Original Article Palmaris longus tendon and its relationship with the median nerve: a population-based morphometric magnetic resonance imaging study Esin Kurtulus Ozturk, Saffet Ozturk, Sitki Safa Taflan

Amyand's hernia is defined as the presence of the appendix vermiformis (inflamed or non-inflamed) within the inguinal hernia sac. It is seen in approximately 1% of inguinal hernia cases. This extremely rare condition is often diagnosed conventionally, at surgery. However, with the increasing use of computed tomography (CT) and ultrasonography (US) examinations, preoperative diagnosis is also possible. The treatment approach varies depending on whether the appendix inside the hernia sac is inflamed or not. For this reason, imaging examinations are of great importance in making a diagnosis and directing treatment. As a result of imaging examinations in an elderly patient in our clinic, colon, small intestine segments, omentum and appendix were detected in the right inguinal canal. Since the appendix was also located within the hernia sac, the case was called Amyand's hernia. In this article, we wanted to draw attention to Amyand's hernia in general and the place of radiological examination in diagnosis and treatment of this disease.

Aim: The purpose of this study is to discuss the prevalence and potential outcomes of incidental extracardiac findings (IEF) identified on cardiac MRI and also explore the age implications of these findings. Materials and Methods: 812 MRIs cardiac MRI were evaluated retrospectively by two radiologists. IEFs were examined in three groups as mild or no clinical significance (group 1), probable clinical significance (group 2) and clinically significant (group 3). In addition, the patient group was divided into 2 groups as over and under 65 years of age and the prevalence of extracardiac involvement was evaluated. Result: Our study consisted of 812 individuals (432 males (52.96%), median age 54 years, range 19-76 years), we identified a total of 187 IEFs in 176 patients. Of these IEFs; 74 (9.1%) belonged to group 1 were of mild or no clinical significance, 70 (8.6%) belonged to group 2 were of probable clinical significance, and 32 (3.9%) belonged to group 3 were clinically significant. 507 (62.4%) were ≤65 years old and 305 (37.6%) were over 65 years old. IEFs were seen significantly more frequently in patients over 65 years of age (n=100, 56.8% p

Background: Accurate pancreatic tumor segmentation on contrast-enhanced computed tomography (CECT) is important for staging, treatment planning, and response assessment in pancreatic ductal adenocarcinoma (PDAC). Although foundation models have shown promise for medical image segmentation, their effectiveness for disease-specific tumor delineation remains uncertain. This study evaluated whether fine-tuning a Segment Anything Model (SAM)-based framework on the target cohorts improves pancreatic tumor segmentation compared with directly applied foundation models. Methods: In this retrospective multicenter study, CECT examinations from patients with pathologically confirmed PDAC acquired between 2015 and 2025 were included. Two foundation model baselines, nnInteractive and MedSAM2, were compared with three TAGS-based configurations representing increasing levels of adaptation: TAGS (Zero-Shot), SAM-TAGS (fine-tuned from SAM weights), and MSD-TAGS (fine-tuned from a pancreas-specific checkpoint). Performance was assessed using patient-level five-fold cross-validation with the Dice Similarity Coefficient (DSC) and Normalized Surface Dice (NSD). A leave-one-center-out analysis was additionally performed to evaluate generalization to institutions absent from training. Results: A total of 500 patients with PDAC from four independent centers were included. MSD-TAGS achieved the highest overall segmentation performance, with a mean DSC of 0.703 and a mean NSD of 0.835. SAM-TAGS achieved a mean DSC of 0.691 and a mean NSD of 0.822. In comparison, nnInteractive achieved a mean DSC of 0.632 and a mean NSD of 0.782; MedSAM2, 0.585 and 0.792; and TAGS (Zero-Shot), 0.496 and 0.639, respectively. Compared with each competing method, MSD-TAGS achieved significantly higher DSC and NSD values (all Holm-adjusted p < 0.001). It also achieved the highest DSC across all four centers and the highest NSD in three of the four centers. Under leave-one-center-out evaluation, MSD-TAGS declined by 0.025 DSC and SAM-TAGS by 0.089. Conclusions: Task-specific adaptation improved pancreatic tumor segmentation with foundation models, and fine-tuned TAGS outperformed two publicly released promptable models applied without adaptation. Models initialized from a pancreas-specific checkpoint showed greater robustness under center-held-out evaluation. These findings support the importance of organ-specific initialization and target-cohort fine-tuning for disease-specific segmentation and warrant further validation before clinical translation. The multicenter pancreatic tumor CT segmentation dataset, including de-identified images and expert segmentation annotations, is publicly available to facilitate future research.

Inguinal bladder herniation is a commonly seen clinical entity which represents 1–4% of all inguinal hernias. However, the extensive inguinoscrotal herniation of the bladder, known as scrotal cystocele, is very rare. Clinical findings can vary from asymptomatic findings to surgical emergencies. Radiographic imaging can play important role in the diagnosis to reduce the risk of bladder injury during hernia repair when urinary symptoms are present. Computed Tomography scan is a gold standart to identify the hernia sac. Computed tomography findings observed in axial planes, should also be carefully evaluted in other planes. Sagittal or coronal images may provide better evaluation of the hernia and its relationships with surrounding tissues. The standard treatment of inguinal bladder hernaiation is either reduction or resection of the herniated bladder followed by hernia repair. This case describes a systematic approach and role of computed tomography in the diagnosis of inguinal bladder hernaiation.

Background: The European League Against Rheumatism (EULAR) recommends pneumococcal 13-valent (PCV13) and 23-valent vaccines in patients with rheumatic diseases (1). Adverse reactions to 23-valent pneumococcal vaccine were previously reported in patients with Behçet Syndrome (BS) (2). These were proposed to be associated with the pathergy phenomenon which may be observed in patients with BS. Objectives: To determine the frequency of adverse reactions to PCV13 in patients with BS who were candidates for TNF inhibitor treatment, together with ankylosing spondylitis (AS) and rheumatoid arthritis (RA) patients as controls. Methods: All of our patients who are candidates for TNF inhibitor therapy have been offered vaccination with PCV13 since 2016. We surveyed all patients with BS, AS and RA who were vaccinated with PCV13 in our infectious diseases outpatient clinic since 2016. Patients’ charts were reviewed and additionally patients were telephoned to identify any adverse local or systemic reactions. Local reactions were defined as redness, swelling, pain, and limitation of arm movement. Systemic reactions were defined as fever, headache, chills, rash, vomiting, joint pain, and muscle pain. Results: A total of 88 patients with BS, 143 patients with AS and 133 patients with RA had been vaccinated in our infectious diseases outpatient clinic. Among these, 55/88 (62%) patients with BS, 86/143 (60%) patients with AS and all 98/143 (68%) patients with RA could be contacted. Twenty-one of 55 (38%) patients with BS, 18/86 (20%) patients with AS and 27/98 (27%) patients with RA reported at least one local and/or systemic reaction after vaccination. Patients with BS reported more systemic reactions than the other two groups (48%, 12%, 23% respectively). On the other hand local reactions were less common among patients with BS (52%, 88%, 77% respectively). The local reactions were confined to erythema at injection site, pain and difficulty in moving among patients with AS and RA while 2 patients with BS had severe papulopustular skin lesions at injection site, in addition to erythema, pain and difficulty in moving. Both of these patients were pathergy positive at the time of the diagnosis. Conclusion: Severe papulopustular skin lesions at PCV13 injection site were observed only, but rarely, in patients with BS. Possibility of recall bias due to the retrospective nature of our study and the lack of other vaccines as controls are limitations of our study. Whether the skin lesions are caused by the skin pathergy reaction needs to be studied prospectively, as the pathergy status at diagnosis may be changed by the time these patients become candidates for TNF inhibitor treatment. References: [1]Furer V, Rondaan C, Heijstek MW, Agmon-Levin N, van Assen S, Bijl M, Breedveld FC, D’Amelio R, Dougados M, Kapetanovic MC, van Laar JM, de Thurah A, Landewé RB, Molto A, Müller-Ladner U, Schreiber K, Smolar L, Walker J, Warnatz K, Wulffraat NM, Elkayam O. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020 Jan;79(1):39-52. doi: 10.1136/annrheumdis 2019-215882. Epub 2019 Aug 14. PubMed PMID: 31413005. [2]Saeidinejad M, Kardash S, Connell L. Behcet’s disease and severe inflammatory reaction to 23-valent pneumococcal polysaccharide vaccine: a case report and review of literature. Scott Med J. 2018 Sep 25:36933018801215. doi: 10.1177/0036933018801215. [Epub ahead of print] PubMed PMID: 30253703. Disclosure of Interests: Berna Yurttas: None declared, Sitki Safa Taflan: None declared, Nese Saltoglu: None declared, Gulen Hatemi Grant/research support from: BMS, Celgene Corporation, Silk Road Therapeutics – grant/research support, Consultant of: Bayer, Eli Lilly – consultant, Speakers bureau: AbbVie, Mustafa Nevzat, Novartis, UCB – speaker