopathologist. A total of 270 nodules were biopsied, 184 (68.1xa0%) specimens were considered as adequate CM and 86 (31.9xa0%) specimens were considered as inadequate CM. Patient age and the presence of heterogeneous echogenicity were found to have prognostic significance in univariate analysis (pxa0<xa00.05). In a multivariate logistic regression model with forward stepwise method, advanced age (pxa0=xa00.001, ORxa0=xa01.042, 95CI 1.018–1.068) and heterogeneous echogenicity (pxa0=xa00.017, ORxa0=xa01.955, 95CI 1.129–3.385) remained associated with an increased risk of inadequate CM obtainment after adjustment for other potential confounders (nodule size >3xa0cm and needle size 20-G usage) and variables found to be statistically significant in univariate analysis. Non-diagnostic FNAB remains a significant problem in the evaluation of thyroid nodules and can be as high as 30xa0%. Inadequate CM rates for elderly patients and heterogeneous nodules were significantly higher than that for other factors. The nodule size and needle size used for sampling did not affect the adequacy of FNAB.

Renal Transplant Complications: Diagnostic and Therapeutic Role of Radiology

Kidney was the first and is the most frequently transplanted organ. Despite improved surgical techniques and transplantation technology, complications do occur and, if left untreated, may lead to catastrophic consequences. Renal transplantation complications may be vascular (eg, renal artery and vein stenosis and thrombosis, arteriovenous fistula, and pseudoaneurysms); urologic (eg, urinary obstruction and leak, and peritransplantation fluid collections, including hematoma, seroma, lymphocele, and abscess formation); and nephrogenic, including acute tubular necrosis, graft rejection, chronic allograft nephropathy, and neoplasm. Early diagnosis and treatment of these complications are paramount to prevent graft failure and other significant morbidities to the patients. Radiology plays a pivotal role in the diagnosis and treatment of these complications, with minimally invasive percutaneous techniques. In this article, we reviewed renal transplantation anatomy, a wide range of complications that may occur after renal transplantation surgery, typical imaging appearances of the complications on varies imaging modalities, and percutaneous interventional techniques that are used in their treatment.

Correlation of volume, position of stone, and hydronephrosis with microhematuria in patients with solitary urolithiasis

Background The aim of this study was to determine the relationship between hematuria and volume, position of stone, and hydronephrosis in patients with a solitary stone, using unenhanced multidetector computed tomography (MDCT). Material/Methods This retrospective study evaluated the clinical and radiological records of 83 patients undergoing MDCT for the evaluation of acute flank pain and suspected renal colic, who also underwent a microscopic urinalysis at the emergency department of our hospital during a 1-year period. Inclusion criteria of the MDCT study were solitary urolithiasis and cumulative stone diameter under 1 cm. Results A total of 83 patients were included in the study, with a mean age of 42.1±14.4 years; 48 (57.8%) were females and 35 (42.2%) were males. Detection of 5 or more red cells on urinalysis was regarded as microscopic hematuria, and was positive in 46 patients (55.4%). There was a positive correlation between the position of the stone (especially upper two-thirds ureteral stones) and microhematuria rate (r: 0.28, p=0.009). There was a statistically significant difference in presence of hydronephrosis between the microhematuria (36 patients, 78%) and non-microhematuria (12 patients, 32%) groups (p<0.001). The median stone volume between the microhematuria and non-microhematuria groups were not statistically different, 37.5 mm3 (range 5–425) and 28 mm3 (range 4–412), respectively (p=0.39). Conclusions Although stone volume is one of the best indicators of stone burden, it was not correlated with microhematuria. However, in patients with renal colic, microhematuria requires ultrasound examination whether hydronephrosis and ureteral stones are present or not. Further studies with larger sample sizes are warranted.

Anaphylaxis due to spontaneous rupture of primary isolated splenic hydatid cyst.

Echinococcosis is a helminthic zoonosis mainly caused by Echinococcus granulosus and commonly encountered in endemic areas. The liver and lung are the most frequently involved organs. A primary isolated hydatid cyst of spleen is an extremely rare disease even in endemic areas. Anaphylactic reaction is a known complication of cystic hydatid disease, a parasitic infestation caused by the larval/cyst stage of E. granulosus that usually occurs after trauma or during interventions. To the best of our knowledge, anaphylaxis with spontaneous rupture of primary isolated splenic hydatidoses had not been reported previously. The main purpose of this report is to highlight life-threatening complications such as anaphylactic shock that should be considered due to primary isolated splenic cyst hydatid rupture in especially endemic regions.

Postpartum ovarian vein thrombosis and renal vein thrombosis in a woman with protein S and C deficiency

A 24-year-old woman was admitted to our hospital with high fever and poor general status developing 7u2005days after emergent caesarean section was performed because of the premature rupture of the membranes. She was admitted to the intensive care unit with a diagnosis of sepsis. Her history revealed one abortus and one stillbirth and no endometriosis. She was dehydrated, with shivering, tachycardia and hypotension. Her alanine transaminase, aspartate aminotransferase, bilirubin, blood urea nitrogen and creatine levels were mildly elevated. Teicoplanin and imipenem …

Unusual presentation of occipital condyle fracture: Contralateral hypoglossal nerve palsy

Neurology India | Sep-Oct 2012 | Vol 60 | Issue 5 Immunohistological examination showed positive for epithelial membrane antigen (EMA), vimentin and 1% Ki-67 positive rate. The postoperative period was uneventful and she was discharged one week after the surgery. At 7 months follow-up, the amnestic symptoms had aggravated and she developed right side motor weakness. Even at this stage the family refused further surgical treatment as they considered it too risky for the patient.

Multidetector CT findings of calvarial eosinophilic granuloma.

Eosinophilic granuloma (EG) is a well-recognised benign form of Langerhans-cell histiocytosis. The estimated incidence of EG is 3–4 per million of the population. More patients are children and adolescents between the ages of 1 and 15u2005years. The value of plain films in the diagnosis of the EG is limited and the extent of the disease is better defined by multidetector CT (MDCT) scanning. MDCT scan with multiplanar and three-dimensional reconstruction image of the skull and brain clearly demonstrates bone destruction and soft-tissue involvement of the tumour. In this article we present the MDCT imaging characteristics of EG of the skull and discuss the differential diagnosis of this rare lesion with reference to recent literatures.

Spinal dural arteriovenous malformation presented with intracranial hypertension in a young patient

Spinal dural arteriovenous malformations (AVM), the most common type of spinal cord vascular malformation, can be a challenge to diagnosis and prompt treatment. The disorder is rare, and the presenting clinical symptoms and signs are non-specific and insidious at onset. Spinal dural AVMs preferentially affect middle-aged men, and patients most commonly present with gait abnormality or lower-extremity weakness and sensory disturbances. İt may rarely present with symptoms of intracranial hypertension including headache and visual disorders. In this report, we present the radiological findings of a 19-year-old male patient with spinal dural AVM presenting with raised intracranial pressure symptoms including papilloedema and headache, and discuss with recent literature.

A rare presentation of craniopharyngioma: delayed puberty

Craniopharyngiomas are the most frequently encountered suprasellar tumours in children. Owing to the slow growth rate of these tumours, they are often quite large before becoming symptomatic. They are more common among children and older adults (55–74u2005years). Depending upon the direction of growth and tumour size, craniopharyngiomas can affect the hypothalamus, pituitary stalk, optic nerves and chiasm and carotid arteries. Compression of these neural and vascular structures frequently precipitates endocrine disorders, visual loss and an increased intracranial pressure. Hypopituitarism leading to a delayed puberty is a rare presentation of craniopharyngioma. The diagnosis of craniopharyngioma is usually made with the classic radiological imaging features based on CT and MRI.

Embolization of Ruptured Hepatic Hydatid Cyst to Pulmonary Artery in an Elderly Patient: Multidetector computed tomography findings.

Pulmonary embolism due to hydatid disease is an unusual condition resulting from the rupture of a hydatic heart cyst or the opening of liver hydatidosis into the venous circulation. A 78-year old male patient complaining of dyspnea, cough and severe chest pain was admitted to our emergency department. A multidetector computed tomography of the chest revealed the presence of multiple nodules in both lungs especially in left and multiple hypodense filling defect in left main pulmonary artery and its branches. In addition, coronal reformatted multidetector computed tomography images also showed two hypodense cystic parenchymal masses on the left lobe of the liver with a cystic embolus in the right atrium. Pulmonary embolism should be kept in mind in patients who have hepatic hydatidosis if suddenly chest pain and dyspnoea occurs, especially in regions where hydatidosis is endemic.