Evaluation of carotid intima media thickness and hematologic inflammatory markers in patients with chronic spontaneous urticaria.

INTRODUCTION: Low grade inflammation is associated with chronic spontaneous urticaria (CSU) and atherosclerosis. There are little data on the relationship between urticarial inflammation and atherosclerosis. The neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) and mean platelet volume (MPV) have recently been studied in many diseases as a biomarker of inflammation. AIM: To evaluate hematologic inflammatory parameters and subclinical atherosclerosis in CSU patients. MATERIAL AND METHODS: C-reactive protein (CRP), NLR, PLR, MPV and carotid intima media thickness (CIMT) in CSU patients were compared with healthy controls. Thirty CSU patients and 30 healthy controls participated in the study. RESULTS: Thirty CSU patients and 30 healthy controls participated in the study. 53.3% of the patient group were females, 46.7% were males and the mean age was 37.7 ±7.7. 53.3% of the healthy control group were females, 46.7% were males and the mean age was 37.1 ±7.2. Body mass index was 24.63 ±2.7 kg/m2 in the patient group and 24.83 ±2.5 kg/m2 in the control group. Left and right CIMT and CRP values were higher in CSU patients and high-density lipoproteins (HDL) values were lower in the CSU patients. There was a positive correlation between the right and left CIMT and urticaria activity severity 4 (UAS4), disease severity, and triglycerides in the patient group, also a negative correlation was found between the right and left CIMT and the HDL values. C-reactive protein was also correlated with UAS4 and disease severity. CONCLUSIONS: This is the first study to evaluate subclinical atherosclerosis in CSU patients. Chronic spontaneous urticaria may be associated with an increased atherosclerotic risk. Serum CRP concentration can also be used as an objective parameter to evaluate disease severity.

Diagnostic role of ultrasound elastography for nail bed involvement in psoriasis.

OBJECTIVE: Psoriasis is a chronic inflammatory disease that affects the skin, joints, and nails. To investigate the efficacy of sonoelastographic evaluation for assessing nail involvement and severity in psoriasis. MATERIALS AND METHODS: Thirty-one psoriasis patients and 31 healthy control subjects were included in the study. The nail thickness and nail bed thickness of the thumbs of all cases were measured by gray scale ultrasonography. In addition, the values of strain elastography were measured by sonoelastography. RESULTS: Of the participants, 38 were male and 24 were female; the ratio of males and females was equal in both groups. There was no significant difference between the patient and control group in terms of gender and age. In the patient group, the mean duration of illness was 13.87 ±â€Š9.8 years, mean PASI score was 5.53 ±â€Š2.38, and mean NAPSI score was 33.97 ±â€Š37.99. The nail plate thickness and elastography strain ratios were found to be statistically higher in the psoriasis group compared to the control group. There was also significant correlation between elastography strain ratios and nail thickness (P = .014), nail bed thickness (P < .001) and NAPSI scores (P = .01). CONCLUSION: Due to the superiority of ultrasound in real-time imaging of the nail structure and the compatibility of sonographic elastography with clinical scores in the assessment of the nail bed, we believe that it can be used as a complementary method.

Conus Medullaris Levels on Ultrasonography in Term Newborns : Normal Levels and Dermatological Findings.

OBJECTIVE: Ultrasonography (US) is the most non-invasive, safe, and, especially in the period of infancy, best method for visualizing and examining the spinal cord. Furthermore, US is the primary work-up for development of the spinal canal, and for follow-up on issues relating to subcutaneous tissues, bone development, and the spinal cord. Conus medullaris terminates at the second lumbar vertebra, according to a consensus in the literature. METHODS: Healthy children under the age of 6 months who were admitted to the radiology clinic for routine USG follow-ups between the dates of March 2012 to December 2014 were included in this study. RESULTS: Our study includes data from 1125 lumbosacral ultrasounds. The terminal point of the conus level of the attended infants, superior, middle part, inferior of the vertebrae L1, L2, and L3. Furthermore, the termination of the discal distance ratio did not differ significantly between genders. CONCLUSION: Therefore, according to our results, gender is not an influencing factor in the termination of the spinal cord. Based on the study we performed, as well as the previous literature, in infants without a recognized spinal pathology, the spinal cord is detected below the vertebra L3.

Retrospective Assessment of Early Changes in the Sacroiliac Joint After Posterior Lumbar Fusion Surgery via Magnetic Resonance Imaging and Computed Tomography.

OBJECTIVES: The need for lumbar-lumbosacral fusion surgery has increased in the recent decade. Although this type of surgical approach has been reported to provide better improvement in low back pain compared with conventional conservative treatments, the ratio of failure varies between 5% and 30% in different studies. METHODS: This retrospective study was conducted through screening patient files between January 2013 and January 2016. Preoperative and postoperative neurologic examination, Visual Analogue Scale, Oswestry Disability Index, and medical and surgical treatments of 66 patients were evaluated. RESULTS: The data from these 66 patients was included in this study. Of the patients, 28 were male and 38 were female. Mean age was 58.3 years for male and 60.1 years for female subjects. Mean duration of follow-up was 15 months. CONCLUSIONS: Our study has revealed that lumbosacral fusion surgery increases sacroiliac joint degeneration. We consider that magnetic resonance imaging is superior to computed tomography for detection of early stage sacroiliac joint degeneration.

Atypical type of Hirayama disease: Onset of proximal upper extremity.

Hirayama disease is a rare, benign motor neuron disease. It has been proposed that the dura mater's posterior wall lacks sufficient elasticity in the lower cervical region and this causes the tense dura part to displace anteriorly upon flexion. The disease is described as involving unilateral upper extremity with a distal-onset. We reported weakness and atrophy of the proximal part of an extremity in a 45-year-old man who is diagnosed with Hirayama disease. Proximal onset is a rare type of Hirayama Disease. Clinicians must be alert of proximal involvement and the diagnosis should be confirmed with electrophysiological and flexion MRI studies.

Management of a complicated redo giant dissecting aortic aneurysm.

Giant aortic aneurysm is defined as an aneurysm of the aorta of greater than 10 cm in diameter. This rare condition is associated with a high risk of morbidity and mortality and it may lead to fatal complications such as rupture and/or dissection if not managed with proper surgical planning and expertise. Other than atherosclerosis, the main causes of giant ascending aortic aneurysms include Marfan and Ehlers-Danhlos syndromes. Herein we report on a young male patient who had had an aortic valve replacement five years earlier due to a bicuspid aortic valve leading to aortic failure, accompanied by aortic coarctation. He had an aneurysmal expansion rate of 1.81 cm/year to reach a final aneurysmal diameter of 13.25 cm, which, to our knowledge, represents the largest size ever reported in the literature for such lesions, and in which the redo and aneurysmal wall were adjacent to the sternal margins.

The clinico-radiological spectrum of Dyke-Davidoff-Masson syndrome in adults.

Dyke-Davidoff-Masson syndrome (DDMS) is characterized by cerebral hemiatrophy, seizure, contralateral hemiplegia/hemiparesis, and mental retardation. In this study, clinical and radiological investigations of seven patients who were diagnosed with DDMS as adult age were evaluated and discussed. Seven patients (four male, three female) were included. The mean age ± SD of the patients was 46 ± 21 years. Clinical presentation of six patients was epileptic seizure. One patient was presented with head trauma due to a fall. Two patients had complex partial seizures, three patients had generalized tonic-clonic seizures (GTC), and one had GTC and myoclonic seizure. Mental retardation was in five patients. A congenital cause was detected in one patient in the etiologic investigation and acquired causes in two patients. In four patients, the etiology was not identified. We observed left-hemisphere involvement in four patients and right-hemisphere involvement in three patients. Brain imaging was performed by CT only in four patients and by MRI only in three patients. All patients were diagnosed with DDMS at adulthood. Atrophy in basal ganglia was detected in five patients, and atrophy in brain stem in four patients. Calvarial thickening was observed in four patients. Three patients had hyperpneumatization in mastoid cells. Sinus hyperpneumatization, including the paranasal and frontal sinuses, was seen in six patients. DDMS can also be diagnosed in adulthood symptomatically (mild-severe) or asymptomatically in adulthood. As a result, DDMS is a syndrome with wide clinical and radiological spectra that can be variably symptomatic at different stages of life.

Retrospective Comparison of Radiological and Clinical Outcomes of PLIF and TLIF Techniques in Patients Who Underwent Lumbar Spinal Posterior Stabilization.

Degenerative disc disease and spinal stenosis lead to various symptoms. Degeneration of facet joints is added to this degenerative process with aging.Seventy-four patients who were admitted to the Spinal Column Outpatient Clinic of the Neurosurgery Department with a diagnosis of degenerative narrow spinal canal and lumbar spondylolisthesis between 2011 and 2013 and who underwent surgery were included in the study.Our study was conducted with 74 patients of whom 73.0% (n = 54) were female and 27.0% (n = 20) were male. Mean age was 54.86 ±â€Š7.87 years (range 34-74).Although we did not detect a difference between the two surgical methods with regard to clinical improvement, transforaminal lumbar interbody fusion (TLIF) is preferred due to radiological advantages observed one year later, ease of application, and the development of fewer complications.

Thoracolumbar burst fractures requiring instrumented fusion: Should reducted bone fragments be removed? A retrospective study.

BACKGROUND: Thoracolumbar burst fractures are common clinical entity encountered in neurosurgical practice, accounting for 10-20% of all spinal fractures. Clinical picture could be devastating due to severe neurological deficits which lead the patients dependent both socially and emotionally. MATERIALS AND METHODS: This study compared two groups of patients who were operated because of thoracolumbar burst fracture secondary to spinal trauma in terms of neurologic deficits, degree of improvement, and radiologic measurements at one-year follow-up. The first group (group I) included the patients who underwent posterior total laminectomy, peroperative reduction of intracanal bone fragments, and posterior spinal instrumentation and the second group (group II) included the patients who underwent total laminectomy, and spinal instrumentation without reduction of free bone fragments. RESULTS: Neither group showed significant correlation with any measurement parameter. Radiological assessments and clinical improvements did not disclosed significant difference between the two groups at one-year follow-up. CONCLUSION: Retropulsion of free bone fragments extend the time of surgery and causes complications. This study found that there is no need to retropulse the bone fragments in the spinal canal in patients with unstable burst fractures who underwent total laminectomy and posterior long segment stabilization.

A Tethered Cord with Hemivertebra: A Case Report and Review of Literature.

Spinal dysraphisms are defined as open and closed dysraphisms. A hemivertebra is a congenital condition seen in 61% of patients with congenital anomalies. The first report of the excision of a hemivertebra was by Royle in 1928. A sixteen-year-old girl was admitted to our clinic with a congenital stain on the waist and a normal neurological examination. No new cases have been reported in recent literature. Our case, which is also rare, is associated with a tethered cord only and no other congenital abnormalities.

Intraoperative antepulsion of a posterior lumbar interbody fusion cage: three case reports.

Spinal fusion surgery techniques develop together with technologic advancements. New complications are seen as the result of new techniques and these may be very severe due to spinal cord and vascular structures in the lumbar region. The posterior lumbar interbody fusion cage (PLIFC) was shown to enhance spinal fusion and to prevent pseudoarthrosis due to its basic dynamic characteristics. PLIFC migrations are usually observed during the postoperative period, just after the mobilization of the patient and usually toward spinal canal. Migration to the retroperitoneal region is a extremely rare condition in the literature. In this article we discussed three cases of PLIFC antepulsion into the retroperitoneal region during the intraoperative period.

Radiation in the orthopedic operating theatre.

OBJECTIVE: The aim of the study was to determine the amount of radiation exposure in the orthopedic operating theater, to show that the radiation dose was decreased with distance from the tube, and to inform personnel about protective measures. METHODS: Ionised radiation was measured in the orthopedic operating theater where fluoroscopy was used between 18 February 2014 and 02 June 2014. Four dosimeters were placed at the head and foot of the operating table and at 200 cm from those areas at a height of 60 cm vertical to the floor. RESULTS: At the end of 104 days, the total values were determined as 90.5 mrem at the foot of the table, 68.17 mrem at the head of the table, 7.5 mrem at 200 cm from the foot of the table, and 5.17 mrem at 200 cm from the head of the table. A significant decrease was observed in the values determined at a distance from the radiation source. CONCLUSION: The rate of radiation determined in the dosimeters decreased when distance from the radiation source increased. During the use of fluoroscopy in orthopedic surgery, the wearing of lead aprons, neck protectors, and glasses, in addition to maintaining a distance from the tube, will reduce the radiation exposure of individuals.

Primary intraosseous meningioma mimicking osteosarcoma: case report.

With an incidence rate of 15-20%, meningiomas are one of the most common brain tumors among benign intracranial tumors. They are distributed as follows in intracranial localizations: parasagittal and falx (25%), convexity (18%), sphenoid wing (18%), parasellar (12%), posterior fossa (10%), intraventricular (2%), intraorbital (1%), and extracranial (1%). The most common extradural localizations are the paranasal sinuses, nasal cavity, skin, neck, glands, and intraosseous space. Intradiploic meningiomas are generally localized in the frontoparietal and orbital regions. Due to their low incidence and lack of adequate preoperative diagnostic testing, intradiploic meningiomas are generally mistaken for primary calvarial bone tumors and en plaque meningiomas. Our case was discussed here with literature findings since primary intradiploic meningioma is uncommon and poses diagnostic challenges.

Intraorbital Encephalocele Presenting with Exophthalmos and Orbital Dystopia : CT and MRI Findings.

A 15-year-old female patient with progressive pulsatile exophthalmos caused by intraorbital encephalocele was evaluated with computed tomography (CT) and magnetic resonance imaging (MRI) in our clinic. She had no history of trauma or reconstructive surgery. When she was a little girl, she had undergone surgery for congenital glaucoma on the right eye. On the three-dimensional image of CT, a hypoplasic bone defect was observed in the greater wing of the right sphenoid bone. MRI and CT scan showed herniation through this defect of the arachnoid membrane and protruded cerebral tissue into the right orbita. Intraorbital encephalocele is an important entity that can cause pulsatile exophthalmos and blindness.

Thoracic extraosseous epidural cavernous hemangioma.

Cavernous hemangiomas were first reported in 1929 by Globus and Doshay, and are defined as benign vascular structures developed between the neural tissues occurring in the central nervous system, consisting of a dilated vascular bed. Cavernous hemangiomas comprise nearly 5-12% of all spinal vascular malformations; however, existence in the epidural space without bone involvement is rare. Only 4% of all cavernous hemangiomas (0.22/1.000.000) are purely epidural cavernous hemangiomas. In this case report, we removed a hemorrhagic thoracic mass presenting with progressive neurological deficits in a 55-year-old male patient. We found this case to be appropriate for presentation due to the rare occurrence of this type of cavernous hemangioma.

Farmedial versus anteromedial portal drilling of the femoral tunnel in ACL reconstruction: a computed tomography analysis.

INTRODUCTION: The success of ACL reconstruction is predicated on a variety of factors. Tunnel placement plays one of the most significant roles in achieving knee kinematics and function. The purposes of this study were to compare femoral tunnel position, angle, length and posterior wall blow-out after ACL reconstruction with hamstring tendons autograft through either a farmedial portal or an anteromedial portal technique. MATERIALS AND METHODS: We evaluated 36 patients who underwent ACL reconstruction between January 2014 and July 2014 in our institute, in a prospective, randomised cohort study. All the surgical procedures were performed by a sports fellowship-trained orthopaedic surgeon with experience in both portal reaming. The operated knees were evaluated with 0.5 mm fine CT scans of 3-D CT between days 3 and 5 postoperatively. RESULTS: According to the 3-D CT measurements, the mean femoral tunnel length was significantly longer (p < 0.05) in the FAM group compared with the AM group. The femoral bone tunnel length averaged 34.2 ± 3.6 mm versus 36.6 ± 3.0 mm (p = 0.042) in AM and the FAM groups, respectively. The femoral tunnel position, as evaluated with use of the quadrant method, was more anterior in the FAM transportal technique group, and the difference between the two groups was significant (p < 0.05). CONCLUSION: FAM tranportal drilling of the femoral tunnel creates longer and anterior femoral tunnels with regard to the AM portal drilling techniques. Additional studies with clinical outcomes are required for the clinical relevance of these techniques and to show which one is superior. LEVEL OF EVIDENCE: Level I, prospective randomised comparative cohort study.

Assessment of the correlation between nasal septal deviation and compensatory hypertrophy of the middle turbinate.

The aim of the study was to investigate the relationship between nasal septal deviation and the middle turbinate hypertrophy using computed tomography. In this retrospective analysis, we examined 77 patients with nasal septal deviation. The mucosal and bone structures of the middle turbinate and the angle of the septum were measured using radiological analysis. Measurements of the middle turbinate on the convex side were compared to those on the concave side. Measurements of the bony and mucosal structure area of the middle turbinate were significantly greater than those on the concave side. The dimensions of medial mucosa thickness and bone thickness were not significantly different between the convex and concave sides. No significant correlation was found between the angle of deviation and other parameters. The present findings suggest that compensatory middle turbinate hypertrophy was caused both by conchal bone growth and mucosal hypertrophy in patients with nasal septal deviation.

Clinical and radiologic review of uncommon cause of profound iron deficiency anemia: median arcuate ligament syndrome.

Median arcuate ligament syndrome is an anatomic and clinical entity characterized by dynamic compression of the proximal celiac artery by the median arcuate ligament, which leads to postprandial epigastric pain, vomiting, and weight loss. These symptoms are usually nonspecific and are easily misdiagnosed as functional dyspepsia, peptic ulcer disease, or gastropathy. In this report, we presented a 72-year-old male patient with celiac artery compression syndrome causing recurrent abdominal pain associated with gastric ulcer and iron deficiency anemia. This association is relatively uncommon and therefore not well determined. In addition, we reported the CT angiography findings and three-dimensional reconstructions of this rare case.

Spontaneous rupture of intracranial dermoid tumor in a patient with vertigo. Computed tomography and magnetic resonance imaging findings.

BACKGROUND: Congenital dermoid cysts are very rare, constituting less than 1% of intracranial tumors. Spontaneous rupture of dermoid tumor is a potentially serious complication that can lead to meningitis, seizures, cerebral ischemia and hydrocephalus. Occasionally, dermoid tumors are incidentally discovered on computed tomography (CT) of the brain or magnetic resonance imaging (MRI) following unrelated clinical complaints. They are also discovered during radiologic investigations of unexplained headaches, seizures, and rarely olfactory delusions. CASE REPORT: In this report we describe a patient complaining of vertigo caused by spontaneous rupture of dermoid cyst, preoperatively diagnosed by CT and MRI. Cranial CT revealed a dense fatty lesion adjacent to the posterolateral parasellar region on the left with multiple small, dense fat droplets scattered in the subarachnoid space corresponding to a dermoid cyst rupture. Cranial MRI sections revealed a lesion with mixed-signal-intensity and multiple hyperintense droplets scattered through the cerebellar surface on the left. No enhancement was found on axial T1-weighted MRI after intravenous Gadolinium administration. Diffusion weighted image (DWI) and apparent diffusion coefficient map studies exhibited explicit restricted diffusion. DISCUSSION: Many studies and literature case reports concerning the rupture of dermoid cyst have been reported. However, multimodal imaging of this rare pathology in the same patient is uncommon. Although dermoid cysts are pathognomonic in appearance on a CT examination, the MRI is also of value in helping to understand the effect of extension and pressure of the mass. DWI is also important for support of the diagnosis and patient follow-up.