Renal cell carcinomas (RCCs) are one of the leading causes of cancer-related death worldwide (1). About one-third of RCCs are metastatic at initial diagnosis, and skeletal metastases are the second most frequent type of RCC metastases following lung metastases (43%) (2, 3). Surgical intervention is an option for the treatment of skeletal metastases of RCCs. Although local ablative therapies like thermal ablation may be preferred for tumors <3 cm, systemic chemotherapy and radiotherapy are other options for suitable patients (4). However, RCCs are usually chemo/radio-resistant (50%), and these treatment options are usually favored for palliative intent (3-5).The 5-year overall survival of patients with RCC bone metastases increases when surgical metastasectomy is performed (4). However, since RCC metastases in the skeletal system are usually hypervascular, the operative blood loss could be as high as 18500 mL, which could threaten patients' lives (6). Transarterial embolization (TAE) of bone tumors was first described in 1975 (7). The operative blood loss can be reduced by adequate devascularization after TAE of the bone metastases (8-11), and a blood loss of less than 3000 mL was defined as clinical success for spinal tumor surgeries (12). Selective TAE of bone metastases can be performed pre-operatively in a single session. Successful embolization can clarify the tumor margins from the surrounding tissue planes, simplifying surgical manipulation of the tumors. Thus, recurrence rates may be lower in patients undergoing this treatment PURPOSE Our purpose is to clarify the optimal timing of surgery after transarterial embolization (TAE) for renal cell carcinoma (RCC) bone metastases. METHODSThis retrospective study included 41 patients with RCC bone metastases embolized between 2013 and 2019. Different-sized particulate and/or liquid embolic agents were used for TAE. Embolizations were categorized into groups 1-3 according to the interval between TAE and surgery (group 1: <1 day, group 2: 1-3 days, group 3: >3 days). Degree of embolization after TAE was graded visually based on angiographic images (<50%, 50%-75%, 75%-90%, >90%). The relationship between the TAE-surgery interval and intraoperative blood loss (IBL) and the correlation between IBL and embolization grade were examined. Lesion sizes and the relationships among lesion localizations and contrast media usage, intervention time, and IBL were also analyzed. RESULTSForty-six pre-operative TAEs (single lesion at each session) were performed in this study (26 in group 1, 13 in group 2, 7 in group 3). Lesion sizes and distributions were similar between groups (p = 0.897); >75% devascularization was achieved in 40 (TAEs 86.96%), but the IBL showed no correlation with the embolization rate (r=0.032, p = 0.831). The TAE-surgery interval was 1-7 days. The median IBL in group 1 (750 mL; range, 150-3000 mL) was significantly lower than those in the other groups (p = 0.002). Contrast media usage (p = 0.482) and intervention times (p = 0.261) were similar for metastases...

ObjectivesThe age-based Cole formula has been employed for the estimation of endotracheal tube (ETT) size due to its ease of use, but may not appropriately consider growth rates among children. Child growth is assessed by calculating the body surface area (BSA). The association between the outer diameter of an appropriate uncuffed-endotrachealtube (ETT-OD) and the BSA values of patients at 24–96 months of age was our primary outcome.MethodsCole formula, BSA, age, height, weight and ultrasound measurement of subglottic-transverse-diameter were evaluated for correlations with correct uncuffed ETT-OD. The Cole formula, BSA, and ultrasound measurements were analyzed for estimation rates in all patients and age subgroups. The maximum allowed error for the estimation of ETT-OD was ≤0.3 mm. Patients’ tracheas were intubated with tubes chosen by Cole formula and correct ETT-OD values were determined using leak test. ETT exchange rates were recorded.ResultsOne-hundred twenty-seven patients were analyzed for the determination of estimation rates. Thirteen patients aged ≥72 months were intubated with cuffed ETT-OD of 8.4 mm and were accepted to need uncuffed ETT-OD >8.4 mm in order to be included in estimation rates, but excluded from correlations for size analysis. One-hundred fourteen patients were analyzed for correlations between correct ETT-OD (determined by the leak test) and outcome parameters. Cole formula, ultrasonography, and BSA had similar correct estimation rates. All three parameters had higher underestimation rates as age increased.Conclusion.The Cole formula, BSA, and ultrasonography had similar estimation rates in patients aged ≥24 to ≤96 months. BSA had a correct estimation rate of 40.2% and may not be reliable in clinical practice to predict uncuffedETT-size.

The aim of this study was to define the incidence and classify locations of accessory spleen using CT in a large Turkish population and to compare our findings with earlier studies performed in other populations.Methods: A total of 930 patients were included in the study and evaluated retrospectively using CT. The CT images were obtained using Philips Ingenuity 128 slice computerized tomography device.Results: 930 patients (413 females, 44.4%; 517 males, 55.6%) who underwent CT imaging for various indications were included in this study. Out of these, 55 had an accessory spleen (5.9%), and four had polysplenia. Most common location of accessory spleen was hilum (49.9%) followed by the gastrosplenic ligament (21.81%), infrasplenic area (18.18%), pancreatic tail (3.64%), splenorenal ligament (3.64%) and suprasplenic area (3.64%). Conclusion:Accessory spleen is a common variation encountered in the abdominal cavity. Most and least common locations of this variation should be well known to prevent radiologic misdiagnosis and surgical complications.

Background: Nerve blocks have been used for decades at head and neck region interventions and recently introduced as an alternative option for subcutaneous port implantation. This study aimed to compare two different local anesthesia techniques used during subcutaneous port implantation. Methods: This retrospective study was conducted with 107 patients who were categorized into two groups according to the local anesthesia techniques used during port implantations. Group 1 underwent local infiltration anesthesia and Group 2 received an ultrasound-guided supraclavicular nerve block. In both groups, prilocaine 2% was used for skin anesthesia and no other systemic anesthetic drugs or additional local anesthetics were administered during port implantation. Local anesthetic doses were 400 mg in Group 1 and 200 mg in Group 2. The time required for adequate cutaneous anesthesia, procedure time, complication rate and visual analog scale (VAS) score were recorded for each patient. Results: Groups 1 and 2 contained 58 and 49 patients respectively. Both groups showed similar demographic distributions of patients ( p > 0.05). Mean procedure times and the time required for adequate cutaneous anesthesia were longer in Group 2 ( p < 0.05). Group 2 also showed 12 immediate complications, although they were temporary and recovered without any intervention under surveillance. Mean VAS scores during port implantation were similar in both groups [Group 1: 1.17(±0.60), Group 2: 1.1(±0.62)] ( p > 0.05). Conclusions: The VAS scores did not differ significantly between groups. Although a supraclavicular nerve block may require lower local anesthetic doses for similar cutaneous anesthesia, it is associated with higher immediate complication rates due to unintended blockade of the peripheral nerves. Thus, if the nerve block is preferred over local infiltration anesthesia during port implantation, to prevent life-threatening complications, caution needed especially for the patients with contralateral vocal cord or diaphragm paralysis.

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Aim: Modiolus is a dense, mobile fibromuscular structure lateral to the mouth corner. It is of great importance in aesthetic and reconstructive surgery. The aim of this study was to enlighten the structural changes in modiolus with demographic variables such as age and gender in living individuals. Methods: This retrospective cohort study was conducted on MR images of healthy individuals. Age and sex-related changes in modiolus level and volume were retrospectively analyzed in 64 patients [37M; 27F; mean age 48.2(16.3)] who underwent head and neck magnetic resonance imaging. ROC analysis was performed to determine the cut off values for age of modiolus. Correlation analysis (Pearson and point biserial correlation) was used to determine whether there was a significant correlation between age and volume. Significance of the differences between the volumes of right and left modiolus of the same individual were evaluated by dependent t tests. Results: The mean volume of the modiolus was calculated as 0.51(0.26) mm 3. The volumes of right and left modioli decreased by aging. Ninety-one percent of the patients with modioli located inferior to horizontal line were over 49 years old. Right and left modioli relocated inferior to horizontal line with age. Modiolus volume was prominently less in women and the downward displacement of modiolus in women was 3.3 times higher than in men. Gender and age had significant effects on modiolus level. The right and left modiolus volumes were similar (P=0.975). Conclusion: Surgeon's knowledge on modiolus and its relations will provide benefit, not only for the procedures such as face lifting and botulinum toxin injection, but also for the surgeries of facial paralysis and trauma patients.

Objectives: Metastases and primary malignancies are common in the liver. Local ablative applications such as transarterial chemoembolization (TACE), and transarterial radioembolization (TARE) provide minimally invasive and safe treatment in unresectable liver tumors. Early detection of response to treatment prevents unnecessary toxicity and cost in non-responder patients and provides an earlier use of other options that may be effective. This study aimed to identify the role of 18 F-fluorothymidine (FLT) positron emission tomography/computed tomography (PET/CT) in the assessment of early response to TACE and TARE treatments in patients with unresectable primary and metastatic liver tumors Methods: This single-center study included 63 patients who underwent 18 F-FLT PET/CT for response evaluation after TACE and TARE. After excluding 20 patients whose data were missing 43 TARE-receiving patients were analyzed. The compatibility of change in semi-quantitative values obtained from the 18 F-FLT PET/CT images with the treatment responses detected in 18 F-fluorodeoxyglucose PET/CT, CT, and MR images and survival was evaluated. Results: There was no correlation between early metabolic, morphological response, and 18 F-FLT uptake pattern, and change in standardized uptake values (SUV) which were ΔSUV max , ΔSUV mean , ΔSUV peak ., ΔSUV mean , Δ SUV peak values. There was no significant correlation between 18 F-FLT uptake pattern, ΔSUV max , ΔSUV mean , ΔSUV peak , and overall survival, progression-free survival (PFS) for the target lobe PFS for the whole-body. The survival distributions for the patients with >30% change in Δ SUV max and ΔSUV peak values were statistically significantly longer than the patients with <30% change (p<0.009 and p<0.024, respectively). Conclusion: There was significant longer PFS for target liver lobe in patients with more than 30% decrease in 18 F-FLT SUV max and SUV peak of the liver lesion in primary and metastatic unresectable liver tumors undergoing TARE.

Amaç: Bu çalışmanın amacı, popülasyonumuzdaki Trakeal Bronkusları (TB) tespit etmek ve sınıflandırmaktır. Gereç ve Yöntem: Bu retrospektif çalışmaya farklı nedenlerle torasik BT çektiren toplam 1500 hasta dahil edildi. 12 bireyde TB tespit edildi. TB'li 12 hastanın; beşi erkek, yedisi kadındı. TB prevalansı %0,8 bulundu. Kadınlarda (% 58,3) erkeklerden (% 41,7) daha sık tespit edildi. Bulgular: TB'lu 12 bireyin yedisinde displaced tip (% 58.3), ikisinde supernumarary tip (% 16.7) ve üçünde pig tip (% 25) bronkus vardı.Displaced tip kadınlar arasında en yaygın olanıdıydı. Beş erkekten ikisinde displaced tip, ikisinde pig tip, birinde supernumerary tip görüldü. Cinsiyet ve tip arasındaki ilişki istatistiksel olarak anlamlı bulunmadı (p = 0.516). TB'nin ortalama çapı 5.24 ±1.53 mm idi. Displaced ve pig bronkus tipleri arasındaki çapa göre fark istatistiksel olarak anlamlıydı (p = 0,017). Bu çalışmada ayrıca carina ve TB arasındaki mesafe de ölçüldü. Displaced tip ile pig bronkus tiplerinin carina'ya olan mesafeleri açısından fark yoktu (p = 0.067).Sonuç: TB'nin tanınması endotrakeal entübasyonda kritik öneme sahiptir. TB, tüpün yan yüzü tarafından tıkandığında, lob kollapsa uğrayabilir. Diğer yandan, yanlışlıkla entübe edildiğinde, aşırı havalanma sonucu pnömotoraks oluşabilir. Abstract ÖzEmre Can ÇELEBİOĞLU1, Selma ÇALIŞKAN2, Sinem AKKAŞOĞLU2, Hilal Göktürk Nakkaş3, İbrahim Tanzer SANCAK4Aim: The aim of the study recognize and classify the Tracheal Bronchus (TB) in our population. Material and Method:A total of 1500 patients who underwent thoracic Computed Tomography (CT) examination for different reasons were enrolled in this retrospective study. 12 patients with TB were reported. Of the 12 patients with TB; five were males and seven were females. Prevalence of TB was found to be 0.8%. It was indicated more frequently in women (58.3%) than in men (41.7%). Results:Of the 12 patients with TB seven had displaced type (58.3%), two had supernumerary type (16.7%) and three had pig bronchus (25%). Displaced type was most common among the females. Of the five males two had displaced type, two had pig bronchus and one had supernumerary type. Relation between gender and type was not found to be statistically significant (p=0.516). The mean diameter of the TB was 5.24±1.53 mm. Difference between displaced and pig bronchus types according to diameter is statistically significant (p=0.017). Distance between carina and TB was also measured in the present study. There was no difference between displaced type and pig bronchus type according to distance from carina (p=0.067). Conclusion:Recognizing the TB is critically important during endotracheal intubation. When the TB is occluded by the side of the tube the lobe may collapse. On the other hand when it is mistakenly intubated, over aeration may lead pneumothorax.