Morphometric evaluation of cerebellar lobules in individuals with unilateral vertebral artery hypoplasia.

PURPOSE: Vertebral arteries (VAs) provide blood circulation to the posterior fossa in general and are the main blood supply of the posterior fossa structures of the brain. Our aim in this study is to analyze the segmental volumetric values of cerebellar structures with the voxel-based volumetric analysis system in individuals with unilateral vertebral artery hypoplasia. METHODS: In this retrospective study, segmental volumetric values/percentile ratios of cerebellar lobules were calculated using 3D fast spoiled gradient recall acquisition in steady-state (3D T1 FSPGR) MRI sequence images of the brain in individuals with unilateral vertebral artery hypoplasia (VAH) and in those without bilateral VAH and any symptoms of vertebrobasilar insufficiency as the control group was evaluated in volBrain ( http://volbrain.upv.es/ ). RESULTS: The VAH group consisted of 50 (19 males/31 females) and the control group had 50 (21 males/29 females) individuals. The cerebellar lobule III, IV, VIIIA and X total volumes and the cerebellar lobule I-II, III, IV, VIIIA and X gray matter volumes were lower in the hypoplastic side than the non-hypoplastic cases and also than the contralateral side of the hypoplastic cases in the VAH group. In addition, it was found that that lobules IV and V had lower cortical thickness and lobules I-II had a higher coverage rate in the intracranial cavity in the hypoplastic side than the non-hypoplastic cases and also than the contralateral side of the hypoplastic cases (p < 0.05). CONCLUSION: In this study, it was found that cerebellar lobule III, IV, VIIIA, X total volumes and cerebellar lobule I-II, III, IV, VIIIA, X gray matter volumes in addition to lobule IV, V cortical thicknesses were low in individuals with unilateral VAH. Being aware of these variations and taking them into account during future volumetric studies on the cerebellum are very important.

The relationship between the flexor and extensor muscle areas and the presence and degree of intervertebral disc degeneration in the cervical region.

BACKGROUND: This study aimed to investigate the relationship between the presence and degree of cervical intervertebral disc degeneration (IVDD) and the cervical region muscle areas. METHODS: The magnetic resonance imaging (MRI) examination of the patients who were sent to our clinic for investigation of neck pain between 2019 and 2020 years were evaluated retrospectively. 143 Turkish women patients between 30 and 40 ages were examined in the study. The presence and degree of IVDD was evaluated for each patient. The areas of the cervical flexor and extensor paravertebral muscles were measured. RESULTS: No cervical disc degeneration was present in 44 (30.76%) patients (grade 1). The cervical intervertebral disc degeneration was grade 2 in 28 (19.58%), grade-3 in 41 (28.67%), and grade 4 in 30 (20.97%) patients. In early stage degeneration (grade 2), an increase was observed in the area of all cervical paravertebral flexor and extensor muscles examined. As the degree of degeneration increased (grades 3 and 4), a decrease was observed in the areas of all muscles. Statistical significance was found for musculus (m) sternocleidomastoideus, m. levator scapulae, m. splenius capitis, m. semispinalis capitis, and m. multifidus muscles (P = .009, r = -0.261; P = .014, r = -0.248; P = .008, r = -0.267; P = .002, r = -0.307; P = .028, r = -0.222, respectively). CONCLUSIONS: IVDD is common in middle-aged females with neck pain. An increase in muscles areas is observed in the early stages of cervical disc degeneration but progressive decrease develops in all cervical paraspinal muscles areas as the degree of disc degeneration increases.

Relationship between cervical posterior subcutaneous fat tissue thickness and the presence and degree of cervical intervertebral disc degeneration.

OBJECTIVE: This study aimed to investigate the relationship between cervical region subcutaneous fat tissue thickness and the presence and level of cervical intervertebral disc degeneration (IVDD). METHODS: Magnetic resonance imaging examinations of patients referred to our clinic for the investigation of neck pain were evaluated retrospectively. A total of 300 women aged 30-40 years were included in the study. The presence and level of IVDD were evaluated for each patient. The cervical subcutaneous fat tissue thickness was also measured. RESULTS: IVDD was determined as Grade 1 for 88 patients (29.3%), Grade 2 for 56 patients (18.6%), Grade 3 for 82 patients (27.3%), Grade 4 for 60 patients (20%), and Grade 5 for 14 patients (4.6%). Subcutaneous fat tissue thickness was higher in patients with cervical disc degeneration (mean: 6.28 ± 0.19 mm) than in those without cervical disc degeneration (mean: 5.33 ± 0.18 mm) (P = .001). There was a positive correlation between the degree of cervical disc degeneration and subcutaneous fat tissue thickness ( = 0.001, r = 0.245). CONCLUSION: An increase in the cervical fat tissue thickness is a predisposing factor for the development of degeneration of the intervertebral disc. There is a close relationship between subcutaneous fat tissue thickness and the degree of degeneration.

Estimating the adequacy of the free quadriceps tendon autograft length using anthropometric measures in anterior cruciate ligament reconstruction.

OBJECTIVE: This prospective study aimed to predict the adequacy of free quadriceps tendon (QT) autograft length using simple anthropometric measures. MATERIALS AND METHODS: One hundred and eighty-four consecutive patients who underwent knee high-resolution MRI were enrolled in this study. The QT and native anterior cruciate ligament (ACL) length were measured using the oblique sagittal section. The adequate free QT length was calculated using the native ACL length and 30 mm for femoral and tibial tunnels in each patient. A QT shorter than the calculated length was considered inadequate. Age, sex, height, weight, body mass index, thigh circumference, and activity score were used to predict the adequacy of QT length with regression analysis. RESULTS: There were 92 men and 92 women with a mean age of 34.1 ± 8.0 years (range 18-45). The mean QT and ACL lengths were 69.0 ± 8.8 mm (range 48.1-90.3 mm) and 35.6 ± 2.5 mm (range 29.2-42.6 mm), respectively. The QT and the ACL lengths were longer in men (p < 0.001 for both). Twenty-three men and 39 women (total: 62, 33.7%) had inadequate QT length for a free QT autograft, and 6 patients (3 males, 3 females, 3.3%) had inadequate QT length with the bone block technique. There was a weak positive correlation between QT length and height (p < 0.001), weight (p < 0.001), and activity score (p = 0.007). Height was the only independent variable that predicted the QT length adequacy (r2 = 0.051, p = 0.009) but ROC analysis showed that height did not have an ability to detect a subject with an inadequate QT length (AUC: 0.384, 95% CI 0.300-0.468). CONCLUSIONS: Free QT autografts may be inadequate in one-third of the patients, while a QT autograft with a bone block is almost always sufficient. Inadequate free QT autograft is more common in women. Although QT length correlated with height, it cannot be used as an accurate diagnostic tool to identify patients with an inadequate QT autograft. Preoperative measurement of the ACL and QT lengths by MRI might be beneficial to decide whether QT is usable, especially when harvesting without a bone block. LEVEL OF EVIDENCE: Level II, diagnostic, prospective cohort study.

The relationship between quadriceps fat pad syndrome and patellofemoral morphology: a case-control study.

BACKGROUND: The purpose of this prospective case-control study is to investigate the relationship between quadriceps fat pad syndrome (QFPS) and patellofemoral morphology. MATERIALS AND METHODS: Twenty-two patients with QFPS and 22 age- and gender-matched healthy volunteers were included. The diagnosis of QFPS was supported both clinically and radiologically. On magnetic resonance imaging (MRI), patellofemoral morphology was evaluated with 13 radiological measurements including trochlear sulcus angle, trochlear sulcus depth, trochlear facet asymmetry, trochlear condyle asymmetry, lateral trochlear inclination angle, patellar translation, tibial tubercle-trochlear groove (TT-TG) distance, Insall-Salvati ratio, patellotrochlear index, patellar tilt, the ratio between lateral and medial facet lengths, interfacet angle, and quadriceps tendon thickness. The mean of measurements was compared between groups using the Mann-Whitney U test. RESULTS: There were 22 patients (12 male, 10 female) with mean age of 30.81 ± 1.41 (range 19-38) years in group I and 22 patients (12 male, 10 female) with mean age of 31.13 ± 1.31 (range 19-39) years in group II. The mean age and the gender distribution were statistically similar between groups (p = 0.845, p = 1, respectively). All measured values except for patellar tilt (p = 0.038) and TT-TG distance (p = 0.004) were similar (p > 0.05 for the other variables). However, all of the measured variables were within the normal range. CONCLUSIONS: QFPS may not be associated with anatomical variations of the patellofemoral joint. Further studies are required to understand the etiology and risk factors. LEVEL OF EVIDENCE: Level III, prospective case-control study.

Topological network mechanisms of clinical response to antidepressant treatment in drug-naive major depressive disorder.

AIM: There is rapidly increasing evidence that remission of MDD is associated with substantial changes in functional brain connectivity. These New data have provided a holistic view on the mechanism of antidepressants on multiple levels that goes beyond their conventional effects on neurotransmitters. METHOD: The study was approved by the Local Ethics Committee of Istanbul Medipol University (10840098-604.01.01-E.65129) and followed the Helsinki Declaration principles. In our study, we have evaluated the effect of six weeks of treatment with antidepressants (escitalopram and duloxetine), and tested the underlying brain functional connectivity through a Graph analysis approach in a well-defined first-episode, drug-naive, and non-comorbid population with MDD. RESULTS: Beyond indicating that there was a significant correlation between the antidepressant response and topological characteristics of the brain, our results suggested that global rather than regional network alterations may be implicated in the antidepressant effect. CONCLUSION: Despite the small-sample size and non-controlled study design, our study provides important and relevant clinical data regarding the underlying mechanisms of the antidepressants on topological dynamics in the human brain.

Recurrent stump appendicitis.

Acute appendicitis is one of the most common reasons for abdominal surgery. Stump appendicitis, one of the rare complications of appendicitis surgery, is an inflammation that develops in the remaining part of the appendix following surgery and occurs at a rate of 1/50.000 in cases with appendectomy. Although patients manifest the same findings as those with acute appendicitis on physical examination and laboratory tests, the history of previous appendectomy may cause delays in diagnosis.. Complications such as perforation and peritonitis can develop if an early diagnosis cannot be made. In this article, we present the first case of recurrent stump appendicitis reported in the literature as far as we are aware.

The Rarest of the Rare: Crossed Fused Renal Ectopia of the Superior Ectopia Type.

Crossed fused renal ectopia is a rare congenital anomaly of the urinary system where one kidney crosses over to opposite side and the parenchyma of the two kidneys fuse. Herein, we present an atypical CFRE case whose renal anatomy does not exactly match any of the already defined CFRE types. Both of the kidneys are ectopic with the crossed ectopic right kidney lying superiorly and fused to the upper pole of the left kidney. Renal arteries were originating from the common iliac arteries. A focal 90% stenosis was observed on the right main renal artery. The patient is borderline hypertensive.

Periaortic Fat Tissue: A Predictor of Cardiac Valvular Calcification, Malnutrition, Inflammation, and Atherosclerosis Components in Hemodialysis Patients.

Cardiac valvular calcification (CVC) in end-stage renal disease is shown to be a component of malnutrition, inflammation, atherosclerosis, calcification (MIAC) syndrome. Thoracic periaortic fat tissue (T-PAFT) is shown to be increased in patients with end-stage renal disease (ESRD), and has positive correlation with MIAC. Negative correlation between CVC and vitamin D is shown in hemodialysis (HD) patients. In this study, we investigated a relationship between body composition, T-PAFT, metabolic and inflammatory parameters, and CVC in HD patients. Seventy-six HD patients (49M) were included. CVC is defined as bright echoes of >1 mm on one or more cusps on echocardiography. Results were expressed as the number of calcified valves (0,1,2). Calcium, phosphorus, parathyroid hormone (PTH), C-reactive protein (CRP), albumin and 25-hydroxy vitamin D levels were studied from predialysis blood samples. T-PAFT was calculated using a method with manual definition of borders on images from multislice computed tomography. Basal metabolic rate, muscle mass, total and truncal fat mass were measured by bioimpedance analysis. There were 65.8% of patients who had CVC. Patients with CVC were older (63.5 ± 14.6 ± 17, P = 0.02). T-PAFT (1599 ± 596, 739.7 ± 179 mm(2) , P = 0.001) and CRP (15.8 ± 11; 11.1 ± 13.2 mg/dL; P = 0.04) were higher in the group with CVC. T-PAFT had positive correlations with CRP, MIAC, body mass index (BMI) and number of calcified valves, negative correlation with left ventricular ejection fraction, and no correlation with albumin, calcium, phosphorus, and PTH. The logistic regression analysis revealed that T-PAFT was a significant predictor of CVC. In this study, T-PAFT showed a positive correlation with inflammation, CVC, and MIAC score in HD patients. T-PAFT was a significant predictor of CVC.

Sex differences in adult craniofacial parameters.

PURPOSE: To compare normal male and female craniofacial parameters in adults and evaluate associations of sex and intercochlear distance with other craniofacial parameters. METHODS: In 60 normal adults (30 men and 30 women) who had no otitis media, craniofacial parameters were measured retrospectively on two-dimensional reformatted computed tomography scans. RESULTS: Compared with women, men had significantly greater mean osseous auditory tube length, cartilaginous auditory tube length, mastoid length, intercochlear distance, sella to posterior nasal spine distance, sella to basion distance, and nasopharynx sagittal area. The intercochlear distance was significantly correlated with mastoid depth, midpoint of the pharyngeal opening distance, sella to nasion distance, and nasopharynx sagittal area and inversely with angle of the auditory tube. Most men and women had Körner septum present, and mean thickness of Körner septum was significantly greater in men than women. CONCLUSIONS: Some craniofacial parameters, especially vertical parameters, differ with sex. These differences begin in childhood and continue in adulthood. Sex must be considered when planning a craniofacial morphologic study, and results of a craniofacial morphologic study should be evaluated with caution when there is no sex matching of the patient and control groups.

Targeted treatment with pazopanib in metastatic soft tissue sarcoma: Nearly complete response in two cases.

Soft tissue sarcomas (STS) are a group of rare mesenchymal cancers that include approximately 50 histological types and account for 1% of all adult cancers. The standard curative treatment option for localized disease is surgical resection and, if a surgically removed tumor exhibits high-risk characteristics, adjuvant chemotherapy and radiotherapy may be administered. Sarcoma presenting at an advanced stage has a dismal prognosis and survival has not markedly improved over the last 20 years. The standard first-line treatment for advanced STS, other than gastrointestinal stromal tumors, is cytotoxic chemotherapy. Therapies targeting pro-angiogenic factors have been a focus of drug development for STS over the last few years. Pazopanib, a multitargeted tyrosine kinase inhibitor, is a novel treatment option for patients with metastatic STS in the second-line setting. This is a presentation of 2 case reports of patients with metastatic STS who responded well to treatment with pazopanib.

[Arthroscopic excision of elastofibroma dorsi at scapulothoracic joint: a surgical technique]. / Skapulotorasik eklemde elastofibroma dorsinin artroskopik eksizyonu: cerrahi teknik.

Elastofibroma dorsi is a rare soft tissue pseudotumor which is located at the anteroinferior aspect of the scapula. In this article, we report a 19-year-old female case who had arthroscopic marginal excision of elastofibroma dorsi at the scapulothoracic joint without recurrences during follow-up. The arthroscopic marginal excision of the elastofibroma dorsi may have good clinical results in selected cases.

Increased frequency of gallbladder stone and related parameters in hemodialysis patients.

BACKGROUND/AIMS: The prevalence of gallbladder stone (GBS) is shown to be increased in some studies in patients with chronic kidney disease (CKD). Nevertheless, some other studies did not confirm these findings. The controversial results about the prevalence of GBS in hemodialysis (HD) patients demand new studies to search GBS prevalence and associating risk factors in HD patients. In the present study, we aimed to investigate GBS prevalence and risk factors in our HD patients. MATERIALS AND METHODS: A total of 104 HD and 149 control patients were involved. Complete physical examinations, including measurements of dry body weight and height, were done. Abdominal ultrasonography was conducted by the same experienced radiologist. Blood samples were drawn via venipuncture from the study participants after they had fasted overnight just before a midweek hemodialysis session for laboratory examinations. RESULTS: The prevalence of GBS in HD patients was 34.6 % (36/104), and that was significantly higher than that of control group 12.9% (17/149; p=0.0001). In all study participants (HD patients and control group), patients with GBS were older than patients with no GBS (63.2±14.2 vs 53.7±16.7; p=0.0001). However, in HD patients, mean age was similar in patients with GBS and no GBS (64.3±13.8 vs 60.1±16.6; p>0.05). Patients with GBS had a higher prevalence of units of blood transfusions than patients with no GBS in hemodialysis patients (2.0±2.9 vs 0.9±1.3; p=0.047) CONCLUSION: The present study showed an increased prevalence of GBS in HD patients compared to healthy controls. The number of blood transfusions and autonomic neuropathy may be responsible for the increased prevalence of GBS in HD patients.

A rare cause of acute lower abdominal pain: Emphysematous cystitis.

Emphysematous cystitis is a relatively rare infection characterized by the accumulation of air within the urinary bladder wall and bladder lumen. Diabetes mellitus and neurogenic bladder are the major risk factors of emphysematous cystitis. The clinical presentation varies from asymptomatic to fatal disease state. Computed tomography is the best diagnostic imaging modality. Here, we present a case of an 81-year-old woman with poorly controlled type II diabetes mellitus who had acute lower abdominal pain after a percutaneous transluminal coronary angioplasty which demonstrated emphysematous cystitis caused by Escherichia coli that resolved with antibiotic treatment.

The relationship between the prevalance and size of lumbar ossified ligamentum flavum and the presence and degree of facet joint degeneration.

OBJECTIVES: To investigate whether there is any relationship between the prevalence and the dimension of OLF and the presence and degree of facet joint degeneration. In addition, it revealed the prevalence and distribution of lumbar OLF with regard to age and spinal levels. METHODS: The stone protocol abdominal CT images of 114 patients were retrospectively analyzed. Presence of OLF, degenerative changes in the posterior vertebral elements was evaluated on axial CT images and incidence for each finding was determined. Additionally, the degree of facet joint degeneration and size of OLF was evaluated and recorded. All findings were also grouped based on age and lumbar level. RESULTS: OLF has been observed in 40 (35%) individuals at 76 (13%) lumbar levels. OLF has been most frequently encountered at the upper lumbar levels. Its frequency and size showed correlation to increased age. Frequency of OLF correlated with the presence of degenerative changes of in the posterior elements (p<0.001). There was an association between the OLF size and the presence (p=0.001) and degree of the degeneration in the posterior elements. There was no lumbar level case where the degree of OLF would lead to enough narrowing to be symptomatic. CONCLUSIONS: OLF prevalence and sizes increase parallel to age. Posterior elements' degenerative changes facilitate OLF development. A close relation exists between OLF size and facet joint degeneration. A direct relationship exists between OLF size and the degree of posterior elements degeneration. It is highly probable for lumbar level OLF size to be insufficient to cause any symptoms.

The CT frequencies of various non-traumatic acute abdominal emergencies in hemodialysis, peritoneal dialysis patients and the general population.

PURPOSE: To investigate the frequency of non-traumatic acute abdominal emergencies in end-stage renal disease (ESRD) (peritoneal dialysis (PD) and haemodialysis (HD)) patients and in the general population as diagnosed by computed tomography (CT) imaging. METHODS: The abdominal CT findings of ESRD patients with non-traumatic acute abdominal pain during the years 2001-2010 have been retrospectively evaluated. Thirty-three HD (14 females, 19 males, mean age: 62 ± 10.5) and 22 PD patients (12 females, 10 males, mean age: 59 ± 9.4) with acute abdominal pathology based on their CT scans have been included into the study. In addition, 127 individuals (68 females, 59 males, mean age: 40.7 ± 12.8) with normal renal functions who presented with non-traumatic acute abdominal pain diagnosed with an acute abdominal pathology based on their CT scans have been prospectively evaluated during the years 2009-2010. RESULTS: While the most frequent etiology in PD patients was peritonitis (45.4%), acute pancreatitis (13.6%) and perforation (18.1), and in HD patients it was nonocclusive mesenteric ischemia (18.1%) and spontaneous intraabdominal bleeding (21.2%). The basic causes of acute abdomen in the general population were ureteral stone (34.6%) and appendicitis (18.1%). CONCLUSIONS: The causes of acute abdominal pain in ESRD patients is significantly different when compared to the general population. And within this special patient population the etiology of acute abdomen differs depending on the renal replacement therapy modality they are receiving. Thus, the causes of acute abdomen in PD patients are mostly peritonitis, acute pancreatitis, and perforation, while being mostly nonocclusive mesenteric ischemia and spontaneous intraabdominal bleeding in patients receiving HD therapy.