Our results were in line with PSC guidelines, but the use of multiple cytological techniques may cause some discrepancies in overall diagnostic yield and in estimated risks of malignancy, which is important due to the widespread utilization of different cytological procedures.

Introduction: The Acibadem Health Group (AHG) has been using telepathology/digital pathology stations since 2006. In 2013, the system was changed from videoconferencing to digital pathology (whole-slide imaging) utilizing 3DHISTECH scanners and software. In 2017, digital cytology started to be used for routine cytopathologic diagnosis for thyroid fine-needle aspiration (FNA) cases. Material and Methods: Two hundred and twenty-seven thyroid cases were received for analysis using telecytology (TC) during the period from November 2017 to May 2018. Rapid on-site evaluation was performed at the Atakent Hospital of the AHG by a cytotechnologist and scanned on the same day. For every case, there were Diff-Quik- and Papanicolaou-stained FNA smears. Each glass slide was digitized with a 3DHISTECH whole-slide scanner in 1 focal Z-plane at ×40 magnification. Results: Two hundred and twenty-seven thyroid FNA specimens were retrieved, of which 25 had histologic follow-up. Samples were classified as nondiagnostic in 3%, benign in 74%, atypia of undetermined significance/follicular lesion of undetermined significance in 13%, suspicious for follicular neoplasia/follicular neoplasia in 3%, suspicious for malignancy in 4%, and malignant in 3%. When only the “suspicious for malignancy” and “malignancy” categories were considered positive tests, cytology sensitivity and specificity using TC for diagnosis was 100%. Conclusions: Our data demonstrate that TC is suitable to provide a primary diagnosis in daily routine cytology practice. Despite the promising results, there were some challenges stemming from the novelty of using TC for the primary diagnosis. The study also addresses both advantages and disadvantages of TC in daily practice to increase the efficiency of the technique in primary diagnosis.

Although the most frequently used technique is laparotomy and open biopsy in our series, other methods provided quicker initiation of chemotherapy and less surgical morbidity. Especially in patients with high stages, cytological evaluation and tru-cut needle biopsy with radiological guidance is a better alternative of laparotomy.

Tortuous vasculature is a common reason for failure to stabilize a guiding catheter in an appropiate position and is associated with a higher incidence of vascular complications. In such a case, the guiding catheter often buckles into the aorta during an attempt to place the balloon or stent. In this report, we used the buddy wire technique to support the guiding catheter, and we passed through the vertebral artery origin stenosis with the help of a microcatheter-microguidewire combination which enabled stent deployment. We kept the buddy wire through the guiding catheter throughout the procedure and the 6F guiding catheter allowed passages of both buddy wire and stent system.

Key words abscess, hemorrhage, neonate, suprarenal mass.Adrenal abscess is a rare disease in the neonatal period. Bilateral abscesses are even more uncommon and only a few cases have been reported in the literature. 1,2 In this article, a newborn with bilateral adrenal abscesses as a complication of adrenal hemorrhage is reported. Case reportA full-term male neonate was born in our hospital with a birthweight 3920 g. It was the first pregnancy and the first delivery of the mother. No problem was noted during the pregnancy, but during the perinatal period fetal distress occurred and the infant was delivered by cesarean section. He underwent resuscitation in the delivery room because of depressed respiration. The laboratory findings on the first day of life were as follows: hemoglobin 16.5 g/dL, hematocrit 49.3%, lactate dehydrogenase 1992 U/L and creatine kinase 1816 U/L. He suffered from perinatal asphyxia and was treated with oxygen in the neonatal intensive care unit for 3 days. He had hyperbilirubinemia and received phototherapy for a short period and then he was discharged on the 7th day in good condition. However, 3 days later, when he was 10 days old, he came back with profound jaundice. The unconjugated bilirubin level was 26.9 mg/dL and his hemoglobin level was 11.4 g/dL. He was treated with phototherapy again. White blood cells, platelet count, clotting tests, renal and hepatic functions, blood glucose and electrolytes were in the normal range but his C-reactive protein level was elevated (129 mg/dL) and there was no evidence of hemolysis. Because of severe hyperbilirubinemia and anemia, an internal hemorrhage was suspected and ultrasonographic examination was performed. Abdominal ultrasonography revealed bilateral adrenal cystic masses measuring 55 ¥ 41 ¥ 54 mm at the left and 61 ¥ 45 ¥ 58 mm in the right suprarenal fossa. The masses were well-circumscribed, roundshaped cystic lesions that contained internal mobile echoes and caused distal acoustic enhancement in the suprarenal space bilaterally. Adrenal hemorrhage was considered as the cause of the masses. Doppler ultrasonography (Fig. 1) and abdominal computed tomography (Fig. 2) confirmed the adrenal hematoma. To exclude a hemorrhagic neoplastic process such as neuroblastoma, neuron-specific enolase and 24-h urinary excretion of vanillylmandelic acid were measured and ultrasound-guided needle aspiration was performed. Neuron-specific enolase and vanillylmandelic acid levels were within the normal ranges, hemorrhagic and purulent material was aspirated from both sides and no neoplastic cells were found on microscopic examination. Pus was drained with percutaneous catheterization of the abscess and cultures were positive for Proteus mirabilis. Percutaneous drainage was continued for 10 days and, according to the antibiogram, the infant was treated with ceftriaxon plus netilmicin for 15 days. The second culture following antibiotic treatment was negative. During his stay in the hospital our patient did not suffer from fever, septic findings or feeding d...

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In one-third of the patients with amoebiasis, amoebic liver abscess (ALA) may occur after the penetration of amoebic trophozoites through the intestinal wall. ALA is seen mostly among men aged 20-45 years with a serious clinical outcome, with fever and abdominal pain on the right upper quadrant. Most patients have no recent history of amoebic colitis; indeed, they have neither gastrointestinal complaints nor Entamoeba histolytica (E. histolytica) cysts/trophozoites in their stools. Therefore, ultrasonography and serology are primary in ALA diagnosis, while searching for E. histolytica DNA in abscess fluid using PCR has been preferred as an effective and reliable method, lately. Early antimicrobial therapy is effective; however, for cases irresponsive to therapy after 72 hours and with large abscess, drainage or surgical intervention is indicated. If left untreated, ALA may disseminate to other organs and cause death. The data concerning the extra-intestinal manifestations of amebiasis in Turkey are limited. Here, a rare case of a young man with an initial diagnosis of pneumonia followed by the identification of ALA after radiological interventions and laboratory tests is presented and the relevant literature is discussed.

Purpose: Hickman catheters (HCs) are commonly used in children who need bone marrow transplantation. Although several methods of implantation have been described, the aim of the present study was to evaluate the results of ultrasonography-and fluoroscopy-guided percutaneous insertion of HCs into a central vein in children. Materials and Methods: Data from patients who were hospitalized for ultrasonography-and fluoroscopy-guided percutaneous placement of HCs from August 2014 to January 2017 were retrospectively evaluated. The data were evaluated with respect to patient characteristics, complications, HC features, and outcomes. Results: Three hundred and six times HC positioned in 206 patients were evaluated. One hundred and twenty-six patients were male, and the remaining 80 were female. The age of the patients ranged from 2 months to 19 (range, 7.31±4.85) years. HC implantation was technically successful in all patients. The right jugular vein was the preferred access vein in 87.4% of HCs. The length of time between HC placement and removal was 147±108.9 days (range, 7-795 days). Three (0.01%) of the recorded complications were classified as early postoperative. Two of those three patients developed bleeding, and one had cardiac tamponade. No mortality was related to HC insertion during the perioperative or postoperative period. Conclusion: Ultrasonography-and fluoroscopy-guided percutaneous HC insertion in a central vein is safe and applicable to all children regardless of size, age, or diagnosis.