Muhammet Firat Oztepe

Underlying Malignancy in Patients Initially Diagnosed with Organizing Pneumonia on CT-Guided Lung Biopsy: When Should Repeat Biopsy be Considered? - Advanced Radiology and Imaging

ObjectivesTo evaluate success, complications and efficacy for endovascular management for carotid blowout syndrome.MethodsImages were evaluated for contrast extravasation, vessel wall irregularity, pseudoaneurysm/aneurysm formation. Hemostatic results in the immediate postprocedural period and procedure related infarcts were assessed.ResultsTotal of 20 lesions in 21 patients were detected on digital subtraction angiography (DSA). In a case of esthesioneuroblastoma with active bleeding, DSA failed to show vascular abnormality. There was active contrast extravasation in 7 cases. Treatment modalities included covered stent placement (n = 3), pseudoaneurysm/aneurysm embolization (n = 4), parent artery occlusion (n = 13) and PVA injection (n = 1) in the immediate postoperative period was achieved in all except one case. During the post-procedural period, 6 patients (28.6%) suffered from cerebral ischemia. Rebleeding episodes were encountered in 10 cases (47.6%) after a mean duration of 35 days which responded to tamponade in 4 cases. Diagnostic DSA was performed in 5 of the cases, which failed to identify bleeding source in 2 and remaining 3 cases were treated by endovascular means. A case with massive hemorrhage 1-hour after endovascular treatment died before any intervention could be performed.ConclusionEndovascular treatment can achieve immediate hemostasis to prevent otherwise a highly morbid and mortal complication. However, rebleeding rates are high and cerebral ischemia with or without neurologic deficit occur in a non-negligible percentage of patients.

Background and Objective: The aim of this study is to evaluate the effectiveness of apparent diffusion coefficient (ADC) values in predicting pathologic subtypes and grade in non-small-cell lung cancer (NSCLC). Materials and Methods: From January 2018 to March 2020, 48 surgically diagnosed NSCLC cases were included in this study. To obtain ADC values, ADC maps were constructed, and a region of interest was put on the tumor. The values were measured three times from different places of the lesion, and the mean value of these measurements was recorded. All MRI scans were evaluated by two radiologists in consensus. Results: A total of 14 cases were squamous cell cancer, 32 cases were adenocarcinoma, and 2 cases were large cell carcinoma. The mean ADC values of adenocarcinoma, squamous cell carcinoma, and large cell cancer were 1.51 ± 0.19 × 10⁻³ mm²/s, 1.32 ± 0.15 × 10⁻³ mm²/s, and 1.39 ± 0.25 × 10⁻³ mm²/s, respectively. There were 11 grade 1, 27 grade 2, and 10 grade 3 NSCLC cases. The mean ADC value was 1.44 ± 0.14 × 10⁻³ mm²/s in grade 1 tumors, 1.25 ± 0.10 × 10⁻³ mm²/s in grade 2 tumors, and 1.07 ± 0.15 × 10⁻³ mm²/s in grade 3 tumors. The cut-off value to discriminate grade 2 from grade 1 tumors was 1.31 ± 0.11 × 10⁻³ mm²/s (85% sensitivity, 75% specificity). The cut-off value to discriminate grade 3 from grade 2 tumors was 1.11 ± 0.15 × 10⁻³ mm²/s (87% sensitivity, 69% specificity). Conclusions: ADC values can accurately predict NSCLC histopathologic subtypes and tumor grade.

Objectives: The aim of this study is to assess the effect of needle size in pediatric percutaneous nephrostomy (PN) placement in terms of complications and success rates. Methods: Seventy one percutaneous nephrostomies were performed in 51 patients aged 1 month to 18 years (mean 6.03 ± 5.88 years) between May 2012 and March 2020. Demographic data, indication for PN placement, puncture technique (calyceal entry level: upper, middle, lower pole or pelvis) and needle size, anesthesia type (general or local anesthesia), duration of catheter use and complications were retrospectively retrieved from the hospital electronic recording system. Results: Thirty procedures were performed using a 21 gauge needle and 41 procedures using a 18 gauge needle. There was no statistically significant difference between the two groups in terms of age, gender, degree of hydronephrosis, and calyceal entry level. Technical success and complication rates were similar in two groups (p = 0.423). Conclusions: In the pediatric age group, both 18 and 21 gauge needle techniques can be used safely based on the preference of the interventionalist.

Bu çalışmada amacımız koronovirüs hastalığı-2019 (COVID-19) pnömoni sonrası kısa dönemde oluşan akciğer bulgularını bilgisayarlı tomografi (BT) ile değerlendirmektir. Mart 2019 – Aralık 2021 tarihleri arasında hastanemize başvuran, COVID-19 enfeksiyonu nedeniyle tedavi edilen ve kontrol görüntülemesi yapılan olgular retrospektif olarak incelendi. Hastaların yaş, cinsiyet, altta yatan komorbidite, pnömoni şiddeti, semptom başlangıç zamanı, hastane yatışı ve yatış süresi bilgileri kaydedildi. Hastaların tanı anında ve ortalama 3 ay sonra çekilen toraks BT görüntüleri değerlendirildi. BT şiddet skorlaması her bir akciğer lobuna 0-5 aralığında puan verilerek 0-25 arasında puanlandı. Tek değişkenli ve çok değişkenli logistic regresiyon analizi ile akciğerde persisten anormallik oluşumu için risk faktörleri araştırıldı. Toplamda 62 hasta (33 erkek, 29 kadın; ortalama yaş 55,2±13,2; yaş aralığı 31-80) çalışmaya dahil edildi. Hastalar total rezolüsyon (27/62; %44) ve rezidü (35/62; %56) grubu olarak ikiye ayrıldı. Rezidü grubunda kontrol BT’de en sık görülen bulgular buzlu cam opasitesi (25/35; %71) ardından parankimal bant (24/35; %69) idi. Retikülasyon (4/35; %11) ve plevral kalınlaşma (14/35; %40) sadece kontrol BT’de görülen bulgulardı. Volüm kaybı hem tanı BT’de (4/35; %11) hem de kontrol BT’de (8/35; %23) görüldü (p=0,344). İleri yaşın (>50 yaş) (OR:23,447 p=0,03) rezidüel akciğer bulgularının oluşmasında bağımsız risk faktörü olduğu saptandı. Post-COVID 3. Ayda kısa dönemde toraks BT’de persistan anormallik oluşma riski ileri yaşta (>50 yaş) yüksektir. Persistan toraks BT bulgularının ne kadarının gerçek fibrozisi yansıttığı uzun dönem takip sonucu ortaya konabilir.

Objective We aimed to compare the technical difficulties, complications, long-term efficacy, and risks between right- and left-sided approach transhepatic tunneled catheterization. Methods We retrospectively evaluated transhepatic tunneled catheter placement cases in our institution between May 2012 and November 2019. Demographic and procedural parameters were recorded. Statistical tests were used to compare the complication rates of right- and left-sided approach. Furthermore, Cox regression analyses were used to investigate the relationship between functional catheter days and included parameters. Results A total of 83 procedures were performed in 46 patients, with a female to male ratio of 1.88 and a mean age of 55.5 ± 18.2 years. Indication for catheter placement was chronic renal insufficiency and loss of central venous access through traditional routes in all cases. Median functional catheter durations were 28 days (1–382) and 55.5 days (1–780) for right-sided and left-sided access, respectively. Complication rates were similar for both sides. There was no difference between primary and revision procedures in terms of safety and efficacy outcomes. In univariate Cox regression analysis, gender was the only variable which was found to be statistically significant (HR = 2.014 (1.004–4.038)) for functional catheter days. In multivariate Cox regression model, gender and access side were included which failed to reach statistical significance. Conclusions In our study, both right- and left-sided approaches provided similar safety and efficacy outcomes, suggesting that both techniques can be employed based on physician’s preference.

Objective To determine the potential predictors of antegrade ureteral stenting (AUS) failure in patients with malignant and benign ureteral obstruction. Method We retrospectively evaluated 116 AUS procedures performed in 80 patients for ureteral obstruction due to malignant and benign causes. Variables such as etiology for obstruction, ureter shape, previous treatment regimen, history of ileal loop diversion, and presence of percutaneous nephrostomy were recorded. Univariate and multivariate logistic regression methods were used between these variables and stent failure. Results Antegrade ureteral stenting was performed as single stage in 24 procedures (n: 24/116, 21%) and performed as a two-step approach after percutaneous nephrostomy in 92 procedures (n: 92/116, 79%). Ureteral stent was successfully deployed in 112 AUS procedures (n: 112/116, 96.5%). In 35 of these successful procedures, the patients were referred to our department due to prior failed retrograde ureteral stenting (RUS). Subsequent stent failure occurred in 40 procedures after a median interval of 39 days. Pre-stenting percutaneous nephrostomy (PN) was a statistically significant risk factor for stent failure (p: 0.041), and age showed an inverse relationship with stent failure (p: 0.008). Complications in early (within the first 30 days after procedure) and late stage occurred in a total of 17 procedures. Early complications included urinary tract infection (n: 11), stent migration (n: 3), and malposition (n: 1). Late complications (after 30 days) were urinary tract infection (n: 1) and stent migration (n: 1). Conclusion This study suggests that AUS can be performed effectively in both benign and malignant ureteral obstructions including cases with prior failed RUS. Two-step AUS after percutaneous nephrostomy was found to be a significant risk factor for subsequent stent failure in our study cohort.