Ismail Serifoglu

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.

Congenital absence of internal carotid artery with intercavernous anastomosis: Case report and systematic review of the literature.

The absence of an internal carotid artery is a rare congenital anomaly. In the absence of the internal carotid artery, collateral circulations develop through the circle of Willis, persistent embryonic arteries or transcranial collaterals of the external carotid artery. Six pathways of collateral circulation have been described. Intercavernous anastomosis is between cavernous segments of the bilateral internal carotid arteries and is rarely seen. Patients with an absence of the internal carotid artery can be completely asymptomatic. However, these patients can present with subarachnoid hemorrhage or stroke accompanying cerebral aneurysm or abnormal collateral. We combined our case with 33 previous publications to form a retrospective series including 35 cases of unilateral internal carotid artery agenesis with intercavernous anastomosis.

The investigation of correlation between semen analysis parameters and intraparenchymal testicular spectral Doppler indices in patients with clinical varicocele.

Objectives Our aim was to evaluate the effect of clinical varicocele on testicular microcirculation measured by spectral Doppler analysis and investigate the correlation between Doppler ultrasonographic findings and semen parameters. Methods Fifty patients who received a diagnosis of clinical varicocele in the Urology Department of our university hospital were enrolled in this prospective study. Varicocele grades were determined according to sonographic parameters, and a scrotal vein with a diameter of 2.5 mm or greater on color Doppler ultrasonography was included in the study. Spectral Doppler measurements of testicular arteries (peak systolic [PSV]/end-diastolic velocity [EDV], resistivity index [RI], pulsatility index [PI]) were measured from capsular and intratesticular branches of testicular arteries. All the patients were also assessed by semen analysis. Results Mean age was 29.08 ± 5.42 years (range, 18–45 years). Among the whole study population, 22 men had isolated left varicocele, and 28 had bilateral varicoceles. No statistically significant correlation was found between the Doppler parameters: RI, PI, and EDV, and semen analysis parameters: count, motility, volume, and morphology. On the other hand, both in unilateral and bilateral varicocele cases, PSV was found to be significantly correlated with sperm count (P < 0.05). Conclusions Spectral Doppler analysis can provide valuable information as a noninvasive method to assess the hemodynamic changes and testicular microcirculation status in cases of clinical varicocele. However, RI, PI, and EDV values of capsular and intraparenchymal branches of testicular arteries may not be used as indicators of semen parameter deterioration. Hopefully, PSV measurement may give more conclusive data to predict sperm count. In addition, the cutoff value for this index has to be determined for future studies.

The Role of Computerized Tomography in the Assessment of Perivesical Invasion in Bladder Cancer

Summary Background The aim of the present study was to identify the contrast patterns of a tumor, and to evaluate the possibility of assessing the invasion of the perivesical fatty tissue in bladder cancer. Material/Methods In this study, 26 patients with bladder cancer were included. Multiphasic CT examination was performed to determine the stage of the disease before radical cystectomy. Results There were statistically significant differences in tumor and perivesical fatty tissue densities between pre- and post-contrast phases (p<0.05). Conclusions Increases in focal density suspected of being invasion of the perivesical fatty tissue can show perivesical invasion with high specificity.

The Doppler ultrasonographic evaluation of hemodynamic changes in hepatic vascular structures in patients with hepatosteatosis.

Summary Background The hemodynamic changes in hepatic vascular structures of hepatosteatosis patients were examined using Doppler ultrasonography. Material/Methods Ninety hepatosteatosis patients, classified as mild, moderate or severe, and 30 healthy volunteers were included in this 120-person study. The height, weight, liver size, blood lipids and blood liver function tests of the subjects were measured. Those values were compared in the patient and control groups. In the patient and control groups, color duplex Doppler ultrasonography was used to examine portal vein peak velocity, portal vein flow volume, hepatic artery resistive index (RI), hepatic artery pulsatility index (PI) and hepatic artery flow volume. Results Similarly to the degree of hepatosteatosis, increases in body mass index, liver size, liver enzyme levels and blood lipid levels were statistically significant (p<0.05). While the difference in portal vein peak velocity in the hepatosteatosis and control groups was not statistically significant, there was an increasing reduction in the degree of steatosis (p>0.05). As the degree of hepatosteatosis increased, there was a reduction in hepatic artery flow volume, portal vein flow volume and total flow volume that was not statistically significant. In the mild hepatosteatosis group, hepatic artery RI and PI values were statistically significantly lower than in the other groups (p<0.05). In the severe hepatosteatosis group, although the hepatic artery RI and PI values were not statistically significant, there was a minimal increase compared to the other groups. Conclusions It is believed that those results were caused by a reduction in liver compliance and hepatic vascular compliance, in addition to resistance increase in vascular structures.

Comparison of Drug-Eluting Balloon and Standard Balloon Angioplasty for Infrapopliteal Arterial Diseases in Diabetic Patients

Objective: To consider the clinical outcomes and restenosis rates of drug-eluting balloons (DEBs) and percutaneous transluminal angioplasty (PTA) in diabetic patients with infrapopliteal (IP) arterial disease. Materials and Methods: This retrospective, single-center study included 51 patients (37 males; mean age: 63.43 ± 9.81 years) with diabetes mellitus having IP arterial disease, from October 2012 to September 2014. Twenty-two patients were treated with PTA, and 29 patients were treated with DEBs. After intervention, the patients were evaluated in the first week and every 3 months, clinically and radiologically. Univariate and multivariate analyses were used to evaluate the clinical outcomes of diabetic patients with IP arterial disease who were treated with either DEBs or PTA. Results: There were no statistically significant differences between the groups in terms of age and gender, risk factors, characteristics of lesions, or the diameters or length of the balloons (P > .05). Primary patency was higher in the DEB group than in the PTA group (97.8% vs 81.1%, P = .020) in the first 3 months. However, there was no statistically significant difference at 1-year follow-up (68.2% vs 48.5%, P = .131). At the 12-month follow-up, there was no difference in clinical improvement between the groups (P = .193). Conclusion: The findings of this study reveal that DEB is a safe alternative treatment method for IP arterial disease in diabetic patients.

Spinal seeding of choroid plexus papilloma

Apreviously healthy 55-year-old man was admitted to the radiology department for magnetic resonance imaging (MRI) examination with low back pain, sciatalgia, and worsening weakness in the bilateral lower extremities. Contrastenhanced T1-weighted MRI of the lumbar spinal region showed heterogeneously marked enhancing mass that fills the spinal cavity (Fig. 1, Right). The mass was hypointense on T1-weighted images and heterogeneously hyperintense on T2weighted images (Fig. 1, Left and Middle). In scanning for additional lesion, we found enhancing drop leptomeningeal lesions in the thoracic spine (Fig. 2, Right). Also, multiple marked enhancing cortical and leptomeningeal nodular lesions on the cerebellum and posterior fossa cisterns were found on cranial MRI (Fig. 2, Left and Middle). After biopsy was taken from the leptomeningeal thoracic spine lesions, histopathologic result was reported as choroid plexus papilloma. The patient was treated with chemoradiotherapy and was followed without progression for 1 year.

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

Postpartum sacral insufficiency fracture

A 32-year-old woman with inflammatory lower back and hip pain was admitted to the Radiology Department for investigation. The patient had a history of osteoporosis and underwent childbirth 2 months before. On the sacroiliac magnetic resonance image, the bilateral ventral subchondral sacral bone showed hypointensity on the axial T1-weighted image (Fig. 1A) and hyperintensity on the axial T2 (Fig. 1B) and coronal T2 fat-saturated image (Fig. 1C), which is compatible with bone marrow edema. In the central region of the bone marrow edema, a hypointense linear band was seen on the T2 short tau inversion recovery (Fig. 1C) and T1 selective partial inversion recovery (Fig. 1D) images, which was compatible with fracture lines. Treatment prescribed to the patient included Vitamin D, calcium replacement, pain control, bed rest, and physical therapy. One year after treatment, sacroiliac magnetic resonance image showed that the sacral bone marrow edema had disappeared, and bilateral symmetrical T1and T2-weighted hyperintensity (Fig. 2A, B) showed signal loss in fat-saturated images (Fig. 2C, D), which was compatible with fatty bone marrow changes. Fracture lines were not seen in the control images.

The Adrenal Gland Volume Measurements in Manifestation of the Metabolic Status in Type-2 Diabetes Mellitus Patients

Objectives. The aim of our study was to investigate the differences in adrenal gland volume between nondiabetic controls and Type-2 diabetic patients and to examine the influence of glycemic control in diabetes mellitus on adrenal gland volume. Methods. From March 2 to November 25, 2015, 62 consecutive patients with Type-2 DM along with 62 nondiabetics matched by age, gender, and BMI were enrolled in this prospective study. Our diabetes patients were categorized into two groups, well-controlled and poorly controlled diabetes groups. Adrenal volumetric measurements were performed by two radiologists, prospectively and independently, with semiautomatic software. Interobserver reliability was studied using the interobserver correlation coefficient (ICC). Results. The total adrenal volume (TAV) was significantly higher in Type-2 diabetic patients when compared with nondiabetic patients (p < 0.05). When we investigated diabetic patients according to glycemic controls, the TAVs in controlled diabetic patients were significantly higher than in those of the poorly controlled or uncontrolled diabetic patients (p < 0.05). Nondiabetic control patients have significantly smaller TAVs when compared to controlled and poorly or noncontrolled diabetic patients (p < 0.05). Conclusion. Our study suggests that adrenal gland volume measurement may be used as an indirect marker of glycemic control in patients with diabetes.