Maksude Esra Kadıoğlu

Background Suspected renal colic is a frequent emergency department presentation. Bedside hydronephrosis assessment may support early triage, consultation, and disposition decisions. Objectives This study evaluated whether emergency medicine residents can reliably detect hydronephrosis and classify its severity using bedside urinary ultrasonography in adults with suspected renal colic. Methods This prospective observational agreement study included 272 adults with suspected renal colic. Bedside urinary ultrasonography was performed by 16 emergency medicine residents with at least two years of residency training and structured ultrasonography education. Before enrollment, residents completed standardized theoretical, hands-on, and supervised radiologist-guided renal ultrasonography training focused on hydronephrosis assessment. Radiologist-performed ultrasonography was completed within 2 h of emergency department admission by an experienced radiologist blinded to residents’ findings. Both groups used the same severity categories: absent, mild, moderate, and severe. Diagnostic performance, agreement, and severity-level concordance were analyzed at the patient level. Computed tomography (CT)-based analyses were exploratory and evaluated CT-detected hydronephrosis rather than stone detection. Results Hydronephrosis was detected in 81 patients by both residents and the radiologist. Overall agreement was 91.18%, with a Cohen’s kappa of 0.789. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 85.19%, 93.72%, 85.19%, 93.72%, and 91.18%, respectively. Exact severity-level agreement was 87.87%, with a linear weighted kappa of 0.813. In the CT subgroup, residents’ ultrasonography for CT-detected hydronephrosis showed 81.63% sensitivity, 86.05% specificity, and 83.70% accuracy. Conclusion Emergency medicine residents with structured ultrasonography training demonstrated substantial agreement with radiologist-performed ultrasonography for detecting hydronephrosis and strong agreement for severity classification. These findings apply to trained residents and may not be generalizable to clinicians without similar training or supervision.

Background/Objective: Pelvic and retroperitoneal lymphoceles remain a clinically significant complication following pelvic surgery. The optimal minimally invasive management strategy continues to be a matter of debate. The objective of this study is to compare daily catheter drainage and catheter length of stay after percutaneous catheterization in patients with iatrogenic pelvic lymphocele who undergo sclerotherapy alone versus sclerotherapy with intranodal lymphangiography and lymphatic embolization (INL–LE). Methods: A total of 47 patients (55 lymphoceles) who developed symptomatic pelvic or retroperitoneal lymphoceles after oncologic pelvic surgery were retrospectively reviewed between September 2020 and April 2023. They were divided into two groups, one treated with sclerotherapy alone (24 lesions) and the other with sclerotherapy combined with INL–LE (31 lesions). The duration of catheter placement, daily drainage volume during sclerotherapy, lymphocele volume, and catheter dwell time subsequent to lymphatic embolization were compared between the two groups. Results: Of the 55 lymphoceles, 31 were treated with sclerotherapy plus lymphangiography/embolization (INL–LE group), whereas 24 lymphoceles were treated with sclerotherapy alone. Baseline characteristics were not different between the groups. Although initial drainage was higher in the INL–LE group, third-day drainage volume, the number of sclerotherapy sessions, and catheter dwell time were all significantly lower compared with the sclerotherapy group (all p < 0.001). Lesion size positively correlated with drainage volume and catheter duration, whereas embolization negatively correlated with drainage volume, the number of sessions, and catheter duration. Based on multivariate analysis, the addition of INL–LE was independently associated with a significantly shorter catheter dwell time (β = −0.803, p = 0.001). Conclusions: In this retrospective cohort, the addition of lymphatic embolization to sclerotherapy was associated with reduced drainage persistence and a shorter catheter dwell time compared with sclerotherapy alone.

Background: Magnetic resonance imaging (MRI) is the gold standard for evaluating lumbar spinal stenosis (LSS); however, its high cost and potential overuse raise concerns. Although plain radiographs are more accessible and cost-effective, there is currently no established radiographic criterion for the diagnosis of LSS. Purpose: To investigate in 100 patients the effect of LSS on objective parameters reflected on radiographs and to adapt existing radiographic indices for the diagnosis of LSS. Material and Methods: Between September 2017 and May 2018, a retrospective evaluation was performed on 100 patients who underwent lumbosacral MRI and lateral lumbosacral radiography for back and/or leg pain. LSS was confirmed in 50 patients, and various angles, measurements, and ratios were calculated on the radiographs of these patients. Results: Pelvic incidence (PI) was significantly higher in the LSS group ( P = 0.029). Foraminal width (FW) and pedicle width (PW) were significantly lower at all levels in patients with spinal stenosis ( P P P <0.005). Receiver operating characteristic (ROC) analysis was performed for the parameters showing significant differences between the LSS and control groups. Cutoff values were calculated for each significant parameter and level, and among them, PW, FW, and SBW:PW showed relatively high sensitivity, specificity and accuracy. Conclusion: PW, FW, and the SBW/PW ratio demonstrated high sensitivity and specificity in the diagnosis of LSS. These parameters may be useful for screening purposes; however, they are not sufficient on their own for clinical or surgical decision-making.

Purpose: Central venous occlusion represents a major obstacle to establishing reliable dialysis access. This study was designed to systematically evaluate the outcomes of utilising the micropuncture technique for catheter placement in patients with central venous obstruction. Materials and methods: A retrospective analysis was conducted on 20 patients with central venous occlusion undergoing micropuncture-assisted recanalisation between July 2020 and March 2023. Patient demographics, procedural details and outcomes were collected. Success rates were evaluated based on catheter functionality and optimal positioning, while complications were categorised using the CIRSE classification system. Results: Recanalisation was successfully performed in 17 out of 20 patients (85%), with short-segment occlusions demonstrating superior success rates (92.8%) compared to long-segment occlusions (66.6%). Acute and subacute thrombus cases showed higher recanalisation success (100% and 87.5%) compared to chronic thrombus cases (50%). No major complications occurred, while minor haematomas were observed in four patients (20%). The mean catheter patency was 11 months, and the primary patency rate at 12 months was 70%. Conclusion: The micropuncture technique is a safe and effective option for catheter placement in patients with central venous occlusion. Its low complication rates and high technical success highlight its utility in clinical practice, particularly for patients with limited vascular access options.

Background/aim: Assessing the validity and clinical utility of axillary ultrasonography (AUS)-guided fine needle aspiration biopsy (FNAB) in detection of nodal metastasis during preoperative axillary investigation in comparison to the histopathologic diagnosis in early-stage breast cancer. Materials and methods: A total of 279 operated primary breast cancer patients (age: 55.3 ± 12.8, ranged 17-90 years) were included. Data on AUS findings at the time of initial diagnosis (first look AUS), second-look AUS findings performed by the breast radiologist during breast biopsy procedure and the AUS-guided FNAB findings were evaluated with respect to the final histopathology report obtained through axillary surgery via sentinel lymph node biopsy (SLNB) and/or axillary lymph node dissection (ALND). The diagnostic performance of each method in detecting metastatic ALNs were compared in terms of sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). Results: The sensitivity, specificity, and accuracy of the first look AUS in detecting nodal metastasis were 64.56%, 86.78%, and 74.19% while the PPV and NPV were 86.44% and 65.22%, respectively. The sensitivity, specificity, and accuracy of the second-look AUS were 70.25%, 87.60%, and 77.78%, while PPV and NPV were 88.10% and 69.28%, respectively. The sensitivity, specificity, and accuracy of the second-look AUS guided FNAB were 89.19%, 73.33%, and 87.30%, while the PPV and NPV were 96.12% and 47.83%, respectively. The consideration of second-look AUS and finding of nodal metastasis in FNAB was associated with significantly higher likelihood of ALND (55.4% vs. 44.6%, p < 0.001) and lower likelihood of SLNB (34.7% vs. 65.3%, p < 0.001) compared to consideration of nonmetastatic ALN status. In 23 (22.3%) patients with positive findings on AUS-guided FNAB, SLNB was applied; 21 had positive results after surgical dissection, indicating that nearly 20% of patients had unnecessary SLNB. Conclusion: US-guided FNAB of suspicious ALNs is a simple, minimally invasive, and highly effective method for preoperative axillary staging in patients with invasive breast cancer avoiding the more invasive method SLNB and it enables the surgeon to proceed directly to ALND in positive cases.