Evaluation of Morphologic and Morphometric Characteristic of Foramen Transversarium on 3-Dimensional Multidetector Computed Tomography Angiography.

AIM: To investigate the size and variations of the foramen transversarium (TF). In addition, to study the anatomical variations of the vertebral artery entering the transverse foramen of the cervical vertebrae. MATERIAL AND METHODS: The images of 141 (90 males, 51 females) patients aged 18-79 years (mean: 52.7 years) were analyzed. As a result, 987 cervical spines (C1-C7) and 1974 foramina transversaria were individually evaluated. Each TF"s anterior-posterior (AP) and transverse diameter (T) was measured bilaterally from multidetector computed tomography (CT) images. The absence of TF was considered as agenesis and a diameter of less than 2 mm as hypoplastic. Double foramina and incomplete double foramina were also noted. We evaluated the levels at which the vertebral arteries entered the transverse foramina. RESULTS: The most frequent variation was duplication of TF, which was noted in a total of 88 (8.91%) cervical vertebrae. Agenesis of TF was seen in 37 (3.74%), and hypoplasia of TF in 26 (2.63%) cervical vertebrae. The vertebral artery entered into the transverse foramen of the 5th cervical vertebra from both sides in 4 (1.84%) patients. The vertebral artery entered into the transverse foramen of the 7th cervical vertebra in 4 (1.84%) patients. The vertebral artery entered into the transverse foramen of the 4th cervical vertebra in only 1 (0.45%) patient. CONCLUSION: We believe that the determination of foraminal variations could be an important guide for neurosurgeons and radiologists in the diagnosis and treatment of diseases in this area.

Review and management of breast lesions detected with breast tomosynthesis but not visible on mammography and ultrasonography.

Background Breast tomosynthesis is more sensitive than mammography and can detect lesions that are not always visible with conventional methods such as digital mammography (MG) and ultrasonography (US). No standardized approach is available for the management of lesions that are detectable with tomosynthesis but are not visible on MG or US. Purpose To review suspicious breast lesions detected with tomosynthesis but not visible on two-dimensional (2D) MG or US and to determine the management options for these lesions. Material and Methods Ethical committee approval was obtained. The radiological records, biopsy or surgery results, and follow-up findings of 107 patients who had a tomosynthesis-positive but MG- or US-negative breast lesion between 2011 and 2016 were retrospectively evaluated. Results Of 107 lesions visible only with tomosynthesis, 74% were architectural distortions and 26% were asymmetrical opacities. All patients underwent magnetic resonance imaging (MRI) for further evaluation. Among the 48 (45%) MRI-negative lesions, none had a suspicious alteration during the follow-up period. Among the MRI-positive lesions, 28% of the 50 architectural distortions and 11% of the nine asymmetrical opacities were malignant. Conclusion Given the inherent high false-positive rate of breast tomosynthesis, breast MRI prior to biopsy may reduce the number of unnecessary biopsies for suspicious breast lesions that are tomosynthesis-positive only.

Carotid Arterial Flow in Pseudoexfoliation Glaucoma and its Role in Diagnosing the Disease.

OBJECTIVE OF THE STUDY: The objective of the study was to investigate the change in carotid arterial flow in pseudoexfoliation glaucoma (XFG) for determining its diagnostic value. MATERIALS AND METHODS: Patients with XFG (N=30) and control subjects (N=22) were recruited. Common carotid artery (CCA) and internal carotid artery of each participant were examined using color Doppler and B-mode ultrasonography. Resistivity index (RI), as a flow parameter of interest, was measured and statistically compared between the 2 groups. Receiver operating characteristic was also produced to assess its diagnostic value. RESULTS: The measured RI values from the controls were within the expected range. Among CCA and internal carotid artery, only RI of CCA exhibited statistically significant changes in XFG (0.75±0.04 vs. 0.70±0.03 cm/s). Threshold value of RI=0.72 yielded 90% sensitivity and 73% specificity in distinguishing the cases of XFG from the controls. CONCLUSIONS: Flow dynamics of carotid arterial system exhibits different characteristics in individuals with XFG than controls. Such differences may serve as a basis for developing potentially new diagnostic biomarkers of XFG. Further studies are justified for examining the carotid flow in pseudoexfoliation syndrome and compare it against XFG for determining its power in differential diagnosis.

A Retrospective 3D Radiologic Analysis of 52 Patients with Mandible Fractures.

When fractured, mandible angulates. For better preoperative evaluation, movements of fractured mandibular segments should be documented in x-, y-, and z-axes. This article quantitatively evaluates the pattern and degree of the angulation. Fifty-two patients with mandible fractures were involved in this study. After defining a three-dimensional (3D) coordination system consisting of the x-axis (the axis directed from the medial to lateral side of the skull), y-axis (directed from the inferior to superior side), and z-axis (directed from the posterior to anterior side), the degree with which the fractured mandible angulated around each of these axes was measured using 3D graphic software. The tendency of the angulation was compared between the three axes. Frequency of complications, operation times, maxilla mandibular fixation (MMF) need, and epidemiologic data were compared with the angulation results. Angulation around the x-axis was the most frequent with a 55.8% incidence, followed by a substantial margin of angulation around the y-axis with a 21.2% incidence; angulation around the z-axis was rare, with an incidence of 15.4%. Furthermore, the degree of z-axis angulation was minor compared with x- and y-axes angulations. There were statistically increased rate of complications, operation time, and MMF need in patients with more than 10 degrees of angulation in any case. Operation time and complication rates are also increased in patients with internal rotation of the proximal segment. Preoperative evaluation of mandible fracture angulation degree is useful for determining postoperative complication rates, MMF need, and operative challenge. This finding is helpful for effective performance to reposition the fractured mandible.

The Effect of Botox on the Implant Stabilization and Capsular Formation: An Experimental Study.

BACKGROUND: Breast augmentation is one of the most common esthetic procedures with increasing frequency throughout the past years. The most demanding complications involving esthetic and reconstructive breast surgery are the malpositioning of the implant and capsular contracture. The etiology, prevention, and management remain to be fully explained. Botulinum toxin (BTX) administration has anti-inflammatory effects that can possibly decrease capsular contracture, and chemical denervation of the pectoral muscle theoretically may decrease incidence of malrotation. In our literature search, we found only 1 clinical study using BTX A for capsular contraction, and there were no experimental studies about the implant stabilization and capsular contracture. Therefore, we have studied the effect of BTX A on the prevention of breast implant malrotation and capsular contracture in a rabbit model. METHODS: Sixteen smooth-surfaced cohesive gel implants were implanted in 8 New Zealand white rabbits. The backs of the rabbits were divided into 2 groups. After skin incision, the exposed latissimus dorsi muscle was elevated, and a submuscular pocket was made. In the experimental group, Botox was injected in the muscle overlying the implant. In the control group, the implants were placed under the muscle, and saline was injected into the muscle. At the end of 3 months, the rabbits were imaged and evaluated by ultrasonography and x-ray to examine capsule formations and the movement of the implants. The animals were killed, and the implants with peri-implant capsule were excised. We evaluated collagen pattern and capsule thickness on ventral, lateral, and dorsal aspects. RESULTS: The Botox group showed less infiltration of inflammatory cells at the third month (P < 0.05). Statistically significant differences in capsular thickness were observed on histopathological examination and ultrasonographic imaging. The capsule was thinner on all aspects and the collagen pattern had a more parallel alignment at low density in the experimental group compared with the control group. With x-ray, we observed an increased lateral movement of the implants in the control group. CONCLUSIONS: The use of Botox effectively decreased implant movement and capsular formation at 12 weeks. More experimental and clinical studies will be required to determine whether this is a durable result that can be reproduced in humans.

Breast involvement in visceral leishmaniasis.

Visceral leishmaniasis usually involves the bone marrow, lymph nodes, liver and spleen. Involvement of the eye or respiratory or gastrointestinal systems is very rare and usually occurs in immunodepressed patients. Only one case of breast involvement by protozoa has been reported in the literature. We report a case of a visceral leishmaniasis with a solid breast mass caused by leishmania and diagnosed by sonography-guided core biopsy.