Risk and Prognostic Factors in Perinatal Hemorrhagic Stroke.

BACKGROUND: Perinatal stroke encompasses a heterogeneous group of focal neurological injuries early in brain development. In this study, we aimed to compare risk and prognostic factors in preterm and term infants with perinatal hemorrhagic stroke (PHS). PATIENTS AND METHODS: The study includes 66 infants with PHS. The infants were evaluated for demographic characteristics, fetal and maternal risk factors, perinatal events, clinical and neuroimaging findings, complications, and sequales. RESULTS: Of 66 infants with PHS, 44 (66.70%) were preterm and 22 (33.30%) were term infants. Primiparity, mucosal bleeding, and multiple lobes involvement were more common in term infants than preterm infants (P < 0.05); however, respiratory insufficiency, neonatal sepsis, perinatal asphyxia, respiratory distress syndrome, use of invasive mechanical ventilation, use of noninvasive mechanical ventilation, and prolonged hospitalization were more common in preterm infants than term infants (P < 0.05). Eight (12.12%) infants died during infancy period. Small for gestational age and mucosal bleeding were more common in infants who are dead than those alive (P < 0.05). Forty-two (63.63%) infants were followed. Cerebral palsy and/or epilepsy and/or hydrocephalus were diagnosed in 36 (85.72%) infants during follow-up. CONCLUSION: Our findings showed that PHS was much more common in preterm infants. Mucosal bleeding and multiple lobes involvement were more common in term infants. PHS has high morbidity and mortality rates. Small for gestational age and mucosal bleeding were more common in infants who are dead.

Associations Between Doppler Internal Jugular Vein Blood Flow and Transverse Sinus Stasis Detected by Magnetic Resonance Imaging.

OBJECTIVES: This study aimed to compare the estimated internal jugular vein (IJV) volume flow with Doppler ultrasound in patients with slow flow in the transverse sinuses and normal transverse sinuses on brain magnetic resonance imaging (MRI). METHODS: Eighty patients between the ages of 18 and 80 years who did not have any signs of sinus vein thrombosis on brain MRI were included. On MRI, cases with hyperintensity due to a signal void loss in the transverse sinuses in coronal fluid attenuation inversion recovery sequences were included in the slow-flow group. The presence of sinus thrombosis was excluded with other MRI pulse sequences and clinical findings. The participants were divided into 2 groups as having normal and slow flow according to MRI findings. Then bilateral IJV volume flow measurements were made by Doppler ultrasound. Bilateral volume flow was estimated by time-averaged blood flow velocities sampled in the center of the IJV, and IJV cross-sectional areas were measured. We defined the dominant IJV as the one having the higher estimated volume flow of the 2 sides. RESULTS: Total estimated IJV blood flow was lower (P < .001) in patients with slow flow on MRI (546 mL/min) compared to those without (768 mL/min). A similar finding was seen for the nondominant IJV. In a receiver operating characteristic analysis, the cutoff value for the total estimated IJV volume flow was determined to be 590 mL/min, and the cutoff value for nondominant estimated IJV volume flow was determined to be 202 mL/min to distinguish between the groups. CONCLUSIONS: Low estimated volume blood flow in the IJV is associated with MRI evidence of stasis in the ipsilateral transverse sinus.

Role of Contrast Enhancement and Corrected Attenuation Values of Renal Tumors in Predicting Renal Cell Carcinoma (RCC) Subtypes: Protocol for a Triphasic Multi-Slice Computed Tomography (CT) Procedure.

BACKGROUND: To distinguish RCC subtypes based on contrast enhancement features of CT images. MATERIAL/METHODS: In total, 59 lesions from 57 patients were included. All patients underwent multi-slice CT imaging with a triphasic protocol, which included non-contrast, corticomedullary, nephrographic and urographic phases. Contrast enhancement features of renal masses were evaluated in terms of CT attenuation values (AV) and differences in contrast density; the aorta or renal parenchyma were evaluated based on corrected or relative values. RESULTS: Clear cell RCC (ccRCC) showed more intense contrast enhancement than other RCC subtypes. When differentiating ccRCC from other RCC subtypes, a cut-off AV of 86-89 HU, aorta-based corrected AV of 89-95 HU and renal parenchyma-based corrected AV of 87-95 HU showed a diagnostic accuracy of 81-86%, 86-88% and 74-78%, respectively, in the corticomedullary phase. Furthermore, a cutoff of 2.42-2.72 for the relative contrast enhancement ratio, a cutoff of 2.59-2.74 for the aorta-based corrected relative contrast enhancement ratio and a cutoff of 2.63-2.76 for the renal parenchyma-based attenuation ratio showed a diagnostic accuracy of 83-88%, 88-90% and 81%, respectively. CONCLUSIONS: The most reliable parameters for differentiating ccRCC from other RCC subtypes are aorta-based corrected AV and aorta-based corrected relative contrast enhancement values in the corticomedullary phase.

Neuroblastoma arising from an unresected sacrococcygeal teratoma in a child.

Malignant transformation of a germ cell tumor, referring to the occurrence of somatic, nongerm cell malignancy within a germ cell tumor is a rare entity. The authors report a case of malignant transformation of an unreseceted sacrococcygeal teratoma to neuroblastoma in a 6-year-old girl and discuss this case in the light of relevant literature. This case shows that complete resection of germ cell tumor is necessary to prevent malignant transformation. In addition, when malignant transformation occurs, the treatment strategy must include surgery together with histology adapted systemic chemotherapy.

[An analysis of meniscal extrusion and associated knee joint lesions by magnetic resonance imaging]. / Menisküs tasmasi ve beraberinde görülen diz eklemi lezyonlarinin manyetik rezonans görüntüleme ile degerlendirilmesi.

OBJECTIVES: We investigated the frequency of meniscal extrusion and associated knee joint lesions by magnetic resonance imaging (MRI) in patients with meniscal tears. METHODS: We retrospectively evaluated MRI findings of 100 patients (41 males, 59 females; mean age 54 + or - 10 years; range 27 to 76 years) with meniscal tears in 126 knee joints. Using coronal images, extrusion was defined as a distance of = or > 3 mm between the peripheral border of the meniscus and the edge of the tibial plateau. All the knees were assessed with respect to the localization and type of meniscal tear and extrusion, accompanying joint effusion, cruciate ligament pathologies, and degenerative bone and cartilage changes. RESULTS: Meniscal extrusion was detected in 31 knee joints (24.6%), with a mean extrusion of 3.72 mm. All extrusions were found to be in the posterior horn of the medial meniscus and were associated with radial tears (n=18, 58.1%), radial-oblique tears (n=9, 29%), complex tears (n=2, 6.5%), and flap tears (n=2, 6.5%). Meniscal tears with extrusion differed significantly from those without extrusion with respect to the localization of all the tears being in the posterior horn of the medial meniscus (100% vs. 60%) and the higher frequency (58.1% vs. 20%) of radial tears (p<0.05). There were no significant differences in the types and frequencies of accompanying pathologies seen in meniscal tears with and without extrusion (p>0.05). CONCLUSION: Meniscal extrusion is a common finding particularly in osteoarthritis. It is mostly seen in the medial meniscus and accompanied by radial tears. Therefore, its presence should alert to the possibility of a radial tear extending to the meniscal root.

A Burkitt's lymphoma case with eyelid, renal and pulmonary involvement.

An eight-year-old boy was admitted with a three-week history of painless masses on the left upper eyelid, in front of the left ear and on the left side of his jaw. On examination, there was a 3x2 cm tumor on the left upper eyelid, and lymphadenopathies in front of the tragus and in the left submandibular area were observed in the absence of hepatosplenomegaly. Complete blood count, peripheral smear and bone marrow aspiration were normal. After the left submandibular lymphadenopathy was removed, he was diagnosed with Burkitt's lymphoma by pathological examinations. Thorax and abdomen computed tomography showed pulmonary and renal involvement. On the seventh day of treatment, eyelid involvement disappeared. After induction therapy, no renal or pulmonary lesions were observed. An unusual clinical presentation of Burkitt's lymphoma with eyelid and pulmonary involvement is reported.

Measurement of spinal canal diameters in young subjects with lumbosacral transitional vertebra.

Despite the high prevalence of lumbosacral transitional vertebra (LSTV), little is known about the biomechanics of this condition. In addition, as previous studies have focused solely on symptomatic and elderly LSTV patients, the relationship between LSTV and congenital or developmental spinal stenosis remains uncertain. In the present study, the spinal canal diameters were measured in young subjects in whom degenerative changes have not yet become significant. Seventeen young adults with LSTV and 24 normal controls were included in this study. The spinal canal sagittal diameter, interpedicular distance, interfacet distance and lateral recess diameter were measured using CT scans. There was no significant difference in the measured values between the two groups. In conclusion, the results indicate that there is no relationship between LSTV and a congenitally narrower canal.