Publications by authors named "Nevra Elmas"

22 Publications

  • Page 1 of 1

Patient-centered oncosurgical planning with cancer models in subspecialty education.

Surg Oncol 2021 Jun 5;37:101537. Epub 2021 Mar 5.

Department of Radiology, Ege University Faculty of Medicine, Turkey.

Background: A fundamental aspect of oncosurgical planning in organ resections is the identification of feeder vessel details to preserve healthy organ tissue while fully resecting the tumors. The purpose of this study was to determine whether three-dimensional (3D) cancer case models of computed tomography (CT) images will assist resident-level trainees in making appropriate operative plans for organ resection surgery.

Methods: This study was based on the perception of surgery residents who were presented with 5 different oncosurgical scenarios. A five-station carousel including cases of liver mass, stomach mass, annular pancreas, pelvic mass and mediastinal mass was formed for the study. The residents were required to compare their perception level of the cases with their CT images, and 3D models in terms of identifying the invasion of the mass, making differential diagnosis and preoperative planning stage.

Results: All residents have given higher scores for models. 3D models provided better understanding of oncopathological anatomy and improved surgical planning. In all scenarios, 70-80% of the residents preferred the model for preoperative planning. For surgical choice, compared to the CT, the model provided a statistically significant difference in terms of visual assessment, such as tumor location, distal or proximal organotomy (p:0.009). In the evaluation of presacral mass, the perception of model was significantly better than the CT in terms of bone-foramen relationship of chondrosarcoma, its origin, geometric shape, localization, invasion, and surgical preference (p:0.004). The model statistically significantly provided help to evaluate and prepare the case together with the colleagues performing surgery (p:0.007). Commenting on the open-ended question, they stated that the tumor-vessel relationship was clearly demonstrated in the 3D model, which has been very useful.

Conclusions: With the help of 3D printing technology in this study, it is possible to implement and evaluate a well-structured real patient scenario setup in cancer surgery training. It can be used to improve the understanding of pathoanatomical changes of multidisciplinary oncologic cases. Namely, it is used in guiding the surgical strategy and determining whether patient-specific 3D models change pre-operative planning decisions made by surgeons in complex cancer mass surgical procedures.
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http://dx.doi.org/10.1016/j.suronc.2021.101537DOI Listing
June 2021

Female form of persistent Müllerian duct syndrome: A rare case report and review of literature.

Int J Surg Case Rep 2020 31;77:298-302. Epub 2020 Oct 31.

Department of Urology, Ege University Hospital, Faculty of Medicine, Izmir, Turkey.

Introduction: Persistent Müllerian duct syndrome (PMDS) is a rare form of internal male pseudohermaphroditism characterized by the presence of rudimentary Müllerian structures in a virilized male often presenting as undescended testes. Thus, each patient diagnosed with undescended testes should promptly be investigated for PMDS because the early diagnosis has direct effects on outcome and prognosis.

Case Report: A 26-year-old-male complained of long-standing abdominal pain two years ago and was diagnosed having bilateral undescended testes in the pelvic region. He underwent the orchidopexy about one year ago but, after 5 months of orchidopexy, he first complained of discomfort in the left and then right inguinal region due to an incisional hernia that presumed to have the ovotesticular disorder of sexual development. On the pelvic MRI exam, the Müllerian duct structures were observed and he was diagnosed as having PMDS.

Discussion: In this case the patient had bilateral cryptorchidism with testes fixed in the para iliac region with respect to the uterus, indicating the female type of PMDS which is a rare type of PMDS. The case is proven genetically and Müllerian duct remnants have been resected to avoid malignant transformation.

Conclusion: Persistent Mullerian duct syndrome (PMDS) is a rare finding and may present as long-standing abdominal pain. Each patient diagnosed with undescended testes should promptly be investigated for PMDS. Diagnosis and management aim to preserve fertility and prevent malignant changes. Therefore, familiarity with this rare condition will lead to adequate management and prevention of complications.
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http://dx.doi.org/10.1016/j.ijscr.2020.10.113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674157PMC
October 2020

Dual-energy CT enterography in evaluation of Crohn's disease: the role of virtual monochromatic images.

Jpn J Radiol 2021 Apr 7;39(4):341-348. Epub 2020 Nov 7.

Department of Radiology, Ege University Faculty of Medicine, Bornova, Izmir, 35100, Turkey.

Purpose: To assess the use of virtual monochromatic images (VMI) for discrimination of affected and non-affected bowel walls in patients with Crohn's disease (CD) as well as to compare mural enhancement between patients with and without CD.

Materials And Methods: This retrospective study included 61 patients (47 with CD, 14 without CD). Attenuation value (AV), signal-to noise ratio (SNR), and contrast-to-noise ratio (CNR) were obtained at VMI energy levels from 40 to 110 keV in 10 keV increment. Analyses were performed among affected and non-affected bowel walls in CD patients, as well as from bowel walls in patients without CD. Image quality and mural enhancement were evaluated at VMI energy levels at 40, 70, and 110 keV.

Results: At all energy levels of VMI, each quantitative data for AV, SNR, and CNR showed statistically significant difference between diseased and non-diseased bowel walls in CD patients. In the quantitative assessment of patients with and without CD, the optimal AV and SNR were obtained at 40 keV, and the optimal CNR was obtained at 70 keV. For the qualitative assessment, the best image quality and mural enhancement were obtained at 70 keV and 40 keV, respectively.

Conclusion: VMI are helpful for the differentiation of affected bowel walls in CD patients, providing high diagnostic accuracy.
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http://dx.doi.org/10.1007/s11604-020-01065-6DOI Listing
April 2021

Correlation of liver-to-spleen ratio, lung CT scores, clinical, and laboratory findings of COVID-19 patients with two consecutive CT scans.

Abdom Radiol (NY) 2021 04 13;46(4):1543-1551. Epub 2020 Oct 13.

Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Turkey.

Purpose: Given the lack of information about abdominal imaging findings and correlation with clinical features of COVID-19, we aimed to evaluate the changes in hepatic attenuation during the course of disease. Our aim was to correlate the liver-to-spleen ratio (L/S), clinical, laboratory findings, and lung CT scores of patients with COVID-19 who had two consecutive chest CTs.

Methods: A retrospective search was performed between March 1, 2020 and April 26, 2020 to identify patients who had positive RT-PCR tests and two unenhanced chest CTs. Scans that were obtained at hospital admission and follow-up were reviewed to assess L/S and lung CT scores. Patients were divided into two groups based on lung CT scores (non-progressive vs progressive). Patient demographics, laboratory findings, length of hospital stay, and survival were noted from electronic medical records.

Results: Twenty patients in the progressive group and 7 patients in the non-progressive group were identified. The mean L/S of the progressive group (1.13 ± 0.3) was lower than that of the non-progressive group (1.21 ± 0.29) at hospital admission but there was no significant difference between the two groups (p = 0.547). L/S at follow-up was significantly different between the groups as the mean L/S values of the progressive and non-progressive groups were 1.02 ± 0.23 and 1.25 ± 0.29, respectively (p = 0.009). L/S was negatively correlated with AST and ALT (r =  - 0.46, p = 0.016 and r =  - 0.534, p = 0.004, respectively). There were significant differences between the two groups in terms of WBC, neutrophil, lymphocyte, monocyte, and platelet counts that were obtained at hospital admission. Length of hospital stay was significantly longer in patients in the progressive group (p = 0.035).

Conclusions: Decrease in L/S may be observed in patients with elevated lung CT scores at follow-up. WBC, neutrophil, lymphocyte, monocyte, and platelet counts at hospital admission may predict the progression of COVID-19.
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http://dx.doi.org/10.1007/s00261-020-02805-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553377PMC
April 2021

Characterization of adrenal lesions on chemical shift MRI: comparison of 1.5 T and 3 T MRI.

Abdom Radiol (NY) 2019 10;44(10):3359-3369

Department of Radiology, Ege University School of Medicine, 35100, Izmir, Turkey.

Purpose: To compare three chemical shift MRI techniques [two-dimensional (2D) dual gradient echo (dGRE), 3D VIBE, and 3D VIBE-Dixon] at 3 T and 2D dGRE technique at 1.5 T to assess their ability of detecting microscopic fat in adrenal adenomas and differentiating between adenomas and non-adenomas.

Methods: Seventy-eight patients with 97 lesions (78 adenomas, 19 non-adenomas) underwent both 1.5 T and 3 T chemical shift MRI. The Wilcoxon signed-ranked test was used to determine if there was significant difference between the signal intensity index (SII) values of each technique to assess their ability to detect microscopic fat in adrenal adenomas. ROC analysis was performed for the SII values of each technique, the adrenal-to-spleen SI ratio of 2D dGRE technique at 3 T, and the fat fraction values of the 3D VIBE-Dixon technique to identify the optimal threshold for differentiation of adrenal adenomas from non-adenomas.

Results: For detection of microscopic fat, the mean SII value of 2D dGRE technique at 1.5 T was significantly higher than that of the chemical shift imaging techniques at 3 T (p = 0.001). For discrimination of adenomas from non-adenomas, the area under the curve (AUC) and 95% confidence interval values of 2D dGRE technique at 1.5 T and 2D dGRE, 3D VIBE, 3D VIBE-Dixon techniques at 3 T were calculated as 1.00 (1.00-1.00), 0.991 (0.978-1.00), 0.999 (0.995-1.00), 0.993 (0.979-1.00), respectively, for the SII.

Conclusion: Chemical shift MRI at 1.5 T using the 2D dGRE technique provided the most accurate differentiation between adenomas and non-adenomas. However, there was no statistically significant difference between chemical shift imaging techniques at 1.5 T and 3 T.
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http://dx.doi.org/10.1007/s00261-019-02067-3DOI Listing
October 2019

Results of 1001 liver transplantations in 23 years: Ege University experience.

Turk J Gastroenterol 2018 11;29(6):664-668

Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey.

Background/aims: Liver transplantation (LT) is now the standard of care for most end-stage liver diseases. Over the next 30 years, advances in medicine and technology will greatly improve the survival rates of patients after this procedure. The aim of the present study was to analyze retrospectively the results of 1001 patients withLT.

Materials And Methods: Medical reports of 989 patients were analyzed retrospectively. Data were obtained from the patient's data chart. Descriptive statistics were used to describe continuous variables (mean, median, and standard deviation).

Results: A total of 1001 LTs for 989 recipients were performed at Ege University Organ Transplantation and Research Center between 1994 and 2017. Therewere 639 male and 350 female recipients. Among 1001 LTs, there were 438 deceased donors and 563 living donors. The age interval of the patients was 4 months to 71 years old. The median Model for End-Stage Liver Disease score was 20. There were 12 deceased liver donors using the split method. There were 12 cases subject to retransplantation. In living donor LT grafts, 423 right lobes, 46 left lobes, and 94 left lateral sectors were used. In the first monitoring,the total annual mortality rate was 130 cases (13%). The mortality rate in retransplantation was found to be 66%. A 1-year survival rate of 87% was generally stablished.

Conclusion: LThas been improving consistently over the last two decades. Ege University is one of the biggest liver transplant centers in Turkey for both technical and educational perspective.
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http://dx.doi.org/10.5152/tjg.2018.18058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284687PMC
November 2018

The effects of chemoradiotherapy on recurrence and survival in locally advanced rectal cancers with curative total mesorectal excision: a prospective, nonrandomized study.

World J Surg Oncol 2017 Nov 22;15(1):205. Epub 2017 Nov 22.

Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkey.

Background: There are only two prospective, randomized studies comparing preoperative long-term chemoradiotherapy and postoperative chemoradiotherapy in locally advanced rectal cancer (LARC); however, conflicting results in terms of locoregional recurrence (LR) and survival rates have been reported. This prospective study aims to compare the effects of preoperative versus postoperative chemoradiotherapy on recurrence and survival rates in LARC patients.

Methods: From January 2003 to January 2016, a total of 336 eligible patients who were clinically diagnosed with LARC (T-T tm or node-positive disease) were prospectively assigned into preoperative chemoradiotherapy (n = 177) and postoperative chemoradiotherapy (n = 159) groups. The preoperative treatment consisted of 50.4 Gy total dose of radiotherapy (delivered in fractions of 1.8 Gy) and concomitant two cycles chemotherapy of 5-fluorouracil and leucovorin. The patients in the preoperative group underwent curative total mesorectal excision (TME) following long-term chemoradiotherapy. Surgery was performed 8 (range 4-12) median weeks after the completion of the chemoradiotherapy. Similar protocol was administered to the postoperative group 4 weeks after the operation. Four cycles of adjuvant chemotherapy were added to the groups. The primary end points were locoregional recurrences and 5-year cancer-specific, overall, and disease-free survivals.

Results: The mean follow-up period was 60.4 (range 12 to 168) months. Five-year cumulative incidence of locoregional recurrence (LR) was 7.4% in the preoperative group and 13.4% in the postoperative group (p = 0.021). Five-year cancer-specific survival (CSS) was 87.5% in the preoperative group and 80% in the postoperative group (p = 0.022). Overall survival (OS) was 79.8 versus 74.7% (p = 0.064), disease-free survival (DFS) was 75.2 versus 64.8% (p = 0.062), and severe late toxicity was 7.4 versus 13.2% (p = 0.002), respectively. The rate of patient compliance was higher in the preoperative group (p < 0.001).

Conclusions: Preoperative chemoradiotherapy, as compared with postoperative chemoradiotherapy, significantly improved local control, patient compliance, CSS, and late toxicity and suggested a trend toward improved overall and disease-free survival.
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http://dx.doi.org/10.1186/s12957-017-1275-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5700528PMC
November 2017

Pazopanib: a novel treatment option for aggressive fibromatosis.

Clin Sarcoma Res 2016 1;6:22. Epub 2016 Dec 1.

Department of Medical Oncology, Ege University Medical School, Tulay Aktas Oncology Hospital, Ege University, Izmir, Turkey.

Background: Aggressive fibromatosis (AF), also known as desmoid tumor, is an uncommon soft tissue neoplasm. AF does not metastasize, but it is locally invasive and its propensity for recurrence after conservative resection is well documented. No effective cytotoxic treatment has been reported, hence there is a need for novel treatment strategies.

Case Presentation: We present the case of an AF successfully treated with an oral tyrosine kinase inhibitor, pazopanib, with mild side effects. As far as we know, this is the first case of AF with complete response to pazopanib.

Conclusion: Pazopanib might be an effective treatment option for AF.
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http://dx.doi.org/10.1186/s13569-016-0061-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5131445PMC
December 2016

Co-occurrence of inflammatory fibroid polyp in Crohn's disease: A MR enterography study.

Turk J Gastroenterol 2015 Jul 2;26(4):361-2. Epub 2015 Jun 2.

Department of Radiology, Abant İzzet Baysal University, Training and Research Hospital, Bolu, Turkey.

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http://dx.doi.org/10.5152/tjg.2015.0191DOI Listing
July 2015

Renal sinus fat invasion and tumoral thrombosis of the inferior vena cava-renal vein: only confined to renal cell carcinoma.

Case Rep Radiol 2014 18;2014:140365. Epub 2014 Nov 18.

Department of Radiology, Ege University School of Medicine, Bornova, 35100 Izmir, Turkey.

Epithelioid angiomyolipoma (E-AML), accounting for 8% of renal angiomyolipoma, is usually associated with tuberous sclerosis (TS) and demonstrates aggressive behavior. E-AML is macroscopically seen as a large infiltrative necrotic tumor with occasional extension into renal vein and/or inferior vena cava. However, without history of TS, renal sinus and venous invasion E-AML would be a challenging diagnosis, which may lead radiologists to misinterpret it as a renal cell carcinoma (RCC). In this case presentation, we aimed to report cross-sectional imaging findings of two cases diagnosed as E-AML and pathological correlation of these aforementioned masses mimicking RCC.
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http://dx.doi.org/10.1155/2014/140365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4251875PMC
December 2014

Primary mesenchymal liver tumors: radiological spectrum, differential diagnosis, and pathologic correlation.

Abdom Imaging 2015 Jun;40(5):1316-30

Department of Radiology, Faculty of Medicine, University of Ege, İzmir, Turkey,

With the exception of hemangioma, benign or malignant primary mesenchymal tumors of the liver are seldom encountered. The aim of this review was to discuss the clinical, histopathological, and imaging features of liver hemangiomas (cavernous, capillary, and sclerosed types), liver lipoma, angiomyolipoma, mesenchymal hamartoma, neurofibroma, infantile hemangioendothelioma, epithelioid hemangioendothelioma, myofibroblastoma, angiosarcoma, malignant fibrous histiocytoma, undifferentiated embryonal sarcoma, and nested stromal tumor. In most of these rare liver tumors, radiological findings obtained by cross-sectional imaging may reflect the characteristic pathologic features required for differential diagnosis; however, definitive diagnosis should be confirmed using histopathological examination.
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http://dx.doi.org/10.1007/s00261-014-0268-9DOI Listing
June 2015

Evaluation of treatment response of chemoembolization in hepatocellular carcinoma with diffusion-weighted imaging on 3.0-T MR imaging.

J Vasc Interv Radiol 2012 Feb 22;23(2):241-7. Epub 2011 Oct 22.

Department of Radiology, Ege University Faculty of Medicine, 35100 Bornova, Izmir, Turkey.

Purpose: To assess the treatment response of hepatocellular carcinoma (HCC) after transarterial chemoembolization with diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance (MR) imaging with a 3-T system.

Materials And Methods: Between February 2010 and November 2010, 74 patients were treated with chemoembolization in our interventional radiology unit. Twenty-two patients (29%) who had liver MR imaging including diffusion and dynamic contrast-enhanced MR imaging on a 3-T system before and after transarterial chemoembolization were evaluated retrospectively. Tumor size, arterial enhancement, venous washout, and apparent diffusion coefficient (ADC) values of lesions, peritumoral parenchyma, normal liver parenchyma, and spleen were recorded before and after treatment. The significance of differences between ADC values of responding and nonresponding lesions was calculated.

Results: The study included 77 HCC lesions (mean diameter, 31.4 mm) in 20 patients. There was no significant reduction in mean tumor diameter after treatment. Reduction in tumor enhancement in the arterial phase was statistically significant (P = .01). Tumor ADC value increased from 1.10 × 10(-3) mm(2)/s to 1.27 × 10(-3) mm(2)/s after treatment (P < .01), whereas the ADC values for liver and spleen remained unchanged. ADC values from cellular parts of the tumor and necrotic areas also increased after treatment. However, pretreatment ADC values were not reliable to identify responding lesions according to the results of receiver operating characteristic analysis.

Conclusions: After transarterial chemoembolization, responding HCC lesions exhibited decreases in arterial enhancement and increases in ADC values in cellular and necrotic areas. Pretreatment ADC values were not predictive of response to chemoembolization.
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http://dx.doi.org/10.1016/j.jvir.2011.08.030DOI Listing
February 2012

Hydatid disease involving some rare locations in the body: a pictorial essay.

Korean J Radiol 2007 Nov-Dec;8(6):531-40

KSU Medical School, Department of Radiology, Kahramanmaras, Turkey.

Hydatid disease (HD) is an endemic illness in many countries, and it poses an important public health problem that's influenced by peoples' socioeconomic status and migration that spreads this disease. Although rare, it may occur in any organ or tissue. The most common site is the liver (59-75%), followed in frequency by lung (27%), kidney (3%), bone (1-4%) and brain (1-2%). Other sites such as the heart, spleen, pancreas and muscles are very rarely affected. Unusual sites for this disease can cause diagnostic problems. This pictorial essay illustrates various radiological findings of HD in the liver, spleen, kidney, pancreas, peritoneal cavity, omentum, adrenal, ovary, lung, mediastinum and retroperitoneum. Familiarity with the imaging findings of HD may be helpful in making an accurate diagnosis and preventing potential complications.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627456PMC
http://dx.doi.org/10.3348/kjr.2007.8.6.531DOI Listing
March 2008

Role of contrast-enhanced 3D magnetic resonance portography in evaluating portal venous system compared with color Doppler ultrasonography.

Abdom Imaging 2008 Jan-Feb;33(1):65-71

Department of Radiology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey.

Aim: The purpose of this study was to evaluate the capability of contrast-enhanced three-dimensional (3D) MR portography in detecting abnormal findings associated with the portal venous system compared with the results of color Doppler ultrasonography (CDUS).

Materials And Methods: MR portography findings were retrospectively compared with the results of CDUS examinations in 161 patients, who were suspected of having portal venous system abnormalities. Portal venous vessels were divided into main 5 groups including the main portal vein, its left and right intrahepatic branches, splenic vein and superior mesenteric vein. Imaging findings were classified as normal, occluded, or partially thrombosed. Results of clinical and imaging follow-up examinations including CDUS, MR portography or angiography, if available, were used as a proof of final diagnosis. The potential sites of varicose veins and collateral vessels were also examined by both imaging methods.

Results: Vascular abnormalities were identified in 79 of 161 patients. There was a statistically significant agreement between the results of MR portography and CDUS in evaluating portal venous system (kappa = 0.871, P < 0.05). The sensitivity of MR portography was slightly superior to CDUS in detecting partially thrombosis and occlusion in the main portal venous vessels. In addition, MR portograms were superior to CDUS in the management of patients with portal hypertension by identifying portosystemic collaterals more adequately, and clearly demonstrated portal venous vessels that cannot be visualized at CDUS.

Conclusion: Results of present study indicates that contrast-enhanced 3D MR portography is well suited and superior to CDUS in the management of patients with portal hypertension.
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http://dx.doi.org/10.1007/s00261-007-9229-xDOI Listing
January 2008

Contrast agents used in MR imaging of the liver.

Diagn Interv Radiol 2006 Mar;12(1):22-30

Department of Radiology, Pamukkale University School of Medicine, Denizli, Turkey.

Several categories of contrast agents with different biodistributions are currently available for magnetic resonance imaging of the liver. They improve lesion detection and characterization by increasing lesion-liver contrast. These agents include nonspecific extracellular gadolinium chelates, reticuloendothelial system- specific iron oxides, hepatocyte-selective agents, and combined perfusion and hepatocyte-selective agents. This article describes the currently used contrast agents in magnetic resonance imaging of the liver, summarizes their mechanisms of action, biodistributions, and safety profiles. Additionally, it reviews their main clinical indications, administration and imaging techniques, and the appearances of common hepatic lesions in contrast-enhanced studies.
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March 2006

[Primary hepatic actinomycosis: a case of inflammatory pseudotumor (case report)].

Tani Girisim Radyol 2004 Jun;10(2):154-7

Ege Universitesi Tip Fakültesi, Radyodiagnostik Anabilim Dali, Izmir, Turkey.

Actinomycosis is an uncommon chronic infection in which primary liver involvement accounts for 5% of all actinomycotic infections. Abdominal actinomycosis is a severe and progressive peritoneal infection due to an anaerobic gram-positive bacterium, Actinomyces israelii. The presence of a long-standing intrauterine device (IUD) is a well-known risk factor in young women. Although hepatic lesions are present in 15% of cases of abdominal actinomycotic infection, liver involvement in the majority of these cases is attributable to metastatic spread from other evident intraabdominal sites. Hepatic actinomycosis presents most commonly as a single abscess. However, hepatic actinomycosis can closely mimic a malignant tumor on clinical and radiological examination. Such lesions have been termed inflammatory pseudotumors. Tissue specimens for microscopic examination are necessary for diagnosis. We report a rare case of inflammatory pseudotumor of the liver caused by actinomycotic infection.
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June 2004

Regenerative nodule mimicking hepatocellular carcinoma in a cirrhotic child due to hepatitis B: an imaging dilemma.

Pediatr Transplant 2004 Apr;8(2):198-200

Department of Pediatric Gastroenterology and Nutrition, Ege University, School of Medicine, Bornova, Izmir, Turkey.

Viral hepatitis B, post-hepatitic cirrhosis and hepatocellular carcinoma (HCC) is the classical sequence of events in hepatitis B virus (HBV) infected children and serum Alpha-fetoprotein (AFP) and ultrasound (USG) screening is recommended during follow up. We present a 13-yr-old girl with cirrhosis related to chronic HBV infection with normal AFP level and a 4 cm mass appearance by USG. Contrast spiral evaluation computed tomography (CT) study demonstrated a single mass located at 8th segment of the liver. Pre-contrast CT and portal venous phase studies showed heterogeneous liver parenchyma without mass appearance. HCC was suspected based on strong arterial enhancement. Two mediastinal lymphadenopathies, 1 cm under the xyphoid and 2 cm above the pericardium, were detected by thorax CT. Mediastinal exploration was undertaken with living related liver transplant donor in a second operating room. She was transplanted with the right lobe of her ABO compatible mother after evaluation of the lymph nodes revealed reactive histology by frozen section. Histologic evaluation of the explant liver documented cirrhosis with a cirrhotic nodule without histologic malignant evidence. False negative results from screening methods are familiar in the literature; however false positivity of a contrast CT study is rare. The significance of screening methods is discussed.
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http://dx.doi.org/10.1046/j.1399-3046.2003.00019.xDOI Listing
April 2004

Experience of the Izmir Pediatric Oncology Group on Neuroblastoma: IPOG-NBL-92 Protocol.

Pediatr Hematol Oncol 2003 Apr-May;20(3):211-8

Department of Pediatric Oncology, Dokuz Eylül University, Institute of Oncology, Izmir, Turkey.

This multicentric study aimed to bring neuroblastoma patients together under IPOG-NBL-92 protocol and evaluate the results within the period between 1992 and 2001 in Izmir. Sixty-seven neuroblastoma patients from 4 pediatric oncology centers in Izmir were included in the study. IPOG-NBL-92 protocol modified from German Pediatric Oncology (GPO)-NB-90 protocol was applied: Patients in stage 1 received only surgery, while surgery plus 4 chemotherapy courses (cisplatin, vincristine, ifosfamide) were given in stage 2 and surgery plus 6 chemotherapy courses (cisplatin, vincristine, ifosfamide, epirubicin, cyclophosphamide) were given in stages 3 and 4 patients. In patients who were kept in complete remission (CR), a maintenance therapy of one year was applied. Radiotherapy was given to the primary site following induction chemotherapy plus surgery in stages 3 and 4 patients with partial remission (PR). The stages of the patients were as follows: 5% in stage 1, 39% in stage 3, 49% in stage 4, and 7% in stage 4S. Primary tumor site was abdomen in 88% of cases. CR rates were as 100% in stage 1, 76% in stage 3, 35% in stage 4, and 75% in stage 4S. Relapse was observed in 32% of patients in a median of 19 months. The median follow-up time for survivors was 33 (17-102) months. Five-year OS rate was 31% and the EFS rate was 30% in all patients. Five-year overall and event-free survival rates were 63 and 30% in stage 3, but 6 and 5%, respectively, in stage 4 patients. Univariate analysis established that the age, stage, primary tumor site, and high LDH and NSE levels conferred a significant difference. The IPOG-NBL-92 protocol has proved to be satisfactory with tolerable toxicity and reasonable CR and survival rates. However, more effective treatments suitable to Turkey's social and economic conditions are urgently needed for children over 1 year of age with advanced neuroblastoma.
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November 2003

CT findings of abdominal tuberculosis in 12 patients.

Comput Med Imaging Graph 2002 Sep-Oct;26(5):321-5

Department of Radiology, Ege University School of Medicine, Bornova, 35100, Izmir, Turkey.

Our purpose was to evaluate the Computed Tomography (CT) findings of the abdominal tuberculosis (TBC) retrospectively which was diagnosed histopatologically. This study included 12 patients. All patients were evaluated by abdominal CT study. Most findings of CT studies were mesenteric calcified or noncalcified lymphadenopathies, ascites, thickened intestinal wall located on the right lower quadrant of abdomen, thickening of peritoneum, mottled soft-tissue densities in omentum and mesenterium. In addition, one of the patients had bilateral calcified adrenal glands and one of them had calcified mass in adrenal gland. If peritoneal thickening, ascites, abdominal lymphadenophaties and thickened intestinal walls are obtained, TBC should be considered in differential diagnosis in developing countries.
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http://dx.doi.org/10.1016/s0895-6111(02)00029-0DOI Listing
November 2002

Stromal predominant type mesenchymal hamartoma of liver: CT and MR features.

Comput Med Imaging Graph 2002 May-Jun;26(3):167-9

Dept. of Radiology, Süleyman Demirel University, Isparta-Türkiye, Turkey.

Mesenchymal hamartoma is a rare pediatric liver tumor. The tumor is mainly cystic but occasionally a solid component is seen. Therefore the tumor can be divided into two forms: (a) cystic predominant, and (b) stromal predominant. In this report, CT and MR features of stromal predominant type mesenchymal hamartoma are presented.
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http://dx.doi.org/10.1016/s0895-6111(01)00041-6DOI Listing
June 2002
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