Sisli Etfal Training and Research Hospital

The most important risk factor in ischaemic stroke patients is hypertension (HT). Blood pressure regulation has an important role in hypertensive acute ischaemic stroke patients (AIS). In this study, we planned to compare the efficacy of nicardipine and esmolol infusion on blood pressure control and clinical outcome in hypertensive AIS patients. The study is a retrospective, cross-sectional study. It includes hypertensive AIS patients admitted to the emergency department. Target blood pressure, time to reach target blood pressure, discharge modified Rankin Scale (mRS), intracranial haemorrhage according to The European Cooperative Acute Stroke Study (ECASS II) and 30-day mortality of patients who were started Nicardipine or Esmolol within the indication were determined and mortality and morbidity of the two groups were compared. The study included 82 acute ischaemic stroke patients who were hypertensive at presentation. The mean age of the patients was 72 years (39–93). No difference was observed between the Nicardipine (n = 40) and Esmolol (n = 42) groups in terms of sociodemographic data, vital functions and clinical status (National Institutes of Health Stroke Scale - NIHSS) at admission. The target blood pressure levels were reached faster and more effectively in the Nicardipine group than in the Esmolol group (p < 0.001). No difference was observed between the two groups in terms of mRS, ECASS II scores and 30-day mortality. Nicardipine is more effective than Esmolol in blood pressure control in AIS patients who are candidates for invasive procedures such as thrombolysis and thrombectomy. The fact that there is no difference in mortality and morbidity between the two drugs suggests that Esmolol can also be used in selected patients.

Background/Aim Misdiagnosis of hereditary angioedema (HAE) leads to inappropriate management of the attacks. A scoring system that anticipates diagnosis can be beneficial for clinicians who are unfamiliar with angioedema. This study aims to develop a practical scoring system for use during acute attacks to predict HAE in patients with recurrent angioedema (RAE). Method To predict HAE, nine HAE experts unanimously identified five predictive items (PIs); absence of urticaria, presence of abdominal pain episodes, family history, early onset of attacks and previous unresponsiveness to anti‐histaminergic treatments. The researchers questioned 106 patients with HAE and 155 patients with mast cell‐mediated angioedema (MMAE) about PIs. A score was attributed to each significant PI based on OR values obtained through logistic regression analysis. The cut‐off point for the prediction of HAE and its sensitivity and specificity were determined by ROC curve analysis. Results In a univariate analysis, all items showed significant differences between HAE and MMAE patients. Regression analysis attributed scores as follows: 23 points for the absence of urticaria, 11 points for the abdominal pain episodes, 9 points for family history, and 53 points for unresponsiveness to antihistaminergic treatments. No score was attributed to early onset of age (p > 0.05). The ROC analysis revealed an area under the curve of 0.990, with a total score of ≥38 demonstrating the best sensitivity (96.4%) and specificity (96.1%). Conclusions HAEps is a valuable tool for diagnosing HAE in patients with RAE. A score of 38 or more indicates the possible presence of HAE with substantial sensitivity and specificity.

The aim of investigate the ability of 3-dimensional diameter measurements of the nodule to predict malignant nodules. Adult patients with thyroid nodules who underwent thyroid surgery or fine-needle aspiration biopsy between December 2017 and December 2022 were included in this retrospective study. Thyroid ultrasound images and final pathology results were collected. Nodule size was remeasured using recorded ultrasound images in 3 dimensions (longitudinal, anteroposterior, and transverse). The ratios of the longitudinal diameter to the transverse diameter (L/T), the longitudinal diameter to the anteroposterior diameter (L/AP), and the anteroposterior diameter to the transverse diameter (AP/T) were calculated. The recent American College of Radiology TI-RADS system was used for the ultrasonographic scoring of the nodules. Patients were grouped as benign or malignant based on their final pathology results. In total, 398 (70.69%) patients had benign nodules and 165 (29.31%) patients had malignant nodules. The malignant group was significantly older than the benign nodule group ( P = 0.011), while sex distributions were similar ( P = 0.101). Malignant nodules could be predicted with the following cutoff values: L/T ≤ 0.97 ( P < 0.001), L/AP ≤1.6 ( P < 0.001), and AP/T > 1.0 ( P < 0.001) or >0.94 ( P < 0.001). Multivariable logistic regression indicated that low (≤1.6) L/AP ratio and high scores for echogenicity, shape, margin, and echogenic foci were independently associated with malignancy. Combining the L/AP ratio with the AP/T ratio could improve the discrimination of malignant thyroid nodules from benign nodules. Incorporating the L/AP ratio into new risk classification systems warrants careful consideration.

Purpose Postoperative hypoparathyroidism is the most common complication after total thyroidectomy(TT). The clinical significance of incidental parathyroid glands(IP) detected in pathological examination of removed surgical material is still controversial. The aim of this study was to evaluate the clinical follow-up findings and risk factors of patients with IP. Methods Postoperative pathology results and postoperative biochemical findings of patients who underwent TT±Central Neck Dissection(CND)/Lateral Neck Dissection(LND) between September,2020 and September,2023 in single institution were retrospectively evaluated. Patients with IP were divided into Group-1, and patients without IP were divided into Group-2. Patients of Group-1 were divided as Single IP and Double IP subgroups according to the number of IP. Results The findings of a total of 412 patients were evaluated. IP was detected in 90(21.8%) of the patients. Postoperative hypoparathyroidism was more common in Group-1 at the 6th hour, 24th hour and 1st month postoperatively (69.7% vs. 31.7%, p < 0.0001; 61.1% vs. 27.7%, p < 0.0001, 26.2% vs. 12.2%, p = 0.002, respectively). Persistent hypoparathyroidism was observed at a rate of 5.3% in Group-2 and 11.5% in Group-1 (p = 0.041). Postoperative hypocalcemia was seen more frequently in Group-1 than in Group-2 at the 12th hour (34.4% vs. 23.2%, p = 0.031, respectively). There was no difference between Single IP vs. Double IP groups for the serum levels of Calcium and PTH. Among the risk factors evaluated for the detection of IP, in the univariance analysis, operation indications(p = 0.018), CND(p < 0.0001), surgeon experience(p = 0.016), thyroid gland volume(p = 0.02), preoperative serum TSH value(p = 0.031); in multivariance analysis, operation type ( ± CND) (OR:2.785; 95% CI: 1.175–6.605; p = 0.020) and operator experience between 10–20 years (OR: 0.117, 95% CI: 0.033–0.418, p = 0.001) and >20 years (OR: 0.254, 95%CI: 0.085–0.760, p = 0.014) were found significant compared to operators experienced <5 years. Conclusion Patients with detected IP after total thyroidectomy have lower postoperative Calcium and PTH. Significant risk factors for the IP were low level of surgeon experience and undergoing CND.

Molluscum contagiosum (MC) is a viral skin infection caused by a DNA virus from the Poxviridae family, typically presenting as pink, umbilicated papules or nodules. While commonly seen in children, MC in adults is often sexually transmitted. Immunosuppressed individuals, including those receiving biological therapies, are at greater risk for extensive and treatment-resistant lesions. Fingolimod, an immunomodulatory agent used in multiple sclerosis (MS), inhibits lymphocyte egress from lymph nodes, reducing T-cell-mediated immune responses and increasing susceptibility to infections, including MC. We report the case of a 35-year-old male with MS, treated with fingolimod for 5 years, who developed extensive genital lesions consistent with MC. Dermatological examination confirmed the diagnosis through clinical findings, Tzanck smear, and histopathology. Despite initial cryotherapy, the lesions persisted. A therapeutic approach using daily topical 10% potassium hydroxide solution was effective, leading to significant lesion regression within 1 month, allowing continuation of fingolimod therapy without interruption. A review of the literature identified 16 reported cases of MC associated with fingolimod therapy. These cases predominantly involved genital lesions and occurred in patients with significantly reduced lymphocyte counts. Therapeutic outcomes varied, with chemical treatments such as potassium hydroxide proving effective in cases unresponsive to physical interventions like cryotherapy or curettage.This case underscores the importance of recognizing MC as a potential complication in fingolimod-treated patients and highlights the utility of potassium hydroxide as a non-invasive treatment option. For patients unresponsive to treatment, collaboration with neurology teams is crucial to evaluate the potential need for altering immunosuppressive therapy. Dermatologists and neurologists should remain vigilant for MC in this population to ensure prompt diagnosis and effective management. This case highlights molluscum contagiosum as a potential complication of fingolimod therapy in multiple sclerosis patients. Topical potassium hydroxide proved effective for treatment, allowing continued immunotherapy. A multidisciplinary approach is essential for managing refractory cases while ensuring optimal MS treatment.

Postoperative pain management is crucial for enhancing recovery and minimizing complications after spinal tumor resections. This case series evaluates the serratus posterior superior intercostal plane (SPSIP) block for postoperative analgesia in 2 patients undergoing thoracic spinal tumor surgeries. Bilateral SPSIP blocks were performed under ultrasound guidance, providing analgesia that specifically covered the levels where the tumor resection was performed. Numerical rating scale (NRS) scores remained low, with minimal opioid consumption and no adverse effects. The findings highlight the efficacy, safety, and opioid-sparing potential of SPSIP block as a novel regional anesthesia technique, emphasizing its utility in managing postoperative pain for thoracic spinal surgeries. Further studies are warranted.

Background As the frequency of bariatric procedures rises, so does the demand for breast contouring operations. Massive weight loss results in ptotic breasts that are challenging to shape. However, concentrating solely on the breasts in the upper body leads to a state of imbalance. In this study, we aimed to add additional volume to the breast tissue by utilizing the lateral chest folds/back folds with combined upper body lifting procedures and show the long-term results. Methods Between January 2018 and June 2024, 24 patients presented to our clinic with a complaint of breast deformity due to massive weight loss. They were evaluated as a whole. Upper body lift and autoaugmentation mastopexy with a lateral thoracic region perforators-based flap were planned in a single stage. Dorsal soft tissue was also utilized for autoaugmentation in selected patients. The viability of the extended dorsal flaps was examined with the intraoperative indocyanine green angiography. Results The body contouring surgery was performed an average of 2.2 years after bariatric surgery. Autoaugmentation with extended fasciocutaneous flap procedures was performed in combination with other upper body lifting procedures according to the patient’s needs. The postoperative follow-up period was 1 month to 5 years. Conclusions In postbariatric patients, focusing only on the breast leads to aesthetic disharmony in the upper body. Using subcutaneous tissue in the autologous augmentation method eliminates sagging in the upper body and provides the desired volume to ptotic breasts. The five-year follow-up results demonstrate that this method provides long-lasting, satisfying results with minimal complications. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Choroid plexus papillomas are rare tumors of the central nervous system. They are mostly observed during childhood and are commonly located in the lateral ventricles. In adults, they are very rare and usually located in the fourth ventricle. We herein present a case of atypical choroid plexus papilloma of the foramen of Luschka in an adult. A 26-year-old male patient was presented with headache, dizziness, visual loss, and gait disturbance. Cranial imaging revealed a giant mass located in the foramen of Luschka with non-intense homogeneous contrast enhancement. Gross total removal of the tumor was achieved via the left telovelar approach. Transient swallowing difficulty and worsening of the nystagmus were observed in the early postoperative period. The patient was free of symptoms for 3 months postoperatively. The pathological examination yielded a diagnosis of atypical choroid plexus papilloma. We aimed to discuss the clinical findings and surgical treatment of the case.

Background: Carotid intima‐media thickness (cIMT) may identify early alterations in the vascular phenotype in children with chronic kidney disease (CKD). Methods and Results: Investigation of longitudinal changes in cIMT SD scores (SDS) in 670 patients from the 4C Study (Cardiovascular Comorbidity in Children With CKD Study), aged 6 to 17 years, with CKD stage 3 to 5 at baseline. The longitudinal trajectory of cIMT SDS over up to 8 years was examined using a longitudinal mixed‐effects model. The yearly progression rate in cIMT SDS (β=0.20 [95% CI, 0.13–0.28]) remained positive during the initial 4.5‐year follow‐up period but slowed down quadratically with increasing observation time (β=−0.02 [95% CI, −0.03 to −0.01]). Risk factors for increased cIMT SDS included time since baseline, younger age, higher height SDS, female sex, elevated diastolic blood pressure, and lower serum albumin, but not estimated glomerular filtration rate. In patients with progressive CKD, higher albuminuria was additionally associated with an increase in cIMT SDS. In patients with stable CKD, serum phosphate and time were the only risk factors identified for elevated cIMT SDS. Annual rates of change in blood pressure were positively correlated with the rate of change in cIMT SDS within the first 4.5 years (for systolic: β=0.42 [95% CI, 0.22–0.62]; for diastolic: β=1.56 [95% CI, 1.01–2.11]). Conclusions: The results show a significant longitudinal increase in cIMT SDS in children with CKD. Changes in blood pressure are associated with the progression of cIMT SDS, suggesting a relevant impact of blood pressure modulation on cIMT SDS.

Objectives To develop an efficient deep learning (DL) model for breast cancer detection in mammograms, utilizing both weak (image-level) and strong (bounding boxes) annotations and providing explainable artificial intelligence (XAI) with gradient-weighted class activation mapping (Grad-CAM), assessed by the ground truth overlap ratio. Methods Three radiologists annotated a balanced dataset of 1976 mammograms (cancer-positive and -negative) from three centers. We developed a patch-based DL model using curriculum learning, progressively increasing patch sizes during training. The model was trained under varying levels of strong supervision (0%, 20%, 40%, and 100% of the dataset), resulting in baseline, curriculum 20, curriculum 40, and curriculum 100 models. Training for each model was repeated ten times, with results presented as mean ± standard deviation. Model performance was also tested on an external dataset of 4276 mammograms to assess generalizability. Results F1 scores for the baseline, curriculum 20, curriculum 40, and curriculum 100 models were 80.55 ± 0.88, 82.41 ± 0.47, 83.03 ± 0.31, and 83.95 ± 0.55, respectively, with ground truth overlap ratios of 60.26 ± 1.91, 62.13 ± 1.2, 62.26 ± 1.52, and 64.18 ± 1.37. In the external dataset, F1 scores were 74.65 ± 1.35, 77.77 ± 0.73, 78.23 ± 1.78, and 78.73 ± 1.25, respectively, maintaining a similar performance trend. Conclusion Training DL models with a curriculum method and a patch-based approach yields satisfactory performance and XAI, even with a limited set of densely annotated data, offering a promising avenue for deploying DL in large-scale mammography datasets. Critical relevance This study introduces a DL model for mammography-based breast cancer detection, utilizing curriculum learning with limited, strongly labeled data. It showcases performance gains and better explainability, addressing challenges of extensive dataset needs and DL’s “black-box” nature. Key Points Increasing numbers of mammograms for radiologists to interpret pose a logistical challenge. We trained a DL model leveraging curriculum learning with mixed annotations for mammography. The DL model outperformed the baseline model with image-level annotations using only 20% of the strong labels. The study addresses the challenge of requiring extensive datasets and strong supervision for DL efficacy. The model demonstrated improved explainability through Grad-CAM, verified by a higher ground truth overlap ratio. He proposed approach also yielded robust performance on external testing data. Graphical Abstract

Objectives This study aimed to investigate the relationship between smartphone use and musculoskeletal pain among healthcare workers of different occupations. The research sought to examine the connection between smartphone habits and the prevalence and severity of musculoskeletal pain, with a focus on work-related and personal smartphone use, physical activity, temporomandibular dysfunction and neck disability. Methods The study utilized a cross-sectional survey design conducted via Google Forms targeting healthcare workers affiliated with Sisli Hamidiye Etfal Training and Research Hospital. The survey comprised 99 questions assessing demographic and professional information, health conditions, smartphone addiction, physical activity level, musculoskeletal pain, and pain-related disability. Results A total of 207 hospital staff members' responses were included in the analysis. Participants with higher smartphone addiction scores exhibited a significantly younger mean age and increased smartphone usage post-pandemic. No significant differences were found in physical activity levels between groups. However, those with higher addiction scores reported more frequent pain in the jaw and elbows, greater neck disability score, and a higher prevalence of temporomandibular dysfunction. The study also revealed a significant association between smartphone addiction and multi-site musculoskeletal pain. Conclusion The findings indicate that smartphone addiction among healthcare workers is associated with specific patterns of musculoskeletal pain, particularly in the jaw and elbows, and increased neck disability scores. The study highlights the need for targeted interventions to promote healthier smartphone habits and mitigate musculoskeletal pain among healthcare professionals.

Objectives Replantation surgery is one of the most difficult areas of reconstructive surgery. The aim of finger replantation is to restore sensation and adequate function of the amputated part in addition to restoring circulation. It is very crucial to investigate prognostic factors to improve the outcomes of this surgery. The type and severity of the injury, along with the duration between the injury and surgery, are the most significant factors influencing the success of replantation. This study investigates the impact of the type of anesthesia used on the success of replantation and other postoperative factors. Methods The finger replantation operations performed in our clinic between December 2018 and December 2023 were retrospectively analyzed. The effects of gender, smoking, type of injury, vein repair, nerve repair, use of vein graft, level of injury, type of anesthesia, preoperative and postoperative hemoglobin values on replantation success were statistically investigated in 192 patients (162 males, 30 females). Ratios in independent groups were compared by chi-square test. Comparisons of numerical variables in the independent groups were conducted using the Mann-Whitney U test, as the assumption of normal distribution was not satisfied. Results In the study, among the 192 patients, 91 received anesthesia via axillary nerve block (47.4%), 33 received general anesthesia (17.2%), and 28 received local anesthesia through digital block (14.6%). It was found that the type of anesthesia had no effect on the success of the replantation (p<0.05). A statistically significant difference was observed in the amount of change in hemoglobin levels between preoperative and postoperative measurements, according to the type of anesthesia. In the group receiving axillary nerve block, the decrease in hemoglobin levels was greater compared to the group receiving local anesthesia. Conclusion Our study found that smoking status and type of injury had no effect on the success of replantation.

Objectives Wrist and forearm deformities are usually due to congenital or post-traumatic causes. These deformities cause progressive pain and limitation of motion and impair quality of life. Acute correction with radius and/or ulna osteotomy and fixation with plate or wire can be applied in treatment, but complications such as vascular/nerve damage, malunion and inadequate correction may be encountered. Treatment with circular external fixators provides correction without residual deformity and is safer because it can provide deformity correction and gradual lengthening both intraoperatively and postoperatively. Computer-assisted circular external fixators (Ca-CEF) facilitate the correction of complex deformities by allowing postoperative deformity planning to be redone. In this study, we analyzed wrist or wrist deformities treated with Ca-CEF. Methods The hospital database was searched for patients who underwent surgery for wrist and forearm deformity between 2010 and 2020. Demographic data, radiographic and functional measurements of the patients were evaluated. Preoperative and postoperative forearm supination, pronation, wrist flexion and extension, Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, Mayo Wrist Score and grip strength were measured. Radiological measurements of radius, ulna lengths, radial inclination and volar tilt were performed. Postoperative complications were analyzed. Preoperative and postoperative data of the patients were analyzed statistically. Results A total of 14 patients were included in the study. The mean age of the patients was 17.1 years (11-34), 8 were female and 6 were male. The mean follow-up period was 18.4 months (6.8-32.9). The planned anatomical correction was achieved in all patients. The mean differences between preoperative functional and radiographic data and postoperative data were 7.8 (p=0.029) for forearm supination, 14.64 (p<0. 001), 6.17 kg for Grip Strength (p=0.001), 3.07 for VAS (p<0.001), 21 points for DASH Score (p=0.003), and 22.14 points for Mayo Wrist Score (p=0.004), which were statistically significantly better. No major complications were observed in any patient. Conclusion The study showed that Ca-CEF provides functional improvement and radiological improvement and is a safe treatment method with low complication rates. This method stands out as an effective option in the treatment of complex deformities.

Objectives Chronic spontaneous urticaria (CSU) is a common disease characterized by wheals and/or angioedema. Since it is a chronic, itch-related disease, it may substantially affect the psychological status and quality of sleep. In this study, it was aimed to evaluate the impact of CSU on depression, anxiety, stress, and quality of sleep, as well as their relation to disease-specific factors. Methods This prospective case-control study included 86 patients with CSU and 86 controls. The sociodemographic and clinical characteristics of the patients, such as scores of urticaria activity score (UAS7) and chronic urticaria quality of life questionnaire (CU-Q2oL), were recorded. Depression, Anxiety, and Stress Scales-21 (DASS-21), Pittsburgh Sleep Quality Index (PSQI), and Dermatology Life Quality Index (DLQI) were used to evaluate their psychological status, quality of sleep, and life. Results Of 172 participants, the patient group comprised 86 patients with CSU, and the control group comprised 86 age and sex-matched volunteers. Of 86 patients with CSU, 60 (69.8%) were females and 26 (30.2%) males with a median age of 34.5 years. In the patients with CSU, the median scores (interquartile range) for depression, anxiety, and stress, according to DASS-21, were 6 (8), 5 (6.25) and 6 (7), respectively. Additionally, the median scores of PSQI and DLQI were 7 (5) and 5.5 (11), respectively. The median scores for depression, anxiety, and stress according to DASS-21, the median scores of PSQI and DLQI were statistically significantly higher in the patient group than in the control group. According to the PSQI classification, 68 (79.1%) patients had poor sleep quality, while 18 (20.9%) patients had good sleep quality. When the patient group was examined in two groups, those with good and poor sleep quality, UAS7, depression, anxiety, stress, and DLQI/CU-Q2oL scores were statistically significantly higher in the patients with poor sleep quality than in the patients with good sleep quality. Conclusion Treatment of urticaria is typically symptomatic and aims to reduce the symptoms of itching and wheals. However, clinicians can contribute to the well-being of patients if they are aware of psychological comorbidities and sleep disturbances.

Objectives Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder in which patients with HS experience profound deterioration in their overall well-being, psychological state and quality of life. This study aimed to evaluate the psychological impact of HS and examined its associations with relevant factors, including sociodemographic and disease-related characteristics. Methods A prospective, single-center study was conducted involving 80 patients with HS. The demographic and clinical characteristics of patients were recorded. Depression Anxiety Stress Scale-21 (DASS-21), Dermatology Life Quality Index (DLQI), and General Health Questionnaire-12 (GHQ-12) were used to assess the psychosocial impact of HS. Results A significant proportion of patients with HS had severe and extremely severe scores in depression, anxiety and stress, with 48.75%, 52.5%, and 48.75% of patients, respectively. Sixty percent of the patients exhibited high psychological disorders while 53.8% experienced severe impairment in their quality of life (QoL). Sociodemographic and clinical factors were evaluated for associations with the scales used in this study. DASS-21 Anxiety (DASS-21A) was significantly positively correlated with lower education levels and higher body mass index (BMI) (p<0.05). There were no significant correlations between the Hurley stages and the other three scales, except for the DASS-21 Stress (DASS-21S) subscale. Patients with a family history had higher DASS-21A, DASS-21 Depression (DASS-21D), DASS-21S, and GHQ-12 (both Likert and traditional scoring) scores compared to those without a family history (p<0.05). Additionally, a positive family history significantly predicted higher scores on DASS-21A, DASS-21D, and DASS-21S (p=0.002; p=0.019; p=0.022, respectively). Conclusion Our findings confirm that a significant proportion of patients with HS had high or extremely high levels on all three scales assessing the psychological burden of HS. Patients were negatively affected psychologically at each Hurley stage. Family history proved to be a strong predictive factor contributing to impaired psychosocial status among individuals with HS. Thus, dermatologists should provide extra care, especially for those with family members affected by this condition.

Congenital hyperinsulinism (HI) is the leading cause of persistent hypoglycemia in infants and children. Focal pancreatic lesions account for 30-40% of cases with congenital HI. With early diagnosis, these patients can be treated by resection of the lesion, making long-term medical care unnecessary. In this case, a 5-day-old newborn boy presented with convulsion due to severe and persistent hypoglycemia at his hospitalization in neonatal intensive care unit. Laboratory studies revealed very low levels of ketone bodies with inappropriately normal insulin levels during hypoglycemia. The patient was unresponsive to diazoxide treatment. The molecular genetic analysis revealed a heterozygous pathogenic variant in the ABCC8 gene. 18F-DOPA-PET/CT scan showed increased uptake of 18F-DOPA consistent with focal lesion at the tail of the pancreas. A focal pancreatectomy operation was performed when he was three months old. Histopathological evaluation confirmed focal endocrine cell hyperplasia. Hypoglycemia did not recur after the operation. CHI patients with ABCC8 / KCNJ11 mutation are not easy to manage with pharmacotheraphy. In the case of an identifiable focal lesion associated with CHI, surgery is the most preferred option. In focal CHI, as in our case, the lesion may not be visually evident and requires a surgeon experienced in CHI.

Objectives 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) is a widespread imaging technique for whole-body scanning. Incidental lesions may be detected in thyroid gland and the importance and management of these lesions are still a matter of debate. The aims of this study were the evaluation of the diagnostic success of ultrasonography and FDG-PET/CT for predicting malignancy and contribution of these techniques for the decision of Fine Needle Aspiration Biopsy (FNAB) in incidental thyroid lesions detected in FDG-PET/CT. Methods Patients who underwent FDG-PET/CT in Nuclear Medicine Unit in a single institution between January 2018 and December 2022 were screened for thyroid incidentaloma with increased focal FDG uptake. Imaging studies and pathology results of the patients with Focal Thyroid Incidentalomas (FTI) were reviewed retrospectively. Results A total of 14.003 FDG-PET/CT reports of 8.259 patients were evaluated. In FDG-PET/CT imaging, 495 (6.0%) patients had increased uptake in thyroid gland, 383 (4.6%) patients had focal and 112 (1.4%) patients had diffuse FDG uptake. The rate of malignancy in FTIs was 19.2%. In the ROC curve analysis, regarding the prediction of malignancy in FTIs with FDG uptake, a SUVmax value of 5.5 and above predicts malignancy with a sensitivity of 71.4% and a specificity of 68.6% (AUC:0.718, p=0.018, 95%CI:0.564-0.872). The sensitivity of ACR-TIRADS-5 was 35.7% (95%CI:14.6-61.7) and sensitivity of the combination of SUVmax>5.5 and ACR-TIRADS-5 was 30.0% (95%CI:8.5-60.7). Conclusion FDG-PET/CT findings can be used for determining malignancy risk and cutoff values such as 5.5 can be threshold for ordering FNAB. In patients with SUVmax less than 5.5, ultrasonographic risk classification criteria should be used for decision-making.

Purpose To evaluate the modified double-flanged technique in cases of subluxated foldable single-piece intraocular lenses (IOLs). Methods This retrospective study was conducted on 14 eyes of 14 patients.The following steps were performed in the surgical technique, respectively;the dislocated foldable single-piece IOL was repositioned into the anterior chamber, and the haptic was extracted through the corneal main incision.A 27-gauge needle was passed through the widest part of the haptic, close to the haptic-optic junction.A 6.0 polypropylene suture was passed through the needle. For the same process on the other haptic, the IOL was rotated 180 degrees.The polypropylene part of the created haptic-polypropylene complex was extracted through the scleral tunnel using a 26-gauge needle as a guide. The 1.5 mm tips of the polypropylene were cauterized to form flanges, which were then embedded into the sclera. The preoperative and postoperative first and sixth month ophthalmological findings were evaluated. Results Both uncorrected visual acuity and best-corrected visual acuity were significantly higher at the postoperative sixth-month follow-up(p < 0.001).Possible causes of IOL subluxation; were pseudoexfoliation in five patients (36%),complicated cataract surgery in three patients (21%),trauma in two patients (14%) and no cause was found in four patients (29%). Of the 28 flanges, 24 (86%) were located intrasclerally, while four (14%) were in the subtenon space.Elevated intraocular pressure was detected in one case (7%) in the early postoperative period, and cystoid macular edema was noted in two cases (14%). Conclusion This study demonstrated that the modified double-flanged technique could be effectively and safely applied in cases of subluxated foldable single-piece IOL.