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Sanli AN, Tekcan Sanli DE, Aydogan F, Altundag MK. Should the Breast Cancer Staging System be Revised? Am Surg 2024; 90:1066-1073. [PMID: 38128067 DOI: 10.1177/00031348231223074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether breast cancer patients at stage T2N0 with tumor size ≥4 cm and <4 cm. METHOD Patients with T2N0 stage breast cancer diagnosed between 2010 and 2019 were analyzed in 2 groups as <4 cm (T2a) and ≥4 cm (T2b) in the study using the SEER 17 Research Plus database. The patients' clinicopathological characteristics and oncological outcomes were included. Group comparisons of prognostic factors, overall survival (OS), and cancer-specific survival (CSS) were made. RESULTS In this study, which involved 70971 patients, the T2a group had higher 5-year OS rate (87.2 ± .2 vs 80.8 ± .5%) and 5-year CSS rate (93.7 ± .1% vs 89.4 ± .4%) than the T2b group (P < .001). Univariate analysis revealed that the overall risk of death was 1.5 times higher in T2b than T2a (HR: 1.533 [95% CI: 1.450-1.622], P < .001), whereas multivariate analysis demonstrated the risk was 1.4 times higher (HR: 1.384 [95% CI: 1.307-1.466], P < .001). The risk of cancer-specific death was 1.7 times higher in univariate analysis (HR: 1.691 [95% CI: 1.561-1.832], P < .001) and 1.4 times higher in multivariate analysis (HR: 1.420 [95% CI: 1.309-1.541], P < .001). CONCLUSION Overall survival and BCSS rates in stage T2b breast cancer patients are significantly lower than in T2a patients. Tumor size ≥4 cm in breast cancer is a negative predictor of prognosis.
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Affiliation(s)
- Ahmet Necati Sanli
- Department of General Surgery, Abdulkadir Yuksel State Hospital, Gaziantep, Turkey
| | | | - Fatih Aydogan
- Department of General Surgery, Kirklareli University, Faculty of Medicine, Kirklareli, Turkey
- Breast Health Center, Memorial Bahcelievler Hospital, Istanbul, Turkey
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Sanli AN, Tekcan Sanli DE, Altundag MK, Aydogan F. Is There a Survival Difference Between Male and Female Breast Cancer Subtypes According to the Prognostic Staging System? A Population-Based Cohort Study. Am Surg 2024; 90:788-799. [PMID: 37916470 DOI: 10.1177/00031348231212588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND In retrospective studies investigating the difference in survival by gender, there are conflicting results. It was aimed to compare overall survival (OS) and breast cancer-specific survival (BCSS) in male and female breast cancer subtypes according to the prognostic staging system. METHODS Overall survival rates and BCSS rates of patients diagnosed with breast cancer between 2010 and 2019 compared by gender for all cohorts, stages, and molecular subtypes using the SEER Database. The stage has been rearranged according to the eighth edition of the AJCC. RESULTS 364 039 patients were included in the study. .7% (n = 2503) of all breast cancers were male breast cancer. Overall survival (male: 5-year OS 73.9%, female = 5-year OS 86%) and BCSS rates (male: 5-year BCSS 78.9%, female = 5-year BCSS 94.7%) were significantly higher in females than in males for all cohorts. OS (male: 5-year OS 66.2% vs female: 5-year OS 88.3%), and BCSS (male: 5-year BCSS 88.4% vs female: 5-year 93.6%) rates were higher in hormone receptor (HR)-positive/Her2-negative female patients. Overall survival rate is higher in females in stage I (male: 5-year OS 81.5%, female: 5-year OS 92.8%), and BCSS rate is higher in stage I (male: 5-year BCSS 94.8%, female: 5-year BCSS 97.5%). Males have 2 times (HR = 2.023) higher overall mortality risk than females, but the risk of dying from breast cancer is only 1.6 times (HR = 1.596) higher. CONCLUSIONS Breast cancer-specific mortality is significantly higher in male breast cancers, especially in the early stage, and HR-positive subtype than females.
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Affiliation(s)
- Ahmet Necati Sanli
- Department of General Surgery, Abdulkadir Yuksel State Hospital, Gaziantep, Turkey
| | | | | | - Fatih Aydogan
- Breast Health Center, Memorial Bahcelievler Hospital, Istanbul, Turkey
- Department of General Surgery, Faculty of Medicine, Kırklareli University, Kırklareli, Turkey
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Sanli AN, Tekcan Sanli DE, Altundag MK, Aydogan F. Secretory Carcinoma of Breast: A Population-Based Study. Am Surg 2024; 90:252-260. [PMID: 37648259 DOI: 10.1177/00031348231199174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
AIM In this study, it was aimed to evaluate the characteristic features and survival of secretory carcinoma of the breast (SCB), which is one of the rare malignant tumors of the breast. METHODS Data of patients with histopathological diagnosis of SCB between 2010 and 2019 were extracted from the SEER database. These patients were evaluated in terms of age, race, molecular subtype, grade, estrogen receptor (ER), progesterone receptor (PR), HER2 receptor, TNM stage, surgical status, chemotherapy and radiotherapy treatment. Overall survival (OS) and breast cancer-specific survival (BCSS) of the whole population and subgroups [in terms of surgery procedure (mastectomy/breast-conserving surgery), and hormone receptor status (positive/negative)] were analyzed. RESULTS 70 patients were included in the study. The mean age was 57 years (range 2-82). 32.9% of the patients were diagnosed under the age of 50. 97.1% of the patients were female; 2.9% were male. The vast majority of patients were white race (81.4%). Although the rates of localization were higher in the upper outer quadrant (31.4%), centrally located tumors (18.5%) were also quite common. The most frequently detected molecular subtype was hormone positive/HER2 negative. All patients were non-metastatic, 81.4% of patients did not have lymph node metastases, and most of the patients were stage IA. Median follow-up was 37 months (range 0-118 months). Considering all patients, OS was 76.3%, 5-year OS was 91.8%, and BCSS was 88%, 5-year BCSS was 97.8%. There was no statistically significant difference in OS and BCSS according to subgroups (P > .01). CONCLUSION SCB, a rare histopathologic type, has high OS and BCSS rates.
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Affiliation(s)
- Ahmet Necati Sanli
- Department of General Surgery, Abdulkadir Yuksel State Hospital, Gaziantep, Turkey
| | | | | | - Fatih Aydogan
- Breast Health Center, Memorial Bahcelievler Hospital, Istanbul, Turkey
- Department of General Surgery, Faculty of Medicine, Kirklareli University, Kirklareli, Turkey
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Tekcan Sanli DE, Sanli AN, Yildirim O, Erginoz E, Yildirim D. Normative reference values of major thoracic arterial vasculature in Turkiye. North Clin Istanb 2023; 10:263-270. [PMID: 37181064 PMCID: PMC10170372 DOI: 10.14744/nci.2021.03206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/13/2021] [Accepted: 08/26/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine normative reference values for major thoracic arterial vasculature in Turkiye and to evaluate differences according to age and gender. METHODS Low-dose unenhanced chest computerized tomography images acquired with pre-diagnosis of COVID-19 between March and June 2020 were evaluated retrospectively. Patients with known chronic lung parenchymal disease, pleural effusion, pneumothorax, chronic diseases such as diabetes, hypertension, obesity, and chronic heart diseases (coronary artery disease, atherosclerosis, congestive heart failure, valve replacement, and arrhythmia) were excluded from the study. The ascending aorta diameter (AAD), descending aorta diameter (DAD), aortic arch diameter (ARCAD), main pulmonary artery diameter (MPAD), right pulmonary artery diameter (RPAD), and the left pulmonary artery diameter (LPAD) were measured in the same sections by standardized methods. The variability of parameters according to age (<40 years; ≥40 years) and gender (male to female) was evaluated by statistical methods. The Student's t test was used to compare the normal distribution according to the given quantitative age and gender, while the data that did not fit the normal distribution were compared with the Mann-Whitney U test. The conformity of the data to the normal distribution was tested with the Kolmogorov-Smirnov, Shapiro-Wilk test, and graphical examinations. RESULTS Totally 777 cases between the ages of 18-96 (43.80±15.98) were included in the study. Among these, 52.8% (n=410) were male and 47.2% (n=367) were female. Mean diameters were 28.52±5.13 mm (12-48 mm in range) for AAD, 30.83±5.25 mm (12-52 mm in range) for ARCAD, DAD 21.27±3.57 mm (11-38 mm in range) for DAD; 23.27±4.03 mm (14-40 mm in range) for MPAD, 17.27±3.19 mm (10-30 mm in range) for RPAD, and 17.62±3.06 mm (10-37 mm in range) for LPAD. Statistically significantly higher values were obtained in all diameters for cases over 40 years of age. Similarly, higher values were obtained in all diameters for males compared to females. CONCLUSION The diameters of all thoracic main vascular structures are larger in men than in women and increase with age.
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Affiliation(s)
- Deniz Esin Tekcan Sanli
- Department of Medical Imaging Techniques, Istanbul Rumeli University, Vocational School of Health Services, Istanbul, Turkiye
- Department of Radiology, Acibadem Kozyatagi Hospital, Istanbul, Turkiye
| | - Ahmet Necati Sanli
- Department of General Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkiye
| | - Onur Yildirim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Ergin Erginoz
- Department of General Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkiye
| | - Duzgun Yildirim
- Department of Radiology, Acibadem University Faculty of Medicine, Istanbul, Turkiye
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Uludag SS, Kurt SA, Sanli DET, Sanli AN, Tutar O, Zengin AK, Ozcelik MF. Evaluating Portal Vein and Right Colon Venous Vascular Anatomy and Its Variations via Multidetector CT in Healthy Individuals. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03583-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Sanli DET. A case of ectopic fibroadenoma mimicking left axillary lymphadenopathy. J Clin Invest Surg 2022. [DOI: 10.25083/2559.5555/7.1.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Fibroadenomas are the most common benign tumors of the breast. Since they originate from the fibroglandular breast tissue, they cannot be localized anywhere outside the breast. However, they can be localized in accessory or ectopic breast tissue and cause confusion in terms of clinical differential diagnosis. Small ectopic fibroadenomas placed in normal breast tissue are generally asymptomatic and nonpalpable. In contrast, lesions located in the axillary region are usually palpable, due to their superficial location and skin that is thinner at this level. This case report presents the clinical and imaging findings of a patient with a preliminary diagnosis of lymphadenopathy, with a superficial axillary location of the lesion and who underwent biopsy. In our case, no obvious accessory breast tissue was detected by physical examination or ultrasound of the left armpit. Even though there was axillary accessory breast tissue, it was not at a level that could be detected by ultrasound.
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Tekcan Sanli DE, Sanli AN, Kandemirli SG, Altundag A, Yıldırım D. Olfactory Cleft Width and Volumes in Patients with COVID-19 Anosmia. ORL J Otorhinolaryngol Relat Spec 2022; 84:269-270. [PMID: 35354144 PMCID: PMC9059028 DOI: 10.1159/000523785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Deniz Esin Tekcan Sanli
- Department of Radiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.,Department of Medical Imaging Techniques, Vocational School of Health Services, Istanbul Rumeli University, Istanbul, Turkey
| | | | | | - Aytug Altundag
- Department of Otorhinolaryngology, Medical Faculty, Biruni University, Istanbul, Turkey.,Department of Ear Nose Throat, Acibadem Taksim Hospital, Istanbul, Turkey
| | - Duzgun Yıldırım
- Vocational School of Health, Mehmet Ali Aydınlar University, Istanbul, Turkey.,Department of Radiology, Acibadem Taksim Hospital, Istanbul, Turkey
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Yildirim D, Kandemirli SG, Tekcan Sanli DE, Akinci O, Altundag A. A Comparative Olfactory MRI, DTI and fMRI Study of COVID-19 Related Anosmia and Post Viral Olfactory Dysfunction. Acad Radiol 2022; 29:31-41. [PMID: 34810059 PMCID: PMC8549400 DOI: 10.1016/j.acra.2021.10.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 12/24/2022]
Abstract
Rationale and Objective To evaluate how COVID-19 anosmia imaging findings resembled and differed from postinfectious olfactory dysfunction (OD). Material and Methods A total of 31 patients presenting with persistent COVID-19 related OD and 97 patients with post-infectious OD were included. Olfactory bulb MRI, DTI and olfactory fMRI findings in both groups were retrospectively assessed. Results All COVID-19 related OD cases were anosmic, 18.6% of post-infectious OD patients were hyposmic and remaining 81.4% were anosmic. Mean interval between onset of OD and imaging was 1.5 months for COVID-19 related OD and 6 months for post-infectious OD. Olfactory bulb volumes were significantly higher in COVID-19 related OD than post-infectious OD. Deformed bulb morphology and increased olfactory bulb signal intensity was seen in 58.1% and 51.6% with COVID-19 related OD; and 63.9% – 46.4% with post-infectious OD; without significant difference. Significantly higher rate of olfactory nerve clumping and higher QA values at orbitofrontal and entorhinal regions were observed in COVID-19 related OD than post-infectious OD. Absence of orbitofrontal and entorhinal activity showed no statistically significant difference between COVID-19 related OD and post-infectious OD, however trigeminosensory activity was more robust in COVID-19 related OD cases. Conclusion Olfactory bulb damage may play a central role in persistent COVID-19 related anosmia. Though there is decreased olfactory bulb volume and decreased white matter tract integrity of olfactory regions in COVID-19 related anosmia, this is not as pronounced as in other post-infectious OD. Trigeminosensory activity was more robust in COVID-19 related OD. These findings may reflect better preserved central olfactory system in COVID-19 related OD compared to COVID-19 related OD.
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Affiliation(s)
- Duzgun Yildirim
- Acibadem University, Department of Medical Imaging, Istanbul, Turkey
| | - Sedat Giray Kandemirli
- University of Iowa, Hospital and Clinics, Department of Radiology, 200 Hawkins Drive, Iowa City, IA 52242.
| | | | - Ozlem Akinci
- Sancaktepe Sehit Prof Dr Ilhan Varank Research and Training Hospital, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Aytug Altundag
- Acibadem Taksim Hospital, Department of Otorhinolaryngology, Istanbul, Turkey
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Sanli DET, Yildirim D. Evaluation of the Effect of Age, Menopausal Status, and Parity on Breast Parenchyma Stiffness by Multiparametric Shear Wave Elastography. Acad Radiol 2022; 29 Suppl 1:S62-S68. [PMID: 34702676 DOI: 10.1016/j.acra.2021.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the relationship between quantitative breast parenchyma stiffness by using multiparametric shear wave elastography (mpSWE) and the potential risk factors of breast cancer. MATERIAL AND METHODS The Vmean, Vmax, Vmin, Vsd values were measured with mpSWE from each breast and each quadrant in all cases under and over the age of 40. Statistical analysis was performed to evaluate the relationship between breast stiffness and age, side, quadrant, menopausal status, mammographic breast density, and obstetric history. RESULTS The study cohort included 964 breasts of 482 patients, where 342 patients were ≥40 years of age; and 140 cases were <40 years of age with a mean age of 45.07 ± 10.96. No significant difference in breast stiffness was detected between right and left breasts (p > 0.05); however, upper quadrants were found to be stiffer than the lower quadrants (p < 0.05). The effect of age on all values was found to be significant (p < 0.05), and stiffness increased with age. All mpSWE values of post-menopausal cases were significantly higher (p < 0.05) than premenopausal cases. Nulliparous cases had higher values than cases with prior parity (p < 0.05). Cases with Type C and D breast density had higher stiffness values than those with Type A and Type B breast density. CONCLUSION Breast parenchyma shows increased stiffness in in post-menopausal, nulliparous and older patients and patients with dense breast density. Similar to the mammographic increased breast density, elastographically increased breast parenchymal stiffness may be used as a possible risk factor for breast cancer or as a predictor of breast cancer.
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Affiliation(s)
- Deniz Esin Tekcan Sanli
- Department of Medical Imaging Techniques, Vocational School of Health Services, Istanbul Rumeli University, Istanbul, Turkey; Department of Radiology, Acibadem Kozyatagi Hospital, Istanbul, Turkey.
| | - Duzgun Yildirim
- Department of Medical Imaging Techniques, Vocational School of Health, Acibadem University, Istanbul, Turkey
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Tekcan Sanli DE, Altundag A, Yıldırım D, Kandemirli SG, Sanli AN. Comparison of Olfactory Cleft Width and Volumes in Patients with COVID-19 Anosmia and COVID-19 Cases Without Anosmia. ORL J Otorhinolaryngol Relat Spec 2021; 84:1-9. [PMID: 34569549 PMCID: PMC8678255 DOI: 10.1159/000518672] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/24/2021] [Indexed: 12/04/2022]
Abstract
Introduction The aim of this study was to assess the relationship between olfactory cleft width/volume and COVID-19-related anosmia. Methods This study consisted of PCR-proven COVID-19 patients. Cases with COVID-19-related anosmia constituted Group 1 and cases without any olfactory dysfunction (OD) throughout COVID-19 infection or after recovery constituted Group 2. A total of 50 patients were included in the study, comprising 24 cases in Group 1 and 26 cases in Group 2. Group 1 patients underwent a 4-item-odor identification test during active symptoms and a Sniffin' Sticks test after reconversion of PCR results to negative. All patients in Group 2 also underwent the Sniffin' Stick test to document normosmia. All cases had paranasal sinus CT performed. Olfactory cleft widths and olfactory volumes were measured. The differences in width and volume between groups and the correlation with odor test scores (threshold-discrimination-identification [TDI]) were calculated. In addition, regression analyzes analysis was performed for cleft widths, volumes, and TDI scores according to age. Results Olfactory cleft widths and olfactory volumes were significantly higher in Group 1 than those in Group 2 (p = 0.001; p < 0.01). There was a significant negative correlation between total TDI scores and olfactory cleft widths and total olfactory volumes (r = −0.665; r = −0.731, respectively). Patients younger than 40 years of age had significantly higher right olfactory cleft width, left olfactory cleft width, and olfactory cleft volume than those in patients older than 40 years of age (p = 0.004, p = 0.005, p = 0.003; p < 0,01, respectively). However, patients younger than 40 years of age had a significantly lower total TDI score and in all other values individually (t-d-i) than those in patients older than 40 years of age (p = 0.004; p < 0.01). Conclusion Patients with COVID-19-related OD had larger olfactory cleft width and volumes than those without OD in this study. Total TDI score was found to be inversely correlated with cleft width and volume.
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Affiliation(s)
| | - Aytug Altundag
- Department of Ear Nose Throat, Acibadem Taksim Hospital, Istanbul, Turkey
| | - Duzgun Yıldırım
- Department of Radiology, Acibadem Taksim Hospital, Istanbul, Turkey
| | | | - Ahmet Necati Sanli
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Altundag A, Saatci O, Sanli DET, Duz OA, Sanli AN, Olmuscelik O, Temirbekov D, Kandemirli SG, Karaaltin AB. The temporal course of COVID-19 anosmia and relation to other clinical symptoms. Eur Arch Otorhinolaryngol 2021; 278:1891-1897. [PMID: 33237475 PMCID: PMC7686554 DOI: 10.1007/s00405-020-06496-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/10/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study aimed to define the clinical course of anosmia in relation to other clinical symptoms. METHODS 135 patients with COVID-19 were reached by phone and subsequently included in the study. Olfactory functions were evaluated using a questionnaire for assessment of self-reported olfactory function. Patients were divided into four subgroups according to the presence of olfactory symptoms and temporal relationship with the other symptoms: group1 had only olfactory complaints (isolated, sudden-onset loss of smell); group2 had sudden-onset loss of smell, followed by COVID-19 related complaints; group3 initially had COVID-19 related complaints, then gradually developed olfactory complaints; and group4 had no olfactory complaints. RESULTS In total, 59.3% of the patients interviewed had olfactory complaints during the disease course. The olfactory dysfunction severity during COVID-19 infection was significantly higher in group1 compared to groups 2 and 3. In groups1-3, the odor scores after recovery from COVID-19 disease were significantly lower compared to the status prior to disease onset. The residual olfactory dysfunction was similar between groups1 and 2, but was more evident than group3. Mean duration for loss of smell was 7.8 ± 3.1 (2-15) days. Duration of loss of smell was longer in groups1 and 2 than in group3. Odor scores completely returned back to the pre-disease values in 41 (51.2%) patients with olfactory dysfunction. Rate of complete olfactory dysfunction recovery was higher in group3 compared to groups1 and 2. CONCLUSION In isolated anosmia cases, anosmia is more severe, and complete recovery rates are lower compared to the patients who have other clinical symptoms. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Aytug Altundag
- Department of Otorhinolaryngology, Biruni University, Istanbul, Turkey
| | - Ozlem Saatci
- Department of Otorhinolaryngology, Istanbul Sancaktepe, Education and Research Hospital, Istanbul, Turkey
| | | | - Ozge Arici Duz
- Department of Neurology, Istanbul Medipol University, Istanbul, Turkey
| | - Ahmet Necati Sanli
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Oktay Olmuscelik
- Department of Internal Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Dastan Temirbekov
- Department of Otorhinolaryngology, Medicalpark Florya Hospital, Istanbul, Turkey
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Sanli DET, Yildirim D. A case of primary bilateral breast lymphoma presenting with a painless mass in the left breast. J Clin Invest Surg 2021. [DOI: 10.25083/2559.5555/6.1.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Breast cancer is the most common cancer in women. Patients usually present with a rapidly progressed painless mass in the breast. The first pathological entity to be considered is breast cancer in case of newly developed painless mass, so that radiological and pathological evaluations must be performed. However, some systemic disorders; benign conditions like rheumatological diseases, and also systemic malignancies such as lymphoma, can mimic breast cancer by involving the breast. It is necessary to distinguish between such diseases through a correct diagnosis, because they have very different treatments and prognoses. We present a case diagnosed as bilateral primary breast lymphoma with a palpable mass in a single breast, its clinical and radiological characteristics. This case report suggests that systemic diseases should be considered in the differential diagnosis of breast diseases and breast masses, especially when there is bilaterally involvement, as discussed in this article.
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Sanli DET, Sanli AN, Kandemirli SG, Esmerer E, Kayadibi Y, Demiryas S, Korman MU. The mutually complementary role of magnetic resonance enterography and conventional enteroclysis in patients with complicated and/or advanced stage of Crohn's disease. BRATISL MED J 2021; 122:270-276. [PMID: 33729820 DOI: 10.4149/bll_2021_045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIM To assess the diagnostic significance of magnetic resonance enterography (MRE) and conventional enteroclysis (CE) in patients with complicated and/or advanced stage of Crohn's disease. METHODS Patients with abnormal CE findings suggestive of mural and/or extramural involvement with the diagnosis or pre-diagnosis of CD are evaluated. After real-time bowel distension by enteroscopic examination, the patients with advanced or complicated stage were taken to the MRE examination in the same session. Mucosal-mural-extramural and activation findings, presence of stenosis/stricture, skip lesions and the mean duration of exams were evaluated with both CE and MRE. The superiority of one method over the other relative to these findings was evaluated. RESULTS A total of 110 patients evaluated by CE had the findings of CD. Of these, 24 patients with abnormal CE findings suggestive of advanced mural and extramural involvements were subsequently evaluated with MRE. CE was superior to MRE in the depiction of early superficial mucosal changes (aphthous-linear ulcer), cobblestone pattern (p = 0.002, p < 0.01), obstruction (p = 0.004, p < 0.01), and differentiation between the string sign and stricture. MRE was superior to conventional enteroclysis in mural and perienteric findings of bowel thickening, fibro-fatty proliferation, abscess (p = 0.016, p 0.05). CONCLUSION CE and MRE are mutually complementary imaging modalities in CD staging, evaluation of activation findings, and detection of complications (Tab. 3, Fig. 8, Ref. 23).
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Basar Y, Alis D, Tekcan Sanli DE, Akbas T, Karaarslan E. Whole-body MRI for preventive health screening: Management strategies and clinical implications. Eur J Radiol 2021; 137:109584. [PMID: 33596499 DOI: 10.1016/j.ejrad.2021.109584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/04/2021] [Accepted: 01/30/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To document the diagnostic yields of whole-body MRI (WB-MRI) screening for asymptomatic individuals by using a classification system that categorizes the findings by clinical relevance and provides a flowchart for further investigations, and to determine the influence of WB-MRI findings on clinical decision-making. METHODS In this institutional review board-approved study, a retrospective review of individuals who underwent WB-MRI between 2009 and 2020 was conducted, and asymptomatic participants who underwent non-contrast-enhanced comprehensive WB-MRI for screening were enrolled. Participants were classified into four categories based on WB-MRI findings, and those with relevant findings (i.e., categories 3 and 4) were referred for further diagnostic workup. The participants' medical records were investigated, and interviews were conducted to reveal false-negative findings and identify the number of WB-MRI-triggered treatments. RESULTS We included 576 participants (377 [65.4 %] men, 199 [34.6 %] women; mean age, 48.40 ± 10.82 years), of which 266 (46.2 %) and 310 (53.8 %) underwent WB-MRI with 1.5 T and 3.0 T magnets, respectively. Approximately one-third of the participants showed clinically relevant findings, and 65 (11.2 %) received a treatment triggered by WB-MRI. Notably, 15 (2.6 %) and 28 (4.8 %) participants had cancers and intracranial aneurysms, respectively. Of the 576 participants, 16 (2.8 %) had false-negative findings, among which five had cancers. CONCLUSION WB-MRI yields numerous important findings that trigger therapeutic interventions in a large sample of asymptomatic adults. However, considering its inherent limitations, WB-MRI might be inadequate for detecting malignancies such as colon, thyroid, and breast cancers; thus, it may serve as a complementary screening method for health-conscious individuals.
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Affiliation(s)
- Yeliz Basar
- Acibadem Maslak Hospital, Department of Radiology, Istanbul, Turkey.
| | - Deniz Alis
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Radiology, Istanbul, Turkey.
| | | | - Tugana Akbas
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Radiology, Istanbul, Turkey.
| | - Ercan Karaarslan
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Radiology, Istanbul, Turkey.
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Sanli DET, Yildirim D, Sanli AN, Turkmen S, Erozan N, Husmen G, Altundag A, Tuzuner F. A practical approach to imaging characteristics and standardized reporting of COVID-19: a radiologic review. Mil Med Res 2021; 8:7. [PMID: 33487174 PMCID: PMC7826494 DOI: 10.1186/s40779-021-00301-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 01/15/2021] [Indexed: 12/15/2022] Open
Abstract
Novel coronavirus (2019-nCoV), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a pathogen that has caused a rapidly spreading pandemic all over the world. The primary mean of transmission is inhalation with a predilection for respiratory system involvement, especially in the distal airways. The disease that arises from this novel coronavirus is named coronavirus disease 2019 (COVID-19). COVID-19 may have a rapid and devastating course in some cases leading to severe complications and death. Radiological imaging methods have an invaluable role in diagnosis, follow-up, and treatment. In this review, radiological imaging findings of COVID-19 have been systematically reviewed based on the published literature so far. Radiologic reporting templates are also emphasized from a different point of view, considering specific distinctive patterns of involvement.
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Affiliation(s)
- Deniz Esin Tekcan Sanli
- Department of Radiology, Acibadem Kozyatagi Hospital, 19 Mayıs Mah, İnönü Cad, Okur Sok, No.24/A, Kozyatağı, 34734 Istanbul, Turkey
| | - Duzgun Yildirim
- Department of Radiology, Acibadem Taksim Hospital, 34373 Istanbul, Turkey
| | - Ahmet Necati Sanli
- Cerrahpasa Medical Faculty, Department of General Surgery, Istanbul University-Cerrahpasa, 34098 Istanbul, Turkey
| | - Suha Turkmen
- Department of Emergency, Acibadem Taksim Hospital, 34373 Istanbul, Turkey
| | - Neval Erozan
- Department of Radiology, Acibadem Kozyatagi Hospital, 19 Mayıs Mah, İnönü Cad, Okur Sok, No.24/A, Kozyatağı, 34734 Istanbul, Turkey
| | - Guray Husmen
- Department of Radiology, Acibadem Kozyatagi Hospital, 19 Mayıs Mah, İnönü Cad, Okur Sok, No.24/A, Kozyatağı, 34734 Istanbul, Turkey
| | - Aytug Altundag
- Department of Otolaryngology, Acibadem Taksim Hospital, 34373 Istanbul, Turkey
| | - Filiz Tuzuner
- Department of Anesthesiology, Acibadem Taksim Hospital, 34373 Istanbul, Turkey
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16
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Sanli DET, Altundag A, Kandemirli SG, Yildirim D, Sanli AN, Saatci O, Kirisoglu CE, Dikensoy O, Murrja E, Yesil A, Bastan S, Karsidag T, Akinci IO, Ozkok S, Yilmaz E, Tuzuner F, Kilercik M, Ljama T. Relationship between disease severity and serum IL-6 levels in COVID-19 anosmia. Am J Otolaryngol 2021; 42:102796. [PMID: 33152573 PMCID: PMC7591946 DOI: 10.1016/j.amjoto.2020.102796] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 12/21/2022]
Abstract
Background An association between IL-6 levels and cytokine storm syndrome in COVID-19 patients has been suggested. Cases with higher IL-6 levels have more rapid progression and a higher complication rate. On the other hand, COVID-19 cases with anosmia have a milder course of the disease. Objective We aimed to investigate whether there is a relationship between serum IL-6 levels and presence of anosmia in COVID-19 patients. Methods Patients with a confirmed diagnosis of COVID-19 based on laboratory (PCR) were stratified into two groups based on presence of olfactory dysfunction (OD). In all cases with and without anosmia; psychophysical test (Sniffin' Sticks test) and a survey on olfactory symptoms were obtained. Threshold (t) – discrimination (d) – identification (i), and total (TDI) scores reflecting olfactory function were calculated. Clinical symptoms, serum IL-6 levels, other laboratory parameters, and chest computed tomography (CT) findings were recorded. Results A total of 59 patients were included, comprising 23 patients with anosmia and 36 patients without OD based on TDI scores. Patients with anosmia (41.39 ± 15.04) were significantly younger compared to cases without anosmia (52.19 ± 18.50). There was no significant difference between the groups in terms of comorbidities, smoking history, and symptoms including nasal congestion and rhinorrhea. Although serum IL-6 levels of all patients were above normal values (7 pg/mL), patients with anosmia had significantly lower serum IL-6 levels (16.72 ± 14.28 pg/mL) compared to patients without OD (60.95 ± 89.33 pg/mL) (p = 0.026). Conclusion Patients with COVID-19 related anosmia tend to have significantly lower serum levels of IL-6 compared to patients without OD, and the lower IL-6 levels is related to milder course of the disease. With the effect of low cytokine storm and IL-6 level, it may be said that anosmic cases have a milder disease in COVID-19. Cytokine storm syndrome in COVID-19 is associated with poor prognosis and mortality. IL-6 is one of the most important mediators of cytokine storm syndrome. Patients with COVID-19-related anosmia usually have a mild disease. Serum IL-6 level of patients with COVID-19-related anosmia is higher than normal, it is lower than patients without anosmia.
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Kandemirli SG, Altundag A, Yildirim D, Tekcan Sanli DE, Saatci O. Olfactory Bulb MRI and Paranasal Sinus CT Findings in Persistent COVID-19 Anosmia. Acad Radiol 2021; 28:28-35. [PMID: 33132007 PMCID: PMC7571972 DOI: 10.1016/j.acra.2020.10.006] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/17/2022]
Abstract
Background and purpose There is limited literature consisting of case reports or series on olfactory bulb imaging in COVID-19 olfactory dysfunction. An imaging study with objective clinical correlation is needed in COVID-19 anosmia in order to better understand underlying pathogenesis. Material and methods We evaluated 23 patients with persistent COVID-19 olfactory dysfunction. Patients included in this study had a minimum 1-month duration between onset of olfactory dysfunction and evaluation. Olfactory functions were evaluated with Sniffin’ Sticks Test. Paranasal sinus CTs and MRI dedicated to olfactory nerves were acquired. On MRI, quantitative measurements of olfactory bulb volumes and olfactory sulcus depth and qualitative assessment of olfactory bulb morphology, signal intensity, and olfactory nerve filia architecture were performed. Results All patients were anosmic at the time of imaging based on olfactory test results. On CT, Olfactory cleft opacification was seen in 73.9% of cases with a mid and posterior segment dominance. 43.5% of cases had below normal olfactory bulb volumes and 60.9% of cases had shallow olfactory sulci. Of all, 54.2% of cases had changes in normal inverted J shape of the bulb. 91.3% of cases had abnormality in olfactory bulb signal intensity in the forms of diffusely increased signal intensity, scattered hyperintense foci or microhemorrhages. Evident clumping of olfactory filia was seen in 34.8% of cases and thinning with scarcity of filia in 17.4%. Primary olfactory cortical signal abnormality was seen in 21.7% of cases. Conclusion Our findings indicate olfactory cleft and olfactory bulb abnormalities are seen in COVID-19 anosmia. There was a relatively high percentage of olfactory bulb degeneration. Further longitudinal imaging studies could shed light on the mechanism of olfactory neuronal pathway injury in COVID-19 anosmia.
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Tekcan Sanli DE, Yildirim D, Sanli AN, Erozan N, Husmen G, Altundag A, Tuzuner F, Dikensoy O, Erel Kirisoglu C. Predictive value of CT imaging findings in COVID-19 pneumonia at the time of first-screen regarding the need for hospitalization or intensive care unit. ACTA ACUST UNITED AC 2020; 27:599-606. [PMID: 33290242 DOI: 10.5152/dir.2020.20421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE In this study, we aimed to reveal the relationship between initial lung parenchymal involvement patterns and the subsequent need for hospitalization and/or intensive care unit admission in coronavirus disease 2019 (COVID-19) positive cases. METHODS Overall, 231 patients diagnosed with COVID-19 as proven by PCR were included in this study. Based on the duration of hospitalization, patients were divided into three groups as follows: Group 1, patients receiving outpatient treatment or requiring hospitalization <7 days; Group 2, requiring hospitalization ≥7 days; Group 3, patients requiring at least 1 day of intensive care at any time. Chest CT findings at first admission were evaluated for the following features: typical/atypical involvement of the disease, infiltration patterns (ground-glass opacities, crazy-paving pattern, consolidation), distribution and the largest diameters of the lesions, total lesion numbers, number of affected lung lobes, and affected total lung parenchyma percentages. The variability of all these findings according to the groups was analyzed statistically. RESULTS In this study, 172 patients were in Group 1, 39 patients in Group 2, and 20 patients in Group 3. The findings obtained in this study indicated that there was no statistically significant difference in ground-glass opacity rates among the groups (p = 0.344). The rates of crazy-paving and consolidation patterns were significantly higher in Groups 2 and 3 than in Group 1 (p = 0.001, p = 0.002, respectively). The rate of right upper, left upper lobe, and right middle lobe involvements as consolidation pattern was significantly higher in Group 3 than in Group 1 (p = 0.148, p = 0.935, p = 0.143, respectively). A statistically significant difference was also found between the affected lobe numbers, total lesion numbers, the diameter of the largest lesion, and the affected lung parenchyma percentages between the groups (p = 0.001). The average number of impacted lobes in Group 1 was 2; 4 in Group 2 and Group 3. The mean percentage of affected lung parenchyma percentage was 25% in Group 1 and Group 2, and 50% in Group 3. CONCLUSION In case of infiltration dominated by right middle or upper lobe involvement with a consolidation pattern, there is a higher risk of future intensive care need. Also, the need for intensive care increases as the number of affected lobes and percentage of affected parenchymal involvement increase.
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Affiliation(s)
| | - Duzgun Yildirim
- Department of Radiology, Acibadem Taksim Hospital, Istanbul, Turkey
| | - Ahmet Necati Sanli
- Department of General Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Neval Erozan
- Department of Radiology, Acibadem Kozyatagi Hospital, Istanbul, Turkey
| | - Guray Husmen
- Department of Radiology, Acibadem Kozyatagi Hospital, Istanbul, Turkey
| | - Aytug Altundag
- Department of Otolaryngology, Acibadem Taksim Hospital, Istanbul, Turkey
| | - Filiz Tuzuner
- Department of Anestesiology, Acibadem Taksim Hospital, Istanbul, Turkey
| | - Oner Dikensoy
- Department of Pulmonary Medicine, Acibadem Taksim Hospital, Istanbul, Turkey
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Dagoglu B, Sanli DET, Suma PP. Comparative analysis of breast imaging: a multi-modality approach may improve the overall quality of clinical output. J Contemp Clin Pract 2020. [DOI: 10.18683/jccp.2020.1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Altundag A, Yıldırım D, Tekcan Sanli DE, Cayonu M, Kandemirli SG, Sanli AN, Arici Duz O, Saatci O. Olfactory Cleft Measurements and COVID-19-Related Anosmia. Otolaryngol Head Neck Surg 2020; 164:1337-1344. [PMID: 33045908 PMCID: PMC7554408 DOI: 10.1177/0194599820965920] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective This study aimed to investigate the differences in olfactory cleft (OC)
morphology in coronavirus disease 2019 (COVID-19) anosmia compared to
control subjects and postviral anosmia related to infection other than
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Study Design Prospective. Setting This study comprises 91 cases, including 24 cases with anosmia due to
SARS-CoV-2, 38 patients with olfactory dysfunction (OD) due to viral
infection other than SARS-CoV-2, and a control group of 29 normosmic
cases. Methods All cases had paranasal sinus computed tomography (CT), and cases with OD had
magnetic resonance imaging (MRI) dedicated to the olfactory nerve. The OC
width and volumes were measured on CT, and T2-weighted signal intensity
(SI), olfactory bulb volumes, and olfactory sulcus depths were assessed on
MRI. Results This study showed 3 major findings: the right and left OC widths were
significantly wider in anosmic patients due to SARS-CoV-2 (group 1) or OD
due to non–SARS-CoV-2 viral infection (group 2) when compared to healthy
controls. OC volumes were significantly higher in group 1 or 2 than in
healthy controls, and T2 SI of OC area was higher in groups 1 and 2 than in
healthy controls. There was no significant difference in olfactory bulb
volumes and olfactory sulcus depths on MRI among groups 1 and 2. Conclusion In this study, patients with COVID-19 anosmia had higher OC widths and
volumes compared to control subjects. In addition, there was higher T2 SI of
the olfactory bulb in COVID-19 anosmia compared to control subjects,
suggesting underlying inflammatory changes. There was a significant negative
correlation between these morphological findings and threshold
discrimination identification scores. Level of Evidence Level 4.
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Affiliation(s)
- Aytug Altundag
- Department of Otorhinolaryngology, Medical Faculty, Biruni University, Istanbul, Turkey.,Department of Ear, Nose, and Throat, Acibadem Taksim Hospital, Istanbul, Turkey
| | - Duzgun Yıldırım
- Vocational School of Health, Mehmet Ali Aydınlar University, Istanbul, Turkey.,Department of Radiology, Acibadem Taksim Hospital, Istanbul, Turkey
| | | | - Melih Cayonu
- Department of Otorhinolaryngology and Head & NeckSurgery, Ankara City Hospital, Ankara, Turkey
| | | | - Ahmet Necati Sanli
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozge Arici Duz
- Department of Neurology, Istanbul Medipol University, Istanbul, Turkey
| | - Ozlem Saatci
- Department of Ear, Nose, and Throat, Sancaktepe Training and Research Hospital, Istanbul, Turkey
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