An unusual presentation of bronchial rupture.

Persistent hydropneumothorax was diagnosed in a 62-year-old female with a history of blunt trauma, although she was treated with chest tube and closed underwater seal drainage. Computed tomography and fiberoptic bronchoscopy findings were consistent with "fallen lung" syndrome. Fiberoptic bronchoscopy also found a cavitary lesion at the right tracheobronchial angle. Forceps biopsy of the cavitary lesion indicated bronchogenic carcinoma. Our final diagnosis was tracheobronchial complete rupture and fallen lung syndrome secondary to malignancy.

Clinical significance of lung perfusion defects in children with post-infectious bronchiolitis obliterans.

Clinical significance of segmental lung perfusion defects in children with bronchiolitis obliterans (BO), have not been reported before. The aim of this study was to evaluate clinical significance of lung perfusion defects in children with BO and to reveal its impact on follow up. The study included 38 children aged 9 to 60 months (17.8 + or - 13.4 months) with BO. Diagnosis was based on persistent respiratory findings beyond six weeks and oligemic-mosaic pattern in lung high resolution computerized tomography. Chest X-ray, 24 hour esophageal pH monitoring, sweat chloride test, immunoglobulin levels and respiratory viral screening were carried out in all. Lung perfusion scintigraphy was carried out at least three months after the first clinical sign of BO. Perfusion defects were scored. Scintigraphy demonstrated perfusion defects in 24 (63.2%) patients but was normal in 14 (36.8%). Number of segments having perfusion defects was 2.9 + or - 2.6. Mean number of exacerbations and days of hospitalization during the first year of follow up were 4.7 + or - 4.4 and 26.9 + or - 29.8 respectively. It was detected that number of perfusion defects correlated significantly with the number of exacerbations and duration of hospitalization (r= 0.66 and p= 0.00). In conclusion, number and extent of segments with perfusion defects in lungs of children with BO are correlated with clinical severity. Therefore, evaluation of lung perfusion status may aid in clinical determination of disease severity and its follow-up.

CT and MRI examinations left behind in the radiology department.

PURPOSE: To retrospectively document the reported computerized tomography (CT) and magnetic resonance imaging (MRI) examinations that were left behind in our radiology department, to calculate their cost, and to determine possible sources of waste in order to draw attention to this subject. MATERIALS AND METHODS: The reported and billed CT and MRI examinations for 2003 that were not taken from the radiology department were documented, and the percentage they represented of all CT and MRI performed that year were determined. The total cost of the examinations, including contrast media, was calculated. RESULTS: In all, 200 CTs out of 4390 and 95 MRIs out of 7003 were left behind in the radiology department during 2003. Total cost of the examinations, including the contrast media, was 31,320 YTL. CONCLUSION: The percentages of CT and MRI examinations left behind in the radiology department were evaluated in this preliminary report. Since we did not find any similar study in the literature, we could not comment on the limits of acceptability of the results; however, we think other radiology departments should determine the percentages CTs and MRIs that are left behind and take the necessary precautions to minimize waste and reduce expenses.

Thorax perfusion CT in non-small cell lung cancer.

OBJECTIVES: We aimed to determine the perfusion differences according to the histological type, stage, volume and prognoses in the non-small cell carcinoma by thorax perfusion CT. MATERIALS AND METHODS: Twenty-four non-small cell carcinoma patients were included in the study. Thorax perfusion CT was done to evaluate the tumors in terms of perfusion parameters: blood flow (BF) and time to peak (TTP) values. RESULTS: The total blood flow of the tumor in squamous cell carcinoma was significantly higher than adenocarcinoma (p=0.031). There was no statistical difference between the perfusion parameters and other parameters. CONCLUSIONS: Perfusion CT may help us in evaluating non-small cell carcinomas.

The correlation between magnetic resonance detected cartilage defects and spiking of tibial tubercles in osteoarthritis of the knee joint.

The aim of the study was to ascertain whether spiking of the tibial tubercle is associated with cartilage defects detected by magnetic resonance imaging (MRI) in patients with osteoarthritis (OA) of the knee joint. Angulation of the tip of the medial and lateral tubercles, and the height of the tubercles above the tibial plateau were measured on a standard anteroposterior radiograph of the knee joint. Cartilage defects in the tibiofemoral joint (TFJ) were determined by MRI examination. The lengthening and sharpening of the angles of the tubercles were significantly more prominent in the patients than controls. A strong association was found between angulation (if less than 70 degrees) and especially the height (if more than 0.16) of the medial tibial spike and MRI-detected cartilage defects in the medial tibiofemoral compartment. The predictive value of the spiking of tibial tubercles for MRI-detected cartilage defects in TFJ is related to the degree and size of the spiking. The presence of tibial spiking itself may not be a reliable sign of early OA.

Assessment of mammographic density changes on plain film mammograms in postmenopausal women on hormone replacement therapy.

BACKGROUND & OBJECTIVES: Mammographic screening is an effective tool for the early detection of breast cancer. Hormone replacement therapy (HRT) has been shown to increase mammographic density and thus may hinder early detection of small tumours. We undertook this study to determine and compare the frequency and degree of change in mammographic density in postmenopausal women in HRT using two different methods: the classical Wolfe classification and a new semiquantitative method, which we named as the comparison wheel. METHODS: This study included 285 women, 206 under hormone treatment, and 79 control subjects. All women underwent baseline mammographic study before the beginning of treatment. Mean interval of the follow up mammograms was 16 months. The methods were compared in evaluating the effects of three types of hormone therapies on mammographic density. RESULTS: The frequency of change was only significant in the combined hormone replacement group when Wolfe classification was used. However, the frequency of increase in density (estrogen group 21%, combined therapy group 42%, tibolone group 28%) was markedly higher when the comparison wheel was used. The inter-rater Kappa value was calculated as 0.977 for the first and 0.957 for the second readings of the two radiologists for the comparison wheel, and 0.973 and 0.968 for the Wolfe classification. The intra-rater Kappa values were determined as 0.972 and 0.957 for the first and and 0.963 and 0.926 for the second radiologist for comparison wheel and Wolfe classification respectively. INTERPRETATION & CONCLUSION: Our findings indicate that the estimated increase of mammographic density depends on the selected hormone regimen, as well as the method of evaluation. The comparison wheel is a semiquantitative method of evaluating changes of mammographic density and is sensitive and reproducible with high inter- and intra-rater Kappa values. This method can be used as an alternative for comparison of digital mammographic applications in the future.

Rhinocerebral mucormycosis: perineural spread via the trigeminal nerve.

We report a case of rhinocerebral mucormycosis associated with an abscess in the lateral aspect of the pons associated with perineural spread of disease via the trigeminal nerve. Contrast enhanced MRI was useful in depicting the extent of the disease and suggesting perineural spread. A pathological diagnosis of mucormycosis was established by means of rhino-orbital punch biopsy.

[Barium sulphate allergy (case report)]. / Baryum sülfat allerjisi.

Barium sulphate is a commonly used agent in the radiographic studies of the gastrointestinal tract and has been regarded as a safe contrast medium. Barium sulphate allergy is very rare. We present a case of barium sulphate allergy which occurred during an upper gastrointestinal study in a 24-year-old woman.

Effect of propofol and clonidine on cerebral blood flow velocity and carbon dioxide reactivity in the middle cerebral artery.

This study was designed to evaluate the effects of propofol alone and propofol-clonidine combination on human middle cerebral artery blood flow velocity (Vmca) and cerebrovascular carbon dioxide (CO2) response by using transcranial Doppler ultrasonography. Mean Vmca in response to changes in arterial partial pressure of CO2 (Paco2) was determined under the following conditions: awake (group 1), propofol anesthesia (group 2), and combined propofol-clonidine anesthesia (group 3). Normocapnic, hypercapnic, and hypocapnic values of heart rate, mean arterial pressure, partial end-tidal CO2 pressure, Paco2, and Vmca were obtained. The mean Vmca in groups 2 and 3 was significantly lower than that in group 1 at each level of Paco2. The calculated Vmca at each level of Paco2 was not different between groups 2 and 3. There was a correlation between Paco2 and Vmca in all groups, but in the anesthetized groups the effect of Paco2 on Vmca was attenuated. The present data demonstrated that clonidine-propofol does not change CO2 reactivity compared with propofol alone, but both anesthetics attenuate cerebral blood flow compared with awake controls.

Somatostatin infusion and hemodynamic changes in patients with non-variceal upper gastrointestinal bleeding: a pilot study.

BACKGROUND: Intravenous somatostatin decreases acid secretion, splanchnic blood flow, and portal pressure, but the evidence for its efficacy in the treatment of non-variceal upper gastrointestinal bleeding has been mixed. We aimed to evaluate the vasoactive effect and possible mechanisms of somatostatin infusion in the cessation of non-variceal upper gastrointestinal bleeding. MATERIAL/METHODS: Patients with non-variceal upper gastrointestinal bleeding without portal hypertension were enrolled in the study. They were given somatostatin infusion in a dose of 250 microgr/hour for 72 hours. Superior mesenteric arterial average flow velocity (SMA-V), SMA pulsatility index (SMA-PI), portal venous volume flow (PV-F), and renal artery resistance index (RA-RI) were measured two times for each patient by Doppler ultrasound; once on the first day of infusion therapy and again 6 hours or more after stopping the infusion. RESULTS: 21 patients (12 male, mean age 44.1 +/- 9.9) with bleeding peptic ulcer were enrolled. During somatostatin infusion, PV-F was 33.7 +/- 12.7 cm3/sec. After stopping infusion, it increased to 56.3 +/- 16.0 cm3/sec (p=0.001). SMA-V was 39.7 +/- 13.1 cm/sec and 64.4 +/- 15.1 cm/sec during somatostatin infusion and after cessation of somatostatin respectively (p=0.01). SMA-PI was 2.0 +/- 0.8 during somatostatin infusion but 2.8 +/- 0.8 without somatostatin infusion (p=0.02). However, RA-RI showed no difference between states with or without somatostatin infusion (p>0.05). CONCLUSIONS: Somatostatin infusion causes a decrease in arterial blood flow to the stomach and duodenum in patients with non-variceal upper gastrointestinal bleeding without portal hypertension. Somatostatin therapy also decreases portal blood flow while not altering renal blood.

Effect of varicocele on testicular artery blood flow in men--color Doppler investigation.

OBJECTIVE: Varicocele can be defined as an abnormal tortuosity and dilatation of the veins of the pampiniform plexus. Contradictory results have been obtained from experimental animal models and a few clinical human studies on testicular arterial blood flow in varicocele. The purpose of this study was to determine the changes in testicular arterial blood flow parameters in patients with varicocele. MATERIAL AND METHODS: A total of 62 patients with a clinical diagnosis of left varicocele and a scrotal vein with a diameter of > or = 3 mm on color Doppler ultrasonography were included in the study. A total of 44 fertile normal male volunteers served as controls. RESULTS: Median testicular arterial blood flow and median flow rate in milliliters per minute per 100 g of testicular tissue were found to be significantly decreased in the patient group compared to the control group: blood flow, 1.42 and 2.00 ml/min; flow rate, 9.63 and 12.35 ml/min/100 g, respectively (p < 0.05). Positive correlations were found between sperm concentration and left testicular artery blood flow (p < 0.05) and between left testicular volume and testicular artery blood flow (p < 0.05). CONCLUSIONS: Testicular arterial blood flow was found to be significantly decreased in men with varicocele. This may be a reflection of the impaired microcirculation. Following decreased testicular arterial blood flow, impaired spermatogenesis may result from defective energy metabolism in the microcirculatory bed.

Ultrasonographic evaluation of pes anserinus tendino-bursitis in patients with type 2 diabetes mellitus.

OBJECTIVE: To assess musculoskeletal ultrasonographic (US) findings in patients with type 2 diabetes mellitus (DM) with and without pes anserinus (PA) tendinitis or bursitis syndrome; and to determine possible etiologic factors such as systemic diabetic microvascular disease complications in these patients. METHODS: The knee joints were examined with an ultrasound real-time scanner using a 10 MHz electronic linear transducer in 48 patients with type 2 DM and 25 controls. The presence of systemic diabetic microvascular disease complications was evaluated. RESULTS: On examination 23 (23.9%) knees of the 14 (29.1%) patients with type 2 DM were found to have PA tendinitis or bursitis syndrome. US revealed that only 4 (8.3%) of the diabetic patients with PA tendinitis or bursitis syndrome had PA tendonitis findings. There were no significant differences in the thickness of PA tendons between the diabetic patients with bilateral knee PA tendinitis or bursitis syndrome (9 patients) and controls, or between the asymptomatic and symptomatic knees in patients with unilateral PA tendinitis or bursitis syndrome (5 patients). The prevalence of morphologic changes of the medial meniscus, effusion and synovitis in the suprapatellar recess, popliteal cyst, and radiographic osteoarthritis (OA) in the diabetic patients with PA tendinitis or bursitis syndrome was found to be increased. CONCLUSION: The prevalence of PA tendinitis or bursitis syndrome is not uncommon on examination in patients with type 2 DM. However, patients with clinically diagnosed PA tendinitis or bursitis syndrome less frequently have morphologic US changes of the PA tendons. Our results also suggest that structural changes such as meniscus lesions that occur in consequence of OA might have a role in the etiology of medial knee pain in diabetic patients.

[High resolution computed tomography findings in patients with asthma]. / Astimli Olgularda Yüksek Rezolüsyonlu Bilgisayarli Tomografi Bulgulari.

Recent studies suggest that thoracal high resolution computed tomography (HRCT) of the thorax can detect the irreversible structural changes in chronic asthma cases. This study is aimed to evaluate these possible changes and their relation with asthma severity. Twenty-eight stable asthmatic patients with normal conventional radiography and 10 healthy controls were included. Twenty of the patients were female (71.4%) and the mean age of the group was 43 +/- 10.5 (30-61). The groups were divided into 2; as group 1 included mild intermittent and mild persistent cases, and group 2 included moderate and severe persistent cases. Asthma and control group, and group 1 and 2 were compared according to the thickness of airwall (T), thickness to outer diameter (T/D), wall area (WA), the percentage wall area (WA%). HRCT showed that air trapping, bronchiectasis, fibrotic lesions and airwall thickening were significantly more common in asthma group (p< 0.05). Emphysema, acinar pattern, collapse and mucoid impact were common in asthma group (p> 0.05). The incidence of T and WA was higher in asthma group but also did not reach statistical significance and the thickening of airwall in small airways was significantly more in asthma group. Any correlation between HRCT findings and asthma severity was not found. So reversible and irreversible bronchial and parenchymal changes, detected by HRCT but not by plain chest radiograms, may be present in asthma cases. The early detection of these changes may lead more aggressive asthma management.

The intracranial complication of acute isolated sphenoid sinusitis.

Acute isolated sphenoid sinusitis is a rare, potentially destructive entity, which has indistinct clinical findings and non-specific symptoms. Hence, it can be easily be misdiagnosed. We present and discuss a case of an isolated sphenoiditis with intracranial complication.