Sinan Tan

Real-time sonoelastography of the Achilles tendon: pattern description in healthy subjects and patients with surgically repaired complete ruptures

ObjectiveThe purpose of this study is to describe the elastographic appearance of the Achilles tendon in healthy subjects and patients with surgically repaired complete ruptures.Materials and methodsNineteen Achilles tendons of 16 amateur footballers with surgically repaired complete ruptures and their contralateral asymptomatic Achilles tendons were assessed with ultrasound and real-time sonoelastography. Additionally, 40 asymptomatic Achilles tendons of 20 healthy amateur footballers were assessed. The Achilles tendons were divided into the distal, middle, and proximal thirds for elastographic image evaluation. Tendons were classified into three main types according to the elasticity features: type 1, blue (hardest tissue); type 2, blue/green (hard tissue); or type 3, green (intermediate tissue). In addition, three subtypes were determined: homogeneous, relatively homogeneous, and heterogeneous.ResultsMost of the Achilles tendons of the patients with surgically repaired complete ruptures were detected to have type 2 elasticity (64.9%), and the remaining had type 1 (35.1%). In contrast, most of the healthy tendons had type 2 (64.2%), and the remaining had either a type 3 (20.8%) or a type 1 (15%) elastographic pattern. All of the ruptured tendons had a heterogeneous structure, whereas all of the healthy Achilles tendons had a homogeneous or relatively homogeneous structure.ConclusionIn sonoelastography, the recognition of normal tendon structure will be useful in assessing pathologies of the Achilles tendon. Additionally, in patients with excellent American Orthopedic Foot and Ankle Society (AOFAS) scores and surgically repaired complete ruptures, a hard and heterogeneous pattern of tendon structure may be a natural consequence of tendon healing.

Real-Time Elastography for Distinguishing Angiomyolipoma From Renal Cell Carcinoma: Preliminary Observations

OBJECTIVE The objective of this study was to determine the diagnostic performance of sonoelastography for differentiating angiomyolipomas from renal cell carcinomas. SUBJECTS AND METHODS Twenty-eight angiomyolipomas and 19 renal cell carcinomas were prospectively examined with real-time elastography. Lesions were classified according to four elastographic patterns on the basis of the distribution of the blue area (representing no strain and hardest tissue component). The elasticity patterns and the strain ratios of the angiomyolipomas and renal cell carcinomas were evaluated independently by two observers. Diagnostic performance and interobserver agreement were analyzed. RESULTS All angiomyolipomas were classified as having a high-strain elastographic pattern (blue areas in < 50% of lesion, considered type 1 or type 2) by both radiologists, whereas 18 of 19 renal cell carcinomas were classified as having a low-strain elastographic pattern (blue areas in ≥ 50% of lesion, considered type 3 or 4) by both radiologists. The respective mean strain ratios measured by two radiologists were 0.15 ± 0.06 and 0.18 ± 0.09 for the angiomyolipomas and 0.64 ± 0.15 and 0.63 ± 0.19 for the renal cell carcinomas. There were significant differences between the elasticity patterns and strain ratios for angiomyolipomas and renal cell carcinomas (p < 0.001). Interobserver agreement was excellent for elasticity patterns and strain ratios, with a weighted kappa coefficient of 0.96 and an intraclass correlation coefficient score of 0.95. CONCLUSION Our results show that real-time elastography may be useful in differentiating angiomyolipomas from renal cell carcinomas, by use of both elasticity patterns and strain ratios.

Irregular Yolk Sac Shape Is It Really Associated With an Increased Risk of Spontaneous Abortion

The yolk sac is the first conceptional structure that becomes sonographically visible within the gestational sac. Because the yolk sac is the primary route of exchange between the embryo and the mother, it is essential in early embryonic life. This study aimed to determine whether an irregular yolk sac shape is associated with an increased risk of spontaneous abortion.

The chorionic bump: Radiologic and pathologic correlation

Chorionic bump is a rare abnormal condition of the gestational sac seen in the first trimester of pregnancies, extending from the choriodecidual surface to the gestational sac. We report the sonographic and histopathologic findings in a case involving three “chorionic bumps” extending from the choriodecidual surface to the gestational sac. Chorionic bump can be associated with a poor prognosis for the pregnancy. Therefore, cases with chorionic bumps must be followed with serial ultrasound examinations throughout the first trimester.

Sonographic Evaluation of the Yolk Sac

This pictorial essay aims to inform related clinicians by summarizing the normal and abnormal sonographic findings of the yolk sac in the first trimester of pregnancy. An abnormality in the sonographic appearance of a yolk sac can predict subsequent embryonic death or abnormalities. Therefore, the accurate recognition of normal and abnormal sonographic findings concerning the yolk sac can be used to anticipate the course of pregnancy.

Evaluation of fetal nasofrontal angle in the second trimester in normal pregnancies

The nasal bone is one of the important fetal structures to be radiologically evaluated in the first and second trimesters. In this study, we aimed to evaluate the nasal root and to determine the normal range of the naso‐frontal angle, which may potentially be used as a predictive or diagnostic parameter in the diagnosis of the above‐mentioned syndromes or other congenital abnormalities with associated nasal features using obstetric ultrasonography in normal fetuses.

Frequency of a Persistent Yolk Sac and Its Relationship With the Gestational Outcome

This study aimed to determine the frequency of a persistent yolk sac in pregnancies at 12 to 13 weeks and to investigate whether a persistent yolk sac is associated with an adverse gestational outcome.

Does steep Trendelenburg positioning effect the ocular hemodynamics and intraocular pressure in patients undergoing robotic cystectomy and robotic prostatectomy

AbstractPurposeTo examine the effect of steep Trendelenburg position (ST) on intraocular pressure (IOP), resistive index of the central retinal artery, and venous impedance index of the central retinal vein during robotic prostatectomy and cystectomy.MethodsA total of fifty-three male patients were included into the study (prostatectomy: 43, cystectomy: 10). During robotic surgery, the effect of the ST on IOP, resistive index of the central retinal artery (CRA-RI), and venous impedance index of the central retinal vein (CRV-VI) was prospectively examined. The measurement times of IOP are as follows: T1: before anesthesia while supine and awake; T2: anesthetized and supine; T3: anesthetized and ST; T4: anesthetized, ST, and intraperitoneal insufflation; T5: anesthetized in ST at the end of the procedure with CO2; T6: anesthetized in ST after desufflation; and T7: anesthetized supine before awakening.ResultsThere was no difference between the IOP values of the right and left eyes in both groups. The highest IOP values were reached at T4 and T5. CRA-RI values were different, while CRV-VI values were similar at T1 and T4. ConclusionsDespite staying in the ST for a long time provided that the ophthalmologic examination was normal, ocular complication risk is low in robotic prostatectomy and cystectomy.

Scrotal calculi in clinical practice and their role in scrotal pain: A prospective study

Scrotal calculi are rare, and their clinical significance is uncertain. Scrotal pain is a frequent, hard‐to‐manage problem in urology clinics. Our purpose in this study was to determine the relationship between the presence of scrotal calculi and scrotal pain in a prospective manner.

Prevalence of scrotal calculi and their relationship with pain.

PURPOSE The purpose of this study was to determine the frequency of scrotal calculi in men referred for scrotal ultrasonography (US), to identify any associated pathologies, and to investigate if any relationship exists between scrotal lithiasis and pain. MATERIALS AND METHODS This was a retrospective study in which 4084 scrotal US examinations in 3435 men were evaluated. Scrotal US was performed using a high-frequency linear transducer. Forty patients were questioned as to whether scrotal pain was present. Patients were asked to grade their scrotal pain intensity using the Numerical Rating Scale. RESULTS Sixty-seven of the 3435 patients with scrotal US examinations had scrotal calculi with a mean size of 3.7 ± 1.4 mm (range, 1.6-7 mm). Twenty patients with scrotal calculi had no scrotal pain. Nine patients with scrotal pain (22.5%) had no US or clinical abnormalities except scrotal calculi. CONCLUSION The frequency of scrotal calculi was 1.95%. Approximately one-quarter of patients with scrotal calculi and pain had no additional abnormalities. Therefore, scrotal calculi should be considered in the differential diagnosis of scrotal pain.