Intensive Care Management of an Adult Patient With Rare Chilaiditi Syndrome Presenting as Abdominal Breathing: A Case Report.

Chilaiditi syndrome (CS) is an uncommon case of the asymptomatic radiographic finding of an intestinal loop between the liver and the diaphragm. The most crucial phases in the diagnosis process are a thorough physical examination and precise imaging, particularly in challenging disorders such as CS. The presence of free air under the right hemidiaphragm in this syndrome, the diagnosis of which is based on radiographic imaging, might direct the start of treatment without the need for surgical intervention. An 86-year-old man, with asthma and chronic obstructive pulmonary disease (COPD) was checked out in our hospital's emergency department (ED) after experiencing nausea and vomiting. Having abdominal breathing while the patient was in an internal medicine department owing to a urinary tract infection (UTI) and acute kidney injury (AKI), he was moved to the intensive care unit (ICU). The patient was treated with respiratory physiotherapy, inhaler bronchodilator treatment, antibiotic therapy, enema, and laxatives. Medical imaging is the primary diagnostic tool for CS, guided by the symptoms. In patients like this elderly patient who was taken to ICU from internal medicine due to acute respiratory failure and abdominal breathing, when free air is detected in the subdiaphragmatic region, control should be provided with computed tomography (CT), and non-invasive mechanical ventilation should be applied.

Molecular genotyping of Echinococcus granulosus sensu stricto from human Echinococcal cysts in Hatay, Türkiye.

Cystic echinococcosis (CE) is one of the zoonotic infections in human, an important global health problem. It was aimed to determine the molecular characterization and phylogenetic analysis of isolates obtained from patients diagnosed with CE in Hatay province, according to the cox1 gene region. A total of 31 patients, 14 males and 17 females, with a mean age of 35.19 (±14.28) years were included in the study. 35 cyst materials obtained from patients were studied. DNA isolation was performed from the samples with protoscoleces determined in the cyst fluid. One-way DNA sequencing was performed with the Sanger Sequencing Protocol through the obtained PCR products. In the study, 35 hydatid cysts of human origin were examined and protoscoleces was detected in 11 (31.43%) of them. Twenty of the patients had liver involvement, seven had lung involvement, and four had both liver and lung involvement. All the samples with protoscoleces detected were observed of PCR product with a size of approximately 446 bp. When the sequence results of the isolates were evaluated within themselves, it was seen that there were three different sequences with 99% similarity to each other. As a result, of the phylogenetic analysis, it was determined that the isolates were identified in the Echinococcus granulosus sensu stricto (E. granulosus s. s.) (G1-G3) complex. This study is thought to contribute to the epidemiology, parasite control, effective diagnosis and treatment techniques, eradication, vaccine and drug development studies of E. granulosus s. s in Türkiye.

Biochemical Analysis of Germinal Membrane and Cyst Fluid by Raman Spectroscopy in Echinococcosis

Objective: Hydatidosis is a zoonotic parasitic infection caused by the larval stage of Echinococcus granulosus. The aim of this study was to investigate the biochemical structures of germinal membrane and cyst fluids obtained from patients with liver involvement during surgery, by Raman spectroscopy at the molecular level. Methods: Molecular characterization of germinal membrane and cyst fluid according to mitochondrial gene region was determined and phylogenetic analysis was performed. Raman spectroscopy was used in samples and spectral bands between 300 and 1800 cm-1 were examined. Results: As a result of PCR, approximately 400 bp DNA band was obtained from germinal membranes and cyst fluids gathered from patients. Peaks were observed at 780, 880, 970, 1151, 1200, 1270 cm-1 for germinal membrane and at 780 and 1200 cm-1 for cyst fluid. The highest spectral bands were obtained at 1333-1335 cm-1 and were determined to be modes indicating the CH3CH2 collagen and polynucleotide chain. Conclusion: In the identification of microorganisms and biochemical analysis of biological tissues; different diagnostic methods such as molecular, serological and conventional methods are used. In addition to these methods, Raman spectroscopy has been shown in studies to be a fast, non-destructive and noninvasive method. Therefore, it is thought to be an alternative method for analyzing the basic biochemical components of microorganisms at molecular level.

Effects of surgical and percutaneous tracheotomy on thyroid hormones.

AIM: To evaluate the effects of surgical and percutaneous tracheotomy on thyroid hormones. MATERIAL AND METHOD: Sixty patients with respiratory problems who underwent surgical tracheotomy and percutaneous tracheotomy between December 2012 and December 2016 were divided into 2 groups. FT3, FT4, thyroglobulin and TSH levels of the groups were statistically evaluated preoperatively and postoperatively. RESULTS: The effects of surgical and percutaneous tracheotomy on free thyroxin (FT4), serum thyroglobulin (TG) and thyroid stimulating hormone (TSH) levels were found to be statistically significant. Although free triiodothyronine (FT3) slightly elevated in both groups, it was not statistically significant. DISCUSSION: Today, percutaneous tracheotomy (PCT) and conventional surgical tracheotomy (CT) have been widely used in intensive care units on patients who are expected to be connected to mechanical ventilation for a long time. Because of the anatomy of the surgical site, tracheotomy may cause damage to the adjacent thyroid gland and tracheal rings CONCLUSION: Surgeons should keep in mind that serum thyroid hormone levels may increase postoperatively. Particularly the patients with cardiac rhythm problems should be followed after surgical and percutaneous tracheotomy due to the systemic effects of thyroid hormones. KEY WORDS: Tracheotomy, Thyroid hormones.

Effect of therapeutic hypothermia on superficial surgical site infection and postoperative pain in urgent abdominal surgery.

BACKGROUND: Although therapeutic hypothermia has been shown to be effective on surgical site infection and postoperative pain in patients undergoing elective surgery, its exact effect on emergency laparotomy remains unclear. In this study, we aimed to investigate the effect of therapeutic hypothermia on superficial surgical site infection and postoperative pain in patients undergoing urgent open abdominal surgery. METHODS: The study included 100 patients who underwent emergency open abdominal surgery from 01/01/2016 to 01/01/2017. The patients were randomly divided into two groups: therapeutic hypothermia, group I underwent cold therapy with local sterile frozen ice compress; and control group II, underwent conventional sterile compress. Age, gender, primary pathology diagnosis, size of incision, wound type and size, and duration of surgery were compared between the groups. Visual analog scale scores were determined every 3 hours, and the requirement for analgesics was assessed for each patient within 48 hours postoperatively. Both before and after 5 days of laparotomy, c-reactive protein (CRP), white blood cell count (WBC), albumin, serum total antioxidant status, and total oxidant status levels were measured, and oxidative stress index was calculated for each patient. The rates of superficial surgical site infection were compared between both groups. RESULTS: The two groups were similar in terms of age, gender, primary pathology diagnosis, size of incision, wound type and size, and duration of surgery (p>0.05). Although no significant difference was found between the groups with regards to visual analog scale scores (p>0.05), requirement for analgesics was lower in the group I compared to that in the control group (p<0.05). No significant difference was found between the groups in terms of preoperative WBC, albumin, CRP, serum total antioxidant status, total oxidant status, and oxidative stress index (OSI) levels (p>0.05). At postoperative day 5, serum total antioxidant status level was significantly higher, and OSI level was significantly lower in the group I compared to the respective levels in the control group (p<0.05). Moreover, the superficial surgical site infection rate was significantly lower in the group I (p<0.05). CONCLUSION: In patients undergoing urgent open abdominal surgery, therapeutic hypothermia led to lower requirement for analgesics and lower superficial surgical site infection rates in the early postoperative period. We consider that therapeutic hypothermia exerts this effect by elevating the serum total antioxidant status level, and decreasing the effects of inflammatory mediators and OSI.

Effects of temporary abdominal closure methods on mortality and morbidity in patients with open abdomen.

BACKGROUND: Open abdomen (OA) in which the abdomen is closed with temporary abdominal closure methods is the most effective in patients who develop severe abdominal sepsis or abdominal compartment syndrome. Major techniques used are Vacuum-Assisted Closure Method (VACM) and non-vacuum assisted closure method (NVACM). In the present study, the effects of different abdominal closure methods on morbidity and mortality were evaluated. METHODS: In the study, the temporary abdominal closure methods of the patients with OA during 2013-2016 were studied retrospectively. OA etiopathologies, mortality prediction scores, final abdominal closure periods and methods, hospitalization periods, complications (enteroatmospheric fistula, mesh infection, and incisional hernia), and mortality rates of patients who underwent VACM and NVACM were determined and compared. RESULTS: The present study included 123 patients who underwent VACM (n=65) and NVACM (n=58). There was no difference between the groups in terms of age, gender, and etiopathogenesis (p>0.05). The mean APACHE 4 and Multiple Organ Dysfunction Score (MODS) scores in the VACM/NVACM groups in treatment period were 47/63 and 11/14, respectively (p<0.05). The mean intensive care and hospitalization periods in the VACM/NVACM groups were 11/16 (days) and 22/28 (days), respectively (p<0.05). The collection and abscess development rates in the VACM and NVACM groups were 46.2% and 77.6%, respectively (p<0.05). The rate of enteroatmospheric fistula (EAF) development in the VACM and NVACM groups were 15.4% and 56.9%, respectively (p<0.05). The mean abdominal closure times in the VACM and NVACM groups were 13 and 17 days, respectively (p<0.05). Mortality rate in the VACM and NVACM groups were 18% (n=18) and 55% (n=32), respectively (p<0.05). CONCLUSION: In patients with OA, the temporary abdominal closure technique VACM has lower complication and mortality rates and shorter hospitalization period than other methods. Therefore, it is an effective and safe method for the treatment of OA.

Treatment of colorectal injuries in the civil war and the factors affecting mortality.

AIM: Colorectal injuries are one of the most common causes of mortality in war. Mainstay treatment of these injuries include primary repair or stoma creation. METHODS: Clinical data of the patients were evaluated retrospectively. Time from injury to hospital admission, method of treatment, the colorectal area affected, injury severity score ISS, hemodynamic instability, and mortality rate were determined. RESULTS: Of the 61 patients included in the study. Mean time from injury to hospital admission was 160±19 minutes. The injury was in the right colon in 24 patients 39.3%, in the left colon in 18 29.5%, and in the rectum in 19 31.2% patients. Median ISS value of 61 patients was 16, IQR 5. Mortality and complication rates were higher in patients with hemodynamic instability and stoma requirement was also higher in this group p<0.05. Total mortality occurred in 15 24.5% patients. Of these, 10 66.6% patients had hemodynamic instability. DISCUSSION: Hemodynamic instability is the most important factor affecting the mortality and the treatment method in wartime colorectal injuries. CONCLUSION: We believe that in victims of war with colorectal injuries, surgical intervention before the development of hemodynamic instability may reduce the rate of mortality and stoma requirement. KEY WORDS: Colorectal injury, Firearm injury, Hemodynamic instability, Stoma.

The role of combination preand postoperative albendazole therapy in the surgical management of liver hydatidosis.

AIMS: ALB is the most commonly used drug for the treatment of echinococcosis. The aim of the present study was to evaluate the effect of ALB using the intraoperative and perioperative periods as dual therapy. MATERIALS AND METHODS: Material of this retrospective study were the consecutive series of 98 patients operated for hepatic hydatidosis (HC) over a period of 7 years, at a single centre. Clinical examination, ultrasonography (US) and computed tomography (CT) were used for establishing diagnosis. Ninety-eight cases of hepatic hydatidosis were treated by albendazole intraoperatively and postoperatively together with surgery. Perioperative ALB treatment was given in a dose of 12-15 mg/ kg per day in four divided doses. The treatment started 2-28 days before the surgery when the diagnosis was established and continued for 2-24 months postoperatively in a cyclic monthly form. A total of 1.7 mg/mL ALB solution was used intraoperatively. Dual albendazole treatment (DALB) includes preoperative and postoperative oral ALB treatment and intraoperative irrigation of cystic cavity with ALB. RESULTS: In the follow-up period one patient died and there was one recurrence of hepatic hydatidosis.Morbidity rates were 10.89% . CONCLUSION: Results of this study suggest that ALB treatment with HC surgery is effective in the prevention of recurrences and/or secondary hydatidosis. KEY WORDS: Albendazole, Recurrens Liver hydatic cyst, Surgical treatment.

Where should the damage control surgery be performed, at the nearest health center or at a fully equipped hospital?

BACKGROUND: Transport of casualties from a combat area to a fully equipped hospital where all techniques of damage control surgery (DCS) can be performed requires a great deal of time. Therefore, prior to transport, prompt control of hemorrhage and contamination should be achieved, and resuscitative procedures should be performed at the nearest health center. The aim of the present study was to investigate the effect of the location at which DCS was performed on rates of mortality. METHODS: The present retrospective study included 51 combat casualties who underwent DCS at the present clinic or at hospitals nearest the combat area due to high kinetic energy gunshot injuries to the abdomen between 2010 and 2015. Patients were evaluated in terms of acidosis, hypothermia, coagulopathy, and mortality. RESULTS: Patients were divided into 2 groups depending on the location where the first step of DCS was performed: (1) at the present hospital or (2) at other hospitals. Group 1 comprised 26 patients (51%), and Group 2 comprised 25 (49%). Total mortality occurred in 23 (45.1%) patients, including 15 (57.7%) patients in Group 1 and 8 (32%) in Group 2. In Group 1, mean time from injury to hospital admission was longer, and deep acidosis, hypothermia, and coagulopathy were more marked. CONCLUSION: Initial surgical control of hemorrhage and contamination in patients injured by high kinetic gunshots should be promptly achieved at the nearest health center. In this way, acidosis, hypothermia, and coagulopathy can be prevented, and the risk of mortality can be reduced.

Effects of Montelukast in an Experimental Model of Acute Pancreatitis.

BACKGROUND We evaluated the hematological, biochemical, and histopathological effects of Montelukast on pancreatic damage in an experimental acute pancreatitis model created by cerulein in rats before and after the induction of pancreatitis. MATERIAL AND METHODS Forty rats were divided into 4 groups with 10 rats each. The study groups were: the Cerulein (C) group, the Cerulein + early Montelukast (CMe) group, the Cerulein + late Montelukast (CMl) group, and the Control group. The pH, pO2, pCO2, HCO3, leukocyte, hematocrit, pancreatic amylase, and lipase values were measured in the arterial blood samples taken immediately before rats were killed. RESULTS There were statistically significant differences between the C group and the Control group in the values of pancreatic amylase, lipase, blood leukocyte, hematocrit, pH, pO2, pCO2, HCO3, and pancreatic water content, and also in each of the values of edema, inflammation, vacuolization, necrosis, and total histopathological score (P<0.05). When the CMl group and C group were compared, no statistically significant differences were found in any parameter analyzed. When the CMe group was compared with the C group, pancreatic amylase, lipase, pH, PO2, pCO2, HCO3, pancreatic water content, histopathological edema, inflammation, and total histopathological score values were significantly different between the groups (P<0.05). Finally, when the CMe group and the Control group were compared, significant differences were found in all except 2 (leukocyte and pO2) parameters (P<0.05). CONCLUSIONS Leukotriene receptor antagonists used in the late phases of pancreatitis might not result in any benefit; however, when they are given in the early phases or prophylactically, they may decrease pancreatic damage.

Anaphylactic reactions presenting with hypertension.

BACKGROUND: Although a few case reports about hypertensive anaphylaxis (HA) are available in the present literature, there is no study about the prevalence of HA. In this study, we review our cases with anaphylaxis presenting with hypertension and ascertain its prevalence. The documents of the patients who had anaphylactic reactions after the procedures performed for the diagnosis and treatment of allergic diseases in GATA Haydarpasa Clinic of Allergy and Immunology between January 2010 and December 2014 were retrospectively reviewed. Within the study period, 324 patients had undergone 4332 procedures in which 62 of them had developed anaphylaxis. RESULTS: During the procedures, the rate of anaphylaxis was found to be 1.43 %. The rate of HA among the anaphylaxis patients was 12.9 % (8 of 62 patients). During treatments, 2 patients received adrenaline injections without any adverse reaction. CONCLUSIONS: HA may be seen at a considerable rate during an anaphylactic reaction. Anaphylaxis and hypertension can be recovered by adrenaline injection when required. According to the best of our knowledge, this study is the first original study about the prevalence of HA in English-language medical literature.

Comparison of tuberculin skin test and quantiferon-TB gold in tube test for diagnosis of latent tuberculosis infection in health care workers: A cross sectional study.

OBJECTIVE: To compare the diagnostic efficacy and agreement of the traditional tuberculin skin test with QuantiFERON-Tuberculosis Gold In-Tube test for latent tuberculosis infection in healthcare workers. METHODS: The cross-sectional analytical study was conducted between March 1 and 31, 2008, at a specialist tuberculosis hospital in Istanbul, Turkey, and comprised healthcare workers who had been employed for at least one year at the hospital and volunteered to take part. Tuberculin skin test and QuantiFERON-Tuberculosis Gold In-Tube test were both performed simultaneously and their results were compared Using SPSS 12. RESULTS: Out of 34 subjects, 20(58.8%) had a positive tuberculin skin test, and 7(20.6%) had a positive QuantiFERON-Tuberculosis Gold In-Tube test. The two tests agreed in only 15(44.1%) cases and disagreed in 19(55.9%). In 16(47.1%) subjects, the QuantiFERON-Tuberculosis Gold In-Tube test was negative and tuberculin skin testwas positive, while in 3(8.8%) participants QuantiFERON-Tuberculosis Gold In-Tube test was positive and tuberculin skin test was negative. Kappa test revealed discordance between the two tests (k=-0.13; p=0.92). CONCLUSIONS: Latent tuberculosis infection prevalence was higher based on tuberculin skin test than QuantiFERON-Tuberculosis Gold In-Tube test. The results of the two tests were discordant.

Comparison of surgical procedures and percutaneous drainage in the treatment of liver hydatide cysts: a retrospective study in an endemic area.

INTRODUCTION: Surgical procedures are still the golden standard option in the treatment of liver cystic echinococcosis. However, minimal invasive technics like percutaneous drainage are rising trends. We aimed to compare the efficacy of surgical and percutaneous options in the treatment of liver hydatidosis in an endemic area. METHODS: Patients who underwent surgical or percutaneous procedures for hydatid disease between January 2007 and December 2012 were retrospectively evaluated. Recurrence rates, hospital stay time, and related factors were analyzed. RESULTS: There were 44 (35.5%) male and 80 (64.5%) female patients in this study. Eighty two patients (Group I) had undergone surgery (66.1%) and 42 patients (Group II) had undergone percutaneous drainage (33.9%). The mean cyst size was 7.28 ± 2.51 cm in Group I and 8.76 ± 3.30 cm in Group II. Nine recurrences (7.3%) were detected during study. Five of the recurrences were in Group II (11.9%) and four (4.9%) of them were in Group I. The mean length of hospital stay of all patients was 5.42 ± 3.16 days. DISCUSSION: Percutaneous drainage techniques can be a good alternative to surgery in selected patients. In complicated cases like cystobiliary fistula, surgery is superior to percutaneous approaches. The hospital stay time, recurrence rate and postoperative complications were not enhanced when compared to percutaneous treatment in our study. Despite all controversy about the low morbidity after percutaneous treatment, surgical approach is still a preferable option in patients with liver hydatidosis when it is performed by experienced surgeons.

On lightlike geometry of para-Sasakian manifolds.

We study lightlike hypersurfaces of para-Sasakian manifolds tangent to the characteristic vector field. In particular, we define invariant lightlike hypersurfaces and screen semi-invariant lightlike hypersurfaces, respectively, and give examples. Integrability conditions for the distributions on a screen semi-invariant lightlike hypersurface of para-Sasakian manifolds are investigated. We obtain a para-Sasakian structure on the leaves of an integrable distribution of a screen semi-invariant lightlike hypersurface.

Community-acquired pneumonia in patients with chronic obstructive pulmonary disease requiring admission to the intensive care unit: risk factors for mortality.

PURPOSE: The aims of this study are to identify factors predicting mortality in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP) requiring intensive care unit (ICU) admission and to examine whether noninvasive ventilation treatment reduces mortality. MATERIALS AND METHODS: An analysis was performed on data from patients with CAP hospitalized in the ICUs of 19 different hospitals in Turkey between October 2008 and January 2011. Predictors of mortality were assessed by both univariate and multivariate statistical analyses. RESULTS: Two hundred eleven patients with COPD and CAP were included. The overall ICU mortality was 23.9%. Noninvasive ventilation treatment (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.03-0.49; P = .003), hypertension (OR, 0.13; 95% CI, 0.02-0.93; P = .042), bilateral infiltration (OR, 13.92; 95% CI, 2.94-65.84; P = .001), systemic corticosteroid treatment (OR, 0.19; 95% CI, 0.35-0.96; P = .045), length of ICU stay (OR, 0.65; 95% CI, 0.47-0.89; P = .007), and duration of invasive mechanical ventilation (OR, 1.11; 95% CI, 1.01-1.22; P = .032) were independent factors related to mortality. CONCLUSION: Noninvasive ventilation, hypertension, systemic corticosteroid treatment, and shorter ICU stay are associated with reduced mortality, whereas bilateral infiltration and longer duration of invasive mechanical ventilation are associated with increased risk of mortality in patients with COPD and CAP requiring ICU admission.

Mortality indicators in community-acquired pneumonia requiring intensive care in Turkey.

BACKGROUND: Severe community-acquired pneumonia (SCAP) is a fatal disease. This study was conducted to describe an outcome analysis of the intensive care units (ICUs) of Turkey. METHODS: This study evaluated SCAP cases hospitalized in the ICUs of 19 different hospitals between October 2008 and January 2011. The cases of 413 patients admitted to the ICUs were retrospectively analyzed. RESULTS: Overall 413 patients were included in the study and 129 (31.2%) died. It was found that bilateral pulmonary involvement (odds ratio (OR) 2.5, 95% confidence interval (CI) 1.1-5.7) and CAP PIRO score (OR 2, 95% CI 1.3-2.9) were independent risk factors for a higher in-ICU mortality, while arterial hypertension (OR 0.3, 95% CI 0.1-0.9) and the application of non-invasive ventilation (OR 0.2, 95% CI 0.1-0.5) decreased mortality. No culture of any kind was obtained for 90 (22%) patients during the entire course of the hospitalization. Blood, bronchoalveolar lavage, and non-bronchoscopic lavage cultures yielded enteric Gram-negatives (n=12), followed by Staphylococcus aureus (n=10), pneumococci (n=6), and Pseudomonas aeruginosa (n=6). For 22% of the patients, none of the culture methods were applied. CONCLUSIONS: SCAP requiring ICU admission is associated with considerable mortality for ICU patients. Increased awareness appears essential for the microbiological diagnosis of this disease.

Protective effects of etanercept and methylprednisolone on pancreatic damage in cerulein-induced acute pancreatitis.

OBJECTIVE: To examine the pharmacological effect of etanercept and methylprednisolone (MP) on acute pancreatitis (AP) induced by cerulein in an experimental rat model. METHODS: The present study was carried out in the Experimental Research Center, Ondokuz Mayis University, Samsun, Turkey between December 2008 and October 2009. Forty adult Sprague-Dawley rats were divided into 5 groups (n=8): 1--sham, 2--cerulein induced pancreatitis (over 20 hours), 3--etanercept (5 mg/kg, intraperitoneal), 4--MP (10 mg/kg, intramuscular), 5--etanercept plus MP. The rats in groups 3, 4, and 5 were cerulein-induced pancreatitis at 20 hours, as well. After the treatment, the pancreas and blood were taken for histopathological and biochemical analysis. RESULTS: All cerulein-treated rats developed biochemical and histopathological AP after 20 hours. Histological findings of pancreatitis and serum levels of amylase and lipase were lower in group 5 compared to group 2. Pancreatic inflammation and total pathological score were statistically reduced in the tissues of the pancreas at 20 hours after the treatment of etanercept plus MP in group 5 compared to groups 2, 3, and 4. CONCLUSION: In the early stage of cerulein induced AP, the administration of etanercept plus MP attenuated pancreatic inflammation and significant damage in rats.

[Diffusion-weighted MRI in the differentiation of brain abscesses and necrotic tumors]. / Beyin apsesi ile nekrotik tümör ayriminda difüzyon agirlikli MRG.

PURPOSE: The differential diagnosis between brain abscesses and necrotic tumors such as glioblastomas and metastases is often difficult by conventional MRI. The goal of our study was to evaluate the ability of the diffusion-weighted (DW) MRI to differentiate these lesions from each other. MATERIALS AND METHODS: MRI was performed in 19 patients (four abscesses, seven glioblastomas, two anaplastic astrocytomas, six metastases). In addition to standard MR sequences, trace DW imaging and apparent diffusion coefficient (ADC) maps were performed. ADC values were calculated for all lesions. For statistical analysis student t-test was used. A p value less than 0.05 indicated a statistically significant difference. RESULTS: The central portion of all six metastases and eight of nine high-grade gliomas showed unrestricted diffusion, whereas all four abscesses showed restricted diffusion (low ADC values) in their cavity. However, restricted diffusion also was found in one glioblastoma. The ADC values of abscesses (0.69-/+0.05 x103 mm2/s) were significantly lower than of 15 malignant necrotic tumors (2.39-/+0.63 x 103 mm2/s). The difference between abscess and necrotic tumors was statistically significant (p<0.001). CONCLUSION: DW MRI can be used to identify a brain abscess and can help to differentiate it from a cystic brain tumor. However, restricted water diffusion is not specific and pathognomonic in the differential diagnosis between abscesses and necrotic tumors.

[Functional magnetic resonance imaging in lesions in or near the sensorimotor cortex]. / Duyusal-motor kortekse komsu lezyonlarda fonksiyonel MRG'nin etkinligi.

PURPOSE: To assess the efficiency of functional magnetic resonance imaging (fMRI) in demonstrating motor-sensorial cortical areas in mass lesions neighboring the perirolandic area and investigating its pre-operative sensitivity. MATERIALS AND METHODS: In the study, 20 right-handed patients with different types of intraxial and extraaxial mass lesions in or neighboring the perirolandic area were used. Of the all lesions, 6 were diagnosed as metastatic masses, 2 as oligodendroglioma, 2 as astrocytoma, 5 as glioblastoma multiforme, 2 as meningioma, 2 as arteriovenous malformations and 1 as porencephalic cyst. The study was performed on a 1.5 T unit. Images were acquired at the axial plane using T1 weighted spin echo, T2 weighted fast spin echo and fast FLAIR. Functional imaging was performed by blood-oxygen-level-dependent (BOLD) technique and single-shot gradient echo-planar sequence (SSEPI). During the sequence period a total of 420 images were acquired, each of which had 10 slices. By matching the resource functional images with T1 and T2 weighted anatomical images, the functional anatomy of the brain has been mapped. Sensorial-motor cortex has been activated by the finger-tapping-paradigm. RESULTS: Two patients could not included in the study because of extensive movement artifacts and meaningless BOLD answers. Eighteen of the patients had significant BOLD answers in bilateral peri-central sulcal area and in the center of the supplementary area. Activation areas were obtained neighboring the mass lesions and edema surrounding the lesion. CONCLUSION: fMRI can demonstrate motor-sensorial cortex in situations in which the anatomical order of perirolandic area has been changed by mass lesions. fMRI shows high sensitivity in the evaluation of lesions neighboring the perirolandic area preoperatively. Therefore fMRI can provide important information in patient selection, detection of different surgical choices and planning the surgical intervention.