Güven Hospital

We report a rare case of contralateral invasive lobular carcinoma (ILC) diagnosed three years after initial treatment for invasive ductal carcinoma (IDC). The new lesion, detected incidentally on screening MRI, mimicked an intramammary lymph node on MRI and ultrasound due to its well-circumscribed appearance and hilar-like echogenicity. Shear-wave elastography revealed high stiffness values, raising suspicion for malignancy. Core biopsy confirmed ILC. This case underscores the critical role of MRI in detecting clinically occult cancers and highlights elastography’s potential to unmask malignancies mimicking benign structures.

entitled "Artificial intelligence in radiology: Diagnostic sensitivity of ChatGPT for detecting hemorrhages in cranial computed tomography scans".The authors evaluated the performance of Generative Pre-trained Transformer 4 with Vision (GPT-4V) in detecting intracranial hemorrhage on non-contrast cranial computed tomography (CT) and demonstrated a marked increase in sensitivity following guided prompting.We commend the authors for addressing a timely and clinically relevant topic.Nevertheless, we believe several methodological considerations merit further discussion.

End-stage liver disease continues to present a major clinical challenge, for which liver transplantation (LT) remains the only treatment capable of restoring long-term survival and organ function. Despite advancements in perioperative care and surgical techniques, predicting post-transplant outcomes remains an area of considerable uncertainty. The neutrophil percentage-to-albumin ratio (NPAR), derived from standard blood tests, has emerged as a marker reflecting both systemic inflammation and nutritional status. While NPAR has shown prognostic potential in various liver-related conditions, its role in LT has not been fully clarified. We retrospectively analyzed data from 167 adult patients who underwent LT between 2012 and 2022. Patients were stratified by post-transplant survival status. Preoperative variables – including serum albumin, model for end-stage liver disease (MELD) score, and NPAR – were compared between survivor and non-survivor groups. Receiver operating characteristic analyses were performed to evaluate the predictive performance of these parameters individually and in combination. Significant differences in albumin, total bilirubin, MELD score, and NPAR were observed between survivor and non-survivor groups (P < .05). Individually, both NPAR and MELD demonstrated limited predictive value (AUC = 0.387 and 0.383, respectively). However, their combined application significantly improved discriminatory ability (AUC = 0.654, P = .007), suggesting a complementary interaction. Although NPAR alone is not a strong standalone predictor of post-transplant survival, its integration with the MELD score enhances prognostic accuracy. These findings support the role of NPAR as an adjunct parameter in refining pre-transplant risk assessment.

Background and AimPneumocystis jirovecii (PJ) can be seen in solid organ transplant (SOT) recipients. Despite guidelines recommending PJP prophylaxis for 6–12 months post-transplantation, the necessity for liver transplant patients remains controversial, with conflicting evidence on PJP rates. This study examined PJP occurrence in 242 liver transplant patients at a single center who received no PJP prophylaxis.Materials and MethodsA retrospective study examined the clinical and microbiological data of 242 liver transplant (LTx) patients to evaluate PJP incidence within one year post-transplant. PJP was diagnosed microbiologically and/or radiologically in cases of clinical suspicion, without systematic screening. The study investigated PJP infection risk factors reported previously, including cytomegalovirus (CMV) infection, bolus steroid therapy, age >65, prolonged neutropenia, and anti-thymocyte globulin (ATG) usage.ResultsThe study involved 242 liver transplant recipients, with an average age of 56 years, predominantly male (71%), and a mean Model for End-Stage Liver Disease (MELD) score of 16. No PJP cases were reported. Among PJP risk factors, none had prolonged neutropenia, though two developed CMV infection. Empirical steroid bolus treatment for suspected acute cellular rejection was given to 62 patients (26%). The cohort included 22 (9%) individuals over 65 years old, and none received ATG.ConclusionThis pioneering study examines a substantial living liver donor transplantation (LDLT) cohort without PJP prophylaxis, suggesting it may be unnecessary in centers with low immunosuppression and a low percentage of risk factors. Prospective studies are essential to establish targeted prophylactic approaches due to variations in PJP incidence across centers.

BackgroundThe study aimed to evaluate real-world data on liraglutide by assessing its efficacy, associated side effects, adverse events, and impact on metabolic parameters within the context of a multicenter national study.MethodsThis retrospective observational study analyzed data from 1009 patients across 38 endocrinology units from Türkiye. Patients with a history of bariatric surgery, those who started orlistat concurrently with liraglutide, and one patient who developed pancreatitis on the 15th day of treatment were excluded from the analyses of weight and laboratory changes.ResultsAt least one side effect was observed in 48% of the patients, with nausea and vomiting being the most common. The most frequent reason for discontinuing treatment was the cost of the medication (42.6%). The median duration of liraglutide use was 4 months (IQR; 3–6), and the median dose was 2.4 mg (IQR; 1.8–3). Among the entire cohort, 76.4% and 40.9% of patients achieved a 5% and 10% weight loss target, respectively. Significant reductions were observed in metabolic parameters during the treatment. The treatment duration was identified as an independent predictor for achieving 5% and 10% weight loss targets (B = 0.315, p < 0.001) and 10% weight loss (B = 0.216, p < 0.001).ConclusionsLiraglutide effectively results in clinically significant weight loss, achieves expected weight loss targets, and improves metabolic parameters in real-world clinical practice. Therefore, liraglutide is still a reasonable GLP-1 analogue in the obesity treatment. However, it may be associated with various side effects, necessitating close monitoring by clinicians.

Radioiodine (RAI) therapy is widely used for thyroid ablation; however, the accumulation of I-131 in non-thyroid tissues may lead to undesirable side effects. Vitamin D, known for its anti-apoptotic and immunomodulatory roles, may help protect against such damage. This study investigates the potential protective effects of vitamin D on RAI-induced liver injury through biochemical, histopathological, and immunohistochemical evaluations. Thirty male Wistar albino rats were randomly divided into three groups: Control (Group I, n = 10), RAI-treated (Group II, 111 MBq/kg, n = 10), and RAI + Vitamin D–treated (Group III, 200 ng/kg/day, n = 10). Liver function was assessed through serum analysis. Liver tissues were evaluated histopathologically and immunohistochemically. Oxidative stress markers including malondialdehyde (MDA), fluorescent oxidation products (FOP), catalase (CAT), and total sulfhydryl (T-SH) levels were measured in liver homogenates. RAI increased apoptotic cell numbers and elevated MDA, FOP, AST, and ALT levels. In contrast, T-SH and CAT levels were highest in the control group. Histopathology showed marked liver damage in the RAI group, which was less severe in the vitamin D group (p < 0.001). TUNEL and caspase-3 analyses confirmed increased apoptosis in the RAI group compared to the others (p < 0.001). Vitamin D alleviated RAI-induced liver injury, likely through its antioxidant, anti-apoptotic, and anti-inflammatory effects.

Hemangioma of the large intestine is a rare condition. Although such lesions do not present a risk of malignant transformation, they are associated with a potential for massive hemorrhage. Therefore, it is imperative to maintain a high index of suspicion for such lesions and to be cognizant of any interventional procedure that may result in excessive bleeding. This report presents the case of a patient who was admitted to the medical facility, where a hemangioma in the transverse colon was identified and subsequently excised without complications.Cite this article as: Moral K, Kaymaz E, Kabaçam G. “A rare cause of colonic polipoid lesion–colonic hemangioma”, Diagn Interv Endosc, 4, 0115, 2025. doi: 10.5152/DiagnIntervEndosc.2025.25115.

Medial open-wedge high tibial osteotomy (MOWHTO) is an effective treatment for medial compartment knee osteoarthritis. However, there is no consensus regarding the optimal management of the pes anserinus during the procedure. This study aimed to investigate the effects of pes anserinus release on radiological healing, alignment correction, and functional outcomes after MOWHTO. This retrospective cohort study included 73 patients who underwent MOWHTO with locking plate fixation. Patients were divided into two groups based on surgical preference: pes anserinus release (n = 35) and non-release (n = 38). Functional outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, six months, and 12 months. Radiographic parameters included the hip-knee-ankle (HKA) angle, medial proximal tibial angle (mMPTA), tibial slope, and time to bone union. Complications were also documented. Both groups were comparable in demographic characteristics and preoperative alignment. The non-release group achieved bone union significantly earlier (median 4.0 vs. 5.0 months, p = 0.019). There were no significant differences in HKA angle, mMPTA or tibial slope between the groups. At six months, KOOS scores were significantly higher in the non-release group (p < 0.001); however, by 12 months, both groups demonstrated similar functional outcomes. No major complications or nonunions were observed in either group. Preserving the pes anserinus during MOWHTO does not compromise alignment correction and may enhance early bone healing and functional recovery. Routine release of the pes anserinus may be unnecessary, and its preservation could offer clinical benefits during the early postoperative period. Further prospective, randomized studies are needed to validate these findings.

Background: Invasive fungal infections (IFIs) after liver transplantation (LT) remain a concern. No universal protocol for antifungal prophylaxis in LT exists. Antifungal prophylaxis varies across European centers. Studies suggest risk stratification for prophylaxis. This study assessed IFI frequency and outcomes in adult LT recipients without antifungal prophylaxis and evaluated risk stratification for predicting IFIs. Method: A retrospective analysis of clinical and microbiological data from 244 liver transplant patients focused on IFI within 100 days post-transplantation. Of these, 225 (92%) had right liver transplants from living donors. We assessed two risk stratification models for predicting IFI: one categorizes patients into low- and high-risk groups, and the other divides patients into three categories, with two eligible for prophylaxis and one not. Results: Of 244 patients, 3% (seven individuals) developed invasive fungal infections (IFI), including two aspergillosis and five candidiasis. IFI occurred in 8% of high-risk and 2% of low-risk patients in the first stratification, with no significant difference between groups (p = 0.144). In the second stratification, IFI was found in 4% of the target and 2% of non-target groups, without a significant difference (p = 0.455). Patients with IFI showed higher mean MELD scores of 21.71 ± 2.35 versus 17.04 ± 6.48 in those without IFI (p < 0.05). Conclusions: This study evaluated IFI outcomes without systemic antifungal prophylaxis in LT recipients. Limited antifungal use in a major living liver donor transplantation (LDLT) group, with low MELD scores and immunosuppression protocols, could be feasible. Future multicenter studies can improve understanding and develop prophylaxis algorithms for LT settings.