Purpose: This study aims to evaluate the feasibility and effectiveness of percutaneous endobiliary Microwave Ablation (MWA) and Radiofrequency Ablation (RFA) prior to metallic stent placement for managing symptomatic, unresectable malignant biliary obstructions (MBOs). Materials and Methods: We conducted a retrospective cohort analysis of 122 patients diagnosed with malignant tumors causing biliary obstructions, comparing outcomes between those receiving stents only and those undergoing prior ablation. Data collected included patient demographics, procedural details, complication rates, stent patency, and overall survival. Results: Among the 122 patients, 101 received stents alone, while 21 underwent ablation (13 with MWA and 8 with RFA). There was no significant difference in stent patency duration (255.7 days for ablation vs. 219.6 days for stent-only, p=0.218) or overall survival (average of 123 days, p=0.105). The complication rate was significantly higher in the ablation group (p=0.023). Conclusion:While endobiliary ablative treatments before metallic stenting appear feasible for palliative care of unresectable MBOs, our findings indicate no significant improvement in stent patency or overall survival. Further randomized controlled studies are necessary to clarify the efficacy and necessity of these techniques.

To investigate the etiology of spontaneous percutaneous nephrostomy (PCN) catheter dislodgements and evaluate factors potentially associated with these dislodgements, including muscle-to-fat composition and tissue characteristics of catheter traces. Data from 92 patients (63 males, 29 females; mean age 63.9 ± 11.4 years, range 28–88) undergoing 151 PCN catheter replacements between January 2016 and June 2021 were analyzed. Patients were divided into Group 1 (prophylactic replacements every 3 months, n = 41) and Group 2 (at least one spontaneous dislodgement, n = 51). Associations were evaluated for factors including intraabdominal visceral adipose tissue index (IAVATI), subcutaneous adipose tissue index (SATI), and abdominal perimeter. Other variables assessed were Eastern Cooperative Oncology Group (ECOG) performance status scores, psoas muscle index (PMI), renal size, renal parenchymal thickness, renal cortex-to-skin distance, posterolateral abdominal wall muscle thickness, and PCN replacement frequency. No significant differences were identified between Group 1 and Group 2 in IAVATI, SATI, or abdominal perimeter values (p = 0.210–0.412). A significant difference in ECOG performance status scores (p = 0.0001), PMI (p = 0.04) and lower renal size, renal parenchymal thickness, renal cortex-to-skin distance, and posterolateral abdominal muscle thickness (p = 0.0001–0.039) were observed in Group 2. PCN replacements were significantly more frequent in Group 2 (p = 0.0001). Multivariate regression identified renal parenchymal thickness and abdominal wall muscle thickness as significant independent predictors (p = 0.0001, p = 0.02). ROC analysis yielded an AUC of 0.843 (95

BACKGROUND AND OBJECTIVE:Arterial stiffness, which is a measure of the elasticity of the arteries, is also a risk factor for the development of cardiovascular diseases and its measurement is important for evaluating the atherosclerosis process. The purpose of this cross-sectional study to investigate whether severe periodontitis in short-term type 2 diabetes may be associated with increased cardio-ankle vascular index (CAVI) values specified for subclinical atherosclerosis risk.METHODS:A total of 136 subjects, including 69 subjects with short-term type 2 diabetes (35 with severe periodontitis and 34 with periodontally healthy) and 67 systemically healthy subjects (32 with severe periodontitis and 35 with periodontally healthy) were enrolled to this study. Assessment of all participants included in this study in terms of arterial stiffness was determined by CAVI. Serum fasting plasma glucose (FPG), glycated haemoglobin (HbA1c), triglyceride (TRG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol (TC) and C-reactive protein (CRP) levels were calculated using standard methods. Full mouth periodontal measurements were recorded. Multiple linear regression analysis was performed to evaluate the relationship between periodontal parameters and mean CAVI values of the groups.RESULTS:Mean CAVI levels were significantly higher in diabetic and periodontitis group compared to the other study groups (p < .05). In diabetes and periodontitis group, CAVI was showed positive correlations with CRP (r = .337, p = .048) and HbA1c (r = .442, p = .008). Also, positive significant correlations were found with probing depth (PD) and clinical attachment level (CAL) in the periodontitis groups. Multiple regression analysis revealed that CAL independently predicted CAVI levels in periodontitis groups (β = .433, p = .019 in diabetes and periodontitis groups and β = .57, p = .001 in systemically healthy and periodontitis group respectively).CONCLUSION:This is the first study investigating the association between severe periodontitis and CAVI in patients with short-term diabetes. Our findings suggest that severe periodontitis may be an intermediate factor in the pathway between type 2 diabetes and cardiovascular disease by increasing the arterial stiffness.

Abstract Introduction Peritoneal lesions cannot be definitively distinguished based on clinical and imaging characteristics alone. This study aimed to evaluate the reliability, diagnostic value, and diagnostic yield of ultrasound‐guided percutaneous core needle biopsy (PCNB) for peritoneal lesions. Methods A retrospective analysis of 129 patients who underwent PCNB for peritoneal lesions was performed to assessed technical completion and diagnostic yield. Results The results showed that ultrasound‐guided PCNB is a safe and reliable diagnostic tool with high diagnostic yield for peritoneal lesions. Technical feasibility and diagnostic yield rates were 100% and 89.9%, respectively. The diagnostic yield was lower for patients with a known history of cancer and a short anteroposterior diameter of the target lesion. Conclusions These findings suggest that ultrasound‐guided PCNB could be considered as a first‐line diagnostic tool for peritoneal lesions, as it offers a minimally invasive and accurate means of obtaining tissue samples for diagnosis.

To evaluate the Superb Microvascular Imaging (SMI) vascular patterns and vascularity index (VI) values of malignant focal liver lesions (FLLs), assess their role in differential diagnosis, and examine interobserver agreement. A total of 107 patients (52 males, 55 females; mean age 62 ± 12.8 years, range 25–87) referred to the interventional radiology clinic for FLL biopsy between April 2022 and April 2023 were analyzed. Two radiologists independently assessed the SMI vascular patterns and calculated VI values. Differences among three lesion groups — hepatocellular carcinoma (HCC, n = 16), non-HCC primary liver malignancies (n = 16), and metastases (n = 75) — were evaluated, and interobserver agreement was assessed. Most metastases (88

PurposeTo investigate whether patients undergoing percutaneous liver mass biopsy (PLMB) can be safely discharged following a two-hour monitoring period.MethodsA multi-center prospective analysis was conducted for 375 patients (196 males and 179 females), mean age 63 +/- 12.45 years (range 37-89) who underwent PLMB between August 2023 and March 2024. Patients were monitored for 24 h, and complications were classified as minor or major. The timing of complications was categorized into three groups: within the first two hours, between the 2nd and 24th hours, and within 1 week after 24 hours.ResultsMinor complications occurred in 18.93% (71/375) and major complications in 2.13% (8/375). Most minor complications (80.2%, 57/71) appeared within the first two hours, 12.7% (9/71) between 2 and 24 h, and 7.1% (5/71) after 24 h. All major complications (62.5%, 5/8) except late-onset cases, occurred within the first two hours. No major complications occurred between 2 and 24 h. Late-onset major complications occurred in 37.5% (3/8) after 24 h.ConclusionThe two-hour monitoring period did not adversely impact patient management regarding minor complications and is safe for identifying all major complications except for late-onset ones. Extending the post-biopsy recovery period does not significantly improve patient care. A two-hour observation period after PLMB, including hemogram monitoring and ultrasound, does not adversely affect patient management regarding minor complications and is safe and efficient for detecting significant complications except delayed ones. Extending recovery time does not significantly improve patient care, as delayed complications appear later. image

Purpose: This study aims to evaluate the clinical outcomes of percutaneous nephrostomy in patients who develop hematuria during percutaneous antegrade double j stent placement. Materials and methods: We conducted a multicenter retrospective cross-sectional study, reviewing medical records from January 2016 to June 2024, to identify patients who underwent percutaneous antegrade double j stent placement and developed hematuria. Percutaneous antegrade double j stent and nephrostomy procedures were performed under ultrasound and fluoroscopic guidance. Results: The study included 151 patients with a mean age of 65.9 ± 15.3 years; 46 (30.5%) were female, and 105 (69.5%) were male. Hematuria was observed in 20 (8.9%) of the 225 antegrade double j stent procedures. Hematuria was significantly more common in patients with benign conditions (35%) compared patients with malignant tumors (9.2%) (p=0.003). Postoperative nephrostomy was performed in 118 (52.4%) of the procedures. Among patients who developed hematuria, 11 (55%) received a nephrostomy, compared to 9 (45%) without hematuria, though this difference was not statistically significant (p=0.811). Conclusion: Percutaneous nephrostomy appears to be an effective intervention for managing hematuria in patients undergoing antegrade double j stent placement. However, the study did not find a statistically significant difference in hematuria incidence with nephrostomy placement, indicating the need for further research with larger sample sizes to confirm these findings and optimize postoperative management strategies.

Purpose To investigate whether patients undergoing percutaneous liver mass biopsy (PLMB) can be safely discharged following a two‐hour monitoring period. Methods A multi‐center prospective analysis was conducted for 375 patients (196 males and 179 females), mean age 63 ± 12.45 years (range 37–89) who underwent PLMB between August 2023 and March 2024. Patients were monitored for 24 h, and complications were classified as minor or major. The timing of complications was categorized into three groups: within the first two hours, between the 2nd and 24th hours, and within 1 week after 24 hours. Results Minor complications occurred in 18.93% (71/375) and major complications in 2.13% (8/375). Most minor complications (80.2%, 57/71) appeared within the first two hours, 12.7% (9/71) between 2 and 24 h, and 7.1% (5/71) after 24 h. All major complications (62.5%, 5/8) except late‐onset cases, occurred within the first two hours. No major complications occurred between 2 and 24 h. Late‐onset major complications occurred in 37.5% (3/8) after 24 h. Conclusion The two‐hour monitoring period did not adversely impact patient management regarding minor complications and is safe for identifying all major complications except for late‐onset ones. Extending the post‐biopsy recovery period does not significantly improve patient care.

OBJECTIVES:To assess the risk variables related to the types of candidemia for each patient, who was admitted into the intensive care unit regardless of the patient with or without complete diagnosis of COVID-19, during the period of March 2019 to December 2022.METHODS:The evaluation comparison of demographic and clinical data of COVID-19 positive and negative patients with candidemia confirmed in blood, 113 cases were assessed. Variables such as gender, age, age of hospitalization, history of hospitalization, concurrently infection, The acute physiology and chronic health evaluation-II scores, comorbidity checking, intubation, central venous catheter use, parenteral nutrition use, steroid use, antibiotic use, lymphopenia, and laboratory variables were evaluated. Candida species distribution, antifungal susceptibility in blood culture were determined.RESULTS:Coronavirus disease-19 was present in 62.8% of cases confirmed candidemia, and these cases were significantly different from COVID-19 negative cases. Significance was found in more intubation, central venous catheter use, parenteral nutrition, and steroid therapy in Group 2. There was no significance with species distribution and associated infection. In total, COVID-19 positive had higher hemoglobin, aspartate aminotransferase, alanine transaminase, and white blood cell levels, which may be associated with the possibility of revealing and controlling candidemia.CONCLUSION:Candida albicans and Candida Parapsilosis (C. parapsilosis) are the species seen in infected COVID-19 patients, while C. parapsilosis and Candida tropicalis are found in non-COVID-19 ones. Risk factors were intubation, parenteral nutrition, central venous catheter, and steroid in the COVID-19 group.

Abstract Purpose: The aim of this research paper is to comprehensively investigate the complications associated with imaging-assisted port catheters (IAPCs) and identify the factors influencing the occurrence of these complications. Materials and methods: Between September 2012 and September 2020, imaging-assisted port catheter-inserted patients were investigated. The analysis revealed a spectrum of complications associated with IAPCs, ranging from complications such as catheter malposition, arrhythmia, catheter occlusions, catheter infections, migration, catheter fractures, and venous thrombosis. Results: Totally, 107 (8.5%) of 1247 port catheters were complicated. The underlying hematologic malignancy emerged as notable risk factors for complications (p

AbstractPurposeTo investigate whether patients undergoing percutaneous liver mass biopsy (PLMB) can be safely discharged following a two‐hour monitoring period.MethodsA multi‐center prospective analysis was conducted for 375 patients (196 males and 179 females), mean age 63 ± 12.45 years (range 37–89) who underwent PLMB between August 2023 and March 2024. Patients were monitored for 24 h, and complications were classified as minor or major. The timing of complications was categorized into three groups: within the first two hours, between the 2nd and 24th hours, and within 1 week after 24 hours.ResultsMinor complications occurred in 18.93% (71/375) and major complications in 2.13% (8/375). Most minor complications (80.2%, 57/71) appeared within the first two hours, 12.7% (9/71) between 2 and 24 h, and 7.1% (5/71) after 24 h. All major complications (62.5%, 5/8) except late‐onset cases, occurred within the first two hours. No major complications occurred between 2 and 24 h. Late‐onset major complications occurred in 37.5% (3/8) after 24 h.ConclusionThe two‐hour monitoring period did not adversely impact patient management regarding minor complications and is safe for identifying all major complications except for late‐onset ones. Extending the post‐biopsy recovery period does not significantly improve patient care.

PURPOSE:To investigate whether patients undergoing percutaneous liver mass biopsy (PLMB) can be safely discharged following a two-hour monitoring period. METHODS:A multi-center prospective analysis was conducted for 375 patients (196 males and 179 females), mean age 63 ± 12.45 years (range 37-89) who underwent PLMB between August 2023 and March 2024. Patients were monitored for 24 h, and complications were classified as minor or major. The timing of complications was categorized into three groups: within the first two hours, between the 2nd and 24th hours, and within 1 week after 24 hours. RESULTS:Minor complications occurred in 18.93% (71/375) and major complications in 2.13% (8/375). Most minor complications (80.2%, 57/71) appeared within the first two hours, 12.7% (9/71) between 2 and 24 h, and 7.1% (5/71) after 24 h. All major complications (62.5%, 5/8) except late-onset cases, occurred within the first two hours. No major complications occurred between 2 and 24 h. Late-onset major complications occurred in 37.5% (3/8) after 24 h. CONCLUSION:The two-hour monitoring period did not adversely impact patient management regarding minor complications and is safe for identifying all major complications except for late-onset ones. Extending the post-biopsy recovery period does not significantly improve patient care.

OBJECTIVES:This study investigated whether kidney transplant donors experience increased arterial stiffness compared with the general population and how arterial stiffness changes over time. MATERIALS AND METHODS:Our study included 59 kidney transplant donors and 27 healthy volunteers. All subjects underwent cardio-ankle vascular index measurements. We studied fibroblast growth factor23, klotho, monocyte chemoattractant protein-1, N-terminal pro-B-type natriuretic peptide, indoxyl sulfate, and p-cresyl sulfate levels. RESULTS:Cardio-ankle vascular index level was higher in donors 6 to 11 years after donation (8.02 ± 0.24 m/s) than in donors 2 to 6 years after donation (7.02 ± 0.27 m/s) and healthy volunteers (6.65 ± 0.22 m/s). Cardioankle vascular index level was positively correlated with age (r = 0.382, P < .001) and levels of triglyceride (r = 0.213, P = .049), blood urea nitrogen (r = 0.263, P = .014), creatinine (r = 0.354, P = .001), calcium (r = 0.228, P = .035), indoxyl sulfate (r = 0.219, P = .042), p-cresyl sulfate (r = 0.676, P ≤ .001), and monocyte chemoattractant protein-1 (r = 0.451, P ≤ .001) and negatively correlated with estimated glomerular filtration rate (r = -0.383, P < .001). Multiple linear regression analysis revealed that age (P = .026, B = 0.244), mean arterial blood pressure (P < .001, B = 0.446), blood urea nitrogen (P = .006, B = 0.302), creatinine (P = .032, B = 0.236), estimated glomerular filtration rate (P = .003, B = -0.323), fibroblast growth factor-23 (P = .007, B = 0.294), N-terminal pro-B-type natriuretic peptide (P = .005, B = 0.304), and monocyte chemoattractant protein-1 (P ≤ .001, B = 0.434) independently predicted cardio-ankle vascular index levels. CONCLUSIONS:Even without additional risk factors, kidney donors should be followed closely for arterial stiffness and cardiovascular disease, especially in the long-term (>5 years) after kidney transplant.

Transarterial radioembolization (TARE) is a widely used treatment method for primary liver cancers and metastasis. Although TARE is relatively safe, it may cause liver abscess, failure, nontarget embolization, and vascular complications. Herein, we report a case of TARE-related hepatic artery pseudoaneurysm that was treated successfully with ultrasound-guided thrombin injection.

Objective: Determining the clinical characteristics associated with SARS-COV-2 infection may contribute to reducing mortality in elderly patients, considering the age-related sensitivity and the excess of complications. Our study aimed to evaluate the factors that determine the severity of the disease in elderly patients followed up in our hospital.Materials and Methods: The files of definite or probable COVID-19 patients over 65 years old who were followed up by the infectious diseases clinic of our hospital between March 15 and October 1, 2020, were evaluated retrospectively.Results: A total of 134 patients were included in the study, 52.2% of the patients were male, and the mean age was 75.11 +/- 7.15 (min 65-max 94). Multimorbidity was detected in 42.5% of the patients, and the most common comorbidities were hypertension (53.7%) and diabetes mellitus (36.6%). Severe COVID-19 was present in 39.6% of patients. The most common complaints were fatigue (70.9%), cough (59.7%), and shortness of breath (59%). When the patients' computed tomography (CT) images of thorax were evaluated, ground-glass was observed in 94.8% (n=127), infiltration in 42.5% (n=57), and consolidation in 32.8% (n=44). Involvement was bilateral in 93.3% (n=125) of the patients. The most common antiviral treatment used for patients was favipiravir 73.1% (n=98). The average hospitalization period of the patients was 12 +/- 6.36 days, the rate of follow-up in the intensive care unit was 20.1% (n=27), and death occurred in 9.7% (n=13) of the patients. In the multivariate analysis, cough and shortness of breath at admission, atelectasis and pleural effusion on thorax CT were found to be significant for severe COVID-19 disease (p<0.05).Conclusion: Providing early medical support to these patients, especially, in the presence of cough and shortness of breath on admission and the presence of pleural effusion and atelectasis on thoracic CT, may help reduce the poor clinical course.

OBJECTIVE The aim of the study was to evaluate the results of ultrasound-guided excisional biopsy in patients with nonpalpable breast lesions and examine factors associated with malignancy. PATIENTS AND METHODS A total of 380 patients who underwent ultrasound-guided excisional biopsy for suspected nonpalpable breast masses, between May 2012 and 2018, were retrospectively examined. Histopathological results of the patients were compared regarding age, ultrasound findings, ultrasonographic and mammographic Breast Imaging Reporting and Data System (BI-RADS) categories and factors predicting malignancy were determined. RESULTS The mean age of the patients was 48.35 ± 11.23 (17-86) years. There was a history of breast cancer in the families of 22 (5.8%) patients, and 187 (49.2%) patients were in menopause. The complication rate was found to be 6.6%. Malignant lesions were detected in 76 (20%) patients and benign lesions were detected in 304 (79.99%) patients. Some benign lesions were high-risk lesions (16.8%). Most of the patients with malignant lesions had early-stage breast cancer (83.3%). In univariate analyzes, ultrasonographic BI-RADS, mammographic BI-RADS and age variables were found to be associated with malignancy (p = 0.0001). In the multiple logistic regression analysis, ultrasonographic and mammographic BI-RADS values were found to be risk factors for malignancy (p = 0.0001). CONCLUSIONS BI-RADS scoring was used to determine risk factors in predicting malignancy in the evaluation of suspected nonpalpable lesions. The ultrasound-guided wire localization biopsy is a useful method in nonpalpable breast lesions with suspected malignancy that cannot be diagnosed by core/vacuum biopsy or in cases where incompatibility between pathology and radiology results exists.

Pınar Korkmaz1, Irem Yıldırım2, Fatma Akkoyun Arıkan3, Halil Aslan1, Duru Mıstanoğlu Özatağ1, Özlem Genç4, Mehmet Karaman5 1Infectious Diseases Clinic 2Neurology Clinic 3Neurology Diseases Clinic 4Microbiology Laboratory 5Internal Medicine Clinic, KSBÜ Evliya Çelebi Training and Research Hospital, Kutahya, Turkey A case of neurobrucellosis A case of neurobrucellosis detected during brucella treatment

ÖZ Giriş: SARS-COV-2 infeksiyonunda yüksek riskli hastaların tanımlanması ve ivedilikle tedaviye başlanması mortalite hızını azaltmak için gereklidir

Introduction: Identification of high-risk patients in SARS-COV-2 infection and prompt initiation of treatment are essential to reduce mortality rate. In our study, it was aimed to evaluate the clinical and laboratory characteristics of patients with a diagnosis of COVID-19 who were hospitalized in our hospital and the factors that determine the severity of the disease. Materials and Methods: The files of definite/probable COVID-19 patients over the age of 18 who were followed by the Infectious Diseases Clink of our hospital between March 15 and November 1, 2020 were evaluated retrospectively. Results: A total of 302 patients were included in the study, 50.3% of the patients were males. Mean age of the patients participating in the study was 62.11 +/- 17.15 years. 51.3% of the patients are 65 years or older. The most common comorbidities in our patients were hypertension and diabetes mellitus. It was determined that lymphocyte count was below 800 in 22.5% of the patients. Involvement was detected on thorax CT in 88.7% of the patients, ground glass was observed in 95.8%. The most commonly used antiviral treatment in patients was favipiravir with 59.6%. Severe disease was present in 25.8% of all patients. In elderly patients with high comorbidities, COVID-19 was more severe, lymphopenia, hypofibrinogenemia and hypoproteinemia were more common in these patients, and there were significant differences in AST, D-dimer, ferritin, LDH, CRP, procalcitonin, troponin, PTZ and INR values in relation to the severity of the disease. Consolidation, infiltration and atelectasis in thorax CT were significantly higher in patients with severe disease. The average hospitalization period of the patients was 10.06 +/- 6.07 days, the rate of follow-up in the intensive care unit was 12.6%, and 5% of the patients died. Conclusion: Good identification of demographic clinical and laboratory prognostic factors for severe COVID-19 may contribute to physicians in the follow-up and treatment of the disease.

Objective: Candida species are among the most common causes of bloodstream infections and are associated with serious morbidity and mortality.Especially with the increasing number of patients receiving chemotherapy and other immunosuppressive treatment, developments in transplantation surgery, widespread use of broad spectrum antibiotics, the incidence of bloodstream infections caused by Candida species has increased in the last two decades.With the increase in the incidence of candidiasis, other Candida species are also increasing.With this change, increasing resistance to conventional treatments is also reported.In this study, it was aimed to evaluate the species distribution, resistance pattern, risk factors and clinical course in candidemia cases in the intensive care unit with a 3-year retrospective analysis.Methods: Hospital infection surveillance forms and medical records of patients who were followed up in Neurology Intensive Care Unit of our hospital's and diagnosed with candidemia between January 2017-December 2019 were retrospectively evaluated.Results: In our study, Candida species were isolated in at least one blood culture from a total of 25 patients.Makale Dili "Türkçe"/Article Language "Turkish"