Objective: In unilateral hydronephrosis (HN), differential renal function (DRF) derived from DMSA scintigraphy reflects split renal function; however, its reliability in dilated kidneys remains controversial. Normalized residual activity (NORA), obtained from MAG3 scintigraphy, is considered a robust indicator of renal drainage. This study aimed to compare NORA with classical and area-corrected DRF methods to determine which better reflects renal excretory function.Methods: A total of 63 patients with unilateral hydronephrosis who underwent both 99mTc-MAG3 and 99mTc-DMSA scintigraphy within one month were retrospectively analyzed. MAG3-derived parameters, including Tmax, T1/2, residual activity at 30 minutes (RA30), and NORA30, were calculated. Renogram patterns were classified into five categories according to diuretic response. DRF was measured using both classical and area-corrected methods based on DMSA scintigraphy. Correlations between drainage parameters, DRF measurements, hydronephrosis grade, and DMSA uptake were evaluated.Results: MAG3-derived drainage parameters (Tmax, T1/2, RA30, and NORA30) showed significant differences across renogram patterns and progressively worsened with increasing obstruction severity (all p < 0.001). Hydronephrosis grade correlated significantly with drainage parameters but not with any DRF measurement. Neither classical nor area-corrected DRF was associated with renogram patterns or hydronephrosis severity (all p > 0.05). Area-corrected DRF demonstrated the strongest correlation with visual DMSA uptake (r = −0.773, p < 0.001). Notably, several kidneys with supranormal classical DRF were reclassified as normal after area correction, and these discordant cases exhibited abnormal NORA30/RA30 values and obstructive renogram patterns.Conclusions: Although area correction improves DRF estimation in asymmetric hydronephrotic kidneys, DRF alone does not adequately reflect excretory function. Drainage parameters, particularly NORA and RA30, provide a more reliable assessment of renal impairment. Integrating NORA into routine evaluation may improve functional assessment and clinical decision-making in unilateral hydronephrosis.
Objective: To compare physician specialists and large language models in the differential diagnosis and plasma exchange decision making of standardized thrombotic microangiopathy case vignettes.Methods: This case vignette based comparative study included three standardized TMA scenarios representing atypical hemolytic uremic syndrome, malignant hypertension associated TMA, and acquired thrombotic thrombocytopenic purpura. Nine evaluators participated: two nephrologists, two hematologists, two internal medicine specialists, and three large language models (ChatGPT-5.2, Gemini Pro, and Microsoft Copilot). For each case, participants provided a most likely diagnosis, three differential diagnoses, supporting clinical reasoning, and a plasma exchange decision. Diagnostic accuracy, plasma exchange appropriateness, and critical management errors were analyzed descriptively and comparatively.Results: A total of 27 independent evaluations were analyzed. Overall Top-1 diagnostic accuracy was 51.9%. Accuracy varied by case, with the lowest performance observed in the aHUS scenario (22.2%) and the highest in malignant hypertension–associated TMA (77.8%). Physicians achieved a Top-1 accuracy of 50.0% (9/18), whereas LLMs demonstrated 55.6% accuracy (5/9). Plasma exchange decision accuracy was 63.0% overall, with overtreatment more common in non-TTP cases. Ten critical management errors (37.0%) were identified. Agreement for plasma exchange decisions demonstrated fair concordance (κ = 0.29).Conclusions: Substantial variability exists in both diagnostic classification and therapeutic decision-making in TMA scenarios. While LLMs demonstrated competitive diagnostic performance in selected cases, management variability persisted across evaluator groups. These findings highlight the diagnostic complexity of TMA and support the role of artificial intelligence as an adjunctive clinical decision-support tool rather than an autonomous decision-maker.
Objective: The main objective of this study is to identify clinical and pathological factors associated with recurrence in patients diagnosed with early-stage (stage I–II) endometrial cancer.Methods: A total of 98 patients diagnosed with stage I–II endometrial cancer who underwent surgical treatment at a single center between 2017 and 2021 were retrospectively analyzed. The patients’ clinical and pathological characteristics, the adjuvant therapies administered, and follow-up outcomes were evaluated. Factors associated with recurrence were assessed using univariate analyses.Results: The mean age of the patients was 59.8 years, and the mean tumor size was 3.58 cm. The mean follow-up period was 49.1 months. The recurrence rate was 8.2%. Five recurrences were identified as locoregional, and three as distant metastases. In univariate analyses, surgical type (p=0.015), adjuvant therapy (p=0.009), and histotype (endometrioid vs. non-endometrioid, p=0.016) were found to be associated with recurrence.Conclusions: The recurrence rate in early-stage endometrial cancer was found to be low, consistent with the literature, and it was determined that 5 of the recurrences were locoregional in nature, while the remaining 3 were distant metastases. Although surgical type, histological type, and adjuvant therapy were identified as factors associated with recurrence in univariate analyses, there is a need for a detailed examination of these factors through multicenter studies involving larger patient cohorts.
Objective: Residual instability may persist after isolated anterior cruciate ligament (ACL) reconstruction. Anterolateral ligament (ALL) augmentation has been suggested to enhance stability, though its clinical utility remains uncertain.Methods: This retrospective cohort study included 60 patients: 30 underwent isolated ACL reconstruction and 30 underwent combined ACL+ALL reconstruction. Outcomes included clinical stability, functional scores (IKDC, Lysholm), return-to-sport parameters, satisfaction, and complications with a mid-term follow-up of ≥12 months. The study was approved by the institutional non-interventional ethics committee.Results: Baseline demographic and perioperative characteristics were comparable between groups. Postoperatively, the ACL+ALL group showed lower pivot-shift positivity (7% vs. 27%, p=0.04), higher IKDC and Lysholm scores at 12 months (p<0.05), and shorter return-to-sport time (7.2 vs. 8.1 months, p=0.04). Patient satisfaction was higher (p=0.02), and the overall complication rate was significantly lower in the ACL+ALL group (10% vs. 33%, p=0.04).Conclusions: Combined ACL+ALL reconstruction yielded superior stability, functional recovery, and a more favorable complication profile compared with isolated ACL reconstruction. Given the retrospective design and limited sample size, results should be interpreted cautiously. Larger prospective trials are needed.
Objective: This report aims to present two atypical cases of autoimmune limbic encephalitis with distinct clinical manifestations and to emphasize the diagnostic challenges when neuroimaging findings are normal or non-specific.Methods: Comprehensive clinical, neurological, and psychiatric evaluations were performed. Diagnostic work-up included brain magnetic resonance imaging (MRI), electroencephalography (EEG), cerebrospinal fluid (CSF) analysis, and autoimmune antibody testing.Results: The first case was a 34-year-old male presenting with isolated executive dysfunction without psychosis, seizures, or movement disorders. MRI showed minimal nonspecific hyperintensities and EEG was normal. CSF analysis revealed mildly elevated protein and strongly positive anti-NMDAR antibodies. Significant cognitive improvement was observed after intravenous methylprednisolone followed by azathioprine. The second case was a 69-year-old male presenting with acute consciousness impairment due to non-convulsive status epilepticus. EEG demonstrated continuous 2–3 Hz spike-wave activity predominantly in the left hemisphere. CSF protein levels were elevated and GAD65 antibodies were positive. Clinical improvement was achieved after treatment with high-dose corticosteroids and intravenous immunoglobulin.Conclusions: Autoimmune encephalitis may present with heterogeneous and atypical clinical features, including isolated cognitive dysfunction or non-convulsive status epilepticus. Normal or nonspecific MRI findings do not exclude the diagnosis. Early recognition and timely immunotherapy are crucial to prevent irreversible neurological damage.
